N.M. Admin. Code § 7.1.22.7

Current through Register Vol. 35, No. 22, November 19, 2024

Section 7.1.22.7 - DEFINITIONS

In addition to the definitions in the Health Information System Act, Section 24-14A-1 et seq. NMSA 1978, the following definitions apply for purposes of this rule:

A. "Administrative database" means any automated data supplied by the data provider, its contracted providers and vendors or public agencies.

B. "Consumer health information report" means a report that provides the public information on which to base health care purchasing decisions, published by the commission pursuant to Sections 24-14A-3 D(11) and 24-14A-3.1D(2) of the Health Information System Act, Section 24-14A-1 et seq. NMSA 1978.

C. "Data provider" means a data source that has provided data to the Health Information System on a regular basis.

D. "Data source" has the meaning given in Section 24-14A-2 of the Health Information System Act, Section 24-14A-1 et seq. NMSA 1978, and includes those categories of persons or entities that possess health information, including any public or private sector licensed hospital, health care practitioner, primary care clinic, ambulatory surgery center, ambulatory urgent care center, ambulatory dialysis unit, home health agency, long-term care facility, pharmacy, third-party payer and any public entity that has health information.

E. "Director" means the director of the commission.

F. "Health care" means any care, treatment, service or procedure to maintain, diagnose or otherwise affect an individual's physical or mental condition.

G. "Health care provider" means any individual, corporation, partnership, organization, facility, institution or other entity licensed, certified or otherwise authorized or permitted by law to provide health care in the ordinary course of business or practice of a profession.

H. "Health care survey" means a survey of health care consumers or health care providers or any other type of subjective assessment of health care.

I. "Health information system" or "HIS" means the health information system established by the Health Information System Act, Section 24-14A-1 et seq. NMSA 1978.

J. "HIS advisory committee" means the committee the commission establishes pursuant to Section 24-14A-3.1 of the Health Information System Act, Section 24-14A-1 et seq. NMSA 1978.

K. "Medical record" means the paper or electronic record of patient visits, treatments and test results assembled by the collective accumulation of notes kept by all health care providers who treat the patient.

L. "Outcome measures" means changes in patient health status and satisfaction resulting from specific medical and health interventions, as distinguished from the effects of other factors that influence patient health and satisfaction.

M. "Patient" means a person for whom health information is contained in the health information system.

N. "Patient confidential information" means the medical record and claims history of an individual patient.

O. "Performance measures" include, but are not limited to, quality indicators, outcome measures and health care service information.

P. "Proprietary information" means confidential technical information, administrative information, and/or business methods that are the property of the data provider and are perceived to confer a competitive position in the health care market by not being openly known by competitors.

Q. "Quality indicator" means a standardized and nationally or professionally recognized measure of a discrete element or aspect of health care useful for the purpose of monitoring quality of care.

R. "Quality of care" means the degree to which health services for individuals and populations increase the likelihood of desired health outcomes or are consistent with current professional knowledge. The provision of health services should reflect appropriate use of the most current knowledge about scientific, clinical, technical, interpersonal, manual, cognitive, and organizational and management elements of health care.

S. "Reporting year" means the calendar year in which the health care services that are the subject of a consumer health information report were delivered.

T. "Risk adjustment" means a method of analyzing patient-level data that accounts for patient risk factors, such as age, sex, severity of illness and presence of multiple diseases, that could affect patient outcomes or resource use. Risk adjustment is intended to provide more accurate comparisons among health care providers than would exist without risk adjustment.

N.M. Admin. Code § 7.1.22.7

8/30/97; Recompiled 10/31/01