electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting April 30,

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). o Please DO NOT use the Q&A—only the presenter sees Q&A, not necessarily the person facilitating the discussion 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: User Story 2: Base Flow Activity Diagram Sequence Diagram Functional Requirements Dataset Requirement Introduction Becky Angeles eLTSS Community 45 mins Homework / Next StepsBecky Angeles5 mins Concert Series Presentation: State of ColoradoPamela Russell Kelly Wilson 30 mins

Announcements Launch of eLTSS Plan Content SWG Goal – to identify and harmonize a core set of domains and an example set of associated data elements that will inform the creation of an eLTSS plan Activities – Identify a core set of domains (clinical and non-clinical) – Define validation criteria to evaluate the domains and associated data elements – Evaluate the domains and data elements against the validation criteria and make a recommendation to the eLTSS Initiative 4

Announcements eLTSS Plan Content SWG – WEBEX Information URL: g.php?MTID=e7ea8bcb868c228d9a8a237e90d g.php?MTID=e7ea8bcb868c228d9a8a237e90d Date/Time: Weekly every Tuesday, beginning May 5, :00am-12pm ET Dial-In: Access code: Attendee ID: provided by Webex 5

Announcements HHS, CMS and ONC announced the release of the following on March 20, 2015: – Stage 3 Notice of Proposed Rulemaking (NPRM) for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Program Stage 3 Notice of Proposed Rulemaking (NPRM) for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Program specifies new criteria that EPs, EHs, and CAHs must meet to qualify for Medicaid EHR incentive payments proposes criteria that providers must meet to avoid Medicare payment adjustments based on program performance beginning in payment year 2018 – 2015 Edition Health IT Certification Criteria 2015 Edition Health IT Certification Criteria aligns with the path toward interoperability identified in ONC's draft shared Nationwide Interoperability Roadmap builds on past editions of adopted health IT certification criteria, includes new/updated IT functionality and provisions that support the EHR Incentive Programs care improvement, cost reduction, and patient safety across the health system – Comment period ends May 29,

Announcements (continued) PUBLIC COMMENTS: You may submit comments, identified by RIN 0991-AB93, by any of the following methods (please do not submit duplicate comments). Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. Federal eRulemaking Portal: Follow the instructions for submitting comments. Attachments should be in Microsoft Word, Microsoft Excel, or Adobe PDF; however, we prefer Microsoft Word. Regular, Express, or Overnight Mail: Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, Attention: 2015 Edition Health IT Certification Criteria Proposed Rule, Hubert H. Humphrey Building, Suite 729D, 200 Independence Ave, S.W., Washington, D.C Please submit one original and two copies. Hand Delivery or Courier: Office of the National Coordinator for Health Information Technology, Attention: 2015 Edition Health IT Certification Criteria Proposed Rule, Hubert H. Humphrey Building, Suite 729D, 200 Independence Ave, S.W., Washington, D.C Please submit one original and two copies. (Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without federal government identification, commenters are encouraged to leave their comments in the mail drop slots located in the main lobby of the building.) 7

Announcements (continued) 2015 Long Term Post Acute Care (LTPAC) & HIT Summit – What: The LTPAC HIT Summit is the premiere health IT conference for individuals within and working with the LTPAC industry for over 10 years. As the key conference of HIT leaders, policy makers, providers, vendors and professionals, the Summit continues to advance initiatives facing the long term, post acute care industry and priorities from the latest Roadmap for Health IT in LTPAC. – When: June 21-23, 8am-5pm ET – Where: Baltimore, MD in the Baltimore Hilton – To register: 8

Concert Series Presentations 9 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 10

Upcoming Concert Series Presentations 11 May 7 th : Inofile / Kno2 May 14 th : State of Minnesota May 21 st : Harmony Information Systems May 28 th : (available)

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 12 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. 13

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 14

Wk. 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 73/12Finalize: Context Diagram & User StoriesReview: User Stories 83/19Review: User Stories CommentsReview: User Stories, Glossary 93/26 Review: User Stories Introduce: Actors & Roles Review: User Stories, Actors & Roles 104/2 Finalize: Actors & Roles Introduce: In/Out of Scope Review: In/Out of Scope 114/9 Finalize: In/Out of Scope Introduce: Assumptions & Pre/Post Conditions Review: Assumptions & Pre/Post Conditions 124/16 Finalize: Scope, Assumptions & Pre/Post Conditions Introduce: Activity Diagram & Base Flow Review: Activity Diagram & Base Flow 134/23 Finalize: Activity Diagram & Base Flow Introduce: Functional Requirements & Sequence Diagram Review: Functional Requirements & Sequence Diagram 144/30 Finalize: Functional Requirements & Sequence Diagram Introduce: Data Requirements Review: Data Requirements 155/7Review: Data Requirements 165/14 Finalize: Finalize Data Requirements Introduce: Risks & Issues Review: Risks & Issues 175/21 Finalize: Risks and Issues Begin End-to-End Review End-to-End Review by community 185/28End-to-End Comments Review & dispositionEnd-to-End Review ends 196/4Finalize End-to-End Review Comments & Begin ConsensusBegin casting consensus vote 206/11Consensus Vote*Conclude consensus voting Proposed Use Case Development Timeline 15

We Need YOU! In order to stick to our timeline and to ensure that the artifacts we develop fit the need of our stakeholders (you), we need your feedback, comments and participation Each week, please review the use case content and provide comments via the wiki at: Term+Services+and+Supports+%28eLTSS%29+Use+Case Term+Services+and+Supports+%28eLTSS%29+Use+Case – Or Becky Angeles directly at with edits, comments or Discussions moving forward will be more technically (systems information and functionality, data sets/data elements, etc.). We encourage tech savvy individuals and teams to participate and provide input. 16

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Dataset Requirements Lists the domains and data elements that will be available within the eLTSS plan Requires input from eLTSS plan data sharing experts to ensure elements are fully specified Identification of data elements form the foundation for harmonization activities 18

The Grocery Store Concept 19 The beneficiary leads, owns and approves the content in the eLTSS plan User Story 1: think of the eLTSS Plan content as a “store” – Plan components/domains are aisles – Component/domain details are items

The Cart 20 Beneficiary chooses what to include in the plan Items can be put in or taken out like a shopping cart

The Aisles – Typical Grocery Store 21 Method of organizing content so that beneficiary can easily locate and use items Like items are organized together by “domain”

eLTSS Plan Content Aisles (Domains) 22 Brief Person-Centered Profile My Personal Story Demographic / Background Information Care Team Functional Status Activities of Daily Living Instrumental Activities of Daily Living Social Support, Engagement and Integration (transportation, employment, housing) Cognitive Function and Memory/Learning Behavior Concerns Service Information Financial / Payer Information Clinical Information ( Medical Conditions/Diagnoses, Crisis Data, Nutrition, Medications, Advance Directives) Alerts/Notifications (Out of Scope?)

eLTSS Plan Content Aisles (Domains) 23 Think of aisle as a domain or “bucket” of data Each aisle has different data items Brief Person-Centered Profile Activities of Daily Living Instrumental Activities of Daily Living Demographic/ Background Information My Personal Story Cognitive Function & Memory/Learning Care Team Alerts/Notifications Clinical Information Social Support, Engagement, Integration Service Info Financial / Payer Info Behavior Concerns Functional Status

Example: My Personal Story Aisle Elements 24 Think of aisle as domain or “bucket” of data Each aisle has different “shelves” of data elements AISLE 1: My Personal Story GOALS PREFERENCES PRIORITIES INTERESTS DESIRED OUTCOMES

My Personal Story Aisle Items (Data Elements) 25 Aisles contain items (data elements) that beneficiary selects, modifies and shares INTERESTS GOALS PRIORITIES PREFERENCES DESIRED OUTCOMES

Item Organization – Data Segmentation 26 Items (data elements) the beneficiary selects and modifies are segmented appropriately (“grocery bags”) INTERESTS GOALS PRIORITIES PREFERENCES DESIRED OUTCOMES

User Story 2: The Checkout Lane 27 User Story 2: The Checkout Lane (“Sharing an eLTSS Plan”) The Confirmation The Cart The Transaction

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Next Steps HOMEWORK – Due by COB Tuesday, May 5th: –Review Use Case Content posted on the eLTSS Use Case –Utilize Comment Form at Term+Services+and+Supports+%28eLTSS%29+Use+Casehttp://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Use+Case – feedback / comments to NEXT WEEK: –Dataset Requirements –Concert Series Presentation: Inofile/Kno2 Join the eLTSS Initiative: –Included on the eLTSS distribution list –Committed Members can vote on artifacts 29

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31 The Colorado Department of Health Care Policy and Financing CORHIO April 30, 2015 Colorado Demonstration Grant for the Testing Experience and Functional Tools (TEFT)

Experience of Care Survey Continuity Assessment Record & Evaluation Tool Personal Health Record e-LTSS Records S&I Framework TEFT Components 32

TEFT In Colorado  Waiver Populations  Elderly, Blind, Disabled (EBD)  Supported Living Services (SLS)-ID/DD  State Partnerships  CCBs, SEPs, RCCOs, ACOs, etc.  Stakeholders – HCBS Providers  HIEs – CORHIO & QHN  Internal Initiatives - Health Care Policy and Finance  Person-centered Approach  No Wrong Door  Assessment Tool Redesign 33

Stakeholder Meetings  Community meetings held from July, 2014 through December 2014  11 on-site meetings and 3 webinars  Attendees included the community centered boards, Single entry points, RCCO’s, ACO’s, HCBS providers and state partners 34

35  Security of information  User flexibility  Opt-Out features  Designed to aid Client in managing LTSS Services Key Considerations:

The Four Domains for Outcomes ED visits Hospital Visits PCP Client Engagement Satisfaction Choice and Control ADLs Self-Efficacy Personal Story Lab Results Health Risk Assessments ClinicalFunctional Utilization Quality of Life 36

Types of Health Information Exchange 37 Results Delivery Patients’ data and lab results automatically routed into appropriate physicians’ EHRs Results Delivery Patients’ data and lab results automatically routed into appropriate physicians’ EHRsQuery-Based Search for a patient and retrieve comprehensive, consolidated information in one place (longitudinal health record) Helpful for emergency situations and/or new patient appointmentsQuery-Based Search for a patient and retrieve comprehensive, consolidated information in one place (longitudinal health record) Helpful for emergency situations and/or new patient appointments DIRECT Point-to-point communication; works a lot like Data is not necessarily made available to patient’s entire care team Part of Stage 2 Meaningful UseDIRECT Point-to-point communication; works a lot like Data is not necessarily made available to patient’s entire care team Part of Stage 2 Meaningful Use

Community Health Record Hospitals Public Health Departments Laboratories Radiology Centers Newborn Screening Results Hospital ADT info Lab Results Pathology Reports Radiology Reports Consult Reports Transcription Notes Lab/Rad Data in the CORHIO Network Reportable Conditions (ELR) Immunizations 38

Data in the CORHIO Network Community Health Record Hospitals Public Health Departments Laboratories Radiology Centers Hospital ADT Info Lab Results Pathology Reports Radiology Reports Consult Reports Transcription Notes Public Health Alerts Immunizations Diagnostic-Quality Medical Images (with CTN) Medications lists Data Analytics Pharmacy Information CCD CCD Upload Orders Future CIIS Newborn Screening Results Reportable Conditions Immunizations Lab/Rad Immunizations 39

The “Perfect State” of HIE Integration of Behavioral Health Statewide & National Connectivity Increased Interoperability Full Integration of Public Health 40

PHR Project Development Develop criteria for PHR solutions Understand technical infrastructure and capabilities for the LTSS population Analyze interoperability between the PHR and Medicaid enterprise system, specifically MMIS – non-clinical Create strategies to connect to our state HIEs - clinical

1.Must be able to integrate data coming from a HIE 2.Must be able to take data input from a client, caregiver or provider in the form of other devices 3.Must be customizable to suit the different user needs including non-clinical and clinical data 4.Must be able to display benefits and waiver related information or partner with a vendor who can 5.Must be secure in managing the data including HIPAA compliance Solutions : Criteria for PHR Products 42

Solutions: Criteria for PHR Products Con’t. 6. Must be able to meet the basic Standards and Interoperability (S&I) Framework requirements 7. Must accept data input from secure Direct Messaging 8. Must be able to send alerts to any stakeholder, including providers and physicians 9. Must be customizable or open sourced 10. Must be from a vendor that is financially viable

Year 2 - Navigation  Teach how to navigate the PHR - Non-clinical, clinical (only a couple elements) Year 3 -Data Feeds Added  PHRs connect to the state HIEs, add more data Year 4 - Dynamic Phase  Clinical enters data, interactive – personal story, answers daily questions, tracks own wellness, interacts with PHR Implementation: Three Phases 44

Three Measures of Success  Frequency of Use  Who is using it and how often  Efficient coordination of services  Tracking scheduled appointments and units  Increase in quality of services  Patient engagement impacts services 45

 Identified 5 communities in Colorado to be Focus Group settings  Reviewed three electronic Personal Health Record (PHR) for LTSS (ManaHealth, Get Real Health and FEI Systems)  Developed a state partner advisory committee  Developing partnership with HCPF IT Department to design MMIS/PHR solution Key Milestones 46

Upcoming Challenges HCBS Providers at different levels of Health Information technology Case Managers and Care coordinators utilizing home grown or purchased “EHR” systems that are not certified to be integrated with an HIE Accessibility to internet, laptops and computers at varying levels PHRs must be usable for the elderly, blind, disabled populations 47

 Focus Groups began in March 2015 in the five communities  PHR Demos to be initiated for clients, caregivers and providers starting in April 2015  Pilot Sites for PHR to be identified from the Focus Groups  First on-site in Grand Junction on April 29 th  Second on-site in Burlington on May 6 th  Third on-site in Colorado Springs May 13 th  Integrate systems - HCPF, HIEs and new IT system The Work Begins 48

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Thank You Pamela A. Russell LTC Program Director/Government Programs CORHIO Danielle Culp Quality Management Department Department of Health Care Policy & Financing

eLTSS Initiative: Project Team Leads ONC Leads – Elizabeth Palena-Hall – Patricia Greim CMS Lead – Kerry Lida Federal Lead – Jennie Harvell Community Leads – Andrey Ostrovsky – Nancy Thaler – Terry O’Malley 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 51

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Scope Further defines the scope of the Use Case itself and NOT the scope of the Initiative Diagrams and other supplemental data / examples help provide context and clarify the basis for the Use Case 53

Scope Subsections Background – describes the relevance of the Use Case in relation to what gaps currently exist within the healthcare industry. Includes all policy and/or regulatory issues/dependencies that may impact the Use Case In Scope – indicates what is in scope for the Use Case. For example, the type of transactions, the information/data to be exchanged, and specific aspects that need to be in place to enable the information to be sent, received and understood the same at both ends of the transmission. Out of Scope – indicates what is out of scope for the Use Case. These points may highlight dependencies on the feasibility, implementability, and usability that result in limitations of the Use Case. At a high level, whatever is not declared “In Scope” is by definition, “Out of Scope”. – Note: Items that are out of scope for the Use Case, Functional Requirements and Standards Harmonization activities can be still be part of a Pilot. Communities of Interest 54

Assumptions Outlines what needs to be in place to meet or realize the requirements of the Use Case (i.e. the necessary privacy and security framework) Functional in nature and state the broad overarching concepts related to the Initiative Serve as a starting point for subsequent harmonization activities 55

Pre-Conditions Conditions that must exist for the implementation of the eLTSS Plan creation and sharing Describe the state of the system, from a technical perspective, that must be true before an operation, process, activity or task can be executed Lists what needs to be in place before executing the information exchange as described by the Functional Requirements and Dataset requirements 56

Post-Conditions Describe the state of the system, from a technical perspective, that will result after the execution of the operation, process activity or task 57

Activity Diagram An Activity Diagram is a action state transition diagram – An action state represents the fulfillment of associated responsibilities in response to the communication received from the previous step – Most transitions are triggered by completion of activities in the source states The Activity Diagram illustrates the Use Case flows events and information between the actors Displays the main events/actions that are required for the data sharing and the role of each system in supporting the sharing 58

Base Flow The Base Flow is the step by step process of the information sharing depicted in the activity diagram Indicates the actor who performs the action, the description of the event/action, and the associated inputs (records/data required to undertake the action) and outputs (records/data produced by actions taken) 59

Sequence Diagram Shows the interactions between objects in the sequential order that they occur Communicates how the sharing works by displaying how the different components interact Transition from requirements expressed as use cases to the next and more formal level of refinement 60

Information Interchange Requirements Define the system’s name and role Specify the actions associated with the actual sharing of information from the sending system to the receiving system 61

System Requirements Lists the requirements internal to the system necessary to participate successfully in the sharing of information May detail a required workflow that is essential to the use case 62