"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

Last week I was on a call with one of our sales team. The call was with a major healthcare organization, who I won’t name but suffice it to say you would recognize them not only by name, but also by their having an extremely large EHR installation. Up front our sales guy asked why they were interested in talking with Cielo, leaving unsaid the obvious point that they are big EHR users. What came back was remarkable: We’re asking ourselves some questions... How does or could a registry fit into our care process? Does or would this have value for our physicians? Could we roll up the data from our various practices and what value would that have? What was remarkable was what was missing, namely the technical types of details like: do you interface with XYZ, can you do reporting for ABC, etc. Instead this group was squarely focused on how a registry might positively impact care delivery, improve the work of their clinicians and provide the ability to look at data across the organization. While we could certainly argue about the details, I think that if a product like ours can’t provide those features, you should move on to another option. These sound exactly like the principles we had in mind when we started building Cielo. It’s great to hear insightful questions from the marketplace, especially from such a large organization. It makes me hopeful about where we are headed in general with health information technology, and it validates what we’re trying to do here at Cielo. Don Nease, MD Chief Medical Officer Cielo MedSolutions, LLC

Anyone remember those old SAT questions: "Hand is to palm as foot is to ____?" Reading the recent paper (1) in April’s Health Affairs detailing one group’s struggle with their EHR and their efforts to implement a medical home made me think of this. Bear with me... If you haven’t had a chance to read it or can’t access the full article, the abstract gives you the idea. Quite simply, rather than finding that their EHR enhanced or facilitated their medical home their experience was that the technology got in the way. This is consistent with the findings of the UMDNJ group which was published in the March/April issue of the Annals of Family Medicine (2). Technology, i.e. EHR’s, was not positively associated with high Patient Centered Medical Home scores. What’s going on here? Aren’t EHR’s and HIT critical to PCMH? Yes, they should be, but they haven’t been designed for that purpose. To quote Fernandopulle and Patel: “Our system and others like it seem primarily driven by the imperative to allow doctors to document, code, and bill visits at a more intensive—and thus higher-paying—level. Although these features allow for increased practice revenue in a fee- for-service setting, they do nothing to improve care. Indeed, they lead to notes that are cluttered with marginally useful pieces of information to support a higher charge, but relatively little useful clinical information to improve future care.” Now to the iPad... I’m in the camp that believes the iPad represents a significant advance in our use of information technology. Just over a week into sales, Apple is on track to sell a million iPad’s sometime this week. The key to this success, I believe, is that Apple started with a clean slate in moving to the tablet form factor. They had the courage to not try to morph their existing MacOS X desktop metaphor to the tablet. Starting from a clean slate is exactly what we’ll be doing over the next few months. We’re beginning to build our next generation product, which I firmly believe will facilitate quality patient care and medical homes in ways which EHR’s have so far been unsuccessful. Some of you will have the opportunity to give us input as we move forward with our work, and I’m really looking forward to hearing from you. Now for the punch line... Back to the SAT analogy question... The desktop computer is to the iPad as Cielo Clinic is to ________? Stay tuned!!! Don Nease, MD Chief Medical Officer Cielo MedSolutions, LLC (1) Fernandopulle and Patel. How the electronic health record did not measure up to the demands of our medical home practice. Health Aff (2010) vol. 29 (4) pp. 622-8 (2) Ferrante et al. Principles of the patient-centered medical home and preventive services delivery. Annals of Family Medicine (2010) vol. 8 (2) pp. 108-16