1. electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting August 20, 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). 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. 3 Agenda TopicPresenterTimeframe Welcome Announcements eLTSS Roadmap Lynette Elliott10 mins eLTSS Pilot Guidance: Functional Requirements Matrix Overview Send and Receive Plan Access, View, Review Plan Update Plan Lynette Elliott Evelyn Gallego 50 mins

4. Announcements Accessibility & Usability in Health Information Technology (HIT): User-Driven Research and Actionable Strategies Responsive to People with Disabilities, Older Adults, and Caregivers – What: This two-day event will explore the advancement of the accessible HIT agenda from a compliance-focused paradigm toward one that is user-driven and responsive to human- centered experiences and contributes to improved health and wellness for individual disabilities, older adults, and caregivers. – When: Thursday and Friday, September 17 - 18, 2015 – Where: U.S. Department of Education, Potomac Center Plaza, 10th Floor Auditorium, 550 12th Street SW Washington, D.C. – To register: http://icdr.acl.gov/AHIT/index.htmlhttp://icdr.acl.gov/AHIT/index.html NOTE: Space is limited. Please register right away. 4

5. Announcements, cont’d… National Association of States United for Aging and Disabilities (NASUAD) “National Home and Community Based Services (HCBS) Conference” – What: The conference always sees a strong presence from U.S. Health and Human Services ranging from the Administration for Community Living including AoA, Office of Disability and IADD to CMS, HRSA, SAMHSA, Office of Developmental Disabilities, and other federal agencies. – When: August 31 – September 3, 2015 (Note: eLTSS and S&I specific workshops are Sept. 2 from 4:15-5:30pm ET) – Where: Washington Hilton ~ Washington, D.C. – To register: https://www.hcbsconference.org/ehome/index.php?eventid=1 13072& https://www.hcbsconference.org/ehome/index.php?eventid=1 13072& 5

6. Announcements, cont’d… mHealth Summit – What: The 2015 mHealth Summit explores what is new in mobile, telehealth and connected health—from the impact on healthcare delivery, clinical care and patient/consumer engagement to new technologies, research, investment activities, policy and shifts in the business environment. – When: December 8 – December 11, 2015 – Where: Gaylord National Resort and Convention Center ~ Washington, D.C. – To register: http://www.mhealthsummit.org/registrationhttp://www.mhealthsummit.org/registration 6

7. Announcements, cont’d… CSAC Recommendations on Person and Family Centered Care Phase 2 Measures finalized – More information: http://www.qualityforum.org/ProjectMaterials.aspx?proje ctID=73867 http://www.qualityforum.org/ProjectMaterials.aspx?proje ctID=73867 – Access Final Report: http://www.qualityforum.org/Publications/2015/03/Perso n-_and_Family-Centered_Care_Final_Report_- _Phase_1.aspx http://www.qualityforum.org/Publications/2015/03/Perso n-_and_Family-Centered_Care_Final_Report_- _Phase_1.aspx 7

8. eLTSS Initiative Timeline 8 Phase 1 Pilots & Testing … Pilot Guide Development Use Case & Functional Requirements Pre-Discovery DEC 14JUNJAN FEBMAYJULAUGSEPOCTNOV Kick Off 11/06/14 Evaluation... Content Work Stream Content Work Stream eLTSS All-Hands Work Group Use Case 1. eLTSS Use Case eLTSS Plan Content SWG 1.eLTSS Plan Domains & Data Elements Pilot Guide Development 1.Candidate Standards & Technologies 2.Three-tiered implementation Approach 3.Functional Requirements Matrix 4.Pilot Guide (Phase 1) MARAPRDEC 15JAN 16 Pilot Execution

9. eLTSS Artifacts Final published Project Charter is 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+Glossaryhttp://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 Final published Use Case document is located here: – 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 9

10. 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. 10

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12. Overview You’ve drafted a Use Case with User Stories You’ve identified Domains and Subdomains You’ve identified Exemplar Question/Answer Sets You’ve defined a Tiered Approach for Pilots What now? – Identify sample coded data sets or sample coded data elements derived from questions/answers – Map Use Case functional requirements to technical solutions, existing standards and compliance with existing regulations/rules How can we operationalize all this activity for Pilots? 12

13. Artifacts and Tools 13 These should be familiar... – Use Case and User Stories – eLTSS Glossary – Domain Harmonization Matrix – Three Tiered Pilots Approach And a NEW artifact will be used to map Use Case functional requirements to technical solutions and existing standards – Functional Requirements Matrix

14. What Is a Functional Requirements Matrix? The Functional Requirements Matrix breaks down the Use Case line by line into functions, activities and Pilot Tiers to help organizations plan their Pilot work – Functions are grouped by Use Case activity (eg. Create Plan, Modify Plan, Send/Receive Plan, etc.) It specifies Use Case Actor, Input, Output and Use Case Receiver for each function It identifies applicable Pilot tiers for each activity (Tier I, II, and III) It specifies Exemplar Tech Solutions, Exemplar Standards and relevant Standards Development Organizations for each function It crosswalks each function to existing regulations/rules 14

15. What does the FRM Look Like? 15 Here’s the more familiar, now hopefully less scary spreadsheet again And we’ll review how you can use it...

16. How to Operationalize the FRM for Pilots Revisit the “big picture” Walk through simplified Use Case User Story steps and describe the following groupings: – Send and Receive Plan – Access, View, Review Plan – Update Plan Show these groupings in the FRM document with all the information that relates to those functions 16

17. But first…Current Ideas We asked attendees to pick a sample grouping and think about which tier you can or would like to pilot – Think about whether you want to focus on content or process – Come back with questions Any thoughts? Questions? Suggestions? 17

18. RECAP: eLTSS Plan Conceptual Framework Displays eLTSS Plan Updates and displays eLTSS Plan; stores/submits data Extract, Transform, & Load eLTSS Plan Data Updates and displays eLTSS Plan; stores/transmits data Generates, updates and displays eLTSS Plan; stores/transmits data eLTSS Plan Groupings Create Plan Approve Services Send/Receive Plan Access/View Plan 1 2 3 4 Update Plan 5 1 2 2 3 3 3 4 4 4 5 5

19. User Story Walk-through: Send and Receive Plan Joan presents a copy of the authorized eLTSS Plan to Ruth and Amy (this can be done via photo copy or electronic exchange). Baseflow.114 Ruth and Amy acknowledge receipt of the authorized eLTSS Plan (e.g. via verbal acknowledgement, paper signature or digital signature). NOTE: This bit of user story is an example from a paper-based aspect and does not account for electronic exchange on the eLTSS Plan. In an electronic environment, the Send/Receive can be either a “push” or a “pull.” INPUTS OUTPUT eLTSS Plan 3

20. User Story Walk-through: Access, View, Review Plan Ruth wakes up with a fever. Her home care assistant, Barbara, assists Ruth in scheduling an appointment to see Dr. Smith. Baseflow.101 At Dr. Smith’s clinic, Dr. Smith performs an assessment on Ruth and determines Ruth has a slight infection. He prescribes new medication for Ruth. Ruth reminds Dr. Smith that she has given him prior authorization to review parts of her eLTSS Plan. Dr. Smith accesses (retrieves) Ruth’s eLTSS Plan (e.g. copy or.pdf of plan within Ruth’s health record, or electronic request to access plan made from Dr. Smith’s clinical IT system to Ruth’s PHR system and/or the MD State LTSS System). Baseflow.017 Baseflow.108 SysReq.106 INPUTS OUTPUT eLTSS Plan 4

21. User Story Walk-through: Update Plan At the end of Ruth’s consultation with Dr. Smith, Dr. Smith provides Ruth with a clinical care summary which includes instructions for administering the new medication. A copy of this summary is sent to Amy and Barbara (e.g. via fax, electronic exchange or mail). Barbara reviews the clinical care summary. Barbara retrieves Ruth’s eLTSS plan and updates the plan with the new medication information. Baseflow.103 Baseflow.110 SysReq.102 Barbara presents these new updates to Ruth and Amy for their review and approval. INPUTS OUTPUT eLTSS Plan 5

22. Recap 22 Revisited the big picture and how the parts fit together Walked through the following groupings today: – Send/Receive Plan – Access/View/Review Plan – Update Plan Out of Scope items are also listed for reference in the FRM (based on the Use Case) in blue italicized type This documentation will help identify the tier, groupings and domains that make the most sense for your organization to pilot

23. Next Steps and Homework Review of Candidate Technologies/Candidate Standards Pick a sample grouping and think about which tier you can or would like to pilot – Think about whether you want to focus on content or process – Come back with questions Complete eLTSS Pilot Interest Survey http://wiki.siframework.org/electronic+Long+Term+Services+and+ Supports+Pilot+Interest+Survey http://wiki.siframework.org/electronic+Long+Term+Services+and+ Supports+Pilot+Interest+Survey – We are actively seeking organizations to pilot the eLTSS Plan using the candidate technologies and standards that will be identified in the eLTSS Pilot Guide 23

24. eLTSS Initiative: Project Team Leads ONC Leadership – Mera Choi (mera.choi@hhs.gov)mera.choi@hhs.gov – Elizabeth Palena-Hall (elizabeth.palenahall@hhs.gov)elizabeth.palenahall@hhs.gov – Patricia Greim (Patricia.Greim@hhs.gov)Patricia.Greim@hhs.gov CMS Leadership – Kerry Lida (Kerry.Lida@cms.hhs.gov)Kerry.Lida@cms.hhs.gov Community Leadership – Andrey Ostrovsky (andrey@careathand.com)andrey@careathand.com – Mary Sowers (msowers@nasddds.org)msowers@nasddds.org – Terry O’Malley (tomalley@mgh.harvard.edu)tomalley@mgh.harvard.edu Initiative Coordinator – Evelyn Gallego-Haag (evelyn.gallego@siframework.org)evelyn.gallego@siframework.org Project Management – 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 Pilot Guide Development – Grant Kovich (grant.kovich@accenture.com)grant.kovich@accenture.com – Atanu Sen (atanu.sen@accenture.com)atanu.sen@accenture.com Pilots Management – Jamie Parker (jamie.parker@esacinc.com)jamie.parker@esacinc.com Standards and Technologies Identification – Angelique Cortez (angelique.j.cortez@accenture.com)angelique.j.cortez@accenture.com 24