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Case Management Modeling and Notation

Case Management Modeling and Notation (CMMN) is a graphical notation used for capturing work methods that are based on the handling of cases requiring various activities that may be performed in an unpredictable order in response to evolving situations. 

Case presentation

A case presentation is a formal communication between health care professionals (e.g., physicians, pharmacists, nurses, therapists, nutritionists) that gives a synthesis of a patient's clinical information. Components of a case presentation typically include: Identifying information; Reason for consultation/admission; Chief complaint (in the patient's own words); recent history, active medical problems, medications, allergies, social history, physical examination findings, relevant test results, assessment, and treatment plans.

CDS alert fatigue

“Alert fatigue” occurs when a provider, after receiving too many alerts or reminders, begins to override or ignore further alerts without attending to them, thus potentially decreasing the care improvements expected from the tools.

CDS Alerts

CDS alerts prompt clinicians about guidance, e.g., drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are the most commonly implemented. Passive CDS includes order sets, patient data reports, and documentation templates while active CDS includes rules and alerts usually delivered through computerized provider order entry (CPOE) or other functions of the electronic health records (EHRs). Two to four active rules and alerts are among the most recognized and widely used types of CDS.

CDS artifacts

CDS artifacts are items that represent medical knowledge from various knowledge sources (e.g., clinical guidelines, peer-reviewed articles, local best practices, and clinical quality measures). The artifacts can take many forms, but the goal is to create computable, interoperable translations using Clinical Quality Language (CQL). As of January 2020, there are 57 CDS artifacts found in the Repository. They span a number of topics including anatomy, health care, diseases, etc. and are contributed by a variety of organizations, including federal agencies.

CDS developer

A Clinical Decision Support (CDS) developer is an individual or organization that translates knowledge to a structured and/or executable tool that aids in making evidence-informed decisions about a patient’s healthcare. CDS developers may or may not be the original knowledge authors (e.g., guideline developers, subject matter experts) or the final implementers. They are responsible for ensuring accurate and consistent reflection of the original clinical knowledge in the appropriate standard coding schemes (e.g., Clinical Quality Language, and terminologies such as Current Procedural Terminology  and SNOMED CT), accounting appropriately for intellectual property and licensing.

Change Review Process

The Change Review Process (CRP) provides electronic clinical quality measure (eCQM) users the opportunity to review and comment on draft changes to the eCQM specifications and supporting resources under consideration by the measure steward. The CRP is conducted through the ONC Project Tracking System (Jira) website. The goal of the CRP is for eCQM implementers to comment on the potential impact of changes to measures so the Centers for Medicare & Medicaid Services (CMS) and measure stewards can make improvements to meet CMS’s intent of minimizing provider and vendor burden in the collection, capture, calculation, and reporting of eCQMs. To participate in the CRP, users must have a Jira account and log into the eCQM Issue Tracker where specific CRP tickets are posted for public comment and voting. Users can sign up for an account on the login in page.

Clinical decision support

Clinical decision support (CDS) is health information technology functionality that builds upon the foundation of an electronic health record (EHR) to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and healthcare.

Clinical Document Architecture

Clinical Document Architecture (CDA) is a popular, flexible markup standard developed by Health Level 7 International that defines the structure of certain medical records, such as discharge summaries and progress notes, as a way to better exchange this information between providers and patients.

Clinical Information Systems

A clinical information system (CIS) is an information system designed specifically for use in the critical care environment, such as the emergency department.  It can network with the many computer systems in a modern hospital, such as laboratory and radiology. It draws information from all these systems into an electronic health record.

Clinical Practice Guideline Representations or Expressions L1-L4

L1 Narrative:  the knowledge is human-readable and unstructured format. This knowledge can be used as an input for crafting policies or making decisions. The structure does not allow machines to utilize knowledge.

L2 Semi-structured:   This level has some structure. paveing the way for clinical domain experts to interpret. HUMAN READABLE

L3 Structured: This adds a machine-interpretable structure to the knowledge representation. Knowledge can be shared across settings and systems. There may be subjectivity in knowledge interpretation. COMPUTER READABLE

L4 Executable: This format enables not only machine-readable but also machine-executable based on the patient’s clinical context with a specific type of CDS tool., e.g., CLINICAL DECISION SUPPPORT

Clinical Practice Guidelines

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. CPGs are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. 

Clinical quality measure

A clinical quality measure (CQM) is a mechanism used for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in an optimal time frame. CQMs are a subset of the broader category of quality measures.

Code repositories

Code repositories are a file archive and web hosting facility that provides secure storage for code and version control. 

Code system

A code system is a managed collection of concepts with each concept represented by at least one internally unique code and a human readable description, e.g., SNOMED CT.

Coding system

A coding system is the symbolic arrangement of data or instructions in a computer program or the set of such instructions.

Comment period

A comment period is the period of time the public has to respond to a request for public comment, such as a proposed rule, Request for Information, a new measure posted on the Measures Management System website, or some other document. The Administrative Procedure Act requires that federal agencies give the public an opportunity to participate in rulemaking. Executive Orders 12866 and 13563 provide that a comment period generally should be no less than 60 days, but the length of the comment period varies if not part of the rulemaking process.

Communication or health communication activities

Communication activities are the study and use of communication strategies to inform and influence individual and community decisions that affect health. Health communications link the fields of communication and health and are increasingly recognized as necessary elements to improve personal and public health. Examples of communication activities include traditional (e.g., print through manuscripts, professional presentations, issue briefs, white papers, television, radio media) and non-traditional (e.g., social marketing techniques and social media platforms) methods of communication to present and disseminate the clinical guidelines and to encourage their use and adherence. Centers for Disease Control and Prevention. (n.d.). Gateway to health communication. Retrieved April 8, 2021, from

Composite measure

A composite measure is a measure that contains two or more individual measures, resulting in a single measure with a single score.

Computable care guidelines

Computable care guidelines are the expression of and sharing of health care guidelines in a grammar that is understood by a software application. Integrating the Health Enterprise. (n.d.). Computable care guidelines. Retrieved April 8, 2021 from

Computer code

Computer code is the symbolic arrangement of data or instructions in a computer program.

Concept maps

Concept maps are visual representations of information that can take the form of charts, graphic organizers, tables, flowcharts, Venn Diagrams, timelines, or T-charts. The Learning Center - University of North Carolina at Chapel Hill. (n.d.). Concept maps. Retrieved April 8, 2021, from

Conflict of interest (COI)

"A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest." For example, a work group member might have pharmaceutical stock for a vaccine that is recommended as part of a clinical guideline. Committee on Conflict of Interest in Medical Research, Education, and Practice. (2009). Principles for identifying and assessing conflicts of interest. In Lo, B., & Field, M. J. (Eds.), Conflict of interest in medical research, education, and practice (pp 44-61). Institute of Medicine, p. 46.

Continuous variable

A continuous variable is a measure score in which each individual value for the measure can fall anywhere along a continuous scale and can be aggregated using a variety of methods such as the calculation of a mean or median (for example, mean number of minutes between presentation of chest pain to the time of administration of thrombolytics).

Critical Access Hospital

A Critical Access Hospital (CAH) is a hospital in a federal program established in 1997 as part of the Balanced Budget Act designed to promote rural health planning, network development, and improve access to health services for rural residents. CAHs represent a separate provider type with their own Medicare Conditions of Participation (CoP) as well as a separate payment method. The Code of Federal Regulations lists the CoPs for CAHs at 42 CFR 485 subpart F.

Crowd sourcing

Crowd sourcing is a method to obtain information or input into a particular task or project by enlisting the services of a large number of people, either paid or unpaid, typically via the Internet.