Glossary

Case Management Modeling and Notation “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.” Visual Paradigm. (n.d.). What is case management and modeling notation (CMMN). Retrieved March 12, 2024, from https://www.visual-paradigm.com/guide/cmmn/what-is-cmmn/

A case presentation is a formal communication between health care professionals (e.g., physicians, pharmacists, nurses, therapists, nutritionists) providing 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.

Clinical Decision Support (CDS) Connect is a freely available web-based platform, including an authoring tool and a repository, enabling the CDS community to identify evidence-based care, translate and codify information into an interoperable health information technology standard, and leverage tooling to promote a collaborative model of CDS development.

Clinical Decision Support (CDS) Hooks is a Health Level Seven International® (HL7®) specification managed by the HL7 Clinical Decision Support (CDS) Workgroup providing a way to embed additional, near real-time functionality within a clinician’s workflow of an electronic health record. A specified event(s) within the clinician’s workflow triggers the CDS service, which gathers the appropriate specified data elements through secure Fast Healthcare Interoperability Resources® (FHIR®) services. By utilizing FHIR services, CDS Hooks provides interoperability between multiple stakeholders operating on different platforms.

The FHIR service app can return appropriate guidance, such as proposed alternative medication or formulary information. CDS Service vendors can test CDS Service functionality using the CDS Hooks Sandbox. More advanced functionality is under development, such as the multi-interested party Da Vinci Burden Reduction Project and provides use cases for alerts/notifications, prior authorization, and document exchange. The Agency for Healthcare Research and Quality's CDS Connect Project provides a web-based platform to assist with development of CDS artifacts and CDS Hooks.

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. CMS conducts the CRP through the Office of the National Coordinator for Health Information Technology Project Tracking System (Jira) website. The goal of the CRP is for eCQM implementers to comment on the potential impact of changes to eCQMs so 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 the eCQM developer posts specific CRP tickets for public comment and voting. Users can sign up for an account on the login in page.

Certified Health Information Technology (IT) Product List (CHPL) is a comprehensive and authoritative listing of all health IT modules certified by the ONC Health IT Certification Program. All products listed are tested by an ONC-Authorized Testing Lab (ONC-ATL) and certified by an ONC-Authorized Certification Body (ONC-ACB) to meet criteria adopted by the Secretary of the Department of Health and Human Services (HHS). For additional information on how to navigate the CHPL, please refer to the CHPL Public User Guide.

ClinFHIR is an open-source tool providing an educational environment and also allows health information technology developers to create or search for Fast Healthcare Interoperability Resources® (FHIR®)-based resources. It serves as a training tool to help people wanting to learn more about FHIR visualize how the parts combine to represent clinical information in a structured and coded manner. It also serves as a development tool with features to build some of the required artifacts, particularly as an aid to learning.

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

Clinical decision support alert fatigue occurs when a clinician, 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.

The most commonly implemented clinical decision support (CDS) alerts prompt clinicians about guidance, e.g., drug-allergy, drug-drug, and drug-disease warnings, or provide dosing guidance. 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 or other functions of the electronic health records.

Clinical decision support (CDS) artifacts are items representing 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. CDS artifacts are found in the Repository. A variety of organizations, including federal agencies, contribute CDS artifacts to the Repository and they span a number of topics including anatomy, health care, and diseases.

A clinical decision support (CDS) developer is an individual or organization that translates knowledge to a structured and/or executable tool aiding in making evidence-informed decisions about a patient’s health care. CDS developers may or may not be the original knowledge authors (e.g., guideline developers, subject matter experts) or the final implementers. They ensure 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.

Clinical decision support (CDS) implementation activities refer to configuration, customization, and other needed steps for health information technologies to function for a specific organization or group of end-users. For example, with CDS, the local implementation will consider end-user workflows to identify the points at which to present the CDS, determine which data fields in local databases will map to data fields that drive the CDS, and educate end-users about important features of the CDS. Typically, this involves translation of guideline recommendations from L3 to L4 or other local adaptation (localization) (See Levels of knowledge representation for CPG).

Clinical Document Architecture (CDA) is a popular, flexible markup standard developed by Health Level Seven International® defining the structure of certain patient medical records, such as discharge summaries and progress notes, as a way to better exchange this information between health care providers and patients. Wallask, S. (n.d.). Clinical document architecture (CDA). TechTarget: Health IT. Retrieved March 12, 2024, from https://searchhealthit.techtarget.com/definition/Clinical-Document-Architecture-CDA

Clinical information systems "are computer systems that provide immediate access to current patient data regarding clinical notes, medication history, laboratory reports, images, and reports either directly or via data networks. They are parts of a hospital information system, which facilitates direct patient care." Islam, M. M., Poly, T. N., & Li, Y-C. J. (2018). Recent advancement of clinical information systems: Opportunities and challenges. Yearbook of Medical Informatics, 27(1), 83–90. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0038-1667075

Clinical practice guidelines (CPGs) are systematically developed statements to assist clinician 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. Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. (2011). Clinical practice guidelines we can trust. Institute of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK209539/pdf/Bookshelf_NBK209539.pdf  

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

CMS Measures Inventory Tool (CMIT) is the repository of record for information about CMS quality measures. CMS and its partners use the inventory to inform stakeholders, manage its measure portfolio, and guide measure development. The functions allow users to find measures quickly, compile and refine sets of related measures, identify measures across the continuum of care, and help coordinate measurement efforts across all conditions, settings, and populations.

The CMS consensus-based entity (CBE) assigns the CMS CBE identification number to a measure that has successfully gone through the CBE endorsement process. The CMS CBE Submission Tool and Repository (STAR) is the database of record of CBE-endorsed measures. 

The Medicare Improvements for Patients and Providers Act of 2008 requires the U.S. Department of Health and Human Services to contract with a consensus-based entity (CBE) regarding performance measurement. The CMS CBE endorses quality measures through a transparent, consensus-based process incorporating feedback from diverse groups of interested parties to foster health care quality improvement.

The CBE also convenes multi-interested party groups to discuss the Measures Under Consideration List as part of the pre-rulemaking process and reviews CMS's existing measure portfolio for possible change recommendations.

The CMS Data Element Library (DEL) is the centralized resource for CMS assessment instrument data elements (e.g. questions and responses) and their associated health information technology standards. It currently includes CMS's post acute care assessment instruments.

When a measure developer creates a new electronic clinical quality measure in the Measure Authoring Development Integrated Environment (MADiE), MADiE assigns the CMS eCQM identification to the new measure. The CMS eCQM ID is an essential data element when submitting eCQM data to CMS.

A CMS Electronic Health Record (EHR) Certification ID is a number generated by the Certified Health Information Technology (IT) Product List (CHPL) and used for reporting to CMS. It represents a single product or combination of products in the CHPL. The CMS EHR Certification ID is different from the CHPL product number. In the CHPL, this is the number generated when the hospital/clinician selects EHR Certification ID for a suite of products making up the hospital's/clinician's EHR solution. If a product changes, then a different CMS EHR Certification ID will be generated. The CMS EHR Certification ID is only unique to the product suite. If two different hospitals/clinicians happen to use the same products, then they will both have the same CMS EHR Certification ID.

CMS requires the CMS EHR Certification ID in several of its quality reporting programs. Check with individual quality reporting programs for requirements.

The CMS Measures Under Consideration Entry/Review Information Tool (CMS MERIT) is the web-based data collection portal allowing measure developers to submit candidate measures to CMS for consideration. The Tool walks the submitter through the process of providing information. Each submitter has a dashboard allowing them to track the progress of their submitted measure and to communicate with CMS through the comment function. The Tool also provides a view of all measures submitted for the current year. Another purpose of CMS MERIT is to give federal officials, the consensus-based entity multi-stakeholder groups, and other stakeholders more information as they review measures.

The CMS Measures Management System (MMS) Hub is a resource providing information about the MMS, guidance for measure developers (content previously found in the Blueprint), and quality measure-related news and events. It includes information on measure development, measure implementation, measure maintenance, tools, templates, opportunities to participate in public comment and technical expert panels, and more.

The CMS National Quality Strategy (NQS) is a long-term initiative with the aim to promote the highest quality outcomes and safest care for all individuals. The CMS NQS has four priority areas: Outcomes and Alignment, Equity and Engagement, Safety and Resiliency, and Interoperability and Scientific Advancement. 

The CMS Quality Reporting Document Architecture (QRDA) Implementation Guides (IGs) are based on the Health Level Seven International® QRDA IGs. The CMS QRDA Category I IG is used for Hospital Inpatient Quality Reporting, Hospital Outpatient Quality Reporting, and the Medicare Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals. The CMS QRDA Category III IG is used for the Eligible Clinician programs addressing aggregate reporting requirements for Primary Care First, traditional Merit-based Incentive Payment System (MIPS) programs, Alternative Payment Model Performance Pathway, and MIPS Value Pathway.

The CMS Quality Reporting Document Architecture (QRDA) Pre-Submission Validation Tools are resources offering QRDA validation tools available to submitters. The intent is to give users a single point of reference for these tools and assist them in selecting the most appropriate tool to meet their individual needs. The tools cover

• Cypress
• Hospital Quality Reporting System via Healthcare Quality Information System (HCQIS) Access Roles and Profile (HARP)

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

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.

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

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 Hub, or some other document. The Administrative Procedure Act requires federal agencies to give the public an opportunity to participate in rulemaking. Executive Orders 12866 and 13563 provide guidance noting 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 activities are the study and use of communication strategies to inform and influence individual and community decisions affecting 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 information, such as clinical guidelines to encourage their use and adherence. For more information see Centers for Disease Control and Prevention's Gateway to Health Communication.

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

Computable care guidelines are the expression of and sharing of health care guidelines in a grammar understood by a software application. Integrating the Health Enterprise. (n.d.). Computable care guidelines. Retrieved March 12, 2024, from https://wiki.ihe.net/index.php/Computable_Care_Guidelines

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

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 March 20, 2024, from https://learningcenter.unc.edu/tips-and-tools/using-concept-maps/

"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" (p. 46). For example, a work group member might have pharmaceutical stock for a vaccine recommended as part of a clinical guideline. Committee on Conflict of Interest in Medical Research, Education, and Practice. (2009). Conflict of interest in medical research, education, and practice. Institute of Medicine. https://doi.org/10.17226/12598

A continuous variable is a measure score in which each individual value for the measure can fall anywhere along a continuous scale and 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).

The Clinical Quality Framework (CQF) is a collaborative community of participants from the public and private sectors focused on providing tools, services, and guidance to facilitate the harmonization of standards for clinical decision support and electronic clinical quality measures use in clinical quality improvement.

The Clinical Quality Framework (CQF) Ruler comprises a collection of plugins tailored for the HAPI Fast Healthcare Interoperability Resources® (FHIR®) JPA server providing an implementation of the FHIR Clinical Reasoning Module for processing quality measures and serves as a knowledge artifact repository and clinical decision support service.

Clinical Quality Language (CQL) is a Health Level Seven International® mixed normative/standard for trial use and it is part of the effort to harmonize standards between electronic clinical quality measures and clinical decision support. CQL provides the ability to express logic that is human readable yet structured enough for processing a query electronically.

The Clinical Quality Language (CQL) Evaluation Engine is an open source Java-based evaluation engine capable of evaluating the result of any CQL expression. Note: this is a component in the CQL translator repository.

Clinical Quality Language (CQL) Execution Framework is a set of JavaScript libraries that can execute CQL artifacts expressed as JavaScript Object Notation Expression Logical Model.

The Clinical Quality Language (CQL) Formatting and Usage Wiki is a collaborative workspace for the development of CQL formatting conventions and usage patterns for the representation of logic within quality measures. All users have editing rights, able to submit edits, add comments and concerns. Items on the Wiki are a work in progress and subject to change.

A Clinical Quality Language (CQL) library is a container for artifact logic/expressions. A CQL library contains declarations which specify the items found in the library. Every electronic clinical quality measure has at least one CQL library. For more information, see the CQL Style Guide and the Health Level Seven International® CQL Author’s Guide.

Clinical Quality Language (CQL) Runner is an online platform for ad hoc testing of CQL.

The Clinical Quality Language (CQL) Style Guide provides standardized expressions of electronic clinical quality measure (eCQM) concepts across eCQMs and defines a uniform “look and feel” to eCQM logic using CQL. The CQL Style Guide focuses on a set of common best practices that have been implemented across CQL-based eCQMs in CMS quality reporting programs. The CQL Style Guide also promotes the use of consistent language within the framework of CQL, including libraries, aliases, definitions, and functions, and provides guidance on other conventions, such as operator precedence. eCQM stewards or developers who are developing or specifying eCQMs for potential inclusion in CMS reporting programs should follow these best practices.

The CQL-to-ELM Translator is an open-source reference implementation that translates the high-level Clinical Quality Language (CQL) syntax into the Expression Logical Model (ELM) representation. The reference implementation is used in support of Clinical Quality Framework implementations as a tool to enable CQL output to be uniformly and automatically translated into ELM XML or JavaScript Object Notation (JSON) documents for sharing and distribution to support implementation, integration, translation, and execution of CQL-based artifacts.

For more information or to get involved, visit the Clinical Quality Framework initiative page on the Health Level Seven International® website.

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) and a separate payment method. The Code of Federal Regulations lists the CoPs for CAHs at 42 CFR 485 subpart F.

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.

Crucible is a suite of open-source testing tools for Health Level Seven International® Fast Healthcare Interoperability Resources® (FHIR®) provided to the FHIR development community to help promote correct FHIR implementations. It currently can test for conformance to the FHIR standard, score patient records for completeness, and generate synthetic patient data.

Cypress, with the fully integrated Cypress Validation Utility + Calculation Check (CVU+), is an open source testing tool used by vendors to certify their electronic health records (EHRs) and health information technology (IT) modules for calculating electronic clinical quality measures (eCQMs). Cypress is an official testing tool for the ONC EHR Certification Program. Testing involves Cypress generating synthetic patient records for the subset of published eCQMs selected for certification and testing the ability of the EHR systems and health IT modules to accurately record, import, calculate, filter, and report eCQMs.

The Cypress Tech Talks are an open forum for discussing technical implementation and tool issues with the Cypress support team.