Overview

CMS is working in collaboration with the DHHS Office of the National Coordinator for Health IT (ONC) to develop an electronic template that will assist providers with data collection during the Power Mobility Devices (PMD) Face-to-Face Examination. This template may also facilitate the electronic submission of medical documentation.

This template may also facilitate the electronic submission of medical documentation. In the "Reference Materials" of this page is a PDF (CMS eClinical Template) which describes the data elements that CMS believes would be useful in supporting documentation requirements for coverage of a PMD.

• Define progress notes for the Face-to-Face evaluation for a PMD
• Define orders for PMD
• Define required and supporting LCMP documentation
• Define required and supporting DME Supplier documentation
• Specification of PMD equipment

Objectives

• Effectively interact with the responsible providers
• Guide the collection of information for the specific use case (PMD in this case)
• Incorporate information from LCMPs and DMEs
• Submit documentation via HIHs to CMS esMD Phase 1 gateway for CMS contractor review
  • Note: use of esMD Phase 1 is the preferred method of submission; however, other methods such as contractor portals, faxes, and paper submission will be considered

Pilot Streams

Stream 1 – EHR Native eClinical Template

1. Test the ability to incorporate eClinical Templates into EHR technology using the vendor’s native template capability and store the resulting data in the EHR database.
2. Validate ability to generate eClinical Template medical documentation as PDF files to:
   • Send to DME
   • Submit via HIH using esMD Phase 1.

Participants:

1. EHR Vendor(s)
2. HIH(s)
3. Provider(s)
4. DME(s)

Stream 2 – Structured Data Capture (SDC) eClinical Template

1. Test the ability to utilize SDC eClinical Templates in EHR technology to prepopulate the template with EHR data, capture missing information, and store new information in the EHR (or incorporate a PDF created from the SDC eClinical Template).
2. Validate ability to create the SDC eClinical Template medical documentation as PDF files to:
   • Send to DME
   • Submit via HIH using esMD Phase 1

Participants:

1. SDC eClinical Template Repository (link to)
2. EHR vendor(s)
3. HIH(s)
4. Provider(s)
5. DME(s)

Stream 3 – Web based portal eClinical Template

1. Test the ability of a Web based portal eClinical Template to capture required and optional information, create a PDF representation and incorporate the resulting PDF result of the eClinical Template in the EHR.
2. Validate ability to:
   • Exchange the PDF between the Provider, LCMP and DME
   • Submit via HIH using esMD Phase 1

Pilot Participants:

1. eClinical Template Web Portal vendor/service
2. HIH(s)
3. Provider(s)
4. DME(s)

Participating Organizations:

Reference Material