electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting February 26,

Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call o Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded o Another reason to keep your phone on mute when not speaking Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know. o Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute All Panelists 2

3 Agenda TopicPresenterTimeframe Welcome Announcements eLTSS Roadmap Lynette Elliott10 mins Use Case Working Session: Context Diagram and User Story Becky Angeles / Community 45 mins Homework / Next StepsBecky Angeles5 mins

Announcements REMINDER - Join the eLTSS Initiative as a Committed Member or Other Interested Party: Only Committed Members can vote on artifacts. ONC issued the Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0 – The draft Roadmap is a proposal to deliver better care and result in healthier people through the safe and secure exchange and use of electronic health information. – Includes Person-Centered Planning and eLTSS initiative – ONC is accepting public comments until 5pm ET April 3, 2015: implementers/interoperability-roadmap-public-comments implementers/interoperability-roadmap-public-comments 4

Announcements Call for Participation: HIMSS 2015 Interoperability Showcase – Seeking organizations that are interested in demonstrating technology that supports an interoperable learning health system – We are looking for a wide range of demonstrations - from query-based exchange and directed exchange to innovative applications and interfaces that enable the seamless use and sharing of health information among clinicians, consumers, payers, the public health community and the scientific community to advance better individual, community and population health. – All demonstrations must be live. No canned demonstrations or static presentations will be considered. – Nominations are due Friday, February 27 at 5:00 p.m. EST – Submit your nomination herehere 5 HIMSS Interoperability Showcase – April 12-15, 2015 – Chicago, IL

New Funding Announcement Advance Interoperable Health Information Technology Services to Support Health Information Exchange Funding Opportunity Announcement Advance Interoperable Health Information Technology Services to Support Health Information Exchange Funding Opportunity Announcement – Letters of Intent Due: March 2, 2015; Application Deadline: April 6, 2015 – Leverages investments and lessons learned from HITECH State HIE Program to accelerate widespread adoption and use of HIE infrastructure – Grantees MUST select at least one eligible care provider and at least two non-eligible care providers for their target populations: 6

Concert Series Presentations 7 Organizations are invited to present on an existing project or initiative that is related to the eLTSS scope of work and/or will help inform the eLTSS target outcomes and deliverables These projects do not have to be technically-focused Criteria for consideration: Has solution, whether it is technical or process driven, been implemented in a one or more of the eLTSS settings: home and community-based setting or clinical setting? Does solution incorporate existing or emerging standards and/or other relevant guidance?

Concert Series Presentations: Logistics Presentations will be scheduled as part of the weekly eLTSS Community Meetings and will occur the last 30 mins of the call Duration: mins webinar (or demo); 5-10 mins Q&A eLTSS Workgroup activities will always take precedence over concert series presentations If you have an interest in participating, please contact Evelyn Gallego ) and Lynette Elliott A pre-planning meeting will be scheduled prior to any public demonstration 8

Upcoming Concert Series Presentations 9 March 5 th : Right Care Now Project March 12 th : State of Maryland March 19 th : Colorado Regional Health Information Exchange (CORHIO) March 26 th : NASDDDS National Core Indicators April 2 nd : Person-Centered Planning Tools April 9 th : PeerPlace April 16 th : MyDirectives.com / A|D Vault, Inc. April 23 rd : Care at Hand

Timelines for Consideration: Two Pilot Phases, SDO Ballot Cycles eLTSS Initiative Roadmap Q3 ‘14Q4 ‘14Q1 ‘15Q2 ‘15Q3 ‘15Q4 ‘15Q4 ‘17 Phase 4: Pilots & Testing Pilot site readiness Implementation of solution Test User Stories and Scenarios Monitor Progress & Outcomes Utilize Requirements Traceability Matrix Phase 5: Evaluation Evaluate outcomes against Success Metrics and Criteria Update Implementation Guidance Develop, review, and finalize the Use Case and Functional Requirements Pre-Planning Call for Participation Conduct Environmental Scan Success Criteria Stakeholder Engagement Finalize Candidate Standards Standards Gap Analysis Technical & Standards Design Develop Requirements Traceability Matrix Develop Implementation Guide Launch initiative Review and Finalize Charter Review initial Candidate Standards 10 Initiative Kick Off: 11/06/14 Phase 1: Pre-Discovery Phase 2: Use Case Development & Functional Requirements Phase 3: Standards & Harmonization

Goals for the eLTSS Initiative Identify key assessment domains and associated data elements to include in an electronic Long-term Services & Supports (eLTSS) plan Create a structured, longitudinal, person-centered eLTSS plan that can be exchanged electronically across and between community- based information systems, clinical care systems and personal health record systems. We will use Health IT to establish a person-centered electronic LTSS record, one that supports the person, makes him or her central to the process, and recognizes the person as the expert on goals and needs.* * Source: Guidance to HHS Agencies for Implementing Principles of Section 2402(a) of the Affordable Care Act: Standards for Person-Centered Planning and Self-Direction in Home and Community-Based Services Programs 11

Project Charter and eLTSS Glossary FINAL Published Project Charter located here: Term+Services+and+Supports+%28eLTSS%29+Charter Term+Services+and+Supports+%28eLTSS%29+Charter eLTSS Glossary posted here: – The eLTSS Glossary is a working document containing eLTSS-relevant terms, abbreviations and definitions as defined by stakeholders – We are looking for your feedback and comments Discussion Thread available Submit any change requests via the Change Request Form located on the wiki – Reminder: the Glossary is a living document and content may change as the initiative progresses 12

Week Target Date (2015) All Hands WG Meeting Tasks Review & Comments from Community via Wiki page due following Tuesday by 8 P.M. Eastern 1-51/22-2/19 Use Case Kick-Off & UC Process Overview Use Case Value Framing Discussions Review and Answer Value Framing Questions on wiki 62/26 Review: Consolidated UC Value Framing Introduce: Context Diagram & User Stories Review: Context Diagram & User Stories 73/5 Finalize: Context Diagram & User Stories Introduce: In/Out of Scope Review: In/Out of Scope 83/12 Finalize: In/Out of Scope Introduce: Assumptions & Pre/Post Conditions Review: Assumptions & Pre/Post Conditions 93/19 Finalize: Assumptions & Pre/Post Conditions Introduce: Activity Diagram & Base Flow Review: Activity Diagram & Base Flow 103/26 Finalize: Activity Diagram & Base Flow Introduce: Functional Requirements & Sequence Diagram Review: Functional Requirements & Sequence Diagram 114/2 Finalize: Functional Requirements & Sequence Diagram Introduce: Data Requirements Review: Data Requirements 124/9Review: Data Requirements 134/16 Finalize: Finalize Data Requirements Introduce: Risks & Issues Review: Risks & Issues 144/23 Finalize: Risks and Issues Begin End-to-End Review End-to-End Review by community 154/30End-to-End Comments Review & dispositionEnd-to-End Review ends 165/7Finalize End-to-End Review Comments & Begin ConsensusBegin casting consensus vote 175/14Consensus Vote*Conclude consensus voting Proposed Use Case & Functional Requirements Development Timeline 13

What we learned so far / What questions need answered Thank you for providing input for our eLTSS Use Case Framing Questions (via the wiki, live discussions or ). We have consolidated the responses and posted the document on the eLTSS wiki at: Supports+Use+Case+Value+Framing+Questions Supports+Use+Case+Value+Framing+Questions This document and YOUR responses will be used as input for various sections of the eLTSS Use Case Artifact 14

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LTSS Information Sharing: As-Is Workflow Transport Emergency Services Personal Care Meals Caregiver Support Housing Home Maintenance & Repair Behavioral Health Employment Education Legal Services Criminal Justice Acute Care Primary Care Specialty Care Long-Term Care Post-Acute Care Emergency Care Intensive Care Person-Centered Patient-Centered

Owner of plan; contributes personal story, demographic data Generates, updates and displays eLTSS Plan; stores/transmits service- related data Updates and displays eLTSS Plan; stores/submits medical, clinical, advance directive data Extract, Transform, & Load financial data Component 1 Component 2 Component n eLTSS Plan Future Creation and Sharing Move from Patient-Centered to Person- Centered Planning and Information Sharing Collects assessment data for eligibility determination and to inform plan of service

User Story Description: – User Stories summarize the interaction between the actors of the Use Case – Specify what information is exchanged from a contextual perspective – Describe the real world application as an example of the Scenario – Provide clinical context 18

User Story Example – Longitudinal Coordination of Care (LCC) Care Plan Exchange A Care Team in Setting A creates a Care Plan for exchange with a second Care Team in Setting B as the patient transfers from, or care is shared between Setting A and Setting B. A Care Plan is prepared, reviewed and signed within the Setting A electronic health record (EHR) system and transmitted to the designated Setting B EHR system. Upon receipt of the Care Plan in Setting B, each Care Team Member reviews and modifies the Care Plan based on new assessments of the patient, and these changes are harmonized within Site B to create a Care Plan for use by the receiving Care Team. 19

User Story Example – Electronic Submission of Medical Documentation (esMD) Electronic Determination of Coverage A Beneficiary has a visit with a Provider for a particular problem. The Provider evaluates and assesses the Beneficiary, making use of all available patient/provider interaction documentation. The Provider then renders the service or device to the Beneficiary. The Provider documents their findings regarding the Beneficiary’s visit within their EHR system. This data should be fully portable to enable data exchange between multiple entities. Once the service or device has been rendered and fully documented within the EHR system, the Provider will sign the clinical, required, and supporting documentation for Determination of Coverage and submit it to the Payer(s) for processing. The Payer(s) receive and process the signed documentation, then respond to the Provider. 20

What We’ve Learned from you – Services Utilized 21 We will focus on Services most utilized to develop our user stories: Financial Literacy Occupational Therapy Personal Care Homemaker Wellness Nutrition Consult Companionship Assisted Living Care / Support for Family / Friends Habilitation Job Coaching Transportation Educational / Technical Support Social Support Medication Management Respite Care Adult Day Services Case Management (i.e., community case workers) Mental Health Services Meal / Food Delivery

eLTSS Plan User Story Need We need your help: – Draft 3 – 4 User Stories based on the list of most used services Assisted Living Personal Care Adult Day Services Case Management Transportation Medication Management Meal/Food Delivery Care / Support for Family / Friends – Volunteers: Nancy/Mary: Payer perspective - habilitation Caroline: Beneficiary perspective with sharing to payer/provider David: Focus on elderly and support for the family (include healthcare provider) Kelly: Provider perspective on Medication Management from provider view Andrey: sharing of data between waiver system, IT systems, health technology Rachel: Beneficiary perspective 22

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Next Steps HOMEWORK – Due by COB Tuesday, March 3rd: –Submit a user story based on prioritized list of services –Review Context Diagram –Send user story / comments to or NEXT WEEK: –Use Case Context Diagram and User Stories –In / Out of Scope –Concert Series Presentation: Right Care Now Project Join the eLTSS Initiative: –Only Committed Members can vote on artifacts 24

eLTSS Initiative: Project Team Leads ONC Leads – Elizabeth Palena-Hall – Patricia Greim CMS Lead – Kerry Lida Federal Lead – Jennie Harvell Initiative Coordinator – Evelyn Gallego-Haag Project Management & Pilots Lead – Lynette Elliott Use Case & Functional Requirements Development – Becky Angeles Standards Development Support – Angelique Cortez Harmonization – Atanu Sen 25

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Use Case Outline Tailored for each Initiative Preface and Introduction** 2.0 Initiative Overview – 2.1 Initiative Challenge Statement** 3.0 Use Case Scope – 3.1 Background** – 3.2 In Scope – 3.3 Out of Scope – 3.4 Communities of Interest** 4.0 Value Statement** 5.0 Use Case Assumptions 6.0 Pre-Conditions 7.0 Post Conditions 8.0 Actors and Roles 9.0 Use Case Diagram 10.0 Scenario: Generic Provider Workflow – 10.1 User Story 1, 2, x, … – 10.2 Activity Diagram o Base Flow o Alternate Flow – 10.3 Functional Requirements o Information Interchange Requirements o System Requirements – 10.4 Sequence Diagram 11.0 Risks, Issues and Obstacles 12.0 Dataset Requirements Appendices – Related Use Cases – Previous Work Efforts – References ** Leverage content from Project Charter