MIDI in my mind is unfortunately incomplete, or rather, makes a lot of assumptions that are great for contemporary western music, but buckle under the strain of other ideas. I've seen some really great early music (1200s?) MIDIs put together by doctorates, and to simulate the early instruments, each note is hand tuned (or perhaps re-tuned using software, I'm not sure). Those instruments were not diatonic. Additionall…
It's used to change around the default MIDI scale, so that you can play with early scales or even scales from other cultures. It's really cool if you get it working with your keyboard. Unfortunately, there's not a lot of software that supports it, although I think Logic Pro did at some point.