1. electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting June 11, 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 Elliott15 mins eLTSS Plan Content SWG DebriefGrant Kovich5 mins Health Datapalooza Summary/DebriefGrant Kovich20 mins eLTSS Pilot Planning OverviewEvelyn/Lynette20 mins

4. Announcements 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: http://www.ahima.org/events/2015june-ltpac http://www.ahima.org/events/2015june-ltpac 4

5. Concert Series Presentations 5 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?

6. 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: 15-20 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 (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 6

7. Upcoming Concert Series Presentations 7 June 18 th : MyDirectives.com (A|D Vault) June 25 th : Right Care Now

8. 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 8 Initiative Kick Off: 11/06/14 Phase 1: Pre-Discovery Phase 2: Use Case Development & Functional Requirements Phase 3: Standards & Harmonization

9. Use Case End-to-End Review & Consensus Timeline DateItem 5/21Open End-to-End Review 5/28Review End-to-End Comments (Close End-to-End Review at 8pm ET) 5/29-6/3End-to-End Review Comment Dispositions 6/4Open Consensus Voting 6/11Close Consensus Voting at 8:00pm ET 6/12-17Consolidate Votes and Address “No” Votes 6/18Review Final Comment Dispositions and Complete all Outstanding Votes Verbally 6/19Publish Consensus Voting Results 9 NOTE: As of today, eLTSS has 84 Committed Members and we have received ONLY 9 votes. Please exercise your privilege to vote!

10. 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 10

11. 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. 11

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13. SWG Approach: Open Forum 13 During Tuesday’s SWG Call, an Open Forum was held to discuss concerns from MD and MN Want to ask each TEFT state for their data elements to assist with gap mitigation – Other states were in agreement – Felt this approach would assist in completing the goals of the SWG – Homework for Week 6 Previous work (NCI domains, definitions, and initial mapping) will serve as a starting point – Will harmonize NCI definitions with each state’s domain definitions – State data elements will be used to fill in gaps where applicable – Will add or remove sub-domains if necessary

14. eLTSS Plan Content SWG Next Steps Sign up for the eLTSS Plan Content SWG on the Wiki – http://wiki.siframework.org/eLTSS+Plan+Content+SWG http://wiki.siframework.org/eLTSS+Plan+Content+SWG – Joining the eLTSS Plan Content SWG ensures that you are included on workgroup communications and announcements. Homework – Each state to provide definitions and data elements for their previously identified domains. – Due Friday, June 12 by 12:00pm Eastern Next eLTSS Plan Content SWG Meeting – Tuesday, June 16 from 11:00am – 12:00pm Eastern http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29 http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29 Thank you! Your commitment and participation are critical to our success. 14

15. eLTSS Plan Content SWG Contact Information For questions, please contact your support leads: – eLTSS Plan Content SWG Lead: Grant Kovich, grant.kovich@accenture.comgrant.kovich@accenture.com – eLTSS Plan Content SWG Co-Lead (Arizona): Lauren Wiggins-Prole, lauren.wiggins@azahcccs.gov lauren.wiggins@azahcccs.gov – eLTSS Plan Content SWG Co-Lead (Colorado): Pam Russell, prussell@corhio.org prussell@corhio.org – eLTSS Plan Content SWG Co-Lead (Connecticut): Dr. Minakshi Tikoo, tikoo@uchc.edu tikoo@uchc.edu – eLTSS Plan Content SWG Co-Lead (Georgia): Irina Connelly, irina.connelly@gtri.gatech.edu irina.connelly@gtri.gatech.edu – eLTSS Plan Content SWG Co-Lead (Kentucky): Sheena Batts, sheena.batts@ky.gov sheena.batts@ky.gov – eLTSS Plan Content SWG Co-Lead (Maryland): David Wertheimer, david.wertheimer@Maryland.gov david.wertheimer@Maryland.gov – eLTSS Plan Content SWG Co-Lead (Minnesota): Tom Gossett, tom.l.gossett@state.mn.us tom.l.gossett@state.mn.us – Initiative Coordinator: Evelyn Gallego, evelyn.gallego@siframework.orgevelyn.gallego@siframework.org – Project Manager: Lynette Elliott, lynette.elliott@esacinc.comlynette.elliott@esacinc.com 15

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17. Health Datapalooza Overview Health Datapalooza (HDP) is a national conference focused on bringing together key industry players with the newest and most innovative ways to use health data to improve patient outcomes Hosted by the Health Data ConsortiumHealth Data Consortium Collaboration between public and private sectors to find meaningful ways to use health data Each day featured general session, fireside chats, breakout sessions, and application demos by exhibitors 17

18. HDP Sessions Attended 18 Opening General Session The Future of Health Data is on FHIR Using Data & Technology to Enable Better Patient Health, Support, and Care General Session IConquerMS Patient- Powered Research: Kicking Butt and Taking No Names in the Fight Against Disease Application Demos: My Clinical Outcomes @Point of Care Self Care Catalysts Healthy Communities Institute Monday, June 1Tuesday, June 2Wednesday, June 3 General Session But What if I Want to Share? Contributing Your Own Data to Foster Public Good Blue Button Overview The Future of Health Data is on FHIR Using Data & Technology to Enable Better Patient Health, Support, and Care General Session IConquerMS Patient- Powered Research: Kicking Butt and Taking No Names in the Fight Against Disease Application Demos: My Clinical Outcomes @Point of Care Self Care Catalysts Healthy Communities Institute Monday, June 1Tuesday, June 2Wednesday, June 3 Blue Button Overview

19. HDP Sessions Attended 19 The Future of Health Data is on FHIR Using Data & Technology to Enable Better Patient Health, Support, and Care General Session IConquerMS Patient- Powered Research: Kicking Butt and Taking No Names in the Fight Against Disease Application Demos: My Clinical Outcomes @Point of Care Self Care Catalysts Healthy Communities Institute Monday, June 1Tuesday, June 2Wednesday, June 3 Blue Button Overview

20. Day 1: The Future of Health Data is on FHIR Dr. Charles Jaffe provided a high-level overview of HL7’s FHIR and an update on The Argonaut Project FHIR relies on the 80/20 rule, in that there are a limited number of diagnoses, physical findings, and lab results—basis for extensions. FHIR development is global and free, licensed without restriction. FHIR is easy to implement: The first VA implementation took two weeks, the second took four hours. Argonaut Phase I is looking to accelerate development of FHIR for balloting of DSTU v2 and create a community of implementers Argonaut Phase II will implement Direct and SMART and has a commitment of 50 vendors to perform iterative, agile project management and testing Links: Argonaut WikiArgonaut Wiki Contact Information: cjaffe@hl7.orgcjaffe@hl7.org 20

21. Day 1: Using Data & Technology to Enable Better Patient Health, Support, and Care Jaffie Rajan presented on Merck’s Digital Health Learning Library which will allow patient to better understand educational materials about their treatment 90 million Americans have trouble understanding and acting on health information Medication non-adherence causes 30-50% of treatment failures, higher rates of hospitalization Digital Learning Experience based on data driven self-improvement More open data leads to a dynamic and personalized sequence of information presented to the patient The more users interact, the better the content becomes Link to Slides: Merck HDP SlidesMerck HDP Slides Contact Information: jaffie.rajan@merck.comjaffie.rajan@merck.com 21

22. HDP Sessions Attended 22 Opening General Session The Future of Health Data is on FHIR Using Data & Technology to Enable Better Patient Health, Support, and Care General Session IConquerMS Patient- Powered Research: Kicking Butt and Taking No Names in the Fight Against Disease Application Demos: My Clinical Outcomes @Point of Care Self Care Catalysts Healthy Communities Institute Monday, June 1Tuesday, June 2Wednesday, June 3 General Session But What if I Want to Share? Contributing Your Own Data to Foster Public Good Blue Button Overview The Future of Health Data is on FHIR Using Data & Technology to Enable Better Patient Health, Support, and Care General Session IConquerMS Patient- Powered Research: Kicking Butt and Taking No Names in the Fight Against Disease Application Demos: My Clinical Outcomes @Point of Care Self Care Catalysts Monday, June 1Tuesday, June 2Wednesday, June 3 Blue Button Overview

23. Day 2: General Session – Overview The General Session featured two application demonstrations Crimson Care Management – Presented by The Advisory Board Company – Electronic care planning tool based on web standards and FHIR 211 Orange County and Community Dashboard – Presented by The Healthy Communities Institute – Provides referral services and evidence-based practices for seniors 23

24. Day 2: General Session – Crimson Care Manager Crimson Care Management offers a technology platform to allow care managers to work smarter and coordinate better cross-continuum care for patients with a foundation around big data Provides a 360-degree view of attributed population to calculate patient risk and prioritize task for care managers Generates tasks, alerts, and reminders for care managers that are triggered automatically in response to real-time patient data Can send and receive information across organizations, helping care managers connect with skilled nursing facilities, home health agencies, and behavioral health programs Link to Slides: Crimson Care Manager Case StudyCrimson Care Manager Case Study Contact Information: MayesK@advisory.comMayesK@advisory.com 24

25. Day 2: General Session – Healthy Communities Institute Healthy Communities Institute provides a system to help change communities and improve quality of life and community health Presented Orange County’s Healthier Together, which tracks public health reporting of chronic conditions in Orange County, CA Data sets include Infant/Child Health, Elderly, Obesity/Diabetes and Behavioral Health Allows for 211 Orange County integration, for care managers to find community services for individuals Links: Orange County's Healthier Together Healthy Communities InstituteOrange County's Healthier TogetherHealthy Communities Institute Contact Information: sheila.baxter@healthycities.orgsheila.baxter@healthycities.org 25

26. Day 2: iConquerMS – Kicking Butt and Taking No Names in the Fight Against Disease iConquerMS is a crowdsourced mobile application that aims to bring together people living with multiple sclerosis to help them conquer the disease Driven by an innovative new model for collection, integration, and analysis of data where the patient is a participant and research collaborator Has enrolled 20,000+ participants to date, all leveraging big data to conquer MS Mobile application and web interface allows for fast and easy data collection anytime, anywhere All data (PDF or XML) is de-identified to assist in research and can also be shared with physicians Links: iConquerMS, PCORIiConquerMSPCORI Contact Information: kenneth.buetow@asu.edukenneth.buetow@asu.edu 26

27. Day 2: Application Demos – My Clinical Outcomes My Clinical Outcomes is a web/API-based mobile platform that captures outcomes that matter to patients throughout the care journey UK Company certified by the International Consortium of Health Outcomes Management and British National Health Service, who will produce standard sets for 50 conditions by 2017International Consortium of Health Outcomes Management British National Health Service Data can be shared in real-time with the physician to ensure the treatment plan is being followed and meets the needs of the patient Patients routinely answer questions about their condition with progress immediately reported back to the physician/care team Progress updates can be made anywhere, anytime Link: My Clinical Outcomes Home PageMy Clinical Outcomes Home Page Contact Information: sally@myclinicaloutcomes.comsally@myclinicaloutcomes.com 27

28. Day 2: Application Demos – @Point of Care @Point of Care is a point of care reference tool used by physicians to allow for accurate content to be delivered when it is most needed Real-time clinical decision support application with content searching via IBM Watson Combines general learning for physicians (CME Accredited) with patient driven learning (HIPAA Certified) Patient Companion Application provides a platform to improve adherence and patient outcomes through education, as well as greater engagement between physician and patient Links: @Point of Care Home Page@Point of Care Home Page Contact Information: d.setiadi@atpointofcare.comd.setiadi@atpointofcare.com 28

29. Day 2: Application Demos – Health Storylines Self Care Catalysts is a healthcare innovator who treats patients as people, looking past the financial and clinical data focusing on person-centered care and improved outcomes Health Storylines allows for constant data collection from mobile applications and devices as well as patient self-tracking and management, engaging patients in their care Physical and emotional health can be tracked in the elderly population to promote healthy aging and can keep friends and family connected to their care by empowering seniors to manage their care Self-tracking of patient care over time leads to greater health outcomes and increased awareness and engagement between person and physician Links: Self Care Catalysts Home Page,Self Care Catalysts Home Page Health Storylines Application Blog Contact Information: leslie@selfcarecatalysts.comleslie@selfcarecatalysts.com 29

30. HDP Sessions Attended 30 Opening General Session The Future of Health Data is on FHIR Using Data & Technology to Enable Better Patient Health, Support, and Care General Session IConquerMS Patient- Powered Research: Kicking Butt and Taking No Names in the Fight Against Disease Application Demos: My Clinical Outcomes @Point of Care Self Care Catalysts Healthy Communities Institute Monday, June 1Tuesday, June 2Wednesday, June 3 General Session But What if I Want to Share? Contributing Your Own Data to Foster Public Good Blue Button Overview The Future of Health Data is on FHIR Using Data & Technology to Enable Better Patient Health, Support, and Care General Session IConquerMS Patient- Powered Research: Kicking Butt and Taking No Names in the Fight Against Disease Application Demos: My Clinical Outcomes @Point of Care Self Care Catalysts Healthy Communities Institute Monday, June 1Tuesday, June 2Wednesday, June 3 Blue Button Overview

31. Day 3: Blue Button Overview The Blue Button Overview featured Steve Posnack, Erica Galvez, Josh Mandel, Gajen Sunthara, and Lana Moriarty speaking about the state of Blue Button Steve: Blue Button is centered around ‘techno-policy;’ the merging of tech infrastructure and policy with patient access to data Erica: Interoperability roadmap focuses on advancing core functions and semantic interoperability of data elements so people can put their health information to good use Josh/Gajen: SMART on FHIR and PHR Demo Lana: We need assistance in establishing Blue Button use cases and drive a community-led demonstration of why it is necessary. Links: SMART App Gallery, SMART: Tech Stack for Health Apps, SMART Security StandardsSMART App GallerySMART: Tech Stack for Health AppsSMART Security Standards Contact Information: jmandel@gmail.com 31

32. Health Datapalooza Summary: Impact for eLTSS Initiative Attending HDP impacted the eLTSS Environmental Scan as well as Standards and Harmonization activities 10 Vendors/Projects added to Environmental Scan 9 individuals have offered to share an application/software demonstration as well as technical specifications for Piloting Guide 6 individuals expressed initial interest in becoming technical resources for eLTSS Initiative during Standards and Harmonization 32

33. Health Datapalooza Summary: Overall Conclusions Health Datapalooza was centered around data liberation, new and meaningful ways to use health data, and challenged everyone to help shape the health data movement CMS has released Medicare claims data sets that will allow innovators and entrepreneurs to build tools, products, and services without the prior limits for research onlyreleased Medicare claims data sets The Health Data Consortium and HHS announced the Obesity Data Challenge between the US and EnglandObesity Data Challenge There are still challenges around truly de-identifying a health data set Transparency isn’t enough when considering the high cost of healthcare services and how physicians are reimbursed Transparency isn’t enough Health data is only powerful if consumers have the means to access and use it 33

34. Health Datapalooza Summary: Contacts Made 34 NameOrganizationEmailApp demo? Technical resource? Aaron Seib*NATEAaron.seib@NATE-trust.orgX David Setiadi@Point of Cared.setiadi@pointofcare.comXX Dmitry Kachaev* AmidaDmitry@amida-tech.comXX Joshua MandelSMART on FHIRjmandel@gmail.comXX Kenneth BuetowiConquerMSKenneth.buetow@asu.eduXX Kevin MayesThe ABCMayesK@advisory.comX Leslie JamisonSelf Care Catalystsleslie@selfcarecatalysts.comX Sally SmithMy Clinical Outcomes sally@myclinicaloutcomes.co.ukX Sheila BaxterHealthy Communities Institute Sheila.baxter@healthycities.orgX Mark ScrimshireMedYearmscrimshire@medyear.orgXX *Initial contact made at Developer Healthcamp on Saturday, May 31

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36. Aim for S&I Pilot Programs Bring awareness on available national standards that will address an existing or emerging interoperability gap Organize and guide the deployment of Pilot projects that will test the suitability of the Initiative specifications, standards, and technology in real-world settings Provide tools and guidance for managing and evaluating the Initiative Pilot Projects Create a forum to share lessons learned and best practices Real world evaluation of Initiative Harmonization Artifact: Pilot Guide – Is this implementable? Useable? 36

37. Why Pilot S&I Standards? Ability to leverage initiative resources. Build on the expertise, tools and any open-source code developed through the S&I Initiative Pilots Workgroup (WG) to create a better, faster, and higher quality implementation. Demonstrate compliance and increase efficiency of development and maintenance. Use the Initiative’s Pilot Guide to inform changes to existing HIT systems. Feedback from Pilots will inform existing standards owned and maintained by Standards Development Organizations (SDOs). Contribute to the community. Each pilot has a high profile among Government agencies, ONC grantees, and within the community of volunteers that support the Nationwide Health Information Network. Be recognized as an early adopter. Use participation in the S&I Initiative to heighten an organization’s name recognition. 37

38. Pilot WG Planning Planning activities begin in advance of harmonization artifacts completing consensus voting Outreach Strategy and approach is critical – Start with organizations identified in Environmental Scan – Encourage active participation from Initiative Workgroup members Promote use of Pilot Interest Survey – Schedule one on one sessions with all organizations that complete pilot interest survey Plan for pilots running from 6 to 12 month timeframe – Timelines should be reflected in the Pilot Organization’s Pilot Documentation/Plan 38

39. Pilot WG Action Plan Developed by Initiative Coordinator and/or Pilot WG Lead to manage activities of the Pilot WG and to educate stakeholders Components referenced during outreach meetings and during launch of Pilot WG 39 Pilot Plan High-level overview of the S&I Initiative being piloted Benefits realization of Pilot Program Outreach & Commitment Strategy Pilot Operations Standards/artifacts available for Piloting Minimal components Sample Pilot System Functions Pilot Support Resources Proposed Timeline for Pilot WG Challenges/Risks Current Status

40. Pilot Workgroup Planning Artifacts: Pilot Interest Survey 40 http://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Pilotshttp://wiki.siframework.org/electronic+Long- Term+Services+and+Supports+%28eLTSS%29+Pilots

41. 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 Community Leads – Andrey Ostrovsky (andrey@careathand.com)andrey@careathand.com – Nancy Thaler (nthaler@nasddds.org)nthaler@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 & 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 eLTSS Plan Content SWG Lead – Grant Kovich (grant.kovich@accenture.com)grant.kovich@accenture.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 41