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Adverse drug events (ADEs): any injury due to medication Also, injuries caused by medications that are known and expected (e.g., drowsiness from diphenhydramine). They may be classified as preventable or unavoidable. Preventable adverse events are a subset of adverse events that are judged to have been avoidable if appropriate and reasonable steps had been taken. For example, an anaphylactic reaction to penicillin is an adverse event. It is a preventable adverse event if the patient's allergy to penicillin is noted in his or her chart or if the patient knows of his or her history of penicillin reactions and is capable of communicating it to the clinician.
Adverse drug reactions (ADRs): result in injuries that are-unavoidable and may be classified as type A or type B. Type A ADRs are known and need to be better quantified. They are usually predictable and dose dependent (e.g., respiratory depression with opiates). Type B ADRs are unknown and need to be quickly identified, quantified, and communicated. They are usually idiosyncratic (e.g., liver toxicity associated with troglitazone).
Adverse event: An adverse event is an injury caused by medical management, rather than by the underlying condition of the patient.
AHIC (American Health Information Community): AHIC is a federally-chartered commission that provides input and recommendations to the federal Department of Health and Human Services on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a smooth, market-led way.
AHIMA (American Health Information Management Association: AHIMA is a professional association that provides medical records professionals with educational resources and programs.
AMA (American Medical Association): The AMA is a legislative advocacy organization that unites physicians nationwide to work on important professional and public health issues.
AMIA (American Medical Informatics Association: AMIA is a professional group dedicated to the development and application of medical informatics in support of patient care, teaching, research, and health care administration.
American National Standards Institute (ANSI): a private nonprofit organization that coordinates the development and use of voluntary consensus standards in the United States. The Institute oversees the creation, promulgation and use of thousands of norms and guidelines that directly impact businesses in nearly every sector: from acoustical devices to construction equipment, from dairy and livestock production to energy distribution, and many more.
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CCR (Continuity of Care Record): CCR is a document standard that functions as an ongoing record of a patient’s care. The CCR is intended to foster and improve continuity and quality of patient care when a patient is referred, transferred, or otherwise goes from one provider to another. The CCR is a standard specification being developed by the Continuity of Care Record (CCR) Workgroup of ASTM International, Committee E31 on Health Informatics.
CHI (Consolidated Health Informatics): One of the 24 Presidential eGovernment initiatives with the goal of adopting vocabulary and messaging standards to facilitate communication of clinical information across the federal health enterprise, enabling all agencies to “speak the same language” based on common enterprise-wide business and information technology architectures.
CMS (Centers for Medicare and Medicaid Services): CMS is the federal agency that administers Medicare, Medicaid and the State Children’s Health Insurance Program (SCHIP). CMS, formerly known as HCFA, is part of the federal Department of Health and Human Services (HHS).
CPOE (Computerized Provider Order Entry): CPOE is a computer application that allows a physician’s orders for diagnostic and treatment services (such as medications, laboratory, and other tests) to be entered electronically instead of being recorded on order sheets or prescription pads. The computer compares the order against standards for dosing, checks for allergies or interactions with other medications, and warns the physician about potential problems.
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Drug Enforcement Administration (DEA) registration number system was implemented as a way to successfully track controlled substances from the time they are manufactured until the time they are dispensed to the patient. At the present time, however, the DEA number also is being used as a physician identifier by pharmacies for non-controlled substances, suppliers of durable medical equipment, and insurance companies for reimbursement purposes. Using the DEA number for purposes such as these could lead to the DEA number falling into the hands of people who sell and use drugs illicitly and could lead to use of the DEA number for fraudulent prescriptions
DICOM (Digital Imaging and Communications in Medicine: DICOM is a comprehensive set of standards for handling, storing and transmitting information in medical imaging. It includes a file format definition and a network communication protocol. This protocol is an application protocol, it uses TCP/IP to communicate between systems. DICOM files can be exchanged between two entities that have the capability to receive the information - image and patient data - in DICOM format.
Drug Utilization Review (DUR) – Study of drug prescriptions to evaluate a medication’s usage and cost-effectiveness; may also be used to analyze treatment choices by individual practitioners, to suggest alternative medications, or to update an organization’s drug formulary.
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EDI (Electronic Data Interchange): EDI is a direct exchange of data between two computers via the Internet or other network, using shared data formats and standards.
E-disease management: E-disease management is the use of Web-based technology in support of disease management to provide patient-clinician communication, patient access to information, and patient self management.
Electronic Signature - Identification of user that performed an action.
E-prescribing: The transmission, using electronic media, of prescription or prescription-related information between a prescriber, dispenser, pharmacy benefit manager, or health plan, either directly or through an intermediary including an e-prescribing network. Eprescribing includes two-way transmissions between the point of care and the dispenser. (Please note that these functions can be performed using single purpose software or e-prescribing functionality imbedded in a multifunctional system such as electronic health record.
Error: The failure of a planned action to be completed as intended (error of execution) or the use of a wrong plan to achieve an aim (error of planning). An error may be an act of commission or an act of omission.
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Fill Status: Informs when Rx filled, not filled, or partially filled. It includes provider, patient, and drug segments of SCRIPT message. Not yet generally used.
Final Standards: To be decided no later than April 1, 2008. Medicare sponsors will be required to transmit prescriptions to dispensing pharmacies and pharmacists in accordance with these standards.
Formulary and Benefit Information: This standard displays the formulary status and alternative drugs as well as co-pays and other status information.
Foundation Standards: standards proposed by DHHS secretary and standards organizations for which there is adequate industry experience; can be proposed as final standards without pilot testing, includes NCPDP Telecommunications, NCPDP SCRIPT for new prescriptions, prescription renewals, cancellations, and changes between prescribers and dispensers.
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HAN (Health Alert Network): HAN is a communication system used by the CDC to exchange disease information with state and local health departments.
HIPAA (Health Insurance Portability and Accountability Act): HIPAA is a federal law intended to improve the portability of health insurance and simplify health care administration. HIPAA sets standards for electronic transmission of claims-related information and for ensuring the security and privacy of all individually identifiable health information.
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Initial Standards: Standards for an electronic prescription drug program that the Secretary would adopt, develop, recognize, or modify before September 1, 2005, taking in consideration recommendations from NCVHS. They will be subject to pilot testing that will occur in AHRQ grant.
-M-
Medicare Advantage (MA) plans: Health plans offered by private insurance companies that contract with Medicare to provide Medicare coverage. Depending on where you live, Medicare Advantage plans may be available both with and without Part D plans. You may also hear Medicare Advantage plans referred to as Medicare health plans. The Medicare Advantage plans used to be called Medicare + Choice Plans.
Medicare Advantage prescription Drug plans (MA-PDs): This type of plan combines a
prescription drug plan with a Medicare Advantage plan that includes medical coverage for doctor's visits and hospital expenses.
Medication error: Any error occurring in the medication use process. Also, preventable, inappropriate use of medication including prescribing, dispensing, and administering. Or, as defined by the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP), any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Also, preventable events that may cause or lead to inappropriate medication use or patient harm; may be classified as potential or actual. Potential errors are defined as reports of confusion or an intuition that an error will occur in the future. They are not considered ADRs or ADEs. Actual errors may or may not reach the patient. Medication errors that reach the patient either cause harm or no harm.
Medication History (Hx): Standard that includes the status, provider, patient, coordination of benefit, and repeatable drug, request, and response segments of SCRIPT.
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National Council for Prescription Drug Programs (NCPDP): a not-for-profit NCPDP accredited Standards Development Organization headquartered in Scottsdale, Arizona. The organization provides a forum and support wherein its diverse membership can efficiently and effectively develop and maintain these standards through a consensus building process. It consists of over 1450 members who represent chain and independent pharmacies, consulting companies and Evaluation Report 112 April 2007 pharmacists, database management organizations, federal and state agencies, health insurers, health
maintenance organizations, mail service pharmacy companies, pharmaceutical manufacturers, pharmaceutical services administration organizations, prescription service organizations, pharmacy benefit management companies, professional and trade associations, telecommunication and systems vendors, wholesale drug distributors, and other parties interested in electronic standardization within the pharmacy services sector of the health care industry.
NCPDP Provider Identifier Number: widely accepted as the dispenser (pharmacy) identifier (there is no single identifier for prescribers). Its database contains information to support various claims processing functions, and it needs to continue to be available for this purpose. The NCPDP database can accommodate the National Provider Identifier (NPI) as a reference field. HIPAA requires the NPI, when it becomes available, to be used in the NCPDP Telecommunication Standard for claims processing. The National Provider System (NPS) enumerates pharmacy organizations, subparts of organizations at a particular address, and pharmacists.
NCPDP SCRIPT Change Request and Response: This the primary means by which a pharmacy may request of a provider a clarification, correction, or change in drug as a result of therapeutic substitution or other rationale.
NCPDP SCRIPT Cancellation: Cancels a prescription previously sent to a pharmacy. Not generally used at present.
NCPDP SCRIPT Fill Status: (see Fill Status)
NCPDP SCRIPT Formulary and Benefit Information: (see Formulary and Benefit Information)
NCPDP SCRIPT Medication History: (see Medication History)
NCPDP SCRIPT Standard: provides for the exchange of new prescriptions, changes, renewals, cancellations, and fill status notifications. Each function has varying degrees of industry experience. The NCPDP SCRIPT new prescription function is most widely used. The renewal function has good industry acceptance, represents an easy transition, and provides the most immediately apparent return on investment. The NCPDP SCRIPT Standard cancellation and change functions are currently underutilized. The NCPDP SCRIPT Standard allows for both free text in certain fields and choices of codes. The NCPDP SCRIPT Standard supports the following:
· New Prescription Transaction - A new prescription from a clinician to a pharmacy electronically.
· Prescription Change Request Transaction - From a pharmacy to a clinician asking for a change in the original new prescription.
· Prescription Change Response Transaction - From a clinician to a pharmacy approving/denying a prescription change.
· Cancel Prescription Request Transaction - From a clinician to a pharmacy requesting a previously sent prescription not be filled or the termination of current drug therapy regime.
· Cancel Prescription Response Transaction - From a pharmacy to a clinician on the status of a prescription cancellation.
· Refill Prescription Request Transaction - From a pharmacy to the clinician requesting additional refills on a prescription that has expired (continuation of therapy).
· Refill Prescription Response Transaction - From a clinician to a pharmacy that approves, denies or modifies the Refill Prescription Request.
· Prescription Fill Status Notification Transaction - From a pharmacy to a clinician when the prescription has been filled, partially filled, or not filled and returned to stock.
· Housekeeping transactions - Retrieve transactions from a mailbox, change password at a switch, verify a message has been received, etc.
NCPDP Telecommunication Standard: the HIPAA standard for eligibility communications between retail pharmacy dispensers and payers/PBMs.
NEDSS (National Electronic Disease Surveillance System: NEDSS is the CDC’s electronic network for disease reporting that links the agency with state public health departments.
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Part D Sponsors: health insurance plans offered by the government and private organizations that contract with Medicare: PDPs, fallback PDPs, Medicare Cost Reimbursement programs, MAs, MAPDs, some PACE Programs.
Pharmacy benefits managers (PBMs): private companies that administer pharmacy benefits and manage the purchasing, dispensing and reimbursing of prescription drugs. PBMs provide their services to health insurers or to large health care purchasers such as public employee systems, other government agencies and labor union trust funds. PBM services to their clients may include negotiating rebates or discounts from pharmaceutical manufacturers, processing claims for prescription drugs and negotiating price discounts from retail pharmacies. PBMs also develop formularies and manage utilization of drugs through prior authorization or utilization reviews. Many PBMs also operate mail order pharmacies or have arrangements to include prescription availability through mail order pharmacies. PBMs play a key role in managing pharmacy benefit plans in the Medicare drug program.
Prescription drug plans (PDPs): A stand-alone plan that offers prescription drug coverage only.
Prior Authorization: This is the portion of X12-278 that supports prior authorization. It required header information, requester, subscriber, utilization management, and other
relevant information.
Programs of All-inclusive Care for the Elderly (PACE): a new benefit of Medicare that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. PACE combines medical, social, and long-term care services for frail people. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than be institutionalized.
Prescriber: a physician, dentist, or other person licensed, registered, or otherwise permitted by the Evaluation Report 114 April 2007 U.S. or the jurisdiction in which he or she practices, to issue prescriptions for drugs for human use.
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ROI (Return on Investment): An ROI analysis means to evaluate an investment by comparing the magnitude and timing of expected gains to the investment costs.
RxNorm: a clinical drug nomenclature produced by NLM, in consultation with the FDA, VA, and HL7. It provides standard names for clinical drugs and for dose forms as administered. It also provides links from clinical drugs to their active ingredients, drug components, and most related brand names. It includes the semantic clinical drug (ingredient plus strength and dose form) and the semantic branded drug representation (proprietary, branded ingredient plus strength).
-S-
Script Standard - Standard for communication of prescription information into and out of the TouchWorks. New prescriptions can be communicated outbound to properly enabled systems, and requests for prescription renewals can be received inbound (subsequent responses to those requests can also be sent outbound).
SDO (Standards Development Organization): Standards Development Organization groups work cooperatively to develop voluntary national consensus standards in healthcare. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. SDOs are generally not-for-profit volunteer organizations whose members develop the standards.
SIG - Prescription disbursement. This Latin term, which is frequently used in medicine and pharmacy, means “label” or “let it be imprinted.”
SIG Messages: Indication, dose, dose calculation, dose restriction, route, frequency,
interval, site, administration time and duration, stop.
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Telemedicine: Telemedicine is that aspect of telehealth that encompasses all those interactions between a health care provider or their surrogate and a patient where there is a geographic and/or temporal separation.
Types of telemedicine:
· Teleconsultation is real time treatment analogous to an office visit;
· Store and Forward images are acquired at many different sites of care, stored in an information system, read and interpreted at other, sometimes remote sites by radiologists who then record their findings in the same system for others to view and use.. Used mostly in radiology, pathology and, increasingly, dermatology;
· Direct Asynchronous Communication is communication between the provider and patient (example: email or secure messaging systems) where there is an exchange of text messages.
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X12N 270/271: the HIPAA standard for eligibility and benefits communications between dentists, professionals, institutions, and health plans.
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