Download CalVet RFP 29GS0033 EW-VHIS Project Appendix D: Glossary

CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS
EW-VHIS PROJECT
REQUEST FOR PROPOSAL (RFP)
CDVA-29GS0033
APPENDIX D
GLOSSARY
April 21, 2010
Addendum 6
Issued by:
State of California
Department of General Services
Procurement Division
707 Third Street, Second Floor
West Sacramento, CA 95605
CALVET
EW-VHIS PROJECT
RFP 29GS0033
APPENDIX D: GLOSSARY – ADD 6
Project Term
Definition
10-10SH Medical
Certificate
10-10SH is a Department of Veterans Affairs form for “State Home Program
Application For Veteran Care Medical Certification”.
Access Permissions
Access permissions are pieces of data that specify who or what, can and cannot
access any designated resource.
Accreditation
Approval by an authorizing agency for institutions and programs that meet or
exceed a set of pre-determined standards.
Activity of Daily Living
(ADL) Score
ADL score is based on how much assistance a Resident needs with
bed mobility, transferring from one position to another, eating, and toilet use. The
total ADL score can range from 4-18; the total score increases as a Resident
needs more assistance from staff.
Acute care
Providing or concerned with short-term medical care especially for serious or
acute disease or trauma.
Advance Directives
Advance directives are written instructions which communicate your wishes about
the care and treatment you want to receive if you reach the point where you can
no longer speak for yourself. Medicare and Medicaid require that health care
facilities that receive payments from them provide patients with written information
concerning the right to accept or refuse treatment and to prepare advance
directives. Every state now recognizes advance directives, but the laws governing
directives vary from state to state.
Aid and Attendance
Pension
Provides benefits for veterans and surviving spouses who require the regular
attendance of another person to assist in eating, bathing, dressing and undressing
or taking care of the needs of nature. It also includes individuals who are blind or a
patient in a nursing home because of mental or physical incapacity. Assisted care
in an assisting living facility also qualifies.
Alert
A system-generated warning to an end-user of possible danger, reflecting a need
for urgency in action or a sense of alarm if a given action is followed based on
established parameters such medication dosage, drug interactions, physical
condition of the Resident, and so forth.
All CDVA Facilities
This phrase is used to refer to the following CDVA facilities:




Ambulatory Health Care
Ambulatory Patient
Classification
Yountville Home
Barstow Home
Chula Vista Home
Three (3) Greater Los Angeles and Ventura County (GLAVC) Homes –
West LA, Lancaster and Ventura Homes
 Redding Home
 Fresno Home
 Sacramento Headquarters
A type of health care service provided without the patient being admitted. It is also
called outpatient care.
Provides the basic product definition for the ambulatory setting. Serves the same
function as the diagnosis related groups (DRGs) in the Medicare inpatient PPS.
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APPENDIX D: GLOSSARY – ADD 6
Project Term
American Dental
Association (ADA) Code
on Dental Procedures
and Nomenclature
Definition
Accurate recording and reporting dental treatment is supported by a set of codes
that have a consistent format and are at the appropriate level of specificity to
adequately encompass commonly accepted dental procedures. These needs are
supported by the Code on Dental Procedures and Nomenclature (Code).
On August 17, 2000 the Code was named as a HIPAA standard code set. Any
claim submitted on a HIPAA standard electronic dental claim must use dental
procedure code from the version of the Code in effect on the date of service. The
Code is also used on dental claims submitted on paper, and the ADA maintains a
paper claim form whose data content reflects the HIPAA standard electronic
dental claim. Organization: American Dental Association (www.ada.org).
American National
Standards Institute
(ANSI)
A private, not-for-profit association of users, manufacturers, and other
organizations that administers U.S. private sector voluntary standards.
American Standard
Code for Information
Interchange (ASCII)
ANSI encoding standard.
Americans with
Disabilities Act (ADA)
Title I of the Americans with Disabilities Act of 1990, which took effect July 26,
1992, prohibits private employers, state and local governments, employment
agencies and labor unions from discriminating against qualified individuals with
disabilities in job application procedures, hiring, firing, advancement,
compensation, job training, and other terms, conditions and privileges of
employment. Organization: US Congress.
Ancillary Care
A term used to describe additional services performed related to care, such as lab
work, X-ray and anesthesia.
ANSI X12 148
Supplementary services which may laboratory, radiology, physical therapy, and
inhalation therapy that are provided in conjunction with medical or hospital care.
The X12 First Report of Injury, Illness, or Incident transaction. This standard could
eventually be included in the HIPAA mandate. Organization: ANSI.
ANSI X12 270
The X12 Health Care Eligibility & Benefit Inquiry transaction. Version 4010 of this
transaction has been included in the HIPAA mandates. Organization: ANSI.
ANSI X12 271
The X12 Health Care Eligibility & Benefit Response transaction. Version 4010 of
this transaction has been included in the HIPAA mandates. Organization: ANSI.
ANSI X12 274
The X12 Provider Information transaction. Organization: ANSI.
ANSI X12 275
The X12 Patient Information transaction. This transaction is expected to be part of
the HIPAA claim attachments standard. Organization: ANSI.
ANSI X12 276
The X12 Health Care Claims Status Inquiry transaction. Version 4010 of this
transaction has been included in the HIPAA mandates. Organization: ANSI.
ANSI X12 277
The X12 Health Care Claim Status Response transaction. Version 4010 of this
transaction has been included in the HIPAA mandates. This transaction is also
expected to be part of the HIPAA claim attachments standard. Organization:
ANSI.
ANSI X12 278
The X12 Referral Certification and Authorization transaction. Version 4010 of this
transaction has been included in the HIPAA mandates. Organization: ANSI.
ANSI X12 811
The X12 Consolidated Service Invoice & Statement transaction. Organization:
ANSI.
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Project Term
Definition
ANSI X12 820
The X12 Payment Order & Remittance Advice transaction. Version 4010 of this
transaction has been included in the HIPAA mandates. Organization: ANSI.
ANSI X12 834
The X12 Benefit Enrollment & Maintenance transaction. Version 4010 of this
transaction has been included in the HIPAA mandates. Organization: ANSI.
ANSI X12 835
The X12 Health Care Claim Payment & Remittance Advice transaction. Version
4010 of this transaction has been included in the HIPAA mandates. Organization:
ANSI.
ANSI X12 837
The X12 Health Care Claim or Encounter transaction. This transaction can be
used for institutional, professional, dental, or drug claims. Version 4010 of this
transaction has been included in the HIPAA mandates. Organization: ANSI.
ANSI X12 997
The X12 Functional Acknowledgement transaction. Organization: ANSI.
Assisted Living Facility
(ALF)
Facilities for people needing assistance with Activities of Daily Living (ADLs), but
wishing to live as independently as possible for as long as possible.
Audit Trail
Information that provides evidence of activities in chronological order.
Authentication
The process of verifying an identity claimed by or for a system entity. An
authentication process consists of two steps: 1. Identification step: Presenting an
identifier to the security system. . Verification step: Presenting or generating
authentication information that corroborates the binding between entity & identifier.
Authorization
The process of determining whether a user is allowed access to a data resource.
The granting of privileges to an individual, a program, or process.
Availability
The concept that information will be useable when and where it is needed.
Backup
A reserve copy of data that is stored separately from the original, for use if the
original becomes lost or damaged. Alternate means to permit performance of
system functions despite a disaster to system resources.
Bar Code
A bar code is a piece of Automatic Identification Technology (Auto ID) that stores
real time data. It is a series of vertical bars or a graphical bar pattern which can,
(depending on the width and pattern) encode numbers and letters in a format
which can easily be retrieved and interpreted by a bar code reader.
Breadcrumbs
Breadcrumbs or breadcrumb trails are a navigation technique used in user
interfaces. Its purpose is to give users a way to keep track of their location within
programs or documents. The term is taken from the trail of breadcrumbs left by
Hansel and Gretel in the popular fairytale.
Business Process
Reengineering (BPR)
Redesign of business processes in order to improve efficiency.
California digital
signature regulations,
California Code of
Regulations, Title 2,
Section 22000
Regulation includes:


Digital Signatures Must Be Created By An Acceptable Technology
Criteria for State to Determine if a Digital Signature Technology is Acceptable
for Use By Public Entities
 List of Acceptable Technologies
 Provisions for Adding New Technologies to the List of Acceptable
Technologies
 Criteria for Public Entities To Use In Accepting Digital Signatures
Organization: California Secretary of State
(www.sos.ca.gov/digsig/regulations.htm)
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Project Term
Definition
California State
Accounting and
Reporting System
(CALSTARS)
Under the provisions of Government Code Section 13300, the California State
Accounting and Reporting System (CALSTARS) was developed to provide all
agencies of the State with an automated organization and program cost
accounting system to accurately and systematically account for all revenue,
expenditures, receipts, disbursements, and property of the State. CALSTARS was
specifically designed to improve the timeliness and accuracy of financial
information, standardize the accounting and reporting functions within and across
the state agencies, and expand each agency's accounting and reporting
capabilities. Organization: California Department of Health Care Services
Care Plan
A written plan for a resident’s care.
Centers for Medicare &
Medicaid Services
(CMS)
The Centers for Medicare & Medicaid Services (CMS) is a Federal agency within
the U.S. Department of Health and Human Services. Programs for which CMS is
responsible include Medicare, Medicaid, State Children's Health Insurance
Program (SCHIP), HIPAA and CLIA. Formerly was HCFA. Centers for Medicare &
Medicaid Services has historically maintained the UB-92 institutional EMC format
specifications, the professional EMC NSF specifications, and specifications for
various certifications and authorizations used by the Medicare and Medicaid
programs. CMS is responsible for oversight of HIPAA administrative simplification
transaction and code sets, health identifiers, and security standards. CMS also
maintains the HCPCS medical code set and the Medicare Remittance Advice
Remark Codes administrative code set.
Certification Commission
for Healthcare
Information Technology
(CCHIT)
The Certification Commission is a nonprofit organization which employs a small
staff to assist in the coordination of volunteer development efforts, communication
and outreach, and the administration of certification testing.
Charge Description
Master (CDM - aka
Chargemaster)
A comprehensive listing of items that could be billed to a patient, payer or
healthcare provider.
Clinical Context Object
Workgroup (CCOW)
An HL7 standard protocol designed to enable disparate applications to
synchronize in real-time, and at the user-interface level.
Commercial Off The
Shelf (COTS)
A term for software that is ready-made, available for immediate sale, lease, or
license to the general public and is used “as-is”, without custom development.
Computerized Physician
Order Entry (CPOE)
A system used by physicians to enter and submit electronic orders.
Continuing Care
Retirement Community
(CCRC)
Facilities/communities that allow seniors to "age in place," with flexible
accommodations that are designed to meet their health and housing needs as
these needs change over time.
Continuum of Care
A range of clinical services provided to a patient that may reflect the treatment
rendered during a single hospitalization or may include care for multiple conditions
spanning the patient's lifetime.
http://www.cchit.org/
Full spectrum of care available at Continuing Care Retirement Communities which
may include Independent Living, Assisted Living, Nursing Care, Home Health,
Home Care, and Home and Community Based Services.
Dashboard
A user interface that resembles the dashboard of an automobile. Dashboards
contain small graphs, charts, and gauges that provide data on key information
within an organization.
Demographic Data
Data that describe the residents within CDVA. Demographic data include, but are
not limited to, age, sex, race/ethnicity, and primary language.
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APPENDIX D: GLOSSARY – ADD 6
Project Term
Definition
DGS
Department of General Services
DGS PD
Department of General Services Procurement Division
Diagnostic Related
Groups (DRGs)
A system to classify hospital cases into one of approximately 500 groups, also
referred to as DRGs, expected to have similar hospital resource use, developed
for Medicare as part of the prospective payment system.
Digital Certificate
A certificate document in the form of a digital data object (a data object used by a
computer) to which is appended a computed digital signature value that depends
on the data object. Most digital certificates conform to the X.509 standard and can
be stored in easily accessible registries or directories so that holders’ certificates
can be located for signature verification or to facilitate message encryption.
Digital Imaging and
Communications in
Medicine
A standard for handling, storing, printing, and transmitting information in medical
imaging.
(DICOM)
Digital Imaging and
Communications in
Medicine (DICOM)
Digital Imaging and Communications in Medicine (DICOM) is a standard for
handling, storing, printing, and transmitting information in medical imaging. It
includes a file format definition and a network communications protocol. The
communication protocol is an application protocol that uses TCP/IP to
communicate between systems. DICOM files can be exchanged between two
entities that are capable of receiving image and patient data in DICOM format.
Organization: National Electrical Manufacturers Association (NEMA) and DICOM
Standards Committee.
Digital Signature
Digital signature is the process by which a private key is used to scramble
information. Since only the signer’s public key is able to unscramble the
information, this is considered sufficient proof of the signer’s identity.
Disaster Recovery
Disaster Recovery Planning consists of a set of activities aimed at reducing the
likelihood and limiting the impact of disaster events on critical business processes.
Domiciliary Care
Residential program of the Veterans Administration providing health and social
services to ambulatory disabled veterans. Generally involves less intensive care
than a skilled nursing facility, but more than independent living.
Drug Formulary
Non-medically necessary personal health care for the purpose of assisting a
person in meeting the requirements of daily living. Such services include, without
limitation, assistance in walking, getting in or out of bed, bathing, dressing, feeding
or using the lavatory, preparation of special diets and supervision of medication
schedules. Domiciliary care does not require the continuing attention of trained
medical or paramedical personnel and is not covered under the PBH benefit plan.
A listing of prescribed drugs covered by an insurance plan or used within a
hospital. A positive formulary lists eligible products while a negative one lists
exclusions. Some insurers will not reimburse for prescribed drugs not listed on the
formulary; others may have limited reimbursement for non-formulary drugs.
Drug Utilization Review
An evaluation of prescribing patterns or targeted drug use to specifically determine
the appropriateness of drug therapy.
DSM-IV
Diagnostic and Statistical Manual of Mental Disorders
Durable Medical
Equipment (DME)
A term used to describe any medical equipment used in the home to aid in a
better quality of living.
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Project Term
Definition
Durable Medical
Equipment (DME)
Equipment that can stand repeated use is primarily and customarily used to serve
a medical purpose, it generally is not useful to a person in the absence of illness
or injury, and is appropriate for use at home, such as hospital beds, wheelchairs,
and oxygen equipment.
Electronic Data
Interchange (EDI)
Computer-to-computer exchange, between trading partners, of business data in
standardized document formats.
Electronic Health Record
(EHR)
An electronic health record (EHR) refers to an resident’s record in digital format.
Electronic Medication
Administration Record
(eMAR)
Electronic report that serves as a legal record of the drugs administered to a
patient at a facility by a nurse or other healthcare professional.
Electronic Treatment
Administration Record
(eTAR)
Electronic report that serves as a legal record of the treatment administered to a
patient at a facility by a nurse or other healthcare professional.
End-User Device
An end-user device is a generic term used to refer to devices that are used by an
individual user (e.g. desktop computer, laptop, and scanner).
Enterprise-wide
Veterans Homes
Information System
(Ew-VHIS)
Generic term used to describe the new health information management system for
CDVA.
Extensible Markup
Language (XML)
A standard proposed by the W3C as an alternative to HTML which currently
dominates Web publishing. Unlike HTML, XML is a meta-language – a language
that allows you to create your own markup languages for your purposes.
Failover
A backup operation that automatically switches to a standby component (e.g.
process, database, server) if the primary component fails or is temporarily shut
down for servicing.
Federal Information
Processing Standard
(FIPS)
Federal Information Processing Standard (FIPS) is a set of standards that
describe document processing, provide standard algorithms for searching, and
provide other information processing standards for use within government
agencies.
Federal Privacy Act of
1994
The Privacy Act of 1974, 5 U.S.C. § 552a (2000), which has been in effect since
September 27, 1975, can generally be characterized as an omnibus "code of fair
information practices" that attempts to regulate the collection, maintenance, use,
and dissemination of personal information by federal executive branch agencies.
However, the Act's imprecise language, limited legislative history, and somewhat
outdated regulatory guidelines have rendered it a difficult statute to decipher and
apply. Moreover, even after more than twenty-five years of administrative and
judicial analysis, numerous Privacy Act issues remain unresolved or unexplored.
Adding to these interpretational difficulties is the fact that many Privacy Act cases
are unpublished district court decisions. A particular effort is made in this
"Overview" to clarify the existing state of Privacy Act law while at the same time
highlighting those controversial, unsettled areas where further litigation and case
law development can be expected. Organization: US Congress
(http://www.usdoj.gov).
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Project Term
Definition
Freedom of Information
Act (FOIA)
Law that requires the U.S. Government to give out certain information to the public
when it receives a written request. FOIA applies only to records of the Executive
Branch of the Federal Government, not to those of the Congress or Federal
courts, and does not apply to state governments, local governments, or private
groups.
FYI Non-Dispense
(Medication)
Medications that are not dispensed to a resident from the pharmacy, but are either
brought by the resident or supplied as ward stock. For example, OTC items such
as Tylenol or aspirin.
Gramm-Leach-Bliley Act
(GLB)
Gramm-Leach-Bliley Act (GLB) is federal legislation enacted in the United States
to control the ways that financial institutions deal with the private information of
individuals.
Graphical User Interface
(GUI)
An application user interfaces that are graphical. GUIs are usually characterized
by the use of a mouse or touch screen to interact with the system. Today’s GUI
integrates use of graphics and icons to make the display more appealing.
Health Insurance
Portability and
Accountability Act
(HIPAA)
The security standard included four sections with mandatory standards. They are
Administrative Procedures, Physical Safeguards, and Technical Security Services,
to “Guard Data Integrity, Confidentiality and Availability”, as well as a section on
Technical Security Mechanisms to Guard against Unauthorized Access to Data
that is Transmitted over a Communications Network. A fifth section sets standards
for digital signatures, although their use is not required.
Health Level Seven, Inc.
(HL7)
Health Level Seven is one of several American National Standards Institute
(ANSI) -accredited Standards Developing Organizations (SDOs) operating in the
healthcare arena. Most SDOs produce standards (sometimes called specifications
or protocols) for a particular healthcare domain such as pharmacy, medical
devices, imaging or insurance (claims processing) transactions. Health Level
Seven’s domain is clinical and administrative data.
HIPAA Privacy Rule
The Privacy Rule requires health plans, most health care providers and health
care clearinghouses to comply with its standards. The rule is enforced by the
Office for Civil Rights of the Department of Health and Human Services (HHS).
Enforcement of the Privacy Rule began April 14, 2003. Over the last four years,
HHS enforcement has obtained significant change that has improved the privacy
practices of covered entities through its enforcement program. As discussed in the
announcement, corrective actions obtained by HHS from these entities have
resulted in change that is systemic and affects all the individuals they serve.
Organization: HHS (www.hhs.gov)
HIPAA Security Rule
The Administrative Simplification provisions of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA, Title II) required the Department of Health and
Human Services (HHS) to establish national standards for the security of
electronic health care information. The final rule adopting HIPAA standards for
security was published in the Federal Register on February 20, 2003. This final
rule specifies a series of administrative, technical, and physical security
procedures for covered entities to use to assure the confidentiality of electronic
protected health information. The standards are delineated into either required or
addressable implementation specifications. Organization: CMS
(www.cms.hhs.gov).
HL7 Messaging
Standard
The HL7 Messaging Standard — Application Protocol for Electronic Data
Exchange in Healthcare Environments — is considered to be the workhorse of
data exchange in healthcare and is the most widely implemented standard for
healthcare information in the world.
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Project Term
Definition
HL7 Reference
Information Model (RIM)
HL7 is a language, and every language has a grammar. The HL7 RIM (Reference
Information Model) specifies the grammar of HL7 messages and, specifically, the
basic building blocks of the language and their permitted relationships. The RIM is
not a model of healthcare, although it is healthcare specific, nor is it a model of
any message, although it is used in messages. At first site the RIM is quite simple.
The RIM backbone has just five core classes and a number of permitted
relationships between them.
Inpatient (IP)
Is a patient is 'admitted' to the hospital and stays overnight or for an indeterminate
time, usually several days or weeks (though some cases, like coma patients, have
stayed in hospitals for years).
Interdisciplinary Team
(IDT)
An IDT is a designated group of people who meet when the need arises to discuss
service delivery issues. Although other individuals may be asked to participate
when needed, the IDT must include:

Intermediate Care
Facility (ICF)
The individual, the individual's representative or both (if there is an LAR,
he or she would be a required participant);
 A provider representative; and
 A DADS representative.
health facilities licensed by the Licensing and Certification Division of the California
Department of Public Health to provide 24-hour-per-day services.
International
Classification of
Diseases, Ninth
Revision, Clinical
Modification (ICD-9-CM,
ICD-10-CM)
This is the universal coding method used to document the incidence of disease,
injury, mortality and illness. A diagnosis and procedure classification system
designed to facilitate collection of uniform and comparable health information. The
ICD-9-CM was issued in 1979. This system is used to group patients into DRGs,
prepare hospital and physician billings and prepare cost reports. Classification of
disease by diagnosis codified into six-digit numbers.
Reference: http://www.cdc.gov/nchs/about/major/dvs/icd10des.htm
International Statistical
Classification of
Diseases, Injuries, and
Causes of Death (ICD)
Provides codes to classify diseases and a wide variety of signs, symptoms,
abnormal findings, complaints, social circumstances, and external causes of injury
or disease.
Level of Care (LOC)
An assessment of the type of care necessary to meet the individual needs of the
client. The assessment takes into consideration the client's needs in all aspects of
development, level of functioning, and potential to benefit from a particular
program.
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Project Term
Levels of Care
Definition
This phrase is used to refer to the following levels of care provided at one or more
CDVA facilities:
Independent Living—Domiciliary (DOM)
These independent living settings is for residents with some functional limitations, but
are able to perform activities of daily living with only minimal assistance. Non-nursing
staff provides supervision. Domiciliary residents have access to the Home’s other
levels of care and medical services. Standards for domiciliary are set by the USDVA.
Residential Care for the Elderly
A Residential Care Facility for the Elderly (RCFE) is available for residents who require
assistance and supervision with some activities of daily living. RCFE services may
include care by licensed nurses. At least 75% of the residents are 60 years of age or
older. A Memory Care program within the RCFE provides supervised environment for
veterans with symptoms of confusion, memory loss, or for veterans who have difficulty
making decisions, solving problems or participating in conversations. This level of care
is licensed by the California Department of Social Services and in accordance with the
standards set by the USDVA.
Intermediate Nursing Care (ICF)
Residents in this level of care require intermittent licensed nursing assistance with
medications and treatments, and they generally require unlicensed nursing assistance
with many daily living activities. Intermediate care differs from skilled nursing care by
the degree of need for the services of licensed nurses. Intermediate care is licensed
by the California Department of Health Services, and also meets the standards set by
the USDVA.
Skilled Nursing Care (SNF)
Skilled nursing care provides the services of licensed nurses on a continuous, 24-hour
basis. It is more comprehensive than intermediate care, but less comprehensive that
acute care. Skilled nursing patients may receive rehabilitation therapies, nursing,
pharmaceutical, activity, and dietary services. A Memory Care program within the
Skilled Nursing level of care provides supervised environment for veterans with
symptoms of confusion, memory loss, or for veterans who have difficulty making
decisions, solving problems or participating in conversations. Skilled nursing care at
the Veterans Homes is certified for participation in the Medicare and and Medi-Cal
reimbursement programs and is licensed by the California Department of Health
Services. Skilled nursing must also meet USDVA standards.
Adult Day Health Care
Members participating in the ADHC program are often candidates for admission to a
Skilled Nursing facility, but have family support which permits them to remain at home.
ADHC is a therapeutic health care program designed to permit members to remain
outside the Skilled Nursing environment, while providing caregiver relief and a social
outlet.
Outpatient Clinic
The outpatient clinic at the Veterans Home is established to serve residents who live in
the RCFE or the Domiciliary neighborhoods. These clinics provide comprehensive
multidisciplinary assessments, as well as ongoing primary care for veterans who are
functionally impaired and/or disabled. The clinics are staffed with providers who will
address the veteran’s routine care needs or will arrange consultant visits with various
medical specialties as needed. Veterans who live within the RCFE or Domiciliary
neighborhoods are eligible to include clinic services in their overall plan of care.
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Project Term
Definition
Lightweight Directory
Access Protocol (LDAP)
An IETF standard protocol for communicating with Directory Services. LDAP
defines a set of operations that directory consumers can use to perform a variety
of operations with objects and attributes stored in a directory.
Long Term Care (LTC)
A set of health care, personal care and social services required by persons who
have lost, or never acquired, some degree of functional capacity (e.g., the
chronically ill, aged, disabled, or retarded) in an institution or at home, on a longterm basis. The term is often used more narrowly to refer only to long-term
institutional care such as that provided in nursing homes, homes for the retarded
and mental hospitals. Within the context of CDVA Homes, the following levels of
care are associated with LTC: SNF, ICF, RCFE and DOM.
LTC COTS system
A COTS system designed and used for health information management in longterm care facilities.
Master Patient Index
A master patient index having a reference for each resident including the health
record
Master Patient Index
(MPI)
A database that maintains a unique index (or identifier) for every patient registered
at a health care organization.
Medicaid (Title XIX)
Government entitlement program for the poor, blind, aged, disabled or members
of families with dependent children (AFDC). Each state has its own standards for
qualification. A Federally aided, state-operated and administered program that
provides medical benefits for certain indigent or low-income persons in need of
health and medical care. The program, authorized by Title XIX of the Social
Security Act, is basically for the poor. It does not cover all of the poor, however,
but only persons who meet specified eligibility criteria. Subject to broad Federal
guidelines, states determine the benefits covered, program eligibility, rates of
payment for providers, and methods of administering the program. All states but
Arizona have Medicaid programs.
Medical Information
Technology, Inc.
(MEDITECH)
The current health information system being used by CDVA.
Medicare (Title XVIII)
A federal program for the elderly and disabled, regardless of financial status. It is
not necessary, as with Medicaid, for Medicare recipients to be poor. A U.S. health
insurance program for people aged 65 and over, for persons eligible for social
security disability payments for two years or longer, and for certain workers and
their dependents that need kidney transplantation or dialysis. Monies from payroll
taxes and premiums from beneficiaries are deposited in special trust funds for use
in meeting the expenses incurred by the insured. It consists of two separate but
coordinated programs: hospital insurance (Part A) and supplementary medical
insurance (Part B). Medicare covers more than 34 million Americans (16% of
population) at an annual estimated cost of more than $133 billion.
Medicare Part A
The Medicare component that provides basic hospital insurance to cover the costs
of inpatient hospital services, confinement in nursing facilities or other extended
care facilities after hospitalization, home care services following hospitalization,
and hospice care.
Medicare Part B
The Medicare component that provides benefits to cover the costs of physicians'
professional services, whether the services are provided in a hospital, a
physician's office, an extended-care facility, a nursing home, or an insured's
home.
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APPENDIX D: GLOSSARY – ADD 6
Project Term
Definition
Medication Dispensing
Device
Automated dispensing systems are drug storage devices or cabinets that
electronically dispense medications in a controlled fashion and track medication
use. Their principal advantage lies in permitting nurses to obtain medications for
inpatients at the point of use. Most systems require user identifiers and
passwords, and internal electronic devices track nurses accessing the system,
track the patients for whom medications are administered, and provide usage data
to the hospital's financial office for the patients' bills.
Minimum Data Set
(MDS)
Federal data collection system for assessing nursing home patients. The MDS for
nursing facility residents is a comprehensive resident assessment instrument
(RAI) that measures functional status, mental health status, and behavioral status
to identify chronic care patient needs and formalize a care plan in response to 18
Resident Assessment Protocols (RAPs). Under Federal regulation, assessments
are conducted at a time of admission into a nursing facility, upon return from a 72hour hospital admission, whenever there is a significant change in status,
quarterly, and annually, Also see resource utilization groups.
If you are a certified Medicare or Medicaid nursing facility, then you must
complete, record, encode and transmit the MDS (Minimum Data Set) for all
residents in your facility, regardless of age, diagnosis, length of stay or payment
category. Organization: CMS,
National Institute of
Standards and
Technology (NIST)
The National Institute of Standards and Technology is a federal technology
agency that develops and promotes measurement, standards, and technology.
Nursing Facility (NF)
A facility which primarily provides to residents, skilled nursing care and related
services for the rehabilitation of injured, disabled, or sick persons, on a regular
basis, health related care services above the level of custodial care to other that
mentally retarded individuals.
Nursing Home Quality
Measures
The nursing home quality measures come from resident assessment data that
nursing homes routinely collect on the residents at specified intervals during their
stay. These measures assess the resident's physical and clinical conditions and
abilities, as well as preferences and life care wishes. These assessment data
have been converted to develop quality measures that give consumers another
source of information that shows how well nursing homes are caring for their
residents' physical and clinical needs.
Open Database
Connectivity (ODBC)
Open Database Connectivity (ODBC) provides a standard software API method
for using database management systems (DBMS). The designers of ODBC aimed
to make it independent of programming languages, database systems, and
operating systems.
Operational Recovery
Plan (ORP)
An Operational Recovery Plan (ORP) provides the information necessary for a
recovery effort in the event of a disaster. It is not designed for the restoration of
“business-as-usual”, but rather business continuation on an emergency level to
restore critical activities within an acceptable timeframe.
Optical Character
Recognition (OCR)
Computer software designed to translate images of typewritten text into machineeditable text.
Order Set
A grouping of patient orders for a specific diagnosis or condition. It promotes
standardized care processes. At times an order may include the utilization of a
particular protocol (i.e., Weaning protocol) or to start a particular Clinical Pathway.
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APPENDIX D: GLOSSARY – ADD 6
Project Term
Definition
Outpatient (OP)
An outpatient is a patient who is not hospitalized overnight but who visits a
hospital, clinic, or associated facility for diagnosis or treatment.
Parenteral
Parenteral is the path by which a drug, fluid, poison or other substance is brought
into contact with the body which is by injection or infusion
Payer
Generally regarded as the guarantor of payment. Could be an employer, health
and welfare fund, insurer, or a broker for the employer or labor organization acting
in a purchasing agent capacity, or an individual.
Payor
A self-insured employer group, insurance company, multi-employer trust fund,
employee organization, governmental unit, health maintenance organization,
health care service contractor or any other entity which has developed a
behavioral health plan for the provision of behavioral health services to members.
Peripheral
Devices that are hooked up externally, typically through some form of computer
bus like USB. Typical examples include joysticks, printers and scanners.
Picture Archival and
Communication System
(PACS)
Computers, commonly servers, dedicated to the storage, retrieval, distribution and
presentation of images.
Point of Service (POS)
Application
An application used by physicians to access patient information and perform work.
Examples of a POS include EMR, EHR, physician practice system, PACS, etc.
Portable Document
Format (PDF)
The Portable Document Format (PDF) is the file format created by Adobe
Systems in 1993 for document exchange. PDF is used for representing twodimensional documents in a device-independent and display resolutionindependent fixed-layout document format. Each PDF file encapsulates a
complete description of a 2-D document (and, with Acrobat 3-D, embedded 3-D
documents) that includes the text, fonts, images, and 2-D vector graphics that
compose the document. PDF is an open standard, and is now being prepared for
submission as an ISO standard.
Preferred Intensity of
Care (PIC)
Identifies what a resident wishes are regarding hospitalization, nutrition,
antibiotics, etc.
Referral
The process of directing or redirecting (as a medical case or a patient) to an
appropriate specialist or agency for definitive treatment.
Rehabilitation Services
The physical restoration of a sick or disabled person by therapeutic measures and
reeducation to participation in the activities of a normal life within the limitations of
a person’s physical disability.
Resident
The recipient of care from CDVA.
Resident Assessment
A comprehensive, standardized evaluation for each resident’s physical, mental,
psychosocial and functional status conducted within 14 days of admission to a
nursing facility, promptly after a significant change in a resident’s status, and on
an annual basis.
Resident Assessment
Instrument (RAI)
The designation for the complete resident assessment process mandated by
CMS, including the comprehensive MDS, Resident Assessment Protocols (RAPs),
and care planning decisions. The RAI helps facility staff gather definitive
information on a resident’s strengths and needs that must be addressed in an
individualized care plan.
Resident Assessment
Protocol (RAP)
The Resident Assessment Protocols (RAPs) is a problem-oriented framework for
organizing MDS information and additional clinically relevant information about an
individual’s health problems or functional status.
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APPENDIX D: GLOSSARY – ADD 6
Project Term
Definition
Residential Care Facility
for Elderly (RCFE)
Facility that provides care, supervision and assistance with activities of daily living,
such as bathing and grooming. They may also provide incidental medical services
under special care plans.
Resource Utilization
Groups (RUGS III)
Patient classification system for nursing home patients used by the Federal
government and some states to determine reimbursement levels for nursing home
care. Also see minimum data set.
Role
A job function within the context of an organization that has associated semantics
regarding the authority and responsibility conferred on the user assigned to the
role [ANSI-RBAC].
Role-Based Access
Control (RBAC)
A form of identity-based access control where the system entities that are
identified and controlled are functional positions in an organization or process.
Scalability
Scalability is a desirable property of a system, a network, or a process, which
indicates its ability to either handle growing amounts of work in a graceful manner,
or to be readily enlarged.[1] For example, it can refer to the capability of a system
to increase total throughput under an increased load when resources (typically
hardware) are added.
Section 508 Amendment
to the Rehabilitation Act
of 1973
In 1998 the US Congress amended the Rehabilitation Act to require Federal
agencies to make their electronic and information technology accessible to people
with disabilities. Inaccessible technology interferes with an individual's ability to
obtain and use information quickly and easily. Section 508 was enacted to
eliminate barriers in information technology, to make available new opportunities
for people with disabilities, and to encourage development of technologies that will
help achieve these goals. The law applies to all Federal agencies when they
develop, procure, maintain, or use electronic and information technology. Under
Section 508 (29 U.S.C. 794d), agencies must give disabled employees and
members of the public access to information that is comparable to the access
available to others. Organization: US Congress.
Server
In information technology, a server is an application, or device that performs
services for connected clients as part of a client-server architecture. A server is
typically a combination and hardware and software that are shared across a
department or enterprise.
Share of Cost (SOC)
This is the amount of money an individual must pay during a month before MediCal will begin to cover health care costs. The amount is determined by the CWD.
Simple Mail Transfer
Protocol (SMTP)
Simple Mail Transfer Protocol (SMTP), documented in RFC 821, is Internet's
standard host-to-host mail transport protocol and traditionally operates over TCP,
port 25. In other words, a UNIX user can type telnet hostname 25 and connect
with an SMTP server, if one is present.
Skilled Nursing Facility
(SNF)
A facility, either freestanding or part of a hospital, that accepts patients in need of
rehabilitation and medical care that is of a lesser intensity than that received in the
acute care setting of a hospital.
State Administrative
Manual (SAM)
The State Administrative Manual (SAM) is a reference source for statewide
policies, procedures, regulations and information developed and issued by
authoring agencies such as the Governor's Office, Department of General
Services (DGS), Department of Finance (DOF), and Department of Personnel
Administration. Organization: DGS (www.dgs.ca.gov).
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Project Term
Definition
State Controller’s Office
(SCO) Interface
The State Controller's Office is responsible for issuing pay to employees of the
State Civil Service, California State University (CSU), Judicial Council and judges,
legislative staff and elected officials. Employees are spread throughout California
and in other states, ranging from elected officials, managers and supervisors, and
higher education faculty, to rank and file workers in a variety of occupations. The
State includes over 150 departments and 24 CSU campuses. To meet its
responsibilities, the SCO operates large, complex legacy systems. While there are
interfaces between the various systems, they were designed as separate
stovepipe applications and thus are not integrated.
State Information
Management Manual
(SIMM)
The Statewide Information Management Manual (SIMM) Sections 10 through 90
contain instructions, forms and templates that State agencies must use to comply
with Information Technology (IT) policy. Organization: California State CIO
(www.cio.ca.gov/).
Structured Product
Labeling (SPL)
The Structured Product Labeling (SPL) is a document markup standard approved
by Health Level Seven (HL7) and adopted by FDA as a mechanism for
exchanging medication information. SPML is based on extensible markup
language (XML). Reference: http://www.fda.gov/cder/guidance/6719fnl.htm
Structured Query
Language (SQL)
SQL 2003 includes SQL/XML to map SQL tables, schemas, and catalogs to XML
documents. Organization: ANSI.
Telemetry
Telemetry also is used for patients (biotelemetry) who are at risk of abnormal
heart activity, generally in a coronary care unit. Such patients are outfitted with
measuring, recording and transmitting devices. A data log can be useful in
diagnosis of the patient's condition by doctors. An alerting function can alert
nurses if the patient is suffering from an acute or dangerous condition.
The Joint Commission
An independent, not-for-profit organization, The Joint Commission accredits and
certifies more than 15,000 health care organizations and programs in the United
States. Joint Commission accreditation and certification is recognized nationwide
as a symbol of quality that reflects an organization’s commitment to meeting
certain performance standards. (http://www.jointcommission.org)
Third-Party Payor
An organization that pays for or underwrites coverage for health care expenses.
Treatment Authorization
Request (TAR)
Authorization requirements are applied to specific procedures and services
according to State and Federal law. Certain procedures and services are subject
to authorization by Medi-Cal field offices before reimbursement can be approved.
All inpatient hospital stays require authorization.
TWAIN
TWAIN is a standard software protocol and applications programming interface
(API) that regulates communication between software applications and imaging
devices such as scanners and digital cameras.
Uniform Billing Code of
1992 (UB-92)
A revised version of the UB-92, a Federal directive requiring a hospital to follow
specific billing procedures, itemizing all services included and billed for on each
invoice, implemented October 1, 1993.
Uniform Electronic
Transactions Act (UETA)
The Uniform Electronic Transactions Act (UETA) is one of the several United
States Uniform Acts proposed by the National Conference of Commissioners on
Uniform State Laws (NCCUSL). Since then 46 States, the District of Columbia,
and the U.S. Virgin Islands have adopted it into their own laws. Its overarching
purpose is to bring into line the differing State laws over such areas as retention of
paper records (checks in particular), and the validity of electronic signatures,
thereby supporting the validity of electronic contracts as a viable medium of
agreement. Organization: National Conference of Commissioners on Uniform
State Laws.
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APPENDIX D: GLOSSARY – ADD 6
Project Term
United States
Department of Veteran
Affairs (USDVA)
Definition
Our goal is to provide excellence in patient care, veterans' benefits and customer
satisfaction. We have reformed our department internally and are striving for high
quality, prompt and seamless service to veterans. Our department's employees
continue to offer their dedication and commitment to help veterans get the
services they have earned. Our nation's veterans deserve no less.
www.va.gov
USDVA VistA
Veterans Health Information Services and Technology Architecture (VistA) is the
United States Department of Veteran Affairs (USDVA)’s electronic health record
(EHR) system.
User
A person authorized to access the Ew-VHIS.
User Acceptance Test
(UAT)
A test process to obtain confirmation by CDVA that the system meets mutually
agreed-upon requirements.
User Interface
The user interface is the aggregate of means by which people (the users) interact
with a particular computer system. The user interface provides means of: a) Input,
allowing the users to manipulate a system b) Output, allowing the system to
produce the effects of the users' manipulation.
User Profile
A record of user-specific data that defines a user's working environment.
Veterans Health
Administration (VHA)
VHA is the largest integrated health system in the United States. VHA provides
care to an extremely vulnerable (older, sicker, poorer, ethnically diverse)
population of approximately 5.3 million patients through 1,400 sites of care,
including 171 medical centers and hospitals, 876 outpatient clinics, and a variety
of other long-term, community mental health, and home care programs.
Vital Signs Record
The measurements of pulse rate, respiration rate, and body temperature. Blood
pressure is also customarily included.
Voice Recognition
Voice Recognition, also known as speech recognition, converts spoken words to
machine-readable input (for example, to the binary code for a string of character
codes).
Web Service
Any piece of software that makes itself available over the Internet and uses a
standardized XML messaging system. XML is used to encode all communications
to a Web service. For example, a client invokes a Web service by sending an XML
message, and then waits for a corresponding XML response. Because all
communication is in XML, Web services are not tied to any one operating system
or programming language--Java can talk with Perl; Windows applications can talk
with Unix applications.
Workflow
The automation of a business process, in whole or part, during which documents,
information or tasks are passed from one participant to another for action,
according to a set of procedural rules [WFMC].
X12
An ANSI-accredited group that defines EDI standards for many American
industries, including health care insurance. Most of the electronic transaction
standards mandated or proposed under HIPAA are X12 standards.
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