ELTSS:FHIR IG Proposal

Electronic Long-Term Services and Supports (eLTSS) Data Exchange FHIR IG

Owning work group name

CBCP

Committee Approval Date:

CBCP Approval Date: 11/20/2018 FMG Approval Date: TBD

Contributing or Reviewing Work Groups

The following workgroups own FHIR Resources that will be referenced in the IG:

• Patient Care
• Orders & Observations
• Financial Management Group

FHIR Development Project Insight ID

1431

Scope of coverage

• Subject: Human
• Disciplines: Long-Term Service and Supports (non-clinical) are comprised of a diverse set of assistances designed to help with general care, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) like eating, toileting, dressing, cooking, driving, managing money, etc. These services are non-clinical in nature and are provided across various settings from facility-based or institutional care to community-based settings.
• Delivery environment: Services and supports provided in the person’s home or in a community setting are referred to as Community-Based Long-Term Services and Supports (CB-LTSS) or Home and Community-Based Services (HCBS). Systems involved in LTSS may include case management systems, PHRs, EHRs, HIEs, provider systems, Medicaid Management Information Systems (MMIS), etc.
• Locale: US Realm

Electronic Long-Term Services & Supports (eLTSS) Service Plan Project aims to enable electronic data-level interoperability and exchange of data reflected on the person-centered service plans. The ultimate goal is to leverage HIT standards and electronic information sharing to improve the delivery and coordination of community-based care provided under programs such as Medicaid Waivers. This project is the continuation of work performed under the eLTSS Initiative, a joint effort by ONC and CMS, that published an eLTSS Core Dataset and balloted the “HL7 Cross-Paradigm White Paper: Electronic Long-Term Services & Supports (eLTSS), Release 1” in the Sep 2018 ballot cycle. Current HL7 Content standards already include content to enable the creation and exchange of medically-focused care plans. This effort aims to ensure that service information can be captured and exchanged alongside the medical interventions for a comprehensive picture of a person’s care. Integrating clinical and service information into comprehensive plans can help to improve the coordination of health and social services that support an individual’s mental and physical health.

The IG will use the following resources to enable eLTSS Plan Creation and Exchange: • CarePlan • CareTeam • Claim • Condition • Contract • Coverage • DocumentReference • EpisodeOfCare • Goal • Location • Observation • Organization • Patient • Practitioner • Questionnaire • QuestionnaireResponse • Related Person • RiskAssesment • ServiceRequest

IG Purpose

The adoption and use of Health IT and quality measurement for community-based long-term services and supports is limited. Limitations include:

• lack of uniformity in the terminology and definitions of data elements, including those important to the beneficiary, needed for assessments and service plans used across and between community-based information systems, clinical care systems and personal health record systems;
• insufficient business and/or financial incentives for service providers to acquire and use Health IT to support coordination of services;
• minimal national standards for quality measurement in LTSS outcomes;
• lack of consensus on the inter-relationships between a beneficiary’s plans across care, services and supports; and
• lack of evidence and understanding of how Health IT may benefit the beneficiary and encourage their adoption and use of Health IT.
• lack of established best practices for complying with legal security and privacy requirements when electronically exchanging data between covered clinical entities and non-clinical entities providing community-based services.

The eLTSS FHIR Implementation Guide will provide an official compilation of all the FHIR-related artifacts and documentation needed to enable exchange of eLTSS Dataset via FHIR (e.g. eLTSS Dataset FHIR mappings, eLTSS data exchange scenarios, examples). The eLTSS FHIR Implementation Guide will be matured to a Standard for Trial Use (STU) and will serve to support continued testing activities and evaluation by implementers.

Content location

Need a github

https://gforge.hl7.org/gf/project/cbcc/docman/eLTSS%20-%20%20ONC%20Electronic%20Long-Term%20Services%20and%20Supports/

Additional Project Background Available Here:

• https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/eLTSS+Home

Proposed IG realm and code

US/eLTSS

Maintenance Plan

The project is funded through ONC and CMS. The maintenance plan is to follow the path as the US Core FHIR IG where the initial content is developed and adopted by various pilot organizations and networks and then transition the Implementation guide to the owning work group (CBCP) for the long term.

Short Description

The eLTSS Data Exchange FHIR IG will ensure that community-based service (non-clinical) information can be captured and exchanged alongside the medical interventions (clinical) for a comprehensive picture of a person’s care. Integrating clinical and service information into comprehensive plans can help to improve the coordination of health and social services that support an individual’s mental and physical health.

Long Description

The eLTSS Data Exchange FHIR IG was developed under the eLTSS Initiative. The eLTSS Initiative is a joint project between the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) and was established to advance data-level interoperability for the Home and Community Based Services (HCBS) community. The initiative formed to facilitate the identification and validation of a data standard for capturing and exchanging person-centered LTSS service plan data. A multi-state consensus-based approach was used to identify and harmonize the data elements to be standardized under this initiative, resulting in the development and publication of a set of 56 data elements, referred to as the eLTSS Dataset. The eLTSS Dataset includes beneficiary demographic, goals, strengths, needs, risk management, plan signatures, and service/provider elements. The eLTSS Dataset was cross walked to the Fast Healthcare Interoperability Resources (FHIR) and Consolidated Clinical Document Architecture (C-CDA) standards and documented in the “HL7 Cross-Paradigm Information Sharing for Electronic Long-Term Services & Supports (eLTSS), Release 1” Informative Document that was balloted through HL7 in September 2018.

This eLTSS FHIR IR advances the Informative Document mapping of the eLTSS Dataset to FHIR into a FHIR implementation guide for consumers (e.g., support planners, case managers, beneficiaries, service providers, clinical providers) to enable the creation and exchange of eLTSS Data between non-clinical and clinical entities (e.g., EHR, PHR, HIE, case management systems).

Involved parties

Community Based Care and Privacy (CBCP) is the primary sponsoring workgroup. A collaborative team made up of ONC and CMS contractors (SRS, Carradora, Georgia Department of Community Health (supported by Georgia Tech)) will create the IG.

Expected implementations

• CMS, ONC
• SAMHSA

Content sources

This project is the continuation of work performed under the eLTSS Initiative, a joint effort by ONC and CMS, that published an eLTSS Core Dataset and balloted the “HL7 Cross-Paradigm Information Sharing for Electronic Long-Term Services & Supports (eLTSS), Release 1” Informative Document in the Sep 2018 ballot cycle.

The IG will depend on US Core profiles for applicable eLTSS data.

Example Scenarios

LTSS is currently a document-oriented exchange paradigm (e.g., consumers exchange the entire service plan as a document), however during outreach stakeholders expressed an interest in the ability to exchange portions of service plan data, query specific elements, receive notifications, etc. The aim of eLTSS is to enable those exchanges and features for LTSS data.

• Use FHIR Resources to generate an eLTSS plan in an LTSS case management system
  • Bundle, CarePlan, CareTeam, Claim, Condition, Contract, Coverage, DocumentReference, EpisodeOfCare, Goal, Location, Observation, Organization, Patient, Practitioner, Questionnaire, QuestionnaireResponse, Related Person, RiskAssesment, ServiceRequest
• Exchange eLTSS Plan from Support Planner (case management system) to Clinical and Institutional-based Provider (EHR system)
  • Purpose: The clinical and institutional-based provider is informed of what service(s) the Beneficiary is eligible for and to supply additional details around the services as well as the Beneficiary to enable better delivery of services and support.
  • eLTSS Data: Clinical and Institutional-based Provider may need cost information (Claim), emergency backup plan (CarePlan), full details on service quantities (ServiceRequest), etc. Important information includes contact information for a financial management worker (Practitioner).
• Exchange eLTSS Plan from Support Planner (case management system) to HCBS Provider (provider system)
  • Purpose: To inform HCBS Provider of service(s) requested by Beneficiary, or are authorized for the Beneficiary, as well as to supply additional detail around those services and the Beneficiary to enable better delivery of services and supports.
  • eLTSS Data: HCBS Providers need service and cost information (Units and Unit Costs, Effective Dates, etc.) (ServiceRequest, Claim), especially if there is a change (e.g., due to a re-assessment). This use case would be the vehicle to communicate these data elements to the HCBS Providers officially, even if the services (and quantity and rates) were previously negotiated. Signatures (Contract) are not required; however, the eLTSS Signature Date data elements (Contract) indicating when the plan was approved (CarePlan) could be important.
• Exchange eLTSS Plan from Support Planner (case management system) to Beneficiary (PHR)
  • Purpose: The Beneficiary has a complete record of what is either proposed or to be provided to them and by whom, and potentially be imported into the Beneficiary’s PHR.
  • eLTSS Data: Beneficiary will not need signatures (Contract) and may not need cost information (Claim).
• Exchange eLTSS Plan from HCBS Provider (provider system) to Clinical Provider (EHR) (vice versa)
  • Purpose: The Clinical Provider is aware of the services the Beneficiary is receiving and what their goals/needs/risks are or have been. The HCBS Provider is aware of the Beneficiary's recent hospital/doctor visit and any discharge/treatment instructions to follow.

IG Relationships

Dependent on the US Core IG where applicable for eLTSS (e.g., Patient, Care Plan, Document Reference, Goal, Condition, Practitioner)

Timelines

• 2/17/2019: Submit a functionally complete IG to CBCP along with the Notice of Intent to Ballot (NIB) to CBCP.
• 3/3/2019: Submit a complete FHIR IG to HL7 for QA.

When IG Proposal Is Complete

When you have completed your proposal, please send an email to FMGcontact@HL7.org