Please Note: CMS has completed and closed EMDI pilot programs. Any new pilot applications will not be accepted. Providers, Document Transfer Vendors, EHRs, and Health IT systems willing to implement provider-to-provider interoperability can find documentation, resources, and reference pilot findings on EMDI Collaboration Website and HL7 FHIR based Post-Acute Order (PAO) (DME-Orders) Implementation guide. For further guidance on involvement in other interoperability initiative, please visit ‘Other Related Interoperability Initiatives’ section.

This space will no longer be updated as of 01/17/2021. Contact Information: onc-jira-questions@healthit.gov

EMDI Pilot Overview

The EMDI Program conducts provider-to-provider pilots related to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health Agency (HHA) supplies/services. All EMDI participants are encouraged to conduct pilots that implement the EMDI use cases. These pilots assist the EMDI program in identifying and measuring provider-to-provider interoperable solutions that reduce provider burden when exchanging medical documentation that is applicable in post-acute care settings.

Figure 1: EMDI Participants

The EMDI pilot program consists of a tier building approach where pilots can take gradual steps to advancing interoperability. This approach is designed to accept pilots that plan an incremental approach to adopting the identified EMDI use cases and interoperability standards. The EMDI pilot program consists of five tiers that closely align with the HIMSS model of Interoperability. The tiers are identified as Tier 0 or No Interoperability, Tier 1 or Foundation Interoperability, Tier 2 or Structural Interoperability, Tier 3 or Semantic Interoperability, and Tier 4 or Organizational Interoperability. The EMDI Initiative encourages organizations to evaluate their workflow to identify their current level of interoperability to identify their desired level of interoperability through participation in the EMDI program.

EMDI Tier	Interoperability Details
Tier 0	No Interoperability: Usually characterized by a stand-alone system that does not have the ability to communicate with other systems electronically.
Tier 1	Foundational Interoperability: This is the ability to establish the inter-connectivity requirements needed for one system or application to securely communicate data to and receive data from another.
Tier 2	Structural Interoperability: This is the ability to define the format, syntax, and organization of the data exchange including at the data field level for interpretation.
Tier 3	Semantic Interoperability: This is the ability to provide common models and codification of the data including the use of data elements with standardized definitions from publicly available value sets and coding vocabularies, providing shared understanding and meaning to the user.
Tier 4	Organizational Interoperability: This is the ability to include governance, policy, social, legal and organizational considerations to facilitate the secure, seamless and timely communication and use of data both within and between organizations, entities and individuals. These components enable shared consent, trust and integrated end-user processes and workflows.

Pilot Measures

The EMDI Pilots are expected to measure and identify successful interoperable standards and processes that acute and post-acute providers can use when implementing an interoperable workflow. Each pilot is expected to collect measures that apply to their current and expected workflow. These measures will be captured before the pilot is conducted and after the pilot has been completed. The measures collected will assist the EMDI Program in evaluating the success of the implemented interoperable solution and identify scalable provider-to-provider interoperable workflows.

Pilot information will be collected by the EMDI team and only approved pilot information will be shared on the EMDI Collaboration website. Participating organizations will be recognized on the EMDI Collaboration website and the ONC HealthIT Interoperability Proving Grounds website for their participation in the EMDI program. Each EMDI pilot is vital to reaching the goal of provider-to-provider interoperability and we encourage all organizations to consider the EMDI program when implementing interoperability.

Figure 2: EMDI Pilot Measurement

EMDI Use Cases

The EMDI Program Guide addresses the content and transport specifications needed to implement the following three use cases:

Use Case 1: Order
• An ordering provider sends a referral containing an order and other needed medical documentation to a service provider/supplier.
• The service provider/supplier decides whether to accept or reject the order. The service provider/supplier communicates this decision back to the ordering provider.

Use Case 2: Request for Medical Documentation
• The service provider/supplier requests additional medical documentation from the ordering provider.
• The ordering provider sends the requested documentation to the service provider/supplier.

Use Case 3: Request for Signature
• The service provider/supplier sends a document requiring a physician signature to the ordering provider and requests that the ordering physician sign, date, and return the document.
• The ordering provider sends the signed/dated document to the service provider/supplier.

Figure 3: EMDI Use Cases

EMDI Pilots

Tier 1 Pilots

Pilot Goal:

Power mobility devices (PMDs) such as power wheelchairs and scooters are crucial for mobility, self-care, employment, and leisure activities. The documentation process for insurance coverage is complex and requires multiple stakeholders. The objective of this project was to develop an electronic submission process for medical documentation for PMDs submitted for preauthorization to a Medicare Administrative Contractor (MAC).

Pilot Information: EMDI University of Pittsburgh Medical Center (UPMC) Pilot

Pilot Status: COMPLETE Pilot Type: DMEPOS

Pilot From: 24 Jul 2017 to 01 Sep 2020

EMDI Use Case: USE CASE 1 USE CASE 3

Hospital	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	DME
University of Pittsburgh Medical Center (UPMC)	Epic	N/A	FTP	N/A	MedForce	NuMotion

Content Standard: Structured PDF

Tier 2 Pilots

Pilot Goal:

Topline Healthcare is an EHR Development Group that uses Codeable Language™ (EHR overlay used to prompt physicians for the appropriate evaluation/documentation). They led a CMS EMDI Pilot that focused on Power Mobility Devices (PMD). Furthermore, they are focusing on an educational component by making physicians aware of the necessity for appropriate medical documentation. Topline Healthcare successfully completed a Center for Medicare & Medicaid Services (CMS) pilot program using its Codeable Language™ technology. CMS recognizes the accomplishment of the processes and software implemented under this program. Topline Healthcare’s pilot was the first of this kind to demonstrate a reduced claim submission error rate (54% to 1%).

Pilot Information: Topline EMDI PMD Workflow Within EMR

Pilot Status: COMPLETE Pilot Type: DMEPOS

Pilot From 29 May 2014 to 25 Jan 2016

EMDI Use Case: USE CASE 1

Service Ordering Provider	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	DME
Physicians Group in Orange County	Meditech/Allscripts	Topline	Portal	Topline	Topline	Life Care Solutions

Content Standard: HL7 CCDA

Pilot Goal:

Topline Healthcare is an EHR Development Group that uses Codeable Language™ (EHR overlay used to prompt physicians for the appropriate evaluation/documentation). They led a CMS EMDI Pilot that focused on Power Mobility Devices (PMD). Furthermore, they are focusing on an educational component by making physicians aware of the necessity for appropriate medical documentation.

Pilot Information: Topline Healthcare Interoperability Pilot

Pilot Status: COMPLETE Pilot Type: Other (Laboratory)

Pilot From 29 May 2014 to 25 Jan 2016

EMDI Use Case: USE CASE 2

Service Ordering Provider	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	Other (Lab)
Concerted Care Group	Epic	Topline	Direct	Topline	Topline	Harwood Labs

Content Standard: HL7 CCDA

Pilot Goal:

This activity supports the well documented goals of HHS and the medical community to insure connectivity within the Gap Continuum is achieved when electronic means are available and is in line with regulation advancement.

Pilot Information: EMDI Suncoast RHIO Pilot

Pilot Status: COMPLETE Pilot Type: OTHER-(Emergency Department)

Pilot From 01 Jun 2017 to 13 Oct 2020

EMDI Use Case: USE CASE 1

Hospital	IV	DTV	Transport	DTV	IV	OTHER
Desoto Memorial Hospital	Meditech	Suncoast RHIO, Inc.	Direct	Suncoast RHIO, Inc.	Suncoast RHIO, Inc.	Desoto Memorial Hospital Department of Health

Standards: CCDA

Pilot Goal:

This activity supports the well documented goals of HHS and the medical community to insure connectivity within the Gap Continuum is achieved when electronic means are available and is in line with regulation advancement.

Pilot Information: EMDI Suncoast RHIO Pilot

Pilot Status: COMPLETE Pilot Type: OTHER-(Emergency Department)

Pilot From 01 Jun 2017 to 13 Oct 2020

EMDI Use Case: USE CASE 2

Hospital	IV	DTV	Transport	DTV	IV	OTHER
Desoto Memorial Hospital	Meditech	Suncoast RHIO	Direct	Suncoast RHIO	Allscripts	Sarasota Memorial Hospital

Standards: CCDA

Pilot Goal:

This activity supports the well documented goals of HHS and the medical community to insure connectivity within the Gap Continuum is achieved when electronic means are available and is in line with regulation advancement.

Pilot Information: EMDI Suncoast RHIO Pilot

Pilot Status: COMPLETE Pilot Type: HHA

Pilot From 01 Jun 2017 to 13 Oct 2020

EMDI Use Case: USE CASE 2

Hospital	IV	DTV	Transport	DTV	IV	Home Health Agency
Desoto Memorial Hospital	Meditech	Suncoast RHIO, Inc.	Direct	Suncoast RHIO, Inc.	Axxess	Desoto Memorial Home Health Agency

Standards: CCDA

Pilot Goal: This activity supports the well documented goals of HHS and the medical community to insure connectivity within the Gap Continuum is achieved when electronic means are available and is in line with regulation advancement.

Pilot Information: Coming Soon

Pilot Status: ON HOLD Pilot Type: DMEPOS

Pilot From: 01 Jun 2017

EMDI Use Case: USE CASE 1

Hospital	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	DME
Southwest Florida Hospital	N/A	Suncoast RHIO, Inc.	Direct	Suncoast RHIO, Inc.	Suncoast RHIO, Inc.	Arthrex

Content Standard: Structured PDF

Tier 3 Pilots

Pilot Goal:

To enable these interoperability services in our HME/DME and Home Health & Hospice product lines for the benefit of our providers and their patients. We have been live with specific subsets of the use cases since 2016.

1) demonstrate that physicians would order HME products and services just as they order other planned follow-ups for their patients:
2) demonstrate that the information could automatically flow to the HME providers; and
3) show that the solution could scale well.

Pilot Information: EMDI Brightree Pilot

Pilot Status: COMPLETE Pilot Type: DMEPOS

Pilot From01 Jun 2016 to 01 Jan 2018

EMDI Use Case: USE CASE 1

Hospital	IV	DTV	Transport	DTV	IV	DME
Greenville Health System	Epic	UpDox	Direct	Medicity	Brightree	Medical Service Company
Ochsner Health System	Epic	UpDox	Direct	Medicity	Brightree	Medical Service Company

Content Standard: HL7 CCDA

Pilot Information: Coming Soon

Pilot Status: ACTIVE Pilot Type: DMEPOS

Pilot From: 01 Jun 2016

EMDI Use Case: USE CASE 1

Hospital	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	DME
N/A	N/A	N/A	REST (FHIR)	Brightree	Brightree	N/A

Content Standard: HL7 FHIR

Pilot Goal:

MedAllies is participating in the EMDI project to advance secure Direct interoperability in support of reducing provider and staff burden through the ability for systems to track orders to completion, i.e. “closing the loop”. Specifically, to use Direct interoperability to ensure closed loop patient referrals, from PCPs to specialists and back, thereby automating referral tracking, enhancing clinical workflows and patient care processes.

Pilot Information: EMDI MedAllies, Netsmart, & eClinicalWorks (360x) Pilot

Pilot Status: COMPLETE Pilot Type: HHA

Pilot From 24 Jul 2017 to 18 Nov 2020

EMDI Use Case: USE CASE 1

Hospital	IV	DTV	Transport	DTV	IV	Home Health Agency
N/A	eClinicalWorks	MedAllies	Direct, 360x	MedAllies	Netsmart	N/A

Standards: HL7 CCDA

Pilot Goal:

Amedisys would like to participate in the EMDI program to define and develop interoperability standards. Having developed multiple interfaces, with vendors, hospitals, and government agencies, we’ve seen everyone with their own implementation of HL7, 837’s, 835’s and others. Currently in the process of developing an internal interface platform for interoperability with HIE’s and would like to use this opportunity to get on board with any early guidance toward industry standardization.

Pilot Information:

EMDI Amedisys and Homecare Homebase Pilot

Pilot Status: COMPLETE Pilot Type: HHA

Pilot From 15 Oct 2020 to 06 Nov 2020

EMDI Use Case: USE CASE 1USE CASE 2

Hospital	IV	DTV	Transport	DTV	IV	DME/HHA
N/A	N/A	N/A	Portal	N/A	Homecare Homebase	Amedisys

Content Standards: HL7 V2 & CCDA

Pilot Goal:

Use of, and feedback on, the application for DME referral, qualification, and billable orders to improve

efficiency and collection rates. Ability to utilize healthcare industry standards to improve the secure digital exchange of healthcare

information to better serve our patients and facilitate our business.

Pilot Information: Coming Soon

Pilot Status: ACTIVE Pilot Type: DMEPOS

Pilot From: 02 Jul 2019 to Present

EMDI Use Case: USE CASE 1

Hospital	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	DME
N/A	N/A	Rotech	REST (FHIR)	N/A	N/A	N/A

Content Standard: HL7 FHIR

Pilot Goal:

To participate in Use Case 1 and receive orders for our DME to interface with Apria's proprietary system.

Pilot Information: Coming Soon

Pilot Status: ACTIVE Pilot Type: DMEPOS

Pilot From: 20 Apr 2020 to Present

EMDI Use Case: USE CASE 1

Hospital	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	DME
N/A	N/A	N/A	REST (FHIR)	DME Hub	DME Hub	N/A

Content Standard: HL7 FHIR

Pilot Goal:

Pilot Information: Coming Soon

Pilot Status: ACTIVE Pilot Type: DMEPOS

Pilot From: 20 Apr 2020 to Present

EMDI Use Case: USE CASE 1

Hospital	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	DME
N/A	N/A	N/A	REST (FHIR)	DME Hub	DME Hub	N/A

Content Standard: HL7 FHIR

Pilot Goal:

We are working to develop a FHIR based solution that could be used as a claim clearinghouse for a seamless interoperable exchange between providers and vendors as well as between providers to providers.

Pilot Information: Coming Soon

Pilot Status: ACTIVE Pilot Type: DMEPOS

Pilot From: 01 May 2020 to Present

EMDI Use Case: USE CASE 1

Hospital	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	DME
N/A	N/A	N/A	REST (FHIR)	DME Hub	DME Hub	N/A

Content Standard: HL7 FHIR

Pilot Information: Coming Soon

Pilot Status: ON HOLD Pilot Type: DMEPOS

Pilot From: 14 Jun 2019

EMDI Use Case: USE CASE 1

Hospital	Interface Vendor	Document Transfer Vendor	Transport Standard	Document Transfer Vendor	Interface Vendor	DME
N/A	N/A	N/A	REST (FHIR)	Colonial Medical	Colonial Medical	N/A

Content Standard: HL7 FHIR

Other Related Interoperability Initiatives

Interoperability Initiative	Point of Contact
Da Vinci Project	jocelyn.keegan@pocp.com
PACIO Project	info@pacioproject.org
Blue Button	Visit CMS.gov or Medicare.gov websites
Carin Alliance	mark.roberts@leavittpartners.com
Social Determinants of Health/ Gravity Project	carrie.lousberg@emiadvisors.net
Patient Generated Health Data	Maria.moen@advoltinc.com

Pilot Documents

Document	Purpose	Submission Method	Download
EMDI Participation Request Sheet	The EMDI Participation Request Sheet allows various healthcare organizations the opportunity to participate in the Electronic Medical Documentation Interoperability (EMDI) program. This is not a legally binding agreement and is to be used to outline the program guidelines and expectations for participation. All organizations participating in EMDI initiatives are expected to complete and submit this document to the EMDI team for review and approval.	CLOSED	Click Here
Pilot Update Template	The Pilot Update Template will be used to provide pilot updates to CMS and the EMDI Team. EMDI participants may submit the Pilot Update template to the EMDI team at any time for review.	CLOSED	Click Here
EMDI Program Guide	The EMDI Program Guide is intended for health IT stakeholders who volunteer to participate in the EMDI program and will build the architecture and the supporting infrastructure necessary for interoperability, and for those who will use that infrastructure.	CLOSED	Click Here
EMDI Pilot Measures	EMDI Measures are designed to capture the efficiencies of the EMDI Use Cases and report the aggregate metrics to CMS.	CLOSED	Click Here

Post-Acute FHIR Order Pilot / HL7 Connectathon Track Participants

Organization Name
Rotech
Colonial Medical
Brightree
Apria Healthcare
HME 360
Global Health IT, LLC
180 Medical
DME Hub
Homecare Homebase
Vorro Health
Epic
Parachute Health
Bonafide