"Welcome to our company blog. Within these blog posts, we hope to share our insights on clinical quality management, the patient-centered medical home, chronic disease management in primary care, evidence-based medicine, and the use of technology in ambulatory care settings."

- David Morin, CEO and Donald Nease Jr., MD, Chief Medical Officer

It's not a registry! Better said, a Clinical Quality Management System, (CQMS) is more than a registry. Registries traditionally have been database tools built to track patients with chronic conditions. The idea was to take your group of patients with severe diabetes, heart failure, (insert chronic disease of choice here) and track them. How often are they seen? What's the status of their key measures? When did the last have their diabetic foot exam? Embedded in the above are a couple of assumptions... First, you've gotta assemble that list of patients. How you do it is huge. Do you do assemble it in the course of delivering care? Hey Maggie! Ms. Smith is really struggling with her asthma. Let's put her into the registry so we can track her more closely. That works, but man it's slow! Do you assemble the registry with billing data? (insert giant sucking sound here) Hoover up some billing data and you've got it, right? After all that's what the payors do to assemble those lists they send us, and we all know how accurate they are. Do you include all 250.xx? How did that patient get into the registry? They've just got glucose intolerance. You get my point. Second, once you've got that list, now you've gotta do something with them. Reporting! This is the golden deliverable of a registry. Give me the list of everyone that patients that are due for their diabetic foot exams! Oh crap! I just saw Mr. Powell, and he needed one. Reporting is great, but it doesn't do much for you when you are in the middle of patient care. The other big problem with reporting is you gotta capture the data that you want in the registry and get it into the registry. This is the "Oh crap! I just DID Mr. Powell's foot exam but I forgot to record it for the registry" problem. Registries require a lot of care and feeding. How is a CQMS different? It contains a registry, but an all-problem, clinician-verified registry. You don't decide how to populate it because you are building it every time you see a patient by recording, updating and correcting their problem list. A CQMS also should be able to deliver reports, but it should also give you something to act on when those patients come in. Mr. Powell, I see here on my Encounter Form that your due for your foot exam, so let's do that today. A CQMS should also be able to receive information from other data sources so you don't have to spend valuable time feeding it. Finally, we believe that a CQMS should integrate into your entire care delivery team. It does that by offering value to every member of the team. Clinicians get their encounter forms with reminders, Nurses get call lists of items that need attention, and administrative staff get reporting of quality measures tell more than the percentage of patients needing services. A CQMS isn't a registry, it's a whole lot more. You'll be hearing more from us on this. Stay tuned! Don Nease, MD Cielo MedSolutions' Chief Medical Officer

Even as veteran tech entrepreneurs and business-builders, it’s safe to say that none of the top business people at Cielo –- neither Dave Morin nor Chris King nor I (http://www.cielomedsolutions.com/about-leadership.asp) –- is in love with technology for its own sake. Yeah, all three of us have built our respective business careers around solving tough problems using technology, some of it pretty super-wazoo stuff. But one thing we’re always in agreement about is, “The technology is never the point!” In fact, here’s the way I’d put it: At Cielo, one important thing we have in common is that we like to identify large, unsolved customer problems that have potential to be solved by intelligently applying existing, proven, off-the-shelf technology. That way, there’s no technology risk associated with developing and implementing the new solution! In addition, we believe in the principle that our customers are doing what they’re currently doing for a good reason – that they tend to know what they’re doing. Corollary: the greater the extent to which a company’s “solution” to the customer’s problem requires the customer to change the way they currently do things –- to alter their workflow –- the less likely that company is to succeed in selling their product into their target market. Sounds logical, eh? Jim Price Chairman & Cofounder Cielo MedSolutions (www.cielomedsolutions.com)

When Dave Morin (http://www.cielomedsolutions.com/about-leadership.asp) and I launched Cielo MedSolutions in 2005, we got lots of advice from lots of smart people. In retrospect, perhaps more than we needed. Some of it came from the smartest folks in the business universe (by their own assessment), namely, venture capitalists. A number of VCs told us, in so many words, that we’d be idiots to build a business providing application software (or software-as-a-service, SaaS, which is the direction we ended up going) for primary care physicians. Why? Well, they pointed out that these docs worked in small practices, made little money, spent even less, were Luddites (neither appreciating nor understanding technology), yada, yada. Said we’d die a death of a thousand paper cuts selling software door-to-door. Overall, a pretty condescending attitude toward the primary care medical profession. At the end of the day, the investor-types pointed to a circular argument: since they couldn’t identify any big, successful companies built on selling IT to the primary care medical profession, there would never BE such a company. (These VCs were probably cousins of the same bunch who, in the late 90’s, were saying “…I’d never invest in Sergey and Larry… they’re just kids... no business experience… dumb branding... Google’s such an obviously silly name… unproven business model…”) So what did Dave and I do? We launched Cielo despite the naysayers. We found dedicated, engaged customers in the primary care community -- in large health systems and small clinics, in for-profit practices and free clinics (http://www.cielomedsolutions.com/education-success.asp). And we landed our investment capital elsewhere (http://www.cielomedsolutions.com/news-pr.asp). And we proceed to build a pretty cool company (www.cielomedsolutions.com). The sweetest revenge is success ;~). Jim Price Chairman & Cofounder Cielo MedSolutions (www.cielomedsolutions.com)

I found Dr. Don Nease's recently posted article on the potential of EMRs to impact prevention and early detection quite informative. We agree that there is great value in an EMR, but also agree with Dr. Nease's views as our customers and prospects come to us talking about the gaps in functionality in areas of prevention, screening and chronic disease management. Cielo Clinic fills that gap and works alongside your EMR, bringing better overall value to your entire health information technology investments. Read at: http://www.preventcancer.org/iDialogue/ Dave Morin CEO Cielo MedSolutions

As of late, I've been on a lot sales calls pertaining to the immediate need for a "chronic disease management system" or a "registry". It's great to see that providers and practices are finding they need technology like ours (Cielo Clinic). But, I'm seeing two consistent issues in the approach to selecting a system that concern me. First is the inability of the prospective customer to document the true clinical and/or business problem to be solved (ensure providers maintain compliance with evidence-based guidelines, build a database of actionable clinical information to improve quality or increase the efficiency of a patient visit, as examples). The problem certainly is not the need for more technology systems to support! What we normally hear is " my payor said I need a registry to participate in their pay-for-performance program". Yes, if your payor says you need a system and there is financial incentive to do it, you should find one. But, what are the goals of the pay-for-performance program? What system features do you need to support these goals? What is required from the system to fit into your workflow and be usable by providers and staff? What do you need to ensure your solution takes you into the future (in other words, "what's next"?). What do you need to track and report on? Second is the assumption that the technology, by vitrue of its implementation, is the solution to the problem. The overlay of a technology on a workflow that can't take advantage of it, support it or understand it is a classic recipe for more problems. The technology is not the solution, it's the effective use of the technology that brings the benefit. These issues transcend health care - as a former technology consultant I've seen these same issues in a variety of industries. I've also seen the disappointment of many a technology purchaser when they find their system doesn't meet their needs, frustrates their staff and just leads to more cost. Cielo Clinic delivers a wealth of benefits to a primary care practice. When we call on you, tell us what you true clinical and business needs are; we love to discuss and analyze them and we are confident we will meet them! Dave Morin CEO Cielo MedSolutions