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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. D-1 CALVET EW-VHIS PROJECT RFP 29GS0033 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. D-2 CALVET EW-VHIS PROJECT RFP 29GS0033 APPENDIX D: GLOSSARY – ADD 6 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) D-3 CALVET EW-VHIS PROJECT RFP 29GS0033 APPENDIX D: GLOSSARY – ADD 6 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. D-4 CALVET EW-VHIS PROJECT RFP 29GS0033 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. D-5 CALVET EW-VHIS PROJECT RFP 29GS0033 APPENDIX D: GLOSSARY – ADD 6 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). D-6 CALVET EW-VHIS PROJECT RFP 29GS0033 APPENDIX D: GLOSSARY – ADD 6 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. D-7 CALVET EW-VHIS PROJECT RFP 29GS0033 APPENDIX D: GLOSSARY – ADD 6 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. D-8 CALVET EW-VHIS PROJECT RFP 29GS0033 APPENDIX D: GLOSSARY – ADD 6 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. D-9 CALVET EW-VHIS PROJECT RFP 29GS0033 APPENDIX D: GLOSSARY – ADD 6 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. D-10 CALVET EW-VHIS PROJECT RFP 29GS0033 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. D-11 CALVET EW-VHIS PROJECT RFP 29GS0033 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. D-12 CALVET EW-VHIS PROJECT RFP 29GS0033 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). D-13 CALVET EW-VHIS PROJECT RFP 29GS0033 APPENDIX D: GLOSSARY – ADD 6 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. D-14 CALVET EW-VHIS PROJECT RFP 29GS0033 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. D-15