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
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) 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
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
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) involves the exchange of health information in an electronic environment.6
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
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) 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
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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