PHR for LTSS Demo - September Update

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PHR for LTSS Demo

PHR for LTSS Demo Past Updates

September 20, 2017

PHR for LTSS Demo - September Update

Personal Health Record for LTSS (PHR):

As part of our effort to continuously add value and more helpful information to the Personal Health Record, we recently suggested to the Otter Tail County users in our pilot to upload some additional forms to their PHR. One of our suggestions was to upload their Health Care Directives. We provided a link to blank HCD forms and instructions through the secure messaging function of the PHR. We also asked case managers to upload the users’ CSP/CSSP (DHS care plan) so that the users and their legal representatives can have instant access to this plan. 

In addition, we created a form that can be used as a "personal profile page" where the users can explain a little bit more about who they are as a person and what matters most to them. It also has a place where they can put their picture if they so choose. We're hoping this personal profile page will be a helpful tool for promoting "person centered" approaches to the care of the users in our pilot.  

The Southern Prairie PHR collaborative is ramping up as they gather a list of people who can participate in the pilot. Assisting with this process are the agencies of Southwest Health and Human Services and Des Moines Valley Health and Human Services. Our goal is to have these users trained and on-boarded to use the PHR before the end of September, 2017. 

We’ll be conducting a “soft launch” of the PHR with the Southern Prairie collaborative, which will entail manually uploading DHS data into the beneficiaries’ PHR records. MN.IT @ DHS is currently building out the functionality that will allow us to automatically push DHS data into the Southern Prairie PHR records, which is how we’re pushing data to the Otter Tail County PHR collaborative. We plan to deploy the “automated launch” for Southern Prairie in January 2017.

We've been negotiating with a potential third PHR Community Collaborative but were ultimately unable to reach an agreement with that Collaborative. Efforts are under way to determine the best approach to allocate funds dedicated to this purpose to other aspects of TEFT work.


Through our weekly ONC S&I Framework calls, we’ve reached a final harmonized national eLTSS standard data set. The Georgia TEFT team will be leading the effort to take the eLTSS standard the next step, which will be hashing out the technical details of the standards’ transport mechanism and bringing the standard to an SDO (Standards Development Organization) to attain official recognition as a standard. We plan to work with the Georgia team to help move this process along.

Provider organizations of the Southern Prairie Community Collaborative are continuing to prepare for exchange of the Otter Tail County eLTSS standard data set. Partner organizations are currently mapping existing data fields within their EHRs to the OTC standard, determining how to extract their data into the standard template we created with OTC, and beginning to test with fake data.

FASI (Functional Assessment Standardized Items):

Our work plan for FASI round 2 is aiming to learn whether there are aspects of FASI that could/should be incorporated at a later date into MnCHOICES, or which could help us improve on the way we ask existing MnCHOICES questions. We do not intend to use the FASI instrument itself beyond the end of the TEFT Grant. 

Experience of Care:

As noted before, we received permission from CMS to forego the second round of testing of the Experience of Care survey a/k/a Beneficiary Experience Survey. DHS leadership concluded that further testing of this survey would unduly burden the targeted population as it would duplicate other efforts already under way in MN.

What are the PHR for LTSS Demo's goals?

  1. Demonstrate use of an untethered Personal Health Record (PHR) system with beneficiaries of LTSS;
  2. Identify, evaluate and test an electronic Long Term Services and Supports (e-LTSS) standard with the Office of the National Coordinator's (ONC) Standards and Interoperability (S&I) Framework process;
  3. Field test a Beneficiary Experience Survey within multiple CB-LTSS programs for validity and reliability; and
  4. Field test a set of Functional Assessment Standardized Items (FASI) measures for use with beneficiaries of CB-LTSS programs.

Where can I learn more?