The Medicaid Glossary: Technology Terms to Know

Technology’s role in health care delivery is continuing to increase. Not only does it help facilitate access to services, but it can also help to more effectively identify and address individual health care needs. Below are commonly used technology-related words and phrases, along with context for how these terms are defined within Medicaid.
 

Electronic Health Record (EHR)

An electronic health record (EHR) is a real-time patient health record that supports the collection of data for clinical care and decision-making as well as billing, quality management, outcome reporting and public health surveillance and reporting. EHRs are a type of health information technology.1

Encounter

An encounter refers to any engagement, appointment or delivered care between a Medicaid member and a provider of any kind, and in which a provider submits a claim thereafter.2

Health Information Exchange (HIE)

Health information exchange (HIE) is the act of electronic sharing of patient information between legally authorized health care providers or an individual/entity that enables exchange of electronic health information for a limited set of purposes. HIEs are a type of health information technology.3

Health Information Network (HIN)

A health information network (HIN) in an entity that oversees or administers policies that define conditions for HIE between multiple unaffiliated entities. The largest HIN in the United States is eHealth Exchange, which currently has participation from 75% of all U.S. hospitals, 70,000 medical groups, more than 8,300 pharmacies and 120 million patients. Many HINs are joint state-private sector endeavors in which participating providers pay a fee to participate.4

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law designed to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers. These standards give patients access to their medical records and provide more control over how their personal health information is used.5

Health Information Technology (HIT)

Health information technology (HIT) involves the exchange of health information in an electronic environment.6

Hotspotting

Hotspotting is a health care process that uses data to identify high-cost, high-need patients and improve their health outcomes through a coordinated care approach. Hotspotting leads to multidisciplinary care plans that combine physical and behavioral health services, as well as interventions to address non-medical needs that impact health. These could include housing or emotional support.7

Outcomes

Health outcomes are a measure of the quality of mental and physical health as a result of care delivery. Outcomes can be determined on a scale from community-based to the state level. Gauging effective outcomes is a key data point used to influence future policy and care reform.8

Protected Health Information (PHI)

Protected health information (PHI) is the term given to personal health information created, received, stored or transmitted by HIPAA-covered entities and their business associates in relation to the provision of health care, health care operations and payment for health care services.9

Read the Full Glossary

These technology-related terms are a small selection of terms available in the UnitedHealthcare Community & State Medicaid Glossary. Read more at uhccs.com/Medicaid-glossary.

This glossary is intended to be informational only and relates to terms used commonly in Medicaid programs and design. In most cases, terms are derived from publicly available sources. Terms covered in this glossary are subject to change and may have alternate definitions when used in relation to other programs or products, or by other sources or companies.

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