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EHR Chapter 9
Terms in this set (245)
Data needed to operate an enterprise and how they are defined, structured and processed, and quality assured.
raw elements that make up our communication
_______ have the innate ability to combine data they collect, and through all their senses, produce information and enhance that information with experience and trial-and-error that produces knowledge.
data that have been combined to produce value
notion first popularized by Peter Drucker in the 1950s
key element of knowledge management and the learning organizations
receiving renewed interest because it is recognized that "quality care of patients requires evaluating large amounts of data at the right time and place in the correct context
often referred to generally as image data, include document images, unstructured text data, video, audio, vectors, and diagnostic images
reflections of original data
a database that contains the patient's name, health record number, and potentially other identifying information, which may be entered by the person who is operating the document imaging scanner or by bar code labels affixed to forms.
a more detailed level of specificity
indexing may be accomplished by:
OCR (optical character recognition
also referred to as discrete data
are the values associated with variables that are the important information to be captured about a patient
is a function that may assume any given value or set of values
is any point or attribute in the range of a function
values for variables in ehrs are generally captured via:
checklists, pull down menus, or templates
examples of document imaging data:
handwritten notes and signed patient consent forms
examples of discrete structured data
lab. orders/results, medication orders/results, online charting and documentation, mpi/registration
examples of diagnostic image data
ct, mr, digital x-rays, nuclear medicine
examples of vector graphic data
ekg, eeg, fetal signal tracings
examples of audio data
voice annotations, heart sounds
examples of video data
ultrasound, cardiac catherization examinations
examples of unstructured text data
ubs and itemized bills, transcribed radiology/pathology reports, other transcribed reports
allows an individual to record context and convey subtle differences that structured data often does not
data may take longer to enter and is more difficult this way
can be easily captured and is very accurate
structured data are generally based on a
standard data dictionary
one form of data entry aid that may be used for medications
available to help users in selecting the desired data to be input
data entry aids
when can narrative data be appropriate
conclusion of a report and h&p exam findings to describe a unique situation
how can narrative data be added to templates
via comment fields
commands that a user can create and retrieve later that produce a specific set of terms, phrases, or sentences
aka smart text or dot phrases
each _______ must be created by either the system implementer or user
computers can be programmed to wrap _______ text around structured data elements to complete sentences
computer programs called __________ also can break apart narrative text by words or phrases and encode the words and phrases for later processing
natural language processors
enables narrative data to be converted to structured data elements and stored in a database
(NLP) natural language processing
enables tagging elements in a document transcribed into an XML format so they can be placed into structured data collection templates
discrete reportable transcription (DRT)
generally refers to a system of communication using an arbitrary set of vocal sounds, written symbols, signs, or gestures in conventional ways with conventional meanings
dictionaries identify ______ and _____ are synonyms
vocabulary and terminolgy
means all the terms that are recognized for communication within the domain
applies when referencing vocabulary standards, suggesting that the terms within the vocabulary are carefully selected for their inclusion and terms outside the boundaries of the vocabulary are not acceptable
includes a prescribed set of terms authorized for specific use. example: CPT
refers to a defined system for naming. example SNOMED
intended to provide a set of concepts and relationships that offers a common reference point for comparison and aggregation of data about healthcare process
refers to those terms seen in ehrs and other HITs used to document and facilitate the delivery of care
more academic term, often represented in complex knowledge bases that are rich with rigorously controlled rules and relationships: used mainly for data analysis
also called code sets
a collection of coded expressions, frequently used for financial or ancillary system communications
a grouping of terms of similar meanings, often for defined purposes.
primary purpose is to categorize diseases for morbidity and mortality reportng
is the process of identifying relationships between two distinct models
ability to use multiple vocabularies across different applications in an ehr system is the function of a
a term often associated with classification is
the science or technique of classification
intent is to show parent-child relationship rbetween terms and is controlled vocabulary that may form a natural heirarchy
refers to a representation of words to enable machine processing
has a hierarchical structure
the term applied when representations are assigned to the words they represent
are computer software programs that assist coders in assigning appropriate codes
ruled based approaches
used to refer to a group of associated codes
may represent terms in an inventory or dictionary terms
when associated with an entire language or terminology, an inventory or dictionary term is often referred to as
frequently used to describe the medical code sets permitted to be used in the hipaa transaction
hipaa code sets
in IT, _____ refers to the repesentation of instructions used to direct the processing of a computer
in IT, _____ refers to writing the instructions
refers to predefined list of data, often to be collection for contribution to a registry or special database for analytical purposes
tasked under hipaa to make recommendations for uniform data standards for patient medical record information
who maintains icd
world health organizations
a comprehensive clinicial reference terminology that allows for consistent capture of detailed clinical information
a widely used terminology for representing laboratory data in ordering lab tests and reportaing lab test results
a standard notion for clinical drugs developed by NLM, FDA, in consultation with the message standard development organizatios
a joint venture of the foundation for integrative healthcare and alternative link, provides more than 45000 codes to describe complementary and alternative medicine and nursing services
ABC coding solutions
from the APA; is widely used in behavioral health both to encode data as well as to supply standard criteria in naming conditions
health and health-related classification system that reports body functions and structures, activities and participation and environmental factors
ICF (international classification of functioning, disability, and health)
is used for describing blood products and tissuses
ISBT (international society for blood transfusion)
a proprietary medical vocabulary developed by Medicomp systems; includes more than 250,000 terms for symptoms, history, physical exam., tests, diagnoses and therapies
purpose is to enable entry,retrieval, and analysis of data relating to all phases of drug development and to the health effects and malfunction of devices
MedDRA (medical dictionary for regulatory activities)
set containing terms to represent nursing diagnoses, outcomes, and intervention
a universal product identifier for human drugs
been proposed by the FDA to improve the quality of information in medical device adverse event reports
UDI (unique device identification)
the branch of linguistics dealing with the study of meaning, including the ways meaning is structured in language and how changes in meaning and form occur over time
is the study of the patterns of formation of sentences and phrases from words and the rule for the formation of grammatical sentences in a language
refers to the specific way each individual data element is used in the information system
one of the first ways data were structured for use in healthcare
the core set of data elements that form the basis of hospital discharge data systems
standardized data specifications for the purpose of measuring healthcare performance
national hospital quality measures
established the the joint commission to provide rigorous comparison of the actual results of care across the hospitals
funded long-term care programs providing nursing homes services and for noncritical access hospital swing bed reporting
home health data reporting
CMS program in which physicians may report quality data and receive incentives based on their medicare reimbursement
PQRS (physician quality reporting system)
a tool developed by NCQA and used by more than 90% of america's health plans to measure performance on important dimensions of care and services
a data set maintained by the ASTM international standards development
a data dictionary of elements that may be used by nurses to report patient problems and patient care goals
PCDS (patient care data set)
collection of actual data in accordance with data set specifications
two of the most common healthcare registeries
cancer & immunization
refers to the functions that can be performed on a panel of patients simultaneously, rather than functions typically performed in an ehr, which relate to only one patient at a time
refers to the massive amount of data available to study
electronic data is typically retained where?
when information is dictated and transcribed, there may be an outline of content, or _______
oldest form of database structure
flat file database
database that stores data in a plain text file, where each line of the text file holds one record
flat file database
database that is no longer used in the development of new ehr systems, it may be found in existing, legacy systems within healthcare organizations
most common form of database
database the is constructed using tables instead of tree structures
database that is the more recent approaches to database management
database that might best be considered a hybrid between a hierarchical and relational database, capturing the benefits of both database structures so that a large amount of data can be processed
not a database structure per se.
use of sufficient bandwidth to transfer data at a stead high-speed rate such that the transfer of data from storage to end user is performed without any noticeable time lag
also called operational database
database that enables data to be entered, retreived, updated, modified, trended and deleted
database that is designed to maintain data on which complex analysis is performed
most common form of database used for OLAP is
OLAP is very commonly used to develop
CRM (customer relationship management)
where is OLAP most aften being used
executive decision support
a transational database designed with an open structure that is not dedicated to the software of any particular vendor or data supplier
a data repository requires the following data integration functions:
data transformation, data cleansing, and linkage
data repository is updated
secondary, or derived, databases are optimized to perform sophisticated analysis on data
process that eliminates redundancy
process is one where intentional redundancies are created
subset is often referred to
most effective way to achieve a consolidated view of healthcare enterprise and the trends affecting it
management where no single transaction can address all the different contractual and regulatory reimbursement formulas to which a typical integrated system is subject
management where one of the greatest returns on investment for warehouses is, where day-to-day patient data can be fed into highly sophisticated analytical applications
management that goes a step beyond clinical management in which factors such as treatment regimens and response to treatment are studied to develop best practices and improved clinical outcomes
management refers to the management of administrative functions
management that contributes to proactively managing the health of a group of individuals
defines data fields, records of which fields may be a part, and any association or interdependence among records
also called a metadata repository or registry
used to capture the results of data modeling, which are data about the data in the data model for a given database or set of databases
data about data
a term that technically refers to the encoding of knowledge on computer to enable systems to reason automatically
a structural framework or representation of knowledge within a given domain
tool that evaluates data quality
example of structured data:
data mapping would be completed by an organization if:
it was trying to consolidate databases; facility was de-identifying data;mediate between a data source in its destiniation
T/F: Health care facilities ehr must be able to produce a CCD in order to meet meaningful use incentive
T/F: all ehrs include an encoder
which of the following is a type of classification system?
an example of unstructured data is
a defined system for naming is called
a predefined group of data elements that will be collected by a healthcare facility
the following is a terminology used for representing lab data?
T/F:the primary purpose of using vocabulary standards is to reduce inconsistency and ensure understanding
ABC Coding Solutions
A joint venture of the Foundation of Integrative Healthcare and Alternative Link. It provides more than 4,500 codes to describe complementary and alternative medicine and nursing services.
A set of rules to be processed by a computer program that involves repetition of a finite number of steps.
Also called data warehouse, this is an organized collection of data that supports statistical analysis.
is a recently coined term that refers to the massive amount of data available to study, but which is so big and often in unstructured format that traditional databases and methods of analysis are difficult to use. "the next frontier for innovation, competition, and productivity" (pg.266)
OLAP (online analytically processing) has most often been used in executive decision support, where it may also be called business intelligence: but it is finding growing applications in quality improvement and CDS system development. (pg.270)
for recording somewhat more standardized data, such as for history and physical exams and many nursing forms to record medication administration, vital signs, and other information. (pg.267)
And organized structure for arranging objects, such as clinical terms or phrases, that aids in their definition, mapping, and use.
In information systems, software instructions that direct computers to perform a specific action; in healthcare, an alphanumeric representation of the terms in a clinical classification or vocabulary.
Under HIPAA, any set of codes used to encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes; includes both the code and their description.
In computer programming, the process of writing software using a specific computer language to encode instruction; and healthcare, the process of assigning numeric or alphanumeric representations of clinical documentation.
In a computer form or template, an area in which to record any non-structured data; often used to further explain or embellish upon data that have been entered into structured data fields.
Continuity of care record (CCR)
ASTM continuity of care record is a standard specification, maintained by the ASTM international standards development organization, for the data set of the most relevant administrative, demographic, and clinical facts about a patient's health care that supports continuity of care when the patient is referred to another provider.(pg264 The capability to produce the CCR is a required standard for the EHR technology to be cerified for the M.U. incentive program.)
A predefined set of terms and their meanings that may be used in structured data entry or natural language processing to represent expressions.
Core data sets for the physicians practice EHR
Model data sets deployed by AHIMA to understand clinical workflow's in physician offices to enable the best design of an EHR system
Standardize performance measures developed to improve the safety and quality of patient care, used by the joint commissions ORYX initiative, CMS quality reporting program for hospitals, and others.
Customer relationship management (CRM)
Online analytically processing is very commonly used to develop customer relationship management software and game building. CRM can help healthcare providers manage physician credentialing and recruitment, referrals, clinical trials, and other information management tasks that require building and manipulating large contact databases. Also being used to create computer games to help people with chronic diseases understand their conditions and make appropriate lifestyle changes. (pg.270)
The dates, numbers, images, symbols, letters, and words that represent basic facts and observations about people, processes, measures, and conditions.
The structure that must support the ability for IT to create the knowledge continuum.
Database management systems (DBMS)
Were developed to store and process structured data. DBMSs are the software and data structures used to support a database. (pg.267)
A database in which there are redundant data in order to optimize analytical performance.
A descriptive list of names, definitions, and attributes of data elements to be collected in an information system or database; the purpose of a data dictionary is to standardize definitions and enable consistent use. Also called a metadata repository or registry, is used to capture the results of data modeling, which are data about the data in the data model for a given database or set of databases. (pg.273)
Data elements for emergency department systems (DEEDS)
A data set design to support the uniform collection of information in hospital-based emergency departments.
Data entry aid
A software feature that helps users select the desired dated to be input, such as a drop-down menu or a copy-and-paste.
The continuum was depicted as a pyramid, sometimes with wisdom added to the top (becoming the data-information-knowledge-wisdom hierarchy). It would enhance the value of information. (pg.245)
The data needed to operate an enterprise, and how they are defined (Vocabulary), structured and processed (architecture), and quality ensured.
The process of extracting in analyzing large volumes of data from a database for the purpose of identifying hidden and sometimes subtle relationships or patterns and using those relationships to predict behaviors.
A well-organized, user-centered, searchable database system that usually draws information from a data warehouse to meet the specific needs of users.
The process of determining the users information needs and identifying relationships among the data.
In a relational database, it is the process of organizing data to minimize redundancy.
Data quality management model
A graphic of the data quality management domains as they relate to the characteristics of data integrity and examples of each characteristic with in each domain.
open-structure database that is not dedicated to the software of any particular vendor or data supplier, in which data from diverse sources are stored so that an integrated, multi-disciplinary view of the data can be achieved; (also called clinical data repository when related specifically to healthcare data.)
A list of recommended data elements with uniform definitions where the data are relevant for a particular use.(pg.261 Data sets were one of the first ways data were structured for use in healthcare. A data set is a predefined group of data elements to be collected. Data sets are often defined for the collection of data for various quality reporting programs, such as those used by the federal government, the Joint Commission, and other accreditation programs.)
is use of sufficient bandwidth to transfer data, at a steady high-speed rate, such that the transfer of data from storage to end user, is performed without any noticeable time lag. (pg.269)
A database that is optimized for analytical query and report processing using data from multiple databases; also called clinical data repository when related specifically to healthcare data.
Diagnostic and statistical manual of mental disorders (DSM)
A nomenclature developed by the American psychiatric Association to standardize the diagnostic process for patients with psychiatric disorders, which includes codes that correspond to ICD-9-CM code; the most recent version is the fifth edition or DSM-5-TR, published in 2000.
Discrete reportable transcription (DRT)
A form of speech dictation in which the resultant transcribe narrative note is analyzed, via natural language processing, for specific terms that are then supplied as structured data to specific fields in a template.
Executive decision support
A system that analyzes a large volume of aggregated data and provides trending information, used in healthcare to support strategic planning and management of the healthcare organization.
General equivalents mapping (GEMS)
A program created to facilitate the translation between ICD-9-CM and ICD-10-CM/PCS.
at a more detailed level of specificity (pg.247) related very specifically to individual words or short phrases (pg.253)
Healthcare effectiveness data and information set (HEDIS)
is a tool developed by the National Committee for Quality Assurance (NCQA)and used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. (pg.263)
Exploratory thinking that aids learning, discovery, understanding, or problem-solving through experimentation, trial and error, applying intuitive judgment, or other techniques.
A website created by CMS and the hospital quality alliance to promote reporting on hospital quality of care.
Hospital inpatient quality reporting program
Reporting for the National healthcare Safety Network is done through the Hospital Inpatient Quality Reporting Program. Data to be reported by hospitals include clinical process of care measures and clinical outcome measures.
Data that have been deliberately selected, process, and organized to be useful.
International classification of functioning, disability, and health (ICF)
is a health and health-related classification system that reports body functions and structures, activities and participation, and environmental factors.
International Society of blood transfusion (ISBT)
developed by the International Council for Commonality in Blood Banking Automation is used for describing blood products and tissues.
The information, understanding, and experience that give individuals the power to make informed decisions.
A management strategy that promotes an integrated and collaborative approach to the process of information asset creation, capture, organization, access, and use.
An employee whose job includes tasks of developing or using experimental-based information in new and different ways; formally considered in contrast to tasks, Which are considered manual labor or performed without autonomous thought. All employees, however, are encouraged to contribute their experience and expertise.
1. The vocabulary used in a language or a subject area or by a particular speaker or group of speakers 2. A collection of words or terms and their meanings for a particular domain.
logical observations identifiers names and codes (LOIC)
A database protocol developed by the Regenstrief Institute for healthcare aimed at standardizing laboratory and other data observed about a patient, such as vital signs or symptoms, outcomes management, and research. (this is required for use in the M.U. incentive program for documenting laboratory data.)
A command that a user can create and retrieve it later that produces a specific set of terms, phrases, or sentences. In EHRs, macros are sometimes called smart text or dot phrases.
Medical dictionary for regulatory activities (medDRA)
Its purpose is to enable entry, retrieval, and analysis of data relating to all phases of drug development and to the health effects and malfunctions of devices. (pg.258 Developed by the International Conference of Harmonisation. IT is owned by the international Federation of pharmaceutical Manufacturers and Associations.)
Descriptive data that characterized other data to create a cleaner understanding of their meaning and to achieve greater reliability and quality of information.
Minimum data set (MDS)
Data collected for public reporting to aid consumers in making choices about care facilities as well as for the government to monitor the quality of care for which they are providing reimbursement. (pg.263 for Long-term Care and Resident Assessment Protocols it mandated by the Omnibus Reconciliation Act of 1987 for federally funded long-term care programs providing nursing home services and for noncritical access hospital swing bed reporting.)
National drug code (NDC)
Codes that serve as product Identifiers for human drugs, Currently limited to prescription drugs and a few select over-the-counter products.
National healthcare safety network (NHSN)
is a program in which CMS requests hospitals to report quality data. The program is voluntary, but the incentive for participating is to receive full reimbursement under Medicare or be subject to a 2 percent reduction .
National hospital quality measures
Also called core measures, standardized performance measures developed to improve the safety and quality of healthcare.
National quality forum (NQF)
A private, not-four-profit membership organization created to develop and implement a nationwide strategy to improve the measurement and reporting of healthcare quality.
National language processing (NLP)
A technology that converts human language (structured or unstructured) into data that can be translated then manipulated by computer systems; branch of artificial intelligence.
A recognize system of terms used in a science or art that follows pre-established naming conventions; a disease nomenclature is listing of the proper name for each disease entity with its specific code number.
Online analytical processing (OLAP)
A methodology that supports complex analysis on a large set of data from multiple sources retained in either a multidimensional or relational database; in contrast, see online transaction processing.
Online transaction processing (OLTP)
A methodology that supports the day-to-day entry of data and immediate retrieval of data from a relational database; also called a transactional data base. In contrast, see online analytical processing.
A common vocabulary organized by meaning, allowing for an understanding of the structure of described information that facilitates a specific topic or domain.
Optical character recognition (OCR)
A method of encoding text from analog paper into bit-mapping images and translating the image into a form that is computer readable.
The joint commissions initiative that supports the integration of outcomes-data and other performance measurement data into the accreditation process.
Outcomes and assessment information set (OASIS)
A standard core assessment data tool developed to measure the outcomes of adult patients receiving healthcare services under the Medicare and Medicaid programs. (pg.263 focuses on measuring data associated with physical equipment and facilities such as using EHR, performing clinically relevant and evidence-based procedures, and outcomes--such as whether the patient is stabilized, declining in health, or improved)
Patient care data set (PCDS)
A terminology of patients problems, patient care goals, and patient care orders that represents and captures clinical data for inclusion in patient care information systems. (pg.264 is a data dictionary of elements that may be used by nurses to report patient problems and patient care goals)
Physician quality reporting system (PQRS)
An initiative payment system for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries; formally known as the physician quality reporting initiative (PQRI).
In healthcare, a detailed plan for care for a specific medical condition based on investigative studies; in medical research, a rule or procedure to be followed in a clinical trial; in a computer network, a rule or procedure used to address and ensure delivery of data.
Registry (pg.265 )
A collection of healthcare information related to a specific disease, condition, or procedure that makes the information readily available for analysis and comparison. Stage 2 M.U. incentive program offers eligible professionals the option of reporting data for the EHR to a cancer registry, other registry, or both.
functions that can be performed on a panel of patients simultaneously, rather than functions typically performed in an EHR, which relate to only one patient at a time. Registry functionality may also be the means by which a provider submits data to an external registry.(pg.266)
clinical drug nomenclature developed by the Food and Drug Administration, the Department of Veterans Affairs, and HL7 to provide standard names for clinical drugs and administered dose forms that link to many of the drug vocabularies commonly used in pharmacy management and drug interaction software, including those of First Databank, Micromedex, MediSpan, Gold Standard, and Multum. (standard code set for clinical drug names required under the M.U. incentive program)
Semantics (pg.260 )
The meaning of a word or term; sometimes referred to comparable meaning, usually achieved through a standard the vocabulary. study of meaning, including the ways meaning is structured in language and how changes in meaning and form occur over time. Semantic, then, refers to the meaning of a word or other symbol
SNOMED CT (Systematized nomenclature of medicine--clinical terms)
a computer processable clinical vocabulary that in 2011 included more than 311,000 clinical concepts and over 1.3 million relationships to represent virtually all healthcare processes; originally developed by the college of American Pathologists and now managed by the international health terminology standard department organization (IHTSDO), based in Denmark, it is designed to index, store, retrieve, and aggregate clinical data in a standardized manner.
Standard orders set
A set of instructions for a specific diagnosis, developed by a team of physicians and following evidence-based guidance, intended to increase physician efficiency, enhance documentation, and improve the quality of care.
A term that refers to the comparable structure or format of data, usually as they are being transmitted from one system to another. study of the patterns of formation of sentences and phrases from words and the rules for the formation of grammatical sentences in a language.
The principles of a classification system, such as data classification, and the study of the general principles of scientific classification. Specialized classifications in use in healthcare may be called taxonomies instead of classifications.
A set of terms representing the system of concepts of a particular subject field; a clinical terminology provides the proper use of clinical words as names or symbols.
A database that enables data to be entered, received, updated, modified, trended, and deleted by the user.
operations performed on a database, such as entering an order for a patient, retrieving vital signs of a patient, or sending a claim for healthcare services; under HIPAA, transactions refers specifically to financial and administrative transactions.
Unified medical language system (UMLS)
A program initiated by the national Library of medicine to build an intelligent, automated system that can understand biomedical concepts, words, and expressions and their interrelationships; includes concepts and terms from many different source vocabularies.UMLS integrates and distributes key terminology, classification and coding standards, and associated resources to promote creation of more effective and interoperable biomedical information systems and services, including electronic health record.
Uniform hospital discharge data set (UHDDS)
A core set of data elements adopted by the US department of health and human services that are collected by hospitals on all discharges and all discharge abstract systems.
Unique device identification (UDI)
The unique identifier for medical devices required by the FDA that contributes to patient safety by helping to identify counterfeit products, improving the ability of staff to distinguish between devices that are similar in appearance but serve different functions, facilitating the recall process, and tracking infection exposure and allergic reaction to devices, and improving studies on medical device effectiveness.
Universal medical device nomenclature system (UMDNS)
A standard international nomenclature and computer coding system for medical devices, developed by ECRI.
1. An attribute associated with a characteristic--for example, "Mary," "Jose," and "Pat" our values of the variable "first name" 2. The quality of outcomes for the level of spending.
A characteristic or property that may take on different values; for example, the variable diagnoses is a storage location for each patient's diagnosis, such as hypertension, diabetes, or other values, and temperature is a variable field in which 98.6°F, 38°C, or other values would be recorded.
all the terms that are recognized for communication within the domain. (pg.251) The body of terms and their definitions. (pg.252)
The ability to use multiple vocabularies across different applications in an EHR system. (I think that a question on this would ask about what was needed in order for the pharmacy, lab, and radiology systems to communicate)
Which of the following is a type of classification system?
True / False
The primary purpose of using vocabulary standards is to reduce inconsistency and ensure understanding.
Data mapping would be completed by an organization if
it was trying to consolidate databases, the facility was de-identifying data, and mediating between a data source in its destination.
HEDIS was developed and is maintained by
A command a user can create and retrieve later that produce a specific set of terms, phrases, or even a sentence is called a
True / False All EHRs include an encoder.
An example of unstructured data is a/an
Which of the following is a type of database used in healthcare?
all of the above
all of the above
What is an advantage of using narrative text in the EHR?
allows you to record context and convey differences in documentation
A physician reporting program developed by CMS to collect quality data on Medicare beneficiaries.
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