The Velox Glossary of Terms serves as an essential reference for understanding the specialized language used throughout the Velox platform. It defines an extensive array of clinical, administrative, and technical terms—spanning from ACOs and FHIR to digital quality measures and data channels—along with their origins (e.g., CMS, NCQA, HL7, Velox). Designed for healthcare IT professionals, payers, providers, and technology partners, this glossary ensures clear communication and consistency across all stakeholders working with clinical data standards and interoperability.
Velox Glossary of Terms
TERM | DEFINITION | ORIGIN |
|---|---|---|
| ACO | Accountable Care Organization – a care provider or group of providers that partcipate in an ACO program defined and administered by CMS | CMS |
| Admin measures | Quality measures that only use administrateive, i.e. claims, data as input | NCQA |
| Administrative Data | Data, specifically claims data used for Admin Measures | NCQA |
| Aggregator | A system or platform that collects and integrates data from multiple sources (e.g., EHRs, payers, labs) into a unified format for analysis, reporting, or downstream use in healthcare applications. | Healthcare IT |
| AHRQ | Agency for Healthcare Research and Quality | CMS |
| All digital | in this caes, the entire quality measurement operation uses dQMs and FHIR-based data | NCQA |
| Allowable data sources | Data soures that can be used to source data used in dQMs, in this case as specificed by the ECDS program | NCQA |
| API | Application Programming Interface – a standardized way for computer programs and different computer systems to interact in a pre-defined way | IT Industry |
| Applegate Model | aka Applegate Alignment Framework | Academic Paper |
| ARO | Accreditation and Recognition Organization | NCQA |
| Bonnie | CMS’ dQM testing tool – publicly available free tool to test dQMs in FHIR-CQL | CMS |
| CAHPS | Consumer Assessment of Healthcare Providers and Systems – a consumer survey program | CMS |
| Care Management | Coordinated efforts to manage medical, behavioral, and social services for patients—especially those with chronic or complex conditions—to improve health outcomes. | Healthcare IT |
| CDI | See Clinical Data Integration | Gartner Groups |
| Claims Adjudication | The process by which a health insurance company reviews and processes a medical claim to determine payment responsibility and amount. | Healthcare IT |
| Clinical Data | all data that are clinically relevant to a patient and their care; not administrative data | General |
| Clinical Data integration (CDI) | A Gartner-defined term for a best-practices-based approach to centrally storing clinical data at a payer organization and making the data available and ready for use by multiple use cases | Gartner Groups |
| Clinical Quality Language | A declarative standardized language to express clinical definitions and decision logic, used for digital quality measures (dQMs) | HL7 |
| CMS | Center of Medicare and Medicaid Services – the US federal agency administering pubic health programs | US Government |
| Code Sets | A specific, finite list of values that explicitly define a category like clinical procedures, lab procedures, diagnoses, lab procedures and more | General |
| Complexity Score | Definition To Come | Velox |
| Configurability | The ability to define behavior of a computer program or specific logic components (like dQMs) via settings, so the same logic can be used for multipe different purposes or use cases without the need for additional programming or duplication | General |
| CPG | Clinical Practice Guidelines | NIH |
| CQL | see Clinical Quality Language | HL7 |
| CQL engine | a computer program, also called ‘runtime engine’ that has the ability to interpret digital quality measure logic defined in FHIR-CQL, apply it to data formatted in FHIR and then output the results of the measure logic. | NCQA |
| Data aggregator | Organizataions that collect clinical data from various sources, standardize them and then make them available for further use | IT Industry |
| Data aggregator validation | An NCQA data source certification program for data aggregators | NCQA |
| Data Channel | A channel is a combination of source and format – i.e. there can be one (and sometimes more than one) channel per source. A channel does not specify the location (rather a system and/or organization) further. it just adds the format. | Velox |
| Data persistence | a technical term for storing data for potentially long periods of time, e.g. on a hard drive | IT Industry |
| Data quality | a term used for the accuracy and completeness of data vis-à-vis a certain specification or standard | Industry |
| Data Source | A data source that sufficiently identifies the origin of the data source, it is a system or data partner where clinical data (with some exceptions for admin data) originates. It can be a FHIR Endpoint or not FHIR data source Eg Health EHR electronic extracts, or Great Hope State immunization registry. | Velox |
| Data vendors | a category of companies that act as intermediaries for clinical data that provide services and software for accessing, retrieving, transforming (mapping) and cleaning such data | Industry |
| DAV | see Data Aggregator Validation | NCQA |
| Digital Community | Term used for the NCQA facilitated community of stakeholders and online platform to share and collaborate around the transition and ongoing optimization of digital quailty measures, programs and operations | NCQA |
| Digital Quality Measure | quality measure implemented in the FHIR CQL standard, using structured clinical data | Industry |
| Digital Quality Transition Roadmap | A framework that guides all stakeholders through the Digital Quality Transition | NCQA |
| DMC | Digital Measure Community – the predecesor of the Digital Community | NCQA |
| dQM | See Digital Quality Measure | Industry |
| Early adopter | A customer that typically adopts a product or technology well ahead of its peers | IT Industry |
| ECDS | Electronic Clinical Data Systems | NCQA |
| ECDS-reported measures | HEDIS measures that are designed to work with structured clinical data from ECDS-defined data sources | NCQA |
| ECQM | Electronic Clinical Quality Measure – CMS defined term for electronic measures that precede dQMs | CMS |
| Execution framework | See Runtime/ Runtime engine | Industry |
| FHIR | Fast HealthCare Interoperability Resources | HL7 |
| FHIR from the source | A concept where FHIR-formatted data comes directly from the source and therefore does not need to be transformed to be used with dQMs | Industry |
| FHIR-CQL | The standard syntax for digital quality measures (dQMs) with CQL providing the syntax and FHIR as the data model | HL7 |
| Format | The structure or arrangement of healthcare data, such as HL7, FHIR, or CCD, which defines how information is organized, exchanged, and interpreted between systems. | General |
| Fraud Waste Abuse | Activities that result in unnecessary costs to the healthcare system, such as billing for services not provided (fraud), overuse of services (waste), or practices inconsistent with sound fiscal, business, or medical practices (abuse). | Healthcare IT |
| Gaps in care | Instances where a patient is missing necessary healthcare services or interventions, such as overdue screenings or missed vaccinations. | Healthcare IT |
| Gaps in Care | a term used to identify – through quaility measurement, and potentially address any conditions or outstanding actions pertaining to a patient. That can be proper treatment of a chronic condition or performing a preventive action like an immunization. | Industry |
| HEDIS | Healthcare Data Effectiveness Information Set – a widely used quality measurement program created and administered by NCQA | NCQA |
| HEDIS certified vendor | A common term for software vendors that have built quality measures that have been certified by NCQA | NCQA |
| HIE | Health Information Exchange – an aggregator of clinical data, typically on a regional or state level | Industry |
| HIN | Health Information Network – see HIE | Industry |
| HL7 | Health Level 7 – a standards organization that defines and maintains healthcare data standards and syntax including FHIR and CQL | HL7 |
| HPA | Health Plan Accreditation | NCQA |
| Hybrid measures | A quality measure that can take both administrative data and data from MRR as input | NCQA |
| JSON | stands for JavaScript Object Notation – an open standard file format and data interchange format to store and transmit data objects | IT Industry |
| Late adopter | A customer that typically adopts a product or technology later than the majority of their peers | IT Industry |
| Mainstream adopter | A customer that typically adopts a product or technology after early adopters, along with the majority of peer organizations | IT Industry |
| MAT | CMS Measure Autoring Tool – publicly available free tool to author dQMs in FHIR-CQL | CMS |
| Meaningful measures | An industry term for better quality measures and also a CMS program name (Meaningful Meaures 2.0) | Industry |
| Measure Alignment | The concept of taking similar measures and consolidating them into one measure to achieve fewer measures that can be used across different domains and use cases | Industry |
| Measure bundle | A set of artifacts used to ‘deploy’ or deliver a digital quality measure | Industry |
| Measure configuration | the ability to set parameters to define exactly how a given dQM is executed, enabling the use of one measure for multiple use cases | Industry |
| Measure developer | an organization or entity that develops and maintains quailty measures | Industry |
| Measure results | the output of the process of applying measure logic to a data set. | Industry |
| Measure steward | an organization or entity that manages measure programs and either develops or contracts with other measure developers to develop measures for their programs | Industry |
| Medical records review | a manual review where a qulified reviewer looks through medical charts and identifies and captures specific data elements for quality measures or other use cases (e.g. risk adjustment) | Industry |
| MIPS | Merit based Incentive Payment System – a CMS value-based program for clinicians particapting in Medicare | CMS |
| MRR | See Medical Records Review | |
| MSSP | Medicare Shared Savings Program – a CMS value-based program for clinicians participating in Medicare | CMS |
| NCQA dMAT | NCQA’s Measure authoring tool | NCQA |
| NextGen Measures | a portion of NextGen Content | NCQA |
| ONC | Office of the National Coordinator for Healthcare IT – an organization within CMS tasked with interoperability, software certification and other rule making and enforcement of various legislation, e.g. 21st Century Cures Act | CMS |
| Operating Model | Generalized model for quality data operations | General |
| Opportunity | Opportunity is a potential better data source for an Organization with less complexity | Velox |
| Opportunity Score | Definition To Come | Velox |
| Opportunity table | A list of Opportunities that maps to the specific OrgID | Velox |
| Organization | An organization in the context of metadata is a payer organization, i.e. it contains one or more plans | General |
| Organization type | A type of organization that participates in the major workstreams as defined in the Digital Quality Transition | NCQA |
| Patient Outreach | Efforts by healthcare organizations to proactively communicate with patients, often through calls, messages, or portals, to improve engagement and care compliance. | Healthcare IT |
| Patient Reported Outcomes Measure | anther term for survey measures, i.e. survey data captured directly from patients | Industry |
| Patient-Centered Medical Home | A term for a coordinated approach to a patients coordianted care. Also, a CMS value-based model for primary care | CMS |
| PCMH | See Patient-Centered Medical Home | CMS |
| Plan sponsor | A financial sponsor of a health plan. Examples are employer groups, federal and state government programs | Industry |
| Population definitions | groupings of patients based on certain characeristcs, including diseases, geography, race and ethnicity | Industry |
| Population Health | The health outcomes of a group of individuals, including the distribution of outcomes within the group, with a focus on improving overall community health. | Healthcare IT |
| Primary source validation (PSV) | An audit program/task performed by licensed auditors to validate the accuracy and provenance of data used in quailty programs | NCQA |
| Prior Authorisation | A requirement by health insurers for providers to obtain approval before delivering certain services or prescriptions to ensure they are medically necessary. | Healthcare IT |
| PROM | see Patient Reported Outcomes Measure | Industry |
| PROM-IG | PROM Implementation Guide – a FHIR implementation guide for surveys | HL7 |
| Provider Comm | The exchange of information between healthcare providers (e.g., physicians, nurses) or between providers and systems to ensure coordinated and informed patient care. | Healthcare IT |
| QHIN | Qualified Health Information Network – a term defined in TEFCA for health exchanges (aggregators) that take on a specific role in a national network of HIEs. | ONC |
| Quality Analytics | The use of data analytics and data visualization on quality data sets | Industry |
| Quality Measure Certification | A formal way of testing and validating that a quality measure’s logic performs according to the specifications | NCQA |
| Quality measure deployment | methods to distribute dQMs to the software instances where they are used | Industry |
| Quality measure development | the process of designing, building and testing a new quality measure | Industry |
| Quality Measure Programs | a grouping of quality measures for a specific purpose and/or population | Industry |
| Quality measure reporting | the process of aggregating and delivering quality measure results to an authority like CMS or NCQA | Industry |
| Quality Measures | A set of defintions and logic that describe exactly how a quality measure functions | Industry |
| Quality operations | The processes and systems in place to monitor, manage, and improve the quality of healthcare delivery. | Healthcare IT |
| Quality report | A document or digital output summarizing healthcare performance metrics, such as patient outcomes or adherence to guidelines, used to assess care quality. | Healthcare IT |
| Quality Score | A metric used to evaluate the performance of a provider, organization, or healthcare system based on factors like clinical outcomes, patient satisfaction, and adherence to best practices. | Healthcare IT |
| Quality software vendor | A technology vendor that provides software solutions for different quality-realted use cases | Industry |
| Reference implementation | A functional implementation that demonstrates how certain solutions are to be architected | IT Industry |
| Risk Adjustment | A method to account for the health status and related costs of patients when comparing outcomes or allocating resources, ensuring fair comparisons across populations. | Healthcare IT |
| ROI ($$) | This refers to the financial return gained from an investment in healthcare technology, usually expressed in actual dollar amounts. For example, savings from reduced hospital readmissions or increased billing accuracy compared to the cost of implementing the technology. | General |
| ROI (x) | This expresses ROI as a ratio or multiplier, such as 2x or 5x, meaning the investment returned two or five times its cost. For instance, an ROI of 3x means for every $1 invested, the organization gained $3 in value (savings or revenue). | General |
| Runtime Engine | A software program or service that can exeucte or run programs and process data | IT Industry |
| Source Master Table | A list of all the Sources be it a FHIR endpoint or a non FHIR source | Velox |
| Stakeholder type | A type of stakeholder, defining a group of like stakeholders, e.g. health plans. In this case, all stakeholder types relevant to the Digital Quality Transition | business term |
| STARS | Medicare rating program used for Medicare Advantage plans and certain provider organizations participating in CMS programs | CMS |
| Supplemental data | Data types and formats that NCQA allows health plans to use to source clinical data for HEDIS reporting | NQCA |
| TEFCA | Trusted Exchange Framework and Common Agreement – An ONC interoperability initiative mandated by the 21st Centrury Cures Act of 2016 | ONC |
| UCSDI | US Core Dataset for Interoperability – an ONC-defied and enforced standard that defines a minimum set of clinical data elemements | ONC |
| Use cases | Specific scenarios or problems in healthcare where technology is applied to improve outcomes, efficiency, or user experience. | General |
| Value Based Care | A healthcare delivery model that rewards providers for delivering high-quality, efficient care rather than volume of services. | Healthcare IT |
| Value-Based Care | A model that focuses on quality of care, provider performance and patient experience. | Industry |
| Value-Based Payment | A payment model for value-based care models that incentivizes high-quality care and good patient experiece. | Industry |
| VBC | See Value-Based Care | Industry |
| VBP | See Value-Based Payment | Industry |
| Velox | Latin: fleet, quick, rapid, swift, fast | Velox |
| Weighted Complexity Score | Definition To Come | Velox |
| Weighted Opportunity Score | Definition To Come | Velox |
| Workstreams | Major processes, in this case how they apply to digital quality operations | General |
| XML | eXtensible markup language – an all purpose way of using the markup concepts of HTML (long used for standard web pages) for organizing data elements in a hierarchical way | IT Industry |
Velox Concept Terms
TERM/CONCEPT | DEFINITION | Video |
|---|---|---|
| Data Channel | Defined by a format and derived from a data source. The data channel is used for the scoring model at Velox. | |
| ‘the green donut’ | The aspirational state of optimized clinical data operations | Link to Video Definition |
| DCIF | Velox takes data inventories (a common tool used by health plans to maintain their clinical data assets) and uses the inventory to populate into the Velox data channel inventory form that can be uploaded to the Velox Platform generating a multitude of KPIs | Link to Video Definition |
| Clinical Data Exchange CDEx | Effectively a concept that is at the foundation of how Velox inventories and scores all of the clinical data operations of a health plan customer. There’s an internal component and an external component. | Link to Video Definition |
| Metadata (Clinical – PII) | Metadata is data about data. Metadata plays a crucial role in categorizing and contextualizing clinical data, ensuring clinicians can access the right information at the right time for better decision making | Link to Video Definition |
| Data Quality (Score)– Fit for use, use case, PIQI | The objective of the PIQI framework is to create a standard way to evaluate and agree on the evaluation of the quality of data coming from any source. And the Clinical Architecture PIQXL Gateway integration allows Velox to let people know what the score is, whether it’s fit for a particular use case, so they can maximize their ability to leverage the content they’re getting to improve the quality of care and the effectiveness of what they’re trying to do. | Link to Video Definition |
| ROI of CDex, ROI Stacking | Inputs to calculate ROI in the CDEx are the clinical data exchange process, looking at data operations and maintenance, looking at data acquisition cost, MRR cost and then use case specific revenue and savings. Veloxthen takes the CDEx and stacks the ROI across use cases. That is, one use case may have a very meaningful ROI, but when you stack them across multiple use cases, the investment to putting your health plan on Velox is even more compelling. | Link to Video Definition |
| Enable stakeholder access to real-time structured clinical data for more agile decision-making in a competitive market with complex regulatory requirements | Definition To Come | Link to Video Definition |
| FHIR– power of resources | Fast Healthcare Interoperability resources (FHIR) breaks down patient information to structured resources grouping data elements. FHIR’s Application Programming interface, or API first approach allows different healthcare stakeholders, including payers, clinicians, and patients, to access standardized data seamlessly. | Link to Video Definition |
| Aggregator model (+TEFCA) (vs. federated) | Definition To Come | |
| APIs – explanation, power of | APIs stands for Application Programming Interfaces or how modern systems talk to each other—sending and receiving data automatically, with no manual human steps in between. In healthcare, FHIR APIs—FHIR short for Fast Healthcare Interoperability Resources—are the new standard. The key here is standardization, with standards based APIs integration querying and support for data channels is more reliable and less costly. | Link to Video Definition |
| Complexity Score | Definition To Come | |
| Create value by freeing up customers to focus on business and operations | Definition To Come | |
| Digital Quality – implications | Definition To Come | |
| Dynamic CDex | Definition To Come | |
| Federated Model | Definition To Come | |
| FHIR – duality of API/data model | Definition To Come | |
| Leverage deep knowledge of interoperability standards, regulations, state-of the art technology, and strategy to mitigate implementation complexities | Definition To Come | |
| Opportunities | When health plans need clinical data—from providers—for things like risk adjustment, quality reporting, or value-based care, they often face a mess of manual chart abstractions, custom integrations, and inconsistently formatted data feeds. But there’s a better way. Every time a health plan replaces a manual or bespoke data channel with a standards-based connection, like FHIR APIs, it represents an opportunity to reduce complexity, cut costs, and improve data completeness. | Link to Video Definition |
| Opportunity Score + inputs | Definition To Come | |
| Payer vs. Provider FHIR APIs | Definition To Come | |
| Push vs. Pull vs. subscription model | Definition To Come | |
| Record Locator / patient level RL | Definition To Come | |
| Requestor and Source | Definition To Come | |
| Standardized data (value of) | Definition To Come | |
| Storing clinical data vs. exchanging (FHIR vs. other ) | Definition To Come | |
| Structured vs. unstructured, NLP (loss of structure) | Definition To Come | |
| Use Metadata to facilitate assessment, planning, and execution of well-informed clinical data business decisions | Definition To Come | |
| Weighted scores | Definition To Come |