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Patient Safety: Achieving a New Standard for Care B Glossary and Acronym List GLOSSARY Adverse event. An event that results in unintended harm to the patient by an act of commission or omission rather than by the underlying disease or condition of the patient. Adverse event triggers. Clinical data related to patient care indicating a reasonable probability that an adverse event has occurred or is occurring. An example of trigger data for an adverse drug event is a physician order for an antidote, a medication stop, or a dose decrease. Alert message. A computer-generated output that is created when a record meets prespecified criteria; for example, receipt of a new laboratory test result with an abnormal value (Shortliffe et al., 2001). Assertional knowledge. Primitive knowledge that cannot be defined from other knowledge. Authentication. A process for positive and unique identification of users, implemented to control system access (Shortliffe et al., 2001). Case-based reasoning. A decision support system that uses a database of similar cases (van Bemmel, 1997). Causal continuum assumption. The assumption that the (failure) causal factors of consequential accidents are similar to those of nonconsequential near misses.
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Patient Safety: Achieving a New Standard for Care Chart review. The retrospective review of the patient’s complete written record by an expert for the purpose of a specific analysis. For patient safety, to identify possible adverse events by reviewing the physician and nursing progress notes and careful examination for certain indicators. Classification. A taxonomy that arranges or organizes like or related terms for easy retrieval (National Committee on Vital and Health Statistics, 2000). Clinical data repository. Clinical database optimized for storage and retrieval for information on individual patients and used to support patient care and daily operations (Shortliffe et al., 2001). Clinical Document Architecture. A document markup standard that specifies the structure and semantics of “clinical documents” for the purpose of exchange (Van Hentenryck, 2001). Clinical domain. A clinical area of interest that might be modeled for a clinical information system. (van Bemmel, 1997) Clinical event monitor. Rule-based programs that sit atop a clinical data repository, supporting real-time error prevention. Clinical information systems. The components of a health care information system designed to support the delivery of patient care, including order communications, results reporting, care planning, and clinical documentation (Shortliffe et al., 2001). Close call. An event or situation that could have resulted in an adverse event but did not, either by chance or through timely intervention (U.S. Department of Veterans Affairs, 2002). Code. A numeric or alphanumeric representation assigned to a term so that it may be more readily processed (National Committee on Vital and Health Statistics, 2000). Comparability. Ability to compare similar data held in different computer systems. Comparability requires that the meaning of data is consistent when shared among different parties (National Committee on Vital and Health Statistics, 2000). Computer detection rules. Boolean combinations of medical events, for example, new medication orders and laboratory results outside certain limits that suggest an adverse drug event might be present. Computerized physician order entry (CPOE). Clinical systems that utilize data from pharmacy, laboratory, radiology, and patient monitoring systems to relay the physician’s or nurse practitioner’s diagnostic and therapeutic plans and alert the provider to any allergy or contraindication that the patient may have so that the order may be immediately revised
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Patient Safety: Achieving a New Standard for Care at the point of entry prior to being forwarded electronically for the targeted medical action (First Consulting Group, 2003). Concept orientation. Elements of the terminology are coded concepts, with possibly multiple synonymous text representations and hierarchical or definitional relationships to other coded concepts. No redundant, ambiguous, or vague concepts exist (Sujansky, 2003). Concept permanence. The meaning of each coded concept in a terminology remains forever unchanged. If the meaning of a concept needs to be changed or refined, a new coded concept is introduced. No retired codes are deleted or reused (Sujansky, 2003). Conceptual model. A model of the main concepts of a domain and their relationships (van Bemmel, 1997). Consistency of views. Consistency of views says that concepts in multiple classes have the same appearance in each context (e.g., corticosteroid as hormone or antiinflammatory agent has the same attributes and descendant concepts). Data acquisition. The input of data into a computer system through direct data entry, collection from a medical device, or other means (Shortliffe et al., 2001). Data element. The basic unit of information having a unique meaning and subcategories of distinct units or values (van Bemmel, 1997). Data interchange standards. Syntactic and semantic rules for defining data elements and which govern the seamless communication between computer systems while preserving the meaning of the data and intended functions. Data mining. The use of a basic set of tools to extract patterns from the data in a data warehouse (van Bemmel, 1997). Data set. A group of data elements specifically selected for a particular clinical purpose, such as clinical quality measurement, patient safety reporting, etc. Data type. Defines how a data element is formatted or expressed. Simple data types include date, time, numeric, string, blob (large binary objects, such as images), currency, or coded element; complex data types include a structure for names, addresses, etc. (Hammond, 2002). Data warehouse. Database optimized for long-term storage, retrieval, and analysis of records aggregated across patient populations, often serving the longer term business and clinical analysis needs of an organization. (Shortliffe et al., 2001).
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Patient Safety: Achieving a New Standard for Care Decision support systems. A system consisting of a knowledge base and an inference engine that is able to use entered data to generate advice (van Bemmel, 1997). Decision trees. A diagrammatic representation of the outcomes associated with chance events and voluntary actions (Shortliffe et al., 2001). Default reasoning. Drawing of plausible inferences on the basis of less than conclusive evidence in the absence of information to the contrary. Definitional knowledge. Knowledge that can be defined or constructed from other knowledge. Domain completeness. Domain completeness must not restrict terminology size through presuppositions about ultimate dimensions (e.g., no preset coding system that restricts depth or breadth of the hierarchy). Electronic health record. A repository of electronically maintained information about an individual’s health care and corresponding clinical information management tools that provide alerts and reminders, linkages with external health knowledge sources, and tools for data analysis (Shortliffe et al., 2001). Encryption. The process of encoding (scrambling) data such that a specific key is needed to decode the data. Most methods are based on the use of prime numbers (van Bemmel, 1997). Error. The failure of a planned action to be completed as intended (i.e., error of execution), and the use of a wrong plan to achieve an aim (i.e., error of planning) (Institute of Medicine, 2000). It also includes failure of an unplanned action that should have been completed (omission). Evidence. Scientific evidence is a replicable and generalizable observation that can be experienced nearly identically by independent people from different places and at different times. Evidence-based guidelines. Consensus approaches for handling recurring health management problems aimed at reducing practice variability and improving health outcomes. Guideline development emphasizes using clear evidence from the existing literature, rather than expert opinion alone, as the basis for advisory materials (Shortliffe et al., 2001). Explicit relationships. The relationships between concepts in a hierarchy are clearly defined (e.g., relationship between staphylococcal pneumonia and pneumonia is differentiated from relationship between staphylococcal pneumonia and staphylococcus, where the former is a class relation and the latter is an etiologic relation). Extensible markup language (XML). A specification designed specifically
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Patient Safety: Achieving a New Standard for Care for Web documents. It allows designers to create their own customized tags to provide functionality not available with HTML (Newton, 2001). Health care terminology. A collective term used to describe the continuum of code set, classification, and nomenclature (vocabulary) (National Committee on Vital and Health Statistics, 2000). Iatrogenic injury. Injury originating from or caused by a physician (iatros, Greek for “physician”), including unintended or unnecessary harm or suffering arising from any aspect of health care management, including problems arising from acts of commission or omission. Informatics. The science that studies the use and processing of data, information, and knowledge (van Bemmel, 1997). Interoperability. The ability of one computer system to exchange data with another computer system such that, at a minimum, the message from the sending system can be placed in the appropriate place in the receiving system (National Committee on Vital and Health Statistics, 2000). Interpreter. A component of production rule system deciding which rule to execute on each selection execute cycle. Judgment. A discriminating or authoritative appraisal, opinion, or decision, based on sound and reasonable evaluation. Knowledge base. A collection of systematically stored facts, heuristics, and models that can be used to make decisions or solve problems (Shortliffe et al., 2001). Knowledge representation. Expresses medical knowledge in computer-tractable form. Knowledge representation formalism. Formalism used to express knowledge. Also known as knowledge representation language. Knowledge representation language. Formalism used to express knowledge. Also known as knowledge representation formalism. Levels of evidence. It is widely recognized that various scientific methodologies produce various levels of evidence, that is, chances of identical experience when replicated by independent observers. In the testing of presumably beneficial health care interventions, the multicenter randomized controlled clinical trial is widely regarded as the top-quality source due to the demonstrable weaknesses of alternative methodolo-
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Patient Safety: Achieving a New Standard for Care gies. Randomized trials are central to Food and Drug Administration drug approval, strongly preferred information sources by most clinical practice guidelines, and prominently featured by the international Cochrane collaboration. When randomization is not possible or randomized controlled trial results are not available, original research data from controlled observations represent the next best choice (e.g., linking risky behaviors to adverse effects). Links. Components of semantic nets representing relationships between objects. Mandatory reporting. Those patient safety reporting systems that by legislation and/or regulation require the reporting of specified adverse events, generally events of serious harm and death. Mapping. The process of cross-linking terms from different terminologies so that comparisons and analyses can be undertaken. Multiple classification. Multiple classification must not restrict terminology such that a concept is prevented from being assigned to as many classes as required (e.g., “viral pneumonia” can be in classes “pneumonia” and “viral diseases”). National Health Information Infrastructure (NHII). A set of technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health (National Committee on Vital and Health Statistics, 2001). Natural language processing (NLP). Accessing data in the narrative form or free text and creating machine-understandable interpretations of those data (van Bemmel, 1997). Near miss. An error of commission or omission that could have harmed the patient, but serious harm did not occur as a result of chance (e.g., the patient received a contraindicated drug but did not experience an adverse drug reaction), prevention (e.g., a potentially lethal overdose was prescribed, but a nurse identified the error before administering the medication), or mitigation (e.g., a lethal drug overdose was administered but discovered early and countered with an antidote). Neural networks. A system in hardware or software of interconnected nodes developed in analogy with the human brain (van Bemmel, 1997). Nodes. Components of semantic nets representing objects or classes of objects. Nomenclature. A nomenclature, or vocabulary, is a set of specialized terms
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Patient Safety: Achieving a New Standard for Care that facilitate precise communication by eliminating ambiguity (National Committee on Vital and Health Statistics, 2000). Nonambiguity. Nonambiguity says that concepts must have exactly one meaning and, where a common term has two or more associated meanings (homonymy), they must be disambiguated into distinct concepts (e.g., “Paget disease” must be split into “Paget disease of the bone” and “Paget disease of the breast”) (Cimino, 1998). Nonredundancy. Nonredundancy says that a mechanism must exist that can help prevent multiple terms for the same concept from being added to the terminology as unique concepts. Nonvagueness. Nonvagueness says that concepts in the terminology must be complete in meaning (e.g., “ventricle” is not usually considered a fully described concept, nor does it represent some generic class of anatomic terms, i.e., it means neither “heart ventricle” nor “brain ventricle” when taken out of context). Notational aspect of knowledge representation language. The way in which information is stored in an explicit format. Also known as syntactic aspect of knowledge representation language. Patient safety. The prevention of harm caused by errors of commission and omission. Procedural knowledge. Knowledge of how other than that. Proof theory. A component of logic system that is a formal specification of the notion of correct inference. Recovery. An informal set of human factors that lead to a risky situation being detected, understood, and corrected in time, thus limiting the sequence to a near-miss outcome, instead of it developing further into possibly an adverse event. Reference terminology. Concept-oriented terminologies possessing characteristics such as a grammar that defines the rules for automated generation and classification of new concepts as well as combination of atomic concepts to form molecular expressions (Spackman et al., 1997). Reporting formats. Sets of data elements required for reporting purposes. Root-cause analysis. A process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event. Typically, the analysis focuses primarily on systems and processes, not individual performance (Joint Commission on Accreditation of Healthcare Organziations, 2003).
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Patient Safety: Achieving a New Standard for Care Rule base. A component of production rule system that represents knowledge as “if-then” rules. Safe care. Safe care involves making evidence-based clinical decisions to maximize the health outcomes of an individual and to minimize the potential for harm. Both errors of commission and omission should be avoided. Safety incident. Defined by the National Research Council as an event that, under slightly different circumstances, could have been an accident. Semantics. Components of logic system that specify the meanings of the well-formed expressions of the logical language. Slots. Components of the frame system that describe objects. Soundness. A property of logic system that every sentence derived from a set of sentences is also a valid consequence of that set of sentences. Standards. A set of characteristics or quantities that describes features of a product, process, service, interface, or material. The description can take many forms, such as the definition of terms, specification of design and construction, detailing of procedures, or performance criteria against which a product, process, and other factors can be measured (National Research Council, 1995). Surveillance. Routine collection and review of data to examine the extent of a disease, to follow trends, and to detect changes in disease occurrence, such as infectious disease surveillance, postmarketing surveillance, etc. (van Bemmel, 1997). Synonomy. Synonomy supports multiple nonunique names for concepts. Syntactic aspect of knowledge representation language. The way in which information is stored in an explicit format. Also known as notational aspect of knowledge representation language. Syntax. The rules (grammar) for the description, storage, and transmission of messages or for the composition of a program statement (van Bemmel, 1997). The rules that specify the legal symbols and constructs of a language (Shortliffe et al., 2001). Terminologies. Terminologies define, classify, and in some cases code data content. User interface. A conceptual layer of a system architecture that insulates the programs designed to interact with users from the underlying data and the applications that process those data (Shortliffe et al., 2001).
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Patient Safety: Achieving a New Standard for Care Voluntary reporting. Those reporting systems for which the reporting of patient safety events is voluntary (not mandatory). Generally, reports on all types of events are accepted. Working memory. A component of production rule system containing information that the system has gained about the problem thus far. ACRONYM LIST ADE adverse drug event AE adverse event AERS Adverse Event Reporting System AHRQ Agency for Healthcare Research and Quality AIMS Australian Incident Monitoring System AMI acute myocardial infarction ANSI American National Standards Institute ASC Accredited Standards Committee ASR Alternative Summary Reporting—Medical Devices ASTM American Society for Testing and Materials BPD Blood Product Deviation Reporting System CDA Clinical Document Architecture CDC Centers for Disease Control and Prevention CEN Comité Européean Normalisation CHF congestive heart failure CHI Consolidated Health Informatics CHIP Children’s Health Insurance Program CIS clinical information systems CMS Centers for Medicare and Medicaid Services COPD chronic obstructive pulmonary disease CORAS Risk Assessment of Security Critical Systems CPOE computerized physician order entry CPT Current Procedural Terminology CQI continuous quality improvement CQuIPS Center for Quality Improvement and Patient Safety DHHS Department of Health and Human Services DICOM Digital Imaging and Communications in Medicine DoD Department of Defense
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Patient Safety: Achieving a New Standard for Care DQIP Diabetes Quality Improvement Project DSM Diagnostic and Statistical Manual DSN Dialysis Surveillance Network E-Codes External Causes and Injury Codes EPC Evidence-based Practice Center ESRD end-stage renal disease FACCT Foundation for Accountability FCG First Consulting Group FDA Food and Drug Administration FMEA failure mode and effect analysis GELLO Guideline Expression Language, Object Oriented GLIF Guideline Interchange Format GP general practitioner GRM Generic Reference Model HACCP hazard analysis and critical control points HAZOP hazard and operability studies HCFA Health Care Financing Administration HCPCS Health Care Financing Administration Common Procedure Coding System HFMEA Healthcare failure mode and effect analysis HHCC Home Health Care Classification HIMSS Healthcare Information Management Systems Society HIPAA Health Insurance Portability and Accountability Act of 1996 HL7 Health Level Seven ICD–9 CM International Classification of Diseases, Ninth Edition, Clinical Modification ICD–10 International Classification of Diseases, Tenth Edition ICD–O International Classification of Diseases, Oncology ICF International Classification of Functioning, Disability and Health ICNP International Classification of Nursing Practice ICPC International Classification of Primary Care IEEE Institute of Electrical and Electronics Engineers IHE Integrating the Healthcare Enterprise
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Patient Safety: Achieving a New Standard for Care IOM Institute of Medicine ISMP Institute for Safe Medication Practice ISO International Organization for Standardization IT information technology JAMIA Journal of American Informatics Association JCAHO Joint Commission on Accreditation of Healthcare Organizations LOINC Logical Observation Identifiers, Names and Codes MAUDE Manufacture and User Data Experience-Medical Devices MDS Minimum Data Set for Nursing Home Care MedDRA Medical Dictionary for Drug Regulatory Affairs MedSun Medical Product Surveillance Network MER Medication Errors Reporting MERS TM Medical Event Reporting System for Transfusion Medicine MeSH Medical Subject Headings MHS PSP Military Health System Patient Safety Program MPSMS Medicare Patient Safety Monitoring System MRI magnetic resonance imaging NANDA North American Nursing Diagnosis Association NASA National Aeronautics and Space Administration NaSH National Surveillance System for Health Care Workers NASHP National Academy for State Health Policy NCHS National Center for Health Statistics NCPDP National Council for Prescription Drug Programs NCPS National Center for Patient Safety NCQA National Committee for Quality Assurance NCVHS National Committee on Vital and Health Statistics NDC National Drug Code NDF RT National Drug File Clinical Drug Reference Terminology NEDSS National Electronic Disease Surveillance System NEMA National Equipment Manufacturers Association NHII national health information infrastructure NHSN National Healthcare Safety Network NIC Nursing Intervention Classification NLM National Library of Medicine NLP natural language processing
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Patient Safety: Achieving a New Standard for Care NM near miss NNIS National Nosocomial Infections Surveillance NOC Nursing Outcomes Classifications NPSF National Patient Safety Foundation NPV negative predictive value NQF National Quality Forum NRC National Research Council NYPORTS New York Patient Occurrence Reporting and Tracking System OASIS Outcome and Assessment Information Set for Home Care PATH Program for Appropriate Technology in Health PCDS Patient Care Data Set PCP primary care physician PHA proactive hazard analysis PMRI patient medical record information PNDS Perioperative Nursing Data Set PPV positive predictive value PQI prevention quality indicator PRA probabilistic risk assessment PS patient safety PSDS patient safety data standards PSRS patient safety reporting system QIPS quality indicators for patient safety QuIC Quality Interagency Coordination Task Force RCA root-cause analysis R-Demo reporting demonstration RIM Reference Information Model RSNA Radiological Society of North America RxNORM normalized notations for clinical drugs SAC Safety Assessment Code SNAEMS Special Nutritionals Adverse Event Monitoring System SNOMED CT Systemized Nomenclature for Human and Veterinary Medicine, Clinical Terms SPARCS Statewide Planning and Research Cooperative System
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Patient Safety: Achieving a New Standard for Care TPS Toyota Production System TQM total quality management UCSF University of California, San Francisco UHI universal health identifier UMDNS Universal Medical Device Nomenclature System UMLS Unified Medical Language System USP United States Pharmacopeial Convention, Inc. VAERS Vaccine Adverse Event Reporting System VHA Veterans Health Administration VSD Vaccine Safety Datalink WONCA World Organization of National Colleges, Academies, and Academic Associations of General Practitioners and Family Physicians XML extensible markup language REFERENCES Cimino, James J. 1998. Desiderata for controlled medical vocabularies in the twenty-first century. Methods Inf Med 37(4–5):394–403. First Consulting Group. 2003. Computerized Physician Order Entry: Costs, Benefits, and Challenges, A Case Study Approach. Online. Available: http://www.leapfroggroup.org/CPOE/AHA%20FAH%20CPOE%20Report%20FINAL.pdf [accessed February 2, 2004]. Hammond, W. E. 2002. Patient Safety Data Standards: View from a Standards Perspective. PowerPoint Presentation to IOM Committee on Data Standards for Patient Safety on May 6, 2002. Online. Available: http://www.iom.edu/file.asp?id=9915 [accessed December 16, 2003]. Joint Commission on Accreditation of Healthcare Organziations. 2003. 2003 Hospital Accreditation Standards. Oakbrook Terrace, Illinois: Joint Commission Resources. National Committee on Vital and Health Statistics. 2000. Uniform Data Standards for Patient Medical Record Information. Online. Available at http://ncvhs.hhs.gov/hipaa000706.pdf [accessed April 15, 2002]. National Committee on Vital and Health Statistics. 2001. Information for Health: A Strategy for Building the National Health Information Infrastructure. Online. Available at http://ncvhs.hhs.gov/nhiilayo.pdf [accessed April 18, 2002]. National Research Council. 1995. Standards, Conformity Assessment, and Trade: Into the 21st Century. Washington, DC: National Academy Press. Newton, H. 2001. Newton’s Telecom Dictionary: The Official Dictionary of Telecommunications, Networking and the Internet. 17th edition. New York, NY: CMP Books.
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Patient Safety: Achieving a New Standard for Care Shortliffe, E. H., L. E. Perreault, G. Wiederhold, and L. M. Fagan. 2001. Medical Informatics: Computer Applications in Healthcare and Biomedicine. New York: Springer-Verlag. Spackman, K. A., K. E. Campbell, and R. A. Cotz. 1997. SNOMED RT: A Reference Terminology for Health Care. Northfield, Illinois: College of American Pathologists. Sujansky, W. 2003. Summary and Analysis of Terminology Questionnaires Submitted by Developers of Candidate Terminologies for PMRI Standards: A Draft Report to the National Committee on Vital and Health Statistics Subcommittee on Standards and Security. National Committee on Vital and Health Statistics Meeting 5. van Bemmel, J. H., and M. A. Musen. 1997. Handbook of Medical Informatics. Heidelberg: Springer-Verlag. Van Hentenryck, K. 2001. HL7: The Art of Playing Together. Online. Available: www.medicalcomputingtoday.com [accessed September 25, 2001].
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