Glossary

The following are medical and computer terms used in this book with their definitions. Terms specific to this book begin with the phrase, "In this book, . . ."

abnormal: A description for diagnostic findings, including clinical laboratory test results, meaning deviating from the normal. See “diagnostic findings”.

access to care: The ability of the patient to obtain the type of care needed at the time necessary.

access: To store or retrieve data from a storage device such as a disk or magnetic tape. To provide the capability to initiate an automated service on a system.

ACR/NEMA: American College of Radiology and the National Electrical Manufacturers Association. This relationship was formed in 1982 to develop the DICOM standard for medical imaging. See “DICOM”.

actionable information: Data that can be used by its receiver to immediately analyze and resolve a problem.

active window: A window is a rectangular box on the screen. The active window is the one currently being used, which appears on top of other windows.

activities of daily living: Activities usually performed in the course of a normal day of a person to meet basic needs, such as eating, toileting, dressing, bathing, teeth brushing and grooming. While a patient is in the hospital, nurses are responsible for insuring they occur.

activity: See “care activity”.

acuity: Intensity of nursing care required to meet the needs of a patient; higher acuity usually requires longer and more frequent nurse visits and more supplies and equipment.

acupuncture: A technique that relies on piercing parts of the body with needles to treat disease or relieve pain.

acute care: Short term care, as opposed to long-term, “chronic”, care.

acute illness: Illness characterized by symptoms that are of relatively short duration, are usually severe, and affect the functioning of the patient in all dimensions; not “chronic”.

addendum: An appendage to an existing document that contains supplemental information. The parent document remains in place and its content is altered by the addendum. For example, a clarification or correction to an interpretation of an anatomic pathology specimen might produce an addendum.

administration of medication: The process whereby a prescribed medication is given to a patient by one of several routes—oral, inhalation, topical or parenteral.

admission: The formal acceptance by a hospital of a patient who is to be provided room, board, and continuous nursing services in an area of the hospital where patients generally stay at least overnight.

admitting diagnosis: A statement of the provisional condition given as the basis for admission to the hospital for study.

admitting physician: The physician who admits the patient to the hospital.

ADT (admission, discharge and transfer system): A clinical system for recording admissions to a hospital, discharges from a hospital and transfers within a hospital and maintains the hospital census.

advance directive: Written instructions a patient has prepared for medical personnel to inform them of the patient’s wishes for treatments and care when the patient is incapacitated, especially regarding life-sustaining treatment if the patient’s condition becomes irreversible. An advance directive is a legal document prepared when the individual is competent and able to make decisions.

advice nurse: A nurse who takes patient phone calls and advises the patient on medical conditions according to protocol; the advice nurse informs the patient when self care is appropriate and when a patient needs to come in and when the patient does not.

Agency for Health Care Policy and Research (AHCPR): An agency of the U.S. Department of Health and Human Services whose mission is to enhance the quality, appropriateness, and effectiveness of health care services and access to these services. AHCPR has developed clinical practice guidelines based upon “evidence-based medicine”.

agent: In this book, a way of categorizing and separating out a set of code and tables, interfaces between systems, databases, and user interfaces (possibly all spread across a number of different software systems), and administrative and operational procedures of employees implementing a business policy, so that the business policy could be implemented and changed by the people responsible for the business policy instead of relying totally on technical staff to do so.

aggregation: For databases, a relationship where one entity (engine) is “a part of” another entity (e.g., car).

AHCPR clinical practice guidelines (AHCPR National Guideline Database): A set of clinical practice guides for various diseases available on-line on the Internet. Each set of guidelines has several versions: Clinical Practice Guidelines, Quick Reference Guides for Clinicians, and Consumer Guides. Examples of conditions for which there are guidelines are “acute pain management”, “urinary incontinence”, and “pressure ulcers in adults”.

alarm: A notification message for an abnormal result, panic result, or other result of a caregiver order that the caregiver wants to be notified about.

alert: A notification message describing a patient put in by one caregiver to later inform other caregivers. More urgent messages are alerts and less urgent messages are reminders.

algorithm: A generic procedure consisting of a finite sequence of well-defined steps (instructions) for producing one or more outputs from a set of inputs. For example, a set of instructions on how to generically draw a graph with its axes on the screen.

allergy: A state of hypersensitivity induced by exposure to a particular antigen (allergen) resulting in harmful immunologic reactions on subsequent exposure.

alliance organizations: Healthcare organizations that HMOs contract with to share hospital space or medical office facilities.

alternate delivery systems: Health services provided as a less expensive substitute for care as an inpatient in a hospital. Examples within general health services include skilled and intermediary nursing facilities, hospice programs, and home health care.

alternative medicine: Acupuncture, naturopathy, care given by chiropractors or osteopaths, and other approaches to medical diagnosis and therapy that have not been developed by use of generally accepted scientific methods. Also called “complementary medicine”.

ambiguous allergy: An allergy that is not clear cut (e.g., the allergy is not confirmed, the benefit of the substance causing the allergy outweighs its allergic side effects, the substance causing the allergic reaction only causes the reaction some of the time).

American Medical Association (AMA): A partnership of physicians and their professional associations dedicated to promoting the art and science of medicine and the betterment of public health.

ANSI (American National Standards Institute): A group that publishes many computing standards. The U.S. representative is the ISO (International Standards Organization). For example, ANSI has standards for COBOL and C.

ANSI ASC X12N: A federally mandated EDI format to be used by providers and payers who electronically transmit claims and related transactions to the federal government. ASC stands for Accredited Standards Committee. The mandated version of ANSI ASC X12N is Version 4010.

ANSI Health Informatics Standards Planning Panel (HISPP): The primary organization working to coordinate healthcare standards being developed by other standard development organizations

analog: A flow of information where things change smoothly and have an infinite number of values, as opposed to “digital”.

analysis: The determination of the total effects of any addition, change or deletion to a project to the other aspects of the project (e.g., requiring a user to remember a status code could divert the caregiver’s attention away from patient care).

analytic disease prediction: In this book, disease prediction based upon a patient having a known risk factor for a disease (e.g., smoking increasing the risk of lung cancer, a severe knee injury increasing the risk of osteoarthritis and knee replacement, the presence of the BRCA1 or BRCA2 genes increasing the risk of breast cancer) or protective factors against that disease. Analytic disease prediction is based upon analytic epidemiology studies. See “disease prediction”, “risk factor” and “analytic epidemiology”.

analytic epidemiology: A branch of epidemiology identifying the causations of diseases, also referred to as etiology. See “etiology”.

anatomic pathology: An ancillary department that determines if tissues are in fact abnormal or diseased. Anatomic pathology deals with wet specimens, tissues, anything out of the body (a piece of bone, skin tissue, muscle, blood vessel, bullet). Anatomic pathology includes surgical pathology, cytology (study of cells), histology (microscopic structure of tissues) and autopsy (multiple body parts). Cytology deals with smears: vaginal, sputum, semen--fluids with cellular material.

ancillary department: Departments providing services for patients or services for departments providing direct medical care. For example, this may include the following: laboratory, x-ray, physical therapy, injections, pharmacy, optical sales and hearing center.

Andover Working Group for Interoperability: A group of companies formed to build upon healthcare standards set up by the Hewlett-Packard Company. The principal standards supported are HL7, DICOM, ASTM for clinical lab data interchange, EDIFACT for healthcare data interchange, HTML for information on the Internet, and IEEE P1073 for medical device communication with computer systems.

angiography: X-ray with contrast material injected into blood showing arteries and veins.

application: A set of files (or databases), programs, equipment, and procedures to support a set of related functions suited to the user’s organizational needs. Such functions may be related to a business, entertainment, science or engineering organizational need.

application database: Any database that is not meant to be used by all automated systems in an organization, containing data specific to a single automated system or to a set of related automated systems. See “corporate database”.

application service provider: “A company that offers individuals or enterprises access over the Internet to application and related services that would otherwise have to be located in their own personal or enterprise computers . . . on a rental, pay-as-you-use basis.” (From http://www.whatis.com/ .

appointment: A scheduled outpatient meeting between a patient and a caregiver. Also, sometimes patients are also scheduled with a room, equipment, a class, etc. Making appointments minimizes wait time for patients and optimizes utilization of resources.

appointment clerk: A person who takes member phone calls and who may schedule an appointment.

arbitration: A dispute resolution process involving a hearing outside of court. The arbitrators, who are supposed to be neutral, hear a complaint and resolve the dispute. The resolution is final and binding to all parties.

architecture: See “system architecture”.

archive:  Archiving is the process of long-term storage and organization of data and documents. An archive is an off-line storage of patient data or other information, in a way that ensures the possibility to restore them on-line when needed.

Arden Syntax: Standards for defining and sharing medical knowledge bases

aspects: Modular units of code that describe a recurring property within a software system that can be defined once and used wherever needed in the software system, possibly in different objects, applications, or computer systems.

aspect-oriented programming: A programming paradigm providing modular units of code called aspects that can be used across objects, applications or computer systems.

ASCII: American Standard Code for Information Exchange: ASCII is a 7 bit code with an 8^th bit used for parity (ISO-7 code) used for defining displayable and non-displayable characters.

assessment: A clinician’s interpretation of the subjective and objective findings, including any tests, x-rays or procedures that are performed and thus an appraisal or evaluation of a patient’s condition, based upon clinical and laboratory data, medical history, and the patient’s account of symptoms.

association: For databases, a relationship existing between instances of entities (e.g., a company has a number of offices, a person works for a company).

association class: Data to describe a formal association (e.g., to describe a contract between an employee and employer).

ASTM (the American Society for Testing and Materials): A not-for-profit organization that provides a forum for members of various groups to meet on common ground and write standards for materials, products, systems and services.

ASTM E1384: ASTM standards for the content and structure of the Computer-Based Patient Record.

ASTM’s E31.12 Subcommittee: An ASTM group meeting on standards for healthcare.

asynchronous communication: Irregularly timed communication where each character is sent independently. Synchronization of the clock of the receiver generally is achieved by adding start and/or stop bits to each character transmitted. See “synchronous”.

Asynchronous Transfer Mode (ATM): A standard for a packet-switched broadband network architecture that allows data, voice and multimedia transmission on the same line.

attending physician: A physician directly responsible for the care of an inpatient.

audit: An official examination and methodical review of the medical record in all aspects of medical care, based upon established standards, usually done by trained medical staff unaffiliated with the healthcare organization.

audit trail: Computerized recording of transactions, the resources, or medical records, that were accessed and the identity of the user.

authentication: (1) computer science: In a computer system or network, the process of verifying that a person, organization, process or device seeking access to a computer system or network is who or what it claims to be; authorization of a person signing on to a system is often done at the time the person enters a user name and password. (2) medicine: Proof of authorship of a medical record entry, such as by a “digital signature”.

authorization: (1) computer science: In a computer system or network, the determination by a security service of what access rights, if any, a person, organization, process or device seeking access has to a given device, application, process or information resource; (2) medicine: To use or disclose health information.

automated patient medical record: Patient medical records available over a network.

automated speech recognition (ASR) access: Access to computers through hardware and software to support interpretation of human speech into text. Same technology as “interactive voice recognition (IVR)”.

back up: The process of copying important software, data or documents onto some other media (magnetic tape, floppy disks, etc.) to guard against its loss should anything happen to the original.

Balanced Scorecard: A management technique for measuring the future financial health of an organization or the financial benefits of a project. It does this by not only using financial figures to predict the future, but also by looking at positive aspects of an organization that would predict the financial health of the organization in the future.

bandwidth: The amount of information that can be handled by a device or system, usually measured in baud rate or bps. Also the range of frequencies that can be passed through a communication channel.

bar code: An array of rectangular marks and spaces in a predetermined pattern. Usually used for automatic product identification.

batch processing: A mode of data processing where programs are put into queues to be processed off-line and where there is no user interaction.

baud: When transmitting data, the number of times the medium’s “state” changes per second. A 2400 baud modem changes the signal it sends on the phone line 2400 times per second. Since each change in state can correspond to multiple bits, the actual bit rate of data may exceed the baud rate.

benefits: The services payable under a specific payer plan.

benign: Not malignant; not recurrent; favorable for recovery.

best practice guideline: A guideline for treating a medical condition that is based upon the best current scientific research, that produces the best outcome.

binary number: A number expressed in base 2. Internally, it is shown as a series of 1’s and/or 0’s and internally in the computer as on or off switches.

biometrics: The utilization of an anatomical or behavioral characteristic in order to verify the identity of an individual; an “authentication” technique.

bit: Short for “binary digit”. A 0 or 1, on or off. Computers use bits in combination to represent data, numbers, characters.

bitmap: A pattern consisting of rows and columns of dots, or bits in memory, that correspond to pixels on a screen.

black box: With regard to computer software systems, everything seen by the users of the system. "Black box" is often used to describe testing, where "black box" testing is done without a knowledge of the internal workings of the system. See "white box" and "internal workings".

bps (bits per second): The speed at which bits are transmitted over a communications medium. This speed may exceed the baud rate.

blood pressure: The pressure exerted by the circulating volume of blood on the walls of the arteries, veins, and chambers of the heart. Systolic pressure is the highest level of blood pressure, which is the pressure exerted in the aorta and large arteries during systolic contraction of the left ventricle. Diastolic pressure is the minimum level of blood pressure, which occurs between contractions of the heart. A typical value for a young adult is 120 mm Hg during systole and 70 mm Hg during diastole.

board-certified: A physician or other healthcare professional who has passed a test given by their national specialty organization.

body surface area: The total area of skin on the entire or a particular part of the body, which is sometimes used in determining dosages of medications. Formulas exist based upon sex, height, weight, build. Body surface area is important in determining pediatric dosages, in determining the extent of burns and in determining radiation doses.

book: The act of making an appointment and recording it in a schedule.

border: A box around an object on a screen to mark its boundary.

bottleneck: A system component that limits the performance of an automated system. Such components include disk subsystems, memory, CPU’s/processors, networks, buses, operating systems, databases, and transaction or application software.

brand-name: See “trade-name”.

broadband: Transmission facilities with a bandwidth greater than those for voice grade facilities.

broadness: In this book, a description for a software system that is built to handle initial automation as well as the current non-automated environment.

browser: A tool that provides an Internet Web user interface to access HTML pages.

business analysis: A process which identifies the changes to be accomplished by a project or phase in terms of a mission, objectives and business requirements for the project or phase.

business policy: A policy to be applied throughout an organization via changes to workflows, systems and data kept for organizational business reasons.

business process reengineering (BPR): Means the same thing as reengineering.

business requirement: A required characteristic of an organization at the end of a project.

button: In a graphical user interface (GUI), an object on the screen that the user can select, either by a mouse click or by an equivalent keyboard operation, sending a command to an application to trigger a specified action such as the start of a particular process.

byte: Eight bits forming a meaningful unit. It may represent an ASCII character or some other coded meaning to the computer. A computer’s memory size is measured in megabytes where 1 megabyte is equal to 1,048,576 bytes.

C: A programming language developed in 1972 by Dennis Richie and Brian Kernighan of AT&T.

C++: An object-oriented extension of the C language developed by Bjarne Stroustrup of AT&T - Bell Labs.

calibration: The set of operations that establish, under specified conditions, the relationship between values indicated by a measuring instrument or measuring system, or values represented by a material measure or a reference material, and the corresponding values of a quantity realized by a reference standard.

call center: A bank of telephones in a managed care healthcare organization with appointment clerks and advice nurses who together (1) make appointments for the member, (2) give the member advice on medical care based upon protocols, including when self care is appropriate and when the patient should come in, and (3) connect the member with medical resources, including physicians and patient education.

capitation: The payment of premiums or dues directly to the provider organization in the form of fixed periodic payment for comprehensive care, set in advance.

capture (data): The recording of data on a form or its entry into a computer.

care activity: Specific tasks to be performed (that one “does”) in the care of a patient to arrive at a specific outcome in a clinical pathway.

caregiver: A healthcare organization employee in any way, directly or indirectly, providing care for a patient.

caregiver messaging system: A system to enable communication between caregivers for care of the patient using e-mail messages that includes the ability to identify a patient associated with the message and to include the message in the patient’s medical record.

care management: Aggregates encounters and other events into episodes for a particular occurrence of a medical condition, possibly across care settings, rather than just focusing on a single encounter or event of an illness or injury.

care plan: A written framework that provides the direction of care for a patient.

care, primary: See “primary care”.

care, secondary medical: Medical care of a patient by a physician acting as a consultant. The physician providing primary care usually refers the patient for this care.

care team: A group of caregivers who jointly care for patients. Care teams may be defined for one or all of the following reasons: (1) to identify nurse practitioners or physicians assistants who are supervised by a particular physician, (2) to identify other caregivers working with or supervised by the physician, (3) to identify to whom to send diagnostic test results if the ordering caregiver is unavailable, (4) to identify to whom to send clinical messages or e-mail if the recipient is not available, or (5) to identify physicians who will back up a physician if the latter physician is unavailable.

Cascading Style Sheets: Tags within HTML that create templates to control different aspects the HTML page's layout, including text font-faces, text line-heights, text styles (like bolding and italics), colors, and margins.

case: One instance of case management for a particular patient. A case is often assigned to a case manager.

case management: An organized system for delivering health care to an individual that includes assessment and development of a plan of care, coordination of services, referrals and follow-ups.

case manager: A person specifically assigned to oversee the case management of an individual for a particular case.

case notes: A set of notes developed by a case manager for a particular case.

CD-ROM: A term referring to storage of information on a CD (compact disc) using ROM (read-only-memory) format.

certified nurse-midwife: A healthcare practitioner who is educated, and who has acquired a national certification and a license within a state, in the two disciplines of nursing and midwifery.

certified registered nurse anesthetist: A registered nurse with training and certification in anesthesiology, who may substitute for an anesthesiologist in many surgical procedures.

change: In this book, in the context of a project, a modification in the way an agreement, workflow or automated system is implemented when the implementation matches the documentation of the implementation. See “error”.

change control board: A group responsible for reviewing changes to controlled documents during a project.

change control process: A defined process to insure that important documents on which a project depends are not changed without careful consideration. Often a change control board is set up to agree upon or reject changes to these “controlled documents”. See “controlled document”.

character: Any symbol, letter, digit, or punctuation mark that can be typed on a keyboard.

character-based terminal: A type of data terminal that displays only alphanumeric or text characters

chart: See “medical record”.

charting by exception: A charting methodology in which data is entered only when there is an exception from what is normal, from what is expected or from what was previously recorded. Reduces time spent documenting.

chart room: A location storing patient medical records.

check box: A box where a pointing device can be put and with a button press a check mark can be entered or removed. A check sets an option. Where there are other check boxes, these check boxes remain as is. Compare this to a “radio button”, where selecting one radio button turns another off.

checkpoint/restart: A technique associated with transactions where the state of the database is recorded at the start of a transaction, and if the transaction should abnormally terminate, then the database would be restored to that state.

chief complaint: The primary reason a patient is coming in for medical care.

chiropractor: A medical professional who treats disease based on the theory that disease is caused by interference with nerve function, and uses manipulation of the joints and the spine to restore normal function.

chronic condition: A condition that lasts a long time, or recurs frequently, and can be treated but not eradicated; opposite of “acute illness”.

chronic disease: Illness that persists over a long period of time and affects the physical, emotional, intellectual, social and spiritual functioning of the patient.

chronic disease management case: A case to track a patient who is being treated for a chronic condition over many encounters where there is likely to be long term continuing care.

CICS (IBM Corporation’s Customer Information Control System): A widely used teleprocessing monitor (transaction processing system) for online application systems found on IBM mainframes.

client: A client process in a client-server architecture. A client is any computer that issues processing request to a server.

client-server architecture: A network configuration in which decentralized client processes request services from centralized server processes.

clinical: Pertaining to a clinic or to the bedside; pertaining to or founded on actual observation and treatment of patients, as distinguished from theoretical or basic sciences.

clinical checking: Checking for patient drug allergies and for drug/drug, drug/food, drug/laboratory and other interactions.

clinical data repository (CDR): A database that combines clinical data related to a patient from various healthcare organization clinical systems. Example information is patient demographics, radiology data, laboratory data, medications, physician orders and H&P’s. (In an automated patient medical record system, this is a portion of the information in the automated patient medical record.)

clinical epidemiology: The use of epidemiology in direct patient care.

clinical information: Data contained in the patient record. Information may also include summary information such as found in CPR repositories: significant health problems, lab results, current medications, etc.

clinical laboratory: Health care professionals who perform a variety of laboratory tests that contribute to the diagnosis and treatment of disease. Areas covered by the clinical laboratory include hematology, clinical chemistry, immunology, immunohematology, and microbiology

clinical laboratory information system:  A clinical system that manages clinical laboratory data to support laboratory management, laboratory data collection and processing.

clinical pathway: A structured way to identify care activities and caregiver work flow needed to care for a patient with a particular condition or disease. Paths through a clinical pathway can be adjusted for the particular needs of an individual patient. Also, clinical pathways for separate diseases can be combined into one clinical pathway.

clinical practice guidelines: Parameters related to a specific disease or medical condition that help clinicians make clinical decisions.

clinical record: See “medical record”.

clinical social worker (CSW): A person who possesses a master’s or doctor’s degree in social work, has performed at least two years of supervised clinical social work, and either: is licensed or certified as a clinical social worker by the State in which the services are performed, or in the case of an individual in a State that does not provide for licensure or certification, has completed at least 2 years or 3,000 hours of post master’s degree supervised clinical social work practice under the supervision of a master’s level social worker in an appropriate setting such as a hospital, SNF, or clinic.

clinical summary: A summary of clinical information about a patient, which may include demographics information, significant health problems, past encounters, primary care physicians and other significant caregivers, and medications.

clinical system:  Information system that manages clinical data to support patient care and clinical decision making. 

clinical trial: A scientifically rigorous investigation of new methods, materials such as medications, or procedures in the treatment of a particular disease or condition.

clinician: Someone who sees, evaluates, and treats patients, especially a physician, nurse practitioner, or physician assistant.

cluster: A group of computers working together to share resources or workload.

clustering: The use of clusters.

code: The programming content of any application.

coding scheme: A method of replacing each member of a vocabulary of names (such as a patient problem or diagnosis) by a number or “mnemonic”.

column: All the values from multiple rows in a database table corresponding to a particular data element in the table.

Common Gateway Interface (CGI) processing: A protocol that enables a web server to pass a web user’s request to an application program and to receive data to forward back to the user. For example, a program using CGI can read and write data files and produce different results each time (whereas a Web server by itself can only read data files).

communicable disease: Any disease that can be transmitted from one person or animal to another by direct or indirect contact.

communications protocol: Communications standards that identify how two computers coordinate the exchange of data.

community-based charts: When multiple facilities of a healthcare organization share the same set of paper patient medical records.

co-morbidity: An accompanying illness or disease that coexists with an already established medical diagnosis.

compiler: A program that translates programs written in a higher level language such as COBOL, C or C++, into code that a computer can execute. Compiled programs run faster than interpreted programs, such as those written in Java. See “interpreter”.

complaint: A reason a patient is coming in for medical care.

complementary medicine: See “alternative medicine”.

component adaptability: The use of various strategies to procure, develop or structure a system or component of a system so that the system or component can more easily be replaced in the future by another equivalent system or component.

compression: An algorithm to transform and compact text or image data to minimize storage requirements or transmission time.

computed radiography: X-ray images captured in a computer, instead of on film.

computer: A device capable of accepting data, manipulating it in a prescribed way, and displaying or storing the results where it is instructed.

computer language: The vocabulary and syntax of a set of symbols that may be used to tell a computer what it is to do.

computer-based patient record (CPR): An electronic patient record.

Computer-based Patient Record Institute (CPRI): An organization whose primary purpose is to promote automation of the patient chart

computer telephony integration (CTI): Systems to enable a computer to act as a call center, accepting incoming calls and routing them to the appropriate device or person.

conceptual view: Models of systems, workflows, etc. which are vehicles for communication and for critique.

concurrency: (1) medicine: Multiple caregiver access to a patient’s medical record, which may be for the same encounter, with possibly more than one update occurring at the same time. (2) computer science: In database processing, the situation wherein multiple processes access the same database record at the same time for various database functions, which may include reading, updating, deleting, etc. In either case, concurrency rules must insure no loss or corruption of the data.

concurrent review: The investigation of patient care while it is in progress, with the intention of modifying that care if appropriate and determining if continued treatment is medically necessary.

conditional order: A type of medication where the medication is given based upon a condition occurring (e.g., the patient experiences pain).

conditional treatment case: In this book, a case developed by a primary care physician, urgent care physician, nurse practitioner, or advice nurse that may be later used to generate a treatment case, or may later be dispensed with.

confidentiality: The act of limiting disclosure of private matters; maintaining the trust that an individual has placed in one who has been entrusted with private matters; not disclosing information about a patient that is considered to be privileged and cannot be disclosed to a third party without the patient’s consent.

consent: The agreement of an individual for a given action relative to the individual. This may be consent for treatment, special procedures, release of information, and advance directives. “Expressed consent” is written; “implied consent” is an action other than an expressed consent on the part of a patient that demonstrates consent; while “informed consent” is freely given consent that follows a careful explanation by a caregiver.

consultation: Process in which the help of a specialist is sought to provide advice or care for a patient. A request for a consultation is often accompanied by a referral; see “referral” and “referral letter”.

content facilitator:

contingency plan: Plan of action to minimize or negate the adverse effects of a risk should it occur.

continuity of care: The coordination of care received by a patient over time by possibly given by multiple caregivers.

contraindication: Any condition, especially any condition of disease, which renders some particular line of treatment improper or undesirable.

control: An item that may appear within a window to allow the user to control the window. These include list boxes, input fields, buttons, check boxes, radio buttons, and others.

control chart: A control chart is a graph of data used in statistical process control that incorporates statistical content- a mean (average) and upper and lower statistical thresholds (control limits), to guide interpretation and decision-making of the data. A “trend document” is a form of control chart. See “trend document”.

controlled document: An important document created during a project that can not be changed without approval of a change control board within a change control process. Examples of such documents are documents to record project objectives and goals, business requirements, workflow requirements, system requirements, program specifications, user documentation. See “change control process”.

controlled substance: A drug whose distribution and use is controlled by federal and/or state government regulation. Controlled substances, which may include narcotics, stimulants and sedatives, are divided into five classes called schedule I through schedule V. See “schedule I through V drugs”.

cooperative business objects (CBOs): Real world “business objects” used in a GUI interface of a computer system that are relatively independent from each other.

cooperative editing systems: Multi-user systems where the actions of one user are instantaneously propagated to all the other participating users.

coordination of care: Methods to assist caregivers in coordinating their care of a patient.

copayment: Fixed dollar payments a patient makes per visit or prescription filled.

copy: (1) To copy information and keep it so you can paste it somewhere else on the screen. (2) To make an exact copy of a file so you can place the duplicate in another location.

corporate database: A database sharing data across many systems in an organization to avoid redundant entrance of information and to insure that data in the organization is in a consistent format. See “application database”.

co-sign: (1) Verbal medical orders from a physician may be entered and signed by a caregiver other than the physician (e.g., a registered nurse, physician assistant, pharmacist, respiratory therapist) but must be later co-signed by the physician (e.g., within 24 hours). (2) Medical or nursing students documentation (e.g., a progress note) may be co-signed by an instructor, indicating the instructors agreement with the information and acceptance of responsibility for the documentation.

cost-benefit analysis: Identification and evaluation of all costs and benefits associated with a particular project.

CPR repository: In this book, a national database containing a summary of a patient’s clinical information in a format using national or international data standards. Possible information might include patient identification information, a patient problem list, patient practitioners, patient encounters, services (including medications, diagnostic tests, immunizations, procedures and therapies), assessments/exams, and care plans.

CPT (Physicians’ Current Procedural Terminology): A system describing medical and surgical procedures in a hierarchical format with six major sections, developed by the American Medical Association. The current version is CPT-4.

CPU (central processing unit):   The part of a computer that controls all the other parts. The CPU fetches instructions from memory and decodes them. This may cause it to transfer data to or from memory or to activate peripherals to perform input or output. Sometimes just called the “processor”.

credentialing: A system that uses national databases to record or verify a healthcare practitioner’s professional credentials. For example, a credentialing system may (1) verify that a healthcare practitioner has a license to practice, (2) record or verify hospital privileges, (3) verify DEA certification, (4) record board certification, (5) identify sanctions against licensure, and (6) identify Medicare/Medicaid sanctions.

crisis: See “panic”.

critical pathway: See clinical pathway.

cryptographic techniques: Methods of concealing data by representing each character or group of characters by others.

CT (computed tomography) scan: A diagnostic test that combines the use of x-rays through the body from multiple angles, the resultant absorption values are analyzed by a computer to produce cross-sectional slices.

cursor: A flashing line, square, rectangle or other symbol on the screen that moves when you move the mouse or other pointing device and can also be moved around via characters or character combinations entered through the keyboard.

cut: To remove information but keep it around so you can paste it back somewhere else.

Defense Advanced Research Projects Agency (DARPA): The U.S. federal government agency that was the originator of the Internet.

data: Symbols that represent observations; often called raw data to emphasize that they are unprocessed. Data are processed and interpreted to yield “information”.

database: The collection of permanently stored data used by one or more applications.

database administration: The tasks necessary to insure data integrity, non-redundancy of data, immediate up-to-dateness of data, integrity of the meaning of data as recorded in data dictionaries, security, and database software installation and upgrades.

database management system (DBMS): A scheme using “software” and sometimes “hardware” to store and retrieve large quantities of interrelated data by one or many different application programs.

data communication: The sending, transmission and reception of information between different electronic systems.

data dictionary: A database about data objects in a database, defining the use of each table in the database and the meaning of each row and data element in each table in a database. See “meta-data”.

data element: The smallest, meaningful piece of information in a business transaction or database. A data element may condense lengthy descriptive information into a short code. Equivalent to a data field in a paper document; a series of data elements are used to build a row in a relational database.

Data Flow Diagrams (DFDs): A structured analysis tool used to track the flow of data through an entire (business, software or other) system, identify transformations on data, and identify data repositories.

data mining: Discovering useful relationships in data warehouses. See “data warehouse”.

data model: A model of the logical data content of a system, expressed in terms of entities, relationships and attributes, such as may appear in an entity-relationship diagram.

data warehouse: A system for storing, retrieving and managing large amounts of data that planners and researchers can use without slowing down the day-to-day operations of the production database.

DEA license: License allowing a physician to prescribe controlled substances. See “Drug Enforcement Administration (DEA)”.

deadlock: A situation wherein two or more processes are unable to proceed because each is waiting for one of the others to do something.

decoupling: Changing systems so they use industry standard connections so that any one system can be replaced by a different one using the same standards without having any effect on any of the other ones.

dedicated line: A permanent connection with a network.

demand management: An approach in HMOs to instruct a patient in self care or to “triage” the patient to the appropriate and most cost effective caregiver for the patient’s medical complaint.

descriptive disease prediction: In this book, a method to predict disease by reviewing the medical records of a large number of persons over a long period of time and identifying those factors either singly or in combination predispose a person to a particular disease. No determination is made as to whether these factors could be used as risk factors for the disease or not. Descriptive disease prediction could be done through a computer program doing pattern matching or using a data warehouse to do on-line analytic processing (OLAP). See “disease prediction”, “on-line analytic processing” and “descriptive epidemiology”.

descriptive epidemiology: A branch of epidemiology identifying patterns or trends in diseases and injuries.

desktop computer: A microcomputer using the traditional full-size case, monitor and keyboard that are designed to be used in a stationary “desk-centered” environment. See “portable computer”.

development system: An automated system used by the programmers, analysts and testers to develop, modify or test the system rather than one used by the organizational users of the system.

(medical) diagnosis (Dx): Identification of the cause of a patient’s illness or discomfort; identification of a specific disease or pathological process.

DSM-IV (Diagnostic and Statistical Manual of Mental Disorders): Diagnostic classification systems that allow consistent diagnoses of emotional illnesses published by the American Psychiatric Association.

diagnostic findings: The results of a diagnostic test. For clinical laboratory tests, diagnostic findings (results) are identified as “normal”, “out-of-range”, “abnormal”, “negative”, “positive”, and “panic” or “crisis”. In general, for results of diagnostic procedures outside of the clinical laboratory, results are “normal”, “abnormal”, “negative” or “positive”. Some results, such as x-rays, require interpretation by an expert to get the results and this description.

diagnostic image: A number of technologies producing images of the internal body including (1) x-rays, (2) fluoroscopy, (3) nuclear medicine, (4) angiography, (5) ultrasound (ultrasonography), (6) interventional radiology, (7) computed tomography, (8) magnetic resonance imaging (MRI) and (9) computed radiography.

diagnostic related group (DRG): A way of classifying patients for government reimbursement and sometimes to establish an initial care plan. Classification is based upon the following: primary and secondary diagnoses, primary and secondary procedures, and length of stay.

diagnostic tests: Clinical laboratory tests and other diagnostic procedures.

dialog box: A window that a GUI program displays to prompt a reply from a user. The dialogue box could consist of multiple controls, which may include list boxes, input fields, buttons, check boxes, radio buttons, etc. See “modal dialog box” and “modeless dialog box”.

differential diagnosis: Identification of a disease by comparison of the symptoms of two or more similar diseases.

DICOM (Digital Imaging and Communications in Medicine): A standard that has been developed by ACR/NEMA to meet the needs of manufacturers and users of medical imaging equipment for interconnection of devices on standard networks. The current version is DICOM-3.

digital: Information represented as discrete numeric values, such as 0 or 1, as opposed to analog. See “analog”.

digital signature: Cryptographic data that undeniably identifies a message with its sender.

dimmed: A menu option that a user can see but not choose. Dimmed items are usually shown in gray letters instead of black.

direct cause disease prediction: In this book, a theoretical approach to disease prediction where the total of a person’s genetics and significant environmental factors are recorded enabling prediction of future diseases based upon analytic epidemiology studies. See “disease prediction” and “analytic epidemiology”.

directory: A listing of all the file names and subdirectories that are available on a computer system or on computers in a network.

discharge: Termination of a period of inpatient hospitalization through the formal release of the inpatient by the hospital; to release from care at a medical care facility by a physician or other medical care worker, such as from the hospital or emergency department.

discharge planning: Set of decisions and activities involved in providing continuity and coordination of care once the patient is discharged from a healthcare facility.

discrete event simulation: The modeling of a system (e.g., a work flow) as it evolves over time by a representation in which the state variables change instantaneously at separate points in time. These points in time are the ones at which an “event” occurs. The time between events is modeled statistically and the expected total time of the running of the system (the execution of a work flow) can be determined by running the model, randomly selecting time values within constraints, over and over again.

disease: A pathological condition of the body that presents a group of clinical signs, symptoms and laboratory findings peculiar to it.

disease management: Identifying populations (patients) with particular acute and chronic diseases, such as diabetes, cancer, coronary artery disease or asthma, and introducing interventions throughout the life cycle of the disease that will both improve the quality of life and lower the costs associated with the disease process.

disease prediction: In this book, any approach to predicting that a patient will get a disease, or to predicting when a patient will get a disease, when a disease will worsen, or when a treatment decision for a disease will need to be made, most often expressed in terms of the probability of that event happening compared to the probability of that event happening for the general population or for an applicable population group. This book identifies these forms of disease prediction: analytic disease prediction, direct cause disease prediction, descriptive disease prediction, and disease progression analysis.

disease progression analysis: In this book, determining the probable progression of a disease or progression to developing a disease for a particular patient by measuring a medical value or state for that patient over time that is predictive of the disease and comparing this progression of values or states with other patients who have developed the disease. Measurements could be recorded on a trend document. See “disease prediction” and “trend document”.

disk: The most common high volume auxiliary storage medium for a computer system. Usually refers to a magnetic disk, but also refers to an optical disk.

disk mirroring: A method of fault tolerance for information stored on disks that involves writing the same information on two different disks with two different controllers. If one drive is lost or unavailable, the other is still available.

distributed database: A database that is stored at multiple locations within a network either by partitioning the data or replicating the database.

distributed facility group: In this book, the set of medical facilities of a healthcare organization handled by a particular computer system that is part of the automated patient medical record system, where the automated patient medical record system consists of a number of distributed computer systems, each in a different geographic location.

distributed systems: Implementation of a single application system on multiple computer systems at different locations with the systems usually connected by a network.

docking station: An addition to a portable computer, such as a pen computer, to add capabilities such as an AC power supply, full size monitor, CD-ROM drive, sound card, hard drive, a recharging unit, etc., to make the computer act more like a desk-top computer when it is being used in a designated fixed location.

document: Written, and sometimes pictorial, form of communication that permanently records information relevant to the health care of a patient.

document type definition (DTD): A DTD defines the elements, attributes, entities and rules for creating one or more documents in a markup language (SGML, HTML, or XML).

documentation: Manuals, online help, README files and other instructions that come with a software package.

document list: A list of documents in a medical record for an identified patient.

documentation management system: A system that supports enterprise-wide on-line documentation on an Intranet. A documentation management system enables enterprise wide creation, controlled access, review and update, routing and management of documents.

domain: The set of values allowed for a data element in a given column or for the set of data elements in a group of columns of a relational database.

domain name: An addressing construct on the Internet network used for identifying and locating computers on the Internet (e.g., “www.whitehouse.gov”), which can be translated by a name server into a numeric IP address. Domain names must be registered through an agency associated with the National Science Foundation (NSF).

dosage: The determination and regulation of the size, frequency, and number of doses of medication or radiation for a patient.

dose: A quantity to be administered at one time, such as a specified amount of medication (e.g., 5 g. for 5 grams).

download: Transferring data or software from a central location to a remote location (e.g., your server or workstation) via a communications link.

drag: The action of using a mouse or other pointing device to select and move an object on the screen.

drag and drop: The action of using a mouse or other pointing device to select and move an object, placing it somewhere else on the screen.

drill down: For tree structured connected document such as hypertext, to go from a higher level down document to a lower level one by selection at the higher level.

drive: Any device that reads and writes information, such as a hard drive, floppy drive, CD-ROM drive, or tape drive.

drug allergy: Hypersensitivity to a pharmacological agent, with reactions that could range from those that are very mild (e.g., a rash) to those that very severe.

drug compendium: A listing of drugs and information about them used by healthcare practitioners who prescribe them. It is used to validate drug orders. It includes both HMO formulary and non-formulary drugs, enables clinical checking (drug interaction checking) and enables drug costing.

Drug Enforcement Administration (DEA): U.S. Government agency that is part of the U.S. Department of Justice that enforces drug laws and regulations including regulations concerning the legal manufacture and distribution of controlled substances. See “DEA license”.

drug formulary: In this book, a listing of all the drugs an HMO recommends, the most effective and least cost ones. Some managed care organizations charge more for non-formulary drugs, whereas in some managed care organizations non-formulary drugs are not covered at all.

drug interaction: Interactions of a drug with other drugs, with foods, with laboratory tests, or other interactions.

drug jumping: Going from physician to physician and/or facility to facility to get a prescribed medication, especially a narcotic or other controlled substance, and especially for a patient who is addicted to that drug.

DTD (Document Type Definition): See “XML DTD”.

durable medical equipment (DME): Equipment leased or sold to patients for use in their homes (e.g., wheelchairs, walkers, canes).

durable medical equipment (DME) formulary: A database that lists and describes all durable medical equipment (DME) offered to patients within a healthcare organization. See “durable medical equipment”.

durable power of attorney for healthcare: See “healthcare proxy”.

DxPlain:   An experimental system of clinical decision support provided by time shared telephone links, which was developed at Harvard University Massachusetts General Hospital in the late 1960s.

EBCDIC: Extended binary-coded decimal interchange code: A character-coding scheme found mostly in large-scale IBM computers.

E code: An injury code, sometimes used for an injury registry, with the injury registry being a database for recording injuries from which epidemiological studies can be done.

EDIFACT: EDI for Administration, Commerce, and Transportation (EDIFACT). An international UN-sponsored EDI standard primarily used in Europe and Asia. An alignment is envisioned between ANSI ASC X12N and EDIFACT EDI standards in the future to create a single EDI standard. The standard is used for the electronic interchange of structured data related to trade in goods and services.

effective: Producing the intended result.

efficacy: The ability to produce the desired effect.

efficient: Serving as an immediate agent in the production of an event.

elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent.

electrocardiography (ECG or EKG):  ECG is the graphic tracing of the variations in electrical potential of the heart.

electroencephalography (EEG) :  A graphic tracing of the variations in electrical potential of the brain.

electronic clipboard: A clipboard and a radio controlled pen. A writing tablet is put on the clipboard and any writing on the paper is also recorded through the clipboard. The commercial version of this is the CrossPad made by the Cross Pen Company.

electronic commerce (E-commerce): The paperless exchange of business information using Electronic Data Interchange (EDI), electronic mail, electronic bulletin boards, electronic funds transfer and other similar technologies. Also known as ANSI ASC X12N standards in the U.S.

Electronic Data Interchange (EDI): The computer to computer exchange of business data in a standardized format between Trading Partners.

electronic health record (EHR): Another term for the automated patient medical record. Health care record stored in electronic format.

electronic medical record (EMR): Another term for the automated patient medical record. Health care record stored in electronic format.

electronic signature: A code or symbol that is the electronic equivalent of a written signature can legally substitute for the written signature.

elective admission: An admission to the hospital that could be medically delayed without endangering the patient, such as for an elective surgery.

eligibility/coverage: Refers to the period of time a healthcare organization subscriber or dependent is entitled to benefits.

e-mail (electronic mail): The use of a computer network by individual users to send, store, and receive messages or documents to and from other individuals.

emergency: The sudden onset of a condition or an accidental injury requiring immediate medical or surgical care. See “prudent layperson standard”.

emergency department (ED): A hospital area staffed and equipped for the reception and treatment of persons requiring immediate medical care.

encapsulation: Hiding data and methods within the object class from outside programmers.

encounter: A face to face interaction between a patient and a healthcare provider. In some cases this may also include an interaction via a phone call or television if this takes the place of the face to face interaction. Encounters could include all of the following: an inpatient stay, outpatient visit, emergency department visit, advice nurse call, a phone call between a patient and a physician, a home health visit, a skilled nursing facility (SNF) visit.

encounter status: An event that may logically precede, occur during or be a result of an encounter or potential encounter, or a result of a situation causing the encounter not to occur. For example, encounter statuses for an outpatient visit could be patient wait-listed, appointed, appointment canceled, appointment no show, patient registered, in the examination room, visit completed, diagnoses and procedures identified.

encounter synopsis: A summary of a patient encounter.

encryption: The transformation of confidential plain text into a cipher text in order to protect it from being read by a third party.

endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease. This is opposed to “epidemic” and “sporadic”.

end-stage renal disease (ESRD): A disease of the kidneys that ends up requiring either dialysis or renal replacement.

enterprise management system: A package of software systems that together manage a distributed computer network, composed of possibly disparate computers, as if the distributed network was a mainframe system.

enterprise scheduling system: A multi-dimensional healthcare organization scheduling system that schedules patients with caregivers and resources (e.g., patients with caregivers, patients and caregivers with rooms--such as operating rooms, patients and caregivers with classes, patients and caregivers with equipment) and provides information for charging for associated services, for automatic ordering of associated supplies, and for recording caregiver time for the caregiver payroll system.

entity: Something about which information is stored. An entity might be a tangible item, such as a patient, physician or room. An entity can also be intangible, such as an agent.

entity-relationship (ER) diagrams: A database analysis diagram that documents business entities about which database information will be stored that shows the relationships that exist between the entities.

entrance “by exception” : See charting by exception.

epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. This is opposed to “endemic” and “sporadic”.

epidemiology: Study of the occurrence, distribution, and causes of disease and the application of this study to the control of health problems.

episode: One or more healthcare services received by an individual during a period of relatively continuous care by healthcare practitioners in relation to a particular clinical problem or situation.

episodic: Care handled by a single outpatient encounter, possibly including calling back the patient. Also see “acute care”.

error: In this book, in the context of a project, an inconsistency between how a project agreement, a workflow or an automated system is implemented and how it is documented—the error may either be an error in the implementation or in the documentation. See “change”.

error of commission: Mistake resulting from overdiagnosis or diagnosing a nonexistent health problem.

error of omission: Mistake resulting from failure of the caregiver to diagnose a health problem or disease.

essential business practice: Some aspect of the current environment and systems that must be preserved in a changed environment because it is essential for the proper functioning of the organization.

Ethernet: A local area network architecture (also known as the IEEE 803.2 standard) developed by the Xerox, Digital and Intel that operates at 10 Mbps and uses the CSMA/CD protocol for media access control. Ethernet is being extended to 100 Mbps. Also, gigabit Ethernets are being considered.

etiology: A study of the causes of disease. Also see “analytic epidemiology”.