1. electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting February 12, 2015 1

2. 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. http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29 3 Reminder: Join the eLTSS Initiative 3

4. 4 Agenda TopicPresenterTimeframe Welcome Meeting Reminders & Announcements eLTSS Roadmap Sweta Ladwa / Evelyn Gallego 5 mins Use Case FramingEvelyn5 mins Use Case Working Session: Person-Centered eLTSS Plan – WHY is this valuable? What makes it valuable? Sweta Ladwa / Community 45 mins Homework / Next StepsSweta Ladwa5 mins Concert Series Presentation: FEI SystemsNish, Chris, Lorraine 30 mins

5. 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. – When we have a Concert Series Presentation, we will meet for 90 mins. 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.

6. Plan for the Coming Weeks All Hands Meetings will be held over the next several weeks to develop the Use Case – All Hands Meetings will be held Thursdays from 12:30 to 1:30pm Eastern When Concert Series Presentations are scheduled, the meeting will be extended to 2:00pm ET – Next Meeting is February 19, 2015 from 12:30 to 2:00pm Eastern – Meeting information can be found on the wiki: http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29 http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29 6 Meeting URLhttps://siframe​work1.webex.com​/siframework1/o​nstage/g.p hp?MT​ID=edef16d2a091​e1c0563ef1ac8ff​0bc8e5 Dial In1-650-479-3208 Passcode669 251 560 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.

7. Announcements 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: http://www.healthit.gov/policy- researchers-implementers/interoperability-roadmap-public-comments http://www.healthit.gov/policy- researchers-implementers/interoperability-roadmap-public-comments ONC and HHS IDEA Lab Staff are hosting a Big Data for Health Innovation Engagement Bootcamp for health care innovators on Thursday, Feb. 12 th from 4 - 6pm ET.Big Data for Health Innovation Engagement Bootcamp – The event will illustrate how startups and developers can use open Federal data to create new technology solutions that could help low-income and vulnerable populations achieve better health. – Participants include the eLTSS Initiative, Administration for Children and Families, Health Resources and Services Administration, Medicaid, Purple Binder, Healthify, ACL, etc. – Event info: http://capconcorp.com/event/onc-bootcamp/ Event info: http://capconcorp.com/event/onc-bootcamp/ 7

8. New Funding Announcements 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: 8 Upcoming Webinar: Feb 24 th at 3pm ET: https://attendee.gotowebinar.com/register/3398558919765946881 https://attendee.gotowebinar.com/register/3398558919765946881 Upcoming Webinar: Feb 24 th at 3pm ET: https://attendee.gotowebinar.com/register/3398558919765946881 https://attendee.gotowebinar.com/register/3398558919765946881

9. 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?

10. 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 (evelyn.gallego@siframework.org ) and Lynette Elliott (lynette.elliott@esacinc.com)evelyn.gallego@siframework.orglynette.elliott@esacinc.com A pre-planning meeting will be scheduled prior to any public demonstration 10

11. Upcoming Concert Series Presentations Feb 12 th : FEI Systems and Maryland Feb 19 th : Improving Post-Acute Care Transformation (IMPACT) Act March 5 th : Right Care Now Project 11

12. 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

13. 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 13

14. Project Charter and eLTSS Glossary FINAL Published Project Charter located here: http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Charter http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Charter eLTSS Glossary posted here: http://wiki.siframework.org/eLTSS+Glossary http://wiki.siframework.org/eLTSS+Glossary – 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

15. USE CASE FRAMING DISCUSSION 15

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 16 Use Case focused on “what” the requirements should be rather than “how”…but we still need to work on the “why”.

17. Use Case Approach: Let’s Start with ‘Why’ 17 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”: https://www.startwithwhy.com ; blog post “How-What-Why (Are we here?) http://productguy.in/how-what-why- are-we-here/https://www.startwithwhy.comhttp://productguy.in/how-what-why- 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’

18. Underlying Principle: Beneficiary/Individual Experience 18 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: http://www.marsdd.com/news-and-insights/transforming-health-decentralized-connected-care/http://www.marsdd.com/news-and-insights/transforming-health-decentralized-connected-care/ QUALITY OF LIFE CONTINUUM OF CARE

19. 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 19

20. 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 20

21. 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) 21

22. TARGETED QUESTIONS FOR THE ‘WHY’ Use Case Development Working Session 22

23. What we learned so far… Questions for Beneficiaries Why is access to an eLTSS plan valuable for you? – Easily figure out who my case manager is, simplify the process of receiving services, improve care – I am more directly engaged, services are better and more educated about what is in the plan – Able to better communicate my needs to direct support workers who have electronic and more accurate records as well as the ability to report to care providers across settings of care – Help coordinate care (across state lines, between caregivers/providers etc.) by providing access to records, appointments, etc. – Avoids crises and promotes smoother living; work together with other family members in decision making 23

24. What we learned so far… Questions for Beneficiaries What kind of information do you want in an eLTSS Plan? – A place to tell my personal story (i.e., interests, goals, preferences, and priorities) What is important to the beneficiary? – Non-clinical data (e.g., tracking of services and budgets) accessible by provider and beneficiary – Clinical Data (e.g., push notifications and medication components) – The plan needs to be longitudinal over time and to include alerts. Looking at the care over time, makes me be proactive for the care of my own health. – Include a crisis plan – When the eLTSS system and patient portal are integrated it is easy to elaborate on the care plan and have the patient communicate changes back to the phr – puts the patient at the center of care. – Current information related to the Advanced Directives – Caregiver/guardian/POA Information – Living Situation – Method of Contact (communication preferences) 24

25. Questions for Beneficiaries How do you benefit from receiving services? – E.g., Stay home, prevent hospitalization, etc. – Provider assistance for daily living activities – Companionship – Cohesion with the community – Social function (build and sustain community connections) – Provider care – ‘My life, My Way’ model- critical, medical, advanced care medical treatments are done ‘my way’ – Transitional planning Which services do you most utilize? – Job coaching – Transportation – Educational/Technical support – Social support – Medication Management – Respite Care – Adult Day services 25

26. Questions for Beneficiaries Continued. Case Management (i.e., community case workers) Meal/food delivery Community availability of resources Financial Literacy Assessment beforehand (OT) In home modifications (contracted) 26

27. Questions for Service Providers How do you think beneficiaries benefit from having a sharable eLTSS plan? What is the most widely-used service you provide? 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? 27

28. Questions for Payers How do you think beneficiaries benefit from having a sharable eLTSS plan? What service do you see used the most? 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? 28

29. NEXT STEPS AND HOMEWORK 29

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

31. FEI SYSTEMS AND MARYLAND Concert Series Presentation: Nish Thakkar, Chris White, Chirag Bhatt, Lorraine Nawara 31

32. eLTSS Initiative: Project Team Leads ONC Leads – Elizabeth Palena-Hall (elizabeth.palenahall@hhs.gov)elizabeth.palenahall@hhs.gov – Patricia Greim (Patricia.Greim@hhs.gov)Patricia.Greim@hhs.gov CMS Lead – Kerry Lida (Kerry.Lida@cms.hhs.gov)Kerry.Lida@cms.hhs.gov Federal Lead – Jennie Harvell (jennie.harvell@hhs.gov)jennie.harvell@hhs.gov Initiative Coordinator – Evelyn Gallego-Haag (evelyn.gallego@siframework.org)evelyn.gallego@siframework.org Project Management & Pilots Lead – Lynette Elliott (lynette.elliott@esacinc.com)lynette.elliott@esacinc.com Use Case & Functional Requirements Development – Becky Angeles (becky.angeles@esacinc.com)becky.angeles@esacinc.com Standards Development Support – Angelique Cortez (angelique.j.cortez@accenture.com)angelique.j.cortez@accenture.com Harmonization – Atanu Sen (atanu.sen@accenture.com)atanu.sen@accenture.com 32

33. BACKUP SLIDES 33

34. Use Case Outline Tailored for each Initiative 34 1.0 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 10.2.1 Base Flow o 10.2.2 Alternate Flow – 10.3 Functional Requirements o 10.3.1 Information Interchange Requirements o 10.3.2 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

35. 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 35

36. 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

37. 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

38. Questions for Beneficiaries Why is access to an eLTSS plan valuable for you? – People receiving services may not be aware who is their case manager - having information electronically available simplifies the process and improves care – 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. – 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. – 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 Non-clinical data being requested revolves around tracking of services and budgets. A place to tell their personal story. Clinical Data needs include push notifications and medication components. – 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. – Remote access to electronic services help coordinate care (across state lines, between caregivers/providers etc.) by providing access to records, appointments, etc. – From the caregiver perspective – a long term care plan avoids crises and promotes smoother living. The 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. The hours needed to manage care affects productivity and wages from professional work duties. Currently uses MS Word to manage care for parent. There needs to be a crisis plan included in the plan. Uses google calendar to share with caregivers/family – The plan needs to be longitudinal over time and to include alerts. Looking at the care over time, makes me be proactive for the care of my own health. – When the eLTSS system and patient portal are integrated it is easy to elaborate on the care plan and have the patient communicate changes back to the phr – puts the patient at the center of care. 38