ONC and FHA Demonstrations in the HIMSS Interoperability Showcase

The upcoming Healthcare Information and Management Systems Society (HIMSS) Conference showcases some of the
most forward-thinking health IT interoperability projects that are transforming the way health information is shared and
utilized throughout the country.

As part of HIMSS 2011, the Office of the National Coordinator for Health IT
(ONC) and the Federal Health Architecture (FHA) will once again host a series
of demonstrations within the HIMSS Interoperability Showcase. This year there
will be approximately 40 demonstrations highlighting how health practitioners
are securely exchanging health data between doctor’s offices, hospitals,
benefit providers, government agencies, and with other health organizations,
all across America. There will be a particular emphasis on demonstrations
related to the Nationwide Health Information Network Exchange, the Direct
Project, the S&I Framework, and CONNECT.

The demonstrations within the ONC and FHA-dedicated area of the HIMSS
Interoperability Showcase provide a range of examples of how nationwide
health IT collaboration will help improve care for Americans.

Programs Demonstrated within the Showcase

Most of the demonstrations within the HIMSS Interoperability Showcase focus on programs that fall under the aegis of the
Office of Interoperability and Standards, namely the Nationwide Health Information Network Exchange, the Direct Project,
CONNECT, and the S&I Framework.

Direct Project
Attendees will also see a series of eight demonstrations that highlight the use of Direct Project specifications. Launched in
March 2010 as a part of the Nationwide Health Information Network, the Direct Project was created to specify a simple,
secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to
known, trusted recipients over the Internet. Today, the Direct Project has more than 200 participants from over 60 different
organizations, including EHR and personal health record (PHR) vendors, medical organizations, systems integrators,
integrated delivery networks, federal organizations, state and regional health information organizations, organizations that
provide health information exchange capabilities, and health information technology consultants.

The participation of any company or organization in the Office of the National Coordinator for Health Information Technology (ONC) and
the Federal Health Architecture (FHA) area within the HIMSS Interoperability showcase does not represent an endorsement by ONC,
FHA or the Department of Health and Human Services.
 Office of the National Coordinator for Health Information Technology and the Federal Health Architecture

CONNECT
A series of demonstrations will show how the CONNECT open-source software gateway supports health organizations securely
exchanging health-related information using nationally recognized standards – despite geographic location in the United States.
Originally built by more than 20 federal agencies, CONNECT uses Nationwide Health Information Network standards and
governance as part of its open-source software framework to connect providers, insurers, federal agencies, states, and others
involved in supporting health and healthcare. CONNECT is free of charge and is managed by the Federal Health Architecture and
the Office of the National Coordinator for Health Information Technology (ONC).

Nationwide Health Information Network Exchange

Attendees will be able to visit with many members of the Nationwide Health Information Network Exchange and see how their
projects are working. Members of the Exchange are organizations that have satisfied the technical and legal requirements
for participation, and they are already reaping the benefits of using harmonized standards and specifications as a basis for
nationwide interoperability. As an example of the value of Exchange participation, the U.S. Social Security Administration, through
its partnership with MedVirginia, has been able to reduce turnaround time for medical disability determinations from an average
of 84 days to 46 days – a 45 percent improvement. Of these, a determination was made in 161 cases (about 3.1 percent) within
48 hours of receipt.

S&I Framework
The Standards and Interoperability (S&I) Framework is an open government initiative focused on providing integrated content
and technical specifications that support the interoperable exchange of healthcare information nationwide. S&I Framework
specifications are guided by the healthcare and technology industry and include integrated functions, processes, and tools.
The Framework supports national health outcomes and healthcare priorities, including Meaningful Use, the Nationwide Health
Information Network, and the ongoing mission to create better care, better population health, and cost reduction through
delivery improvements.

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Demonstrations Occurring within the ONC and FHA Area of the

Interoperability Showcase
The Virtual Lifetime Electronic Record (VLER)
Department of Defense, Department of Veterans Affairs, Kaiser Permanente, and MedVirginia
President Barack Obama, along with Defense Secretary Robert M. Gates and VA Secretary Eric Shinseki, announced the Virtual
Lifetime Electronic Record (VLER) initiative in April 2009 to enhance the continuity of care for our Service men and women
by ensuring that electronic records will transition along with them and remain with them forever. VLER will result in increased
information available to clinicians and healthcare organizations, which will in turn improve the continuity of services and care for
our Service Members and Veterans. Initially, VLER will permit authorized users to share health information and eventually enable
sharing of electronic health, benefits and administrative information for Service Members and Veterans. This demonstration will
highlight progress being made toward achieving interoperability within the VLER initiative.

Authorized Release of Information to a Trusted Entity

Kaiser Permanente, MedVirginia and Social Security Administration
The demonstration will show how the Social Security Administration requests information from medical providers (Kaiser
Permanente and MedVirginia) based on authorization to release information and receives the information using the Nationwide
Health Information Network. The information flow is seamless and does not require any human intervention. This exchange of
information dramatically reduces the time required for the exchange compared to the traditional process.

Claim Status Transactions Over Nationwide Health Information Network Using CORE Connectivity
CAQH Committee on Operating Rules for Information Exchange (CORE), Community Health Information Collaborative (CHIC), and Noridian
This CAQH CORE, Noridian, CHIC HIE-Bridge and ApeniMED (formerly known as MEDNET) interoperability demonstration
shows how healthcare administration is simplified through collaboration and alignment with national initiatives. Building on
last year’s demonstration in which CORE and CMS’s Medicaid IT Architecture (MITA) collaborated to demonstrate eligibility
transactions (270/271) using the CORE Eligibility and Connectivity Rules transmitted from an HIE to multiple Medicaid systems
over the Nationwide Health Information Network, this year the collaboration continues to show claim status transactions
(276/277) from CHIC HIE-Bridge to Medicare via Noridian, a Medicare contractor, over the Nationwide Health Information
Network using the CORE Phase II Connectivity Rule.

Patient-Centric Access Control Policy Demonstration Using Nationwide Health Information

Network Standards
Office of the National Coordinator for Health IT
The Nationwide Health Information Network expands the frontier for securely sharing patient health information between
healthcare organizations. As HIE’s and other health-related service providers begin to share patient medical information, it
remains a top priority to ensure patient privacy is maintained in accordance with the patient’s wishes. This demonstration
illustrates how a HIE could implement a dynamic Access Control Policy service, which is administered and reviewed by the
patient. In the demo, attendees will observe a patient granting a HIE permission to share medical data with a health care
provider. Later the patient will chose to revoke the permission of sharing medical data with the health care provider.

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The Nationwide Health Information Network Exchange

Office of the National Coordinator for Health IT
The nationwide health information network is a set of standards, services and policies that enable secure health information
exchange over the Internet. A group of federal agencies, local, regional and state-level health information exchange organizations
and integrated delivery networks has been helping to develop these standards, services and policies. Currently, eight organizations
are exchanging information in production as part of the Nationwide Health Information Network Exchange, supporting care
coordination, biosurveillance and quality reporting, and disability determinations. In 2011, it is expected that 20 entities, including
provider practices, will be securely sharing live health information as part of this Exchange.

Standards & Interoperability Framework

Office of the National Coordinator for Health IT (ONC)
During this demonstration, participants will learn about the Standards & Interoperability Framework. This framework consists of a
team of experts collaborating with ONC to support the development of healthcare specifications in order to facilitate wider use of
health IT standards and to increase the level of interoperability across the nation. The demonstration will describe each part of the
framework and how all the parts interrelate. Participants will learn of opportunities to help shape health IT interoperability for the
future by becoming involved in these critical efforts.

popHealth Open Source Clinical Quality Measure Reporting Tool

Office of the National Coordinator for Health IT
This demonstration will provide an overview of popHealth, an ONC-sponsored reference implementation for Meaningful Use clinical
quality measure reporting. popHealth integrates with data from a provider’s EHR (using established HITSP C32 or CCR data
standards) to produce clinical quality measure reports for the 44 core and non-core Stage 1 measures. popHealth provides physicians
with a better understanding of the overall health of their patient population and streamlines the submission of quality measures to
federal agencies as part of the EHR incentive program. popHealth is easy to use, and available as open-source software.

Addressing Meaningful Use Profiles Using CONNECT-Based Interoperability

Federal Health Architecture
Two healthcare organizations will exchange patient medical information by utilizing the CONNECT open source gateway in this
interoperability demonstration. The patient medical data exchange will include such meaningful use profiles as Patient Discovery,
Query for Documents and a Retrieve Document. This demonstration will highlight a Nationwide Health Information Network-based
implementation of the CONNECT gateway.

Enhancing Tribal Care Coordination

Indian Health Service
This demonstration showcases health information exchange between facilities across the IHS enterprise-wide health information
exchange (HIE) and also the Nationwide Health Information Network. The demo begins with generation of a C32 patient
summary document at a facility within the IHS enterprise. This document gets pushed to the IHS HIE. Subsequently, a provider
logs on to a patient data viewer and retrieves all C32 documents for the patient from both the IHS HIE and the Nationwide
Health Information Network.

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Health Information Exchange with Federal Partners Through Nationwide Health

Information Network
Conemaugh Health System and U.S. Army Medical Research and Material Command (USAMRMC), Telemedicine and Advanced
Technology Research Center (TATRC)
During this demonstration, participants will learn about the Military Interoperable Digital Hospital Testbed (MIDHT). In partnership
with Northrop Grumman Corporation, Conemaugh Health System (located in Johnstown, PA) is capable of dynamically
assembling a HITSP defined C32 from the Allscripts electronic health record using the CONNECT 3.1 platform. Through
exchange with federal partners via the Nationwide Health Information Network, coordination of care and safety should improve for
shared patients being cared for in both the public and private sectors. This Congressional Special Interest project is administered
by the Department of the Army.

Distributed Decision Support Services and Knowledge Management Repository

Naval Health Research Center and U.S. Army Medical Research and Material Command (USAMRMC), Telemedicine and Advanced
Technology Research Center (TATRC)
Distributed Decision Support Services and Knowledge Management Repository project (DDSS-KMR) leverages the open source
CONNECT architecture and provides additional capabilities for delivering the data and services required for sophisticated real-
time clinical decision support. DDSS-KMR will be demonstrated using live reference information systems from the VA (VistA), the
Indian Health Service (RPMS), and the open source community (Open Vista). EMR clients using each system have been modified
to now include the project’s Universal Inbox, a reusable module providing a centralized clinical decision support workflow
sensitive environment.

Integrating Patient Demographics Using an Extensible EMPI

U.S. Army Medical Research and Material Command (USAMRMC), Telemedicine and Advanced Technology Research Center (TATRC)
Leveraging Small Business Innovative Research (SBIR) funds, this project will demonstrate how patient identifying and
demographic data must be integrated first before the patient’s clinical data can be accurately integrated into an Electronic Health
Record (EHR). This demonstration will illustrate how a patient’s identifying criteria, captured at different provider settings, will be
integrated using an extensible, open source Master Patient Index called OpenEMPI, despite the presence of variations and errors
in the demographic data of the patient. This scenario will also demonstrate how OpenEMPI can be easily utilized as the EMPI
within the Nationwide Health Information Network.

Provider-to-Provider Interoperability through a Health Information Services Exchange

U.S. Army Medical Research and Material Command (USAMRMC), Telemedicine and Advanced Technology Research Center (TATRC)
This project demonstrates the functionality of a Health Information Services Exchange (HISE). A HISE is the next generation
of HIE (Health Information Exchange) network. The HISE enables the sharing of patient health information among facilities,
providers and patients who may or may not be members of the Nationwide Health Information Network or a HIE. The HISE
extends the privacy and security of the patient health record to these recipients even when the recipients are not online. It
includes a master patient ID index and a master patient consent form that is enforced by the HISE in all transactions involving
patient health information. The presentation will show how a Department of Defense (DoD) provider interacts with the HISE to
seamlessly make a referral to a non-DOD provider.

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Patient Education Via HL7 Infobutton Request Over Nationwide Health Information Network
U.S. Army Medical Research and Material Command (USAMRMC), Telemedicine and Advanced Technology Research Center (TATRC)
TATRC and Healthwise have partnered to demonstrate how patient education can be integrated seamlessly into the clinician’s
workflow within an EMR application. For this demonstration, the Infobutton Manager applet is launched from within the
Department of Defense’s EMR application (AHLTA) via standard HL7 Infobutton requests, available as web services on the
Nationwide Health Information Network. The context for the patient visit is passed to the Infobutton Manager allowing the
clinician to quickly view, select and prescribe the most relevant patient education materials. With the two-way HL7 interface, the
information prescription is then documented in the patient’s chart.

Visualization of Medical Resources for Emergency Decision Support

U.S. Army Medical Research and Material Command (USAMRMC), Telemedicine and Advanced Technology Research Center (TATRC)
The Information Placement and Retrieval through the Nationwide Health Information Network (InfoPRN) is a medical logistics
research project being developed through the United States Army Telemedicine and Advanced Technology Research Center
(TATRC). Its goal is to ensure emergency responders have timely access to the data necessary to treat both military and
civilian personnel during a mass casualty event coordinating across jurisdictional and organizational “boundaries.” During this
demonstration, participants will learn how InfoPRN provides capabilities to exchange and share medical resource information
between private and public organizations supporting healthcare through the Nationwide Health Information Network.

Enabling Provider Communication Using a Standardized Provider Directory

Social Security Administration
Social Security Administration (SSA) will demonstrate interactions with a provider directory based on integrating the Healthcare
Enterprise (IHE) interoperability profile, Healthcare Provider Directory (HPD), targeted to improve the efficiency of electronic
medical records retrieval over the Nationwide Health Information Network. Through the HPD standardized interface, SSA
systems will perform lookup queries to identify providers and their relationships, obtain demographic data, contact information,
and medical records locations, including e-mail and electronic health record end points, enabling directed communication to
providers, intended to reduce network traffic, minimize unnecessary transmissions of medical records, with the objective of
improving efficiency of disability determination processes.

Enforcing Patient Privacy in Healthcare

Department of Veterans Affairs
A recent report by the President’s Council of Advisors on Science and Technology (PCAST) underscores the need for tagged data
in the enforcement of patient privacy. The tagged data approach provides fine-grained controls for implementing privacy controls,
including patient-controlled privacy preferences. The Department of Veterans Affairs will demonstrate an attribute-based access
control model supporting PCAST. The approach is capable of enforcing patient privacy using currently available commercial
security products. HL7 standard sensitivity vocabulary is used to tag EHR data matched with Organization for the Advancement of
Structured Information Standards (OASIS) extensible access control markup language (XACML) policy rules.

Consultation, Referral and Result Exchange through Direct Messaging

Department of Veterans Affairs and CareSpark
This demonstration illustrates the feasibility of utilizing the Direct Project constructs to enable secure messaging between a
federal agency (Veterans Affairs), and a regional health information exchange network (CareSpark). This demonstration shows the
secure, standards-based transmission of a referral for mammography from a VA medical center to a private sector provider clinic,
and the reply from the private sector provider clinic with a text-based report. VA and CareSpark are using two Health Information

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Service Providers (HISPs) based on the Direct Project Reference Implementations (Java and C#) that are publicly available from
the Office of the National Coordinator for Health IT (ONC).

Hudson Valley Direct Project Supporting Care Coordination

Albany Medical Center, Asthma and Allergy Associates of Westchester, Community Care Physicians, Institute for Family Health,
Scarsdale Medical Group, LLP
MedAllies, a Health Information Service Provider (HISP), has fully engaged clinicians throughout the Hudson Valley and
their disparate EHR vendor partners to create a Direct project that pushes critical clinical information across EHR systems to
support care coordination and transitions of care, in a manner that is completely consistent with the clinicians’ established EHR
workflows. The project has focused on the common care transition episodes of patient discharge from hospital back to their
primary care physician (PCP); and a consultation request from a PCP to a specialist, then the clinical consultation from the
specialist back to the PCP.

Immunization Submission
The Direct Project
This demonstration will explain how the Direct Project technical standards and services are being used today to securely transport
immunization data from Hennepin County Medical Center to the Minnesota Department of Health. To show the flexibility and
possibilities of the Direct Project, an immunization submission workflow will be shown along with an optional ability to easily and
securely send a copy of the immunization to a patient’s Direct-enabled personal health record.

Direct Project and CONNECT Working Together In California HIE

Redwood MedNet
This demonstration will highlight the roles of the Direct Project and the CONNECT open source gateway as clinical messaging
tools. Redwood MedNet will demonstrate how these solutions work within its operational health information exchange service in
Northern California.

Direct Exchange Using Certificate Authority Supporting Medical Home

MedVirginia
This project demonstrates the electronic exchange of clinical information and patient summary record using the Direct Project
compliant MEDfx LIFESCAPE provider portal. The demonstration will show the secure exchange of referrals from providers using
LIFESCAPE to MedVirginia-based care managers using MEDfx’s Medical Home Information System with a patient summary
record to support the fulfillment of Stage 1 Meaningful Use criteria. It will use both the Direct Project protocols and Nationwide
Health Information Network/CONNECT for transport, integrated with the Verizon certificate authority and provider registry to
define the circle of trust.

Wisconsin HIE Secure Messaging and Directory Services

Wisconsin Statewide Health Information Network (WISHIN), Inc., Wisconsin Health Information Exchange, and Wisconsin
Department of Health Services
During this demonstration, participants will learn about Wisconsin’s approach for supporting Stage 1 Meaningful Use HIE
requirements using a Health Information Service Provider, the Direct secure messaging solution, and a provider directory
developed by the Wisconsin Medical Society; and how Wisconsin’s State HIE program, Medicaid, and Regional Extension Center
will also use the directory for EHR and HIE adoption tracking, reporting, and outreach.

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Traveling Wilburys – Continuous Care DIRECT from Wine Country

HealthBridge
During this demonstration, HealthBridge and Redwood MedNet will show how continuity of care for patients can be enhanced
using the Direct platform to share healthcare information between two operational health information exchanges. In this scenario,
the Wilburys of Cincinnati go on vacation in the Wine Country of California. When the Wilburys have to visit a health care provider,
Direct connectivity allows HealthBridge and Redwood MedNet to exchange health information seamlessly and securely between
the treating physician in California and the primary care physician in Cincinnati.

Care Collaboration: Connecting the Hospital, Physicians and Patients

Medical Professional Services, Inc. (MPS)
This demonstration uses Direct protocols to connect and securely share clinical information among a hospital, patients and a
diverse group of MPS physicians who have a heterogeneous set of health IT tools (ranging from e-mail only to fully functional
EHRs), in support of Meaningful Use and improved collaboration and continuity of care. This demonstration will track information
as it follows the following flow: a primary care provider refers patient to specialist including summary care record; the specialist
sends a response back to the referring provider; and the physician sends summary of care record to the patient.

The Direct Project

Office of the National Coordinator for Health IT
Launched in March 2010 as a part of the Nationwide Health Information Network, the Direct Project was created to specify a
simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to
known, trusted recipients over the Internet in support of Stage 1 Meaningful Use requirements. The Direct Project has more than
200 participants from over 50 different organizations. These participants include EHR and PHR vendors, medical organizations,
systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations,
organizations that provide health information exchange capabilities, and health information technology consultants.

The CONNECT Open Source Solution

Federal Health Architecture
CONNECT is an open source software gateway that allows health organizations to securely exchange health-related information
with each other using nationally recognized standards. Originally built by more than 20 federal agencies, CONNECT uses
Nationwide Health Information Network standards and governance as a framework to connect providers, insurers, federal
agencies, states and others involved in supporting healthcare. Today the CONNECT solution is available as an open source
offering to any organization wishing to address their health IT interoperability needs – free of charge. The open source community
is made up of more than 2,000 individual organizations and is managed by the Federal Health Architecture and the Office of the
National Coordinator for Health IT.

Continuity of Care in the Emergency Department

WakeMed Hospitals
In this demonstration, WakeMed Hospitals bridges the information gap between the WakeMed Emergency Department and those
that provide care post-discharge using Axial Alerts. Axial Exchange provides a software solution aligned with CONNECT and other
open source components. In working with the EHRI SIG as well as customers, Axial recognized the importance of delivering
clinical summaries from the WakeMed Pediatric ER to local pediatricians. These summaries are not only designed to contain key
clinical information, but also are designed to be viewable on most web browsers and smart phones. The importance of continuity
of care is heightened in emergency department settings, as these visits are often unplanned. Without timely coordination with
post-discharge providers, care is negatively impacted and the probability of return emergency department visits increase.

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Positive Impact of Multiple Input Devices for EHR Adoption

CONNECT
The CONNECT EHR Interoperability Special Interest Group (EHRI SIG) and RoverINK will demonstrate the result of an innovation
prototype. This demonstration supports a complete usability framework for clinicians’ that works the way they do by incorporating
handwriting, keyboards, Tablets, iPads and dictation into electronic records. By incorporating clinicians’ existing work flow, EHRs
support the meaningful use of EHRs without impeding processes.

The information collected from the multiple input devices are exportable XML to Natural Language Processor (NLP) and data coded
to standards. Discreet data elements are generated, including free form notes to produce interoperable formats (CDA, C32). This
demonstration will populate an NLP and enterprise content management system for easy health information analysis and document
retrieval. This helps eliminate objections regarding the method of input allowing clinicians to continue in their personal work flow.

Open Behavioral Health Information Technology Architecture (OBHITA)

Substance Abuse and Mental Health Services Administration (SAMHSA)
This demonstration will illustrate the benefits of an Open Behavioral Health Information Technology Architecture (OBHITA) and
its future integration with CONNECT. With OBHITA and CONNECT, Behavioral Health providers can improve outcomes and
overall quality of care through seamless integration with primary care networks and statewide HIEs. The OBHITA project aims to
achieve the following objectives; (a) share the artifacts produced under this contract with other Behavioral Health IT developers
(b) establish a common platform for states to manage their safety-net services network, and (c) standardize data collection and
sharing while maintaining compatibility with behavioral health-specific patient privacy regulations.

Nebraska College Student’s Life Saved Using CONNECT Gateway

Thayer County Health Services
A college student with a medical history, away from home for the first time, needs clinical information that is critical for care.
Using the CONNECT gateway, demographics, lab results, medications, allergies, and transcribed documentation are available to
providers on demand. While attending Sonoma State University in Northern California, our patient visits one of Redwood Mednet’s
care facilities for medical services, where they can request records instantly from his hometown in Hebron NE. When our student
returns home during semester break or holidays, TCHS providers can request instant updates on results and care documentation
from visits in California.

CONNECTing EHRs and PHRs to Support Patient Health

MyCommunityHealthCare.com, MyPrimaryCare.net and PatientsPortal.net
This demonstration will use CONNECT open source technology with a set of re-usable and configurable adaptor development toolkits
to demonstrate how a community based health care organization, an outpatient practice and an online patient health portal (PHR) can
exchange patient summary records, immunization and public health records between EHRs and PHRs using CONNECT.

Leveraging EHRs to Improve Quality of Member Care

AmeriHealth Mercy and Independence Blue Cross
Health plans face many opportunities and challenges for supporting health care providers in leveraging EHRs and the
Accountable Care Act. Working together, AmeriHealth Mercy, a leader in Medicaid managed care, and Independence Blue Cross,
a large commercial carrier, have created an initiative that gives health care providers better access to health plan information and
improves the quality of member care. During this demonstration, AmeriHealth Mercy and Independence Blue Cross collaborated
with community partners, health care providers, and vendors to improve transitions in care by focusing on two use cases -sharing
medication information and hospital admissions through secure patient portals, provider portals, and HIEs.

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Interoperable PHR CONNECTs Cancer Patients, Providers and Payers

Rocky Mountain Health Plans (RMHP) and Denver Health Medical Center (DH)
This demonstration employs CONNECT to overcome the fragmented health information that jeopardizes chronically ill patients.
The interoperable SmartPHR exchanges, consolidates and updates machine-readable continuity of care (CCR) data with
multiple EHRs; enforces patient privacy preferences; and maintains anytime/anywhere privilege-suitable access for patients,
EHR-deprived providers and data analysts via web-connected devices. First, an RMHP providers’ EHR outputs a CCR after a
patient encounter. Second, the SmartPHR retrieves and consolidates the CCR via CONNECT. Third, a Denver Health Medical
Center oncologist accesses the SmartPHR and updates the cancer careplan. Last, the SmartPHR returns an updated CCR to the
repository for import to authorized providers’ EHRs.

Global Medical Data Exchange

Palmetto Primary Care
Electronic Health Network will demonstrate how medical data can be exchanged on a global scale using Cisco MDES and
CONNECT. EHN will show patient data being exchanged between Palmetto Primary Care Physician (PPCP) Specialists and a
European physician. Second, EHN will show how the same patient’s data can be shared with an epSOS compliant EMR if an
American requires care while in Europe. The use case will illustrate a bi-directional exchange of medical data between providers
from local to an international level using epSOS and CONNECT. The demonstration’s overarching goal is to illustrate that the
Nationwide Health Information Network can have access to American patient records established in both the U.S. and Europe.

Electronic Submission of Medical Documentation (esMD) to Medicare

Centers for Medicare & Medicaid Services
During this presentation, participants will learn about the Electronic Submission of Medical Documentation (esMD) pilot. This
pilot will allow medical providers to send unstructured medical documentation (PDF and TIFF) through a Nationwide Health
Information Network Exchange gateway to selected Medicare or Medicaid review contractors looking for improper payments.
Participants will learn which health information handlers have been approved by CMS to offer esMD gateway services to
providers. Participants will also learn which review contractors plan to receive esMD transactions.

ONC Office of Interoperability and Standards Office of the National Coordinator for Health Information Technology Website
330 C St, SW, 1st Floor, Washington, D.C. 20201 Department of Health and Human Services http://healthit.gov
200 Independence Ave. SW, Suite 729-D, Washington, D.C. 20201