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A Guide to Healthcare Buzzwords and What They Mean: Part One (A through L)

Welcome to our guide to Healthcare Buzzwords!

Understanding Healthcare Jargon

ACO

An acronym for “Accountable Care Organization”, an ACO is a model of healthcare delivery in which a group of healthcare providers agree to accept payment for their services based on the aggregated health outcomes of the patients they see, as opposed to the total number of services performed. ACOs reward providers in a “fee for health” model, as opposed to a traditional “fee for service” model. Although the term ACO can apply to a variety of types of organizations, regulations for establishing ACOs to participate in the Medicare Shared Savings Program specifically were included in the Patient Protection and Affordable Care Act of 2010.

Big Data

“Big Data” is a blanket term used to describe the tremendous amount of raw data that we create as part of our everyday lives. As we become more proficient in capturing, storing, and analyzing these massive data sets – and the increasingly complex tools needed to do so – there is tremendous hope in the ability for industries to glean insights from the mountain of data they already have. Healthcare, with the tremendous amount of data that is already collected and stored in the form of medical records, is considered one of the areas with the most to gain from advances in “Big Data” tools.

CCHIT

An acronym for “Certification Commission for Healthcare Information Technology”, CCHIT is one organization authorized by the Office of the National Coordinator of the Department of Health and Human Services to certify Electronic Health Record products for quality, security and interoperability. This certification is necessary for providers to receive “stimulus” funds from Medicare or Medicaid as reimbursement for achieving “Meaningful Use” of the EHR. Other organizations providing certifications include Drummond Group, ICSA Laboratories, Inc. and InfoGuard Laboratories, Inc.

Cloud vs. Closet

The “Cloud” versus the “Closet” is a way of defining the two most common ways of managing and sharing software products in a medical practice. The “Closet” is the traditional model where a server is installed, often into an extra closet where the phone system is also kept that runs the Practice Management and/or Electronic Medical Record software on the desktops in the practice. Generally, the practice owns their own software and hardware, and pays for it upfront as a capital expense. In the “Cloud” model, which is rapidly gaining favor, a constant Internet connection allows the server hardware to be kept offsite in the vendor’s data center. The software is paid for on a monthly, operational expense basis, and security, upgrades and maintenance are all outsourced to the vendor.

EMR/EHR

Acronyms for “Electronic Medical Record” and “Electronic Health Record.” The two terms are generally used interchangeably to describe any software that that documents medical services delivered between providers and patients. There is however a general distinction between the two, highlighted in this blog post from the ONC. An Electronic Medical Record generally refers to the digitized version of a paper record that is kept in an office as a record of the patient’s services from that provider. In other words, only the patient’s interactions with the providers of that office. An Electronic Health Record on the other hand generally refers to the complete history of a patient’s life and conditions as they visit different providers in different health settings. With the EHR’s focus on health as opposed to medicine, and portability with the patient as opposed to static and office-based, EHR tends to be the “official” term used by the ONC.

eRx

“eRx” is an abbreviation for “e-prescribe”, or the ability to transmit  information from a provider to a pharmacy and back to facilitate filling prescriptions with a completely electronic process. By eliminating the paper scripts and the patients having to take them to their pharmacy, eRx facilitates more accurate, timely information between prescriber and pharmacy, and ensures that the information is accurately logged into the patient’s EHR. The ability to e-prescribe is a component of achieving Meaningful Use for providers to receive stimulus funds.

HDHP

An acronym for “High Deductible Health Plan”, an HDHP is a type of insurance coverage where more of the initial cost of care is shifted to the responsibility of the patient. Using higher deductibles, as well as co-pays or co-insurance, high-deductible health plans are often combined with Health Savings Accounts to provide heath coverage at lower premiums for patients and/or employers. As health insurance costs continue to rise, HDHPs are becoming more popular as a coverage model.

HIE #1 (Health Information Exchange)

A Health Information Exchange is a central hub where different health providers and locations can “exchange” electronic medical information so that a patient’s medical history is available to any provider or care setting in which the patient receives treatment. The exchange allows for the health data to be shared across different types of software in different places, so access to the exchange insures access to the most accurate patient data available. Health Information Exchanges are being set up in regional, state and national settings, and were a key part of Patient Protection and Affordable Care Act (PPACA or ACA) of 2010.

HIE #2 (Health Insurance Exchange)

A Health Insurance Exchange is a controlled marketplace where consumers can compare and purchase health insurance, as well as find out about any subsidies or tax benefits they can take advantage of  to offset the cost of coverage. Each state has the option of setting up their own state-level exchange, or participating in the federally-run exchange. The exchange also sets minimum coverage levels for each state, and mandates that insurance companies disclose actuarial percentages and coverage levels of similar plans so that consumers can make informed decisions about coverage.

HIM

Health Information Management is the field of study that deals with overseeing and maintaining health care information for a patient population. Although HIM refers to the management of both paper-based and electronic health records, the field increasingly focuses on the storing, securing, and disclosing of electronic data. Issues like ethics, health informatics, and health information policy are changing the way Health Information Management is viewed in the larger context of the healthcare system.

HIPAA

An acronym for the “Health Insurance Portability and Accountability Act of 1996”, HIPAA is a federal statute that was designed to regulate health insurance to make it easier to “carry” coverage with you after leaving a job, as well as to set standards for the protection and transmission of protected health information. HIPAA was appended by the HITECH Act of 2009 to set disclosure reporting requirements in the case of a breach as well as define business associates as entities covered under HIPAA. Generally, when people refer to “HIPAA Requirements” they are talking about the privacy restrictions of the two bills.

HSA

An acronym for “Health Savings Account”, an HSA is a specialized bank account that allows its holder to defer federal tax liability in order to save for future medical expenses. Money deposited in an HSA is not subject to Federal Income Tax. HSAs, like a flexible spending account, or a health reimbursement account are combined with a high deductible health plan to replace traditional health insurance with money from the HSA covering short term costs and helping with patient responsibilities while the HDHP covers catastrophic injuries or illness.

ICD-10

ICD-10 is an abbreviation for “International Statistical Classification of Diseases and Health Related Problems, 10th revision”. The ICD system is the set of alphanumeric codes that are used to classify diseases and bill medical payers for services. The United States currently uses the ICD-9 system, but is set to switch to the new standard on October 14, 2014. ICD-10 is much more complex than ICD-9, with almost five times as many available codes, and a much more specific hierarchy. ICD-10 is also referred to as “I-10.”

Interoperability

Interoperability is the concept that information stored in EHR software should be usable by any other software package. Interoperability is key to coordinating and improving care, because the health information is worthless without the software compatibility to share it between providers. This “breaking down of barriers” between different EHR software packages is crucial not only to sharing health information, but to creating a thriving and innovative healthcare information technology marketplace. Examples are a hospital system EMR’s interoperability with a private practice EMR, and both system’s EMR interoperability with a reference laboratory’s Information System.

IPA

An acronym for “Independent Practice Association”, an IPA is a group of independent physicians, or groups representing independent physicians to contract their services to managed care organizations and payers. IPAs can be formed to collaborate on care in a region, promote the political effectiveness of the independent physician, as well as to negotiate professional fees for their members, although it is important to note that the IPA does not negotiate on behalf of its members for services delivered outside managed care agreements because of federal trade laws.

What are some of the buzzwords you are hearing, wondering about, and maybe even growing tired of? Let us know in the comments!




Public-Private Partnership on Preventing Health Care Fraud Intends to “Take Away the Crooks’ Head Start”

Secretary Sebelius and Attorney General Holder from an earlier conference in 2010

(August 25, 2010 – Source: Kevork Djansezian/Getty Images North America)

At a press conference last Thursday, Secretary of Health and Human Services Kathleen Sebelius and Attorney General Eric Holder announced the creation of a “Public-Private Partnership” to prevent healthcare fraud. The voluntary partnership between federal and state agencies, private healthcare insurers and fraud prevention groups is designed to share information among all groups proactively to go after common healthcare fraud schemes. Sharing information like best practices, front line observations on emerging threats as well as “scrubbed” patient population data will allow coordinated efforts between payers and law enforcement to stop fraud before it happens.

“Previously, neither the government nor insurers chased the money until it was ‘out the door’ in what has been called a pay-and-chase model.  Now, we’re taking away crooks’ head start” – Secretary of Health and Human Services Kathleen Sebelius

Building on new legislative tools passed as part of the Affordable Care Act, as well as initiatives like the Healthcare Fraud Prevention and Enforcement Action Team (or HEAT for short), the new public-private partnership is designed to share intelligence with all stakeholders in fraud prevention so more fraud can be prevented as opposed to prosecuted.

For fraudulent providers and billers, the effects of the new partnership should be pretty obvious – more and better ways for you to get caught. But for the the compliant majority, data sharing partnerships like this one provide insight into how payers law enforcement will be working together in the future. As more health data is standardized, easily blinded and shareable, information partnerships between all parts of the healthcare ecosystem will become more common, and software vendors will find more ways to slice and dice the “big data” to detect fraudulent billing.




2.0 Tuesday: HealthCamp RDU Approaches, Cloud Updates in Healthcare, A New King of the Web Browsers

visualizing large amounts of binary data

As managers, providers and employees, we always have to be looking ahead at how the technology on our horizon will affect how our organizations administer health care. In the spirit of looking forward to the future, we present “2.0 Tuesday”, a feature on Manage My Practice about how technology is impacting our practices, and our patient and population outcomes.

We hope you enjoy looking ahead with us, and share your ideas, reactions and comments below!

HealthCamp RDU and Health Innovation Week DC Bring Stakeholders Together for Conversations on the Future of Healthcare

Over the next two weeks two separate events will give stakeholders from all ends of the healthcare spectrum a chance to be a part of an open-ended conversation about the future of care. HealthCamp RDU on Wednesday May 23rd in Raleigh, North Carolina, and Health Innovation Week, beginning June 2nd in Washington D.C. will be fantastic gatherings for providers, patients, advocates, managers, and vendors to come together, engage in conversation, and share their own experiences and visions for the future. With the large-scale changes taking place in healthcare today, more than ever it is critical to share your point of view, and events that bring together such a wide range of attendees offer fantastic opportunities to do just that. Check out their sites for more information on these great events!

(via The Health Care Blog , Triangle Business Journal)

Overheard in the Healthcare Cloud

  • “So it’s not just about taking cloud computing and automating the healthcare system we have today, it literally means innovating and reinventing the health care system to make it it much more patient-centric” – Former Apple CEO John Sculley, on why he thinks Healthcare is one of the applications of “the cloud” with the highest potential
    (via The Guardian)
  • One of the biggest drivers of value in the cloud for healthcare is the collection, analysis, and application of “Big Data”. The term “Big Data” means the access to, and more importantly, analysis of huge sets of data created by medical providers and devices while treating patients. The end goal is to use the huge sets of data to gain insights into patient care and the human body with statistical analysis. Companies like SAS, Oracle, Microsoft, IBM and Dell all make technologies that allow massive sets of data to be managed and analyzed for insights to improve health. For example: “The use of data-mining technology has already led to some measurable improvements in patient care. New York-Presbyterian, which started using Microsoft technology to scan patient records in 2010, has reduced the rate of potentially fatal blood clots by about a third.
    (via Bloomberg Businessweek)
  • Another big driver of value in the cloud: Mobility. With improved network access, and a continually improving global networked infrastructure, knowledge workers can now share expertise on a global scale relatively easily. Like how IBM SmartCloud technology is helping groups such as Colleagues in Care Global Health Network bring care to underserved areas. “The organization is using IBM cloud-based social analytics and collaboration services to provide the global network of health-care volunteers with immediate access to critical data and information for the current health-care needs of the Haitian citizens. The network consists of about 200 doctors, nurses and business professionals coming together virtually from all around the globe including Canada, China, Haiti, France, Ireland, Italy, the United Kingdom, and the United States.
    (via eWeek)

Google Chrome Overtakes Microsoft Internet Explorer as The Word’s #1 Web Browser

At least by one measure and by one website’s count, Google’s Chrome Web Browser is now the most used Web Browser in the world. Internet statistics site StatCounter, which analyzes the traffic of about 3 million sites worldwide, is reporting that in the past few weeks, for the first time, users of Chrome outnumbered users of Microsoft’s Internet Explorer Worldwide. In some individual regions (North America, for example) Internet Explorer is still number 1, and StatCounter may not have a representative sample of the world’s sites being monitored, but it is another example of how quickly and how broad Google’s influence has become.

What’s your favorite browser? Tell us in the comments below!

(via Lifehacker)

Be sure to check back soon for another 2.0 Tuesday!