Healthcare Systems and Health Information Management Study Guide

Vocabulary practice flashcards covering fundamental healthcare systems, continuum of care, insurance models, regulatory standards, patient safety, and health information management concepts.

Continuum of care

Matching a person's changing health needs with the appropriate type and intensity of care, within or across organizations.

Primary care

First contact care that provides general, preventive, and routine services, such as a family doctor treating a common infection.

Secondary care

Specialist care, such as an evaluation of heart symptoms by a cardiologist.

Tertiary care

Advanced specialized care for complex conditions, such as complex heart surgery or care at a major burn center.

Quaternary care

Highly complex, uncommon care often delivered at teaching or research centers, such as rare transplants or experimental specialized procedures.

Diagnostic services

Hospital department grouping dedicated to finding or identifying health problems, including laboratory, radiology, pathology, and cardiology.

Therapeutic services

Hospital department grouping that treats or supports patients, including nursing, pharmacy, physical and respiratory therapy, dietary, and dental services.

General services

Hospital department grouping providing administrative support, including health information management (HIM), billing, registration, HR, and patient education.

Public health

Field focused on populations and communities to prevent illness, control communicable and chronic diseases, improve sanitation, and reduce environmental hazards.

Occupational Safety and Health Administration (OSHA)

Federal agency typically under the Department of Labor that sets workplace safety and occupational health standards.

Centers for Disease Control and Prevention (CDC)

Agency responsible for disease monitoring, prevention recommendations, and public health guidance.

Centers for Medicare & Medicaid Services (CMS)

Agency that administers Medicare and collaborates with states to administer Medicaid.

Agency for Healthcare Research and Quality (AHRQ)

Agency producing research and evidence to improve healthcare quality and safety.

Managed care

Organized insurance and care arrangements intended to control costs and utilization while maintaining access and quality.

Health Maintenance Organization (HMO)

An organized insurer and provider arrangement that commonly requires primary care physician (PCP) gatekeeper referrals and utilizes capitation.

Independent Practice Association (IPA)

A network of independent clinicians contracted together that reimburses via capitation or fee-for-service.

Preferred Provider Organization (PPO)

A network of preferred doctors, groups, and facilities providing contracted rates or discounted fees, usually offering greater freedom to see specialists without referral.

Capitation

A set payment per enrolled patient per time period, independent of the number of covered encounters provided.

Fee-for-service

A healthcare payment method where separate reimbursement is issued for each qualifying service or procedure provided.

Prospective payment system (PPS)

A predetermined reimbursement method where the payment amount is generally established in advance based on specified classifications.

Diagnosis-related groups (DRGs)

Categories for classifying hospital inpatient stays for Medicare prospective payment, incorporating specific adjustments.

Tax Equity and Fiscal Responsibility Act (TEFRA)

A 1982 federal statute enacted by Congress as an important Medicare cost-control law.

Bylaws

A formal internal framework governing roles, responsibilities, staff processes, and privileges within a healthcare organization.

Licensure

Government-granted legal authority permitting an individual or facility to practice healthcare.

Accreditation

External review of a healthcare organization against established standards; commonly voluntary but carrying practical and legal implications.

Credentialing

The formal verification of a clinician's qualifications, including education, residency training, license, and sanctions.

Clinical privileging

Facility-level approval granting a practitioner permission to perform specific clinical procedures or activities.

Peer review

The professional evaluation of a clinician's quality of care and clinical performance by colleagues in the same field.

Hospital infection control committee

A multidisciplinary team that develops policies, monitors practices, and tracks trends or outbreaks to prevent and reduce healthcare-associated infections (HAIs).

HIPAA Security Rule

Federal regulation establishing administrative, physical, and technical safeguards for electronic protected health information (ePHI).

Interoperability

The capacity of different health information technology systems to exchange and meaningfully use information.

Health insurance exchange (HIX)

A marketplace established for individuals and groups to compare and purchase health insurance options.

Health information exchange (HIE)

The electronic sharing and transmission of clinical healthcare information across organizations.

Philanthropic foundations

Entities that distribute donated or grant funding to finance healthcare research, education, projects, and innovation.

To Err Is Human

A landmark 2000 National Academy of Medicine report focusing on strategies to reduce preventable medical errors.

Crossing the Quality Chasm

A 2001 National Academy of Medicine report calling for a broad redesign of the healthcare delivery system to close the quality gap.

American Health Information Management Association (AHIMA)

Professional association originally founded in 1928 as ARLNA that advances the HIM profession through education, credentials, advocacy, and standards.

Registered Health Information Technician (RHIT)

An AHIMA credential associated with associate-level study, certifying technical competence in managing health information operations.

Registered Health Information Administrator (RHIA)

An AHIMA management and administration credential associated with bachelor-level HIM study.