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MIRCal - Glossary
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- Abstract:
See "Record" - Ambulatory Surgery Data:
For each encounter during which at least one ambulatory surgery procedure is performed, each hospital and freestanding ambulatory surgery clinic shall submit an ambulatory surgery data record, as specified in Subsection (a) of Section 128737 of the Health and Safety Code, for each encounter during the quarterly reporting period, according to the format specified in Subsection (c) of Section 97215 and by the dates specified in Subsection (c)(3) of Section 97211. An ambulatory surgery procedure is defined by Subsection (a) of Section 128700 of the Health and Safety Code as those procedures performed on an outpatient basis in the general operating rooms, ambulatory surgery rooms, endoscopy units, or cardiac catheterization laboratories of a hospital or a freestanding ambulatory surgery clinic. A hospital shall not report an Ambulatory Surgery Data Record if the encounter resulted in a same-hospital admission. 3 - Ambulatory Surgery Procedures:
Those procedures performed on an outpatient basis in the general operating rooms, ambulatory surgery rooms, endoscopy units, or cardiac catheterization laboratories of a hospital or a freestanding ambulatory surgery clinic. 1 - Approval Criteria:
Those tests performed which are intended to determine compliance of with the reporting requirements and specifications included in the California Code of Regulations, Title 22, Division 7, Chapter 10, Article 8 Discharge Data Reporting Requirements. - California Hospital Discharge Data Set:
The California Hospital Discharge Data Set consists of the data elements of the data elements of the hospital discharge abstract data record, as specified in Subdivision (g) or Section 128735 of the Health and Safety Code. - Core System (Phase):
This phase of the MIRCal system is the full design, development and implementation of a system to collect patient information from hospitals, validate/verify the information received, and to produce online and paper reports of that information. - Data Mining:
The ability for users of a system to interrogate a database ad hoc. - Data Report:
A report is defined as the collection of all records submitted by a hospital for a designated reporting period. - Data Warehousing:
The ability of a system to store data resulting from Data Mining to be used in future inquiries of that database. - Data Submitter:
Either the Health Care Facility or the facility's Designated Agent. - Designee:
See "Designated Agent" - Designated Agent:
An entity designated by a hospital to submit that hospital's discharge data records to the Office's Discharge Data Program; may include the hospital's abstractor, a data processing firm, or the data processing unit in the hospital's corporate office. - Discharge:
A discharge is defined as a newborn or a person who was formally admitted to a hospital as an inpatient for observation, diagnosis, or treatment, with the expectation of remaining overnight or longer, and who is discharged under one of the following circumstances: - is formally discharged from the care of the hospital and leaves the hospital,
- transfers within the hospital from one type of care to another type of care
- has died
- DRG - Diagnosis Related Groups:
is a classification scheme with which to categorize patients according to clinical coherence and expected resource intensity, as indicated by their diagnoses, procedures, age, sex, and disposition, and was established and is revised annually by the U. S. Centers for Medicare and Medicaid Services (CMS). - Electronic Media:
Standard computer storage media for data including; 8 track cartridge tapes, 3 1/2" floppy diskette, CD-ROM, and magnetic reel tape. - Electronic Transmission:
Transmission of a digital discharge data report over telecommunications systems/networks. - Emergency Department:
In a hospital licensed to provide emergency medical services, the location in which those services are provided. 1 - Emergency Care Data:
Each hospital shall submit an emergency care data record, as specified in Subsection (a) of Section 128736 of the Health and Safety Code, for each encounter during the quarterly reporting period, according to the format specified in Subsection (b) of Section 97215 and by the dates specified in Subsection (c)(2) of Section 97211. A hospital shall not report an Emergency Care Data Record if the encounter resulted in a same-hospital admission. 3 - Encounter:
A face-to-face contact between a patient and the provider who has primary responsibility for assessing and treating the condition of the patient at a given contact and exercises independent judgment in the care of the patient. 1 - Expanded System (Phase):
Phase of the MIRCal system that will add to the core system by accepting patient information from Emergency Departments, ambulatory surgery centers within hospitals and freestanding licensed ambulatory surgery clinics. - Extension:
Extension of time to file discharge data reports are available to hospitals that are unable to complete their submission of discharge data reports by the due date prescribed in Regulation. - Freestanding Ambulatory Surgery Clinic:
A surgical clinic that is licensed by the state under paragraph (1) of subdivision (b) of Section 1204. 1 - Health Care Facility:
A licensed Hospital, Emergency Department, or Ambulatory Surgery Center as defined in Section 128700 of the California Health and Safety Code. - HIPAA:
Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Administrative Simplification (AS) provisions of this Act are intended to reduce the costs and administrative burdens of health care by making possible the standardized, electronic transmission of many administrative and financial transactions that are currently carried out manually on paper. - HID:
Healthcare Information Division. Division of the Office of Statewide Health Planning and Development that has responsibility for the collection of patient level data. - HIRC:
Healthcare Information Resource Center. A section within the Healthcare Quality and Analysis Division of the Office of Statewide Health Planning & Development, responsible for the analysis and dissemination of patient level data. - ICD-9-CM:
The International Classification of Diseases, 9th Revision, Clinical Modification, published by the U. S. Department of Health and Human Services. Coding guidelines and annual revisions to ICD-9-CM are made nationally by the "cooperating parties" (the American Hospital Association, the Healthcare Financing Administration, the National Center for Health Statistics, and the American Health Information Management Association). - Modification:
Hospitals may file a request with the Office for modifications to the California Hospital Discharge Data Set. The modification request must be supported by a detailed justification of the hardship that full reporting of discharge data would have on the hospital; an explanation of attempts to meet discharge data reporting requirements, and a description of any other factors that might justify a modification. - On-line Transmission:
See "Electronic Transmission." - Outcome Measure:
A performance indicator that assesses patient health subsequent to, and resulting from, a healthcare treatment, procedure, or other therapeutic interventions. - Outpatient:
An outpatient is a person who has been registered or accepted for care but not formally admitted as an inpatient and who does not remain over 24 hours, as specified in Subsection (2) of Section 70053 of Title 22 of the California Code of Regulations, or a patient at a freestanding ambulatory surgery clinic who has been registered and accepted for care. 2 - Penalty:
When a health care facility has not submitted a discharge data abstract in accordance with the provisions of Subdivision (g) of Section 128735 and Subdivision (c) of Section 128755 of the Health and Safety Cod, and the facility has not been granted a modification or extension, it may be liable for a civil penalty of one hundred dollars per day as defined in Subdivision (g) of Section 128770 of the Health and Safety Code. - Provider:
The person who has primary responsibility for assessing and treating the condition of the patient at a given contact and exercises independent judgment in the care of the patient. This would include a practitioner licensed as a Medical Doctor (M.D.), a Doctor of Osteopathy, (D.O.), Doctor of Dental Surgery, (D.D.S.), or Doctor of Podiatric Medicine, (D.P.M.). 2 - Record:
The set of data elements specified in Subsection (g) of Section 128735, Subsection (a) of Section 128736, or Subsection (a) of Section 128737 of the Health and Safety Code, for one discharge or for one encounter. 2 - Report:
The collection of all records submitted by a hospital for each reporting period as defined in law and regulation. - Risk Adjustment:
Comparing hospitals on their outcomes is difficult because different hospitals treat different types of patients. Some hospitals treat patients who are older or sicker than those at other hospitals. A technique called risk-adjustment accounts for these differences in patient characteristics. Risk factors are the patient demographic (e.g. age, gender) and clinical (e.g. diabetes, hypertension) characteristics that might influence the outcome of medical care. - Risk-Adjusted Outcomes Study:
Risk-adjusted outcomes studies provide important and valuable indicators of quality. Hospitals and providers use the studies in their continuous efforts to improve the quality of care they provide. Purchasers, plans and consumers use the information in making informed decisions regarding the choice of providers of health care (See Outcome Measure and Risk Adjustment see definition above).
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1 Health and Safety Code, Section 128700
2 Proposed Regulations in Title 22, California Code of Regulations, Section
97212
3 Proposed Regulations in Title 22, California Code of Regulations, Section
97213
Page last revised: October 1, 2007 4:25 PM