electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting February 5,

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 Reminder: Join the eLTSS Initiative 3

4 Agenda TopicPresenterTimeframe Welcome Meeting Reminders & Announcements eLTSS Roadmap Lynette Elliott / Evelyn Gallego 5 mins Project Charter Consensus & eLTSS GlossaryEvelyn Gallego5 mins Concert Series Presentation: Observations of Daily Living (ODLs) Patti Brennan25 mins Use Case Framing DiscussionEvelyn Gallego20 mins Use Case Working Session: Person-Centered eLTSS Plan – WHY is this valuable? What makes it valuable? Becky Angeles / Community 30 mins Homework / Next StepsLynette Elliott / Becky Angeles 5 mins

All Hands Workgroup Meeting Structure Our Community Meetings are scheduled for one hour a week. We believe your time is valuable and appreciate your participation in this initiative. In order to make the most of our time together, we will start the meeting software for all community meetings at 12:25 pm Eastern. – This gives attendees time to log in to the WebEx and then dial in to the teleconference prior to the meeting start. We will begin the All Hands Meetings at precisely at 12:30 pm Eastern with administrative items and announcements. 5 Thank you for your participation and we look forward to working with you in the coming months.

Plan for the Coming Weeks All Hands Meetings will be held over the next several weeks to finalize the Project Charter – All Hands Meetings will be held Thursdays from 12:30 to 1:30pm Eastern – Next Meeting is February 12, 2015 – Meeting information can be found on the wiki: Meeting URLhttps://siframe​work2.webex.com​/siframework2/o​nstage/g.p hp?MT​ID=ebd25d20410a​ef6a7a83eb4b796​ Dial In Passcode Attendee IDProvided by WebEx upon login REMINDER Please check the wiki for the latest meeting schedule. REMINDER Please check the wiki for the latest meeting schedule.

ONC Announcements and Annual Meeting 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: comments comments ONC held its Annual Meeting on February 2-3, 2015 in Washington, D.C. – Over 1,200 health IT partners gathered for two days of plenaries and breakout sessions – eLTSS Initiative Introduced in two breakout sessions on Day 2 7

Concert Series Presentations 8 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 Duration: 15 to 20 mins webinar (or demo); 5 to 10 mins Q&A Presentations will occur following eLTSS Workgroup activities i.e. eLTSS workgroup will work on project charter review during first part of meeting; concert series presentation will occur during second half of meeting 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 9

Upcoming Concert Series Presentations Feb 12 th : FEI Systems and MD Feb 19 th : Improving Post-Acute Care Transformation (IMPACT) Act March 5 th : Right Care Now Project 10

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 4: 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 11 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 12

Project Charter Consensus THANK YOU to those Committed Members who voted on the Project Charter! Consensus Vote Results: – 31 Votes Yes: 22 Yes (with Comments): 7 Object (with Comments): 2 FINAL Published Project Charter located here: Term+Services+and+Supports+%28eLTSS%29+Charter Term+Services+and+Supports+%28eLTSS%29+Charter 13

eLTSS Glossary The eLTSS Glossary is a working document containing eLTSS-relevant terms, abbreviations and definitions as defined by stakeholders Posted here: We are looking for your feedback and comments – A discussion thread will be available on the wiki – Please submit any change requests via the Change Request Form (coming soon) located on the wiki Reminder: the Glossary is a living document and content may change as the initiative progresses 14

OBSERVATIONS OF DAILY LIVING (ODLS) Concert Series Presentation: Patti Brennan, RN, PhD 15

USE CASE FRAMING DISCUSSION 16

PhaseTypical Activities 1.Pre-Discovery  Development of Initiative Synopsis  Development of Initiative Charter  Definition of Goals & Initiative Outcomes 2.Discovery  Creation/Validation of Use Cases, User Stories & Functional Requirements  Identification of interoperability gaps, barriers, obstacles and costs  Review of Vocabulary 3.Implementation  Evaluation of candidate standards  Development of Standards Solution Plan  Creation of Implementation Guidance 4.Pilot  Validation of aligned specifications, testing tools, and reference implementation tools  Revision of documentation and tools  Development and presentation of Pilot Proposals 4.Evaluation  Measurement of initiative success against goals and outcomes  Identification of best practices and lessons learned from pilots for wider scale deployment  Identification of hard and soft policy tools that could be considered for wider scale deployments S&I Framework Deliverables Framework 17 ✔ Use Case focused on “what” the requirements should be rather than “how”…but we still need to work on the “why”.

Use Case Approach: Let’s Start with ‘Why’ 18 WHY HOW WHAT What is the driving purpose of a person-centered plan? Why is it important to you? Why should we care? What is an eLTSS Plan? What information (e.g. assessment content) does it contain? How is an eLTSS Plan created, shared and stored? References: Simon Sinek’s “The Golden Circle”: ; blog post “How-What-Why (Are we here?) are-we-here/ are-we-here/ Most of our time is spent explaining the ‘what’ and the ‘how’ of our ideas While most ideas get spread because of the ‘why’

Underlying Principle: Beneficiary/Individual Experience 19 Acute Care Institutional Care Community-Based Care Independent Healthy Living Hospital Specialty Clinic ICU Nursing Home Skilled Nursing Facility Behavioral Health Clinic Primary Care Home Health Adult Day Care Individual Home Assisted Living Self-Directed Image adapted from: QUALITY OF LIFE CONTINUUM OF CARE

Let’s Build from the Value Statements… Improve provider workflows for eLTSS plan development and exchange Reduce data collection burden processes for beneficiaries, providers and payers Integrate beneficiary priorities, preferences and goals identified in CB-LTSS setting with goals/outcomes included in beneficiary care plan Improve timeliness for collecting and sharing LTSS information Enable beneficiaries to lead decision making regarding appropriate care and services to be received Identify critical gaps and unnecessary overlaps in the care and services needed and delivered to a beneficiary Enable beneficiaries to exchange important care and service plan information across provider groups and with accountable entities and other parties 20

Framing Question: What’s In it for Me? Who is the Me? – Individual – Caregiver – Service Provider – Public Health – Payer – Regulator – Other Accountable Entity What is the information need? – Sharing of data to improve quality, safety and efficiency (cost) – Inform policy and public health decisions 21

Framing Discussion For Community Keeping Beneficiary Experience at center, what are the key drivers (operational, business, financial) for the eLTSS Plan Use Case? – Independent Healthy Living – Change of Status (ADT) – Shared Decision-Making – Medication Reconciliation – Readmission Risk – Service & Care Plan Reconciliation – Single-Sign on – Health Information Exchange at time of Transition – Quality Measurement in LTSS – Increased Referrals for LTSS Providers with more streamlined communication with MCOs 22

Example: Medication Reconciliation Meals on wheels driver delivers meal and notes change in status of beneficiary Using mobile app, Driver accesses beneficiary’s eLTSS Plan and captures change in status Alert is sent to nurse care manager at MCO Nurse receives alert through his/her IT system Nurse sends VNA to beneficiary home to conduct assessment VNA conducts visit and assessment using his/her mobile app Med Reconciliation is completed; eLTSS Plan is automatically updated Beneficiary is kept out of hospital (OUTCOME) 23

TARGETED QUESTIONS FOR THE ‘WHY’ Use Case Development Working Session 24

Questions for Beneficiaries Why is access to an eLTSS plan valuable for you? – Tom G: People receiving services may not be aware who their case mgr is, having information electronically available simplifies the process and improves care – Nancy T: When states have electronic records that people can contribute to, people are more directly engaged, services are better and are more educated about what is in the plan. – Ellen B: Direct support workers don’t have accurate records or reporting to care providers across settings of care. The electronic record would provide a better baseline for disabled people to better communicate needs on their behalf. – Pam R: There is a mixture of clinical & non-clinical information in the plan. There is a need to get the non-clinical information into the plan and to be accessible by provider and beneficiary – Matt: (MN): Remote access to electronic services to coordinate care (across state lines, between caregivers/providers etc.). Access to records, appointments, etc. – Kelly (CO): Some of the non-clinical data people are asking for revolve around tracking of services, budgets. A place to tell their personal story. Clinical Data includes push notifications and medication components. Andrey: There are solutions available for tracking of services and budgets as noted above. One of our community members may have a statewide access to an eLTSS Care Plan rather than for individual access points. – Lisa N: From the caregiver – a long term care plan avoids crises, smoother living, planning process encourages you to think about all scenarios – work together with other family members in decision making. The plan makes it more possible for families to work together. Currently uses MS Word. Hours needed to manage care affects productivity and wages from professional work duties. Terry: There needs to be a crisis plan included in the plan. Ellen: Uses google calendar to share with caregivers/family – John Derr: Needs to be longitudinal over time, needs alerts. Looking at the care over time, makes me be proactive for the care of my own health. – Chris White: MD integrates its eLTSS system and patient portal to elaborate on the care plan and patient communicates changes back to the phr – puts the patient at the center of care. 25

Questions for Beneficiaries How do you benefit from receiving services? – E.g., Stay home, prevent hospitalization, etc. Which services do you most utilize? How have you received these services (referral, sought service by self, recommendation, etc.)? – How did you provide the necessary information to receive that service (survey, submitted paperwork, etc.) – What information did you have to provide? What value do you feel you received in this process? – What would you change about this process? – What worked for you in this process? 26

Questions for Service Providers What information do you currently share? How do you currently exchange service information? – With whom? What are the costs and benefits of sharing information? – Sharing electronic information? How do you think beneficiaries benefit from having a sharable eLTSS plan? 27

Questions for Payers What information do you currently share? How do you currently exchange service information? – With whom? What are the costs and benefits of sharing information? – Sharing electronic information? How do you think beneficiaries benefit from having a sharable eLTSS plan? 28

NEXT STEPS AND HOMEWORK 29

Next Steps JOIN THE INITIATIVE: The electronic Long-Term Services and Supports Initiative is OPEN for anyone to join. HOMEWORK: –Review and Answer the Use Case Framing Questions on the Use Case wiki: Value+Framing+Questions Value+Framing+Questions –Review and Comment on the Draft In Scope and Out of Scope Sections of the Use Case: Term+Services+and+Supports+%28eLTSS%29+Use+Case Term+Services+and+Supports+%28eLTSS%29+Use+Case 30

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 31

BACKUP SLIDES 32

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

Week Target Date (2015) All Hands WG Meeting Tasks Review & Comments from Community via Wiki page due following Tuesday by 8 P.M. Eastern 11/22 Use Case Kick-Off & UC Process Overview Introduce: In/Out of Scope Review: In/Out of Scope 22/19 Review: In/Out of Scope Introduce: Context Diagram & User Stories Review: Context Diagram & User Stories 32/26Review: Context Diagram & User StoriesReview: Continue Review of User Stories 43/5 Review: Finalize User Stories Introduce: Assumptions & Pre/Post Conditions Review: Assumptions & Pre/Post Conditions 53/12 Review: Assumptions & Pre/Post Conditions Introduce: Activity Diagram & Base Flow Review: Activity Diagram & Base Flow 63/19 Review: Activity Diagram & Base Flow Introduce: Functional Requirements & Sequence Diagram Review: Functional Requirements & Sequence Diagram 73/26 Review: Functional Requirements & Sequence Diagram Introduce: Data Requirements Review: Data Requirements 84/2 Review: Finalize Data Requirements Introduce: Risks & Issues Review: Risks & Issues 94/9 Review: Risks and Issues Begin End-to-End Review End-to-End Review by community 104/16End-to-End Comments Review & dispositionEnd-to-End Review ends 114/23Finalize End-to-End Review Comments & Begin ConsensusBegin casting consensus vote 124/30Consensus Vote*Conclude consensus voting Proposed Use Case & Functional Requirements Development Timeline 34

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

eLTSS Plan Future Sharing Options Generates, updates and displays eLTSS Plan; stores/transmits data Updates and displays eLTSS Plan; stores/submits data Extract, Transform, & Load eLTSS Plan Data Move from Patient-Centered to Person-Centered Planning and Information Exchange Updates and displays eLTSS Plan; stores/transmits data