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Appendix C: Glossary and Abbreviations

Prospects for Care Coordination Measurement Using Electronic Data Sources

Accountable Care Organization (ACO)—A group of health care providers who give coordinated care and chronic disease management, and thereby improve the quality of care patients get. The organization's payment is tied to achieving health care quality goals and outcomes that result in cost savings.1

All-Payer Claims Database (APCD)—Also known as an All-Payer, All-Claims Database. Large-scale databases that systematically collect health care claims data from a variety of payer sources that include claims from most health care providers. Statewide APCDs are databases, typically created by a State mandate, that generally include data derived from medical claims, pharmacy claims, eligibility files, provider (physician and facility) files, and dental claims from private and public payers. In States without a legislative mandate, there may be voluntary reporting of APCD data.2

Care Plan—Outlines the patient's current and longstanding needs and goals for care and/or identifies coordination gaps. The plan is designed to fill gaps in coordination, establish patient goals for care, and, in some cases, set goals for the patient's providers. Ideally, the care plan anticipates routine needs and tracks current progress toward patient goals.3 (Also sometimes referred to as a nursing care plan or plan of care.)

Continuity of Care Document (CCD)—A joint effort of HL7 and ASTM4 to foster interoperability of clinical data to allow physicians to send electronic medical information to other providers without loss of meaning, which will ultimately improve patient care.5

Continuity of Care Record (CCR)—A proposed standard for exchanging basic patient data between one care provider and another to enable this next provider to have ready access to relevant patient information. The standard is proposed by the E31 Committee on Healthcare Informatics of ASTM, an American National Standards Institute (ANSI) standard development organization.6

Data Element/Field—A basic unit of information collected about anything of interest—for example, a medication name or a patient diagnosis. A data element is a unit of data for which the definition, identification, representation, and permissible values are specified by means of a set of attributes.7

Data Repository—A database acting as an information storage facility. Although often used synonymously with data warehouse, a repository does not have the analysis or querying capabilities of a warehouse.8

Electronic Health Records (EHR)—A longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. Though often used interchangeably with the term electronic medical record (EMR), EHRs and EMRs differ in the scope of the information they contain. While EMRs contain information pertaining to a single practice or hospital, EHRs are designed to incorporate information from other providers or settings into a single record. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter as well as supporting other care-related activities directly or indirectly via interface including evidence-based decision support, quality management, and outcomes reporting.9

Electronic Medical Records (EMR)—An application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications. This environment supports the patient's electronic medical record across inpatient and outpatient environments, and is used by health care practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO). The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.10 Though often used interchangeably with the term electronic health record (EHR), EMRs and EHRs differ in the scope of the information they contain. While EMRs contain information pertaining to a single practice or hospital, EHRs are designed to incorporate information from other providers or settings into a single record.

Health Care Entity—Discrete units of the health care system that play distinct roles in the delivery of care. Examples include individual nurses or physicians, primary care practices, multispecialty practices, or hospitals.11

Health Information Exchange (HIE)—Those organizations formed as a corporate entity to provide services that includes core services focused on data exchange and sharing of patient data across disparate stakeholders at the local, State, regional and national level. Health Information exchange organizations require an organizational, financial, and business structure that supports a sustainable service offering that supports a broad range of stakeholder participation.12

Health Information Technology (Health IT)—The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decisionmaking.13

Health Insurance Portability and Accountability Act (HIPAA)—A Federal law intended to improve the portability of health insurance and simplify health care administration. HIPAA sets standards for electronic transmission of claims-related information and for ensuring the security and privacy of all individually identifiable health information.14

Health Level Seven International (HL7)—A messaging standard that is widely used in messaging across health care applications. That is, it is used to send structured, encoded, data from one application (such as the laboratory system) to another (such as the EHR).15

International Classification of Diseases, 9th Edition/Revision, Clinical Modification (ICD-9-CM)—The official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. The ICD-9-CM is used to code and classify mortality data from death certificates.16

International Classification of Diseases, 10th Edition/Revision, Clinical Modification (ICD-10-CM)—The tenth revision of the International Classification of Diseases, Clinical Modification. ICD-10-CM will affect coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare claims.17

Interoperability—The ability of software and hardware on multiple pieces of equipment made by different companies or manufacturers to communicate and work together.18

Logical Observation Identifiers Names and Codes (LOINC)—Used to identify individual laboratory results (e.g. hemoglobin values), clinical observations (e.g., discharge diagnosis), and diagnostic study observations (e.g., chest x-ray impression). LOINC is most widely used in laboratory systems.19

Meaningful Use (MU)—The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use: (1) The use of a certified EHR in a meaningful manner, such as e-prescribing. (2) The use of certified EHR technology for electronic exchange of health information to improve quality of health care. (3) The use of certified EHR technology to submit clinical quality and other measures. Simply put, "Meaningful Use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.20

National Drug Code (NDC) Directory—The Drug Listing Act of 1972 requires registered drug establishments to provide the Food and Drug Administration (FDA) with a current list of all drugs manufactured, prepared, propagated, compounded, or processed by it for commercial distribution. (See Section 510 of the Federal Food, Drug, and Cosmetic Act (Act) (21 U.S.C. § 360)). Drug products are identified and reported using a unique, three-segment number, called the National Drug Code (NDC), which serves as a universal product identifier for human drugs. FDA publishes the listed NDC numbers and the information submitted as part of the listing information in the NDC Directory.21

Office of the National Coordinator (ONC) for Health Information Technology—Organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS). ONC is the principal Federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.22

Patient Registry—A database of confidential patient information that can be analyzed to understand and compare the outcomes and safety of health care. The data may originate from multiple sources, including hospitals, pharmacy systems, physician practices, and insurance companies.23

Patient Centered Medical Home (PCMH)—The AHRQ defines a medical home as an organizational model for primary care that delivers the core functions of primary health care. The medical home is patient-centered, provides clear access to comprehensive and coordinated care, and employs a system-based approach to quality and safety. Health information technology plays a central role in implementing the medical home. AHRQ also recognizes the need for significant workforce development and fundamental payment reform to provide the hallmark accessibility, affordability, and high quality of the patient centered medical home.24

Primary Care Physician/Practice (PCP)—The Institute of Medicine defines primary care as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.25

RxNorm—RxNorm provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software, including those of First Databank, Micromedex, MediSpan, Gold Standard Alchemy, and Multum. By providing links between these vocabularies, RxNorm can mediate messages between systems not using the same software and vocabulary.26

Quality Data Model (QDM)—An "information model" that clearly defines concepts used in quality measures and clinical care and is intended to enable automation of electronic health record (EHR) use. Developed by the National Quality Forum, the QDM provides a way to describe clinical concepts in a standardized format so individuals (i.e., providers, researchers, measure developers) monitoring clinical performance and outcomes can clearly and concisely communicate necessary information. The QDM describes information so that EHR and other clinical electronic system vendors can consistently interpret and easily locate the data required.27

Standards and Interoperability (S&I) Framework—The Standards and Interoperability Framework is a set of integrated functions, processes, and tools being guided by the healthcare and technology industry to achieve harmonized interoperability for healthcare information exchange. The Standards and Interoperability Framework is an investment by the country in a set of harmonized interoperability specifications to support national health outcomes and healthcare priorities, including Meaningful Use, the Nationwide Health Information Network, and the ongoing mission to create better care, better population health and cost reduction through delivery improvements.28

Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT)—One of a suite of designated standards for use in U.S. Federal Government systems for the electronic exchange of clinical health information; is also a required standard in interoperability specifications of the U.S. Healthcare Information Technology Standards Panel.29


1. HealthCare.gov Glossary, http://www.healthcare.gov/glossary/a/accountable.html. Accessed August 23, 2011.
2. Adapted from APCD Council All-Payer Claims Database Fact Sheet, http://www.apcdcouncil.org/sites/apcdcouncil.org/files/APCD%20Fact%20Sheet_FINAL_2.pdf  [Plugin Software Help]. Accessed August 18, 2011.
3. Adapted from Care Coordination Measures Atlas. McDonald KM, Schultz E, Albin L, Pineda N, Lonhart J, Sundaram V, Smith-Spangler C, Brustrom J, and Malcolm E. Care Coordination Atlas (Prepared by Stanford University under subcontract to Battelle on Contract No. 290-04-0020). AHRQ Publication No. 11-0023-EF.
4. American Society for Testing and Materials.
5. Health Level Seven, Inc., http://www.hl7.org/documentcenter/public_temp_0F4E7D58-1C23-BA17-0CD957B03BBCC0CB/pressreleases/20070212.pdf  [Plugin Software Help]. Accessed August 18, 2011.
6. Healthcare Information and Management Systems Society, http://www.himss.org/content/files/StandardsInsight/2003/12-2003.pdf  [Plugin Software Help]. Accessed August 18, 2011.
7. Adapted from U.S. Health Information Knowledgebase (USHIK). http://ushik.ahrq.gov/dr.ui.drOrgDataAlph?Search=All&Referer=DataElement&System=mdr&ItemDisplaySize=50. Accessed 8-21-11.
8. West Virginia State Medical Association Glossary of Health Information Technology Terms, http://www.wvsma.com/shared/content_objects/pdfs/glossary%20of%20hit%20acronyms%20and%20terms%20-%20revised.pdf  [Plugin Software Help]. Accessed August 22, 2011.
9. Healthcare Information and Management Systems Society, http://www.himss.org/asp/topics_ehr.asp . Accessed August 18, 2011.
10. Healthcare Information and Management Systems Society Web site, EHR vs. EMS, yes there's a difference, http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf  [Plugin Software Help]. Accessed August 18, 2011.
11. Adapted from Care Coordination Measures Atlas. McDonald KM, Schultz E, Albin L, Pineda N, Lonhart J, Sundaram V, Smith-Spangler C, Brustrom J, and Malcolm E. Care Coordination Atlas (Prepared by Stanford University under subcontract to Battelle on Contract No. 290-04-0020). AHRQ Publication No. 11-0023-EF.
12. Office of the National Coordinator for Health Information Technology, http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204. Accessed August 18, 2011.
13. West Virginia State Medical Association Glossary of Health Information Technology Terms, http://www.wvsma.com/shared/content_objects/pdfs/glossary%20of%20hit%20acronyms%20and%20terms%20-%20revised.pdf  [Plugin Software Help]. Accessed August 22, 2011.
14. West Virginia State Medical Association Glossary of Health Information Technology Terms, http://www.wvsma.com/shared/content_objects/pdfs/glossary%20of%20hit%20acronyms%20and%20terms%20-%20revised.pdf  [Plugin Software Help]. Accessed August 22, 2011.
15. National Institutes of Health, http://www.ncrr.nih.gov/publications/informatics/ehr.pdf [Plugin Software Help]. Accessed August 18, 2011.
16. Adapted from Centers for Disease Control and Prevention Web site: http://www.cdc.gov/nchs/icd/icd9cm.htm. Accessed August 18, 2011.
17. Adapted from Centers for Medicare and Medicaid Services, https://www.cms.gov/Medicare/Coding/ICD10/index.html. Accessed August 23, 2011.
18. West Virginia State Medical Association Glossary of Health Information Technology Terms, http://www.wvsma.com/shared/content_objects/pdfs/glossary%20of%20hit%20acronyms%20and%20terms%20-%20revised.pdf [Plugin Software Help].  Accessed August 22, 2011.
19. National Institutes of Health, http://www.ncrr.nih.gov/publications/informatics/ehr.pdf [Plugin Software Help]. Accessed August 18, 2011.
20. Centers for Medicare and Medicaid Services, https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. Accessed August 24, 2011.
21. U.S. Food and Drug Administration, http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm. Accessed August 24, 2011.
22. Office of the National Coordinator for Health Information Technology, http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__onc/1200. Accessed August 18, 2011.
23. Agency for Healthcare Research and Quality, http://archive.ahrq.gov/news/press/pr2007/regguidepr.htm. Accessed August 18, 2011.
24. Adapted from Care Coordination Measures Atlas. McDonald KM, Schultz E, Albin L, Pineda N, Lonhart J, Sundaram V, Smith-Spangler C, Brustrom J, and Malcolm E. Care Coordination Atlas. (Prepared by Stanford University under subcontract to Battelle on Contract No. 290-04-0020). AHRQ Publication No. 11-0023-EF.
25. Primary Care: America's Health in a New Era. Eds. Donaldson MS, Yordy KD, Lohr KN, Vanselow NA. Washington, DC: Committee on the Future of Primary Care, Institute of Medicine; 1996.
26. U.S. National Library of Medicine—National Institutes of Health, http://www.nlm.nih.gov/research/umls/rxnorm/. Accessed August 24, 2011.
27. National Quality Forum, http://www.qualityforum.org/QualityDataModel.aspx . Accessed August 23, 2011.
28. Health and Human Services, Office of the National Coordinator Dashboard for Interoperability, http://jira.siframework.org/wiki/display/SIF/Introduction+and+Overview . Accessed September 1, 2011.
29. U.S. National Library of Medicine—National Institutes of Health, http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html. Accessed August 18, 2011.


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Current as of March 2012
Internet Citation: Appendix C: Glossary and Abbreviations: Prospects for Care Coordination Measurement Using Electronic Data Sources. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/prospectscare/prospectsapc.html