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183 lines
11 KiB
Markdown
183 lines
11 KiB
Markdown
# Healthcare Reference Supplement
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Clinical code tables, full CMS quality measure specifications, drug classification libraries, FHIR resource reference, and glossary.
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---
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## SNOMED CT Condition Codes
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| Code | Condition | ICD-10 | US Prevalence | CMS Measure |
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|------|-----------|--------|---------------|-------------|
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| 44054006 | Type 2 Diabetes Mellitus | E11.x | ~37M adults | CMS122, CMS134 |
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| 46635009 | Type 1 Diabetes Mellitus | E10.x | ~1.6M adults | CMS122, CMS134 |
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| 38341003 | Essential Hypertension | I10 | ~116M adults | CMS165 |
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| 84114007 | Heart Failure | I50.x | ~6.7M adults | CMS135 |
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| 40055000 | Chronic Kidney Disease | N18.x | ~37M adults | CMS134 |
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| 53741008 | Coronary Artery Disease | I25.x | ~20M adults | — |
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| 13645005 | COPD | J44.x | ~16M adults | — |
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| 195967001 | Asthma | J45.x | ~25M adults | — |
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| 49436004 | Atrial Fibrillation | I48.x | ~6M adults | — |
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| 431856006 | CKD Stage 2 | N18.2 | — | — |
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| 55822004 | Hyperlipidemia | E78.5 | — | — |
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> **Note:** Use bare codes when querying the test server. Do not use system-qualified URIs (e.g., use `code=44054006`, not `code=http://snomed.info/sct|44054006`).
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## LOINC Laboratory and Vitals Codes
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| Code | Display | Category | Unit | Clinical Context |
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|------|---------|----------|------|-----------------|
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| 4548-4 | Hemoglobin A1c | Metabolic | % | Diabetes monitoring (CMS122) |
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| 2345-7 | Glucose | Metabolic | mg/dL | Diabetes screening |
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| 2160-0 | Creatinine | Renal | mg/dL | Kidney function |
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| 33914-3 | eGFR (CKD-EPI) | Renal | mL/min/1.73m² | CKD staging |
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| 85354-9 | Blood Pressure panel | Vital Signs | — | Component observation (CMS165) |
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| 8480-6 | Systolic Blood Pressure | Vital Signs | mmHg | Component of 85354-9, or standalone |
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| 8462-4 | Diastolic Blood Pressure | Vital Signs | mmHg | Component of 85354-9, or standalone |
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| 2093-3 | Total Cholesterol | Lipids | mg/dL | Cardiovascular risk |
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| 2571-8 | Triglycerides | Lipids | mg/dL | Cardiovascular risk |
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| 2085-9 | HDL Cholesterol | Lipids | mg/dL | Cardiovascular risk |
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| 18262-6 | LDL Cholesterol | Lipids | mg/dL | Statin therapy target |
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| 42637-9 | BNP | Cardiac | pg/mL | Heart failure marker |
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| 33762-6 | NT-proBNP | Cardiac | pg/mL | Heart failure marker |
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| 2823-3 | Potassium | Electrolyte | mEq/L | ACEi/ARB/MRA safety |
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| 2951-2 | Sodium | Electrolyte | mEq/L | HF fluid status |
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| 718-7 | Hemoglobin | Hematology | g/dL | Anemia (CKD) |
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| 1742-6 | ALT | Hepatic | U/L | Statin monitoring |
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| 14959-1 | Urine Albumin/Creatinine Ratio | Renal | mg/g | Nephropathy screening (CMS134) |
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## FHIR Coding Systems
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| System URI | Code System | Example |
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|-----------|-------------|---------|
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| `http://snomed.info/sct` | SNOMED CT | 44054006 (Type 2 Diabetes) |
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| `http://hl7.org/fhir/sid/icd-10-cm` | ICD-10-CM | E11.9 (T2DM, unspecified) |
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| `http://loinc.org` | LOINC | 4548-4 (HbA1c) |
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| `http://www.nlm.nih.gov/research/umls/rxnorm` | RxNorm | Medication identifiers |
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| `http://hl7.org/fhir/sid/ndc` | NDC | National Drug Codes |
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---
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## CMS Quality Measure Specifications
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### CMS122v12 — Simplified vs. Full eCQM
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| Component | This System (Simplified) | Full eCQM Specification |
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|-----------|------------------------|------------------------|
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| **Denominator** | Patients 18–75 with diabetes (SNOMED 44054006 or 46635009) | + at least 2 outpatient encounters during measurement year; specific encounter value sets (CPT 99201-99215, HCPCS G0438-G0439) |
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| **Numerator** | Most recent HbA1c > 9.0% OR no HbA1c recorded | Same threshold, but HbA1c must be during measurement period; specific LOINC value set (4548-4, 4549-2, 17856-6) |
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| **Exclusions** | Hospice, palliative care, advanced illness + frailty | + specific value sets for hospice (SNOMED 385763009+), palliative care (ICD-10 Z51.5), advanced illness (200+ ICD-10 codes), frailty indicators, dementia medications (specific RxNorm codes) |
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| **Measurement period** | Any recent HbA1c | January 1 – December 31 of the performance year |
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### CMS165v12 — Simplified vs. Full eCQM
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| Component | This System (Simplified) | Full eCQM Specification |
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|-----------|------------------------|------------------------|
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| **Denominator** | Patients 18–85 with hypertension (SNOMED 38341003) | + diagnosed before or during first 6 months of measurement period; at least 2 outpatient encounters |
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| **Numerator** | Most recent BP < 140/90 | BP measured during an outpatient encounter within measurement period |
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| **Exclusions** | Hospice, ESRD, pregnancy | + kidney transplant, palliative care, advanced illness + frailty |
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### CMS135v12 — Simplified vs. Full eCQM
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| Component | This System (Simplified) | Full eCQM Specification |
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|-----------|------------------------|------------------------|
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| **Denominator** | Patients 18+ with HF (SNOMED 84114007) + LVEF < 40% | + specific HF diagnosis value set (ICD-10 I50.1, I50.20-I50.23, I50.40-I50.43, I50.9) |
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| **Numerator** | Prescribed ACEi, ARB, or ARNI | + specific RxNorm medication value sets; at least 1 prescription during measurement period |
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| **LVEF source** | Not queryable via standard FHIR Observation | Typically in DiagnosticReport or CarePlan |
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---
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## Drug Classification Tables
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### Diabetes Medications
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| Class | Generic Names | Brand Names | Matching Strings |
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|-------|-------------|-------------|-----------------|
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| Biguanide | metformin | Glucophage, Fortamet, Riomet | `metformin` |
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| Sulfonylureas | glipizide, glyburide, glimepiride | Glucotrol, DiaBeta, Amaryl | `glipizide`, `glyburide`, `glimepiride` |
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| Insulin | lispro, glargine, aspart, detemir, degludec, NPH | Humalog, Lantus, Novolog, Levemir, Tresiba | `insulin` |
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| GLP-1 RA | liraglutide, semaglutide, dulaglutide, exenatide, tirzepatide | Victoza, Ozempic, Wegovy, Rybelsus, Trulicity, Byetta, Mounjaro | `liraglutide`, `semaglutide`, `dulaglutide`, `exenatide`, `tirzepatide`, `victoza`, `ozempic`, `trulicity`, `byetta`, `mounjaro`, `rybelsus` |
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| SGLT2i | empagliflozin, dapagliflozin, canagliflozin, ertugliflozin | Jardiance, Farxiga, Invokana, Steglatro | `empagliflozin`, `dapagliflozin`, `canagliflozin`, `ertugliflozin`, `jardiance`, `farxiga`, `invokana`, `steglatro` |
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| DPP-4i | sitagliptin, saxagliptin, linagliptin, alogliptin | Januvia, Onglyza, Tradjenta, Nesina | `sitagliptin`, `saxagliptin`, `linagliptin`, `alogliptin` |
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### Antihypertensives
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| Class | Generic Names | Matching Strings |
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|-------|-------------|-----------------|
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| ACE Inhibitors | lisinopril, enalapril, ramipril, benazepril, fosinopril, quinapril | `lisinopril`, `enalapril`, `ramipril`, `benazepril`, `fosinopril`, `quinapril` |
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| ARBs | losartan, valsartan, irbesartan, olmesartan, telmisartan, candesartan, azilsartan | `losartan`, `valsartan`, `irbesartan`, `olmesartan`, `telmisartan`, `candesartan`, `azilsartan` |
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| ARNIs | sacubitril/valsartan | `entresto`, `sacubitril` |
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| CCBs | amlodipine, nifedipine, diltiazem, verapamil | `amlodipine`, `nifedipine`, `diltiazem`, `verapamil` |
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| Beta-Blockers | metoprolol, atenolol, carvedilol, bisoprolol, propranolol, nebivolol | `metoprolol`, `atenolol`, `carvedilol`, `bisoprolol`, `propranolol`, `nebivolol` |
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| Thiazides | HCTZ, chlorthalidone, indapamide | `hydrochlorothiazide`, `hctz`, `chlorthalidone`, `indapamide` |
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| Loop Diuretics | furosemide, bumetanide, torsemide | `furosemide`, `bumetanide`, `torsemide` |
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| Aldosterone Antagonists | spironolactone, eplerenone | `spironolactone`, `eplerenone` |
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### Heart Failure GDMT (Four Pillars)
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| Pillar | Drug Class | Specific Agents | Evidence |
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|--------|-----------|----------------|----------|
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| 1 | ACEi/ARB/ARNI | Sacubitril/valsartan preferred; lisinopril, enalapril, losartan, valsartan alternatives | ACC/AHA 2022 Class I |
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| 2 | Beta-Blocker | Carvedilol, metoprolol succinate, bisoprolol ONLY | ACC/AHA 2022 Class I |
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| 3 | Aldosterone Antagonist | Spironolactone, eplerenone (if eGFR > 30, K+ < 5.0) | ACC/AHA 2022 Class I |
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| 4 | SGLT2 Inhibitor | Dapagliflozin, empagliflozin (regardless of diabetes) | ACC/AHA 2022 Class I |
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### Statins
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| Intensity | Drugs |
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|-----------|-------|
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| High | atorvastatin 40-80mg, rosuvastatin 20-40mg |
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| Moderate | atorvastatin 10-20mg, rosuvastatin 5-10mg, simvastatin 20-40mg, pravastatin 40-80mg |
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| Low | simvastatin 10mg, pravastatin 10-20mg, lovastatin 20mg |
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---
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## FHIR Resource Quick Reference
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### Endpoints and Search Parameters
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| Resource | Endpoint | Common Search Parameters | Key JSON Paths |
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|----------|----------|------------------------|----------------|
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| Patient | `GET /Patient` | `name`, `birthdate`, `gender`, `_id`, `_count` | `.name[0].given[0]`, `.name[0].family`, `.birthDate`, `.gender` |
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| Condition | `GET /Condition` | `patient`, `code` (SNOMED), `clinical-status`, `_count` | `.code.coding[].code`, `.clinicalStatus.coding[0].code`, `.onsetDateTime` |
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| Observation | `GET /Observation` | `patient`, `code` (LOINC), `category`, `_sort`, `_count`, `date` | `.valueQuantity.value`, `.effectiveDateTime`, `.component[]` |
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| MedicationRequest | `GET /MedicationRequest` | `patient`, `status`, `_count` | `.medicationCodeableConcept.text`, `.status` |
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| Encounter | `GET /Encounter` | `patient`, `_sort`, `_count`, `type` | `.type[0].text`, `.period.start`, `.class.code` |
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### Bundle Navigation
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```python
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import subprocess, json
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r = subprocess.run(["curl", "-sf", "--max-time", "30", url],
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capture_output=True, text=True, timeout=35)
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bundle = json.loads(r.stdout) if r.returncode == 0 else {"entry": []}
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entries = bundle.get('entry', [])
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total = bundle.get('total', len(entries))
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for link in bundle.get('link', []):
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if link.get('relation') == 'next':
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next_url = link['url']
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```
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---
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## Glossary
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| Term | Definition |
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|------|-----------|
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| **FHIR** | Fast Healthcare Interoperability Resources. HL7 standard for exchanging healthcare data via REST APIs. R4 is the current normative version. |
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| **SNOMED CT** | Systematized Nomenclature of Medicine. Standardized clinical terminology (~350K concepts). Used for diagnosis coding. |
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| **LOINC** | Logical Observation Identifiers Names and Codes. Standard for identifying lab tests and vital signs. |
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| **ICD-10-CM** | International Classification of Diseases, 10th Revision. Used for billing and reimbursement. |
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| **RxNorm** | Standardized nomenclature for clinical drugs. |
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| **eCQM** | Electronic Clinical Quality Measure. Machine-readable quality measure specs published by CMS. |
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| **CMS** | Centers for Medicare & Medicaid Services. Administers Medicare, Medicaid, and quality programs. |
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| **MIPS** | Merit-based Incentive Payment System. Adjusts Medicare payments based on quality measure performance (up to ±9%). |
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| **PHI** | Protected Health Information. Any individually identifiable health information covered by HIPAA. |
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| **HIPAA** | Health Insurance Portability and Accountability Act (1996). Governs privacy/security of health information. |
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| **BAA** | Business Associate Agreement. HIPAA-required contract when sharing PHI with a third party. |
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| **HCC** | Hierarchical Condition Category. Risk adjustment model for Medicare Advantage payments. |
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| **GDMT** | Guideline-Directed Medical Therapy. Evidence-based treatment per clinical practice guidelines. |
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| **SaMD** | Software as a Medical Device. FDA classification for software meeting medical device definition. |
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| **Bulk FHIR** | FHIR Bulk Data Access spec. Async API (`$export`) for large-volume patient data extraction as NDJSON. |
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| **Synthea** | Open-source synthetic patient data generator. Creates realistic fictional records in FHIR format. |
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