Clear definitions of the clinical, data, technology, and insurance terms you’ll encounter across our site and in conversations about Gesund.
An explicit statement that the available evidence does not support a conclusion. This may result from missing information, conflicting findings, or unreadable records.
Abstention can apply to a specific clinical question while other findings remain supported. It is different from reporting no findings: insufficient evidence does not establish that a condition is absent or well controlled.
A life insurance underwriting process that allows eligible applicants to qualify without certain traditional requirements, such as a paramedical exam or newly collected blood and urine samples.
Carriers use application information, electronic data, and their own underwriting criteria to determine eligibility. Applicants who do not qualify may need additional evidence or traditional underwriting.
Medical information requested from an applicant’s treating physician for underwriting. An APS commonly includes clinical notes, specialist reports, medications, lab results, and other records held by the practice.
It may contain records exported from an EHR and arrive as digital documents, scans, or faxed pages. Its contents depend on the request and what the responding practice supplies. Its usefulness depends on the clinical detail and history it contains, not simply its length.
Evaluating medical evidence across sources and time to establish what it means for a person’s clinical story. This includes a condition’s onset, severity, control, progression, treatment response, and relationships to other conditions.
Clinical interpretation considers supporting and conflicting evidence, identifies gaps, and makes clear what remains unresolved. It establishes what the record supports while leaving underwriting decisions with the carrier or reinsurer.
Clinical information organized around a specific condition across sources and time. In Gesund’s output, this includes onset, severity, control, trajectory, treatment response, and relationships to other conditions, together with supporting evidence and unresolved questions.
This structure preserves the clinical interpretation so it can be used in review, rules, analytics, and data science.
A digital clinical record maintained by a healthcare provider or organization. It can include diagnoses, medications, laboratory results, encounters, procedures, and narrative notes.
An electronic retrieval may return structured data, documents, or both. Coverage, historical depth, and clinical detail vary by source and access method. Different retrievals may return additional information, overlapping records, or duplicates. Understanding a condition may require connecting evidence across multiple providers and time periods.
Reinsurance considered on an individual case basis. The insurer submits a case to a reinsurer, which assesses it and determines whether to offer coverage and on what terms.
It is often used for complex medical histories, large coverage amounts, or cases requiring individual consideration outside automatic reinsurance arrangements.
The electronic sharing of health information among participating organizations. The term also refers to the organizations and networks that support that exchange.
Records obtained through an HIE may bring together clinical information from multiple providers. Availability for life insurance underwriting depends on participating sources, access arrangements, and appropriate authorization. Coverage is not universal, and the information returned may overlap with records obtained elsewhere.
Exchanged records can contain duplicates, inconsistent terminology, and gaps. Their value depends on the additional clinical evidence they provide and what that evidence helps clarify.
The ability of different systems to exchange information and use what they receive. In healthcare, this includes preserving the meaning of information as it moves between providers, networks, and applications.
Interoperability enables access and exchange. It does not, by itself, resolve duplicate entries, conflicting information, or gaps in the clinical story.
Information that identifies where evidence originated and how it supports a finding. Depending on the source, this may include a document passage, encounter, laboratory result, or other data entry, together with its date and origin.
A clinical interpretation may draw on several pieces of evidence across sources and time. Preserving provenance helps a reviewer examine that support and assess the conclusion.
Matching a request for additional evidence to the specific question that remains unresolved.
It starts with understanding what the existing record already establishes, what is still unclear, and which additional information could help resolve it. The carrier or reinsurer determines the requirements under its own guidelines.
The Trusted Exchange Framework and Common Agreement (TEFCA) establishes common rules for sharing health information across participating U.S. health information networks.
Individual Access Services (IAS) enables people to request their own health information through participating services, with their permission and identity verification. It can bring together records from multiple organizations without requiring a separate visit to each provider’s portal.
The information returned depends on participating organizations, available records, and successful matching to the individual. Access does not guarantee a complete medical history.
Learn more about TEFCA from HealthIT.gov.
Learn more about Individual Access Services from The Sequoia Project.
Clinical information organized and interpreted for underwriting review. Conditions are characterized across time, including onset, severity, control, treatment response, and relationships to other conditions, to the extent the evidence supports.
The clinical story comes with supporting evidence, limitations, data gaps, and unresolved questions. The underwriter applies judgment; underwriting decisions remain with the carrier or reinsurer.
A standardized core set of health information used to support electronic access and exchange. It includes clinical notes, diagnoses, medications, laboratory results, vital signs, procedures, and other information.
USCDI helps define what health systems must be capable of exchanging under applicable certification and exchange requirements. It is not the entire medical record, and it does not guarantee that every data element is available for every person or returned through every retrieval method.