1. electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting October 15, 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 Pilots Kick Off RecapJamie Parker15 mins Pilot Plan Presentation: Janie Appleseed Lisa Nelson15 mins Pilot Guidance: Data Set Suggestion updates Becky Angeles 20 mins

4. Announcements Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap version 1.0 – What: This draft interoperability roadmap lays out a clear path to catalyze the collaboration of stakeholders who are going to build and use the health IT infrastructure. These documents include all the public comments that were submitted during the public comment period. – Roadmap Website: https://www.healthit.gov/policy-researchers- implementers/interoperabilityhttps://www.healthit.gov/policy-researchers- implementers/interoperability – Rules: https://www.federalregister.gov/articles/2015/10/16/2015-25595/medicare- and-medicaid-programs-electronic-health-record-incentive-program----stage- 3-and https://www.federalregister.gov/articles/2015/10/16/2015-25597/2015- edition-health-information-technology-certification-criteria-2015-edition- base-electronic 4

5. Announcements, cont’d… Common Clinical Data Set Renamed the “Common MU Data Set.” This does not impact 2014 Edition certification. Includes key health data that should be accessible and available for exchange. Data must conform with specified vocabulary standards and code sets, as applicable. 5 Patient nameLab tests SexLab values/results Date of birthVital signs (changed from proposed rule) RaceProcedures EthnicityCare team members Preferred languageImmunizations ProblemsUnique device identifiers for implantable devices Smoking StatusAssessment and plan of treatment MedicationsGoals Medication allergiesHealth concerns 2015-2017 Send, receive, find and use priority data domains to improve health and health quality ONC Interoperability Roadmap Goal Red = New data added to data set Blue = New standards for data

6. Announcements, cont’d… National Call for Applications Opens: Community Health Peer Learning Program – What: In July 2015 the Office of the National Coordinator for Health Information Technology (ONC) has awarded AcademyHealth $2.2 million to lead the Community Health Peer Learning Program (CHP). Throughout this two-year program, AcademyHealth will work in partnership with ONC to establish a national peer learning collaborative for 15 competitively-awarded communities to address specified population health management challenges through increased sharing and use of data. – When: Application Due Date November 10, 2015 ~ Anticipated Award Date January 8, 2016 – For more information: http://www.academyhealth.org/Programs/ProgramsDetail.cfm?ItemNumber= 16918&navItemNumber=17093 http://www.academyhealth.org/Programs/ProgramsDetail.cfm?ItemNumber= 16918&navItemNumber=17093 – To apply: http://www.academyhealth.org/Programs/content.cfm?ItemNumber=17238 http://www.academyhealth.org/Programs/content.cfm?ItemNumber=17238 6

7. Announcements, cont’d.. Aging 2.0’s AgeTech Expo – Charting the Course: Innovations in Aging – What: The Aging2.0 AgeTech Expo brings together aging services providers and tech companies for cross-sector innovation insights and collaboration opportunities. The 2-day conference and technology exposition features innovation tours and workshops, inspiring keynotes, practical education panels, technology exhibits and the live “Pitch-for-Pilots (P4P)” session. – When: November 19-20, 2015 – Where: Hyatt Regency Hotel ~ San Francisco, CA – For more information: http://www.aging2.com/expo/http://www.aging2.com/expo/ – To register: http://www.aging2.com/expo/#registrationhttp://www.aging2.com/expo/#registration 7

8. 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 8

9. eLTSS Initiative Timeline 9 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 MARAPRDEC 15JAN 16 Pilot Execution

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

11. 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 11

12. 12

13. Aim for S&I Pilot Programs Bring awareness to national standards addressing existing or emerging interoperability gap Organize and guide the deployment of Pilot projects to test the suitability of the Initiative specifications including those identified in the Use Case and Functional Requirements Matrix Provide tools and guidance for executing, managing and evaluating the Pilot Create a forum to share lessons learned and best practices Conduct Real world evaluation of : – The eLTSS Use Case – eLTSS Functional Requirements Matrix – Pilot Guide The goal is to determine if the work we have done to date is implementable? Useable? And if not what else needs to be done 13

14. Pilot Process…making it to the goal 1.Kick Off (08OCT15 call last week) 2.Completion of the Pilot Plan Template Presentation – TEFT Grantees will work with Technical Assistance Team to Complete – Non-TEFT organizations will be sent a draft of this presentation for completion and review 3.Presentation of Pilot to the larger eLTSS community 4.Begin work on the Requirements Traceability Matrix 5.Attend Thursday Community Calls and provide updates 6.Complete Pilot 7.Prepare a “Lessons Learned” and pilot close out presentation 14 Steps 1, 2, 3 Steps 4 Step 7 Steps 6 Steps 5 OctNovDecJan ’16FebMarch April (round 1 complete)

15. eLTSS Pilots TEFT State Grantees Minnesota Georgia Connecticut Kentucky Colorado Maryland Arizona Non-TEFT Organizations Care At Hand FEi Janie Appleseed Kno2 Meals on Wheels (Sheboygan) National Disability Institute ADVault Therap Services 15

16. Tentative Presentation Schedule DATEORGANIZATIONTEFT/NONPoint of Contact 10/15/2015Janie AppleseedNon TEFTLisa Nelson 10/22/2015National Disability InstituteNon TEFTMary Lynn Revoir FEi SystemsNon TEFTChirag Bhatt Kno2Non TEFTDane Meuler ADvaultNon TEFTScott Brown 10/29/2015Meals on WheelsNon TEFTKelly Heyn MN Department of Human ServicesTEFTTom Gossett GA Department of Community HealthTEFTBonnie Young Care at HandNon TEFTAndrey Ostrovsky

17. The Functional Requirements Matrix The Functional Requirements Matrix is often referred to as the FRM The functional requirements matrix is an excel workbook that can aid in understanding the vocabulary found in the pilot planning presentation. We recommend viewing the excel sheets within the workbook. eLTSS functional requirements matrix

18. 18 Excel SheetsDescription Use Case Functional Requirements This tab contains information about the Use Case Functional Requirements. Within this sheet, each row serves as a specific transaction that is directly linked to the eLTSS Use Case. There is information provided for each transaction including: ID, User Story, Description, Use Case Activity, Tier, Use Case Actor, Input, Output, Use Case Receiver, and Corresponding Initiative Requirements. Exemplar Technologies, Standards, and SDOs/Vendors (Concert Series Presenters) This tab contains Exemplar Technologies, associated technical standards, and the corresponding SDOs/Vendors which were presented to the eLTSS Community through a Concert Series Presentation. The information obtained from these presentations can assist in satisfying eLTSS Functional Requirement groupings across all three Tiers of Pilot Implementation. Exemplar Technologies, Standards, and SDOs/Vendors (Environmental Scan) This tab contains Exemplar Technologies, associated technical standards, and the corresponding SDOs/Vendors found through independent research and/or vendor engagement at industry conferences and other networking forums. The information found through this process can assist in satisfying eLTSS Functional Requirement groupings across all three Tiers of Pilot Implementation. S&I Initiative Standards This tab contains technical standards and the corresponding Standards Development Organizations (SDOs) used in other S&I Framework Initiatives that can be used as a reference when considering technical solutions for eLTSS Initiative Pilots. eLTSS Plan Components This tab contains the domains and sub-domains defined by the eLTSS Plan Content SWG that inform the eLTSS Dataset Suggestions. Dataset Suggestions This tab contains information on eLTSS Community-defined data elements and the corresponding domains and sub-domains that comprise the eLTSS Plan Content. These data elements are also mapped to any applicable standards or Federal initiatives that apply. C-CDA Care Plan 2.1 (V2) This tab contains the sections, definitions, and templates listed within the C-CDA Care Plan 2.1 (V2). Version History Contains information about the authors of the document and specified owner of each worksheet Functional Requirements Matrix Document: Excel Workbook Sheet Breakdown

19. Requirements Traceability Matrix Also commonly referred to as the RTM, this document is your guide to piloting. The RTM is a fillable form that covers all the necessary requirements in the FRM. Completing this form will assist in successfully accomplishing the pilot goals. Requirement Traceability Matrix

20. Useful Links eLTSS Pilot Starter Kit http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+ Pilots#Pilot Starter Kit http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+ Pilots#Pilot Starter Kit eLTSS Glossary: http://wiki.siframework.org/eLTSS+Glossary eLTSS Reference Materials http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Ref erences http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Ref erences

21. Next Steps Schedule a time slot for your Pilot Plan Presentation Pilot presentations will be held during community calls – Oct 15 th – Oct 22 nd – Oct 29 th – Please pick a time and email jamie.parker@esacinc.com or any member of the support team your preferred time to present and we will schedule youjamie.parker@esacinc.com If you are interested in piloting, please express your interest using the Pilot Interest Survey form: – 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 21

22. 22

23. 23

24. Dataset Suggestion Recap eLTSS Plan Content SWG was formed to identify the Dataset Requirements for the eLTSS plan (Domains, Sub- domains, Exemplar Questions and Answers) – Exemplar Coded Elements (when available) have been suggested for those Questions and Answers to complete the Dataset Suggestions eLTSS Functional Requirement Matrix includes Dataset Suggestion tab eLTSS Use Case section 11 will be updated (and re- posted on the wiki) with the Dataset Suggestions (Domains, Subdomains, Questions/Answers, Coded Elements) 24

25. Formatting Updates Made to Dataset Suggestion Spreadsheet Added separate columns to capture the Element Vocabulary and Answer/Value Vocabulary Reordered columns so the Exemplar Question is next to the Coded Element Added Hyperlinks to Regulation(s) or Suggested Standard(s) 25

26. Content Updates Made to the Dataset Suggestion Spreadsheet Updated with elements from the ONC 2015 Edition Health IT Certification Rule and Common Clinical Data Set Added Personal Finance Information Elements from the National Disability Institute’s work on Banking Status, Financial Behaviors and Financial Capability of Adults with Disabilities Added Residence and Housing Elements from the US Housing and Urban Development’s (HUD) 2014 Homeless Management Information System (HMIS) Data Standards 26

27. Coded Datasets applicable for eLTSS: Common Clinical Data Set 27 Patient Name EthnicityMedicationsVital signsUnique Device Identifier(s) (UDIs) for a Patient’s Implantable Device(s) SexPreferred Language Medication Allergies ProceduresAssessment and Plan of Treatment Date of Birth Smoking Status Laboratory Test(s) Care Team Member(s) Goals RaceProblemsLaboratory Value(s) / Result(s) ImmunizationsHealth Concerns Source: ONC 2015 Edition Health IT Certification RuleONC 2015 Edition Health IT Certification Rule

28. Coded Datasets applicable for eLTSS: Social, Psychological and Behavioral Data 28 Financial Resource Strain (CARDIA)Physical Activity EducationAlcohol Use (AUDIT-C) StressSocial Connection and Isolation (NHANES III) DepressionExposure to violence: Intimate partner violence (HARK) Source: ONC 2015 Edition Health IT Certification RuleONC 2015 Edition Health IT Certification Rule

29. Data Standards applicable for eLTSS: Housing / Residence from HUD/HMIS 29 Type of Residence HUD-assigned Continuum of Care Code Homeless and At-Risk of Homelessness Status Source: 2014 HMIS Data Standards2014 HMIS Data Standards

30. Data Standards applicable for eLTSS: Personal Finance from NDI 30 Financial Supports Income Banked Status Type of Account and Where Banked Savings Goal $ Amount Credit Behavior Money Management Financial Literacy Source: Banking Status and Financial Behaviors of Adults with Disabilities and Financial Capability of Adults with DisabilitiesBanking Status and Financial Behaviors of Adults with Disabilities and Financial Capability of Adults with Disabilities

31. eLTSS Dataset Requirement Objective Pilots to validate whether these are the right coded elements to capture when creating, sharing, exchanging and updating the eLTSS Plan Ensure there are synergies with other related dataset projects: – Prioritized use of available measures and instruments for the structured recording of social, psychological, and behavioral data – Quality measures identified for the NQF HCBS Measures Ensure eLTSS coded elements are aligned with the Health IT Common Clinical Data Set, IMPACT data elements, Functional Assessment Standardized Items (FASI) 31

32. Dataset Coded Element Statistics 32 Domain Sub-domain # of Q&As # of Coded MatchesPercent Person Information Work11654.5% Residence 121083.3% Community Inclusion13753.8% Choice & Decision Making600.0% Relationships8337.5% Self-Direction 18316.7% Demographics 231878.3% Person-Centered Profile 10110.0% Health, Wellness, and Rights Health 221463.6% Medications 121083.3% ADLs/IADLs 181477.8% Safety 12325.0% Wellness 14750.0% Psychological Well-Being 9555.6% Restrictions 10110.0% Service Planning and Coordination Service Coordination 500.0% Personal Finance Information 232087.0% Service Information 12541.7% Family and Caregiver Information Family Information 7457.1% Community Connections 1100.0% Access & Support Delivery 500.0% Information & Planning 7114.3% TOTALS 26813249.3%

33. Dataset Coded Element Gaps Pilots will identify and prioritize elements to test in their pilot projects: many will be “uncoded” Based on pilot outcomes, pilots will determine which non-coded elements should be “prioritized” for future code identification Pilots will report these findings to S&I following completion of their pilot project 33

34. Comments/Discussion 34

35. 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 CMS Leadership – Kerry Lida (Kerry.Lida@cms.hhs.gov)Kerry.Lida@cms.hhs.gov Community Leadership – 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 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 35