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  • Policies +


    LaHIE Brochure
    Louisiana Health Care Quality Forum

    LaHIE Policy and Procedures
    Louisiana Health Care Quality Forum

  • Glossary +


    The ability to obtain needed medical care; often affected by the availability of insurance, cost and/or geographic location

    An obligation or willingness to accept responsibility for performance

    Accountable Care Organization (ACO)
    A group of health care providers who provide coordinated care and chronic disease management to improve quality of care

    Acute Care Hospital (ACH)
    A hospital that provides inpatient medical care and other related services for surgery, acute medical conditions or injuries

    Aggregate Data
    Data extracted from individual health records and combined to form de-identified information about groups of patients which can be compared and analyzed

    Install or begin using certified electronic health record technology capable of meeting meaningful use requirements

    Adverse Drug Reaction
    An undesirable response associated with use of a drug that compromises therapeutic efficacy, enhances toxicity or both

    Agency for Healthcare Research and Quality (AHRQ)
    ederal agency within HHS focused on improving health care quality, safety, efficiency and effectiveness; supports research and technology assessment, including health IT implementation

    Ambulatory Care
    All health services provided on an out-patient basis and do not require overnight care

    The discovery and communication of meaningful patterns in data; refers to the use of specific data to develop in-depth understandings of the workings of the health system

    American Recovery and Reinvestment Act (ARRA) of 2009
    Included an investment of $59 billion in health care initiatives, including $19 billion in health information technology (IT). The health IT provisions of ARRA are found primarily in Title XIII, Division A, Health Information Technology and in Title IV of Division B, Medicare and Medicaid Health Information Technology, which are known as the HITECH Act

    Confirmation by a provider that the meaningful use standards have been met



    Bayou Health
    Refers to a group of health plans in which Louisiana’s Medicaid/LaCHIP patients can enroll; each health plan is accountable to DHH and the state

    Behavioral Health
    An umbrella term that includes mental health and substance abuse

    A level of care set as a goal to be attained by a health care provider or organization

    Best Practices
    The best clinical or administrative practice or approach at the moment, given the situation, the consumer or community needs and desires; the evidence about what works for a particular situation and the resources available



    Care Coordination

    Refers to information-sharing across providers, patients, types and levels of service, sites and time frames to ensure that patients’ needs and preferences are met and that care is efficient and of high quality


    Care Coordination Tools

    Tools that transmit health information, improve clinical practice and enhance patient-provider relationships


    Care Setting

    Any facility or office in which an individual receives health care


    Case Management

    The monitoring and coordination of treatment rendered to patients with specific diagnosis or requiring high-cost or extensive services


    Case Manager

    The health care professional who coordinates the services necessary to carry out a case management plan


    Certified Electronic Health Record Technology (CERHT)

    EHR technology certified under the ONC Health IT Certification Program to ensure the technology meets the adopted standards, criteria and other technical requirements to achieve meaningful use


    Centers for Medicare and Medicaid Services (CMS)

    The federal agency that manages the Medicare, Medicaid and CHIP programs


    Chartered Value Exchange (CVE)

    Multi-stakeholder collaborative supported by AHRQ to convene providers, payers, patients and purchasers at the local level to improve health care


    Children’s Health Insurance Program (CHIP)

    Federal-state program that provides health care coverage for uninsured, low-income children who are not eligible for Medicaid


    Chronic Disease Management

    An integrated care approach to managing illness through screenings, check-ups, monitoring and coordinating treatment and patient education



    An itemized statement of health care services and their costs provided by the hospital, physician office or other health care provider and submitted for reimbursement to the health care insurance plan by either the insured party or the provider


    Clinical Data

    Data captured during the process of diagnosis and treatment


    Clinical Data Repository

    A central database that focuses on clinical information


    Clinical Decision Support

    Interactive computer programs or systems that help clinicians perform complex tasks associated with the care management process


    Clinical Quality Improvement

    An interdisciplinary process designed to raise the standards of the delivery of preventive, diagnostic, therapeutic and rehabilitative measures to maintain, restore or improve health outcomes of individuals and populations


    Clinical Quality Measure

    A mechanism used for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in an optimal time frame



    Various types of health care providers; may include, but not limited to, physicians, nurses and allied health professionals



    A recognized relationship among different sectors or groups which have been formed to take action on an issue in a way that is more effective and sustainable


    Computerized Provider Order Entry (CPOE)

    Refers to EHRs as part of larger health IT system to assist with clinical decision support



    Individuals who have advanced skill sets in a specific content area and provide expert advice, training and support to health care providers and their office staff


    Continuity of Care

    Process by which the patient and the physician are cooperatively involved in ongoing health care management toward the goal of high quality, cost-effective medical care


    Continuity of Care Document (CCD)

    An XML-based markup standard intended to specify the encoding, structure and semantics of a patient summary clinical document for exchange; provides a means for a provider, system or setting to aggregate patient data and forward it to another provider, system or setting to support the continuity of care


    Continuum of Care

    Refers to an integrated system of care that guides and tracks patients over time through a comprehensive array of health services spanning all levels of intensity of care


    Core Measures

    Specific clinical measures that, when viewed together, permit a robust assessment of the quality of care provided in a given focus area


    Cost of Care

    Measure of the total health care spending, including total resource use and price, by payer or consumer, for a health care service or group of health care services associated with a specified patient population, time period and units of clinical accountability


    Critical Access Hospital (CAH)

    A hospital certified under a set of Medicare Conditions of Participation (CoP) which are structured differently than the acute care hospital CoP






    Information processed by a computer



    An electronic list of information that can be sorted and/or searched


    Data Capture

    Refers to entering a specific data element into the specified health IT application versus the paper chart


    Data Integrity

    The extent to which health care data are complete, accurate, consistent and timely


    Data Mining

    The process of extracting information from a database and then quantifying and filtering discrete, structured data


    Data Source

    Source from which data is obtained for measurement


    Data Warehouse

    A database that makes it possible to access information from multiple databases and combine the results into a single query and reporting interface (see also Clinical Data Repository)



    The number below the line in a fraction. Denotes how many parts make up the whole


    Direct Exchange

    Electronic transmission of health information through a direct connection between the EHR systems of health care providers without the use of a health data intermediary


    Direct Messaging

    Similar to secure web email but designed specifically for the secure exchange of patient health information by authorized health care providers or organizations through an HIE; a requirement for Stage 2 Meaningful Use


    Direct Patient Care

    Any activities by a health care professional involving direct interaction, treatment, administration of medications or other therapy or involvement with a patient



    Effectiveness of Care

    Refers to health care services that are of proven value and have no significant tradeoffs; health care services are supported by evidence of efficacy


    Efficiency of Care

    Measure of the relationship of the cost of care associated with a specific level of performance measured with respect to quality


    eHealth Exchange

    (formerly the Nationwide Health Information Network, or NHIN)

    A growing community of exchange partners who share information under a common trust framework and a common set of rules; designed to help improve the health and welfare of Americans through health information exchange that is trusted, scalable and enhances the quality of care and health outcomes by supporting comprehensive longitudinal health records



    A contact between and individual and the health care system for a health care service or set of services related to one or more medical conditions


    End of Life Care

    Care that helps those with advanced, progressive, incurable illness to live as well as possible until death



    ED Utilization

    Refers to the use of a hospital’s emergency department (ED) or emergency room (ER)



    The secure use of electronic information and communications technologies in support of health care delivery, such as electronic health records, electronic prescribing, health information exchange and telemedicine


    Electronic Health Record (EHR)

    Digital record of health-related information for an individual – also known as an electronic medical record (EMR)


    Electronic Prescribing (e-Prescribe)

    The electronic transmission, not including fax, of prescriptions to and from pharmacies and point of care



    EHR Reporting Period

    The period in which an Eligible Professional or Eligible Hospital demonstrates meaningful use


    Eligible Hospitals (EHs)

    Hospitals that are eligible to receive Medicaid and/or Medicare EHR incentive payments from CMS


    Eligible Professionals (EPs)

    Health care professionals who are eligible to receive Medicaid and/or Medicare EHR incentive payments


    Emergency Medical Condition

    An illness, injury, symptom or condition requiring immediate medical attention/treatment to avoid severe harm


    Equity in Health

    Refers to fairness in health care delivery, meaning peoples’ needs guide the distribution of opportunities for well-being


    Evidence-Based Practice

    Applying the best available research, or evidence, when making decisions about health care; a method of improving and evaluating patient care



    Refers to a CMS provision that allows providers to report that specific meaningful use measures do not apply to them because have no patients, or no or insufficient number of actions that would allow calculation of the meaningful use measure




    A traditional method of paying for medical services under which doctors and hospitals are paid for each service they provide


    Federally Qualified Health Centers (FQHCs)

    Safety net providers such as community health clinics and public housing centers that provide health services regardless of the ability to pay and are funded by the government






    Health Care Consumer

    Refers to anyone who uses, has used or may use any health or health-related service


    Health Disparities

    Differences between groups of people that may affect how frequently a disease affects a group, how many people get sick, or how often the disease causes death


    Health Information

    Information regarding medical, clinical or health-related subjects that individuals may use to make appropriate health decisions


    Health Information Exchange (HIE)

    The electronic sharing of health-related information among organizations via a secure network


    Health Insurance Portability & Accountability Act (HIPAA) of 1996

    Sets standards and rules to ensure the security and privacy of personal health information


    Health Information Technology for Economic and Clinical Health (HITECH) Act

    Provides HHS with authority to establish programs to improve health care quality, safety and efficiency through health IT measures such as EHRs and HIEs


    Health IT

    Health information technology - the use of computer hardware and software to privately and securely store, retrieve, and share patient health and medical information


    Health Level 7 (HL7)

    A standards-developing organization that provides standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services


    Health Outcome

    Refers to the result of the health care a person receives


    Healthcare Effectiveness Data and Information Set (HEDIS)

    A set of measures used by many U.S. health plans to evaluate performance on important dimensions of care and service




    Home Health Care

    Health care services a person receives at home



    Services to provide comfort and support for persons in the last stages of a terminal illness




    A quantitative or statistical measure or gauge for monitoring clinical care


    Informed Decision-Making

    Process designed to help patients understand the nature of the disease or condition being addressed, the clinical service being provided and the impact of their own care preferences to enable them to actively participate in decision-making



    The ability of two or more systems to communicate, or exchange, useable information; does not mean the same thing as health information exchange


    Incentive Payments

    A program established in ARRA to pay incentives to certain classes of eligible Medicare and Medicaid professionals who adopt and become meaningful users of EHRs



    Joint Commission

    An independent, not-for-profit organization that provides health care accreditation and related services to support performance improvement within health care organizations






    Louisiana Children’s Health Insurance Program (LaCHIP)

    Provides health coverage to uninsured children up to age 19; a no-cost health program that pays for hospital care, doctor visits, prescription drugs and more (See also Children’s Health Insurance Program)


    Louisiana Department of Health and Hospitals (DHH)

    State agency focused on protecting and promoting health and ensuring access to medical, preventive and rehabilitative services for Louisiana residents



    Louisiana Immunization Network for Kids Statewide (LINKS)

    Web application that allows users to conveniently search for patients in its central registry and view the patient’s vaccination record; also allows authorized users to add and edit patient records and vaccination records as well as maintain facility, physician and lot number data


    Louisiana Physician Orders for Scope of Treatment (LaPOST)

    A document by which a person with a serious, advanced illness may communicate his/her wishes concerning medical treatment and end-of-life care with a physicians order; approved by Louisiana Legislature in 2010 as Act 954


    Long-Term Care

    Services provided in institutional settings such as nursing homes




    Managed Care

    A health care delivery system designed to control access to and use of health care services to limit costs and to improve quality


    Mandatory Reporting

    A system under which physicians or other health care professionals are required by law to inform health authorities when a specified event occurs


    Master Patient Index (MPI)

    An electronic medical database that holds information on every patient registered at a health care organization; stores information such as name, date of birth, gender, race, social security number, address and medical history to provide a clear and complete view of an individual patients and a large-scale view of the organization’s demographics


    Meaningful Use (MU)

    Sets specific objectives that Eligible Professionals and Eligible Hospitals must achieve to qualify for the CMS EHR Incentive Programs; means providers must show they are using certified EHR technology in ways that can be measured significantly in quality and quantity



    Tools that show whether the standards for prevention, screening and management of health conditions are being met


    Measure Set

    A collection of measures with a common purpose and developer


    Medication Error

    Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient or consumer


    Model of Care

    A concept that provides an outline of how to plan current and future facility and clinical service; used to help guide and direct a patient’s experience within a health care system



    National Committee for Quality Assurance (NCQA)

    An accrediting body for PCMH recognition; private, not-for-profit organization dedicated to improving health care quality


    National Quality Strategy (NQS)

    A nationwide effort to provide direction for improving health and health care in the U.S.; guided by three aims focused on better care, healthy people and communities and affordable care



    The number above the line in a fraction. Denotes the number of parts out of the whole that are being counted.



    Office of the National Coordinator for Health Information Technology (ONC)

    Agency within HHS that supports the adoption of health IT and promotes nationwide health information exchange to improve health care



    Palliative Care

    Appropriate and compassionate care for patients with serious, advanced illness


    Patient-Centered Care

    Care based on a patient’s cultural traditions, personal preferences and values, family situation and lifestyle; designed to ensure that transitions between difference health care providers and care settings are coordinated and efficient


    Patient-Centered Medical Home (PCMH)

    Refers to a health care setting where patients receive comprehensive primary care services; have an ongoing relationship with a primary care provider who directs and coordinates their care; have enhanced access to non-emergent primary, secondary and tertiary care; and have access to linguistically and culturally appropriate care.


    Patient Engagement

    A connection between the patient and his/her health care provider; describes a trusted relationship in which patients and their families are empowered and active in health care decisions


    Patient Portal

    A secure online website designed to give patients 24-hour access to their personal health information from any location with an internet connection; secure username and password required for access


    Patient Privacy

    Refers to the rights of patients to determine when, how and to what extent their personal health information is shared with others


    Patient Safety

    The avoidance of injuries to patients from the care that is intended to help them


    Patient Volume

    Under the Medicaid EHR program, the minimum participation threshold where the numerator is the total number of Medicaid patients or needy individuals treated in any 90-day period in most recent calendar year preceding the reporting and the denominator is all patient encounters in the same 90-day period.



    Refers to a health care payment system in which providers receive incentives for meeting or exceeding quality benchmarks



    In health care, generally refers to entities other than the patient that finance or reimburse the cost of health services; usually refers to insurance carriers, other third-party payers or health plan sponsors such as employers or unions


    Payment Reform

    Seeks to improve current mechanisms for reimbursing providers by focusing on provider quality


    Performance Measure

    Provides an indication (e.g., rate, ratio, index, percentage) of an organization's/or provider's ability to provide care most likely to ensure a good patient outcome


    Personal Health Record (PHR)

    An electronic application through which individuals can maintain and manage their health information in a private, secure and confidential environment


    Physician Orders for Life-Sustaining Treatment (POLST)

    An approach to improving end-of-life care planning based on conversations between patients, loved ones and health care professionals designed to ensure that seriously ill or frail patients can choose the treatments they do or do not want and that their wishes are documented and honored


    Physician Quality Reporting System (PQRS)

    (formerly called the Physician Quality Reporting Initiative, or PQRI) A voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals and group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS)


    Point of Care

    Refers to the point in time at which health care products and/or services are delivered


    Population Health

    The health outcomes of a group of individuals, including the distribution of such outcomes within the group; refers to an approach to health that aims to improve the health of an entire population


    Preventive Care

    Medical care focused on prevention and early-detection of disease or illness; includes age and gender appropriate lifestyle changes, immunizations, vaccinations, physical exams, screening tests and other measures; services that help patients stay healthy


    Primary Care Provider (PCP)

    A health care provider who provides, coordinates or helps a patient access a range of health care services; usually a doctor, but may be a physician assistant, clinical nurse specialist or nurse practitioner


    Public Health

    The science dealing with the protection and improvement of community health by organized community effort



    In health care, refers to an individual or organization that buys health care services





    Quality of Care

    The degree to which delivered health services meet established professional standards and judgments of value to the patient; a measure of performance of safety, timeliness, effectiveness, efficiency, equity and patient-centeredness


    Quality Improvement

    Refers to comprehensive efforts to improve health care and the health of individuals and populations


    Quality Measurement

    The process of collecting data to assess performance conducted at a single point in time or repeated over time


    Quality Metric

    A measure that allows a user to quantify the quality of a selected aspect of care by comparing it to a criterion; used to provide a more complete overview of the health care quality status of health care providers and organizations



    The process of making a logical inquiry or request from a database




    Record Locator Service (RLS)

    Electronic index of patient identifying information that directs providers in an HIE to the location of patient health records held by providers and group purchasers


    Regional Extension Center (REC)

    Established by the HITECH Act to provide education, outreach and technical assistance to help primary care providers adopt and meaningfully use certified EHR technology



    The process by which health care providers receive payment for their services


    Rural Health Clinic (RHC)

    A federally qualified health clinic certified to receive special Medicare and Medicaid reimbursement as a strategy to increase rural Medicare and Medicaid patients’ access to primary care services





    Safety Net

    In health care, term refers to health care providers who deliver services to patients regardless of their ability to pay



    The physical, technological, and administrative safeguards used to protect individually identifiable health information


    Shared Decision-Making

    Occurs when a patient and his/her health care provider openly communicate about the options, benefits, outcomes and risks of available treatment and reach a plan based on medical evidence, the patient’s values and the doctor’s advice



    Refers to a physician who focuses on a specific area of medicine to diagnose, manage, prevent or treat certain types of symptoms or conditions



    Refers to persons or groups that have a vested interest in health care delivery, quality, safety, outcomes, improvement and costs


    Standard of Care

    The expected level and type of care provided by the average caregiver or health care provider under a certain given set of circumstances


    Standardized Measures

    Nationally-recognized criteria for evaluating the quality of health care provided to patients


    Summary of Care Record

    A record that includes, at a minimum, diagnostic test results, problem list, medication list and medication allergies; eligible hospitals should also include procedures in this record



    Systematic, ongoing collection, collation and analysis of health-related information that is communicated in a timely manner to all who need to know which health problems require action within a community


    Syndromic Surveillance

    Surveillance using health-related data that precedes diagnosis and signals a sufficient probability of a case or an outbreak to warrant a further public health response







    The use of telecommunications technologies and electronic information to support long-distance clinical health care, patient and professional education or public health and health administration


    Third-Party Reporting

    For the EHR Incentive Programs, CMS implemented functionality that allows Eligible Providers to designate a third party to register and attest on his/her behalf


    Transition of Care

    A transfer of a patient from one clinical or care setting to another




    People who have health insurance but who face out-of-pocket health care costs or limits on benefits that may affect their ability to pay for services or access health care services



    People who lack public or private health insurance


    Unique Patient

    Refers to a Medicare or Medicaid patient seen during the EHR reporting period



    Expand the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training


    U.S. Department of Health and Human Services (HHS)

    Federal agency that oversees CMS




    Value-Based Health Care

    Describes a health care management strategy focused on creating high-quality and high-value care while reducing costs; designed to remove barriers and encourage patients/consumers to pursue healthy lifestyles


    Value Set

    A list of specific clinical terms and the codes that correspond with them; defines each of the clinical terms in the elements of a quality measure


    Volume-Based Health Care

    Describes a health care system based on fee-for-service reimbursement



    Work Flow

    A repeatable pattern of activity enabled by the organization of resources, defined roles and information into a process that can be documented and learned; work flow improvements for health care providers are designed to lessen the burden of providing health care and to lead to greater overall health care quality





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    Louisiana Health Care Quality Forum

    8550 United Plaza Blvd., Ste. 301
    Baton Rouge, Louisiana 70809
    Ph (225) 334-9299 | Fax 225-334-9847

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