electronic Long-Term Services &
Supports (eLTSS) Initiative
All-Hands Workgroup Meeting
May 14, 2015
1
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
S&I Framework to Participants:
addressed publically in the chat, or discussed in the From
Hi everyone: remember to keep your phone
on mute 
meeting (as appropriate).
o Please DO NOT use the Q&A—only the presenter
All Panelists
sees Q&A, not necessarily the person facilitating the
discussion
2
Agenda
Topic
Presenter
Timeframe
Welcome
Announcements
eLTSS Roadmap
Lynette Elliott
10 mins
eLTSS Plan Content SWG Working Session
Grant Kovich
45 mins
Homework / Next Steps
Grant Kovich
5 mins
Concert Series Presentation: State of
Minnesota
Tom Gossett
30 mins
3
Announcements
HHS, CMS and ONC announced the release of the following
on March 20, 2015:
– Stage 3 Notice of Proposed Rulemaking (NPRM) for the Medicare and
Medicaid Electronic Health Records (EHRs) Incentive Program
• specifies new criteria that EPs, EHs, and CAHs must meet to qualify for Medicaid
EHR incentive payments
• proposes criteria that providers must meet to avoid Medicare payment
adjustments based on program performance beginning in payment year 2018
– 2015 Edition Health IT Certification Criteria
• aligns with the path toward interoperability identified in ONC's draft shared
Nationwide Interoperability Roadmap
• builds on past editions of adopted health IT certification criteria,
• includes new/updated IT functionality and provisions that support the EHR
Incentive Programs care improvement, cost reduction, and patient safety across
the health system
– Comment period ends May 29, 2015
4
Announcements (continued)
• PUBLIC COMMENTS: You may submit comments, identified by RIN 0991-AB93,
by any of the following methods (please do not submit duplicate comments).
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
•
•
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Federal eRulemaking Portal: Follow the instructions for submitting comments.
Attachments should be in Microsoft Word, Microsoft Excel, or Adobe PDF; however, we
prefer Microsoft Word. http://www.regulations.gov .
Regular, Express, or Overnight Mail: Department of Health and Human Services, Office of
the National Coordinator for Health Information Technology, Attention: 2015 Edition
Health IT Certification Criteria Proposed Rule, Hubert H. Humphrey Building, Suite 729D,
200 Independence Ave, S.W., Washington, D.C. 20201. Please submit one original and two
copies.
Hand Delivery or Courier: Office of the National Coordinator for Health Information
Technology, Attention: 2015 Edition Health IT Certification Criteria Proposed Rule, Hubert
H. Humphrey Building, Suite 729D, 200 Independence Ave, S.W., Washington, D.C. 20201.
Please submit one original and two copies. (Because access to the interior of the Hubert
H. Humphrey Building is not readily available to persons without federal government
identification, commenters are encouraged to leave their comments in the mail drop slots
5
located in the main lobby of the building.)
Announcements (continued)
• 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
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Concert Series Presentations
• 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?
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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)
• A pre-planning meeting will be scheduled prior to any public
demonstration
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Upcoming Concert Series Presentations
•
•
•
•
•
•
May 21st: Harmony Information Systems
May 28th: (available)
June 4th: (available)
June 11th: (available)
June 18th: MyDirectives.com (A|D Vault)
June 25th: Right Care Now
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eLTSS Initiative Roadmap
Q3 ‘14
Q4 ‘14
Q1 ‘15
Q2 ‘15
Q3 ‘15
Q4 ‘15
Q4 ‘17
Initiative Kick Off: 11/06/14
Pre-Planning
• Call for
Participation
• Conduct
Environmental
Scan
• Success Criteria
• Stakeholder
Engagement
Phase 2: Use Case Development
& Functional Requirements
Phase 1: Pre-Discovery
• Launch initiative
• Review and Finalize Charter
• Review initial Candidate
Standards
Phase 4: Pilots &
Testing
• Pilot site readiness
• Implementation of
• Develop, review, and finalize
solution
the Use Case and Functional
• Test User Stories and
Requirements
Scenarios
• Monitor Progress &
Phase 3: Standards & Harmonization Outcomes Phase 5:
Evaluation
• Finalize Candidate Standards
• Utilize Requirements
Traceability Matrix
• Standards Gap Analysis
• Evaluate outcomes
• Technical & Standards Design
against Success
• Develop Requirements Traceability
Metrics and
Matrix
Criteria
• Develop Implementation Guide
• Update
Implementation
Guidance
Timelines for Consideration: Two Pilot Phases, SDO Ballot Cycles
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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.
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Project Charter and eLTSS Glossary
• FINAL Published Project Charter located here:
http://wiki.siframework.org/electronic+LongTerm+Services+and+Supports+%28eLTSS%29+Charter
• eLTSS Glossary posted here:
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
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Proposed Use Case Development Timeline
Wk.
Target Date
(2015)
1-5
1/22-2/19
Use Case Kick-Off & UC Process Overview
Use Case Value Framing Discussions
Review and Answer Value Framing Questions on wiki
6
2/26
Review: Consolidated UC Value Framing
Introduce: Context Diagram & User Stories
Review: Context Diagram & User Stories
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3/12
Finalize: Context Diagram & User Stories
Review: User Stories
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3/19
Review: User Stories Comments
Review: User Stories, Glossary
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3/26
Review: User Stories
Introduce: Actors & Roles
Review: User Stories, Actors & Roles
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4/2
Finalize: Actors & Roles
Introduce: In/Out of Scope
Review: In/Out of Scope
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4/9
Finalize: In/Out of Scope
Introduce: Assumptions & Pre/Post Conditions
Review: Assumptions & Pre/Post Conditions
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4/16
Finalize: Scope, Assumptions & Pre/Post Conditions
Introduce: Activity Diagram & Base Flow
Review: Activity Diagram & Base Flow
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4/23
Finalize: Activity Diagram & Base Flow
Introduce: Functional Requirements & Sequence Diagram
Review: Functional Requirements & Sequence Diagram
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4/30
Finalize: Functional Requirements & Sequence Diagram
Introduce: Data Requirements
Review: Data Requirements
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5/7
Finalize: User Stories
Introduce: Risks, Issues & Obstacles
Review: Risks, Issues & Obstacles
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5/14
Dataset Requirements – eLTSS Plan Content SWG
Review: Refer to SWG Homework
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5/21
Begin End-to-End Review
End-to-End Review by community
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5/28
End-to-End Comments Review & disposition
End-to-End Review ends
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6/4
Finalize End-to-End Review Comments & Begin Consensus
Begin casting consensus vote
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6/11
Consensus Vote*
Conclude consensus voting
All Hands WG Meeting Tasks
Review & Comments from Community via Wiki page
due following Tuesday by 8 P.M. Eastern
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We Need YOU!
• In order to stick to our timeline and to ensure that the artifacts we
develop fit the need of our stakeholders (you), we need your
feedback, comments and participation
• Each week, please review the use case content and provide
comments via the wiki at: http://wiki.siframework.org/electronic+LongTerm+Services+and+Supports+%28eLTSS%29+Use+Case
– Or email Becky Angeles directly at becky.angeles@esacinc.com with edits, comments
or feedback
• Discussions moving forward will be more technically (systems
information and functionality, data sets/data elements, etc.). We
encourage tech savvy individuals and teams to participate and
provide input.
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eLTSS Plan Content SWG Information
• SWG Goal
– To identify and harmonize a core set of domains and an
example set of associated data elements that will inform the
creation of an eLTSS plan
• Next Meeting: Tuesday, May 19 from 11:00am-12:00pm
Eastern
– WebEx information available on the Wiki
• Sign up to participate in the SWG
– http://wiki.siframework.org/eLTSS+Plan+Content+SWG
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Definitions for eLTSS Community Identified Domains
Domain
Definition
Brief Person-Centered
Profile/My Personal
Story
Interests, goals, preferences, and priorities of a patient written by the patient in
their own words.
Clinical Information
Medical conditions or diagnoses (e.g., cerebral palsy, HIV/AIDS, stroke, epilepsy,
quadriplegia, autism, schizophrenia) can potentially impact an individual’s daily
functioning. Common categories of medical conditions/diagnoses for exploration
include eating disorders, skin conditions, heart disease, musculoskeletal disease,
neurological/cognitive disease or diagnosis, respiratory disease, behavioral
diagnoses, gastrointestinal disease, autoimmune disease, and cancer.
Care Team
Group of individuals that are responsible for the care of a patient, including
patients, their caregivers, and clinicians proposed by multiple providers and
disciplines for multiple conditions to coordinate care of the patient during the
continuum of care for a patient.
Functional Status
These items include screening items on impairments (e.g.,
bladder, bowel, swallowing, vision, hearing, weight-bearing, grip strength,
respiratory status, and endurance), as well as measures of self-care, mobility, and
safety-related functions (medication management, phone management), and other
items relevant to less impaired populations.
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Definitions for eLTSS Community Identified Domains
Domain
Definition
Cognitive Function
and
Memory/Learning
Problems with memory or cognitive functioning can interfere at home, school, work, or
in the community. Areas to explore might include: limitations with cognitive functioning
attributable to a diagnosed condition (e.g., intellectual disability, traumatic brain injury,
Alzheimer’s disease) or noted difficulties in the areas of attention/concentration,
learning, perception, task completion, awareness, communication, decision-making,
memory, planning or problem-solving. For children, these skills must be assessed
against age-appropriate developmental expectations for children of a similar age.
Behavior Concerns
Challenging behaviors are commonly characterized as those behaviors that are selfinjurious, hurtful to others, destructive to property, disruptive, unusual or repetitive,
socially offensive, uncooperative, or withdrawn or inattentive.
Service Information
Includes items that are important for the transfer of information between facilities but
were not otherwise captured, such as information on allergies.
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Definitions for eLTSS Community Identified Domains
Domain
Definition
Social Support, Engagement, and
Integration
These items target social support issues, including
information on structural barriers in the home, living
situations, caregiver availability, and the need for assistance,
as well as issues related to discharge complications.
Financial/Payer Information
Financial information typically includes individual or
household income (including wages, benefits, and other
income) and general assets.
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Domain Harmonization Matrix Working Session
eLTSS Community
Kentucky
Brief Person-Centered Profile/My Personal Story
Person Profile/Social History
Clinical Information
Clinical Information
Care Team
Care Team
Functional Status
Functional Status/Lifestyle
Cognitive Function and Memory/Learning
Cognitive Function and Memory/Learning
Behavior Concerns
Behavior Concerns
Service Information
Service Information
Demographic/Background Information
Demographic
ADLs
ADLs
IADLs
IADLs
Social Support, Engagement, and Integration
Social Support
Financial/Payer Information
Financial/Payer Information
Target Population:
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Domain Harmonization Matrix Working Session
eLTSS Community
Maryland
Brief Person-Centered Profile/My Personal Story
Clinical Information
Client Common Program Information
Care Team
Functional Status
Client Common Program Information
Cognitive Function and Memory/Learning
Client Common Program Information
Behavior Concerns
Client Common Program Information
Service Information
Client Program Information
Demographic/Background Information
Client Information,
Client Common Program Information
ADLs
Client Common Program Information
IADLs
Client Common Program Information
Social Support, Engagement, and Integration
In-Home Support Assurance System (ISAS)
Financial/Payer Information
Agency Staff Information,
Money Follows the Person
Target Population:
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Domain Harmonization Matrix Working Session
eLTSS Community
Minnesota
Brief Person-Centered Profile/My Personal Story
Person Information
Clinical Information
Support Options and Strengths
Care Team
Summary of Services,
Emergency and Back-Up
Functional Status
Health and Safety
Cognitive Function and Memory/Learning
Cognitive and Behavioral Support Plan
Behavior Concerns
Cognitive and Behavioral Support Plan
Service Information
Summary of Services
Demographic/Background Information
Person Information
ADLs
Support Options and Strengths
IADLs
Support Options and Strengths
Social Support, Engagement, and Integration
Community Support
Financial/Payer Information
Funding the Plan
Target Population:
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Domain Harmonization Matrix Working Session
eLTSS Community
Minnesota
Choosing Community LTSS
Coordinated Services and Supports Plan Signatures
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Domain Harmonization Matrix Working Session
eLTSS Community
Connecticut
Brief Person-Centered Profile/My Personal Story
Clinical Information
Diagnosis and Health Conditions,
Communication/Hearing and Vision
Post Assessment Outcomes,
Assistive Technology/Durable Medical Equipment/
Specialized Medical Equipment
Care Team
Informant,
Additional Contacts
Functional Status
Environmental and Overall Status
Cognitive Function and Memory/Learning
Cognition,
Psychosocial Wellbeing
Behavior Concerns
Mood and Behavior
Service Information
History and Resources,
Institutional Data
Demographic/Background Information
Identification Information
ADLs
ADLs
Target Population:
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Domain Harmonization Matrix Working Session
eLTSS Community
Connecticut
IADLs
IADLs
Social Support, Engagement, and Integration
Formal and Informal Supports,
Living Situation
Financial/Payer Information
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Domain Harmonization Matrix Working Session
eLTSS Community
Colorado
Brief Person-Centered Profile/My Personal Story
Clinical Information
Emergency Room Data
Care Team
Functional Status
Cognitive Function and Memory/Learning
Behavior Concerns
Service Information
Authorized Services,
Eligibility Span Information
Demographic/Background Information
ADLs
ADLs
IADLs
Social Support, Engagement, and Integration
Financial/Payer Information
Target Population:
Claims Data
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Domain Harmonization Matrix Working Session
eLTSS Community
Georgia
Brief Person-Centered Profile/My Personal Story
Beneficiary Identifying Information
Clinical Information
Beneficiary Background
Care Team
Care Team Contact Info
Functional Status
Equipment and Supplies Required for Month
Home Modifications
Cognitive Function and Memory/Learning
Behavior Concerns
Service Information
Plan Information and Important Dates,
Service Information
Demographic/Background Information
Beneficiary Background
ADLs
ADLs/IADLs
IADLs
ADLs/IADLs
Social Support, Engagement, and Integration
Beneficiary Background
Financial/Payer Information
Target Population:
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Domain Harmonization Matrix Working Session
eLTSS Community
Georgia
Beneficiary Goals
Signatures and Dates
Notes/Comments
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Domain Harmonization Matrix Working Session
eLTSS Community
NASDDDS (Nancy Thaler)
Brief Person-Centered Profile/My Personal Story
Clinical Information
Health,
Medications,
Wellness
Care Team
Functional Status
Cognitive Function and Memory/Learning
Choice and Decision Making
Behavior Concerns
Service Information
Safety
Demographic/Background Information
ADLs
IADLs
Target Population: Developmental Disability
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Domain Harmonization Matrix Working Session
eLTSS Community
Social Support, Engagement, and Integration
NASDDDS (Nancy Thaler)
Relationships,
Respect/Rights,
Satisfaction,
Self-Determination,
Community Inclusion,
Work
Financial/Payer Information
Restraints
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Discussion
Discussion/Reactions
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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
– Joining the eLTSS Plan Content SWG ensures that you are included on
workgroup communications and announcements.
• Homework
– Each state validate domain mappings
– Due Monday, May 18 at 5:00pm Eastern
• Next eLTSS Plan Content SWG Meeting
– Regularly scheduled SWG Meeting
– Tuesday, May 19 from 11:00am – 12:00pm Eastern
– http://wiki.siframework.org/eLTSS+Plan+Content+SWG
• Thank you! Your commitment and participation are critical to
our success.
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eLTSS Plan Content SWG Contact Information
• For questions, please contact your support leads:
– eLTSS Plan Content SWG Lead: Grant Kovich, grant.kovich@accenture.com
– eLTSS Plan Content SWG Co-Lead (Arizona): Lauren Wiggins-Prole,
lauren.wiggins@azahcccs.gov
– eLTSS Plan Content SWG Co-Lead (Colorado): Pam Russell,
prussell@corhio.org
– eLTSS Plan Content SWG Co-Lead (Connecticut): Dr. Minakshi Tikoo,
tikoo@uchc.edu
– eLTSS Plan Content SWG Co-Lead (Georgia): Irina Connelly,
irina.connelly@gtri.gatech.edu
– eLTSS Plan Content SWG Co-Lead (Kentucky): Sheena Batts,
sheena.batts@ky.gov
– eLTSS Plan Content SWG Co-Lead (Maryland): David Wertheimer,
david.wertheimer@Maryland.gov
– eLTSS Plan Content SWG Co-Lead (Minnesota): Tom Gossett,
tom.l.gossett@state.mn.us
– Initiative Coordinator: Evelyn Gallego, evelyn.gallego@siframework.org
– Project Manager: Lynette Elliott, lynette.elliott@esacinc.com
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eLTSS Initiative: Project Team Leads
•
ONC Leads
–
–
•
CMS Lead
–
•
Grant Kovich (grant.kovich@accenture.com)
Standards Development Support
–
•
Becky Angeles (becky.angeles@esacinc.com)
eLTSS Plan Content SWG Lead
–
•
Lynette Elliott (lynette.elliott@esacinc.com)
Use Case & Functional Requirements Development
–
•
Evelyn Gallego-Haag (evelyn.gallego@siframework.org)
Project Management & Pilots Lead
–
•
Andrey Ostrovsky (andrey@careathand.com)
Nancy Thaler (nthaler@nasddds.org)
Terry O’Malley (tomalley@mgh.harvard.edu)
Initiative Coordinator
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•
Jennie Harvell (jennie.harvell@hhs.gov)
Community Leads
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–
–
•
Kerry Lida (Kerry.Lida@cms.hhs.gov)
Federal Lead
–
•
Elizabeth Palena-Hall (elizabeth.palenahall@hhs.gov)
Patricia Greim (Patricia.Greim@hhs.gov)
Angelique Cortez (angelique.j.cortez@accenture.com)
Harmonization
–
Atanu Sen (atanu.sen@accenture.com)
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37
Scope
• Further defines the scope of the Use Case
itself and NOT the scope of the Initiative
• Diagrams and other supplemental data /
examples help provide context and clarify the
basis for the Use Case
38
Scope Subsections
• Background
– describes the relevance of the Use Case in relation to what gaps currently exist
within the healthcare industry. Includes all policy and/or regulatory
issues/dependencies that may impact the Use Case
• In Scope
– indicates what is in scope for the Use Case. For example, the type of transactions,
the information/data to be exchanged, and specific aspects that need to be in place
to enable the information to be sent, received and understood the same at both
ends of the transmission.
• Out of Scope
– indicates what is out of scope for the Use Case. These points may highlight
dependencies on the feasibility, implementability, and usability that result in
limitations of the Use Case. At a high level, whatever is not declared “In Scope” is
by definition, “Out of Scope”.
– Note: Items that are out of scope for the Use Case, Functional Requirements and
Standards Harmonization activities can be still be part of a Pilot.
• Communities of Interest
39
Assumptions
• Outlines what needs to be in place to meet or
realize the requirements of the Use Case (i.e.
the necessary privacy and security framework)
• Functional in nature and state the broad
overarching concepts related to the Initiative
• Serve as a starting point for subsequent
harmonization activities
40
Pre-Conditions
• Conditions that must exist for the
implementation of the eLTSS Plan creation and
sharing
• Describe the state of the system, from a
technical perspective, that must be true before
an operation, process, activity or task can be
executed
• Lists what needs to be in place before executing
the information exchange as described by the
Functional Requirements and Dataset
requirements
41
Post-Conditions
• Describe the state of the system, from a
technical perspective, that will result after the
execution of the operation, process activity or
task
42
Activity Diagram
• An Activity Diagram is a action state transition diagram
– An action state represents the fulfillment of associated
responsibilities in response to the communication received
from the previous step
– Most transitions are triggered by completion of activities in
the source states
• The Activity Diagram illustrates the Use Case flows
events and information between the actors
• Displays the main events/actions that are required for
the data sharing and the role of each system in
supporting the sharing
43
Base Flow
• The Base Flow is the step by step process of the
information sharing depicted in the activity diagram
• Indicates the actor who performs the action, the
description of the event/action, and the associated
inputs (records/data required to undertake the action)
and outputs (records/data produced by actions taken)
44
Sequence Diagram
• Shows the interactions between objects in the
sequential order that they occur
• Communicates how the sharing works by displaying
how the different components interact
• Transition from requirements expressed as use cases to
the next and more formal level of refinement
45
Information Interchange Requirements
• Define the system’s name and role
• Specify the actions associated with the actual
sharing of information from the sending
system to the receiving system
46
System Requirements
• Lists the requirements internal to the system
necessary to participate successfully in the
sharing of information
• May detail a required workflow that is
essential to the use case
47
Dataset Requirements
• Lists the domains and data elements that will
be available within the eLTSS plan
• Requires input from eLTSS plan data sharing
experts to ensure elements are fully specified
• Identification of data elements form the
foundation for harmonization activities
48