eltss plan content sub-work group week 2 meeting may 12, 2015 11:00am–12:00pm 1
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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– Hold = Elevator Music = frustrated speakers and
participants• This meeting is being recorded
– 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.– Send comments to All Panelists so they can be
addressed publically in the chat, or discussed in the meeting (as appropriate).
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From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute
All Panelists
Agenda
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Topic Time Allotted
Welcome and Announcements 5 minutes
Kickoff Meeting Recap 15 minutes
Introduction to Domain Harmonization Matrix 25 minutes
Discussion/Reactions 10 minutes
Homework and Next Steps 5 minutes
Meeting Reminders
• eLTSS Plan Content SWG Meetings are held Tuesdays @ 11:00am – 12:00pm Eastern– Next meeting: May 19, 2015 from 11:00am–12:00pm Eastern– Meeting information can be found on the Wiki:
• http://wiki.siframework.org/eLTSS+Plan+Content+SWG– Duration: May 5–July 21 (11 Weeks)
• eLTSS All-Hands Meetings are held Thursdays @ 12:30pm Eastern– Next meeting: May 14, 2015 from 12:30–2:00pm Eastern– This meeting will be a working session for the Plan Content SWG!– Meeting information can be found on the Wiki:
• http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29
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REMINDER - Please check the Wiki for the latest meeting schedule –meeting link and call in numbers may change.
eLTSS Use Case Context for SWG
• This initiative will identify key domains that will inform the creation of a structured, longitudinal, person-centered electronic LTSS plan for CB-LTSS beneficiaries.
• The eLTSS plan will be designed in such a way that it can be shared electronically across multiple CB-LTSS settings (e.g., adult day services, beneficiary homes, group homes, foster homes, assisted living, supportive housing, home health and hospice), institutional settings (e.g. hospitals, nursing facilities, primary care, post-acute care) and with beneficiaries and payers.
• eLTSS Initiative Project Charter– http://wiki.siframework.org/electronic+Long-Term+Services+and+Su
pports+%28eLTSS%29+Charter
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eLTSS Plan Content SWG Objectives
Identify and harmonize a core set of domains that will inform the creation of a structured, longitudinal, person-centered electronic LTSS plan for CB-LTSS beneficiaries:• clinical and non-clinical domains with terminology consistent
across the seven TEFT states and• example set of discrete data elements for the purpose of
clarifying the type of information that will be collected per domain area.
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Primary Focus Secondary Focus
TEFT State Requirements Non-TEFT State Initiative Requirements
Common Clinical Data Set RequirementsUse Case Requirements
eLTSS SWG Focus
The eLTSS Plan Content SWG will prioritize TEFT state domain requirements; however, we welcome non-TEFT organizations to provide input and participate in the process based on their respective organization requirements and real-world implementation experience. Non-TEFT organization requirements will be considered for future revisions of the eLTSS Implementation Guide.
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TEFT States… We Need You! (1 of 2)
• For each state to be able to pilot, we must identify and harmonize relevant domains and data elements:– Understand requirements of each state in greater detail– Pinpoint required domains and develop consensus list
• Target Populations: Aged, Disabled, TBI, Intellectual/Developmental Disability, SMI– Draft example list of data elements based on final list of domains
• This SWG will focus specifically on the requirements of the TEFT states, who will use the Implementation Guide (IG) to pilot their eLTSS Solution– Domains and data elements provide framework for IG– By identifying now, do not inhibit IG development later– IG developers can select and harmonize standards that meet the needs of each
state’s eLTSS system• Public process by nature of S&I Initiative
– TEFT State piloting is a priority; will recognize community input but not harmonize at this time
• By addressing the requirements of the TEFT States, we ensure they are set up for eLTSS System piloting success! 8
TEFT States… We Need You! (2 of 2)
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Community Services Required
Neighborhood Support
County Services
Community Data
Neighborhood Information
Community Supports
Community Needs
States: What do you call the domain for service information?
Collaboration Among the TEFT states = Key to Initiative Success
eLTSS Plan Content SWG Method & Approach
The eLTSS Plan Content SWG will:• Identify a core set of domains
– Pinpoint concrete definitions and key attributes for the domains
• Define criteria for evaluating each domain– Relate to state, Common Clinical Data Set, and Use Case
requirements– Look for synergies within other initiatives (i.e. IMPACT Act, National
Core Indicators Domains, NQF Domains, etc.)
• Perform domain validation– Internal validation tools (e.g. matrix)– Gap mitigation
• Finalize and present consensus list of domains• Outline example data elements based on approved domains
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eLTSS Initiative Timeline
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Phase 1 Pilots &Testing …
Standards & HarmonizationUse Case &Functional
RequirementsPre-Discovery
DEC 14 JUNJAN FEB MAY JUL AUG SEP OCT NOV
Kick Off11/06/14
Evaluation...
ContentWork Stream
eLTSS All-Hands Work Group
Use Case WG1. eLTSS Use Case
eLTSS Plan Content SWG1. eLTSS Plan Domains &
Data Elements
Standards & Harmonization WG1. Candidate Standards2. Solution Plan3. Implementation Guide (Phase 1)
MAR APR DEC 15 JAN 16
eLTSS Plan Content SWG Timeline
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Week TargetDate eLTSS Plan Content SWG Meeting Tasks Homework
due Fridays 12pm Eastern
1 5/5 Kickoff• Introduction to Domains and Data Elements
• States begin to identify current relevant domains
2 5/12• Introduce/Review Domain Harmonization Matrix• Validate Domain Mappings
• Review domain mappings• Continue to identify relevant
domains
3 5/19• Finalize Validation of Domain Mappings• Validate/Populate Additional State Domains within
Matrix
• Review domain mappings• Continue to identify relevant
domains
4 5/26• Finalize List of Additional State Domains• Identify Baseline for Domain Standards Evaluation• Validate Criteria for Domain Standards Evaluation
• Review criteria for domain standards evaluation
5 6/2 • Identify Baseline for Domain Standards Evaluation• Validate Criteria for Domain Standards Evaluation
• Review criteria for domain standards evaluation
6 6/9• Finalize Validation Criteria for Domain Standards
Evaluation• Begin Evaluation of Domains per Validated Criteria
• Perform domain evaluation per assigned section
7 6/16 • Continue Evaluation of Domains per Validated Criteria
• Perform domain evaluation per assigned section
Introduction to Domains and Data Elements (1 of 2)
For eLTSS Initiative, want to list domains and example data elements present within the eLTSS Plan
– Requires input from data sharing experts = YOU
Top-down approach to classifying eLTSS plan elements:• Domain = High-level description that specifies a sub-domain• Sub-Domain = More granular groupings which define
categories for individual data elements• Data Element = Even more specific term that serves a
specific function– Function is described by field labels and definition
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Introduction to Domains and Data Elements (2 of 2)
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Domain
Sub-Domain
Data Element
Vitals ProblemsLab
Results
Medications
Blood Pressure (BP)
Heart Rate
Systolic BP Diastolic BP
Allergies
Unit of data for which the definition, identification, representation, and permissible values are specified by means of sets of attributes
Logical, high-level groupings that categorize many sub-domains
More granular groupings of criteria specified within the domain that is used to define categories for individual data elements
Common Clinical
Data Set
Normal
Tachy.Brady.
Introduction to Domain Harmonization Matrix (1 of 7)
Domain Harmonization Matrix will serve as the primary conduit for identified domains and validation tool within the SWG:• Initial spreadsheet created with information from current
initiatives• Additions to the spreadsheet include:
– TEFT State Domains– Use Case Requirements
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Develop Consensus List of Harmonized Domains
Create Domain Harmonization Matrix
Add/Validate Use Case Requirements
Validate TEFT State Domains
Identify TEFT State Domains
Repeat Process for Sub-Domains
Introduction to Domain Harmonization Matrix (2 of 7)
Current Initiatives present in the Domain Harmonization Matrix include:
• eLTSS Initiative Community (Based on Use Case)• CMS Balancing Incentive Program• IOM: Capturing Social & Behavioral Domains (Phase I)• IMPACT Act• NCI Domains and Sub-Domains• ACL Person Centered Planning• NQF PRO Domains• LCC Care Plan Data Set Requirements• CARE Item Set Domains• MU2 Data Sets (Common Clinical Data Set)
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Introduction to Domain Harmonization Matrix (3 of 7)
Internal validation of initiative domains demonstrated that many domains have the same meaning, even though the label may not be consistent
• Example: Clinical Information Domain vs. Medical Information Domain
• Varying definitions and labels for the domain across six initiatives• Understood that even though definitions/labels vary, the specified
domain is collecting the same type of information
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Introduction to Domain Harmonization Matrix (4 of 7)
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Source eLTSS Community CMS BIP
ACL Person Centered
CounselingNQF PRO Domains
LCC Care Plan Data Set Reqs.
CARE Item Set
DomainClinical Information
Medical Conditions/Diagnoses
Medical Needs
Symptoms and Symptom Burden
Health Concerns
Medical Status/Clinical Complexity
Definition
Push notification, medical conditions/diagnoses,medicationcomponent
Medical conditions or diagnoses that can potentially impact an individual’s daily functioning
E.g. pain, fatigue
Identifies issues, current status, and likely course of Care Team to increase likelihood of achieving goals of care
Measure patient medical status and include factors defining complexity in medical diagnoses
Introduction to Domain Harmonization Matrix (5 of 7)
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Source eLTSSCommunity CMS BIP
ACL Person Centered
CounselingNQF PRO Domains
LCC Care Plan Data Set Reqs.
CARE Item Set
DomainClinical Information
Medical Conditions/Diagnoses
Medical Needs
Symptoms and Symptom Burden
Health Concerns
Medical Status/Clinical Complexity
Sub-Domains
Current DiagnosisCurrent Health Status
Health Status Evaluation
Medication Mgmt.
Nursing ConcernsSurgical Concerns
Introduction to Domain Harmonization Matrix (6 of 7)
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Source eLTSS Community CMS BIP IOM LCC Care Plan
Data Set Reqs.
DomainDemographic/Background Info
Background Info Individual Factors/Socio-demographic
Patient Data
Definition
Basic contact and demographic info for the individual applying for services or supports
Demographic and clinical data used for any document
Introduction to Domain Harmonization Matrix (7 of 7)
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Source eLTSS Community CMS BIP IOM LCC Care Plan
Data Set Reqs.
DomainDemographic/Background Info
Background Info Individual Factors/Socio-demographic
Patient Data
Sub-Domains
Country of OriginSexual Orientation
Gender
Race/Ethnicity Race/EthnicityEducationEmploymentFood and Housing Insecurity
Domain Harmonization Matrix Working Session
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eLTSS Domain
Person Centered
ProfileClinical
InfoCare Team
Functional Status
Cognitive Function
Behavior Concerns
Service Info
Demographic/Background
InfoADLs IADLs Social
SupportFinancial
/Payer Info
MN Domain
Person Info
Support Options and Strengths
Summary of Services
Health and Safety
Cognitive and Behavioral Support Plan
Cognitive and Behavioral Support Plan
Summary of Services
Person Information
Support Options and Strengths
Support Options and Strengths
Community Support
Funding the Plan
• Homework 1: TEFT States Identify Current Relevant Domains• Responses added to Matrix and harmonized with current
validation criteria (based on community and initiatives)• Working Session will take place during Thursday’s All-Hands
Meeting
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– Verification of domains provided by TEFT States by SWG team– Due Thursday, May 14
• Next eLTSS Plan Content SWG Meeting– Working session during Thursday’s All-Hands meeting– Thursday, May 14 from 12:30 – 2:00pm Eastern
• http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29
• 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.org 25
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