Glossary of Terms
This glossary contains definitions for 200 concepts in the course "Modeling Healthcare Data with Graphs". All definitions follow ISO 11179 metadata registry standards: precise, concise, distinct, non-circular, and free of business rules.
Abuse Detection
The identification of healthcare practices that deviate from accepted medical standards but may not involve intentional fraud.
Example: Detecting a provider who consistently orders unnecessary tests that increase costs without improving patient outcomes.
Access Control
A security mechanism that restricts who can view or modify specific data resources based on defined policies.
Example: A hospital system that allows doctors to view patient records but restricts access to billing staff.
Adverse Event
An unintended harm or injury caused by medical treatment rather than the underlying disease.
Example: A patient develops an allergic reaction after receiving a new medication prescribed by their doctor.
Aggregate Query
A graph database query that computes summary statistics across multiple nodes or edges.
Example: Calculating the average number of prescriptions per patient across all cardiology visits in 2024.
Allergy
A documented immune system reaction to a specific substance such as food, medication, or environmental trigger.
Example: A patient record showing a severe allergy to penicillin antibiotics.
Allowed Amount
The maximum fee an insurance payer approves for a specific healthcare service or procedure.
Example: An insurance policy that sets the allowed amount for a routine office visit at $150, regardless of the provider's actual charge.
Anomaly Detection
A computational method that identifies data patterns significantly different from expected norms.
Example: Using graph algorithms to find a provider billing for 30 patient visits per day, far exceeding typical practice patterns.
Appointment
A scheduled time slot for a patient to receive care from a healthcare provider at a specific location.
Example: A patient books a 30-minute appointment with their primary care physician for an annual physical examination.
Artificial Intelligence
Computational systems that perform tasks typically requiring human intelligence, such as pattern recognition and decision-making.
Example: An AI system that analyzes chest X-rays to identify potential pneumonia cases for radiologist review.
Audit Trail
A chronological record of system activities that documents who accessed or modified data and when.
Example: A log showing all users who viewed a patient's protected health information during the past month.
Authentication
The process of verifying the identity of a user, device, or system before granting access.
Example: A clinician entering their username and password plus a security code to access the electronic health record system.
Authorization
The process of determining what resources and actions an authenticated user is permitted to access.
Example: After login, the system grants a nurse authorization to view patient records but not to modify billing information.
Benefit Plan
A structured set of healthcare services and coverage levels provided to insurance members.
Example: An employer-sponsored health insurance plan covering preventive care, hospital stays, and prescription medications with specified copayments.
Betweenness Centrality
A graph metric measuring how often a node appears on the shortest paths between other nodes in the network.
Example: Calculating betweenness centrality to identify a primary care provider who serves as a key referral hub connecting patients to specialists.
Billing Code
A standardized identifier used to represent a specific healthcare service or procedure for payment purposes.
Example: A medical office uses billing code 99213 to charge for a standard office visit with an established patient.
Board Certification
Official recognition that a physician has completed specialty training and passed examinations in a medical discipline.
Example: A physician holds board certification in cardiology from the American Board of Internal Medicine.
Capitation
A payment model where providers receive a fixed amount per patient regardless of services delivered.
Example: A clinic receives $50 per member per month for all primary care services, incentivizing preventive care and cost management.
Capstone Project
A comprehensive final project where students apply course concepts to solve a real-world healthcare graph modeling challenge.
Example: A student designs a fraud detection system using graph analytics to identify suspicious provider billing patterns across multiple insurance claims.
Care Plan
A coordinated set of interventions and goals designed to manage a patient's health conditions.
Example: A diabetes care plan including monthly blood sugar monitoring, dietary counseling, and medication management.
Care Team
A group of healthcare professionals collaborating to deliver coordinated patient care.
Example: A care team consisting of an oncologist, radiation therapist, nutritionist, and social worker treating a cancer patient.
Centrality Measure
A graph metric quantifying the importance or influence of a node within the network structure.
Example: Computing centrality measures to identify which hospitals serve as major referral centers in a regional healthcare network.
Charge Master
A comprehensive price list containing all services, procedures, and supplies a healthcare facility can bill.
Example: A hospital's charge master lists prices for thousands of items from aspirin tablets to organ transplant procedures.
Chronic Disease Management
Ongoing coordinated care focused on helping patients control long-term health conditions.
Example: A management program for heart failure patients including regular monitoring, medication adjustment, and lifestyle coaching.
Claim Adjudication
The process of reviewing an insurance claim to determine coverage eligibility and payment amount.
Example: An insurance company adjudicates a hospital claim by verifying the patient's coverage, checking medical necessity, and calculating the approved payment.
Claim Denial
A payer's refusal to pay for a submitted healthcare service based on coverage rules or documentation issues.
Example: An insurance company denies a claim for an MRI scan because prior authorization was not obtained before the procedure.
Claim Dispute
A formal challenge by a provider or patient contesting an insurance payer's claim decision.
Example: A hospital files a dispute after an insurer denies payment for an emergency surgery deemed medically necessary.
Claim Processing
The administrative workflow of receiving, reviewing, and paying healthcare service claims.
Example: An insurance company receives 10,000 claims daily and processes them through automated validation before payment.
Clinic
An outpatient healthcare facility where patients receive non-emergency medical services.
Example: A family medicine clinic providing routine checkups, vaccinations, and treatment for minor illnesses.
Clinical Decision Support
Technology systems that provide healthcare providers with knowledge and guidance during patient care.
Example: An electronic health record system alerts a physician that a prescribed medication may interact with the patient's existing drugs.
Clinical Discovery
The process of identifying new medical insights or patterns through analysis of patient data.
Example: Using graph analytics on millions of patient records to discover that a common medication reduces risk of an unrelated disease.
Clinical Guideline
Evidence-based recommendations for appropriate healthcare interventions under specific clinical circumstances.
Example: Guidelines recommending annual mammograms for women over 40 to screen for breast cancer.
Clinical Protocol
A detailed procedure defining the steps healthcare providers follow when treating a specific condition.
Example: A hospital's stroke protocol specifying the diagnostic tests and treatments to administer within the first 60 minutes of patient arrival.
Clinical Workflow
The sequence of activities healthcare professionals perform to deliver patient care services.
Example: The emergency department workflow from patient triage through examination, treatment, and discharge or admission.
Clustering Coefficient
A graph metric measuring the degree to which nodes tend to cluster together in tightly connected groups.
Example: Calculating clustering coefficients to identify groups of providers who frequently refer patients to one another.
Community Detection
A graph algorithm that identifies densely connected groups of nodes with sparse connections between groups.
Example: Detecting communities in a provider network to identify potential fraud rings where providers collude to submit false claims.
Connected Components
Subgraphs where every node can reach every other node through some path, with no connections to other components.
Example: Finding connected components in a disease transmission network to identify isolated outbreak clusters.
Contract Negotiation
The process of establishing payment rates and terms between healthcare providers and insurance payers.
Example: A hospital negotiates with an insurance company to set reimbursement rates for surgical procedures.
Copayment
A fixed amount an insured person pays for a covered healthcare service at the time of care.
Example: A patient pays a $30 copayment at each doctor's office visit, with insurance covering the remaining cost.
Cost Of Care
The total financial resources required to deliver specific healthcare services to a patient.
Example: The cost of care for a knee replacement surgery includes surgeon fees, hospital facility charges, anesthesia, and rehabilitation.
Coverage
The specific healthcare services and conditions included in an insurance policy's benefits.
Example: An insurance policy provides coverage for hospitalizations and surgeries but excludes cosmetic procedures.
CPT Code
Current Procedural Terminology codes that identify medical procedures and services for billing purposes.
Example: CPT code 90791 represents an initial psychiatric diagnostic evaluation.
Cycle Detection
A graph algorithm that identifies circular paths where a sequence of edges returns to the starting node.
Example: Detecting referral cycles where providers refer patients to each other in a circular pattern, potentially indicating fraud.
Cypher Query Language
A declarative query language designed for querying and updating graph databases, developed for Neo4j.
Example: A Cypher query finds all patients diagnosed with diabetes who visited a cardiologist: MATCH (p:Patient)-[:HAS_DIAGNOSIS]->(d:Disease {name: 'Diabetes'})-[:VISITED]->(doc:Provider {specialty: 'Cardiology'}) RETURN p, doc.
Data Governance Framework
A structured system of policies, procedures, and responsibilities for managing organizational data assets.
Example: A healthcare system's data governance framework defining who can access patient data, retention policies, and quality standards.
Data Lineage
A documented history tracing data's origin, movements, transformations, and usage throughout its lifecycle.
Example: Tracking a patient's lab result from the testing device through the lab information system to the electronic health record.
Data Model
An abstract representation defining how data elements relate to each other and to real-world entities.
Example: A data model representing patients, providers, and encounters with their properties and relationships.
Data Privacy
Practices and policies protecting sensitive information from unauthorized access or disclosure.
Example: Hospital policies restricting employee access to patient records based on their job responsibilities.
Data Provenance
Information documenting the sources and processes that produced a specific data element.
Example: Recording that a blood pressure reading originated from a specific monitoring device at a particular date and time.
Data Quality
The degree to which data is accurate, complete, consistent, timely, and fit for its intended purpose.
Example: Measuring data quality by checking what percentage of patient records have complete demographic information and valid diagnosis codes.
Data Security
Technical and administrative measures protecting data from unauthorized access, modification, or destruction.
Example: Encrypting patient records in transit and at rest to prevent unauthorized access if systems are compromised.
Data Stewardship
The responsibility for ensuring data assets are properly managed, maintained, and protected.
Example: A chief data officer serving as data steward, overseeing data quality initiatives and governance policies.
Data Traceability
The ability to track data through its entire lifecycle from creation to deletion.
Example: Tracing a medication order from physician entry through pharmacy fulfillment to administration and documentation.
Database Schema
A formal structure defining how data is organized in a database, including tables, fields, and relationships.
Example: A relational database schema with tables for patients, appointments, and providers connected by foreign keys.
De-Identification
The process of removing or obscuring personally identifiable information from datasets.
Example: Removing patient names, addresses, and dates of birth from medical records before using them for research.
Deductible
The amount an insured person must pay for covered healthcare services before insurance begins paying.
Example: A patient with a $2,000 annual deductible pays full cost for services until reaching that amount, after which insurance coverage begins.
Degree Centrality
A graph metric counting the number of edges connected to a node.
Example: Calculating degree centrality to identify patients who have visited the most different healthcare providers.
Diagnosis
A healthcare provider's determination of a patient's disease or condition based on symptoms and tests.
Example: A physician makes a diagnosis of hypertension after measuring consistently elevated blood pressure over multiple visits.
Directed Acyclic Graph
A graph containing directed edges with no cycles, meaning you cannot follow edges to return to a starting node.
Example: A treatment pathway graph showing sequential steps in cancer therapy where each step leads only forward to the next stage.
Directed Graph
A graph where edges have a direction, flowing from a source node to a target node.
Example: A directed graph representing patient referrals where edges point from referring providers to receiving specialists.
Disease
A pathological condition affecting an organism's structure or function, impairing normal health.
Example: Type 2 diabetes mellitus is a chronic disease affecting how the body processes blood sugar.
DME Fraud
Fraudulent schemes involving durable medical equipment billing, often for unnecessary or undelivered items.
Example: A supplier bills Medicare for expensive power wheelchairs that were never delivered to patients.
Dosage
The specified amount and frequency of a medication prescribed for a patient.
Example: A prescription specifies a dosage of 500mg of amoxicillin taken three times daily for ten days.
Drug Code
A standardized identifier for pharmaceutical products used in prescribing and billing systems.
Example: NDC code 0069-2587-01 uniquely identifies a specific strength and manufacturer of a common antibiotic.
Drug Interaction
A situation where one medication affects the activity or safety of another when taken together.
Example: A drug interaction warning alerts that combining warfarin and aspirin increases bleeding risk.
Duplicate Claim
Multiple insurance claims submitted for the same service provided to the same patient.
Example: A medical office accidentally submits the same procedure claim twice for one patient visit, triggering fraud detection.
Edge
A connection between two nodes in a graph representing a relationship.
Example: An edge connecting a patient node to a provider node represents a treatment relationship.
Edge Property
An attribute or characteristic associated with a relationship between two nodes in a graph.
Example: A PRESCRIBED_BY edge between a patient and physician might have properties for medication name, date, and dosage.
Electronic Health Record
A digital version of a patient's medical history maintained by healthcare providers over time.
Example: A hospital's electronic health record system contains all patient visits, diagnoses, medications, lab results, and imaging studies.
Emergency Department
A hospital unit providing immediate medical care for acute illnesses and injuries without requiring an appointment.
Example: A patient with chest pain goes to the emergency department for immediate evaluation and treatment.
Evidence-Based Medicine
Medical practice integrating clinical expertise with the best available research evidence.
Example: A physician prescribes antibiotics for pneumonia based on clinical trials demonstrating efficacy for that infection.
Explainability
The ability to understand and articulate why a system or algorithm produced a specific result.
Example: A clinical decision support system explains why it recommended a particular treatment by citing the patient factors and research evidence it considered.
Fee-For-Service Model
A healthcare payment system where providers receive separate payment for each service delivered.
Example: A physician bills separately for an office visit, blood test, and X-ray performed during one patient encounter.
Formulary
A list of prescription medications approved for use and covered by a health insurance plan.
Example: An insurance company's formulary includes generic medications at low cost but requires prior authorization for expensive brand-name drugs.
Formulary Rule
A policy governing which medications are covered by insurance and under what conditions.
Example: A formulary rule requires patients to try a generic medication before approving coverage for a more expensive brand-name alternative.
Fraud Detection
The process of identifying intentional deception in healthcare billing or service delivery.
Example: Using graph analytics to detect a provider billing for services to deceased patients.
GQL Standard
Graph Query Language, an ISO standard for querying graph databases similar to SQL for relational databases.
Example: GQL allows database vendors to implement a common query language for graph operations.
Graph Algorithm
A computational procedure designed to solve problems involving graph-structured data.
Example: The shortest path algorithm finds the fastest route for a patient transfer between two hospitals in a healthcare network.
Graph And LLM Integration
The combination of graph databases with large language models to enable semantic reasoning over structured relationships.
Example: An integrated system uses a graph database to store patient relationships and an LLM to answer natural language questions about care patterns.
Graph Career Path
Professional opportunities for data scientists and engineers specializing in graph database technologies.
Example: Healthcare organizations hire graph database specialists to build analytics platforms for population health management.
Graph Database
A database management system that stores data as nodes and edges, optimized for traversing relationships.
Example: Neo4j is a graph database used to model patient-provider-payer relationships in healthcare systems.
Graph Embedding
A technique that represents graph nodes as vectors in a continuous space while preserving structural properties.
Example: Converting patient nodes into 128-dimensional vectors where similar patients have nearby vector representations.
Graph Index
A data structure accelerating graph queries by organizing nodes or edges for rapid lookup.
Example: An index on patient ID properties enables fast retrieval of specific patient nodes without scanning the entire graph.
Graph Neural Network
A neural network architecture designed to operate on graph-structured data for pattern recognition and prediction.
Example: A graph neural network predicts which patients are at high risk for hospital readmission based on their position in the care network.
Graph Path
A sequence of connected nodes and edges traversed while moving through a graph.
Example: A graph path showing a patient's journey from primary care physician to specialist to hospital admission.
Graph Pattern Matching
Finding subgraph structures that conform to a specified pattern template.
Example: Matching patterns to find all instances where a provider prescribed opioids to patients who visited multiple emergency departments.
Graph Pattern Recognition
Identifying recurring structural motifs or configurations within graph data.
Example: Recognizing fraud patterns where groups of providers share unusual referral and billing relationships.
Graph Query
A request to retrieve or manipulate data from a graph database based on node and edge criteria.
Example: A query finding all patients treated by a specific cardiologist who also have diabetes.
Graph Query Optimization
Techniques for improving the performance and efficiency of graph database queries.
Example: Rewriting a query to filter nodes early rather than traversing unnecessary relationships.
Graph Theory Basics
Fundamental mathematical concepts describing structures composed of nodes and edges.
Example: Understanding that healthcare relationships can be modeled as graphs where patients, providers, and payers are nodes connected by edges.
Graph Traversal
The process of visiting nodes and edges in a graph following a specific strategy.
Example: Traversing a patient's medical history by following edges chronologically from earliest to most recent encounters.
GSQL
A query language for the TigerGraph database combining declarative and imperative programming features.
Example: GSQL enables complex multi-step graph analytics queries for fraud detection across millions of healthcare claims.
HCPCS Code
Healthcare Common Procedure Coding System codes used for billing medical services, supplies, and equipment.
Example: HCPCS code E0100 represents a cane with a quadruped base.
Healthcare Analytics Platform
An integrated system for collecting, processing, and analyzing healthcare data to generate insights.
Example: A platform combining graph databases, machine learning, and visualization tools to identify cost reduction opportunities.
Healthcare Cost
The financial resources required to deliver medical services and maintain the healthcare system.
Example: The United States has the highest per-capita healthcare costs globally, exceeding $12,000 per person annually.
Healthcare Cost Analysis
Systematic examination of expenses associated with delivering medical services to identify efficiency opportunities.
Example: Analyzing cost patterns reveals that preventive care reduces expensive emergency department visits.
Healthcare Data Exchange
The electronic sharing of medical information between different healthcare organizations and systems.
Example: A health information exchange allows hospitals, clinics, and labs to securely share patient records.
Healthcare Fraud
Intentional deception or misrepresentation in medical billing to receive unauthorized payments.
Example: A clinic bills for medical services that were never actually provided to patients.
Healthcare Interoperability
The ability of different healthcare information systems to exchange and use shared data.
Example: Interoperability enables a pharmacy to electronically receive prescriptions from any physician's office regardless of their software.
Healthcare Payer
An organization that finances or reimburses healthcare services, typically an insurance company or government program.
Example: Medicare serves as the healthcare payer for Americans aged 65 and older.
Healthcare Patient
An individual receiving medical care or treatment from healthcare providers.
Example: A patient visits their primary care physician for an annual wellness examination.
Healthcare Provider
A licensed professional or organization delivering medical services to patients.
Example: Physicians, nurses, hospitals, and clinics are all healthcare providers.
Healthcare System
The organizational structure delivering medical services to a population, including providers, payers, and facilities.
Example: The U.S. healthcare system combines private insurance, government programs, and provider networks.
HIPAA
Health Insurance Portability and Accountability Act, a federal law protecting patient health information privacy and security.
Example: HIPAA requires healthcare organizations to implement safeguards preventing unauthorized disclosure of patient records.
Hospital
A licensed healthcare facility providing inpatient medical, surgical, and nursing care services.
Example: A regional hospital offers emergency services, surgical suites, intensive care, and specialized treatment departments.
Hospital Department
A specialized unit within a hospital organized around specific types of medical care.
Example: The cardiology department includes cardiac catheterization labs, echocardiography, and cardiovascular intensive care.
ICD Code
International Classification of Diseases codes used to document diagnoses and conditions in medical records.
Example: ICD-10 code E11.9 represents Type 2 diabetes mellitus without complications.
Immunization
The process of making an individual immune to disease through vaccination.
Example: A child receives immunizations against measles, mumps, and rubella at age 12 months.
Inpatient Care
Medical services provided to patients who are admitted to a hospital for at least one overnight stay.
Example: A patient receives inpatient care for five days following hip replacement surgery.
Insurance Claim
A formal request submitted to an insurance company for payment of covered healthcare services.
Example: A hospital submits an insurance claim for $45,000 for a patient's appendectomy surgery.
Insurance Policy
A contract between an insurer and member specifying covered services, costs, and conditions.
Example: An insurance policy outlines the deductible, copayments, and maximum out-of-pocket costs for the year.
Kickback Scheme
An illegal arrangement where healthcare providers receive payment for patient referrals.
Example: A laboratory pays physicians $50 for each patient blood test referral, violating federal anti-kickback laws.
Knowledge Graph
A graph database containing entities and relationships representing real-world knowledge in a domain.
Example: A medical knowledge graph connects diseases, symptoms, treatments, and medications based on clinical research.
Lab Result
The outcome of a laboratory test performed on a patient's biological sample.
Example: A lab result shows a patient's hemoglobin A1C level is 7.2%, indicating suboptimal diabetes control.
Lab Test
A diagnostic procedure analyzing patient samples to detect disease or monitor health status.
Example: A complete blood count lab test measures different components of blood to screen for various conditions.
Labeled Property Graph
A graph data model where nodes and edges have types (labels) and associated key-value properties.
Example: A labeled property graph includes Patient nodes with name and birthdate properties connected by PRESCRIBED edges with dosage properties.
Large Language Model
An artificial intelligence system trained on vast text data to understand and generate human language.
Example: A large language model assists clinicians by generating patient summary notes from electronic health records.
Link Prediction
A graph algorithm that estimates the likelihood of future connections between unconnected nodes.
Example: Predicting which patients are likely to develop diabetes based on their similarity to other patients in the graph.
Machine Learning
Computational methods enabling systems to improve performance on tasks through experience without explicit programming.
Example: A machine learning model learns to predict hospital readmission risk by analyzing patterns in thousands of patient records.
Master Data Management
Processes ensuring critical business data is consistent, accurate, and controlled across an organization.
Example: Master data management ensures a patient has one consistent identifier across all hospital systems.
Medical Coding System
A standardized set of codes representing diseases, procedures, and healthcare services for documentation and billing.
Example: Medical coding systems like ICD and CPT enable consistent communication of diagnoses and treatments across providers.
Medical Condition
A health state deviating from normal physiological function, including diseases, syndromes, and injuries.
Example: Asthma is a chronic medical condition causing inflammation and narrowing of airways.
Medical Encounter
An interaction between a patient and healthcare provider for evaluation, diagnosis, or treatment.
Example: A medical encounter occurs when a patient visits the emergency department for chest pain evaluation.
Medical License
Official authorization granted by a state allowing an individual to practice medicine within that jurisdiction.
Example: A physician must maintain an active medical license in every state where they see patients.
Medical Necessity
The requirement that healthcare services are appropriate and required to diagnose or treat a condition.
Example: Insurance companies determine medical necessity before approving coverage for expensive imaging studies.
Medical Terminology
The specialized vocabulary used by healthcare professionals to describe anatomy, conditions, and procedures.
Example: Medical terminology enables precise communication, such as using "myocardial infarction" instead of "heart attack."
Medication
A substance used to treat, prevent, or diagnose disease administered to patients.
Example: A physician prescribes medication to lower a patient's high blood pressure.
Metadata Management
The processes and systems for organizing, storing, and maintaining data about data.
Example: Metadata management tracks which department owns each data element and when it was last updated.
Multidisciplinary Team
Healthcare professionals from different specialties collaborating on patient care.
Example: A multidisciplinary team for cancer treatment includes an oncologist, surgeon, radiologist, and social worker.
Node
A fundamental graph element representing an entity or data point.
Example: In a healthcare graph, a node might represent a patient, provider, or medication.
Node Embedding
A technique converting graph nodes into dense numerical vectors for machine learning applications.
Example: Node embeddings allow similar patients to be grouped together based on their medical histories and relationships.
Node Property
An attribute or characteristic associated with a node in a graph.
Example: A Patient node might have properties including name, date of birth, and blood type.
Operating Margin
The percentage of revenue remaining after subtracting operating expenses, indicating financial performance.
Example: A hospital with a 5% operating margin earns $5 for every $100 in revenue after covering costs.
Out-Of-Pocket Maximum
The most an insured person pays for covered services in a plan year, after which insurance pays 100%.
Example: After reaching the $6,000 out-of-pocket maximum, all subsequent covered services are fully paid by insurance.
Outpatient Facility
A healthcare location providing services not requiring overnight hospital admission.
Example: Outpatient surgery centers perform procedures where patients go home the same day.
Pagerank Algorithm
A graph algorithm measuring node importance based on the quantity and quality of connections.
Example: Using PageRank to identify influential healthcare providers based on referral network patterns.
Path Query
A graph query finding sequences of connected nodes and edges matching specified criteria.
Example: A path query traces a patient's journey from primary care through specialists to hospital admission.
Patient Demographics
Statistical characteristics of patients including age, gender, race, location, and socioeconomic factors.
Example: Patient demographics help researchers understand health disparities between different population groups.
Patient History
A comprehensive record of an individual's past medical conditions, treatments, and health events.
Example: A patient history reveals previous heart surgery and ongoing treatment for high cholesterol.
Patient ID
A unique identifier assigned to distinguish one patient from all others in a healthcare system.
Example: Each patient receives a permanent patient ID at their first visit to ensure records are correctly matched.
Patient Journey
The complete sequence of healthcare interactions and experiences from initial symptoms through treatment and recovery.
Example: A cancer patient's journey includes diagnosis, surgery, chemotherapy, radiation, and survivorship care.
Patient Outcome
The health status or result achieved following medical treatment or intervention.
Example: A successful patient outcome after knee replacement surgery includes pain reduction and restored mobility.
Patient Record
A comprehensive collection of medical information documenting an individual's healthcare encounters and history.
Example: A patient record contains diagnoses, medications, lab results, imaging studies, and provider notes from all visits.
Payer Mix
The distribution of patients across different insurance types and payment sources for a healthcare provider.
Example: A hospital's payer mix is 40% commercial insurance, 35% Medicare, 15% Medicaid, and 10% uninsured.
Per-Person Healthcare Cost
The average amount spent on healthcare services per individual in a population over a specified period.
Example: The per-person healthcare cost in the United States exceeds $12,000 annually, highest among developed nations.
Phantom Billing
Fraudulent submission of claims for services or supplies never actually provided to patients.
Example: A provider bills Medicare for office visits with patients who never came to the clinic.
Pharmacy Benefit Manager
An organization administering prescription drug plans and negotiating prices between payers and pharmacies.
Example: A pharmacy benefit manager processes prescription claims and determines patient copayment amounts at the pharmacy counter.
Population Health Analytics
Analysis of health data across patient groups to identify trends, risks, and improvement opportunities.
Example: Population health analytics reveals that diabetic patients in one neighborhood have higher hospitalization rates than others.
Predictive Analytics
Statistical techniques using historical data to forecast future events or behaviors.
Example: Predictive analytics identifies patients at high risk for heart failure readmission within 30 days of discharge.
Premium
The amount paid periodically to maintain active health insurance coverage.
Example: An employee pays a $300 monthly premium for family health insurance coverage.
Prescription
A written or electronic order from a licensed provider authorizing a patient to receive a specific medication.
Example: A physician writes a prescription for antibiotics to treat a patient's bacterial infection.
Preventive Care
Healthcare services focused on maintaining health and preventing disease rather than treating illness.
Example: Annual wellness visits, vaccinations, and cancer screenings are forms of preventive care.
Primary Care Provider
A physician serving as a patient's first point of contact and coordinator for overall healthcare needs.
Example: A family medicine physician serves as primary care provider, managing routine care and referring to specialists when needed.
Prior Authorization
A requirement that insurance approve specific services or medications before they are provided.
Example: An insurance company requires prior authorization before approving an expensive MRI scan to verify medical necessity.
Profitability
The degree to which revenues exceed expenses, indicating financial viability of healthcare operations.
Example: A hospital achieves profitability when revenue from patient services exceeds the costs of delivering care.
Project Presentation
A formal communication where students demonstrate their capstone project results, methods, and conclusions.
Example: Students present their fraud detection graph application to faculty, explaining the algorithms used and findings discovered.
Protected Health Information
Any individually identifiable health data protected under HIPAA privacy regulations.
Example: Protected health information includes patient names, medical record numbers, diagnoses, and treatment details.
Provider Capacity
The maximum number of patients or services a healthcare provider can handle in a given timeframe.
Example: A clinic's provider capacity is 25 patient appointments per day per physician.
Provider Compensation
The payment methods and amounts used to reimburse healthcare providers for services delivered.
Example: Provider compensation models include salary, fee-for-service, or value-based payment arrangements.
Provider Credential
Official documentation verifying a healthcare professional's qualifications, training, and authorization to practice.
Example: A hospital credentials committee reviews provider credentials including medical degrees, licenses, and board certifications.
Provider Network
A group of healthcare providers and facilities contracted with an insurance plan to deliver care.
Example: An insurance company's provider network includes 500 physicians and 50 hospitals in the metropolitan area.
Provider Network Fraud
Organized schemes where multiple providers collude to submit fraudulent claims or inappropriate referrals.
Example: Provider network fraud occurs when a group of clinics share patient information to bill for services never rendered.
Provider Performance
Measures evaluating the quality, efficiency, and outcomes of care delivered by healthcare providers.
Example: Provider performance metrics include patient satisfaction scores, complication rates, and adherence to clinical guidelines.
Provider Rating
Numerical or qualitative scores assessing healthcare provider quality based on patient outcomes and satisfaction.
Example: Online provider ratings allow patients to view physician reviews and quality measures when choosing care.
Provider Schedule
The calendar of time slots when a healthcare provider is available to see patients.
Example: A provider schedule shows a physician has appointment slots available Tuesday and Thursday mornings.
Provider Specialization
A healthcare provider's focus on a specific area of medicine requiring advanced training.
Example: Provider specialization allows patients with heart conditions to see cardiologists with expertise in cardiovascular care.
Quality Metric
A quantitative measure used to assess healthcare process quality, outcomes, or patient experience.
Example: Hospital readmission rates within 30 days serve as a quality metric for discharge planning effectiveness.
Quality of Life Metric
Measures assessing patient well-being, function, and satisfaction beyond clinical disease measures.
Example: Cancer treatment quality of life metrics include pain levels, ability to work, and emotional well-being.
Query Performance
The speed and efficiency with which a database executes queries and returns results.
Example: Query performance improves dramatically when using graph databases for relationship-heavy queries compared to relational databases.
RAG Architecture
Retrieval-Augmented Generation, combining document retrieval with language models to generate informed responses.
Example: A RAG architecture retrieves relevant medical literature and uses an LLM to answer clinician questions with cited sources.
Real-World Implementation
Practical deployment of healthcare graph solutions in operational clinical or administrative settings.
Example: A hospital implements a graph-based clinical decision support system that providers use during patient encounters.
Recommendation System
An algorithm suggesting relevant items, services, or actions based on user characteristics and patterns.
Example: A recommendation system suggests appropriate clinical guidelines based on patient diagnosis and characteristics.
Referral
The process of directing a patient to another healthcare provider for specialized evaluation or treatment.
Example: A primary care provider sends a referral to a cardiologist when a patient has concerning heart symptoms.
Referral Network Analysis
Examination of patterns in how providers refer patients to identify relationships and potential anomalies.
Example: Referral network analysis reveals that a physician always refers patients to a specific imaging center, suggesting a potential kickback arrangement.
Reimbursement
Payment made by insurance or patients to healthcare providers for services rendered.
Example: A hospital receives reimbursement from Medicare for treating an elderly patient's pneumonia.
Relational Database
A database organizing data into tables with rows and columns linked through defined relationships.
Example: A relational database stores patient information in one table and appointments in another, connected by patient ID.
Revenue
Income generated by a healthcare organization from delivering services and receiving payments.
Example: A hospital's annual revenue totals $500 million from patient care, government programs, and commercial insurance.
Revenue Cycle
The complete process from patient registration through billing, payment collection, and revenue realization.
Example: The revenue cycle includes scheduling, insurance verification, charge capture, claims submission, and payment posting.
Risk Adjustment
Modifying payment amounts based on patient health status and complexity to account for care difficulty.
Example: Risk adjustment increases Medicare payments for treating patients with multiple chronic conditions.
Risk Stratification
Categorizing patients into groups based on their likelihood of adverse health outcomes or high costs.
Example: Risk stratification identifies high-risk diabetes patients needing intensive case management to prevent complications.
Role-Based Access Control
A security approach granting system permissions based on user job functions rather than individual identities.
Example: Role-based access control allows all nurses to view patient records but restricts billing system access to finance staff.
Semantic Search
Information retrieval using meaning and context rather than exact keyword matching.
Example: Semantic search finds relevant medical research when a clinician asks "treatments for resistant hypertension" using natural language.
Shortest Path Algorithm
A graph algorithm finding the minimum number of edges or lowest-weight path between two nodes.
Example: The shortest path algorithm finds the quickest referral chain from a patient's primary physician to a specialized treatment center.
Similarity Measure
A quantitative method for assessing how alike two nodes or subgraphs are based on defined criteria.
Example: Computing similarity measures identifies patients with comparable medical histories for cohort analysis.
Specialist Provider
A physician with advanced training focused on treating specific diseases, organ systems, or patient populations.
Example: An oncologist is a specialist provider treating patients with cancer.
Subgraph Query
A graph query extracting a subset of nodes and edges matching specified patterns or conditions.
Example: A subgraph query extracts all nodes and relationships for patients treated in the cardiology department during 2024.
Symptom
A physical or mental feature perceived by the patient indicating disease or abnormal condition.
Example: Chest pain, shortness of breath, and fatigue are symptoms that may indicate heart disease.
Transparency
The degree to which system operations, decisions, and data are visible and understandable to stakeholders.
Example: Transparency in healthcare pricing allows patients to understand costs before receiving services.
Treatment Plan
A structured approach outlining specific interventions, medications, and procedures for managing a patient's condition.
Example: A treatment plan for pneumonia includes antibiotics, rest, fluids, and a follow-up appointment in one week.
Treatment Timeline
A chronological representation showing the sequence and timing of medical interventions for a patient.
Example: A treatment timeline displays when a cancer patient received surgery, chemotherapy cycles, and radiation therapy.
Unbundling
A fraudulent billing practice of separating procedure components to charge more than the bundled service rate.
Example: Unbundling occurs when a provider bills separately for steps of a surgical procedure that should be billed together.
Upcoding
A fraudulent practice of billing for more expensive services than actually provided.
Example: Upcoding happens when a physician bills for an extensive office visit when only a brief consultation occurred.
Utilization Review
Evaluation of healthcare services to determine if they are medically necessary and appropriate.
Example: Utilization review may identify that a patient's extended hospital stay is no longer medically necessary for acute care.
Value-Based Care
A healthcare payment model rewarding providers for patient health outcomes rather than service volume.
Example: Value-based care contracts pay bonuses to providers who achieve target rates for diabetes control and preventive screenings.
Value-Based Payment
Reimbursement systems linking provider compensation to quality metrics and patient outcomes rather than service quantity.
Example: A value-based payment arrangement rewards a clinic for reducing emergency department visits among their diabetic patients.
Vector Embedding
A mathematical representation of data as dense numerical vectors capturing semantic meaning and relationships.
Example: Vector embeddings convert patient diagnoses into numbers that position similar conditions near each other in multi-dimensional space.
Vector Store
A specialized database optimized for storing and searching high-dimensional vector representations of data.
Example: A vector store enables fast similarity searches to find patients with medical histories similar to a new patient.
Vital Sign
A measurable indicator of basic body functions used to assess health status.
Example: Blood pressure, heart rate, temperature, and respiratory rate are vital signs measured at each clinical visit.
Waste In Healthcare
Unnecessary healthcare spending that does not improve patient outcomes, including overtreatment and inefficiency.
Example: Ordering duplicate lab tests that were already completed recently represents waste in healthcare.