electronic Long-Term Services &
Supports (eLTSS) Initiative
All-Hands Workgroup Meeting
April 30, 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
Use Case Working Session:
User Story 2:
Base Flow
Activity Diagram
Sequence Diagram
Functional Requirements
Dataset Requirement Introduction
Becky Angeles
eLTSS Community
45 mins
Homework / Next Steps
Becky Angeles
5 mins
Concert Series Presentation: State of Colorado Pamela Russell
Kelly Wilson
30 mins
3
Announcements
Launch of eLTSS Plan Content 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
• Activities
– Identify a core set of domains (clinical and non-clinical)
– Define validation criteria to evaluate the domains and
associated data elements
– Evaluate the domains and data elements against the validation
criteria and make a recommendation to the eLTSS Initiative
4
Announcements
eLTSS Plan Content SWG – WEBEX Information
• URL:
https://siframework1.webex.com/siframework1/onstage/
g.php?MTID=e7ea8bcb868c228d9a8a237e90d821682
• Date/Time: Weekly every Tuesday, beginning May 5,
2015 11:00am-12pm ET
• Dial-In: 1-650-479-3208
• Access code: 660 956 148
• Attendee ID: provided by Webex
5
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
6
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.
•
•
•
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
7
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
8
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?
9
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
10
Upcoming Concert Series Presentations
•
•
•
•
May 7th: Inofile / Kno2
May 14th: State of Minnesota
May 21st: Harmony Information Systems
May 28th: (available)
11
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
12
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.
13
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
14
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
7
3/12
Finalize: Context Diagram & User Stories
Review: User Stories
8
3/19
Review: User Stories Comments
Review: User Stories, Glossary
9
3/26
Review: User Stories
Introduce: Actors & Roles
Review: User Stories, Actors & Roles
10
4/2
Finalize: Actors & Roles
Introduce: In/Out of Scope
Review: In/Out of Scope
11
4/9
Finalize: In/Out of Scope
Introduce: Assumptions & Pre/Post Conditions
Review: Assumptions & Pre/Post Conditions
12
4/16
Finalize: Scope, Assumptions & Pre/Post Conditions
Introduce: Activity Diagram & Base Flow
Review: Activity Diagram & Base Flow
13
4/23
Finalize: Activity Diagram & Base Flow
Introduce: Functional Requirements & Sequence Diagram
Review: Functional Requirements & Sequence Diagram
14
4/30
Finalize: Functional Requirements & Sequence Diagram
Introduce: Data Requirements
Review: Data Requirements
15
5/7
Review: Data Requirements
Review: Data Requirements
16
5/14
Finalize: Finalize Data Requirements
Introduce: Risks & Issues
Review: Risks & Issues
17
5/21
Finalize: Risks and Issues
Begin End-to-End Review
End-to-End Review by community
18
5/28
End-to-End Comments Review & disposition
End-to-End Review ends
19
6/4
Finalize End-to-End Review Comments & Begin Consensus
Begin casting consensus vote
20
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
15
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.
16
17
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
18
The Grocery Store Concept
• The beneficiary leads, owns and approves the content in the
eLTSS plan
• User Story 1: think of the eLTSS Plan content as a “store”
– Plan components/domains are aisles
– Component/domain details are items
19
The Cart
• Beneficiary chooses what to include in the plan
• Items can be put in or taken out like a shopping cart
20
The Aisles – Typical Grocery Store
• Method of organizing content so that beneficiary can easily
locate and use items
• Like items are organized together by “domain”
21
eLTSS Plan Content Aisles (Domains)
•
•
•
•
•
•
•
•
•
•
•
•
•
Brief Person-Centered Profile
My Personal Story
Demographic / Background Information
Care Team
Functional Status
Activities of Daily Living
Instrumental Activities of Daily Living
Social Support, Engagement and Integration (transportation, employment, housing)
Cognitive Function and Memory/Learning
Behavior Concerns
Service Information
Financial / Payer Information
Clinical Information (Medical Conditions/Diagnoses, Crisis Data, Nutrition, Medications, Advance
Directives)
• Alerts/Notifications (Out of Scope?)
22
eLTSS Plan Content Aisles (Domains)
Brief Person-Centered
Profile
Instrumental Activities of
Daily Living
Clinical Information
My Personal Story
Social Support,
Engagement, Integration
Alerts/Notifications
Demographic/ Background
Information
Cognitive Function &
Memory/Learning
Care Team
Behavior Concerns
Functional Status
Service Info
Activities of Daily Living
Financial / Payer Info
• Think of aisle as a domain or “bucket” of data
• Each aisle has different data items
23
Example: My Personal Story Aisle Elements
AISLE 1: My Personal Story
GOALS
PREFERENCES
PRIORITIES
INTERESTS
DESIRED OUTCOMES
• Think of aisle as domain or “bucket” of data
• Each aisle has different “shelves” of data elements
24
My Personal Story Aisle Items (Data Elements)
INTERESTS
DESIRED
OUTCOMES
PRIORITIES
GOALS
PREFERENCES
• Aisles contain items (data elements) that beneficiary
selects, modifies and shares
25
Item Organization – Data Segmentation
PREFERENCES
GOALS
DESIRED
OUTCOMES
INTERESTS
PRIORITIES
• Items (data elements) the beneficiary selects and
modifies are segmented appropriately (“grocery bags”)
26
User Story 2: The Checkout Lane
The
Confirmation
The Cart
• User Story 2: The Checkout Lane (“Sharing an eLTSS
Plan”)
27
28
Next Steps
• HOMEWORK – Due by COB Tuesday, May 5th:
– Review Use Case Content posted on the eLTSS Use Case
– Utilize Comment Form at http://wiki.siframework.org/electronic+LongTerm+Services+and+Supports+%28eLTSS%29+Use+Case
– Email feedback / comments to becky.angeles@esacinc.com
• NEXT WEEK:
– Dataset Requirements
– Concert Series Presentation: Inofile/Kno2
• Join the eLTSS Initiative: http://wiki.siframework.org/eLTSS+Join+the+Initiative
– Included on the eLTSS distribution list
– Committed Members can vote on artifacts
29
30
Colorado Demonstration
Grant for the Testing
Experience and Functional
Tools (TEFT)
The Colorado Department of Health Care Policy and Financing
CORHIO
April 30, 2015
31
TEFT Components
Experience of
Care Survey
e-LTSS
Records
S&I
Framework
Continuity
Assessment
Record &
Evaluation
Tool
Personal
Health
Record
32
TEFT In Colorado
 Waiver Populations
 Elderly, Blind, Disabled (EBD)
 Supported Living Services (SLS)-ID/DD
 State Partnerships
 CCBs, SEPs, RCCOs, ACOs, etc.
 Stakeholders – HCBS Providers
 HIEs – CORHIO & QHN
 Internal Initiatives - Health Care Policy and Finance
 Person-centered Approach
 No Wrong Door
 Assessment Tool Redesign
33
Stakeholder Meetings
Community meetings held from July, 2014
through December 2014
11 on-site meetings and 3 webinars
Attendees included the community centered
boards, Single entry points, RCCO’s, ACO’s,
HCBS providers and state partners
34
Key Considerations:
Security of information
User flexibility
Opt-Out features
 Designed to aid Client in managing LTSS Services
35
The Four Domains for Outcomes
•Lab Results
•Health Risk
Assessments
•Client
Engagement
•Satisfaction
•Choice and
Control
•ADLs
•Self-Efficacy
•Personal Story
Clinical
Functional
Quality of
Life
Utilization
•ED visits
•Hospital Visits
•PCP
36
Types of Health Information
Exchange
Results Delivery
• Patients’ data and lab
results automatically
routed into appropriate
physicians’ EHRs
Query-Based
• Search for a patient and
retrieve comprehensive,
consolidated information
in one place (longitudinal
health record)
• Helpful for emergency
situations and/or new
patient appointments
DIRECT
• Point-to-point
communication; works a
lot like email
• Data is not necessarily
made available to
patient’s entire care team 37
• Part of Stage 2
Meaningful Use
Data in the CORHIO
Network
Public Health Departments
Laboratories
Radiology Centers
Hospitals
Newborn
Screening
Reportable Conditions (ELR) Results
Hospital ADT info
Consult Reports
Transcription Notes
Lab/Rad
Lab Results
Pathology Reports
Radiology Reports
Community Health Record
Immunizations
38
Data in the CORHIO
Network
Laboratories
Public Health Departments
Radiology Centers
Hospitals
Pharmacy
Information
CIIS
Immunizations
Reportable Conditions
Immunizations
Public Health Alerts
Newborn
Screening
Results
Medications lists
Radiology Reports
Lab Results
Pathology Reports
Diagnostic-Quality
Hospital ADT Info
Consult Reports Community
Transcription Notes
Lab/Rad
Health Record
Medical Images
(with CTN)
Data
Analytics
Immunizations
Future
CCD
Orders
CCD Upload
39
The “Perfect State” of HIE
Integration
of Behavioral
Health
Full
Integration
of Public
Health
Statewide
& National
Connectivity
Increased
Interoperability
40
PHR Project Development
• Develop criteria for PHR solutions
• Understand technical infrastructure and capabilities
for the LTSS population
• Analyze interoperability between the PHR and
Medicaid enterprise system, specifically MMIS –
non-clinical
• Create strategies to connect to our state HIEs clinical
Solutions: Criteria for PHR Products
1. Must be able to integrate data coming from a HIE
2. Must be able to take data input from a client,
caregiver or provider in the form of other devices
3. Must be customizable to suit the different user
needs including non-clinical and clinical data
4. Must be able to display benefits and waiver related
information or partner with a vendor who can
5. Must be secure in managing the data including
HIPAA compliance
42
Solutions: Criteria for PHR Products
Con’t.
6. Must be able to meet the basic Standards and
Interoperability (S&I) Framework requirements
7. Must accept data input from secure Direct Messaging
8. Must be able to send alerts to any stakeholder, including
providers and physicians
9. Must be customizable or open sourced
10. Must be from a vendor that is financially viable
Implementation: Three Phases
Year 2 - Navigation - 2015
 Teach how to navigate the PHR - Non-clinical, clinical (only a couple
elements)
Year 3 -Data Feeds Added - 2016
 PHRs connect to the state HIEs, add more data
Year 4 - Dynamic Phase - 2017
 Clinical enters data, interactive – personal story, answers daily questions,
tracks own wellness, interacts with PHR
44
Three Measures of Success
 Frequency of Use
 Who is using it and how often
 Efficient coordination of services
 Tracking scheduled appointments and units
 Increase in quality of services
 Patient engagement impacts services
45
Key Milestones
Identified 5 communities in Colorado to be Focus
Group settings
Reviewed three electronic Personal Health Record
(PHR) for LTSS (ManaHealth, Get Real Health and FEI
Systems)
Developed a state partner advisory committee
Developing partnership with HCPF IT Department to
design MMIS/PHR solution
46
Upcoming Challenges
HCBS Providers at different levels of Health Information
technology
Case Managers and Care coordinators utilizing home grown or
purchased “EHR” systems that are not certified to be
integrated with an HIE
Accessibility to internet, laptops and computers at varying
levels
PHRs must be usable for the elderly, blind, disabled
populations
47
The Work Begins
Focus Groups began in March 2015 in the five
communities
PHR Demos to be initiated for clients, caregivers
and providers starting in April 2015
Pilot Sites for PHR to be identified from the Focus
Groups
 First on-site in Grand Junction on April 29th
 Second on-site in Burlington on May 6th
 Third on-site in Colorado Springs May 13th
Integrate systems - HCPF, HIEs and new IT system
48
49
Thank You
Pamela A. Russell
LTC Program Director/Government
Programs
CORHIO
prussell@corhio.org
Danielle Culp
Quality Management Department
Department of Health Care Policy &
Financing
Danielle.culp@state.co.us
eLTSS Initiative: Project Team Leads
•
ONC Leads
– Elizabeth Palena-Hall (elizabeth.palenahall@hhs.gov)
– Patricia Greim (Patricia.Greim@hhs.gov)
•
CMS Lead
– Kerry Lida (Kerry.Lida@cms.hhs.gov)
•
Federal Lead
– Jennie Harvell (jennie.harvell@hhs.gov)
•
Community Leads
– Andrey Ostrovsky (andrey@careathand.com)
– Nancy Thaler (nthaler@nasddds.org)
– Terry O’Malley (tomalley@mgh.harvard.edu)
•
Initiative Coordinator
– Evelyn Gallego-Haag (evelyn.gallego@siframework.org)
•
Project Management & Pilots Lead
– Lynette Elliott (lynette.elliott@esacinc.com)
•
Use Case & Functional Requirements Development
– Becky Angeles (becky.angeles@esacinc.com)
•
Standards Development Support
– Angelique Cortez (angelique.j.cortez@accenture.com)
•
Harmonization
– Atanu Sen (atanu.sen@accenture.com)
51
52
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
53
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
54
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
55
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
56
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
57
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
58
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)
59
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
60
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
61
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
62