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The Latest Word

January 1, 1998
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The business of healthcare has sprung a language all its own, and so has information technology. But put the two together and you’ve got what may be the most inaccessible argot of acronyms and assertions an industry has ever depended upon.

What’s the difference between EDI and EFT? Between an IPA and an HMO? Between an Experience Rating and Outcomes Measurement? For this first edition of The Latest Word, contributing writer Pamela Tabar scoured the business, healthcare and computer press for words, acronyms, and usages that are the currency of intellectual exchange in healthcare today. Nearly 30 sources were mined for the most current vocabulary contributions; more than 90 percent of the terms were verified in at least three sources. And you don’t have to be a programmer to read the definitions.

You’ll find more space devoted to hard-to-find words. Entries are cross-referenced in bold type, and acronyms/abbreviations are cross-listed with definitions following whichever form is best known. Many terms relate to the Internet and the Web, where healthcare is rapidly heading. Keep this industry glossary handy for future reference.

Send us your comments--and especially your recommendations for future editions to: Terry Monahan

AAPCC: [managed care] Adjusted Average Per Capita Cost. The amount of funding a managed care plan receives from the Health Care Financing Administration to cover costs. The formula, calculated by region, allows for 95 percent of fee-for-service rates.

ACR-NEMA: [telemedicine] American College of Radiology and the National Equipment Manufacturers Association. Together, these two groups have determined many of the standards for teleradiology, including DICOM.

ActiveX: An object-oriented programming language developed by Microsoft. Originally designed to run in Windows, ActiveX is now used in Web sites and the Internet Explorer browser. Also See Java.

Admission-discharge-transfer system (ADT): A software system healthcare facilities use to track patients from their arrival to their departure.

AI: See artificial intelligence.

Alpha site: An initial test site for a prototype system or product, usually in a controlled setting such as a laboratory. Compare beta site.

Ambulatory care: [managed care] Services for patients who do not need to stay in a healthcare facility overnight. Also called out-patient care.

American National Standards Institute (ANSI): The many committees and accreditation boards of this non-profit organization work to establish acceptance of electronic data standards. ANSI is the U.S. member of the International Standards Organization (ISO).

Analog transmission: A method of information transfer that transforms varying frequencies and volumes of sound into electric impulses. Standard telephones use this, but other communication forms are quickly gaining popularity such as cellular (radio waves), digital and satellite. Compare digital transmission.

Ancillary services: Tests, procedures, imaging and support services provided in a healthcare setting.

ANSI: See American National Standards Institute.

Applet: See Java.

Application server: Unlike a general file server, this server is loaded with sophisticated hardware geared toward performing a few specific application tasks.

Architecture: This structure term refers to a system’s form and how its pieces communicate and work together. Also see client/server and tiered architecture.

Artificial intelligence (AI): Both a system and a concept, this refers to the idea of a computer system that can think and "learn" like a human. A computer with artificial intelligence could update and increase its knowledge based on previous problems and results, making itself "smarter." Also see expert system and symbolic reasoning.

ASCII: American Standard Code for Information Interchange. This coding language translates each character into a numeric form readable by any computer. This "universal" language allows otherwise incompatible systems to exchange information.

Asynchronous transfer mode (ATM): A telecommunications method for relaying images, sound and text simultaneously at very high speeds.

Attachment: Any extra information appended to a claim or electronic message, and may include graphics as well as text. Also see MIME.

Audit trail: A software tracking system used for data security. An audit trail is attached to a file each time it is opened so an operator can trace who has accessed a file and when.

Backbone network: The electronic spine that joins multiple networks together, including the Internet, most commonly via T1 lines.

Bandwidth: A measurement describing how much information can be transmitted at once through a communications medium such as analog transmission, radio frequency or digital transmission. When the Internet experiences a "traffic jam," it’s usually caused by too many people trying to access or send data at once--more data than the bandwidth can handle.

Baseband transmission: Unmodulated signals sent on a single channel. Used mainly in local area networks, including those that use Ethernet and token ring. A baseband transmission consumes the entire channel unless a multiplexer is used.

Batch: A non-interactive, one-way transmission of data used for sending information that doesn’t need an immediate response. Batch files are often scheduled to be sent when the network or system is less busy such as after business hours. Also called batch EDI. Compare real-time EDI.

Baud rate: An older term measuring bandwidth usage, now more commonly described as bits per second.

BBS: Bulletin board service. Users dial this computer access service via modem to send and receive email, participate in newsgroups and lists or exchange files. These days, many BBSs provide access to the World Wide Web.

Beam splitter: [telemedicine] A device that divides the image beam of a clinical examining scope so the physician has the choice of looking at the image on a video monitor or directly through the scope.

Beta site: A place where a new product can be tested by people outside the research and development team under real-life conditions. Often several beta sites are used before a system is placed on the public market. Compare alpha site.

Bisynchronous communications: Data transmitted between two synchronized computers. Signals are sent between each portion of data so the sending computer knows when the receiving computer is ready for the next data stream. Compare asynchronous transfer mode.

Bit: Short for binary digit. The smallest piece of computerized information, corresponding to a circuit that is off (0) or on (1).

Bit depth: [telemedicine] A description of the number of colors or shades of gray a monitor can display or a scanner can process. The higher the bit depth, the more color hues can be supported. Also called gray scale.

Bitmapping: The process of assigning colors or depths to the pixels of a computerized image. Bitmapping is intrinsic to raster graphics and is best suited for images that require high definition and little manipulation. Compare vector graphics.

Bits per second (bps): A description of how much data can be transmitted across a carrier. A modem might transmit 33.6K bps or a T1 line may carry more than a million bps.

Block grant: [managed care] A proposed method of administering Medicaid benefits. Under a block grant system, Medicaid would not be federally controlled--instead, each state would be given a single grant, and the state would have to decide who is eligible for the benefits and how to divide the funds.

Bookmark: [WWW] This software tool can "memorize" the location of a favorite or often-used page on the World Wide Web. By using the drop-down list of saved bookmarks, a user can return to the page later without retyping its address.

Boolean: A standard language of qualifiers (such as "&" and "OR") used to restrict an informational or statistical search to certain parameters. Boolean characters can be great help when searching the Internet. For example, on the Infoseek search engine, searching for "healthcare agency" produces more than 4 million matches, or all entries that contain either "healthcare" or "agency." But a search for "healthcare & agency" locates only the matches that contain both words, limiting the results to 33.

Bridge: A connector between two networks or between two parts of the same network. A bridge acts as a "shipping clerk" by forwarding data between the parts.

Broadband: A transmission method used for high-capacity data that require very large amounts of bandwidth such as video. Broadband is commonly carried by fiber-optic or coaxial cable and is capable of transmitting more than 1 million data bits per second.

Browser: [WWW] A software program that interprets documents written in HTML, the main programming language of the World Wide Web. A browser such as Netscape or Microsoft Explorer is required to experience the photos, video and sound elements on a Web page and assists in quick, easy travel around the Web.

Bus topology: A network where all user stations are connected to one central cable. All messages stop at every station and are picked up or sent on according to the address on the data packet. Compare star topology and ring topology.

Business Coalitions on Health: Groups of business owners (especially self-insured companies), associations and others that discuss ways to keep healthcare affordable.

Byte: Short for binary digit eight, because a byte is eight bits.

C+/C++: C is an established programming language found in many operating systems, including UNIX. As object-oriented technology gains popularity, C++, a daughter-program based on objects, is quickly becoming a favored programming language. Also see Java.

Capitation: [managed care] A payment structure where a caregiver is paid a set amount per patient in advance, regardless of how many procedures are performed later. Opposite of fee-for-service.

Case management: [managed care] The idea of creating a coordinated, ongoing and personalized strategy for patients who have a variety of healthcare needs such as the elderly and those with long-term illnesses. A primary care physician acts as a case manager, planning specialist referrals and giving a sense of continuity within the separate services delivered. Also see disease management.

Case mix: [managed care] The collective pool of patients in any health system or physician office, including data on age, gender and health status.

CCD (charge coupled device): [telemedicine] In a camera or scanner, it’s the semiconducting device containing the photosensitive cells. Since each pixel, or dot, of an image requires a cell, the more CCDs in a scanner, the higher the resolution of the image.

CDPD: See cellular digital packet data.

Cell/Cell switch: A cell is a tiny, fixed unit of information such as a character or word, packaged with routing instructions to the receiver. A cell switch acts as a travel agent, finding and reserving the route a cell must travel to reach its destination.

Cellular Digital Packet Data (CDPD): A high-capacity data transmission and routing service for cellular networks.

Central Processing Unit (CPU): Technically, it’s the hardware inside a computer that processes the commands. CPU also is used, somewhat erroneously, as a more general term for the entire box containing the processor, memory and disk drives, i.e. "the monitor, the printer and the CPU."

Centralized computing: An information system where all critical data and programs are stored on one main computer, usually a mainframe. Unlike the task-sharing concept of a client/server system, the central computer retains all the brains and brawn.

CHAMPUS: [managed care] Civilian Health and Medical Program of the Uniformed Services. A cost-sharing health plan for inactive military personnel under age 65, their eligible dependents and the dependents of those on active duty.

CHAMPVA: [managed care] Civilian Health and Medical Program of the Department of Veterans Affairs. A cost-sharing health plan for the dependents of qualifying disabled veterans.

CHIN: See community health information network.

Claim: A bill for healthcare service. A provider sends the claim to the patient’s insurance or health plan, which may review the claim for validity before paying the benefits.

Clearinghouse: A service that takes claims and other electronic data from providers, verifies the information and forwards the proper forms to the payors. More than a transfer station, a clearinghouse acts as a fact-checker and data format translator.

Client/server: A network system where a dedicated computer (server) handles some of the processing tasks while multiple smaller computers (clients) complete other processes by tapping into the server’s shared files and programs. Also See distributed computing.

Clinical decision support: See decision support system.

Closed panel: See staff model HMO.

Coaxial cable: An electrical cable with an extra layer of conductive material surrounding the core. The current standard for cable television, coaxial cable can carry more data than standard telephone wire but less than fiber-optics.

CODEC: [telemedicine] Short for Coder/Decoder. Uses hardware and/or software to translate analog transmissions into digital ones and compresses the signals. A CODEC is an efficient way to transmit video, since it allows the images to be sent using a lower bandwidth, but another CODEC is needed on the receiving end to uncompress the signals.

Coinsurance: The portion of a covered claim that a patient must pay.

COLD:See computer output to laser disk.

Copayment:The flat fee that a patient pays, usually at the time of service.

Commission:A type of finder’s fee set by insurance brokers or agents for selling health plans. The commission fee is built into the premiums paid by the insured group.

Common Object Request Broker Architecture (CORBA): A standard for enabling object-oriented communications across multiple platforms and languages.

CORBAmed:A healthcare task force that recommends standards for object-oriented communication in the healthcare industry.

Community Health Information Network (CHIN): Providers and payors within a specific area who are networked to exchange medical and administrative information among them, eliminating redundant data collection and reducing paperwork.

Computer Output to Laser Disk (COLD):A technology used to store data on laser-written disks, allowing users to read, distribute and archive the information.

Computer-based Patient Record (CPR): Much more than a computerized version of a medical chart, a CPR is a sort of "personal electronic library" providing access to all resources on a patient’s health history and insurance information. A CPR is a linking system rather than an independent database, and is more a process than a product. A CPR system can link to separate sources detailing a patient’s entire medical history, including images, laboratory results and drug allergies. The National Academy of Science Institute of Medicine and the Computer-based Patient Record Institute, among others, have suggested standard characteristics for CPRs, including common coding terminology, clinical decision support, secure confidentiality and electronic data interchange capabilities.

Continuous speech recognition: A vocal-to-digital translation system with heightened capabilities; unlike standard speech recognition systems, it can interpret words spoken in a natural cadence and within several contexts.

Coordination of Benefits (COB): When a patient carries more than one type of health insurance, insurers and health plans use this verification systems to make sure the same claim is not paid twice.

CORBA:See Common Object Request Broker Architecture.

Cost shifting: A leveling method where one patient group is charged more to make up for another group’s underpayment or inability to pay.

CPT code: See Current Procedural Terminology.

CPU:See Central Processing Unit.

Credentialing:The examination of a healthcare professional’s credentials, practice history and medical certification or license.

CSU/DSU:[telemedicine] Short for Channel Service Unit/Data Service Unit. This device acts as connector between a data transmission system and the communications line. The CSU/DSU provides the links protocols, enhances the signals and ends the transmission when the data is transferred.

Current Procedural Terminology (CPT): A procedure identification system that serves as the basis for healthcare billing. CPT coding assigns a five-digit code to each service or procedure provided by a physician. CPT coding simplifies billing and is a way to protect a patient’s medical privacy. Also see HCPCS.

Data: Pieces of information or commands.

Data entry: The transcription of information from the original source into a machine-readable form. Although keyboard entry is the most familiar, other fast-growing methods include scanners, speech recognition and automatic device-to-system technology.

Data mining: The comparison and study of large databases in order to discover new data relationships. Mining a clinical database may produce new insights on outcomes, alternate treatments or effects of treatment on different races and genders.

Data repository: A database acting as an information storage facility. Although often used synonymously with data warehouse, a repository does not have the analysis or querying functionality of a warehouse.

Data warehouse: This vast database stores information like a data repository but goes a step further, allowing users to access data to perform research-oriented analyses.

Database:An aggregation of records or other data that is updatable. Databases are used to manage and archive large amount of information. Also see relational database.

Decision support system: Software that taps into database resources to assist users in making decisions on care options. A clinical decision support system gives physicians structured (rules-based) information on diagnoses and treatments.

Demand management: The creation and maintenance of a health plan’s customer service aspects such as informational hotlines, scheduling, referral services and patient education resources. Also see triage.

DICOM:[telemedicine] Digital Imaging and Communications in Medicine. A standard developed by American College of Radiology and the National Equipment Manufacturers Association to define the connectivity and communications protocols of medical imaging devices.

Digital dictation: A technology similar to a transcriptionist’s tape recorder, only better. Since the voice files are saved in computerized (digital) form, they can be played back at any speed without distortion. Future developments in continuous speech recognition eventually may make digital dictation systems obsolete.

Digital service unit: See CSU/DSU.

Digital transmission: Voice, image or text data transformed and transmitted as combinations of zeros and ones (bits), and then transcribed back into the original medium by the recipient. Digital transmission is faster and less susceptible to noise interference than analog transmission.

Digital versatile disk (DVD): An optical disk capable of storing more than 4 gigabytes of audiovisual data on a single side--a quad-sided disk can hold about 17 GB. Current marketing is targeted at full-length movies, but the DVD’s high MPEG compression standard and immense storage capacity may have a significant impact on future telemedicine.

Directory service: Acts as a postal sorter for network communications by looking up the electronic destination and routing the data the fastest way. The service can detect an incorrect address before transmission and notify the sender rather than clogging the network with a misdirected package.

Disease management: [managed care] The development of an integrated treatment plan for patients with long-term illnesses or recurring conditions instead of viewing each physician visit as a separate event.

Disenrollment:[managed care] The act of terminating the membership of a person or group in a health plan.

Diskless workstation: See dumb terminal.

Distributed computing: A system where tasks are divided among several computers rather than having all processes originating from one central computer. Client/server systems are one type of distributed computing. Compare centralized computing.

Document imaging: Using a scanning device and software to translate a paper document into a computer file. The file then can be sent to recipients on a network or the World Wide Web, much like having a FAX machine connected to the Internet.

DPR:See drug price review.

DRG (diagnosis related group): [managed care] Patient study groups classified by age, gender, health condition and predicted treatment needs. A formula is calculated based on the particular DRG to determine how much money providers will be given to cover future procedures and services, primarily for in-patient care.

Drug Price Review (DPR): A monthly report that lists the average wholesale prices of prescription drugs.

Dumb terminal: A keyboard and screen used to input data to and receive data from a host computer. So named because it cannot process anything without the assistance of the main computer.

Duplexing:Running two file servers or identical drives at the same time, so a backup system is already running if the primary system fails. Compare mirroring.

DVD:See digital versatile disk.

EDI:See electronic data interchange.

EDIFACT:An acronym for Electronic Data Interchange For Administration, Commerce and Transport. Developed by the United Nations, these standards work toward universal, international conventions for electronic data interchange.

Electronic data interchange (EDI): A standard transmission format for business information sent from one computer to another using strings of data. EDI also can accommodate encryption. Also see batch and real-time EDI.

Electronic funds transfer (EFT): Financial transactions or data exchanged between computers, or "electronic banking."

Electronic mail: See email.

Electronic patient record:See computer-based patient record.

Eligibility: The ability to be part of a healthcare plan, including a definition of the specific benefits for which a member qualifies and the time frame of coverage.

Email:A communique, with or without attachments, sent from one computer user to another. Some systems still deliver email at set intervals, but most deliver messages within a few minutes of sending. Email has evolved considerably from its BBS roots, and many types of email can accommodate downloadable image files as well as attachments.

Employee contribution: The portion of health plan premiums paid by an employee (often debited from wages) to the company’s contracted payor. Also see employer mandate.

Employer mandate: For companies that provide health insurance for their employees, this stipulation forces the company to pay for at least part of the insurance premium for each employee.

Encryption:Coding attached to data with the intent to keep the information secure from anyone but the addressee. Encryption can include a password, public and private keys, or a complex combination of all.

End station: Any terminate point in a network, usually a desktop or workstation computer.

Enterprisewide network: A system where all computers in a healthcare system’s various buildings are connected to exchange information.

Enrollee:A member of a health plan or a member’s qualifying dependent.

EOB:See explanation of benefits.

Episode of care: Healthcare services provided for a specific illness during a set time period.

ERISA:Employee Retirement Income Security Act of 1974. A federal outline for regulating employee benefit plans, including healthcare plans sponsored and/or insured by an employer.

Ethernet:A popular method for sending data through a local area network using a single-channel cable and a special data collision protocol to detect network availability. Also see packet switching and compare fiber distributed data interface.

Executive information system: A system that allows executives to analyze company data and reach management conclusions through decision-making tools, much as a physician might use a decision support system to narrow diagnosis options.

Experience rating: A method of determining a company’s health insurance premiums by estimating the future healthcare risks of its employees. The risk level of the work environment is considered as well as the age, gender and health history of each employee.

Expert system: A topic-specific software program designed to imitate human decision making using detailed knowledge of a particular subject and rules for applying the facts to a scenario. Also see artificial intelligence.

Explanation of benefits (EOB): After a provider sends a claim to a payor, a billing statement is prepared for the patient that details the charges for services rendered, which portions of the service are paid by insurance and the amount the patient has to pay.

Fast packet: See packet switching.

FDDI:See fiber distributed data interface.

Fee schedule: A list of maximum fees, per service, a provider will be reimbursed within a fee-for-service payment system.

Fee-for-service:The most common U.S. healthcare payment system. A physician declares his or her own rates and is paid after each medical service delivered, as opposed to a flat-rate plan such as capitation. Also see fee schedule.

Fiber distributed data interface (FDDI): A transmission standard that uses fiber-optic technology to exchange data at speeds of 100-200 million bps, more than ten times faster than Ethernet.

Fiber-optic network: A communication carrier system using thread-like strands of glass or plastic-coated glass instead of wire, allowing the transmission of data as pulses of light. Fiber-optic systems can carry much more simultaneous information than copper wire, and with the help of repeaters, can carry over great distance without interference distortion.

File server: A computer dedicated to managing the flow of information among networked computers and used as a storage location for programs and files shared by network users. Also see client/server.

File transfer protocol (FTP): A standard application governed by TCP/IP for transferring files between computers or across the Internet. These days, nearly every system can accept FTP files.

Firewall:A security device situated between a private network and outside networks. The firewall screens user names and all information that attempts to enter or leave the private network, allowing or denying access or exchange based on pre-set access rules. Also see

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