Digital health is a fast-moving field. With new technologies, tools, and buzzwords emerging all the time, it can be hard to keep up.
Whether you’re a healthcare professional, digital health founder, patient advocate, or policy leader, this glossary is for you. We’ll break down the jargon, explain what each term means, and give practical use cases to make the concepts clear.
Bookmark this page and come back to it whenever you need a refresher.
A
Accountable Care Organization (ACO)
Definition: A group of healthcare providers who voluntarily come together to give coordinated high-quality care to Medicare patients and share in savings.
Use case: A hospital, group of primary care doctors, and specialists form an ACO to manage care for 20,000 Medicare beneficiaries, aiming to reduce duplicate testing and avoid hospital readmissions.
See also: Value-Based Care, Shared Savings Program
Advanced Alternative Payment Model (APM)
Definition: A payment approach under MACRA that provides added incentive payments to deliver high-quality and cost-efficient care.
Use case: A health system participating in a bundled payment model for orthopedic surgeries receives a 5% Medicare incentive under APM.
See also: MACRA (Medicare Access and CHIP Reauthorization Act), Merit-based Incentive Payment System (MIPS), Bundled Payments
AI-Powered Diagnostics
Definition: AI tools used to support or automate clinical diagnoses.
Use case: A dermatology platform uses AI to flag suspicious moles during teledermatology exams.
See also: Clinical decision support, Real-world evidence, Natural Language Processing (NLP)
Alternative Payment Model (APM) Risk Adjustment
Definition: A method of evaluating patient populations in APMs to adjust payments based on expected healthcare utilization.
Use case: A primary care practice uses risk scoring tools to stratify its diabetic population by comorbidity severity, impacting capitation payments.
See also: Risk Adjustment Factor (RAF) Score, Risk-Based Contracting
Ambient Clinical Intelligence
Definition: Voice-enabled tools that capture and document clinical encounters in the background.
Use case: A smart assistant records and summarizes a provider’s exam notes during a primary care visit.
See also: Speech-to-text in healthcare, Electronic Health Record (EHR), Clinical workflow optimization
Ambulatory Care
Definition: Medical care provided without an overnight hospital stay. It includes checkups, lab tests, minor treatments, and specialist visits, usually done in clinics or outpatient centers.
Use case: A patient visits their doctor’s office for a checkup and has some blood tests done. They go home right after the appointment—there is no hospital stay.
See also: Outpatient care, Care coordination
Ambulatory Surgery Center (ASC)
Definition: A healthcare facility focused on providing same-day surgical care, including diagnostic and preventive procedures.
Use case: A patient has a cataract surgery at an ASC rather than a hospital, lowering the cost for both the patient and payor.
See also: Outpatient Care, Cost-to-Charge Ratio
Anonymized Health Data
Definition: Health data that has been stripped of personal identifiers for privacy.
Use case: A research team analyzes anonymized EHR data to study diabetes trends.
See also: De-identified data, Data security, Real-world evidence
Annual Wellness Visit (AWV)
Definition: A yearly Medicare-covered visit to develop or update a personalized prevention plan.
Use case: During an AWV, a nurse practitioner reviews the patient’s chronic conditions, updates screenings, and schedules preventive labs.
See also: HEDIS (Healthcare Effectiveness Data and Information Set)
Anticipatory Care Planning
Definition: Proactive planning for a patient’s future health and social needs.
Use case: A care manager develops early plans for frailty in high-risk elderly patients.
See also: Population health management, Risk stratification, Transitional care management
Application Programming Interface (API)
Definition: A set of protocols enabling different software applications to communicate and exchange data.
Use case: A telehealth solution uses an API to pull real-time patient vitals from the EHR during a virtual visit.
See also: Fast Healthcare Interoperability Resources (FHIR), Interoperability
Attributed Lives
Definition: The number of patients a provider or ACO is accountable for in value-based or population health models.
Use case: A health system is responsible for care and cost outcomes for its 40,000 attributed lives under a commercial ACO contract.
See also: Risk-Based Contracting, Population Health Management
Automated Chart Review
Definition: Software that scans patient records for documentation gaps or quality issues.
Use case: An ACO uses automated tools to flag missing diagnoses that impact risk scoring.
See also: Clinical Documentation Improvement, Risk adjustment factor, Clinical workflow optimization
B
Behavioral Health Integration (BHI)
Definition: The practice of integrating behavioral health services into primary or specialty care settings.
Use case: A family clinic embeds a licensed therapist who collaborates with PCPs on depression management for patients with diabetes.
See also: Collaborative Care Model, Chronic Care Management
Behavioral Nudging
Definition: Subtle digital prompts that influence patient decisions or behaviors.
Use case: A text reminder nudges a patient to refill their blood pressure medication.
See also: Patient engagement, Medication adherence, Digital therapeutics
Bidirectional Data Exchange
Definition: The ability of systems to send and receive health data in real-time.
Use case: A specialist’s EHR updates with the patient’s primary care visit notes after both systems share data via Health Information Exchange (HIE).
See also: Health Information Exchange (HIE), Interoperability
Blockchain in Healthcare
Definition: A secure, decentralized technology used for managing health records or supply chains.
Use case: A blockchain ledger tracks COVID-19 vaccine distribution from manufacturer to clinic.
See also: Data security, Interoperability, Health IT
Bundled Payments
Definition: A single payment covering all services related to a treatment or condition over a defined period.
Use case: A hospital receives $28,000 for a hip replacement episode, including surgery, anesthesia, rehab, and follow-ups.
See also: Advanced Alternative Payment Model (APM), Value-Based Purchasing
Business Associate Agreement (BAA)
Definition: A legal contract that ensures HIPAA compliance when a vendor handles protected health information on behalf of a provider.
Use case: A telehealth platform signs a BAA with a clinic before accessing patient video data.
See also: HIPAA (Health Insurance Portability and Accountability Act), Data Security
Business Case Development
Definition: The process of creating a clear explanation for why a project should be approved. It outlines the expected benefits, costs, and financial value, such as return on investment (ROI).
Example: A hospital prepares a business case for starting a remote patient monitoring program, showing how it could lower readmission rates and save money.
See also: Reimbursement strategy, Healthcare operations
C
Capacity Planning
Definition: Estimating resources (staff, equipment, space) needed to meet patient care demand.
Use case: A clinic analyzes rising telehealth visits to hire more nurses and add virtual care slots.
See also: Workflow integration, Healthcare operations
Capitated Payment Model
Definition: A payment arrangement where providers receive a fixed amount per patient per period, regardless of services delivered.
Use case: A primary care group is paid $50 per member per month to manage care for a Medicaid population.
See also: Population Health Management, Risk-Based Contracting
Care Coordination
Definition: Deliberate organization of patient care activities to facilitate appropriate delivery of healthcare services.
Use case: A nurse care manager coordinates follow-up visits and home care for patients discharged after heart failure hospitalization.
See also: Care Management, Transitional Care Management (TCM)
Care Gap Closure
Definition: Identifying and resolving gaps in recommended care or screenings for patients.
Use case: A health plan uses claims data to flag patients due for colorectal screening and sends reminders to their providers.
See also: Healthcare Effectiveness Data and Information Set (HEDIS), Quality Measures
Care Management
Definition: A set of activities intended to improve patient care and reduce unnecessary healthcare use, often for those with chronic conditions.
Use case: A CCM nurse calls high-risk diabetic patients monthly to monitor medication use and set care goals.
See also: Chronic Care Management, Patient Engagement
Care Navigation
Definition: Support provided to patients as they move through the healthcare system, especially during complex or transitional phases.
Use case: A hospital assigns a navigator to oncology patients to help coordinate appointments, insurance paperwork, and education.
See also: Patient Experience, Care Coordination
Care Team Collaboration Tools
Definition: Platforms that help providers communicate and coordinate patient care.
Use case: A mobile app allows real-time secure messaging between physicians and nurses.
See also: Care coordination, Workflow integration, Chief Medical Information Officer (CMIO)
Case Mix Index (CMI)
Definition: A measure of the relative costliness of a hospital’s patient population, based on diagnosis-related group codes.
Use case: A tertiary care hospital treating more complex cases will have a higher CMI than a community hospital.
See also: DRG (Diagnosis-Related Group), Hospital Reimbursement
Centers for Medicare & Medicaid Services (CMS)
Definition: The federal agency that administers Medicare, Medicaid, and other health programs.
Use case: CMS oversees programs like MIPS, ACO REACH, and value-based hospital penalties.
See also: Quality Payment Program (QPP), Medicare Advantage
Channel Partnership
Definition: A business arrangement where a company partners with another to distribute its products or services.
Use case: A digital health startup forms a channel partnership with a large EHR vendor to reach more health systems through its platform.
See also: Strategic partnerships, Procurement process
Chief Compliance Officer (CCO)
Definition: The executive responsible for ensuring that all digital health practices meet legal and regulatory standards.
Use case: A CCO audits HIPAA compliance across all vendors and cloud tools used in virtual care.
See also: HIPAA, Business Association Agreement, Regulatory compliance
Chief Digital Officer (CDO)
Definition: The executive leading digital transformation initiatives, consumer tech, and digital experience.
Use case: A health system CDO launches a new digital front door that combines scheduling, chat, and check-in.
See also: Digital front door, Patient experience, Consumer-centric health design
Chief Experience Officer (CXO)
Definition: The leader responsible for patient, provider, and user experience across the healthcare journey.
Use case: The CXO leads design of a mobile-first app to improve telehealth satisfaction and follow-through.
See also: Patient engagement, Human-centered design
Chief Information Officer (CIO)
Definition: Executive responsible for IT strategy, security, and infrastructure in a healthcare organization.
Use case: A hospital CIO evaluates vendors for a new data aggregation platform that connects EHR and analytics tools.
See also: Chief Medical Information Officer (CMIO), IT Governance
Chief Innovation Officer
Definition: An executive who drives strategic innovation, often focused on digital transformation, new models, and pilot testing.
Use case: The innovation officer runs a sandbox to evaluate 10 AI tools for clinical impact and ROI.
See also: CMS Innovation Center, Emerging tech, Health tech pilot programs
Chief Medical Information Officer (CMIO)
Definition: A clinical leader who bridges medical and IT departments, focusing on EHR usability, clinical workflow, and informatics.
Use case: The CMIO leads the rollout of a new decision support tool to improve diabetes care pathways.
See also: CIO, Clinical Decision Support (CDS)
Chief Medical Officer (CMO)
Definition: A clinical leader responsible for guiding medical policies, safety, and clinical performance.
Use case: The CMO sets protocols for virtual urgent care and ensures alignment with evidence-based practice.
See also: Chief Medical Information Officer (CMIO), Quality metrics, Care model design
Chief Nursing Informatics Officer (CNIO)
Definition: A nurse leader who integrates clinical practice with health IT and workflow improvement.
Use case: A CNIO implements an alert system to reduce missed sepsis diagnoses in med-surg units.
See also: Nursing informatics, Clinical Decision Support (CDS), Quality improvement
Chief Nursing Officer (CNO)
Definition: A senior executive responsible for overseeing nursing services and ensuring high-quality patient care.
Use case: The CNO leads efforts to improve nurse staffing models and reduce patient falls in a hospital.
See also: Healthcare operations, Patient safety
Chief Operating Officer (COO)
Definition: The executive overseeing daily operations, delivery, and internal business processes.
Use case: The COO leads the integration of a telehealth platform across five new clinical partners.
See also: CEO, Workflow integration, Healthcare operations
Chief Population Health Officer
Definition: An executive focused on managing health outcomes, risk, and cost across attributed populations.
Use case: The officer leads risk-based contracts for managing 80,000 attributed lives in multiple ACOs.
See also: Population health, Risk-based contracting, ACO
Chief Strategy Officer (CSO)
Definition: The leader who develops and aligns long-term strategic goals, often across markets and innovations.
Use case: A CSO defines go-to-market strategy for a remote monitoring platform targeting Medicare Advantage plans.
See also: Business case development, Market segmentation, Strategic partnerships
Chief Technology Officer (CTO)
Definition: The executive responsible for building and managing the technology infrastructure and product stack.
Use case: A digital health CTO leads development of a new FHIR-enabled patient engagement platform.
See also: Application Programming Interface (API), (SaaS) Software as a Service in healthcare, Interoperability
Chronic Care Management (CCM)
Definition: Medicare-covered service supporting patients with two or more chronic conditions through ongoing non-face-to-face care.
Use case: A nurse monitors 250 diabetes and heart failure patients monthly using CCM codes (e.g., CPT 99490), generating recurring revenue.
See also: Remote Patient Monitoring, Care Management
Claims Adjudication
Definition: The process insurers use to review and decide whether a submitted healthcare claim should be paid, denied, or adjusted.
Use case: Insurance uses software to verify a claim for surgery, checking coverage, coding, and eligibility before payment.
See also: Claims processing workflow, Claims denial management
Claims Denial Management
Definition: Systems and procedures to handle denied insurance claims, including finding reasons and fixing errors.
Use case: A medical billing team uses denial AI-driven software to catch coding mistakes, correct them, and resubmit denied claims.
See also: Claims adjudication, Revenue cycle management
Claims Processing Workflow
Definition: The step-by-step process of handling insurance claims, from submission to payment or denial.
Use case: A clinic’s claims workflow includes verifying patient info, submitting electronic claims, tracking denials, and appealing.
See also: Claims adjudication, Claims denial management
Clinical Decision Support (CDS)
Definition: Tools that provide providers and staff with intelligently filtered information to enhance clinical decision-making.
Use case: A CDS tool alerts a provider to check kidney function before prescribing a new ACE inhibitor.
See also: Chief Medical Information Officer (CMIO), Electronic Health Record (EHR)
Clinical Documentation Improvement (CDI)
Definition: Strategies to ensure medical record documentation accurately reflects diagnoses and supports coding.
Use case: A hospital implements CDI software to ensure documentation justifies sepsis diagnosis and DRG assignment.
See also: Case Mix Index, Reimbursement Optimization
Clinical Effectiveness
Definition: How well a treatment or intervention works when used in real-world clinical practice.
Use case: A health system evaluates the clinical effectiveness of its telehealth program for depression by comparing patient outcomes to those from in-person therapy.
See also: Quality improvement, Quality measures
Clinical Quality Measures (CQMs)
Definition: Metrics that assess a healthcare provider’s performance in delivering care consistent with accepted standards.
Use case: A provider is scored on the percentage of hypertensive patients whose blood pressure is under control.
See also: HEDIS (Healthcare Effectiveness Data and Information Set)
Clinical Registry
Definition: A database of health information focused on specific diseases or outcomes.
Use case: A stroke registry collects treatment timelines to improve emergency response.
See also: Real-world evidence, Population health management
Clinical Surveillance Software
Definition: Real-time monitoring tools that detect clinical deterioration or infection risks.
Use case: A hospital uses surveillance software to identify sepsis early based on EHR vitals.
See also: Clinical decision support, Patient safety, Hospital readmission reduction
Clinical Workflow Optimization
Definition: Process redesign and technology deployment aimed at improving the efficiency of clinical operations.
Use case: Automating vitals capture and syncing directly to the EHR reduces nurse workload and errors.
See also: Usability in Clinical Workflows, Electronic Health Record (EHR)
CMS Innovation Center (CMMI)
Definition: Division of CMS responsible for testing new payment and service delivery models.
Use case: CMMI launched the Primary Care First model to promote outcomes-based reimbursement in primary care.
See also: Value-Based Care, Advanced Alternative Payment Model (APM)
Co‑Insurance
Definition: The percentage of a medical bill a patient pays after meeting their deductible. The insurance covers the rest.
Use case: With a 20% co‑insurance, if a $500 imaging test is done, the patient pays $100 and insurance pays $400.
See also: Deductible, Out‑of‑pocket costs
Collaborative Care Model
Definition: A team-based mental health approach that connects a primary care provider, behavioral health specialist, and care manager.
Use case: A depressed patient sees a primary care doctor and care manager who coordinates regular sessions with a psychologist.
See also: Federally qualified health center, Integrated care
Community Health Needs Assessment (CHNA)
Definition: A requirement for hospitals to identify key health needs of their service area.
Use case: A health system surveys local residents and identifies diabetes, behavioral health, and transportation as top concerns.
See also: Social Determinants of Health, Population Health Management
Consumer-Centric Health Design
Definition: Designing healthcare services and solutions around the preferences, behavior, and needs of patients.
Use case: A digital intake form lets patients select language, device preference, and communication method.
See also: Patient Engagement, Digital Front Door
Continuity of Care Document (CCD)
Definition: An electronic document standard (usually XML format) used to exchange a summary of patient information during care transitions.
Use case: After discharge, a CCD is sent to the patient’s primary care provider for care transition continuity.
See also: Health Information Exchange (HIE), Interoperability
Conversational AI
Definition: Automated chatbots or voice assistants that use language processing to interact with patients or providers.
Use case: A virtual assistant asks patients pre‑visit screening questions and updates their electronic health record (EHR).
See also: AI in healthcare, Workflow integration
Cost-to-Charge Ratio (CCR)
Definition: A financial metric used to estimate the actual cost of care based on billed charges.
Use case: A healthcare CFO evaluates the CCR to assess how efficiently the health system delivers services relative to revenue.
See also: Net Patient Revenue, Operating Margin
CPT Code (Current Procedural Terminology)
Definition: A standardized coding system used to describe medical, surgical, and diagnostic services.
Use case: CPT 99457 is used for 20 minutes of remote patient monitoring management services.
See also: Fee-for-Service (FFS), Reimbursement Strategy
Credentialing and Privileging
Definition: The process of verifying a clinician’s qualifications and authorizing them to provide specific patient services.
Use case: A health system uses a digital tool to regularly verify licenses and certifications of remote behavioral health providers.
See also: Regulatory Compliance
D
Data Security
Definition: Measures and practices that protect health information from unauthorized access, loss, or tampering.
Use case: A hospital uses encryption and two-factor authentication to secure patient records in its electronic health record system.
See also: Health Insurance Portability and Accountability Act (HIPAA), IT governance
Data Transparency
Definition: Openness about how health data are collected, used, shared, and reported — allowing patients and stakeholders to understand data practices.
Use case: A health app clearly shows users how their fitness data are shared with research partners and gives them control over access.
See also: Patient rights, Regulatory compliance
Deductible
Definition: The fixed amount a patient must pay out of pocket before their insurance coverage begins.
Use case: A patient with a $1,000 deductible pays for their initial medical costs until that amount is met; afterward, the insurer pays for covered services.
See also: Co‑insurance, Out‑of‑pocket costs
De‑identified Data
Definition: Health data that have had personal identifiers removed, making it hard to trace back to any specific individual.
Use case: A research team uses large sets of de‑identified claims data to study trends in asthma treatment across the country.
See also: Data transparency, Precision medicine
Digital Biomarkers
Definition: Objective, quantifiable data collected via digital devices that reflect health-related measures.
Use case: A smartwatch collects tremor frequency data used as a biomarker for Parkinson’s disease progression.
See also: Remote Monitoring, Patient-Generated Health Data
Digital Consent
Definition: An electronic process for obtaining patient permission for care or data use.
Use case: A patient reviews and signs surgery consent forms via a mobile app.
See also: Informed consent management, Data security
Digital Front Door
Definition: A patient-facing entry point to healthcare services through digital tools.
Use case: A health system app enables appointment scheduling, bill pay, and video visits all in one place.
See also: Consumer-Centric Health Design, Telehealth
Digital Intake and Check-In
Definition: Technology-enabled tools that allow patients to complete administrative tasks before or upon arrival.
Use case: A patient completes forms, updates insurance, and signs consents via smartphone before a physical therapy appointment.
See also: Workflow Integration, Patient Access Mandates
Digital Therapeutics
Definition: Software-driven interventions that prevent, manage, or treat diseases, often with clinical validation.
Use case: A digital CBT program for anxiety is FDA-cleared and prescribed alongside traditional therapy.
See also: SaMD (Software as a Medical Device)
Digital Twin in Healthcare
Definition: A virtual replica of a patient, medical device, or even an entire healthcare system, used for simulation, monitoring, or prediction.
Use case: A heart model simulates outcomes of two stent options before surgery.
See also: Predictive analytics, Real-world evidence, Genomics-informed care
Discharge Planning
Definition: The process of preparing a patient to leave a hospital and ensuring necessary follow-up care.
Use case: A discharge nurse arranges home health visits and sends prescriptions electronically before patient discharge.
See also: Transitional Care Management, Hospital readmission reduction
Disease Management Program
Definition: A coordinated healthcare approach focused on managing chronic conditions to improve outcomes.
Use case: A payer runs a disease management program for COPD patients that includes education and 24/7 support line.
See also: Chronic Care Management, Population Health
DRG (Diagnosis-Related Group)
Definition: A system used by hospitals to classify inpatient cases into groups that are expected to have similar hospital resource use.
Use case: Under Medicare, a patient admitted for hip replacement is assigned into a specific DRG, and the hospital is paid a flat rate for that DRG.
See also: Hospital reimbursement, Prospective payment system
E
Edge Computing in Healthcare
Definition: Local data processing near the data source to reduce delay and reliance on the cloud.
Use case: A wearable monitors heart rate and triggers alerts instantly, without cloud delay.
See also: Remote monitoring, IoT in healthcare, Device interoperability
Electronic Health Record (EHR)
Definition: A digital version of a patient’s paper chart containing medical history, diagnoses, medications, and treatment plans.
Use case: A clinician reviews EHR notes to verify allergy information before ordering antibiotics.
See also: Chief Medical Information Officer (CMIO), Clinical Workflow Optimization
Encounter Summary
Definition: Auto-generated summaries of clinical visits using AI or speech-to-text.
Use case: A digital scribe sends the visit summary and instructions to a patient’s portal.
See also: Ambient clinical intelligence, Patient engagement, Electronic Health Record
Episode-Based Payment Model
Definition: A payment approach where providers receive a fixed amount for all care delivered during an episode of treatment.
Use case: A provider receives a bundled payment for a 90-day knee replacement episode, covering surgery, rehab, and follow-up.
See also: Bundled Payments, Value-Based Purchasing
E-prescribing (eRx)
Definition: The electronic generation and transmission of prescription orders to a pharmacy.
Use case: A provider sends an eRx for a statin refill directly from the EHR to the patient’s preferred pharmacy.
See also: Medication Adherence, Clinical Workflow
Evidence-Based Guidelines
Definition: Clinical recommendations developed through the systematic review of evidence to optimize patient care.
Use case: A cardiologist follows ACC/AHA guidelines for lipid management when prescribing statins.
See also: Clinical Decision Support, Quality Measures
F
Federally Qualified Health Center (FQHC)
Definition: Community-based health organizations that provide primary care services in underserved areas, regardless of ability to pay or immigration status.
Use case: An FQHC offers integrated behavioral health and dental services, reimbursed on a prospective payment system (PPS).
See also: Medicaid, Safety Net Providers
Fee-for-Service (FFS)
Definition: A reimbursement model where providers are paid for each individual service rendered.
Use case: A clinic bills Medicare separately for an office visit, flu shot, and lab work — each with its own CPT code.
See also: CPT Code, Revenue Cycle Management
FHIR (Fast Healthcare Interoperability Resources)
Definition: A data standard developed by HL7 for exchanging healthcare information electronically.
Use case: A digital health app uses FHIR APIs to pull a patient’s immunization history from their EHR.
See also: Interoperability, Application Programming Interface (API)
G
Genomics-Informed Care
Definition: Care that incorporates genetic data into decision-making and treatment to improve patient outcomes.
Use case: A cancer patient’s therapy is selected based on BRCA test results.
See also: Precision medicine
H
Health AI Governance
Definition: Policies and oversight structures to ensure ethical and safe use of AI in healthcare.
Use case: A hospital reviews AI models for bias before approving them for clinical use.
See also: Compliance, CMIO, Risk management
Healthcare Operations
Definition: The daily management of a health system’s services, staff, finances, and quality to ensure patient care runs smoothly.
Use case: A hospital’s operations team oversees resource scheduling, supply chain, billing processes, and performance monitoring.
See also: Capacity planning, Quality improvement
Health Data Harmonization
Definition: The process of bringing together health data from different sources and making it consistent and comparable for analysis and research.
Use case: A care team reconciles EHR and lab feeds to build a clean dashboard.
See also: Structured data capture, Interoperability, FHIR
Health Equity Metrics
Definition: Measures used to track and assess disparities in health outcomes and healthcare access across different population groups.
Use case: A health plan tracks colorectal cancer screening rates by race to identify disparities.
See also: Social Determinants of Health (SDoH), Quality Reporting
Health Information Exchange (HIE)
Definition: The secure, electronic sharing of health data across organizations and systems.
Use case: A specialist accesses a patient’s recent lab results and discharge notes from a local HIE.
See also: Continuity of Care Document (CCD), Interoperability
Health IT
Definition: Technology used in healthcare settings to manage patient information, clinical operations, and care delivery.
Use case: A primary care office uses an electronic health record (EHR) system to store patient notes, labs, and appointment schedules.
See also: Electronic Health Record, FHIR (Fast Healthcare Interoperability Resources)
Health Level Seven (HL7)
Definition: A set of international standards for the exchange and integration of electronic health information.
Use case: An EHR sends lab order messages using HL7 v2.x format to a third-party lab.
See also: FHIR (Fast Healthcare Interoperability Resources), Health Information Exchange (HIE)
Health Literacy Tools
Definition: Digital aids that help patients understand and act on their health information.
Use case: An app provides medication instructions in plain language and Spanish.
See also: Patient engagement, Digital front door, Patient activation
Health Outcomes Survey (HOS)
Definition: A CMS-mandated survey measuring patient-reported outcomes for Medicare Advantage enrollees.
Use case: A health plan uses HOS results to evaluate effectiveness of chronic disease outreach programs.
See also: Medicare Advantage, Quality Metrics
Health Plan Star Ratings
Definition: A CMS system that rates Medicare Advantage and Part D plans based on quality and performance to help patients choose the right plan for them.
Use case: A Medicare Advantage plan’s 4.5-star rating helps it attract new enrollees and earn bonus payments.
See also: HEDIS (Healthcare Effectiveness Data and Information Set), Health Outcomes Survey (HOS)
Health System Consolidation
Definition: The merging or acquisition of hospitals, clinics, or health systems to form larger organizations.
Use case: Several independent community hospitals merge into one regional system to streamline supply buying and share specialty staff.
See also: Strategic partnerships, Healthcare operations
HEDIS (Healthcare Effectiveness Data and Information Set)
Definition: A standardized set of performance measures used to compare health plan quality.
Use case: A plan tracks diabetes eye exam rates to improve its HEDIS performance on chronic condition management.
See also: Quality Payment Program, Health Plan Star Ratings
Hierarchical Condition Category Coding (HCC Coding)
Definition: A system that categorizes diagnoses into risk-adjusted groups used to predict future healthcare costs and ensures that providers are fairly compensated for the care they deliver.
Use case: A practice code for diabetes with complications (HCC 18), which increases RAF score and reimbursement.
See also: Risk Adjustment Factor (RAF) Score, Risk Adjustment
HIPAA (Health Insurance Portability and Accountability Act)
Definition: The Health Insurance Portability and Accountability Act, a U.S. law setting standards for protecting patient health information.
Use case: A telehealth vendor signs a HIPAA business associate agreement and uses secure messaging to prevent patient data breaches.
See also: Data security, Regulatory compliance
Home-Based Diagnostics
Definition: At-home medical testing supported by digital tools and remote reporting.
Use case: A COVID-19 test kit lets users scan results and send data to providers.
See also: Remote patient monitoring, Mobile health, Patient-Generated Health Data (PGHD)
Hospital-Acquired Condition (HAC) Reduction Program
Definition: A Medicare initiative that reduces payments to hospitals with high rates of certain preventable conditions.
Use case: A hospital loses 1% of its Medicare payments after being penalized for a high rate of central line infections and responds by implementing infection control protocols.
See also: Patient Safety, Quality Payment Programs
Hospital-at-Home (Virtual Ward)
Definition: Delivering hospital-level services to patients in their homes.
Use case: A patient with pneumonia receives IV therapy and vitals monitoring at home.
See also: Transitional care, Remote monitoring, Telehealth
Hospital Readmissions Reduction Program (HRRP)
Definition: A CMS program penalizing hospitals with excess readmissions for specific conditions.
Use case: A hospital invests in post-discharge outreach to reduce 30-day readmission rates for heart failure.
See also: Value-Based Purchasing, Transitional Care Management
Hospital Reimbursement
Definition: Methods hospitals use to get paid for care, including fixed rates, bundled payments, or fee-for-service.
Use case: A hospital receives a set payment based on a DRG for a patient’s surgery instead of billing each service separately.
See also: DRG (Diagnosis-Related Group), Reimbursement strategy
Human-Centered Design
Definition: A design approach that focuses on the needs, preferences, and experiences of end users — patients, providers, or staff.
Use case: A development team conducts interviews with nurses and patients before building a new patient portal to ensure it’s easy to use.
See also: Workflow integration, Patient experience
I
Identity and Access Management (IAM)
Definition: Technology to control user access to health data systems.
Use case: A health system uses IAM to quickly onboard and assign appropriate access permissions to staff and volunteers during a COVID‑19 vaccination campaign — ensuring vaccine nurses, clerks, and support personnel access only the systems they need .
See also: Data security, Regulatory compliance, EHR integration
In-Network vs. Out-of-Network Services
Definition: Describes whether a provider has a contracted agreement with a patient’s health plan.
Use case: A patient pays lower copays when seeing an in-network dermatologist compared to an out-of-network provider.
See also: Insurance Design, Patient Out-of-Pocket Costs
Informed Consent Management
Definition: The process of ensuring patients are fully informed about their treatment options and understand the potential risks, benefits, and alternatives.
Use case: A digital platform collects e-signatures for informed consent prior to a scheduled colonoscopy.
See also: Patient Rights
Integrated Delivery Network (IDN)
Definition: A unified network of healthcare facilities and services providing coordinated and comprehensive care to a defined population.
Use case: An IDN includes hospitals, clinics, labs, and pharmacies all coordinated under one regional health system.
See also: Health System Consolidation, Value-Based Care
Integration Partner
Definition: A third-party company that helps connect different digital health systems, apps, or platforms.
Use case: A telehealth company hires an integration partner to connect its platform with multiple EHR systems using FHIR APIs.
See also: FHIR (Fast Healthcare Interoperability Resources), Workflow integration
Intelligent Scheduling (Healthcare)
Definition: AI or rules-based systems that manage provider appointments and resource allocation.
Use case: An algorithm fills canceled appointments with urgent waitlist patients.
See also: Workflow optimization, Patient access, Capacity planning
Interoperability
Definition: The ability of different health IT systems to exchange, interpret, and use data cohesively.
Use case: A hospital’s EHR automatically updates with lab results from an external reference lab.
See also: FHIR, API, HL7
See also: FHIR (Fast Healthcare Interoperability Resources), Workflow integration
IoT in Healthcare
Definition: Medical devices or sensors connected through the internet to monitor patient health or track equipment use.
Use case: A hospital’s smart IV pump sends alerts when it’s low on fluids, reducing errors and improving efficiency.
See also: Wearables, Data security
IT Governance in Healthcare
Definition: A framework ensuring that information technology supports an organization’s goals, manages risks, and complies with regulations.
Use case: A health system’s IT committee reviews new software requests, evaluates risk, and oversees data privacy policies.
See also: Data security, Regulatory compliance
L
Longitudinal Patient Record
Definition: A comprehensive, continuous health record that tracks a patient across time, providers, and care settings.
Use case: A patient’s record includes pediatric immunizations, adult chronic condition data, and recent hospitalizations — all in one view.
See also: Electronic Health Record, Interoperability
Low-Acuity Care Pathways
Definition: Protocols and workflows designed for patients with conditions that don’t require high-intensity care.
Use case: A virtual care service guides patients with minor issues like sore throats to nurse practitioners using preset care steps.
See also: Triage, Care Navigation
M
Machine-Readable Formats
Definition: Structured data formats that can be processed by software, not just viewed by people.
Use case: An insurance API uses machine-readable plan details in JSON, CSV, or XML to update a member portal.
See also: FHIR (Fast Healthcare Interoperability Resources), Application Programming Interface (API), Data transparency
MACRA (Medicare Access and CHIP Reauthorization Act)
Definition: 2015 legislation that created the Quality Payment Program, shifting Medicare payments to performance-based models.
Use case: A primary care provider participates in MIPS under MACRA and receives a 3% payment adjustment based on quality scores.
See also: Quality Payment Program (QPP), Merit-based Incentive Payment System (MIPS), Advanced Alternative Payment Model (APM)
Market Segmentation
Definition: Dividing a population into groups based on shared characteristics to better target health programs or products.
Use case: A digital health company segments users by age and health conditions to tailor wellness messaging for diabetics.
See also: Business case development, Patient experience
Medicaid
Definition: A U.S. public insurance program jointly funded by federal and state governments that covers low-income people.
Use case: A pregnant woman on Medicaid receives prenatal and delivery care at no or low cost.
See also: Federally Qualified Health Center (FQHC), Safety net providers
Medical Loss Ratio (MLR)
Definition: The percentage of insurance premiums that must be spent on clinical services and quality improvement, rather than on administrative costs or profit. The Affordable Care Act requires insurance companies to spend at least 80% or 85% of premium dollars on medical care.
Use case: A health plan with an 85% MLR must spend no more than 15% on administrative costs and profit.
See also: The Affordable Care Act (ACA)
Medication Adherence
Definition: The degree to which a patient correctly follows prescribed medication regimens.
Use case: A digital pill dispenser tracks if elderly patients take their blood pressure meds daily and alerts caregivers when doses are missed.
See also: Chronic Care Management (CCM), Meds-to-Beds
Medication Reconciliation Tools
Definition: Digital tools that verify patient medication lists across care settings.
Use case: A nurse compares hospital discharge meds with Electronic Health Record (EHR) lists at a follow-up visit.
See also: Meds-to-beds, Patient safety
Medication Therapy Management (MTM)
Definition: Services provided by pharmacists to optimize drug therapy and improve therapeutic outcomes.
Use case: A Medicare Part D plan reimburses pharmacists for performing MTM reviews for members on multiple chronic meds.
See also: Medicare Advantage
Meds-to-Beds (Bedside Medication)
Definition: A hospital program that delivers discharge prescriptions to the bedside before the patient leaves.
Use case: A robotic cart brings antibiotics and an inhaler to the patient’s room with pharmacist instructions at discharge.
See also: Medication Adherence, hospital readmission reduction
Medicare Advantage
Definition: A CMS-approved alternative to traditional Medicare, offered by private insurance companies.
Use case: A patient enrolls in a Medicare Advantage plan that includes gym memberships, transportation, and low copays.
See also: Health Plan Star Ratings, Risk Adjustment
Merit-based Incentive Payment System (MIPS)
Definition: A CMS program under MACRA that adjusts Medicare payments based on quality, cost, and technology use.
Use case: A physician group boosts MIPS scores through better diabetes control and earns a 5% positive payment adjustment.
See also: Quality Payment Program (QPP), MACRA (Medicare Access and CHIP Reauthorization Act)
Mobile Health (mHealth)
Definition: Use of mobile devices to support public health and clinical care.
Use case: A prenatal app helps track symptoms and sends reminders for appointments.
See also: Patient-Generated Health Data (PGHD), Digital front door, Wearables
N
National Committee for Quality Assurance (NCQA)
Definition: A nonprofit organization that sets standards and accredits healthcare providers to improve quality.
Use case: A primary care clinic earns NCQA Patient-Centered Medical Home (PCMH) accreditation by showing it uses care teams, tracks follow-ups, and offers same-day appointments to improve patient access and coordination.
See also: Quality measures, Quality reporting
Natural Language Processing (NLP)
Definition: AI that interprets and extracts meaning from unstructured clinical text.
Use case: A tool flags depression symptoms in mental health notes across a health system.
See also: Clinical decision support, Electronic Health Record, AI-powered diagnostics
Net Patient Revenue
Definition: The total amount a healthcare provider earns from patient services after contractual adjustments, discounts, and bad debt.
Use case: A hospital with $600 million in gross charges and $300 million in adjustments reports $300 million in net patient revenue.
See also: Cost-to-Charge Ratio (CCR), Operating Margin
Network Adequacy
Definition: The ability of a health plan to provide sufficient in-network providers to meet patient access needs.
Use case: A state regulator audits whether a Medicaid plan offers pediatric specialists within 30 miles of enrollees.
See also: In-Network Services
Nursing Informatics
Definition: Integration of nursing science with data and technology to improve patient care.
Use case: A nurse informaticist works on improving fall-risk alert protocols in the EHR.
See also: Clinical workflow optimization, Clinical quality measures, Chief Medical Information Officer (CMIO)
O
ONC (Office of the National Coordinator for Health Information Technology) Rule
Definition: Regulations by the Office of the National Coordinator for Health Information Technology focused on expanding access and interoperability of health IT.
Use case: A hospital updates its EHR system to meet the latest ONC rule requiring APIs so patients can freely share their health data.
See also: FHIR (Fast Healthcare Interoperability Resources), Data transparency
Operating Margin
Definition: The difference between a hospital’s operating revenue and costs, shown as a percentage of revenue. It reflects how much income is left after covering patient care expenses. In non-profit settings, it’s called “net income” or “surplus.”
Use case: A hospital may reduce supply costs and increase outpatient visits to improve its operating margin from 2% to 5%.
See also: Reimbursement optimization
Out-of-Pocket Maximum
Definition: The most a patient will pay during a coverage period for covered services before the insurer pays 100%.
Use case: After hitting a $6,000 out-of-pocket max, a patient’s chemotherapy is fully covered for the rest of the year.
See also: Deductible, Co-insurance
Outpatient Care
Definition: Medical services provided without an overnight hospital stay, such as clinic visits or day surgery.
Use case: A patient has a same-day cataract surgery in an outpatient clinic and goes home the same day.
See also: Hospital reimbursement, Ambulatory care
P
Patient Access Mandates
Definition: Policies that require providers and payers to give patients access to their own health information through online or digital means.
Use case: Under the CMS interoperability rule, payers must offer patients digital access to their claims data via FHIR APIs.
See also: ONC (Office of the National Coordinator for Health Information Technology) Rule, Data Transparency
Patient Activation
Definition: A measure of a patient’s knowledge, skill, and confidence in managing their own health.
Use case: A diabetes app with goal-setting tools improves patient activation scores among high-risk users.
See also: Patient Engagement
Patient Attribution
Definition: The method used to assign a patient to a specific provider or provider group for accountability in care.
Use case: A Medicare beneficiary is attributed to a primary care physician based on where they receive the majority of visits.
See also: Accountable Care Organization (ACO), Value-Based Care
Patient Engagement
Definition: Strategies and tools that involve patients in their own health and care decisions.
Use case: A two-way messaging platform lets patients confirm appointments, receive health tips, and respond to care team prompts.
See also: Patient Activation, Digital Front Door
Patient Experience
Definition: How patients feel about their care, including communication, wait times, and overall satisfaction.
Use case: A health system uses surveys after clinic visits to gather feedback and reduce long wait times.
See also: Patient safety, Quality improvement
Patient Feedback Loop
Definition: Process of collecting, analyzing, and acting on patient satisfaction data.
Use case: After a negative comment, a manager follows up to resolve the patient’s concern.
See also: Patient experience, Quality metrics, Digital front door
Patient-Generated Health Data (PGHD)
Definition: Health-related data created, recorded, or gathered by patients outside of clinical settings.
Use case: A patient’s home blood glucose readings sync to the provider’s portal through a connected device.
See also: Remote Monitoring
Patient-Centered Medical Home (PCMH)
Definition: A care delivery model where primary care practices coordinate comprehensive, team-based care.
Use case: A PCMH uses care coordinators, nutritionists, and behavioral health integration to manage complex patients.
See also: Value-Based Care, National Committee for Quality Assurance (NCQA)
Patient Rights
Definition: The entitlements patients have, such as informed consent, privacy, and the right to access their health records.
Use case: A hospital informs patients of their right to view and get copies of their medical records under HIPAA.
See also: HIPAA (Health Insurance Portability and Accountability Act), Data transparency
Patient Safety
Definition: Actions taken to prevent harm to patients during healthcare delivery.
Use case: A hospital uses barcoded wristbands to ensure the right patient gets the correct medication.
See also: Quality improvement, Clinical effectiveness
Payment Integrity
Definition: Processes to ensure claims are paid accurately and in compliance with policies, preventing fraud and waste.
Use case: A payer flags duplicate claims for a single procedure during automated pre-adjudication review.
See also: Claims Adjudication, Risk Adjustment
Payor Mix
Definition: The proportion of revenue a provider receives from different insurance sources.
Use case: A rural hospital with 70% Medicare and Medicaid payor mix may face tighter margins than one with more commercial coverage.
See also: Net Patient Revenue, Reimbursement Strategy
Performance-Based Risk Sharing
Definition: Agreements in which payment for a solution depends on achieving predefined outcomes.
Use case: A digital therapeutics company is paid only if its weight loss tool helps patients hit clinical targets after six months.
See also: ROI Model
Personal Health Record (PHR)
Definition: A patient-controlled, digital collection of health information.
Use case: A patient uploads allergy history and imaging into their personal record for new specialists.
See also: Patient-Generated Health Data (PGHD), Patient access mandates
Pharmacy Benefit Manager (PBM)
Definition: A third-party administrator that manages prescription drug benefits on behalf of health insurance plans, large employers, and other payers.
Use case: A PBM negotiates discounts with drug manufacturers and determines formulary placement for statins.
See also: Medication Adherence, Medical Loss Ratio (MLR)
Population Health Management
Definition: The aggregation and analysis of patient data to improve health outcomes for defined groups.
Use case: A provider uses a registry to identify all uncontrolled hypertensive patients and schedules outreach calls.
See also: Attributed Lives, Risk Stratification
Precision Medicine
Definition: Medical care designed to match a person’s genetics, lifestyle, and environment to improve treatment results.
Use case: An oncologist orders genetic testing for a tumor to choose a targeted therapy that works best for a patient’s cancer type.
See also: Predictive analytics, Personalized care
Predictive Analytics
Definition: Using data and algorithms to predict future health events or outcomes, helping providers act earlier.
Use case: A clinic uses predictive models to identify patients at high risk of hospital readmission, then provides extra support.
See also: Precision medicine
Predictive Risk Modeling
Definition: Using data to estimate a patient’s likelihood of future health events.
Use case: A model flags seniors likely to be admitted for Congestive Heart Failure (CHF) within 90 days.
See also: Risk adjustment, Population health, Anticipatory care planning
Prior Authorization Automation
Definition: Technology that streamlines the process of getting payer approval for treatments and prescriptions before care is delivered.
Use case: A clinician uses EHR-integrated software that auto-submits and tracks prior authorization requests in real time.
See also: Workflow Integration, Claims Denial Management
Prior Authorization
Definition: A requirement by payers to approve certain services or medications before they are provided.
Use case: A cardiologist submits a prior auth request for a nuclear stress test for a patient with chest pain.
See also: Utilization Management, Claims Workflow
Procurement Process
Definition: The steps organizations follow to buy goods or services — like medical supplies or software — at best value.
Use case: A hospital issues a request for proposals (RFP) for new MRI machines and selects a vendor based on price, quality, and maintenance support.
Provider Directory Accuracy
Definition: The accuracy of information about provider credentials, locations, and plan participation available to patients.
Use case: A patient tries to book with a listed in-network endocrinologist who no longer accepts their insurance, suggesting outdated information.
See also: Network Adequacy, Regulatory Compliance
Q
Qualified Health Information Network (QHIN)
Definition: A health information exchange network that meets technical and legal standards set by the U.S. Office of the National Coordinator under TEFCA.
Use case: A hospital joins a QHIN to securely share patient data across systems and states, improving care coordination.
See also: Trusted Exchange Framework and Common Agreement (TEFCA), Interoperability
Quality Improvement
Definition: Systematic, data-driven actions to make health care safer, more effective, efficient, equitable, timely, and centered on patients.
Use case: A clinic tracks hand-hygiene rates, identifies drops in compliance, and institutes staff reminders—resulting in fewer infections.
See also: Clinical effectiveness, Patient safety
Quality Measures
Definition: Standards or indicators used to assess health care quality, such as rates of screenings, complications, or patient satisfaction.
Use case: A cardiology department tracks the percentage of heart attack patients who receive aspirin within 24 hours of arrival.
See also: Quality reporting, National Committee for Quality Assurance (NCQA)
Quality Metrics
Definition: Precise, numerical measures used to assess healthcare quality — like safety, efficiency, and patient satisfaction — to guide performance improvements
Use case: A hospital reporting that 95 % of its diabetic patients received HbA1c tests within the past year is a clear, trackable metric showing care quality.
See also: Quality measures, Performance dashboard
Quality Payment Program (QPP)
Definition: CMS framework under MACRA for rewarding value and quality through MIPS and APMs.
Use case: A practice improves blood pressure control metrics and earns a QPP bonus under the MIPS track.
See also: MACRA (Medicare Access and CHIP Reauthorization Act), Merit-based Incentive Payment System (MIPS)
Quality Reporting Program
Definition: A structured initiative where providers, facilities, or organizations collect and submit data on quality metrics to regulators, payers, or accrediting bodies to show how well they’re meeting care standards.
Use case: A health center sends data on blood pressure control to CMS under the Merit‑Based Incentive Payment System, meeting requirements and qualifying for performance-based payments.
See also: Quality payment program, National Committee for Quality Assurance (NCQA)
R
Readmission Penalty
Definition: A CMS reduction in hospital payments for higher-than-expected readmission rates.
Use case: A hospital reduces pneumonia readmissions to avoid a 2% penalty under HRRP.
See also: Hospital Readmissions Reduction Program (HRRP), Transitional Care
Real-World Evidence (RWE)
Definition: Clinical evidence regarding the usage and benefits of a treatment derived from real-world data sources.
Use case: A health system publishes RWE showing improved HbA1c among patients using a digital lifestyle intervention.
See also: Patient-Generated Health Data (PGHD), Data-Driven Outcomes
Regulatory Compliance
Definition: Ensuring healthcare organizations meet all legal and industry rules, such as privacy laws or safety standards.
Use case: A telehealth provider conducts regular audits to ensure all services comply with federal and state telemedicine laws.
See also: HIPAA
Reimbursement Optimization
Definition: Efforts to improve how well a provider gets paid, by reducing denials and maximizing allowed charges.
Use case: A billing department reviews denied claims weekly, corrects coding errors, and increases successful payments.
See also: Claims denial management, Revenue cycle management
Reimbursement Policy
Definition: A set of rules and guidelines that determine how healthcare services are paid for by insurers, including what services are covered, how much is paid, and under what conditions.
Use case: A digital health company studies the reimbursement policy of several payers to understand which telehealth services will be covered and at what rates before launching in new markets.
See also: Fee-for-service (FFS), Value-based care, Reimbursement strategy
Reimbursement Strategy
Definition: A plan that outlines how an organization will approach getting paid — balancing fee‑for‑service, bundled payments, and value‑based models.
Use case: A multispecialty group may decide to pursue accountable care contracts to earn shared savings and reduce reliance on fee‑for‑service.
See also: Value‑based purchasing, Shared savings program
Remote Patient Monitoring (RPM)
Definition: The collection of patient health data outside traditional settings, typically via digital devices.
Use case: A clinic monitors heart failure patients’ weight and blood pressure daily and adjusts treatment when needed.
See also: Chronic Care Management (CCM)
Remote Therapeutic Monitoring (RTM)
Definition: Use of digital tools to track therapy progress and response outside the clinic.
Use case: A physical therapist tracks a patient’s mobility via an app with motion sensors.
See also: RPM, Patient-Generated Health Data (PGHD), Digital therapeutics
Revenue Cycle Management (RCM)
Definition: The financial process used by healthcare systems to bill, track, and collect incoming payments from patients.
Use case: A hospital tracks denial rates and automates follow-up processes to improve cash flow.
See also: Net Patient Revenue
Risk Adjustment Factor (RAF) Score
Definition: A score used to predict future healthcare costs based on patient health conditions and demographics.
Use case: A patient with multiple chronic illnesses has a high RAF score, increasing the payer’s capitated payment to their provider.
See also: Hierarchical Condition Category Coding (HCC Coding)
Risk-Based Contracting
Definition: Agreements where providers assume financial risk in exchange for the potential to share in cost savings.
Use case: A health system accepts full-risk capitation for managing care of its Medicaid population.
See also: Advanced Alternative Payment Model (APM), Shared Savings
Risk Management
Definition: Identifying and reducing risks to patient safety, finances, and reputation.
Use case: A hospital uses incident reporting software to monitor and address safety events such as falls or medication errors.
See also: Patient safety
Risk Stratification
Definition: Grouping patients based on their health risk to target care more effectively.
Use case: A primary care organization uses risk scores to identify patients with chronic conditions who need more frequent check‑ins.
See also: Predictive analytics, Care management
ROI Model (Return on Investment Model)
Definition: A financial framework used to evaluate the profitability and impact of a solution or initiative.
Use case: A digital health vendor projects a 4:1 ROI based on reduced readmissions and improved MIPS scores.
See also: Business Case Development, Performance-Based Risk Sharing
S
SaaS (Software as a Service) in Healthcare
Definition: Cloud-based software delivered over the internet for clinical or administrative use.
Use case: A hospital uses a SaaS tool to track HEDIS quality measure performance across multiple clinics.
See also: Workflow Integration, Application Programming Interface (API)
Safety Net Providers
Definition: Health care organizations — like public hospitals or clinics — that serve vulnerable populations, regardless of ability to pay.
Use case: A community health center offers no‑cost flu vaccines to uninsured patients in low‑income neighborhoods.
See also: Federally qualified health center, Medicaid
SaMD (Software as a Medical Device)
Definition: Software intended to be used for medical purposes — such as diagnosing or treating health conditions — without being part of hardware.
Use case: A mobile app analyzes a user’s heart rhythm via smartphone camera to detect irregularities.
See also: Digital therapeutics, Regulatory compliance
Secure Patient Messaging
Definition: Encrypted communication between patients and care teams.
Use case: A patient sends a message to their doctor asking about side effects from a new medication.
See also: Patient engagement, Clinical workflow
Self-Triage Tools
Definition: Digital tools that help patients decide what kind of care they need.
Use case: A chatbot asks symptoms and recommends telehealth or in-person urgent care.
See also: Care navigation, Conversational AI
Shared Savings Program
Definition: A voluntary, value-based payment model from CMS where healthcare providers (organized as an ACO) collaborate to deliver coordinated, high-quality care to Medicare beneficiaries. If they reduce care costs below spending benchmarks and meet quality targets, they share in the savings.
Use case: A group of doctors and hospitals forms an Accountable Care Organization under CMS’s Shared Savings Program. They coordinate care, reduce unnecessary hospital stays, and meet quality standards—earning part of the cost savings generated for Medicare.
See also: Value‑based purchasing, Reimbursement strategy
Smart Medication Packaging
Definition: Packaging — such as pill bottles, blister packs, or boxes — with embedded sensors or connectivity (e.g., RFID, NFC, Bluetooth) that track when medications are taken, monitor storage conditions, and send alerts or reminders to patients, caregivers, or providers.
Use case: An older adult uses a smart pill box that lights up and sends a reminder at dose times. If a dose is missed, the system alerts a family caregiver and logs the event for review during the next provider visit.
See also: Medication adherence, Internet of things (IoT)
Social Determinants of Health (SDoH)
Definition: Non-clinical factors like housing, food, and transportation that influence health outcomes.
Use case: A care team refers a diabetic patient to a community food pantry after identifying food insecurity during intake.
See also: Community Health Needs Assessment (CHNA), Health Equity Metrics
Speech-to-Text in Healthcare
Definition: Software that converts spoken language into written clinical documentation.
Use case: A provider uses an AI tool with speech recognition to complete progress notes during home visits.
See also: Ambient clinical intelligence, Natural Language Processing (NLP), Electronic Health Record
Strategic Partnerships
Definition: Formal collaborations between health care organizations, payers, tech firms, or community groups to achieve shared goals.
Use case: A hospital partners with a telehealth vendor to expand virtual specialty visits in rural areas.
See also: Health system consolidation, Procurement process
Structured Data Capture
Definition: The process of collecting information in a standardized format that can be used for analysis and reporting.
Use case: A nurse inputs tobacco use via dropdowns in the EHR, making it trackable across population health tools.
See also: Interoperability
Supply Chain
Definition: The system used by healthcare organizations to order, store, and distribute medical supplies and equipment.
Use case: A hospital’s supply chain manager uses software to track Personal Protective Equipment (PPE) inventory and reorder before shortages occur.
See also: Procurement process, Capacity planning
T
Telehealth Parity Laws
Definition: State laws requiring that telehealth services be reimbursed at the same rate as in-person care.
Use case: A telepsychiatry session is reimbursed at the same rate as a clinic visit in states with parity laws.
See also: Reimbursement Policy, Virtual Care
The Affordable Care Act (ACA)
Definition: U.S. federal law passed in 2010 that expanded insurance coverage, created marketplaces, and set consumer protections.
Use case: A young adult stays on their parent’s plan until age 26, thanks to ACA regulations.
See also: Medicaid expansion
Transitional Care Management (TCM)
Definition: Services provided to patients moving from inpatient to home settings or other facilities, focused on preventing readmissions.
Use case: A primary care team contacts a patient within two days of hospital discharge for pneumonia, reviews medications, and schedules a follow-up visit to prevent complications.
See also: Care Coordination, Hospital Readmissions Reduction Program (HRRP)
Triage
Definition: Sorting patients by the urgency of their health needs to ensure timely care.
Use case: In an emergency department, a nurse assesses patients on arrival to identify those who need immediate attention versus those who can wait.
See also: Patient safety, Outpatient care
Trusted Exchange Framework and Common Agreement (TEFCA)
Definition: A federal initiative to establish a national framework for secure and standardized health data exchange across networks.
Use case: A digital health platform adopts TEFCA standards to make sure its systems can connect with any national health information network.
See also: Qualified Health Information Network (QHIN), ONC (Office of the National Coordinator for Health Information Technology) rule
U
Utilization Management
Definition: Reviews of health care services by payers or providers to ensure they are appropriate, necessary, and cost‑effective.
Use case: Before approving an MRI, an insurer reviews the patient’s condition to confirm it follows clinical guidelines.
See also: Claims adjudication, Value‑based purchasing
V
Value Analysis Committee for Health Systems
Definition: A multidisciplinary team evaluating new clinical products or solutions for cost, quality, and operational fit.
Use case: The committee reviews ROI data and clinician feedback on a new digital wound care platform.
See also: Procurement Process, Clinical Effectiveness
Value-Based Care
Definition: A model of healthcare where providers are paid based on patient outcomes rather than number of services delivered.
Use case: A health system receives bonuses for improving diabetes control among patients while reducing ER visits.
See also: Value-based purchasing, Shared savings program
Value‑Based Purchasing
Definition: A payment model where providers are paid based on patient outcomes, quality, and cost efficiency instead of volume only.
Use case: A hospital receives bonus payments for meeting benchmarks in readmission rates, patient satisfaction, and safe care.
See also: Shared savings program, Quality payment programs
Virtual Care
Definition: Any healthcare service delivered remotely using digital communication tools such as video, phone, chat, or secure messaging. It includes telehealth, remote monitoring, and online consultations.
Use case: A health system offers virtual care visits for primary care, dermatology, and mental health, allowing patients to connect with providers without visiting a clinic.
See also: Telehealth, Remote patient monitoring, Digital front door
Virtual Clinical Trials
Definition: Research studies conducted remotely using apps, sensors, and telehealth.
Use case: A diabetes trial collects weight, A1c, and surveys without site visits.
See also: Real-world evidence, Remote patient monitoring, Patient engagement
W
Wearables
Definition: Devices like smartwatches or fitness trackers that collect health data such as heart rate or activity.
Use case: A fitness tracker measures sleep patterns and alerts users when they deviate from healthy sleep habits.
See also: IoT in healthcare
Workflow Integration
Definition: The seamless insertion of digital tools or processes into existing clinical routines so they enhance rather than disrupt care.
Use case: A hospital integrates a clinical decision support alert into the EHR that prompts doctors to prescribe a follow-up test during routine ordering
See also: Human-centered design, Healthcare operations
Workforce Management Platform
Definition: Software that helps healthcare organizations manage schedules and staffing.
Use case: A hospital uses analytics to balance nurse staffing across units.
See also: Capacity planning, Clinical workflow
Bookmark This Page and Return to It Whenever You Need a Quick Reference.
Whether you’re a clinician, founder, policymaker, or health plan leader, staying fluent in the language of digital health helps you make better decisions and collaborate more effectively.
Use this glossary to cut through the jargon, align with your team, and stay current in a fast-changing field. We’ll keep updating it as new terms and technologies emerge — so check back often for the latest.
If you’re navigating digital health decisions right now and need a sharper edge — on positioning, product, or simply making your digital health strategy real — get in touch.
