| A | B |
|---|
| Healthcare Data | Data created and collected during healthcare-related episodes in different healthcare settings. |
| Demographic Data | Personal data elements such as name, date of birth, address, or sex used to identify the patient. |
| Clinical Data | Medical information related to the patient, including symptoms, diagnoses, treatments, and interventions. |
| Coded Data | Clinical data converted into codes using standardized nomenclature and terminologies. |
| Financial Data | Data collected to understand resource use in relation to clinical activities. |
| Statistical Data | Data collected and analyzed to support planning, reporting, workload projections, and resource allocation. |
| Financial and Statistical Data | Data used by healthcare management for budgets, workload projections, and resource allocation. |
| Aggregate Data | Data compiled into meaningful categories that does not identify individual patients. |
| Primary Use | The use of health information for direct patient care, including assessment, diagnosis, and treatment. |
| Secondary Use | The use of health information beyond direct care to improve population health and healthcare outcomes. |
| Patient Registration | The process used to collect demographic data and create the building blocks of the patient record. |
| Patient Interview | A method of collecting clinical data directly from the patient. |
| Physical Examination | A method of collecting clinical data through assessment of the patient. |
| Patient-Reported Outcome | Health information reported directly by the patient about symptoms, function, or quality of life. |
| Health Information Exchange (HIE) | A system that allows authorized healthcare professionals to share and access clinical data across organizations. |
| Patient Satisfaction Survey | A survey used to collect feedback from patients about their healthcare experience. |
| Population Health Survey | A survey used to collect data about the health status or needs of a population. |
| Abstract | A standard template where demographic, clinical, and coded data are collected and submitted for various purposes. |
| Management Information System Standards | Standards used in Canada to collect and report financial and statistical data for health service organizations. |
| Healthcare Data Use | The use of health data for care, legal evidence, reimbursement, planning, research, policy, and quality measurement. |
| Healthcare Communication | The use of patient record information to support communication between healthcare providers. |
| Clinical Decision-Making | Using patient information to support assessment, diagnosis, treatment, and care decisions. |
| Continuity of Care | Consistent care supported by the sharing and use of patient information across providers and settings. |
| Legal Evidence | Use of the health record as a documented history of healthcare services in legal proceedings. |
| Reimbursement Claim | A claim submitted to a payer for payment of healthcare services provided. |
| Strategic Planning | Using healthcare data to support long-term organizational planning and decision-making. |
| Administrative Decision-Making | Using health information to guide management and operational decisions. |
| Public Health Surveillance | Using health data to monitor population health and disease patterns. |
| Public Policy Development | Using healthcare data to inform legislation, regulations, accreditation standards, and health policy. |
| Performance Measure | A metric calculated from healthcare data to assess performance. |
| Quality Care Indicator | A measure used to assess the quality of healthcare services. |
| Benchmark Value | A reference value used to compare performance, such as Expected Length of Stay. |
| Expected Length of Stay (ELOS) | A benchmark value estimating the expected hospital stay for an admission. |
| Health Information Standards | Standards addressing structure, dissemination, vocabulary, and other requirements for interoperable health data. |
| Data Standards | Standards that support reliable, comparable, and transferable health data across systems. |
| Data Messaging Standards | Standards that define how data is exchanged between systems. |
| Data Structure Standards | Standards that specify how data is organized and formatted. |
| Data Content Standards | Standards that define the meaning and classification of data. |
| Data Management Standards | Standards that govern how data is stored, maintained, and used. |
| Standards Development Organization (SDO) | An agency involved in developing healthcare informatics standards nationally or internationally. |
| Ownership | The legal responsibility for the health record, typically held by the healthcare organization that created and maintains it. |
| Custodianship | The responsibility to maintain the confidentiality, integrity, and accessibility of the health record. |
| Legal Framework | The federal, provincial, and territorial laws and privacy legislation that govern health records. |
| Access and Disclosure | Rules governing who may access the legal health record and when information may be shared. |
| Consent | Permission required for disclosure of health information unless disclosure is authorized by law. |
| Electronic Health Record | An electronic format of the legal health record that must meet privacy, security, integrity, and accessibility requirements. |
| Documentation Standards | Standards that guide what information is collected, who collects it, and how it is presented, stored, and communicated. |
| Institutional Requirements | Policies and procedures that prescribe how long information must be retained and in what format. |
| Legislative Requirements | Requirements in laws that prescribe how and when information may be collected, stored, accessed, and destroyed. |
| Data Governance | The management, control, and protection of data assets within healthcare organizations. |
| Data Ownership | Accountability for specific data assets within an organization. |
| Data Quality Standards | Standards used to ensure data is accurate, complete, reliable, and usable. |
| Data Lifecycle Management | Managing data from creation or collection through use, retention, and disposition. |
| Data Stewardship | Responsibility for managing and protecting data according to standards and policies. |
| Information Governance | Management of all information assets across the lifecycle, including structured and unstructured information. |
| Structured Data | Organized information such as patient records, lab results, and clinical data. |
| Unstructured Information | Information such as medical documents, images, and correspondence. |
| Creation | The information governance stage where information is produced or captured. |
| Organization | The information governance stage where information is arranged and classified. |
| Access | The information governance stage governing who may view or use information. |
| Retention | The information governance stage determining how long information is kept. |
| Disposal | The information governance stage involving the approved destruction or removal of information. |
