1. electronic Long-Term Services & Supports (eLTSS) Initiative All-Hands Workgroup Meeting September 24, 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 EnviroscanGrant Kovich10 mins eLTSS Plan Dataset RequirementsBecky Angeles40 mins

4. Announcements Health Information Exchange Annual Conference, sponsored by National Association for Trusted Exchange (NATE), Strategic Health Information Exchange Collaborative (SHIEC), and HIE Users Group (HUG) – What: Agenda includes pre-conference Data Provenance mini- summit, listening session with Steve Posnack (ONC), HIE Innovations Roundtable featuring leading HIEs from across the nation, patient engagement and care coordination sessions, etc. – When: September 27-30, 2015 – Where: Silver Baron Lodge ~ Park City, Utah – To register: http://events.r20.constantcontact.com/register/event?oeidk=a0 7eaz4e3j2253d5d13&llr=kvyj8qeab http://events.r20.constantcontact.com/register/event?oeidk=a0 7eaz4e3j2253d5d13&llr=kvyj8qeab 4

5. Announcements Aging 2.0 #30in30in30 Pitch Event – What: #30in30in30 is an initiative supported by Aging2.0 to encourage local communities around the world to host pitch events for new innovative products and services that stand to improve the lives of older adults. We are taking part to host 30 Pitch Events in 30 cities around the world in 30 days. – When: Monday, September 28, 2015 – Where: 1776 Campus ~ 1133 15th St. NW 12th Floor ~ Washington D.C. 20016 – To register: https://www.eventbrite.com/e/aging20-30in30in30- washington-dc-united-states-tickets-17815520702https://www.eventbrite.com/e/aging20-30in30in30- washington-dc-united-states-tickets-17815520702 5

6. Announcements, cont’d… ONC 2015 Health IT Summit – What: The 2015 Consumer Health IT Summit will bring together federal and private sector leaders who are working to enable consumers to become involved partners in their health via health IT. The 2015 Consumer Health IT Summit will bring together federal and private sector leaders who are working to enable consumers to become involved partners in their health via health IT. – When: October 1, 2015 – Where: Washington Hilton ~ Washington, D.C. – To register: http://event.capconcorp.com/wp/e- health/registration/http://event.capconcorp.com/wp/e- health/registration/ – More info: http://event.capconcorp.com/wp/e-health/http://event.capconcorp.com/wp/e-health/ 6

7. Announcements, cont’d... Comment on the draft 2016 Interoperability Standards Advisory – What: The draft 2016 Advisory represents feedback received from public comment on the 2015 Interoperability Standards Advisory as well as many of the recommendations from the HIT Standards Committee. Public comments will be used to update this draft in order to publish a final 2016 Advisory by the end of 2015. – When: The comment period will be open for 45 days and will end at 5 p.m. on Friday, November 6, 2015 – To review the draft and submit comments: http://www.healthit.gov/standards-advisory/2016 http://www.healthit.gov/standards-advisory/2016 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

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14. Dataset Requirement 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 Requirements eLTSS Use Case section 11 will be updated (and re- posted on the wiki) with the Dataset Requirements (Domains, Subdomains, Questions/Answers, Coded Elements) eLTSS Functional Requirement Matrix will be updated with a Dataset Requirement tab 14

15. What is a Dataset? Why do we need one for eLTSS? 15 Dataset (grouping) Coded Element (semantics) Coded Element (semantics) Vitals Problems Lab Results Medications Systolic BP Diastolic BP Allergies Height Logical groupings of data elements Unit of data for which the definition, identification, representation, and permissible values are specified by means of sets of attributes. MU2 Dataset Coded elements enable the standardization of how we capture data and thereby compare data collected within various sources or systems: questionnaires, observations, assessments, plans.

16. What is a Coded Element? Data elements describe the characteristics of a piece of data while codes describe a particular concept A coded element refers to a data element that has a code associated with it that specifies the semantic meaning of the element Coded element may or may not have a list of values Coded elements may exist in a panel or hierarchy structure based on the terminology structure it came from Coded elements provide semantic interoperability 16

17. Coded Element Example Health, Wellness, and RightsWellness Smoke/chew tobacco? - If Y, How often? Tobacco smoking status Select from List LOINC 72166-2 MU2 Dataset (chew tobacco is not included in MU2 ) 17 DomainSubdomainExemplar QuestionCoded Element Answer Type VocabularyAdditional Notes

18. Coded Element Example in the IG for CDA R2.0: C-CDA R2.1 for Clinical Notes 18

19. Coded Datasets applicable for eLTSS: Common Clinical Data Set 19 Patient Name EthnicityMedicationsVital signsImmunizations SexPreferred Language Medication Allergies Care Plan field(s) including goals and instructions Unique Device Identifier(s) for a patient’s implantable device Date of Birth Smoking Status Laboratory Test(s)ProceduresNotes/Narrative RaceProblemsLaboratory values/results Care team members Source: 2015 Edition Health Information Technology Certification Criteria NPRM2015 Edition Health Information Technology Certification Criteria NPRM

20. Coded Datasets applicable for eLTSS: Social, Psychological and Behavioral Data 20 Financial Resource Strain (Overall financial resource strain from CARDIA) Physical Activity (Exercise Vital Signs) Education Alcohol Use (AUDIT-C) Stress Social Connection and Isolation (NHANES III) Depression Exposure to violence: Intimate partner violence Source: 2015 Edition Health Information Technology Certification Criteria NPRM2015 Edition Health Information Technology Certification Criteria NPRM

21. 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 across the eLTSS Dataset and 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 Dataset and the IMPACT data elements 21

22. Dataset Coded Element Statistics 22 Domain Sub-domain # of Q&As # of Coded MatchesPercent Person Information Work11654.5% Residence9777.8% Community Inclusion13753.8% Choice & Decision Making600.0% Relationships8337.5% Self-Direction16212.5% Demographics252496.0% Person-Centered Profile11327.3% Health, Wellness, and Rights Health231878.3% Medications151386.7% ADLs/IADLs181477.8% Safety12325.0% Wellness14750.0% Psychological Well-Being9555.6% Restrictions10110.0% Service Planning and Coordination Service Coordination600.0% Personal Finance Information6233.3% Service Information12541.7% Family and Caregiver Information Family Information7457.1% Community Connections1100.0% Access & Support Delivery500.0% Information & Planning7114.3.0% TOTALS 25412549.2%

23. 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 – Process will be clarified at S&I Pilot Execution Phase kick-off 23

24. Next Steps: TEFT States ONLY TEFT States will work with their Technical Assistance Team on pre-planning activities for the S&I Pilot Execution Phase Planning Materials to be shared with TEFT States next week: – TEFT Grantee Pilot Status Questionnaire – Pilot Process Prototype 24

25. Upcoming All-Hands Schedule October 1 st : Review of cross-walk of relevant Policy Levers for eLTSS Functional Requirements: – HHS Person-Centered Planning Guidance – CMS 1915 HCBS Rule – CMS Meaningful Use Stage 2 Rule – CMS Meaningful Use Stage 3 NPRM – CMS Chronic Care Management Rule – CMS Medicaid Managed Care NPRM October 8 th : Launch Pilot Execution Phase – Introduction to Pilot Execution Deliverables: Requirements Traceability Matrix Pilot Proposal Template Pilot Evaluation Checklist Template Pilot Execution Consideration Final Report Out and Lessons Learned 25

26. Next Steps: Sign up to be a Pilot Site! Confirm your interest in participating in an eLTSS Pilot! Complete 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 Current List of Interested Pilot Organizations: Care at Hand Inofile, LLC (Kno2) FEI Systems Therap Services A|D Vault, Inc. 26 Janie Appleseed Meals on Wheels of Sheboygan County, Inc. National Disability Institute

27. Comments/Discussion 27

28. 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 – 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 28