Clinigence Health Help Desk

Authoritative domain Since a domain can be thought of as a question or a property, and the domain items can be thought of as possible answers to the question or possible values of the property an authoritative domain is a domain created and maintained by an authority. Examples of authoritative domains: ICD-9, CPT, SNOMED, RXNorm.

Authority An entity that defines a program or set of data. For example, the Centers for Medicare & Medicaid Services (CMS) is the authority that defines the Meaningful Use program; the American Medical Association is the authority that defines and maintains CPT codes.

Branches (see Guideline Tree)

Class The subsets which are contained in a partition. Each partition will contain 2 or more mutually exclusive classes. For example, if a partition contains 2 classes: patients under 5 years old and patients 5 years old and older, then when that partition is applied to any patient and date/time, the patient will always be in one class or the other, and never both.

Code list A group of treatments, diagnoses or patient attributes used to qualify patients for a particular classification. Code lists are generally supplied by the authority that develops and maintains the program definition, such as CMA or BCBS. Example: The following items are from the code list for Blood Pressure Measurements

Complement Those patients who meet the criteria for the denominator of a measure, but do not meet the criteria for the numerator. In the top portion of the Measure Detail screen, the complement class is labeled "Patients Outside Target Criteria." In most cases, the patients in the complement class are those who will be candidates for an intervention.

Domain A domain can be thought of as a question or a property, and the domain items (or terms in the domain) can be thought of as possible answers to the question or possible values of the property.  For example, a domain might be "Gender" and the possible values might be "Male" and "Female".  Or the domain might be Smoking Status and the domain items might be "Smoker", "Non-Smoker", and 'Ex-Smoker".

Exclusion Some guidelines are defined with an Exclusion Class that reduces the number of patients counted in the denominator. If a patient meets the criteria for the exclusion class, they are excluded from the denominator so that those patients don't lower a provider's score on a specific measure. Examples of exclusions include existing diagnoses (like pregnancy) or previous procedures (like mastectomy).

Filter  A set of constraints which contain the information needed to determine if a patient's chart contains a specific "feature.” Filters determine whether or not a patient is included in a specific class.

Guideline A guideline consists of a set of measures which are usually but not always targeting a specific population (age or gender), specific medical condition (heart disease, diabetes) or a type of treatment (vaccinations). Examples: Childhood Immunization Status; Colorectal Cancer Screening

Guideline tree A set of partitions and relationships between the partitions.  Except for root partitions, each partition is related to a particular class in another partition (i.e its parent class).  Root partitions have no parent class.  When a guideline is applied to a set of patients, each patient “walks the tree” by starting in the root partitions, descending into one of its classes, jumping to its child partition and descending into one of its classes, and so on.  The end result is that each node in the guideline tree contains some subset of the original set of patients.  The specific subset can be thought of as a combination of all the criteria required to get through each partition.  For example one of the nodes in the guideline might contain the subset of all patients under 5 years old with at least one office visit within 12 months and a BMI which falls outside of the normal range.

Measure  A measure is a calculation, usually a percentage but sometimes a count or period of time.  Demographic and clinical rules define the details of the calculation.  For example, when the calculation is a percentage there are rules that determine which patients are eligible for the denominator and rules that determine which patients in the denominator also meet the numerator criteria. Example: Patients age 2-18 who received Influenza vaccine within 12 months

Nodes Since partitions can be re-used across multiple guidelines a node identifies a particular instance of a partition used in a specific guideline. For example, the partition for age >=18 years is reused in many guidelines and each instance of that partition is assigned a unique node ID.

Partition A set of specifications which, when applied to a patient and date/time, will classify the patient into precisely one of the classes which make up the partition.  For example, if a partition contains 2 classes: patients under 5 years old and patients 5 years old and older, then when that partition is applied to any patient and date/time, the patient will always be in one class or the other, and never both.

Process vs. Outcome There are two types of measures in the Clinigence application, process and outcome.

Process measures – Used to determine if the providers are following the protocol defined in the measure.

Program  The highest level in the reporting hierarchy, a program consists of a set of guidelines and rules which dictate guideline participation, goals, reporting, financial impacts, etc. Examples: PQRS 2013; Meaningful Use