Glossary of Healthcare Terms: C

CABG

Coronary Artery Bypass Graft.

Cabulance

A a taxi cab conveying pregnant woman, in labor, to the hospital.

CAD

Coronary Artery Disease.coronary artery bypass graft (CABG)

Call Center

A central hub for receiving calls and routing callers to the appropriate resources. In healthcare, call centers can be used to offload non-emergency callers, link consumers to educational messages, or route them to physician scheduling systems. Call center technology combined with expert systems also can help attending caregivers make triage decisions for after hours calls.

Capitation

Refers to risk sharing schemes wherein a provider agrees to provide all care for each member at a flat rate (per month). The provider goes at risk for the entire expense, in effect becoming a co-insurer for its members.

Capitation can also refer to a set amount of money received or paid out. It is based on membership rather than on services delivered and is usually expressed in units per-member-per-month (see PMPM).

CareMax^SM

McKessonHBOC

’s CareMax network was designed specifically to help independent pharmacies operate more effectively in a managed care environment. McKessonHBOC

contracts with managed care organizations for the benefit of CareMax members, freeing them of the burden of having to handle lots of administrative details themselves and helping them look like a chain to managed care organizations.

•	A nationwide network of independent pharmacists connected by OmniLink^SM
•	Provides access to new managed care networks that require a single contract and single check reimbursement
•	Offers profitable new programs to enhance patient care
•	Includes all the benefits of OmniLink and Valu-Rite^SM membership

Not only does this save time and improve patient care, but the CareMax network helps independent pharmacies position themselves competitively for the future.

Keeping up with competition and administrative details are daunting challenges in today’s increasingly complex managed care environment, especially for pharmacies that must meet compliance requirements and deliver quality patient care. In the past four years 12% of independent pharmacies have sold out to competitors or closed their doors. Managed care organizations are definitely driving the marketplace today and to help independent pharmacies compete McKessonHBOC

developed OmniLink and the CareMax.

Carrying Cost

Cost of carrying inventory (invested capital, handling, insurance, storage.) Usually defined as a percent of the dollar value of inventory per unit of time (usually one year). Such costs in hospitals vary from 25-35% annually (circa 1996).

Carve-in

Carve-in programs limit capitated rates to a subset of services. An organization may decide to be aggresive and carve-in, at a competitive rate, a subset of healthcare care services that are considered commodities in a region.

Carve-out

Carve-out programs exclude certain services from an organization’s capitated rate. A provider who is strong or otherwise has a lock in a specialty or a disease in a region can usually negotiate a carve out for services in that specialty (thus, preserving profitability).

Case

See Patient Case.

Case Cart

A group of supplies used for a specific procedure. See exchange cart and PAR Area/PAR Level.

Case Management

A process established by employers and insurance companies (payors) to control (reduce) healthcare costs.

The case manager controls all healthcare matters for one a patient, including specialists, hospitalizatin, tests, etc.

Case Mix

The classification of patient population based on age, gender, and such factors as type and severity of illness and resources for treatment. Used For Diagnosis related groups DRGs, patient classification, severity of illness classification, etc.

Case Size

This field is used as a divisor. The labeler’s catalog case price is divided by the case size to calculate the trade container price.

CAT

Computed Axial Tomography. See CT.

Catalog Number

A vendor’s identification number describing an inventory item.

CBC

Complete Blood Count.

Chief Complaint. This the main reason a patient seeks medical help.

CCD

Common Category Database. Defunct product catalog and product coding scheme promulgated by HIBCC, implemented by IMS, Philadelphia, PA.

CCOW

Clinical Context Object Workgroup

. At this time (ca. April 2000) this standard is Web-hostile.

CDC

Center for Disease Control

and Prevention.

CDM

Charge Description Master. This is essentially a price list outlining the procedures performed in a hospital and the charges associated with each. Same as CRT. See also CPT

CDSS

Clinical Decision Support System

CDT

Current Dental Terminology. A listing of descriptive terms and identifying codes developed by the American Dental Association (ADA) for reporting dental services and procedures to dental benefits plans.

CEA

Cost-Effectiveness Analysis.

CEN TC 251

Comitteé Européen de Normalisation

, created in 1961 to prevent technical barriers to trade. CEN accomplishes this by the dissemination of information on standardization work in Europe.

CEN TC 251 is the technical committee responsible for the organization, coordination and monitoring of the development and promulgation of standards in healthcare informatics.

Central Supply

Central Supply is the processing and distribution department for a hospital for medical and surgical supplies. They process all instruments for sterilization and equipment decontamination. In addition, they dispense supplies usually in the smallest unit of issue. The pharmacy usually handles the distribution of drugs.

CHAMPUS

Civilian Health and Medical Program, Uniformed Service

is a health benefits program covers medical necessities only. It provides authorized in-patient and out-patient care from civilian sources, on a cost-sharing basis. Retired military are eligible as well as dependents of active-duty, retired and deceased military.

This benefit was recently replaced by Tricare.

CHAMPVA

Civilian Health and Medical Program, Veteran Affairs

is a healthcare benefits program for

1.	Dependents of veterans who have been rated by VA as having a total and permanent disability
2.	Survivors of veterans who died from VA-rated service-connected conditions, or who at the time of death, were rated permanently and totally disabled from a VA-rated service-connected condition
3.	Survivors of persons who died in the line of duty and not due to misconduct

Due to the similarity between CHAMPVA and TRICARE (formerly known as CHAMPUS), the two programs are easily and often mistaken for each other. However, they are separate programs and that there are distinct differences between them.

Charge

Total charge of one unit of an inventory item.

Charge Code

Also called “Charge Number” or “Charge Code Number.” A number or other identifier assigned by a hospital’s financial department to some product, service, or event for which there is some charge to the patient or their health plan.

Charge codes may refer to a unit of an NDC or to other costs (e.g., one minute of physical therapy). Only NDCs in use by a hospital will have a charge code.

CHD

Coronary Heart Disease.

CHIM

Center for Healthcare Information Management

CHIME

College of Healthcare Information Management Executives

CHIN

Community Health Information Network

CICU

Cardiac Intensive Care Unit (see ICU).

CISA

Certified Information System Auditor.

CIT

Critical Incident Traning.

Class of Trade

COT.

Claim

A request (usually via a provider) to a patient’s health insurance plan for payments for healthcare services provided. See Denial of Claim.

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 clearinghourse acts as a fact-checker and data format translator.

CLIMS

Clinical Laboratory Information Management Systems. Used for receiving clinical orders for laboratory services and for delivering the results.

Clinical Best Practices

Those clinicians and procedures that produce the highest quality of care at agreeable costs.

Clinical Data Repository

Clinical Data Repository. For example,

•	IDX (neé PHAMIS)
•	3M
•	OACIS

Clinical Decision Support

The use of information to help a clinician diagnose and treat a patient's health problem, including information about the patient and information about the kind of health problem afflicting the patient and alternative tests and treatments for it.

Clinical Information System

Hospital-based information system designed to collect and organize data related to the care given to a patient, rather than administrative data.

Clinical Integration

The degree of integration and coordination of patient care across operating units of an IHDN. Clinical integration subsumes both horizontal and vertical integration.

Clinical Outcomes

The results of a treatment plan (e.g., “the patient died”).

Clinical Pathways

A treatment plan of care (i.e., a protocol workflow) against which progress is measured. A clinical pathway shows exact timing of all key patient care activities intended to achieve expected outcomes within designated time frames. This includes documentation of problems, expected outcomes/goals, and clinical interventions/orders.

See Clinical Protocol.

Clinical Practice Guideline

An outline of broad parameters for the diagnosis, treatment, prevention, or rehabilitation of a particular health problem.

Clinical Protocol

A rigorous, detailed model of the process of care for a particular health problem. See Clinical Pathways.

Clinicians

The care provider staff, including pharmacists, nurses, internists, therapists, etc.

Closed Requisition

A supply requisition that has been printed, sent to the vendor and replenished completely.

CME

Continuing Medical Education.

CMMS

As of July, 2001, incoming agency Secretary Tommy Thompson changed the name of the Health Care Financing Administration, to “Centers for Medicare and Medicaid Services.” So HCFA is now CMMS (from an acronym to an abbreviation).

In any case, this still is the Federal agency that manages Medicare, Medicaid and Child Health.

CMN

Certificate of Medical Necessity.

CMP

Competitive Medical Plans.

CNM

Certified Nurse Midwife. See also other Nursing Titles.

COAS

Clinical Observation Access Service. The CORBAmed standard interface to integrate clinical information in a distributed enterprise.

COB

Coordination of Benefits. When a patient carries more than one type of health insurance, insurers and health plans use this verification system to figure which part of the claim should go to which payor and to make sure the same claim is not paid twice..

COBRA

The Consolidated Omnibus Budget Reconciliation Act of 1985. It requires group insurance plans of more than 20 employees to continue to offer health insurance for you and your family for 18 months after you leave your job. If you opt for this coverage, you pay the premium. See also EMTALA.

COBRANDING

Refers to the joint branding of a web page or section of a consumer health web site between two or more corporate entities or individuals. Co-branding may involve the joint operation of services, health information content or products that appear on a consumer health web site

[Source: Hi-Ethics Coalition

COI

See Complexity of Illness.

COLD

Computer Output to Laser Disk.

Columbia Bay Area Healthcare

Formerly known as Good Samaritan Health System, it is made up of,

•

four hospitals

•	San José Medical Center
•	Good Samaritan Hospital
•	Mission Oaks Hospital, in San José
•	South Valley Hospital, in Gilroy

•

two surgery centers

•

one home healthcare center

•

a partridge in a pear tree

They provide care for about 60,000 lives in the South Bay. Thomas May, formerly of UniHealth, is its CEO (ca. April 2000).

Complexity of Illness

Complexity of Illness (COI) is a numerical assessment of complexity assigned to a case after discharge. It is usually measured on a 1-to-4 scale, with 1 being the least complex,

Code	Description
1	Minor
2	Moderate
3	Major
4	Extreme

The state of California mandates the use of APR-DRG and the 1-to-4 COI measure; hospitals in other states, however, may use other COI ranges.

Compliance

Refers to the following of rules governing the dispensing and purchasing of pharmaceuticals within a provider network. For dispensing (prescriptions), this is compliance to a formulary. For purchasing, this is compliance to a contract established with either a GPO or a pharmaceutical manufacturer.

Computer-based Patient Record

The Computer-based Patient Record (CPR) is a compilation of non-redundant, longitudinal health data about a person across a lifetime, including facts, observations, interpretations, plans, actions, and outcomes.

Health data includes information on,

•	allergies,
•	history of illness and injury,
•	functional status,
•	diagnostic studies,
•	assessments,
•	orders,
•	consultation reports,
•	treatment records

It also includes wellness data such as

•	immunization history,
•	behavioral data,
•	environmental information,
•	demographics,
•	health insurance,
•	administrative data for care delivery processes,
•	legal data such as consents.

The who, what, when, and where of data capture are also identified.

In addition to physical health information, these records may also include infomation about,

•	family relationships,
•	sexual behavior,
•	substance abuse,
•	private thoughts and feelings collected during psychotheraphy.

The Institute of Medicine

of the National Academy of Sciences

has developed a very specific definition of a Computer-based Patient Record

. Accordingly, the system must meet the following requirements,

•	Must be longitudinal; it must be linked with other clinical records, and must follow a patient from cradle to grave
•	Must assist in the process of clinical problem-solving and provide convenient access to authorized users at all times
•	Must enable providers to evaluate and manage the quality and costs of care
•	Must support a massive, flexible database in a complex hospital environment and adequately address the problems of direct data entry by healthcare providers
•	Must provide clinicians with an accessible, intelligible assembly of clinical data that characterizes the condition, prior management and current treatment plan of a patient
•	Must provide a clearly defined and well-organized database to permit epidemiological assessment of patient outcomes and patterns of practice, revealing merits of management strategies in specific clinical contexts
•	Must provide interactive decision support tools based on information derived from critically analyzed population data
•	Must decrease administrative record keeping and form submission responsibilities that burden healthcare providers

According to one source, the complete health record, includes the following,

•	Identification
•	Insurance Policies
•	Contacts
•	Problems
•	Birth Data
•	Growth and Development
•	Medical History

•	Surgical History
•	Obstetrical History
•	Dental History
•	Medications
•	Allergies
•	Vaccinations
•	Screening Tests

•	Family Genetics
•	UnHealthy Habits
•	Travel History
•	Enviromental Risks
•	Review of Systems
•	Eye Information
•	Devices and Prosthesis

•	Vital Signs
•	Physical Exam
•	Health Maintenance
•	Chart
•	Laboratory Studies
•	Imaging Studies
•	Healthcare Documents
•	Other

The table below gives an excellent comparison of terms that are thrown around loosely in healthcare. It appeared in the article “Defining the CPR,” by Richard S Dick, PhD, and William F Andrew, PE in the April 1999 issue of ADVANCE for Health Information Executives

Comparison of Criteria
This comparison of criteria among the PPR, EMR/EPR and CPR is intended to help define various terms used interchangeably in the health care information management marketplace. The basis for comparison is the IOM's 1991 study report (revised 1997) on the CPR. Note that the ERM/EPR is recognized as a transitional technology facilitating the evolution of a robust CPR — the ultimate vision of the IOM. The EMR/EPR will remain, in an ever-increasing capacity, a supplemental component technology of the CPR designed to provide historical support for the CPR.
Criteria	PPR	EMR/EPR	CPR
Clinical data dictionary	No	No	Yes
Standardized vocabulary	No	No/Partial	Yes
Technology standard	No	No/Partial	Yes
Nosology and coding structure	No	No/Partial	Yes
Standard codes	No	No/Partial	Yes
Messaging standard	No	Yes	Yes
Structured data	No	No	Yes
Unstructured data	Yes	YEs	Supported
Machine readable	No	Yes	Yes
Clinical documentation	Manual	Paritla/Computer	Online
Clinical decision support	No	No	Yes
Management analysis	No	Rare	Yes
Access to remote databases	No	No	Yes
Feedback support	No	Rare	Yes
Document imaging - scanned	No	Yes	Supported
Document imaging - imported	No	Yes	Supported
Document imaging - COLD	No	Yes	Supported
Diagnostic imaging	No	Supported via communication	Supported
Full motion video (video conferencing, ultrasound, etc.)	No	Supported	Supported
Dictation	Transcription	Partial/Scanned	Supported
Voice files	No	Supported	Supported
Audio files	No	Supported	Supported
Signal tracings	No	Supported	Supported
Secured access	Limited	Yes	Yes
Customized views	Limited	Yes	Yes
Meets all current and anticipated legal and administrative standards for medical records	Yes	Yes	Not currently
Legal patient record	Yes	Yes, state-by-state	Future
Note: This list is not all-inclusive. You may find additional applicable criteria. Please direct your comments to William F. Andrew, PE, at 941.299.4767.

Co-insurance

The amount that you pay, as a portion of your bill, in a fee for service or PPO insurance plan. This amount is usually expressed as a percentage of the total — if the insurance company pays 80% of the claim, you pay 20% of co-insurance. This can be paid out-of-pocket or with another insurance policy (hence the name).

This method of splitting the bill does not come into effect until you have paid your full deductible.

Co-pay

The amount paid by patients every time they use medical services or get prescription drugs.

Co-insurance -- The amount you are required to pay, as a portion of your bill, in a fee for service or PPO medical plan. This amount is usually expressed as a percentage of the total -- if the insurance company pays 80 percent of the claim, you pay 20 percent. This method of splitting the bill does not come into effect until you have paid your full deductible.

COPD

Chronic Obstructive Pulmonary Disease. According to the Virtual Hospital

Chronic obstructive lung disease is a disorder characterized by abnormal tests of expiratory flow that do not normalize with treatment and do not change markedly over time. Within this definition, the two major categories of disease are:

Emphysema Acondition of the lung characterized by an abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by the destruction of their walls, but without obvious fibrosis

Chronic Bronchitis Chronic or recurrent excess mucus production (for most days during at least three months during two consecutive years). Airways obstruction is implied in the definition

CORBA

The Common Object Request Broker Architecture. See OMG and CORBAmed

CORBAmed

CORBAmed

is the OMG’s Healthcare Domain Task Force. Its main goal is to adopt vendor-neutral common interfaces that:

•	Improve the quality of care and reduce costs by using CORBA technologies for interoperability throughout the global Healthcare community
•	Use the OMB technology adoption process to standardize interfaces for healthcare objects
•	Incorporate input from other healthcare standards organizations and consortia.

CORBAmed uses existing healthcare content standards such as HL7, UMLS, and CEN TC 251, and its design is based on ISO standard traslations for common middleware technologies including DCOM, Java, CORBA, and XML. CORBAmed 1.0 (ca. Nov 1999) includes PIDS, TQS, COAS, and RAD.

Cost

Total cost of one unit of an inventory item.

Cost-Effectiveness Analysis

A structured, comparative evaluation of two or more healthcare interventions.

Cost Shifting

Refers to the shifting of cost from public patients (e.g., Medicare, Medicaid) to private ones. This happens as a side effect of HCFA mandating lower length of stay (LOS) at healthcare institutions and of paying a percentage of charges rendered. These institutions in return raised their per-procedure and supply charges across the board, impacting private patients in addition to the (targeted) public patients.

COT

Class of Trade (COT) refers to a designation given to a healthcare provider facility as eligibility for a pricing plan. There are five classes of trade,

1.	Government
2.	Not for Profit (NFP)
3.	Alternate Care Site (e.g., Outpatient clinics, DINB, Hospice services)
4.	Extended Care
5.	Acute Care
6.	(Full) Retail

The cost of pharmaceuticals and medical & surgical supplies increases as you move from class one to class five. See Class of Trade.

CPI

Continuous Process Improvement.

CPR

1.	Computer-based Patient Record.
2.	“Cardio-Pulmonary Resuscitation” (better known as “Mouth-to-Mouth Resuscitation”).

CPS

Carte du Professionnel de Santé. An identification card for French healthcare providers; now a smart card.

CPT

Current Procedure Terms. A systematic listing and coding of healthcare procedures and services performed by clinicians. (The American Medical Association’s) CPT-4 refers to procedures delivered by physicians; (the American Dental Association

CPT-2 codes) CPT-2 refers to procedures delivered by dentists.

RRAs code CPTs from the patient’s chart. This code is then used as input to the calculation of DRGs or some other patient classification scheme (e.g., APR-DRG). In order to completely describe an event, one or more diagnosis codes (e.g., ICD-9s) must be assigned to it as well.