Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 1010 - HEALTH CARE DATA COLLECTION AND SUBMISSION CODE › Section 1010.20 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Act" means the Health Finance Reform Act.
"Admission, Discharge and Transfer (ADT) trigger event" means
				messages from HL7 standard, triggered by admission (A01), Register (A04),
				Update (A08) and Discharge (A03).
"Affirmation statement" means a document that, when signed by a
				hospital or ambulatory surgical treatment center administrator or an authorized
				representative of a hospital or ambulatory surgical treatment center submitting
				data to the Department, affirms, to the best of the signer's knowledge, that
				any necessary corrections to data submitted to the Department have been made
				and that the data submitted are complete and accurate.
"Agency for Healthcare Research and Quality" or "AHRQ" means a
				federal agency that is a part of the U.S. Department of Health and Human
				Services.
"Ambulatory patient classification" or "APC" means a definition
				by the Centers for Medicare and Medicaid Services (CMMS) for the prospective
				payment system (PPS) under Medicare for hospital outpatient services. All
				services paid under the PPS are classified into groups called APCs. Services in
				each APC are similar clinically and in terms of the resources they require. A
				payment rate is established for each APC based on the resources involved in
				treatment.
"Ambulatory surgical treatment center" means a facility
				licensed under the Ambulatory Surgical Treatment Center Act.
"Application" means technical software tools that provide
				access and analysis for the syndromic surveillance data.
"Batch" means a file that transfers multiple messages
				together.
"CCYYMMD" means a calendar date in the format of century, year,
				month and day of the week, where 1 = Sunday, 2 = Monday, etc.
"CCYYMMDD" means a calendar date in the format of century,
				year, month and day, without separators.
"Chief complaint" means a patient's self-reported complaint of
				reason for visit. It is the most complete description and may include multiple
				symptoms as free text summary of the patient's own words as well as a drop-down
				selection of symptoms.
"Claims and encounter" means either a request to obtain
				payment, and necessary accompanying information, from a health care provider to
				a health plan, for health care or an inpatient stay or outpatient visit in
				which a claim is not generated.
"Cleaned claims data" means data that have passed validity
				tests that edit for individual element content and comparison with related
				elements for appropriate context within the time periods and value ranges
				appropriate for the data file.
"Clinical Classification Software" or "CCS" means a diagnosis
				and procedure categorization scheme developed by the Healthcare Cost and
				Utilization Project.
"Compliance percentage" means the value obtained when the
				number of cleaned and unduplicated claims and encounters per calendar month is
				divided by the reported discharge count for the same calendar month, with the
				dividend of this calculation multiplied by 100.
"Computed tomographic scan" or "CT scan" means a computed
				tomographic scan of the head and other parts of the human body.
"Consumer Guide to Health Care" means a comparative health care
				information report showing conditions and procedures that demonstrate the
				widest variation in charges and quality of care in inpatient and outpatient
				services provided in hospitals and ambulatory surgical treatment
				centers.
"Current Procedural Terminology" or "CPT" means a listing of
				descriptive terms and identifying codes providing a consistent and standardized
				language for reporting medical services and procedures performed by physicians.
				These codes are maintained and distributed by the American Medical Association
				(330 N. Wabash Ave., Suite 39300, Chicago IL 60611-5885).
"Custom dataset" means requests for specific data elements for
				particular research or reporting tasks. This may include specific aggregations
				or combinations of data values into categories or groups.
"Data submission manual" means the Department's Technical
				Reference for Data Submission document specifying the details of the record
				layout, the outpatient surgical procedure code range, specifications of
				identification of emergency department and observation cases and contact
				information for questions related to data submission.
"Data submission profile" means a set of validation and
				verification reports containing accumulated statistical summaries of all data
				submitted to the Department by the facility for each month of the current
				collection period. These reports contain information identifying claims and
				encounters that fail Departmental edits, as well as data quality statistics
				showing data accepted up to and including the latest submission.
"Data use agreement" means a written contract between parties
				that defines the care and handling of sensitive or restricted use data,
				including, but not limited to, the terms of the agreement, ownership of the
				data, security measures and access to the data, uses of the data, data
				confidentiality procedures, duration of the agreement, disposition of the data
				at the completion of the contract, and any penalties for violation of the terms
				of the agreement.
"De-identified" means data that do not contain directly
				identifiable individual patient health information as defined in HIPAA privacy
				regulations (Security and Privacy); or data that, through analysis by an
				experienced expert statistician or by the use of probability software, can be
				shown to have a low probability of individual identification.
"Department" or "DPH" means the Illinois Department of Public
				Health.
"Diagnosis Related Group" or "DRG" means a patient
				classification scheme that provides a means of categorizing hospital inpatients
				according to the resources required in treatment, developed for the Centers for
				Medicare and Medicaid Services for use in the Medicare Prospective Payment
				System.
"Diagnostic" means the process used to identify or
				characterize, as accurately as possible, the details of a medical condition or
				injury.
"Electronically submit" means that required data submission
				will be carried out by the transfer of appropriate files to the Department's
				secure web server. Physical media of any form or type will not be used in the
				transfer of these data.
"Emergency Department" or "ED" means the location within
				hospitals where persons receive initial treatment by health care professionals
				for conditions of an immediate nature caused by injury or illness. The person
				treated may or may not be admitted to the hospital as an inpatient. Services
				furnished to an individual who has an emergency medical condition are defined
				in 42 CFR
				424.101.
"Emerging technology" means new approaches to the treatment of
				medical conditions through the use of existing machines and equipment in new
				and different ways or the development of new machines and equipment for a
				specific form of medical treatment.
"Ethnicity" means the classification of a person's ethnic
				background. Classification categories collected will follow the Federal Office
				of Management and Budget (OMB) Statistical Policy Directive Number 15, "Race
				and Ethnic Standards for Federal Statistics and Reporting".
"Facility" means a hospital, as defined in the Hospital
				Licensing Act and the University of Illinois Hospital Act, or an ambulatory
				surgical treatment center, as defined in the Ambulatory Surgical Treatment
				Center Act. For syndromic surveillance, a facility can also be a site that
				provides urgent care, and does not include ambulatory surgical treatment
				centers.
"Final closing date" means the final day, 65 days after the end
				of each calendar quarter, on which electronically submitted corrections and
				missing data are accepted for each quarterly data submission period.
"Federal Information Processing Standards" or "FIPS" means a
				standardized set of numeric or alphabetic codes issued by the National
				Institute of Standards and Technology (NIST) to ensure uniform identification
				of geographic entities through all federal government agencies.
"Fully populated test data" means that each field or individual
				element specified in each record of the file contains data values. Complete
				data allow the exercise of all parts of the computer program used to produce
				the file. This will provide more robust testing outcomes, reduce the number of
				test runs necessary, and improve the quality of data submissions.
"Healthcare Common Procedure Coding System" or "HCPCS" means a
				set of health care procedure codes based on the American Medical Association's
				Current Procedural Terminology (CPT). The HCPCS was established to provide a
				standardized coding system for describing the specific items and services
				provided in the delivery of health care. HIPAA made the HCPCS mandatory for
				Medicare and Medicaid billings. HCPCS includes three levels of codes:
Level I consists of the American Medical Association's Current
				Procedural Terminology (CPT) and is numeric.
Level II codes are alphanumeric and primarily include
				non-physician services such as ambulance services and prosthetic
				devices.
Level III consists of temporary codes for emerging
				technologies, services and procedures.
"Healthcare Cost and Utilization Project" or "HCUP" means a
				group of health care databases and software tools and products created by a
				government and industry partnership and sponsored by AHRQ.
"Health plan" means an individual or group plan that provides,
				or pays the cost of, medical care. Further explanation can be found in HIPAA
				privacy regulations.
"HH" means clock time in hours using 24-hour time from 00 to 23
				rounded to the nearest hour.
"Health Insurance Portability and Accountability Act privacy
				regulations" or "HIPAA privacy regulations" means regulations promulgated at
				45 CFR
				160 and
				45 CFR 164, Subparts A and E,
				under section 264(c) of the Health Insurance Portability and Accountability Act
				of 1996.
"Health Level 7 (HL7)" means the industry standards
				organization (
www.hl7.org
) for healthcare data
				exchange. HL7 is a registered trademark of Health Level Seven, Inc. Reg. U.S.
				Pat and TM office.
"HL7 version
				2.5.1" means a nationally
				recognized standard for electronic data exchange between systems housing health
				care data. HL7 version 2.5.1 defines syntax, format and standard vocabulary for
				HL7 messages.
"Hospital" means any institution, place, building, or agency,
				public or private, whether organized for profit or not for profit, that is
				subject to licensure by the Illinois Department of Public Health under the
				Hospital Licensing Act, and the University of Illinois Hospital as defined in
				the University of Illinois Hospital Act.
"Imaging" means the technique and process used to create images
				of the human body or its parts or functions for clinical purposes seeking to
				reveal, diagnose or examine disease or injury.
"Implementation guide" means a national HL7 standard document
				that guides the HL7 messages for syndromic surveillance submissions defining
				the message and content references for electronic health record
				certifications.
"Initial closing date" means the date, 60 days after the end of
				each calendar quarter, established for all hospitals and ambulatory surgical
				treatment centers to electronically submit inpatient and outpatient claims and
				encounter data to the Department.
"Invasive" means a medical procedure that penetrates or breaks
				the skin or a body cavity by means of a perforation, incision, catheterization
				or other methods into a patient's body.
"Limited datasets" means data containing protected health
				information (PHI) that excludes certain direct identifiers of the individual or
				of relatives, employers or household members of the individual, as defined in
				HIPAA privacy regulations.
"Magnetic resonance imaging" or "MRI" means a technology used
				to visualize internal body structures by using strong magnet fields in
				conjunction with radio frequency fields to analyze deep soft tissue without the
				use of harmful radiation.
"Major Diagnostic Category" or "MDC" means a collection of DRGs
				for categorizing specifically defined interventions and illnesses related to an
				organ or a body system, not to the cause of an illness or injury.
"Mammography" means the process of utilizing low-dose X-rays to
				examine the human breast as a diagnostic and screening tool for the detection
				of cancer.
"Meaningful Use" is the original term in the Health Information
				Technology for Economic and Clinical Health (HITECH) Act for the exchange of
				health care data across systems to promote meaningful use of health information
				technology to improve the quality and value of American health care. Meaningful
				Use is the criteria cited to satisfy the CMMS final rule of the federal HITECH
				Act of 2009 (78 FR 5565, January 25, 2013). Meaningful Use program was later
				termed Promoting Interoperability.
"Minimally invasive" means a medical procedure carried out by
				entering the body through the skin or through a body cavity or anatomical
				opening, but with the smallest disturbance possible to these structures.
				Special medical equipment may be used, such as fiber optic cables, miniature
				video cameras and special surgical instruments handled via tubes inserted into
				the body through small openings in its surface.
"National Provider Identifier" or "NPI" means a unique
				identification number assigned to all health care providers to be used by all
				health plans. The NPI will be issued and maintained by the National Provider
				System.
"National Uniform Billing Committee" or "NUBC" means the group
				including all major national provider and payer organizations formed to develop
				and maintain the national standard health care uniform bill.
"Near real-time" means the timeliness of the data submitted for
				syndromic surveillance. Near real-time is defined in the implementation guide
				as data that must be submitted at least within 24 hours of the date and time of
				the patient's initial encounter. Updates to a patient record must also be
				submitted within 24 hours of the information being added to the record. Real
				time data transmission, or very frequent batch data transmission, is at least
				hourly or <15 minutes from entry in the hospital record.
"National Institute of Standards and Technology (NIST)" means
				the government agency that developed the syndromic surveillance message
				certification tool.
"Non-invasive surgery" means a medical procedure using highly
				focused beams of radiation when the nature or location of the condition is not
				amenable to mechanical intervention.
"Observation care" or "OC" means services furnished to a person
				by a hospital on the hospital's premises, including use of a bed and at least
				periodic monitoring by a hospital's nursing or other staff, which are
				reasonable and necessary to evaluate an outpatient's condition or to determine
				the need for a possible admission to the hospital as an inpatient. In general,
				the duration of observation care services is less than 24 hours, although, in
				some circumstances, patients may require a second day.
"Office of the National Coordinator (ONC)" means the national
				agency that establishes the standard used for syndromic surveillance in the
				CMMS final rule of the HITECH Act of 2009.
"On-boarding" means the process for a hospital or facility to
				connect to DPH to test and submit syndromic surveillance messages.
"Organizational Identifier (OID)" means the registration of a
				facility obtained at HL7.org. This is an alternative Facility ID to the NPI for
				syndromic surveillance.
"Outpatient" means any health care service provided in a
				hospital to a patient who is not admitted to the hospital as an inpatient, or
				any health care service provided to a patient in a licensed ambulatory surgical
				treatment center. For syndromic surveillance, Emergency Department services are
				uniquely identified as separate from other outpatient visits.
"Outpatient surgery" means specific procedures performed on an
				outpatient basis in a hospital or licensed ambulatory surgical treatment
				center. Specific ranges of required procedure codes can be found in the
				Department's data submission manual.
"Patient class" means patient classification within a facility,
				including for example Emergency, Inpatient or Observation.
"Personal health information" or "PHI" means the information
				defined in HIPAA privacy regulations.
"Public Health Information Network" or "PHIN" means the Center
				for Disease Control's (CDC) national initiative to increase capacity of public
				health agencies to electronically exchange data and information across
				organizations and jurisdictions. The PHIN Vocabulary Access and Distribution
				System (VADS) standard code set values are available at
https://www.cdc.gov/phin/resources/vocabulary/index.html
.
"Positron emission tomography scan" or "PET scan" means a
				nuclear medicine imaging technology that creates a three dimensional view of
				functional body processes.
"Public use data" means any form of data from the Department's
				comprehensive discharge database or facility-level database that contains
				de-identified data.
"Race" means the classification of a person's racial
				background. Classification categories collected will follow the Federal Office
				of Management and Budget (OMB) Statistical Policy Directive Number 15, "Race
				and Ethnic Standards for Federal Statistics and Reporting".
"Raw data" means any file, individual record, or any subset
				thereof that contains information about an individual health care service
				provided to a single patient and is released by the Department in data products
				or custom data files.
"Reciprocal data availability" means that, if a data requester
				controls the discharge data or syndromic surveillance of another state, release
				of Illinois discharge data or syndromic surveillance to that state entity would
				be contingent on the availability of discharge data or syndromic surveillance
				from that state of comparable quantity, quality and content at a similar price
				point.
"Research" means a systematic investigation, including
				development, testing and evaluation, designed to develop or contribute to
				generalizable knowledge. Activities that meet this definition constitute
				research, whether or not they are conducted or supported under a program that
				is considered research for other purposes. For example, some demonstration and
				service programs may include research activities.
"Secure file transfer protocol (SFTP)" means a network protocol
				for sending files securely in a protected shell for data submissions.
"Small number" means any number that is small enough to be
				useful in an attempt to determine the identity of a specific individual patient
				when used in conjunction with other elements in the data file or when the data
				file is linked with information from other sources. The Department considers a
				small number to be any cell size fewer than 10.
"Sonography" and "Ultrasonography" mean the use of sound waves
				at frequencies above the audible range of human hearing as a diagnostic tool
				for visualizing internal body structures, including tendons, muscles, joints,
				organs and other internal masses.
"Standard" means technical specifications for data
				exchange.
"Surgery" means treatment of diseases or injuries by manual
				and/or instrumental methods. The methods may include invasive, minimally
				invasive, or non-invasive procedures, depending on the condition treated and
				the nature of the instruments and technology used.
"Syndromic Surveillance" means a data collection process that
				regularly and systematically uses health-related data in near real-time to make
				information available on the health of a community. The information provides
				disease trends and detection of emerging events for surveillance.
"Therapeutic" means medical activities designed to treat or
				cure a disease, condition or injury.
"Uniform" means related unique data values that are combined
				into a smaller number of common categories.
"Uniform bill" means
the uniform electronic billing
				form pursuant to the Health Insurance Portability and Accountability
				Act
, which is developed as a standard instrument for use by
				institutions and payers in the handling of health care claims. (Section
				4-2(d)(1) of the Act)
"Unique Physician Identification Number" or "UPIN" means a
				unique identification number assigned to all Medicare providers. The UPIN
				Registry is maintained by the National Heritage Insurance Company under
				contract from the Centers for Medicare and Medicaid Services.
"Urgent Care Services" means services defined in
				42 CFR
				405.400 that are furnished within 12 hours in
				order to avoid onset of an emergency medical condition. Urgent Care Services
				differs from services provided in response to an emergency medical condition
				because immediate care is not needed to avoid placing the health of the
				individual in serious jeopardy or to avoid serious impairment or
				dysfunction.
"Validation" means the process for healthcare systems to test
				and certify the syndromic messages to be correctly formatted with complete
				information.