KR Tutorial Glossary

Accountability – Refers to identifying the healthcare party (i.e., individuals, organizations, business units) or agents (e.g., software, device, instrument, monitor) that is responsible for data origination, amendment, verification, translation, stewardship, access and use, disclosure, and transmission and receipt.(1)

Accredited Standards Committee (ASC) X12N – The standards development organization (charted by ANSI to develop uniform standards for inter-industry electronic interchange of business transactions – electronic data interchange) insurance subcommittee that develops standards for claims and other administrative transactions.(2)

Administrative Data Sources – Administrative data are information generated through overseeing public and private health insurance, enrolling members, paying bills, and other administrative activities. Data sources include financial data, facility and personnel data, and utilization or encounter data. Public health often relies on administrative data to provide services and make decisions.

Agency for Healthcare Research and Quality (AHRQ) – Within the U.S. Department of Health and Human Services, AHRQ is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services. AHRQ’s broad programs of research bring practical, science-based information to medical practitioners and to consumers and other healthcare purchasers.(3)

Agency for Toxic Substances and Disease Registry (ATSDR) – ATSDR performs specific functions concerning the effect on public health of hazardous substances in the environment. These functions include public health assessments of waste sites, health consultations concerning specific hazardous substances, health surveillance and registries, response to emergency releases of hazardous substances, applied research in support of public health assessments, information development and dissemination, and education and training concerning hazardous substances.(4)

Aggregate data – Data elements assembled into a logical format to facilitate comparisons or to elicit evidence of patterns.(5)

American Medical Informatics Association (AMIA) – The American Medical Informatics Association is an organization of individuals, institutions, and corporations dedicated to developing and using information technologies to improve health care. The members of AMIA include physicians, nurses, computer and information scientists, biomedical engineers, medical librarians, and academic researchers and educators. AMIA is the official United States representative organization to the International Medical Informatics Association.(6)

American National Standards Institute (ANSI) – The American National Standards Institute is the organization that accredits U.S. standards development organizations (SDOs) to ensure they are following due process in promulgating standards. The organization does not create standards itself.(7)

Assessment – Assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities. Assessment is one of the three core functions of public health as defined by the Institute of Medicine.(8)

Assurance – Assuring that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the quality and effectiveness of that care. Assurance is one of the three core functions of public health as defined by the Institute of Medicine.(9)

Behavioral Risk Factor Surveillance System (BRFSS) – The states, in collaboration with CDC, conduct the BRFSS survey annually to track health risks, such as excessive drinking, overeating, and smoking. “The objective of the BRFSS is to collect uniform, state specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases in the adult population.”(10)

Board of Health – An appointed board representing constituencies served by the state public health agency.(11)

Cabinet – The head of the state public health agency who is appointed by and answers to the governor.(12)

Census – Every ten years, the federal government is Constitutionally required to conduct a census of the population. Specifically, this activity is performed by the U.S. Census Bureau, part of the Department of Commerce. In addition to recording the number of individuals in the country, the census also collects numerous amounts of other information, including age, gender, race, ethnicity, housing status, income, etc. These data provide the denominators for population statistics.

Centers for Disease Control and Prevention (CDC) – CDC serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States.(13) The CDC is made up of 12 centers, including the National Center for Health Statistics, the agency responsible for compiling statistical information to guide actions and policies to improve health.(14)

Centers for Medicare and Medicaid Services (CMS) – CMS is responsible for operation of Medicare, Medicaid, and the State Children’s Health Insurance Program (S-CHIP).

Classification Systems Standards – Classification systems organize terms for easy use of information for retrieval, analysis and decision support.

Clinical and Laboratory Data – Clinical and laboratory data are found on a patient’s medical record. Health care professionals generate this information as a direct result of interaction with the patient, or with individuals who have personal knowledge of the patient, or with both. Clinical data include patient demographics, health history, details of present illness or injury, orders for care and treatment, observations, test results, records of medication administration, diagnoses/problems, allergies, and other health care information. In addition, clinical data can be used with other data sources to determine incidence and prevalence of disease. Laboratory data include information gathered from laboratory services such as health and environmental assessment, surveillance, quality assurance, training, and consultation. Laboratory data also include information from a core set of tests in pathology, hematology, chemistry, microbiology, and environmental science.

Code Sets Standards – Representation assigned to a term so that it may more readily be processed; code sets are lists of codes and their associated terms.(15)

Comparability – The ability of different parties to share precisely the same meaning for data.(16)

Computer-based Patient Record (CPR) – The term coined by the Institute of Medicine in its work The Computer-based Patient Record: An Essential Technology for Health Care (Washington, DC: National Academy Press, 1991, rev. 1997). It may be used synonymously with electronic medical record (EMR) or electronic health record (EHR). It is electronic patient medical record information that resides in a system specifically designed to support users by providing accessibility to complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids.(17)

Consolidated Healthcare Informatics Initiative (CHI) – Born out of a Presidential charge to maximize the federal government’s productivity from technology, the Consolidated Healthcare Informatics Initiative is an effort dedicated to establishing federal health information interoperability standards as the basis for electronic health data transfer in all activities and programs and among all agencies and departments.(18) The target audience for this initiative is up to 20 federal agencies, including the DHHS (e.g., CDC, Centers for Medicare and Medicaid Services, Indian Health Service, Food and Drug Administration), Department of Defense, Department of Veterans Affairs, as well as others such as Social Security Administration, Department of State, and General Services Administration.

Covered Entities – Under HIPAA, Congress required health plans, health care clearinghouses, and those health care providers who conduct certain financial and administrative transactions electronically (such as eligibility, referral authorizations and claims) to comply with each set of final administrative simplification standards.(19) A health care clearinghouse is a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements. Health care provider is a provider of services, a provider of medical or other health services, and any other person furnishing health care services or supplies. Health plan is an individual or group plan that provides, or pays the cost of, medical care.(20) Other businesses may voluntarily comply with the standards, but the law does not require them to do so.(21)

Current Dental Terminology (CDT-2) – The official coding system for dentists to report their professional services and procedures to third parties for payment. It is produced and maintained by the American Dental Association.(22)

Current Population Survey (CPS) – The U.S. Census Bureau collects monthly information about the population of the United States through the CPS. Every March, the CPS focuses on health related information, including whether individuals have health insurance.(23)

Current Procedural Terminology (CPT-4) – The official coding system for physicians to report their professional services and procedures to third parties for payment. It is produced and maintained by the American Medical Association.(24)

Data Content Committees (DCC) – DCCs are committees that provide a national forum for discussion, review, and action regarding the determination or maintenance of specific datasets (or data content) to reside in the health care financial and administrative transaction standard.

Data Elements for Emergency Department Systems (DEEDS) – The recommended data set for use in emergency departments; it is published by the Centers for Disease Control and Prevention (CDC).(25)

Data Integrity – The property that data have not been altered or destroyed in an unauthorized manner or by unauthorized users; it is a security principle that protects information from being modified or otherwise corrupted either maliciously or accidentally.(26)

Data Quality – Refers to the features and characteristics that ensure data are accurate and complete and that they convey the intended meaning.(27)

Data Registry – see Registry Data

Data Standards – According to ISO, a standard is “documented agreements containing technical specifications or other precise criteria to be used consistently as rules, guidelines, or definitions of characteristics, to ensure that materials, products, processes and services are fit for their purpose.”(28) There are several types of data standards including terminology standards and message format standards.

Diagnostic and Statistical Manual of Mental Disorders (DSM) – Produced by the American Psychiatric Association to facilitate communication among mental health clinicians, researchers, and administrators; to improve patient care by facilitating reliable and valid diagnosis and differential diagnosis; to facilitate education and training in psychopathology; and to facilitate collection of statistical data about mental disorders.(29)

Digital Imaging and Communications in Medicine (DICOM) – An ANSI-accredited standards development organization that has created a standard protocol for exchanging medical images among computer systems.(30)

Disease Surveillance – The objective of disease surveillance is to provide early and precise information on key aspects of disease activity such as time, location, virus type, and disease severity. Analysis of this information provides the necessary data to predict disease transmission and guide the implementation of control measures.(31)

Domain – A field of action, thought, or influence. In health care, domain is often used to describe one of many different clinical areas.(32)

Electronic Data Interchange (EDI) – EDI is a system of electronic messaging used by computer systems to “talk” with one another. Electronic messaging requires much more technological infrastructure than is needed for simply sharing data files. It requires a common set of questions and responses that both communicating systems understand.

Encounter Data – see Service Utilization

Encryption – Computer transmission technology which enables information to be transmitted securely and satisfies the interoperable implementation of new security requirements for Internet transactions.(33)

Environmental Protection Agency (EPA) – The federal agency responsible for many environmental programs and regulations.

Epidemiology – Branch of medical science dealing with the distribution and determinants of health-related events in specified populations and the application of this study to the control of health problems.(34)

Essential Public Health Services – The services identified in Public Health in America (defined below): monitoring health status; diagnosing and investigating health problems; informing, educating, and empowering people; mobilizing community partnerships; developing policies and plans; enforcing laws and regulations; linking people to needed services; assuring a competent workforce; conducting evaluations; and conducting research.(35)

Facility Data – Facility data include information on the characteristics of various health related resources, including where these resources are located, whether they are licensed, etc. State departments of health often maintain directories of facilities as well as license facilities, such as long term care and health maintenance organizations.

Federal, State, or Local Public Health Agency – A government or nongovernment entity authorized to provide one or more essential public health services. Included are health, mental health, substance abuse, environmental health, occupational health, educational, and public health agencies.(36)

Financial Data – Financial data include, but are not limited to, the documentation of the charges for services, costs of providing services, revenues generated from services and revenues from other sources. State agencies must collect financial data for administering programs such as Medicaid.

Food and Drug Administration (FDA) – The FDA promotes and protects the public’s health by helping safe and effective products reach the market in a timely way, and monitoring products for continued safety after they are in use.(37)

Geographic Information System (GIS) – Combines modern computer and supercomputing digital technology with data management systems to provide tools for the capture, storage, manipulation, analysis, and visualization of spatial data. Spatial data contain information, usually in the form of a geographic coordinate system, that gives the data location relative to the earth’s surface. These spatial attributes enable previously disparate data sets to be integrated into a digital mapping environment.(38)

Governance – The act or process of exerting authoritative direction or control.(39)

Graduate Program in Public Health – Any academic postbachelor’s degree program that specifically trains public health workers. Included, for example, are programs in schools of public health, nursing, environmental health, medicine and dentistry, and veterinary medicine.(40)

Harmonization – The coordination process used by standards development organizations to make standards work together. Processes to achieve harmonization include convergence, modeling, mapping, translation, and other techniques.(41)

HCFA (now CMS) Common Procedure Coding System (HCPCS) – Currently incorporates CPT-4, national codes for reporting certain health care supplies, durable medical equipment and other services not listed in CPT-4, and local codes for Medicaid reporting. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), local codes will transition to national codes.

Health – Refers to the general condition of the body or mind. The World Health Organization has defined health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. When referencing the health system in general, the reference is to all actions contributing to health, including public health, health care, preventive care, health maintenance, and consumer health.(42)

Health Alert Network (HAN) – The Health Alert Network is designed to build preparedness and response capacity at the local health department level in partnership with colleagues at the state departments of health. Funding for HAN supports connections to the Internet, training of the public health workforce via distance learning systems (satellite, Internet, or both), and the capacity to send urgent health alerts to local agencies and selected groups via information broadcast technologies (e.g., broadcast fax services, autodialing).

Health Care – Refers specifically to the treatment of illness or injury to the body or mind in order to restore good health or mitigate the effects of chronic disease or disability.(43)

Health Care Information Systems are computer systems that capture, store, process, communicate, and present any health care information, including Patient Medical Record Information (PMRI).(44) Data sets used in health care information systems describe a minimum group of data elements to be collected in a standardized manner for a specific purpose. Examples not referenced elsewhere in this Glossary include the Uniform Hospital Discharge Data Set (UHDDS) developed by the National Committee on Vital and Health Statistics (NCVHS), Uniform Ambulatory Care Data Set also developed by NCVHS, Medicare Cost Report data set developed by the Centers for Medicare and Medicaid Services (CMS), the Health Plan Employer Data and Information Set (HEDIS) established for managed care accreditation by the National Committee for Quality Assurance (NCQA), and ORYX, which is a program of outcomes measurement systems established for accreditation purposes by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).(45) Data systems that provide tracking data for five or more national Healthy People 2010 objectives, include the National Vital Statistics System, National Health Interview Survey, National Health and Nutrition Examination Survey, National Hospital Discharge Survey, and Behavioral Risk Factor Surveillance System.(46)

Health Care Services Data Reporting Guide – The Public Health Data Standards Consortium developed an implementation guide áÐy GET http://63.107.122.13/images/studieservices data reporting guide is based on the HIPAA implementation guides, specifically the claim and encounter transaction standard, but includes data elements that specifically address public health data needs for encounter data, including specifications for data elements such as race and county as well as a limited set of clinical data elements.

Healthcare Cost and Utilization Project (HCUP) – The Healthcare Cost and Utilization Project is a family of healthcare databases and related software tools and products developed through a Federal-State-industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases bring together the data collection efforts of State data organizations, hospital associations, private data organizations, and the Federal government to create a national information resource of patient-level health care data.(47)

Health Industry Business Communications Council (HIBCC) – An ANSI-accredited, industry sponsored organization that facilitates electronic communications by developing standards for information exchange, including electronic data interchange message formats, bar code labeling data standards, and universal numbering systems. The Universal Product Number (UPN) provides an identifier for medical/surgical product labels.(48)

Health Information – Any information, whether oral or recorded in any form or medium, that: is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.(49)

HIPAA Administrative Simplification – Title II, Subtitle F, of the Health Insurance Portability and Accountability Act of 1996(HIPAA) , which gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information.(50)

Health Level Seven (HL7) – HL7 is one of several standards development organizations accredited by ANSI that is creating standards for representing and communicating data related to health care. HL7 has focused on the clinical and administrative data generated within and across health care institutions.(51) Version 2.3 provides a protocol that enables the flow of data between systems. Version 3.0 is being developed through the use of a formalized methodology involving the creation of a Reference Information Model (RIM) to encompass not only the ability to move data but to use data once it is moved.(52)

Health Resources and Services Administration (HRSA) – HRSA works to increase the availability of quality health care to low income, uninsured, isolated, vulnerable and special needs populations and meets their unique health care needs.(53)

Health Status Indicators – Eighteen measures of health status, defined by the CDC in 1991, that represent a broad overview of a community’s health and that can be used by various levels of government. Health Status Indicators include infant mortality, death rates for selected diseases, incidence rates of selected infectious diseases, measures regarding pregnancy and birth, childhood poverty, and air quality.(54)

Home Health Care Classifications (HHCC) – Consists of the HHCC of Nursing Diagnoses, which is a code set/vocabulary representing nursing diagnoses and/or patient problems in home health care and the HHCC of Nursing Interventions code set/vocabulary that represents interventions, procedures, activities, and/or service performed in home health care.(55)

Human Services – Human services encompasses services provided to the public such as welfare, food stamps programs, social services, child support, adoption, economic assistance, rehabilitation and adult day care.

Hyper Text Markup Language (HTML) – Standard text format for web browsers.

Incidence – The number of new cases of disease during a prescribed period of time.

Index – A statistical measure that is the result of aggregating statistics measuring the same construct.

Indian Health Service (IHS) – The IHS provides a comprehensive health services delivery system for American Indians and Alaska Natives with opportunity for maximum tribal involvement in developing and managing programs to meet their health needs.(56)

Individually Identifiable Health Information – Any health information (see definition of health information), including demographic information collected from an individual, that identifies the individual; or with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.(57)

Infant Mortality Rate – The number of deaths of infants less than one year old per 1,000 live births in a population.(58)

Informatics – The collection, classification, storage, retrieval, and dissemination of recorded knowledge.(59)

Information Infrastructure – Includes the standards, laws, regulations, business practices, and technologies needed to facilitate authorized sharing of comparable data in a safe and secure manner.(60)

Information Model – A set of rules for describing, combining, and relating the units of a knowledge representation structure.(61)

Institute of Electrical and Electronics Engineers (IEEE) – Medical Data Interchange (MEDIX) committee is working on a standard set of hospital system interface transactions based on the International Standard Organization (ISO) standards; another IEEE committee has developed a standard for a medical information bus (MIB) to link instruments in critical care.(62)

Interface – Computer hardware or software that is designed to communicate information between devices, between programs, or between a computer and a user.(63)

International Statistical Classification of Diseases and Health Related Problems (ICD) – Produced by the World Health Organization and now in its tenth revision, ICD is the standard diagnostic classification for all general epidemiological and many health management purposes.

ICD-9-CM is the clinical modification of the 9th edition of ICD prepared by the U.S. and adopted in 1979. It is maintained by the National Center for Health Statistics (NCHS), CDC, in conjunction with CMS. The NCHS is also preparing a clinical modification of the 10th edition of ICD (ICD-10-CM).(64)

International Classification of Functioning, Disability and Health (ICF) – A classification system first issued by the World Health Organization in 1980 as the International Classification of Impairments, Disabilities and Handicaps (ICIDH); it provides a scientific model of disability and the basis for a common language for clinical use, data collection, and research.(65)

International Organization for Standardization (ISO) – ISO is a major international standards organization (ANSI is the U.S. member), which coordinates and develops international voluntary consensus standards that facilitate world trade and contribute to public safety and health.

Interoperability – Refers to the ability of one computer system to exchange data with another computer system such that, at a minimum, the message from the sending system can be placed in the appropriate place in the receiving system. At the highest level, the data content of the message should be comparable, i.e., the data embedded in the message should convey the same meaning in both systems.(66)

Institute of Medicine (IOM) – Institute of Medicine is one of The National Academies. Its mission is to advance and disseminate scientific knowledge to improve human health. It provides objective, timely, authoritative information and advice concerning health and science policy to government, the corporate sector, the professions, and the public.(67)

Laboratory Data – see Clinical Data

Leading Health Indicators – A set of 10 key determinants, defined in Healthy People 2010, that influence health and can serve as a barometer for evaluating the health of the Nation. Leading Health Indicators include individual behaviors, the social and physical environment, and community health programs and address areas that most influence the health of individuals, communities, and the Nation.(68)

Local Board of Health – An appointed board representing constituencies served by the local health agency.

Local Public Health Agency (LPHA) – An administrative or service unit of local or state government, concerned with health, and carrying some responsibility for the health of a jurisdiction smaller than the state.(69)

LOINC (Logical Observation Identifiers, Names and Codes provides a set of universal names and identifier codes for laboratory and clinical observations.(70)

Maternal and Child Health (MCH) block grant program – Title V Block Grant program funded by the Health Resources and Services Administration (HRSA) to states to administer to the underserved.

Medical Expenditure Panel Survey (MEPS) – The Agency for Healthcare Research and Quality (AHRQ) conducts the Medical Expenditure Panel Survey (MEPS) on the financing and utilization of medical care in the United States. The survey collects data on frequency, cost, and payer type for health services.(71)

Message Format Standards – Message format or electronic data interchange (EDI) standards ensure that the electronic exchange of information is efficient, unambiguous and secure. These protocols make communication or the exchange of data between disparate computer systems (interoperability) possible without human intervention. These message format standards should be universal enough that they do not require negotiation of an interface agreement between the two systems in order to make the two systems communicate.(72)

Metathesaurus – is intellectual middleware; The National Library of Medicine’s Unified Medical Language System (UMLS) Metathesaurus cross-references national and international medical vocabularies.(73)

Metropolitan Statistical Area (MSA) – The general concept of a metropolitan area is that of a large population nucleus, together with adjacent communities having a high degree of social and economic integration with that core. Metropolitan areas comprise one or more entire counties, except in New England, where cities and towns are the basic geographic units. The Office of Management and Budget (OMB) defines metropolitan areas for purposes of collecting, tabulating, and publishing federal data. Metropolitan area definitions result from applying published standards to Census Bureau data.(74)

National Association of County and City Health Officials (NACCHO) – The national nonprofit organization representing local public health agencies (including city, county, metro, district, and Tribal agencies).(75)

National Center for Health Statistics (NCHS) – NCHS is the federal health statistics agency responsible for compiling statistical information to guide actions and policies to improve the health of public.(76)

National Committee on Vital and Health Statistics (NCVHS) – NCVHS is the statutory federal advisory committee to the Secretary of the Department of Health and Human Services (DHHS) on national health information policy, including the implementation of HIPAA.

National Council for Prescription Drug Programs (NCPDP) – The ANSI-accredited standards development organization in the pharmacy services sector of the health care industry. It creates standards for exchange of financial and clinical claim data between pharmacies, switches, and payers.(77)

National Drug Codes (NDC) – A 10 digit number that is developed and maintained by the U.S. Food and Drug Administration (FDA) to identify drug products marketed in the United States. NDC numbers are not assigned to drug products not marketed in the United States, blood products, medical devices, in vitro diagnostic products, dietary supplements, or drug products used only in pre-market approval investigations.(78)

National Electronic Disease Surveillance System (NEDSS) – The vision of NEDSS is to have integrated surveillance systems that can transfer appropriate public health, laboratory, and clinical data efficiently and securely over the Internet. The NEDSS initiative is made up of the NEDSS system architecture, the NEDSS base system, and NEDSS electronic laboratory reporting. To initiate implementation of NEDSS, states have received funds to either develop their own systems using specified NEDSS system architecture and standards, or to adopt all or a portion of the CDC-developed NEDSS Base system.(79) The NEDSS system architecture electronically integrates and links together several types of surveillance systems with the use of standard data formats; a communications infrastructure built on principles of public health informatics; and agreements on data access, sharing and confidentiality.(80) NEDSS is focused on the use of data and information systems standards to advance the development of efficient, integrated and interoperable (the ability of one computer system to exchange data with another computer system) surveillance systems at the state and local levels.

National Health Information Infrastructure (NHII) – The National Health Information Infrastructure (NHII), facilitated by the Department of Health and Human Services (DHHS) in conjunction with public and private sector organizations, can be defined as the development of a comprehensive, knowledge-based, network of interoperable systems capable of providing information for sound decisions about health when and where needed.(81) It includes standards, laws, regulations, business practices, and technologies. For example, information systems standards are needed to facilitate the sharing of comparable data. State and federal laws are needed to protect the privacy of health care information and remove barriers to sharing data between states. Federal regulations are needed that define consistent policies and practices to protect the integrity of and provide security for health care information. Cost effective systems and technologies are needed to utilize the infrastructure and translate its efficiency and effectiveness into value for the user.(82)

National Health Interview Survey – “The National Health Interview Survey (NHIS) is the principal source of information on the health of the civilian noninstitutionalized population of the United States and is one of the major data collection programs of the National Center for Health Statistics (NCHS). The main objective of the NHIS is to monitor the health of the United States population through the collection and analysis of data on a broad range of health topics” (e.g. monitor trends in illness and disability and to track progress toward achieving national health objectives; epidemiologic and policy analysis of such timely issues as characterizing those with various health problems; determining barriers to accessing and using appropriate health care; and evaluating Federal health programs).(83)

National Hospital Discharge Survey (NHDS) – The National Center for Health Statistics (NCHS) conducts the NHDS, which is one of a suite of health care surveys. The NHDS has been conducted continuously by the Centers for Disease Control's NCHS since 1965. National estimates of hospital use derived from the NHDS are published for each calendar year by NCHS.(84)

National Institutes of Health (NIH) – The mission of NIH is science in pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability. The NIH is made up of 27 institutes and centers.(85)

National Institute of Standards and Technology (NIST) – NIST in the Department of Commerce’s Technology Administration was established by Congress to assist industry in the development of technology needed to improve product quality, modernize manufacturing processes, ensure product reliability, and facilitate rapid commercialization of products based on new scientific discoveries. It carries out its mission through Measurement and Standards Laboratories, the Advanced Technology Program, a Manufacturing Extension Partnership, and the Malcolm Baldrige National Quality Award.(86)

Needs Assessment – A formal process – which is the first step in a community health improvement process – of identifying problems and assessing the community’s capacity to address health and social service needs. Examples include Assessment Protocol for Excellence in Public Health, Planned Approach to Community Health, Healthy Cities, and Model Standards.(87)

Nomenclature Standards – Nomenclature standards are “… a set of specialized terms that facilitates precise communication by minimizing or eliminating ambiguity.”(88)

Nursing Interventions Classifications (NIC) – A comprehensive classification that names and describes treatments performed by nurses.(89)

Nursing Outcomes Classification (NOC) – Provides a standard language with measures for patient outcomes influenced by nursing practice.(90)

Passwords – A sequence of characters required for access to a computer system.(91)

Patient Care Data Set (PCDS) – A compilation of pre-coordinated terms actually used in patient records to record patients’ problems, therapeutic goals, and care actions. These terms are recognized by the Nursing Information & Data Set Evaluation Center of the American Nurses Association and are being used as source material for building searchable structure text that closely approximates clinical vernacular.(92)

Patient Medical Record Information (PMRI) – Information about a single patient. Health care professionals generate this information as a direct result of interaction with the patient, or with individuals who have personal knowledge of the patient, or with both. PMRI documents the course of a patient’s illness and treatment, communicates between care providers, assists in evaluating the adequacy and appropriateness of care, substantiates claims for payment, protects the legal interests of all concerned parties to the information, and provides case studies for education and data to expand the body of medical knowledge. PMRI includes patient demographics, health history, details of present illness or injury, orders for care and treatment, observations, records of medication administration, diagnoses/problems, allergies, and other health care information. PMRI facilitates the creation of a lifetime health record for individuals. PMRI of many individuals may be aggregated to provide the basis for continuous quality improvement, outcomes analysis, and population-based care management.(93)

Patient Safety – Described in the Institute of Medicine report, To Err is Human: Building a Safer Health System (Washington, DC: National Academy Press, 1999), as “freedom from accidental injury.” The report describes that the human cost of medical errors – the majority of which do not result from individual recklessness but from basic flaws in the way the health system is organized – is immense, and recommends a four-part plan to create both financial and regulatory incentives that will lead to a safer health care system.(94)

Policy Development – Policy development is formulating public policies, in collaboration with community and government leaders, designed to solve identified local and national health problems and priorities.(95) Policy development is one of the three core functions of public health as defined by the Institute of Medicine.

Population-based Prevention Research – Research to identify effective public health prevention practices for particular populations.(96)

Population Health Surveys – In order to better assess the health of the population, surveys are conducted at the state and federal level on general or specific health indicators. Population health surveys are not collected for specific program purposes but rather provide an information base for multiple public health programs.

Prevalence – The proportion of a population that has disease at a specific time.(97)

Program Support Center (PSC) – The PSC is charged with providing a full range of program support services to all components of DHHS focusing primarily on products and services in the following areas: Human Resources; Health Resources; Administrative Services; and Financial Management.(98)

Proportion – A percent of the whole (i.e., number of deaths/population).

Public Health – Public health addresses the health of the population as a whole rather than medical health care, which focuses on treatment of the individual ailment. According to the Institute of Medicine, the mission of public health is defined as "fulfilling society's interest in assuring conditions in which people can be healthy."(99) A similarly broad vision guides the Public Health Data Standards Consortium, which is healthy people in healthy communities and the mission that promotes physical and mental health and prevents disease, injury, and disability.(100)

Public Health Data Standards Consortium (PHDSC) – PHDSC was established in 1999 by the CDC’s National Center for Health Statistics, with support from The Agency for Healthcare Research and Quality and guidance from the NCVHS, to represent the interests of public health and health services research in the standards development and implementation process. The mission of the PHDSC is to improve the health and health care of the U.S. population through improved health related information by expanding involvement in existing health data standards and content organizations and determining standards needs through consultation with data leaders and data users.

Public Health Informatics – “…the systematic application of information and computer science and technology to public health practices, research and learning.”(101) It is the efficient and effective organization and management of data, information and knowledge generated and used by public health professionals to fulfill the core functions of public health: assessment, policy and assurance.(102)

Public Health Infrastructure – The resources needed to deliver the essential public health services to every community – people who work in the field of public health, information and communication systems used to collect and disseminate accurate data, and public health organizations at the State and local levels in the front lines of public health.(103)

Public Health Workers – Individuals who are responsible for providing the essential public health services whether or not they work in an official health agency. At the State level, many workers have public health responsibilities even though they may work for nonpublic health agencies, such as environmental, agricultural, and education departments. This definition does not include those workers who occasionally contribute to the public health effort while fulfilling other responsibilities.(104)

Qualitative Data – Qualitative data are collections of perceptions, attitudes, observations, and context, instead of the collection of numbers or statistics found in quantitative data. The information developed from these data helps to understand the root causes and precursors of health problems identified through quantitative data.(105)

Quantitative Data – Quantitative data are measurable and tangible. They involve the counting of people, behaviors, conditions, or other events; classifying those events into categories; and using math and statistics to answer questions.(106)

Rate – A rate is a measure of some event, disease or condition in relation to a unit of population, along with some specification of time (i.e., death/population for a given year).

Ratio – Similar to a proportion, except the numerator and denominator are different (i.e., deaths per city).

Registry Data – Registry data is an information resource kept by a registration authority that describes the meaning and representational form (meta-data) of data units, including data element identifiers, definitions, units, allowed value domains, etc.(107) State and federal public health agencies maintain records of incidences of certain injuries, diseases, and disabilities, as well as actions taken to prevent illness (e.g., immunizations). Other types of registries include those for cancer, spinal cord injuries, blood lead, organ donor, and birth defects. According to the Agency for Toxic Substances and Disease Registry, a registry is “a system for collecting and maintaining, in a structured record, information on specific persons from a defined population.”(108) According to the Centers for Disease Control and Prevention (CDC), “immunization registries are confidential, population-based, computerized information systems that attempt to collect vaccination data about all children within a geographic area.”(109)

Screening Data – Screening data are a core component of public health information because they reflect interventions by health care professionals before precursor signs of disease are detectable.(110)

Service Utilization or Encounter Data – As services are utilized, information on those encounters are recorded to acknowledge occurrence, facilitate billing and payment, and analyze patterns of service delivery. Encounter data are a rich source of administrative as well as clinical information. Public health agencies, hospitals and health systems, and public and private payers all collect encounter data.

Social Security Administration (SSA) – The SSA is responsible for administering the Social Security program, which provides federal economic relief to citizens. The SSA also plays important roles in public health, including disability determination and supporting electronic death registration systems.

Standard – A prescribed set of rules, conditions, or requirements describing the following information for products, systems, services, or practices: classification of components; specification of materials, performance, or operations; or delineation of procedures.(111)

Standards Development Organization (SDO) – SDOs are organizations that develop and maintain the models, data dictionaries, structure, syntax, and implementation materials for electronic transaction standards between and within providers. All designated SDOs maintain policies that meet the requirements of the American National Standards Institute (ANSI), which accredits standards committees and provides an open forum for participants to identify, plan and agree on standards and assurance of due process.

State Public Health Agency – State agency responsible for public health activities. State public health agency operations and location within the state government varies from state to state. State public health agencies may be responsible for children’s health, nutrition services, women’s health, disease control, environmental health and food and drug safety at the state level.

Substance Abuse and Mental Health Services Administration (SAMHSA) – SAMHSA is charged with improving the quality and availability of prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses.(112)

Surveillance Data – “Surveillance is a continuous and systematic process of collection, analysis, interpretation, and dissemination of descriptive information for monitoring health problems.“(113) Surveillance data systems, e.g., systems for infectious diseases, store information on exposure or trends in adverse health effects over a specified period of time that can be used by public health officials for planning, evaluation, or implementation of public health interventions.(114)

Systematized Nomenclature of Human and Veterinary Medicine (SNOMED) – Structured nomenclature and classification of the terminology used in human and veterinary medicine for indexing medical record information. It is produced and maintained by the College of American Pathologists.(115)

Terminology Standards – Ways to define and classify individual health terms and/or relate terms to one another so that they are easily and consistently understood by users.(116) Terminology standards include code sets, classification systems and nomenclature.

Transactions – Transaction include the following: health claims or equivalent encounter information, health claims attachments, enrollment and disenrollment in a health plan, eligibility for a health plan, health care payment and remittance advice, health plan premium payments, first report of injury, health claim status, referral certification and authorization.(117)

Umbrella Agency – Some public health agencies are part of a larger state agency or umbrella agency.(118)

Unified Medical Language System (UMLS) – UMLS is a system designed by the National Library of Medicine (NLM) to help health professionals and researchers retrieve and integrate electronic biomedical information from a variety of bibliographic databases, factual databases, and expert systems.(119)

Uniform Data Standards – Methods, protocols, or terminologies agreed to by an industry to allow disparate information systems to operate successfully with one another. Uniform data standards for PMRI include data definitions, message format protocols, medical terminologies, and data quality methods that are adopted across the health care delivery system.(120)

U.S. Department of Agriculture (USDA) – USDA is the federal agency responsible for food and agriculture including farm and foreign agricultural services, food nutrition and consumer service, food safety, marketing and regulatory programs, natural resources and environment and rural development. Specifically related to public health, USDA also operates the Women, Infants, and Children (WIC) nutrition program.

Vital Records – State and local governments are responsible for registering the universe of births, deaths, and marriages in their jurisdictions. Vital records data systems are based on the national vital statistics system, which includes standard certificates and model laws. Birth certificates are completed by hospitals and submitted to health departments. They include public health relevant information on both the mother and the infant. Death certificates are completed by mortuaries and submitted to the health department; underlying and multiple cause-of-death data are provided by physicians. The latter are particularly important for assessing the burden of disease and premature mortality at the population level.(121)

Vital Statistics Data – see Vital Records

Women, Infants, Children (WIC) nutrition program – Special Supplemental Program administered by USDA.

Internet References

Endnotes

(1) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(2) Ibid.
(3) Ibid.
(4) Agency for Toxic Substances and Disease Registry (January 30, 2003). About the Agency for Toxic Substances and Disease Registry [On-line], Available: http://www.atsdr.cdc.gov/about.html
(5) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line] Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(6) American Medical Informatics Association. (January 16, 2003). About AMIA [On-line], Available: http://www.amia.org/informatics/
(7) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(8) Institute of Medicine, Committee for the Study of the Future of Public Health, Division of Health Care Services. (1988). The Future of Public Health.
(9) Ibid.
(10) Centers for Disease Control and Prevention (August 30, 2002). 2001 BRFSS Overview [On-line], Available: http://www.cdc.gov/brfss/ti-surveydata2001.htm
(11) Institute of Medicine (2002). The Future of the Public’s Health in the 21st Century: The Governmental Public Health Infrastructure, pp. 112.
(12) Ibid.
(13) Centers for Disease Control and Prevention (November 2, 2002). About CDC [On-line], Available: http://www.cdc.gov/aboutcdc.htm
(14) National Center for Health Statistics (November 23, 2002). About NCHS [On-line], Available: http://www.cdc.gov/nchs/about.htm
(15) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(16) Ibid.
(17) Ibid.
(18) Christopherson, Gary A., Deputy CIO for Health, Department of Veterans Affairs. (August 29, 2002). Consolidated Health Informatics: Health Information Interoperability Standards in Federal Healthcare: Presentation to the National Committee on Vital and Health Statistics.
(19) U.S. Department of Health and Human Services. (January 29, 2003). Administrative Simplification Under HIPAA: National Standards for Transactions, Security and Privacy Fact Sheet [On-line], Available: http://www.hhs.gov/news/press/2002pres/hipaa.html
(20) Minnesota Department of Human Services. (January 14, 2003). HIPAA Definitions/Concepts [On-line], Available: http://www.dhs.state.mn.us/hipaa/HIPAA_definitions.htm
(21) U.S. Department of Health and Human Services. (January 29, 2003). Administrative Simplification Under HIPAA: National Standards for Transactions, Security and Privacy Fact Sheet [On-line], Available: http://www.hhs.gov/news/press/2002pres/hipaa.html
(22) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(23) U.S. Department of Labor, Bureau of Labor Statistics (February 6, 2003). Current Population Survey [On-line], Available: http://www.bls.gov/cps/home.htm
(24) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(25) Ibid.
(26) Ibid.
(27) Ibid.
(28) International Organization for Standardization. (December 5, 2002). What are standards? [On-line], Available: http://www.iso.ch/iso/en/aboutiso/introduction/index.html
(29) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(30) Ibid.
(31) Centers for Disease Control and Prevention. (January 31, 2003). CDC Proactive Surveillance Goals and Objectives [On-line], Available: http://www.cdc.gov/ncidod/dvbid/dengue/slideset/set1/ii/slide02.htm
(32) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(33) Massachusetts Health Data Consortium. (January 31, 2003). Massachusetts Health Data Consortium Resource Center Report Public Key Encryption Pilot Projects
(34) U.S. Department of Health and Human Services. (November, 2000). Healthy People 2010: Understanding and Improving Health: Public Health Infrastructure Terminology [On-line], Available: http://www.healthypeople.gov/document/HTML/Volume2/23PHI.htm
(35) Ibid.
(36) U.S. Department of Health and Human Services. (November, 2000). Healthy People 2010: Understanding and Improving Health: Public Health Infrastructure Terminology [On-line], Available: http://www.healthypeople.gov/document/HTML/Volume2/23PHI.htm
(37) U.S. Food and Drug Administration (January 15, 2003). About the U.S. Food and Drug Administration [On-line], Available: http://www.fda.gov/opacom/hpview.html
(38) U.S. Department of Health and Human Services. (November, 2000). Healthy People 2010: Understanding and Improving Health: Public Health Infrastructure Terminology [On-line], Available: http://www.healthypeople.gov/document/HTML/Volume2/23PHI.htm
(39) Merriam Webster Dictionary. (January 31, 2003). Merriam Webster Online [On-line], Available: http://www.m-w.com/
(40) U.S. Department of Health and Human Services. (November, 2000). Healthy People 2010: Understanding and Improving Health: Public Health Infrastructure Terminology [On-line], Available: http://www.healthypeople.gov/document/HTML/Volume2/23PHI.htm
(41) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(42) Ibid.
(43) Ibid.
(44) Ibid.
(45) Ibid.
(46) U.S. Department of Health and Human Services. (November, 2000). Healthy People 2010: Understanding and Improving Health: Public Health Infrastructure Terminology [On-line], Available: http://www.healthypeople.gov/document/HTML/Volume2/23PHI.htm
(47) Agency for Healthcare Research and Quality. (August 2002). Healthcare Cost and Utilization Project (HCUP), 1988-2000 [On-line], Available: http://www.hcup-us.ahrq.gov/overview.jsp
(48) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line] Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(49) Minnesota Department of Human Services. (January 14, 2003). HIPAA Definitions/Concepts [On-line], Available: http://www.dhs.state.mn.us/hipaa/HIPAA_definitions.htm
(50) Workgroup for Electronic Data Interchange. (February 12, 2003). A HIPAA Glossary [On-line], Available: http://www.wedi.org/public/articles/hipaa_glossary.pdf
(51) Health Level 7. (January 15, 2003). What is HL7? [On-line], Available: http://www.hl7.org
(52) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(53) Health Resources and Services Administration (February 6, 2003). About HRSA [On-line], Available: http://www.hrsa.gov/about.htm
(54) U.S. Department of Health and Human Services. (November, 2000). Healthy People 2010: Understanding and Improving Health: Public Health Infrastructure Terminology [On-line], Available: http://www.healthypeople.gov/document/HTML/Volume2/23PHI.htm
(55) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(56) Indian Health Service (October 16, 2002). Indian Health Service Fact Sheet [On-line], Available: http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/ThisFacts.asp
(57) Minnesota Department of Human Services. (January 14, 2003). HIPAA Definitions/Concepts [On-line], Available: http://www.dhs.state.mn.us/hipaa/HIPAA_definitions.htm
(58) Centers for Disease Control and Prevention, National Center for Health Statistics. (July 24, 2000). National Vital Statistics Reports, Table 27 - Infant, neonatal, and postneonatal mortality rates by race and sex: United States, 1940, 1950, 1960, 1970, and 1975-98. Vol. 48, No. 11
(59) Merriam Webster Dictionary. (January 31, 2003). Merriam Webster Online [On-line], Available: http://www.m-w.com/
(60) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(61) Ibid.
(62) Ibid.
(63) Ibid.
(64) Ibid.
(65) Ibid.
(66) Ibid.
(67) Ibid.
(68) U.S. Department of Health and Human Services. (November, 2000). Healthy People 2010: Understanding and Improving Health: Public Health Infrastructure Terminology [On-line], Available: http://www.healthypeople.gov/document/HTML/Volume2/23PHI.htm
(69) National Association of County and City Health Officials (October 2001). LPHA Infrastructure, A Chartbook, pp.9.
(70) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(71) Agency for Healthcare Research and Quality (October 2002). Overview of the MEPS Web Site [On-line], Available: http://www.ahcpr.gov/data/mepsweb.htm
(72) Greenberg, Marjorie and Gib Parrish. (December 2002). Standards and Their Use in Health Statistics: Unpublished draft paper.
(73) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(74) U.S. Census Bureau. (January 30, 2003). U.S. Census Bureau State and County Quick Facts. [On-line], Available: http://quickfacts.census.gov/qfd/meta/long_metro.htm
(75) The National Association of County and City Health Officials. (January 31, 2003). About NACCHO. [On-line], Available: http://www.naccho.org/about.cfm
(76) National Center for Health Statistics. (January 31, 2003). About NCHS. [On-line], Available: http://www.cdc.gov/nchs/about.htm
(77) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(78) Ibid.
(79) Centers for Disease Control and Prevention. (December 9, 2002). Description of the NEDSS Base System. [On-line], Available: http://www.cdc.gov/nedss/BaseSystem/NEDSSBaseSysDescription.pdf
(80) Centers for Disease Control and Prevention. (July 27, 2001). Updated Guidelines for Evaluating Public Health Surveillance Systems. Recommendations from the Guidelines Working Group. MMWR July 27, 2001/ 50(RR12); 1-35 [On-line], Available: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm
(81) Yasnoff, William A. (December 2, 2002). National Health Information Infrastructure (NHII): Presentation at the National Association of Health Data Organizations Annual Meeting.
(82) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(83) Centers for Disease Control and Prevention, National Center for Health Statistics (August 31, 2002). National Health Interview Survey [On-line], Available: http://www.cdc.gov/nchs/about/major/nhis/hisdesc.htm.
(84) Centers for Disease Control and Prevention, National Center for Health Statistics (December 14, 2002). National Hospital Discharge Survey: 2000 Annual Summary With Detailed Diagnosis and Procedure Data [On-line], Available: http://www.cdc.gov/nchs/products/pubs/pubd/series/sr13/160-151/sr13_153.htm
(85) National Institutes of Health (January 28, 2003). About NIH [On-line], Available: http://www.nih.gov/about/
(86) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf
(87) U.S. Department of Health and Human Services. (November, 2000). Healthy People 2010: Understanding and Improving Health: Public Health Infrastructure Terminology [On-line], Available: http://www.healthypeople.gov/document/HTML/Volume2/23PHI.htm
(88) The National Committee on Vital and Health Statistics. (July 6, 2000). NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record Information [On-line], Available: http://ncvhs.hhs.gov/hipaa000706.pdf<