electronic Long-Term Services & Supports (eLTSS) InitiativeKick Off Presentation & Draft CharterNovember 6, 2014

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• Opening Remarks – Steve Posnack, MS MHS, Director, Office of Standards and Technology, ONC

• The Standards & Interoperability Framework – Steve Posnack

• TEFT Grant Program: Kerry Lida, PhD, TEFT Program Lead, Division of Community Systems Transformation, CMS

• Initiative Introduction and Draft Charter – Evelyn Gallego-Haag, Initiative Coordinator, eLTSS Initiative

• Next Steps/Call for Participation – Lynette Elliott, Project Manager, eLTSS Initiative

• Questions and Resources

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Agenda

Steve Posnack, ONC

Office of Standards & Technology (OST)

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• Coordinates nationwide efforts to implement and use most advanced HIT and electronic exchange of health information

• Established by HITECH in 2009

What is the S&I Framework?

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• ONC kicked-off the Standards & Interoperability Framework in 2010.

• The S&I Framework is an open, collaborative community made up of stakeholders from the public and private sectors.

• Each S&I initiative is focused on a critical interoperability challenge and does so through a well defined process that includes:

Development of clinically-oriented user stories and use cases. Harmonization of interoperability specifications and

implementation guidance. Real-world experience and implementer support through new

initiatives, workgroups and pilot projects. Mechanisms for feedback , evaluation, and implementation

testing.

S&I Framework: The Value of Community Participation

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ONC Programs

Community S&I Framework

HIT Standards CommitteeHIT Policy Committee

SDOs

• State HIE Program & CoPs• REC Program & CoPs• Beacon Program

• Technology Vendors• System Integrators• Government Agencies

(National & International)

• Industry Associations• Providers• Individuals/Consumers• Other Experts

• HL7• IHE• CDISC• Other SDOs

ENABLING

S&I Framework Metrics

ONC supports this infrastructure with project management, SMEs, coordination tools, and other resources to support accelerated work timelines.

* As of August 2014, 3,172 people had registered on the S&I Framework wiki, and 1991 people representing 598 organizations had committed to the S&I Framework.

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To date,

14 initiativeshave resulted in

technical solutions to facilitate standardized,

interoperable healthcare information exchange.

S&I Framework Phases

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Phase Planned Activities 1. Pre-Discovery Development of Initiative Synopsis

Development of Initiative Charter Definition of Goals & Initiative Outcomes

2. Discovery Creation/Validation of Use Cases, User Stories & Functional Requirements Identification of interoperability gaps, barriers, obstacles and costs Review of Vocabulary

3. Implementation Evaluation of candidate standards Development of Standards Solution Plan Creation of Implementation Guidance

4. Pilot Validation of aligned specifications, testing tools, and reference implementation tools Revision of documentation and tools Development and presentation of Pilot Proposals

4. Evaluation Measurement of initiative success against goals and outcomes Identification of best practices and lessons learned from pilots for wider scale

deployment Identification of hard and soft policy tools that could be considered for wider scale

deployments

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YOU ARE HERE

eLTSS Success Metrics: Alignment with National Interoperability Vision

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• Leverage Health IT to increase health care quality, lower health care costs and improve population health

• Support health–not limited to care delivery

• Build incrementally from current technology

• Establish best minimum possible• Create opportunities for

innovation• Empower individuals

eLTSS Success Metrics: Alignment with National Quality Strategy

11Source: http://www.ahrq.gov/workingforquality/nqs/webinar051314/webinar3.pdf

Kerry Lida, PhD, CMS

Background: What is LTSS?

• A broad array of assistance needed by, and provided to, individuals with physical, cognitive, and/or mental impairments who never acquired, or have lost, the ability to function independently

• LTSS programs focused on providing support with daily activities and include services such as:– Assistance with ADLs and IADLs– Adult day care– Care management– Social services– Assistive technologies– Education and training– Counseling– Other supportive services directed towards the impaired individual

and their informal caregiver(s)13

Why is LTSS important?

• As part of the Affordable Care Act (ACA), Congress has provided incentives to promote the use of community-based LTSS and promoted the movement from institutions to communities for people who require LTSS– Money Follows the Person (DRA and Extended through

ACA, Section 2403))– Community First Choice (ACA, Section 2401)– Balancing Incentives Program (ACA, Section 10202)– Person-Centered Planning and Self-Direction in Home and

Community-Based Services (ACA, Section 2402(a))• These programs target diverse beneficiary populations, most

of which are eligible for services provided by the states

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Why is LTSS important? (cont’d)

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One-third of Medicaid spending is for LTSS

The Need for Standardized Assessments

• Challenges in achieving standardized, comparable psychosocial data due to variance in:– Programs– Populations– State requirements (providers, services)– Self-reported data

• To alleviate challenge, CMS is advancing development of national, standardized items that can be applied across Community-Based LTSS (CB-LTSS)

• There are limited quality measures for LTSS. In addition, medical, behavioral, LTSS service systems are currently siloed and must be integrated

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CMS Medicaid Vision

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CMS Medicaid Alignment with National Quality Strategy

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Acute Care

Institutional Care

Community-Based Care

Independent Healthy Living

Hospital

Specialty Clinic

ICU

Nursing Home

Skilled NursingFacility

Behavioral Health Clinic

Primary Care

Home Health

Adult Day Care

Individual Home

Assisted Living

Self-Directed

Image adapted from: http://www.marsdd.com/news-and-insights/transforming-health-decentralized-connected-care/

QU

ALIT

Y O

F LI

FE

COST OF DELIVERY SERVICE

CMS TEFT Program: Background

• Introduced in Affordable Care Act (ACA) Section 2701• Requirement for HHS to identify and publish initial

voluntary core set of adult quality measures for adults eligible for Medicaid

• In response, CMS established Testing Experience and Functional Tools (TEFT) in Medicaid community-based long term services & supports (LTSS) Planning and Demonstration Grant Program

• March 2014: CMS awarded Demonstration Grants to 9 states: AZ, CO, CT, GA, KY, LA, MD, MN, NH

19http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Grant-Programs/TEFT-Program-.html

CMS TEFT Components

1. Test a beneficiary experience survey within multiple CB-LTSS programs for validity and reliability

2. Test a modified set of CARE functional assessment measures for use with beneficiaries of CB-LTSS programs

3. Demonstrate use of PHR systems with beneficiaries of CB-LTSS

4. Identify, evaluate and harmonize an eLTSS standard in conjunction with the ONC S&I Framework

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State Grantees and TEFT Components

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State Experience of Care Survey LTSS CARE Health IT (PHR &

eLTSS Record)

AZ * * *

CO * Pending *

CT * * *

GA * * *

KY * * *

LA * (Round 1)

MD * *

MN * * *

NH *

TEFT eLTSS Standard Component

• Grantees who selected to work on eLTSS Component of TEFT Program will participate in eLTSS Initiative

• Once eLTSS standard is identified, Grantees will test and validate standard(s) with selected providers and beneficiaries

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PHR Demonstration

• Grantees who selected PHR component will also participate in eLTSS S&I process

• Grantees that choose to test additional quality measures as part of the use of PHR systems are expected to share those measures with CMS– Measures from Medicaid Adult Health Quality

Measure core set and other State-specific quality measures for relevant populations

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PHR demonstration Requirements

• PHR System functionality must enable:– Collection of Medicaid adult core quality measures– Collection of CB-LTSS information – Collection of “Treatment” outcomes identified

through eLTSS record– Dissemination of this information among individuals,

their families/guardians, case managers and providers• Grantees can choose to use the following PHR

systems:– DoD provided PHR Systems– Pre-specified Commercial PHR– State-sponsored and developed PHR (i.e. State HIE

Patient Portal)

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Evelyn Gallego-Haag, ONC

Why Use Health IT for Community-Based LTSS?

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TOOLS THAT MAKE OUR LIVES EASIER

Why Use Health IT for Community-Based LTSS?

• Health IT supports formation of more coordinated systems and person-centered planning

• Focus on leveraging national and state investments made in health IT infrastructure to bridge quality measurement gaps specific to the experience and outcomes of care for individuals receiving community-based LTSS

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We will use Health IT to establish a person-centered electronic LTSS record, one that supports the person, makes him or her

central to the process, and recognizes the person as the expert on goals and needs.*

We will use Health IT to establish a person-centered electronic LTSS record, one that supports the person, makes him or her

central to the process, and recognizes the person as the expert on goals and needs.*

* Source: Guidance to HHS Agencies for Implementing Principles of Section 2402(a) of the Affordable Care Act: Standards for Person-Centered Planning and Self-Direction in Home and Community-Based Services Programs

Challenge & Opportunity for eLTSS

• Health IT is recognized as a tool with the highest potential to provide timely and relevant data in a form that is quickly usable for research, public health, quality improvement and consumer engagement

• Linking clinical and non-clinical data in a standardized and structured way can improve the quality and effectiveness of care and services to those populations that need it most

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The adoption and use of Health IT and quality measurement for community-based long-term services and supports is limited. Limitations include minor financial incentives for service providers as well as the lack of uniformity in the terminology and definitions of data elements needed for assessments and service plans used across and between community-based information

systems and clinical care systems.

The adoption and use of Health IT and quality measurement for community-based long-term services and supports is limited. Limitations include minor financial incentives for service providers as well as the lack of uniformity in the terminology and definitions of data elements needed for assessments and service plans used across and between community-based information

systems and clinical care systems.

The Value of person-centered eLTSS planning

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• Standardized Data Elements for the capture, sharing and efficient re-use of eLTSS record information

• Improved provider workflows through secure, single-point data entry for eLTSS record development and exchange

• Improved timeliness for collecting and sharing LTSS information between provider groups, between providers and beneficiaries, and between providers and payers

• Reduced paper based and manual processes during eLTSS information gathering and sharing

• Enabled sending and receiving provider groups to initiate changes for beneficiary interventions

• Enabled beneficiaries to engage directly in decision making regarding care and services received

eLTSS Initiative Some S&I Principles

• Although this initiative is sponsored by the government, it is open to the community at large as a collaborative opportunity for public and private volunteers working towards shared objectives

• Leverage existing, widely used, and openly available standards and services.

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From here on, we are discussing the DRAFT charter – objectives, use cases, scope statements, and work groups – all will be up for the community to

review and formulate on the wiki

From here on, we are discussing the DRAFT charter – objectives, use cases, scope statements, and work groups – all will be up for the community to

review and formulate on the wiki

eLTSS CharterScope Statement

Identify, evaluate and harmonize Health IT standards for:1.Key domains and associated data elements of community-based LTSS assessment and services2.The creation, exchange and re-use of interoperable, person-centered records for use by providers and beneficiaries, and payers

The eLTSS record will be designed so that it can be exchanged electronically across multiple CB-LTSS settings, institutional settings and with beneficiaries and payers

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Draft Charter for S&I Community Review on

the Wiki

Draft Charter for S&I Community Review on

the Wiki

eLTSS CharterData Exchange Framework

Standards identified for eLTSS record will support interoperable exchange with various information systems to include: 1.Community-based Information Systems2.Clinical Information Systems (e.g. EHRs)3.State Medicaid Systems and/or other Payer Systems4.Health Information Exchange Systems 5.Personal Health Record Systems (PHRs)

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Draft Charter for S&I Community Review on

the Wiki

Draft Charter for S&I Community Review on

the Wiki

Content or data elements of the eLTSS record will be specific to the types of services rendered and information collected for CB-LTSS. Information collected may contain relevant clinical data needed to support the continuum of beneficiary care, support and services.

Content or data elements of the eLTSS record will be specific to the types of services rendered and information collected for CB-LTSS. Information collected may contain relevant clinical data needed to support the continuum of beneficiary care, support and services.

LTSS Information Sharing: As-Is Workflow

Transport

EmergencyServices

Personal Care

Meals

Caregiver Support

Housing

Home Maintenance & Repair

Behavioral Health

Employment

Education

Legal Services

Criminal Justice

Acute Care

Primary Care

Specialty Care

Long-Term Care

Post-Acute Care

Emergency Care

Intensive Care

Person-Centered

Patient-Centered

eLTSS Record Exchange: To-Be Workflow

Updates and displays eLTSS Record; stores/transmits data

Updates and displays eLTSS Record; stores/submits data

Updates and displays eLTSS Record; stores/transmits data

Extract, Transform,& Load eLTSS Record Data

Move from Patient-Centered to Person-Centered Planning and Information Exchange

Move from Patient-Centered to Person-Centered Planning and Information Exchange

eLTSS Record Exchange: To-Be Workflow

Updates and displays eLTSS Record; stores/transmits data

Updates and displays eLTSS Record; stores/submits data

Updates and displays eLTSS Record; stores/transmits data

Extract, Transform,& Load eLTSS Record Data

Move from Patient-Centered to Person-Centered Planning and Information Exchange

Move from Patient-Centered to Person-Centered Planning and Information Exchange

1. Identifies Service Need

2. Acknowledges Service Need; updates eLTSS Record

3. Receives updated eLTSS Record with new

Service

Timelines for Consideration: Two Pilot Phases, SDO Ballot Cycles

eLTSSS&I Phases Roadmap

Q3 ‘14 Q4 ‘14 Q1 ‘15 Q2 ‘14 Q3 ‘14 Q4 ‘14 Q4 ‘17

Phase 4: Pilots & Testing

•Pilot site readiness•Implementation of solution•Test User Stories and Scenarios•Monitor Progress & Outcomes•Utilize Requirements Traceability Matrix

Phase 4: 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

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Initiative Kick Off: 11/06/14

Draft Charter for S&I Community Review on

the Wiki

Draft Charter for S&I Community Review on

the Wiki

Phase 1: Pre-Discovery

Phase 2: Use Case Development& Functional Requirements

Phase 3: Standards & Harmonization

eLTSS Initiative Roadmap: 2014 to 2015

Mile

ston

es

Use Case Consensus

Phase 2: Use Case Development & Functional Requirements

Candidate Standards Evaluation

Standards Solution Plan Consensus

Use Case Development & Consensus

Implementation Guide Consensus

eLTSS Concert Series Presentations

Phase 3: Standards & Harmonization

Standards Gap Analysis Standards Solution Plan Development

Requirements Traceability Matrix Development

Implementation Guidance Development

Phase 4: Pilots & Testing (Phase 1)eLTSS Pilot Proposal Review & Execution

Standards Development Organizations Outreach

Phase 1: Pre-DiscoveryProject Charter Development

Candidate Standards Identification

eLTSSLaunch

Project Charter Consensus

Phase 1 Pilots: Oct 2015 to Oct 2016Phase 2 Pilots: Nov 2016 to Nov 17

eLTSS CharterExisting Efforts to Consider• CMS Standards & Guidance: e.g. OASIS dataset, MDS, CARE Item Set, PACE, BIP Tools, HCBS

Taxonomy

• Other Relevant Projects:

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We welcome consideration of other efforts and standards suggested by the community. Please visit the eLTSS References wiki page to review and comment on relevant initiatives:

http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29+References

We welcome consideration of other efforts and standards suggested by the community. Please visit the eLTSS References wiki page to review and comment on relevant initiatives:

http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29+References

Draft Charter for S&I Community Review on

the Wiki

Draft Charter for S&I Community Review on

the Wiki

• National Association of Social Workers Standards for Social Work Practice

• Case Management Society of America (CMSA) Standards of Practice for Case Management

• American Medical Association (AMA) and American Academy of Home Care Physicians (AAHCP) Guidelines for Uniform Assessment

• Administration of Aging (AoA) Standardized Data Collection Tools

• MassHealth, One Care Implementation Council, and UMass Medical School One Care Early Indicators Projects (EIP)

• Other S&I Initiatives: e.g. Direct, BlueButton, SDC, DAF

• CMS ACA Funded Projects: MFP, BIP, CFC, CMMI

• HL7 Person Health Record System Functional Model Release 1

• Openmhealth.org

• Guided Care by Johns Hopkins University

• Case Management Information System by Community Care of North Carolina

• National Association of State Directors of Development Disabilities Services (NASDDDS) and Human Services Research Institute (HSRI) National Core Indicators

Lynette Elliott, ONC

electronic Long-Term Services and Supports InitiativeCall for Participation

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• To make this initiative a success, we need the help of volunteers who are eager to make rapid progress on this important project

• We need experts to develop standards, first-movers to pilot new tools, innovators to push the envelope, and patients and providers willing to give feedback

• Minimum commitment: regular participation in community meetings (1-2 hours / week) and active contribution to one or more workgroups (1-3 hours / month). It is okay to participate in one phase and not another.

• There will be opportunities for your organization to o Pilot new ways to give providers and beneficiaries’ access to

information o Hear about and provide input to the latest policy and standard

issues affecting information exchange and individual accesso Directly contribute to a potential game-changer for health care

http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29

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electronic Long-Term Services and Supports InitiativeWiki Page

electronic Long-Term Services and Supports InitiativeNext Steps

• The electronic Long-Term Services and Supports Initiative is OPEN for anyone to join.

• This community will meet frequently by webinar and teleconference

• We use Wiki pages to facilitate discussion

• Information on how to join the Community can be found on the electronic Long-Term Services and Supports “Join the Initiative” Wiki page:

• http://wiki.siframework.org/eLTSS+Join+the+Initiative

• In order to ensure the success of our initiative and the subsequent pilot, we encourage broad and diverse participation from the community.

• This is your chance to have an impact on the creation and implementation of a pilot program in this important area of health IT development.

• Please review the Proposed Project Charter

• http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29+Charter

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• Identification of key client assessment domains and associated data elements to include in an eLTSS record

• Identification of functional requirements from a Use Case describing key conditions and business rules to enable eLTSS record exchange while protecting privacy and confidentiality

• Development of concise implementation guidance using easy-to-understand documentation, user-friendly tooling and formal models to assist providers, software vendors and others in applying technical requirements for interoperable exchange of eLTSS record data

• Execution of seven TEFT grantee driven and one or more non-TEFT grantee driven pilots to evaluate the specific use case for eLTSS record exchange across provider information systems and with beneficiary PHR systems

electronic Long-Term Services and Supports CharterExpected Deliverables

43Continued…

• Identification and validation of national standards for eLTSS record capture and exchange to include an agreed upon set of data elements that can be integrated and rendered in CB and institutional LTSS, and other clinical electronic information systems

electronic Long-Term Services and Supports CharterExpected Deliverables, cont’d…

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• Over the next 6-8 weeks, we will hold All Hands Meetings to review, edit and finalize the Project Charter

– All Hands Meetings will be held Thursdays from 12:30 to 1:30pm Eastern

– eLTSS wiki page will be updated with meeting information

• After the Project Charter is complete, we will begin Use Case development

• We are planning to host a series of presentations from related projects and initiatives

– Similar to “concert series” hosted by other S&I Initiatives

– If you have an interest in participating, please contact the support team: Evelyn Gallego (evelyn.gallego@siframework.org ) and Lynette Elliott (lynette.elliott@esacinc.com)

electronic Long-Term Services and Supports Initiative Schedule

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electronic Long-Term Services and Supports Initiative Resources and QuestionsPlease feel free to reach out to any member of the eLTSS Initiative team:

•ONC Leads– Elizabeth Palena-Hall (elizabeth.palenahall@hhs.gov) – Mera Choi (mera.choi@hhs.gov); Farrah Darbouze (farrah.darbouze@hhs.gov)

•CMS Lead– Kerry Lida (Kerry.Lida@cms.hhs.gov)

•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@accenturefederal.com)

•Harmonization– Atanu Sen (atanu.sen@accenture.com)

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