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February 24, 2020

EMI Advisors LLC partners with Integrating the Health Enterprise on ONC/IHE USA Cooperative Agreement

EMI Advisors LLC has partnered with the Integrating the Health Enterprise (IHE) USA on the Office of the National Coordinator for Health Information Technology (ONC) and IHE USA Cooperative Agreement. ONC and IHE USA are collaborating to accelerate the creation of new and updated IHE profiles to support the use of the HL7® FHIR® (Fast Healthcare Interoperability Resources) standard.

IHE Profiles provide a common language for purchasers and vendors to define the integration needs of health care sites and the integration capabilities of healthcare IT products. They provide health care professionals seeking to acquire or upgrade systems a convenient, reliable tool that reduces the cost and anxiety of implementing interoperable systems by providing a way to specify a level of compliance to standards sufficient to achieve truly efficient interoperability.

EMI Advisors, LLC (EMI) will take part in this agreement by providing program management and policy assistance in developing profiles that utilize FHIR and that are being deployed and implemented across a variety of national and international based data interoperability initiatives.

“ONC and IHE are instrumental in bringing together key stakeholders, including clinical providers, payers, and data interoperability standards experts, to guide the business and clinical requirements for the standards development and adoption process. Through this Cooperative Agreement, both organizations will help to unify stakeholder efforts for real-world standards testing and implementation,” said Evelyn Gallego, CEO of EMI. “EMI is proud to help advance this partnership between ONC and IHE.”

Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, President of IHE USA sees the collaboration between ONC, IHE USA, EMI Advisors and other key project partners as an important illustration of the work on the ground being done to move the nation and globe towards achieving health IT policy goals. “The Office of the National Coordinator notes that the consistent implementation of established standards within health IT systems is necessary to achieve interoperability among healthcare providers. This collaboration will quickly broaden IHE’s offering of profiles to include the consistent implementation of popular health standards for more effective, secure and interoperable exchange of health data.”

January 24, 2020

EMI Advisors LLC Partners With Cognitive Medical Systems In Securing a Prime Contract

EMI Advisors LLC has joined Cognitive Medical Systems, in securing a National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) prime contract.

EMI Advisors LLC, a boutique consulting firm that specializes in assisting public and private clients bridge the gap between health and human services policies, technology innovation, and business requirements, will serve as Cognitive’s key partner on this important initiative.

“The standards development community has made significant strides in developing and publishing robust health data standards to support interoperable data exchange,” said Evelyn Gallego, CEO of EMI Advisors.

“We are at a pivotal point to expand on this work to enable person-centered e-care planning for individuals living with multiple chronic diseases. We are delighted to partner with Cognitive and support NIDDK in the development and testing of a FHIR enabled e-Care Plan.”

Cognitive Medical Systems will direct the efforts for NIDDK’s Health Information Center to build electronic common data element models and profiles that describe key concepts related to kidney and other chronic diseases. Evelyn Gallego will serve as Standards Development Organization (SDO) liaison and Katiya Shell, Project Manager at EMI Advisors, will provide SDO coordination.

Fast Healthcare Interoperability Resources (FHIR) is the draft standard for health data formats and elements, with great interoperability potential. It is also an application programming interface (API) and has become one of the most popular protocols for health information exchange between disparate systems and data. Under this project, Cognitive’s team will utilize FHIR to develop a comprehensive Implementation Guide for NIDDK’s e-Care plan, and then create applications and pilots to demonstrate that the standard and toolsets enable clinicians to better manage patients with multiple chronic conditions (MCC), including chronic kidney disease, Type 2 diabetes, cardiovascular disease, and pain.

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December 16, 2019

Why Data Standards Matter for SDOH integration in Clinical Care: A Trajectory of the Gravity Project

Evelyn Gallego
CEO & Founder

As the EMI team closes out 2019, I want to reflect on what a phenomenal year this has been for all things related to social determinants of health (SDOH).

EMI as bridge to SDOH future

Addressing whole-person care as part of the clinical care model is becoming a top priority for stakeholders across the health ecosystem.  Investments in mobile clinics, housing supports, and food and transportation benefits consistently demonstrate an impact on overall well-being while reducing health care-related costs.  The outcomes of these interventions, coupled with the growing number of “calls to action” for health systems to play a more prominent role in reducing patient social risk, underscore the importance of designing and implementing SDOH-related programs, policies, and supporting technologies.

Yet we remain behind the curve. Current technical barriers to integrating SDOH data into the health care system fall into four key areas:

  1. Data Definitions. There is no agreement on terms and definitions for SDOH concepts regardless if they are captured in clinical or community-based settings. This lack of shared knowledge across sectors makes data less meaningful and useful, and ultimately promotes siloed work processes.
  2. Coding Gaps. For SDOH data to have shared meaning across sectors and thereby be ‘interoperable’ it needs to be represented using publicly available value sets and coding vocabularies. Existing coding gaps and overlaps inhibit the ability to document specific SDOH activities in clinical settings.
  3. Disparate Data Collection in Electronic Health Records (EHRs)Many health systems using certified EHRs are collecting some SDOH data but do so inconsistently and with variation. Most EHRs support screening activities but remain limited in how they use or integrate with community referral platforms.
  4. Misaligned Guidance and Incentives. Current SDOH innovations at scale are bolstered by new value-based payment models and accountable care organizations (ACOs) focused on enhanced data and analytics. However, state and local health systems remain dependent on federal financing to effectively navigate and coordinate fragmented and complex SDOH programs.

A critical first step in addressing these data gaps is achieving consensus on the relative data definitions regardless of the data capture system: enter the Gravity Project.

What is the Gravity Project?

Initiated by the Social Interventions Research and Evaluation Network (SIREN), with funding from the Robert Wood Johnson Foundation and in partnership with EMI Advisors LLC, the Gravity Project is a multi-stakeholder public collaborative of 800+ participants focused on developing, testing, and validating standardized SDOH data for use in patient care, care coordination between health and human services sectors, population health management, public health, value-based payment, and clinical research.

The Gravity Project is a direct response to multi-stakeholder recommendations and calls to action around creating national standards for representing SDOH data in EHRs. The eventual standards need to be able to support both:

Why do We Need Data Standards for SDOH? 

SDOH by definition are the conditions in which people are born, live, work, and age. SDOH encompasses all the elements needed for whole-person care. It is well documented that taking these conditions into account is critical to improving both primary prevention and the treatment of acute and chronic illnesses.

The recent National Academy of Sciences report on integrating social care into health care delivery acknowledges that the current shift to value-based payment models provides the necessary incentive for the health care sector to move beyond acute care delivery. This shift requires systems to incorporate and use standardized data sources beyond what is available in electronic health records (EHRs).

Health systems need to capture standardized SDOH data to:

  • Promote data collection and improve data usage. Coded data facilitates clinical and administrative decision making and quality improvement.
  • Facilitate the sharing of data across organizations. For data interoperability across and in between health care and social services systems, data needs to be accessed, shared, and exchanged using consensus-based and open standards.
  • Facilitate payment for social risk and social needs data collection and intervention activities. Coded data is used to design payment models, process claims for reimbursement, and monitor resource utilization.

Laying the Foundation

As the Gravity Project works to define and test coded data elements for key SDOH domains and create open application programming interfaces (APIs) using the HL7 Fast Health Interoperability Resource (FHIR), we are setting the groundwork needed to facilitate social care integration in health systems.

The foundation is laid but there is still much work to do. All health care and social service stakeholders—from clinical providers, community-based providers, EHR vendors, referral platforms, government organizations, research entities, and digital platforms—are encouraged to join Gravity and help us design the digital infrastructure of the future.

It takes a village.

To learn more about the Gravity Project, contact

To learn how EMI Advisors can support your digital health strategy, contact


Evelyn Gallego

Evelyn Gallego, MBA, MPH, CPHIMS
CEO & Founder, EMI Advisors LLC

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May 2, 2019

EMI Advisors, LLC announces the launch of the Gravity Project: A National Collaborative to Advance Interoperable Social Risk and Protective Factors Documentation

With mounting interest around collecting and using social risk and protective factor data in health care settings, new challenges have emerged related to the capacity of existing medical terminology standards to effectively capture the necessary data. With funding from the Robert Wood Johnson Foundation and in partnership with the Social Interventions Research and Evaluation Network (SIREN), EMI Advisors, LLC has launched the Gravity Project, a national collaborative effort to help reduce barriers to interoperable social risk and protective factors documentation.

The Gravity Project will convene a public collaborative process from May to December 2019 to accomplish the following goals for the social domains of food security, housing stability and quality, and transportation access:
1. Develop use cases related to documenting social risk and protective factors data on screening, diagnosis, planning, and treatment/intervention activities;
2. Identify common data elements and their associated value sets to support the uses cases;
3. Develop a consensus-based set of code recommendations for capturing and grouping these data elements for interoperable electronic exchange and aggregation; and
4. Initiate an HL7® Fast Health Interoperability Resource (FHIR®) Implementation Guide based on the defined use cases and associated data sets.

Participation in the Gravity Project is open to all interested organizations and individuals.

The Gravity Project kickoff meeting will be held Thursday, May 2 from 4:00-5:00pm Eastern (1:00-2:00pm Pacific). Pre-registration is required. Click here to register for the kickoff meeting.

Project workgroup meetings will be held weekly on Thursdays from 4:00-5:00pm Eastern (1:00-2:00pm Pacific) beginning May 9, 2019. To join the Gravity Project and be included on the listserv, sign up here.

To learn more about the project and review project documentation, please visit the HL7 Gravity Project Confluence wiki.

Links to previous SIREN work on this topic, funded by Kaiser Permanente:
SIREN’s compendium of existing social determinants of health-related codes.
Documenting social determinants of health-related clinical activities using standardized medical vocabularies. JAMIA Open, December 2018.

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January 8, 2019

EMI awarded National Institutes of Health Information Technology Acquisition and Assessment Center’s CIO-SP3 IDIQ Contract

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November 6, 2018

EMI awarded contract to facilitate the development of SDOH standards in Electronic Health Records

EMI awarded the contract to advance standardization of Social Determinants of Health (SDOH) value sets within electronic health records on behalf of SIREN at the University of California in San Francisco.

SIREN’s mission is to catalyze and disseminate high-quality research that advances efforts to address social determinants of health (SDH) in healthcare settings.

SIREN projects are focused on:

Catalyzing high-quality research to fill evidence gaps through an innovation grants program and support for researchers in this field; Collecting, summarizing, and disseminating research resources and findings to researchers and other industry stakeholders via an interactive website and evidence library, reports, and meetings and presentations;
Increasing capacity to evaluate SDH interventions by providing evaluation, research, and analytics consultation services to safety-net and mission-aligned health systems.
The Network is supported by Kaiser Permanente and the Robert Wood Johnson Foundation and housed at the Center for Health and Community at the University of California, San Francisco.