Patient Demographic Data Quality Framework

Business Glossary, Metadata, and Data Standards


Business glossary practices ensure collaborative agreements on business terms and definitions, creating common understanding about patient demographic data that supports business processes for all relevant stakeholders.

Introductory Notes

A business glossary is a compendium of business terms and definitions, which have been approved by stakeholders and are maintained and governed. The language representing the data should be aligned with the language of the business.

Consistent terms and definitions, with corresponding metadata, are essential to managing patient demographic data across its lifecycle in the context of meaning. Agreement about term names and definitions is essential to ensure that all stakeholders who supply or consume the data understand it the same way without ambiguity. If common understanding of terms for shared data is lacking, business processes are negatively affected.

The business glossary represents agreement among key stakeholders on the language and associated meaning pertaining to patient data needed to support quality care, efficient payments, and patient safety. If business terminology is not uniquely named and defined, confusion and inefficiencies may cause issues.

The benefits of building and maintaining a glossary of standard patient demographic business terms include:

  • Increased understanding and communication among business units and stakeholders;
  • Improved foundation for developing data requirements for new data stores;
  • Improved accuracy and clarity of reports;
  • Improved agility for effective sharing and integration of patient data;
  • Enabled tracing of data lineage from receipt or acquisition through its movement across business processes and data stores;
  • Enhanced agility in exchanging data with external suppliers or consumers; and
  • Increased collaborative effort and positive achievement for governance participants.

Standardizing business terms is the starting point for standardizing metadata (formats, values, ranges, lengths) and any physical specifications that are required to optimize patient identification and matching. Building knowledge (metadata) about patient demographic data is the baseline for making decisions about modifying or adding to the set of core demographic data elements. Standard business terms should be easily accessible to all stakeholders.

Business terms relevant to patient demographic data may be: adopted from a glossary included with vendor services or software, adopted (or adapted) from an existing set of industry standard terms, or created by the organization itself. What is important is that the organization creates, approves, and updates consistent business terms and definitions, fostering a shared understanding and usage across the data lifecycle. Each term in the glossary should refer to a basic concept without ambiguity or duplication.

Business terms can be challenging to define, reconcile, approve, and maintain. Usage of terms within a single business unit may support the needs of that business unit, but vary from the usage in other groups. In addition, terms may have connotative meanings that must be explored, harmonized, and decided upon through collaborative agreements.

In many organizations, development of data stores takes place in the context of an information systems project. Without applying consistent business terms, there is a risk of creating new names and alternate definitions that may complicate future data integration and incur rework. Standard business terms are the underpinning for trend and predictive analyses, semantic modeling, taxonomies, and ontologies.

An organization is advised to create a defined process by which business terms and their corresponding definitions are created, approved, updated, maintained, and governed. Standards for business terms, including naming conventions, abbreviations, standard definitions, and standard metadata (for example, date created, data owner, etc.) should accompany the process.

Additional Information

Improving and sustaining high quality patient demographic data depends on standard attributes that collectively ensure that each patient record is complete and unique. Provided the metadata standard is adhered to, it helps to ensure that the data necessary to perform key business tasks is available and, when provided, efficiently align with other systems.

Standard metadata cannot be relied upon without a trustworthy business glossary, as such a glossary represents agreement on the language and meaning among key stakeholders pertaining to the patient data needed to support quality care, efficient payments, and patient safety. Moreover, if business terminology is not uniquely named and defined, then confusion and inefficiency will result.

In order to ensure that data attributes are uniquely and precisely specified, many organizations design logical data models that reference approved business glossary terms. It is also a best practice to store and maintain glossary entries in a centralized repository, link them to the related metadata, and assign them a unique identifier.

Example Work Products

  • Defined business terms in project documentation
  • Business glossary maintained by a business unit
  • Business term and logical attribute mapping

Additional Information

For some organizations, the business glossary is an afterthought that emerges when confusion over the meaning of metadata surfaces. This most often occurs when data is integrated into a common container, i.e., a data warehouse. In particular, matching patient demographic data from multiple sources is hampered by inconsistently described metadata. When tied to common terms and meanings, this could be more easily reconciled. For example, how people of different ethnic backgrounds use their family names can be addressed through precise definitions. These definitions inform business rules that specify specific process and procedural steps, for instance, those taken at the point of initial patient registration.

A key discriminator differentiating the business glossary from other types of metadata is that it serves primarily as a business knowledge resource. Once a key concept has been precisely named and defined, it can be replicated through metadata in multiple and disparate systems while ensuring a higher degree of affinity with an authoritative meaning on which all stakeholders agree.

Example Work Products

  • Business glossary
  • Business term process
  • Business term glossary management process

Additional Information

A business glossary not only supports the consolidation of multiple sources of common data, but is also a valuable resource for defining and understanding data requirements. Therefore, it is a best practice to embed a standard process for developing and updating glossary terms in the organization’s selection process for new technologies, e.g., Health IT Modules.

Business glossary terms often have one-to-many relationships to metadata, because the same concept has multiple instantiations. For example, a precise definition of the concept of patient may require that multiple types of patients need to be identified. Attributes in the context of an implemented system may describe predetermined values or associated rules. For example, a record for a deceased patient must have a date of death and an aged record may be deemed an inactive patient.

Additional Information

Even though business glossary terms are not physically implemented per se, changes in their meaning may have significant impacts due to one-to-many relationships with metadata, both from single concept to multiple instantiations, and the fact that glossary terms may define a collection of attributes as well as codes and values across multiple attributes. Therefore, a change in definition may result in modified rules for stored data, e.g., defining a “suffix” as separate from “last name” can have impacts that need to be evaluated. For example, identification of those systems in which a suffix can be typed into a last name field. Changes to business terms should be approved by a governance body that represents the impacted stakeholders.

Additional Information

Although there is no single adopted industry standard for patient demographic data applying to all healthcare organizations, the organization should keep informed about advances in data quality techniques, vendor systems, and proposed improvements, e.g., adding mother’s maiden name to improve patient matching. In addition to ONC, organizations that address patient demographic data include, but are not limited to:

Provider Organizations

  • American Academy of Family Physicians (AAFP)
  • American College of Physicians (ACP)
  • American Hospital Association (AHA)
  • American Medical Association (AMA)
  • Medical Group Management Association (MGMA)

Health IT and Health Information Management Organizations

  • American Health Information Management Association (AHIMA)
  • College of Healthcare Information Management Executives (CHIME)
  • Electronic Health Record Association (EHR Association)
  • Health IT Now Coalition
  • Integrating the Healthcare Enterprise (IHE)
  • National Association for Healthcare Access Management (NAHAM):
  • Workgroup for Electronic Data Interchange (WEDI)

Consumer Groups

  • Center for Democracy and Technology (CDT)
  • National Partnership for Women and Families
  • Patient Privacy Rights (PPR)
  • Society for Participatory Medicine (S4PM)


  • Department of Defense (DOD) working with Sysnet International: Sysnet International has found that at least 7 to 8 attributes are needed to address geographic variability. The project with the DOD did not develop a standard list of data attributes.
  • Social Security Administration (SSA): SSA recommends that ONC explore additional data attributes beyond the basics of the patient identification segment in HL7 to see if there could be other attributes that improve the patient patch.

Example Work Products

  • Policy mandating use of standard business terms
  • Business terms compliance process
  • Mapping of business terms to physical data elements
  • Results from impact assessment
  • Business glossary update log

Practice Evaluation Questions

Tier 1: Foundational

1.1 Has the organization uniquely defined names and definitions for patient demographic business terms?

Tier 2: Building

2.1 Is a process to define, manage, use, and maintain the business glossary defined and followed?

Tier 3: Advanced

3.1 Does data governance for the business glossary process stipulate the use of business terms in system requirements and the mapping of business terms to implemented data stores?

3.2 Does the organization conduct impact assessments and obtain governance approval prior to implementing changes to business terms?

3.3 Does the organization participate in industry groups, which address emerging standards and best practices for patient demographic business terms?