Cielo MedSolutions’ Company Blog

The Advisory Board Company Announces Acquisition of Population Management Analytics and Patient Registry Software Company Cielo MedSolutions

2011-02-05T15:54:00.003-05:00

We're very proud to announce our acquisition by The Advisory Board Company (Washington D.C.).

An except from The Advisory Board Company's February 3, 2011 Press Release entitled "Company Reports Quarterly Revenue Growth of 23.5% and Contract Value Growth of 18.3%; Issues Guidance for Calendar Year 2011; Announces Acquisition of Population Management Analytics and Patient Registry Software Company"

...The Company also announced the acquisition, as of February 1, 2011, of Cielo MedSolutions, a leading provider of population management analytics and patient registry software in the ambulatory environment. The cash transaction enhances The Advisory Board Company's existing suite of physician performance management solutions through the addition of analytics and workflow tools that give providers visibility across a patient population to enable appropriate clinical decisions.

Robert Musslewhite commented, "We are excited to add Cielo's outstanding tools to our portfolio and the talented Cielo team to the Advisory Board. As the market moves towards value-based payment structures, there is increasing urgency for physicians practicing at hospitals and health systems to understand care provided to their patients across all settings. The addition of Cielo to the portfolio allows us to provide these population management analytics and patient registry capabilities in a physician-friendly interface through the Crimson platform. In addition, as our members build capabilities to manage patients across the full continuum of care and work with us to develop the structures to do so--for example through our Medical Home Collaborative, now more than 200 hospitals strong--Cielo's solutions will also provide key value to them."

Cielo's Chief Executive Officer David Morin added, "The Advisory Board's Crimson platform, deep knowledge base of best practices, and network of over 2,900 members provides the ideal environment to leverage the strengths and capabilities of the Cielo tool. I--along with the entire Cielo team--am thrilled to join forces with the Advisory Board to enhance our impact on physician practice across care settings. We are excited about the large market opportunity ahead of us and the new ways we will work together to help members provide greater value in patient care."Mr. Musslewhite concluded, "We are very excited about the acquisition and the opportunities to incorporate Cielo into our work. Hospitals and physicians look to us as their solution for physician performance, and since patient registry is a key tool that they use, the addition of this functionality to our portfolio will greatly enhance our ability to serve member needs in this terrain."

Dave Morin

Mercy Family Care - Marysville

2010-12-13T15:29:00.001-05:00

At the last Blue Cross Blue Shield of Michigan quarterly Physician Group Incentive Plan meeting (Dec 2010), one of our customers, Mercy Family Care - Marysville, presented on their use of Cielo Clinic and the quality, efficiency and financial gains they have seen from using it.

In this presentation, the care team shows how Cielo fits into their workflow, how a diabetes educator is using the product in coordination with the care team and how patients are educated through the tool. It also provides specific detail on key measure quality improvement and the additional dollars gained by using the program for quality and managed care programs ($80,000+ for 3 physicians!) .

Click here to see a link to the presentation and congratulations to the Mercy Family Care - Marysville team!

Dave Morin
Co-Founder and CEO
Cielo MedSolutions

2,000,000 Patients Served....

2010-12-07T19:28:00.000-05:00

Cielo Clinic has reached a new milestone, it has now served up over 2,000,000 patient encounter forms. That means over 2,000,000 patient visits have used Cielo Clinic for care reminders, problem lists and care documentation.

Quite a milestone and many more to come!

Dave Morin
Co-Founder and CEO
Cielo MedSolutions

Cielo's Phase II STTR

2010-11-17T22:17:00.000-05:00

We are proud to announce that we have been awarded a $1.3 million Phase II STTR from the National Cancer Institute to develop and prototype a next-generation clinical quality management system.

This award is a follow-on to our previous Phase I project. In the Phase I we studied and documented what technology primary care practices and providers need for disease management and quality improvement. In this Phase II project, we will be developing and prototyping a system that meets these needs. As was the case in Phase I, we are teaming with the University of Michigan Health System Department of Family Medicine on the project.

We are also very proud of the perfect score we received on the grant. We think this is a testament to the need of our work.

We'll be working with lots of great people on this and involving many in the healthcare community. We look forward to showing you what we come up with with!

For more information on the grant, click here.

Dave Morin
Co-Founder and CEO
Cielo MedSolutions

Cielo Clinic and Behavioral Health

2010-11-05T10:47:00.001-04:00

A 2006 report by the National Association of State Mental Health Program Directors has shown that behavioral health patients die 25 years earlier than the general population. There's strong evidence that this is due to the lack of attention to primary health problems and risk factors in these patients.

To support care collaboration between primary and behavioral health providers on behavioral health patients, Cielo is working with the National Council for Community Behavioral Healthcare, the oldest and largest national community behavioral healthcare advocacy organization in the country, to implement Cielo Clinic.

Through a series of projects, pairs of practices (a pair being one community health center or primary care practice and one behavioral health clinic) will utilize Cielo Clinic to provide both point-of-care reminders for behavioral and primary care health matters and population management. Regardless of which provider a patient sees, their encompassing care needs will be presented to the provider seeing them.

As a part of this project, Cielo has developed specialized synchronization software that will keep each Cielo database in synch for data changes. So, when a diabetes prompt is answered by a behavioral health provider, the primary care provider will get the info about what was done, and vice-versa.

These projects span across the United States and they are a great testament to the power of a clinical quality management system for care coordination and use outside of primary care.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

Oakland Southfield Physicians Group Featured in AHRQ's Effective Health Care Program Publication

2010-09-28T11:14:00.001-04:00

The Agency for Healthcare Research and Quality (AHRQ) today released a publication entitled "Registries for Evaluating Patient Outcomes: A User’s Guide, Second Edition", a compendium of best practices for registry use.

One of our longtime customers, Oakland Southfield Physicians Group (OSP), was featured in the document regarding their ability to integrate and exchange health information from multiple sources with Cielo Clinic. OSP has always done a superb job of interfacing a wide-range of data into Cielo's clinical data repository and their success with our product is testament to the value of doing this.

The story can be found here: http://www.effectivehealthcare.ahrq.gov/ehc/products/74/531/Registries%202nd%20ed%20final%20to%20Eisenberg%209-15-10.pdf (Page 269)

And, further detail can be found here:
http://www.ospdocs.com/OSP+Advantage/Clinical+Quality+Registry-21.html

Dave Morin

Co-Founder and CEO

Cielo MedSolutions

Clinical Data and Clinical Research

2010-08-12T09:57:00.003-04:00

If you happen to be attending the 2010 NAPCRG Conference in Seattle, be sure to listen in on Dr. Nease's (our CMO) presentation of his research (done in conjunction with other members of our Medical Advisory Board), chosen as an Extended Paper for the conference - "Are Coronary Heart Disease and Depression Independently Associated? A Primary Care Population-based Analysis." Donald Nease MD, University of Michigan; Denise Campbell-Scherer, MD; Lee Green, MD, MPH; Michael Klinkman, MD, MS; Ananda Sen, PhD.

Not only is it a fascinating paper on the linkages between CHD and Depression, but it also is a wonderful illustration of what can be done with a registry-type solution that collects true clinical data in a longitudinal matter (yes, this is referring to our product, Cielo Clinic, the tool that was used in this research).

Further narrative from Dr. Nease on the use of registry-type solutions for research can also be found in his recent posted comment on the Health Care Blog (the post is entitled "What's In an EHR?", Dr. Nease's thoughts are in a comment at the bottom of the post).

Dave Morin
Co-Founder and CEO
Cielo MedSolutions

ICPC, ICD and SNOMED-CT

2010-07-22T16:12:00.006-04:00

As we now know, meaningful use will require the use of either ICD-9 or SNOMED-CT for coding problem lists. As our customers know, there is a limit to the value of using ICD-9 coding for disease management (see these prior blog posts). Therefore, Cielo Clinic utilizes the ICPC classification system in addition to ICD-9 and ICD-10 coding, integrated into the ENCODE thesaurus, to provide the flexibility and specificity needed by care providers.

The World Health Organization (WHO) and the International Health Terminology Standards Development Organisation have announced that work is now underway to harmonize WHO classifications (this includes ICPC) with SNOMED-CT. This is great news for those using ICPC, including Cielo Clinic users. The value of ICPC can be preserved for disease management while allowing it to exist in a "meaningful use" world.

Dave Morin
Co-Founder and CEO
Cielo MedSolutions LLC

PQRI E-Prescribing Bonus Reimbursement

2010-06-24T09:03:00.004-04:00

Cielo Clinic is now approved to submit Physician Quality Reporting Initiative (PQRI) e-prescribing measures to the Centers for Medicare and Medicaid Services (CMS) on behalf of care providers. To take advantage of this opportunity, Cielo Clinic users simply need to implement the integrated e-prescribing module and e-prescribe through it. Cielo Clinic manages the data required for this incentive payment and submits it on a provider’s behalf to CMS.

This is in addition to Cielo's approval to submit PQRI quality measures.

Each of these submissions can result in an 2.0% reimbursement on total allowed charges for covered Medicare physician fee schedule services.

Dave Morin
CEO and Co-Founder

Cielo MedSolutions LLC

Welcome Jordan Washburn!

2010-06-01T10:06:00.002-04:00

Please welcome our latest team member, Jordan Washburn. Jordan will be taking on a Software Engineer role focused on user interface and software development for our Cielo Clinic products. Prior to Cielo, Jordan has worked at numerous web-based software companies and has an MS in Health Information Technology and a BS in Computational Linguistics, both from the University of Michigan.

Dave Morin
Co-Founder and CEO
Cielo MedSolutions LLC

Three great questions

2010-04-22T11:14:00.001-04:00

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

The SAT, iPad, EHR's and what's next

2010-04-11T20:31:00.001-04:00

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

Welcome our new CTO, Dale Hunscher

2010-03-28T21:48:00.002-04:00

I am very pleased to introduce the latest member of the Cielo team, Mr. Dale Hunscher. Dale is the company's new Chief Technology Officer and he brings a tremendous amount of expertise to the company.

Dale has spent over 25 years in software engineering and software design management roles. For the last seven years, he served in various healthcare informatics roles at the University of Michigan and was widely published during that time. Prior to the University, Dale was the CEO of an Ann Arbor software design company.

His blog, FutureHIT, examines the future of health information technology and is widely read in the healthcare informatics circles.

Dale's expertise in healthcare software design and architectures further ensures that Cielo will continue to lead the market in internet-delivered solutions for clinical quality management.

Dave Morin
Co-Founder and CEO
Cielo MedSolutions LLC

Continued Growth in 2009

2010-02-14T15:51:00.004-05:00

2009 provided Cielo with 100% growth, the third year of triple-digit growth by our company. Of course, we're proud of that. But more so, we're proud of what our customers are doing with Cielo Clinic - high-performing patient-centered medical homes, great increases in care quality, stronger pay-for-performance reimbursements. This is the greatest testament we share on the power of our product.

Dave Morin
Co-Founder and CEO
Cielo MedSolutions LLC

A Medical Home in Action

2010-01-25T17:19:00.000-05:00

If you are looking for some great examples of a high-performing patient-centered medical home implementation, the University of Michigan Health System Department of Family Medicine has published a few slide shows and articles on their implementation and their outcomes to-date. I mentioned one of these pieces in a prior blog post, but we get so many requests for examples I wanted to share it again, along with a new piece. Lots of great detail in both of them.

Article: Patient-Centered Medical Home

Slide Show: From Philosophy to Reality: Making our House a Home

Dave Morin
CEO and Co-Founder
Cielo MedSolutions LLC

PQRI Registry Submission is Working!

2010-01-06T14:30:00.002-05:00

We've now talked to many of the providers for whom, on their behalf, we submitted quality data to PQRI (via Cielo Clinic). All of the providers we have spoken with have received their reimbursement! Reimbursements have ranged from hundreds of dollars to thousands of dollars, but since it is a formula on allowed charges, of course the amounts will vary.

We've also received comments from people that have previously done the very-manual claims submission process for PQRI that registry submission is the "only way to go". Remember, just by using our product in the normal course of care delivery, we are taking care of capturing the data needed for reporting and, at the appropriate time, doing the data uploads. That's pretty simple and that's how it should be.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

Cielo's Partnership with DrFirst

2009-12-04T09:09:00.002-05:00

This is exciting. Through our partnership with DrFirst, our customers will be able to e-prescribe right from Cielo Clinic. Here's an example of what that means at the point-of-care:

Dr. Smith is seeing Pam Doe. Using Cielo Clinic on his laptop, he notices a reminder to prescribe a statin. So, on Pam's Cielo Clinic encounter form, he clicks on the eRx button. This automatically logs him into DrFirst, takes him to Pam Doe's eRx record in DrFirst and updates the eRx record with any changes (like an address change).

Dr. Smith prescribes the statin through DrFirst. He then goes back to Cielo Clinic, where that new prescribed drug is now on Pam's active medication list.

What didn't he do?

He didn't have to jump out of Cielo Clinic, log into Dr. First and find Pam Doe. He also didn't have to update DrFirst with any record changes and he didn't have to update Pam's medication list in Cielo Clinic.

For a busy doc seeing 30-40 patients a day, this is a significant time savings!

We really think this sort of integration is important. Just a simple interface won't do - that doesn't make your job easier at the point-of-care. A subtle but important difference that Cielo MedSolutions understands.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

Health Center Data Warehouses

2009-10-03T11:48:00.002-04:00

Nice piece published by the George Washington University School of Public Health and Health Services on data warehouses and quality improvement - "Health Center Data Warehouses: Opportunities and Challenges for Quality Improvement". The Michigan Primary Care Association is truly a leader in this concept and this paper highlights the pitfalls and promise of using a data warehouse for QI, a must-read if you considering this.

Dave Morin
Cielo MedSolutions

MyCareTeam

2009-09-17T04:00:00.000-04:00

To expand the reach of our registry into all areas of clinical care, I'm pleased to announce our latest partnership with MyCareTeam.

MyCareTeam is a Massachusetts-based company that has a wonderful, proven diabetes management product. Their product, MCT-Diabetes, allows patients to download data from their home glucose monitoring device into their web-based diabetes management tool. This web-based management tool then helps patients monitor their glucose, look at trends and build up a health record. This health record can be shared with care providers or uploaded to Google Health.

Our partnership will allow MCT-Diabetes to download this information right into a patient record in Cielo Clinic. So, a diabetic patient monitoring their glucose could, through MCT-Diabetes, send their information to their provider and this information would be seamlessly inserted into the patient's Cielo Clinic electronic health record. Our population management tools and decision support engine can then make use of this data to help with management. Great stuff for a Medical Home.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

Getting it Right

2009-09-16T14:46:00.002-04:00

Kudos to Joe Fortuna, chairman-elect of the healthcare division of the American Society of Quality, for speaking to the 21st Century Health Care Caucus of the U.S. House of Representatives on technolgy implementation in health care. Click for article

Joe stressed the importance of getting the business processes of a practice organized prior to implementing a new technology and ensuring the culture of the practice is ready for the new technology tool. I couldn't agree more. My 20+ years of experience in technology implementations has proven to me, over and over again, that a successful technology implementation is as much about the technology as it is about the organization's ability to adopt it -meaning it has clear definition about what it wants to accomplish, it's processes are streamlined (automating lousy processes only makes the lousiness go faster) and the people using the technology are engaged, ready to take advantage of the technology tool and willing to put in the effort to make it work.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

They briefed the caucus on the importance of proper preparation to ensure successful implementation of healthcare IT and emphasized the need to optimize the business processes and culture of provider organizations before deploying new information technologies.

Cielo’s HITECH Act Update, August 30, 2009

2009-08-30T16:28:00.005-04:00

Cielo MedSolutions now provides periodic email updates on the implementation of this Act and its impact on an ambulatory care practice. Below is our first update. If you'd like to be on the email list, simply let us know at info@cielomedsolutions.com.

Of course, the usual disclaimers are in place: this is a rapidly changing landscape as no final decisions have been made on the HITECH Act and views expressed in this document are only opinions.

SNOMED-CT is the Problem and Procedure Vocabulary

From the HIT Policy Committee, August 14, 2009, Report From Clinical Operations Workgroup update slides:

“Primary vocabulary standards:
· Clinical problems and procedures: SNOMED CT
· Drugs: RxNorm
· Ingredient allergies: UNII
· Lab tests: LOINC
· Units of measure: UCUM
· Administrative terminology: CAQH CORE and HIPAA”

From the HIT Policy Committee, August 14, 2009, Clinical Quality Workgroup: Progress Report update slides:

"· Multiple versions of measures to provide options
o 2011 – ICD 9 or SNOMED CT
o 2013 – ICD10 or SNOMED CT
o 2015 – SNOMED CT
· Can use internal codes using SNOMED CT expertise to map to SNOMED CT
· EHR certification should require problem list”

Views: it looks as though problem lists will ultimately need to be built with SNOMED CT versus ICD9 or ICD10 and the open question is the year it needs to be done. This could be a significant issue for systems that do not have a clinical thesaurus that can cross-reference problem terms across different vocabularies (in other words, a system needs to be able to know how an ICD9 or ICD10 code maps to a SNOMED code). In addition, registry and EMR systems that only utilize billing files for problem documentation may struggle with using an alternative coding system (problems will still come in from billing files only in ICD9). Because Cielo uses a clinical thesaurus (the ENCODE table mapped to ICD9, ICD10 and ICPC) and one of Cielo’s Medical Advisory Board members is leading a committee to map ICPC to SNOMED, this will not be an issue for Cielo Clinic.

Registries called out as key to ARRA

From the National Committee on Vital and Health Statistics Report of Hearing on “Meaningful Use” of Health Information Technology, April 28-29, 2009:

"Testifiers reported that the ability to get data out of EHRs easily – both for reporting and for creating panels of patients, is difficult with today’s EHRs. However, it was noted that in addition to embedding registry functionality in an EHR, such functionality (and others) may better be delivered through applications and services that are not part of a single all-encompassing application, such as population or disease registries."

Views: This testimony from industry leaders reinforces the growing sentiment that registry solutions are a very viable solution for meaningful use.

Modular Approach Available through EHR-M

From the HIT Policy Committee Review of Initial Recommendations by the Certification and Adoption Workgroup, Paul Egerman and Marc Probst, Intermountain Healthcare, August 14, 2009:

“Recommendation 4 – Flexible Software Sources - provide for certification of components so EHRs can be purchased from multiple sources”

Views: a registry can be certified via EHR-M. You will be able to assemble best of breed components from a variety of vendors to meet meaningful use. You will probably find this can be done at a total price-point lower than a monolith EMR. Cielo is assembling the best-of-breed products that, together, will be pre-interfaced and meet meaningful use.

Submissions Will be Electronic

“CMS noted that only measures that "can be submitted electronically" will be allowed.”

Source: CMS Sheds Light on Meaningful Use, HDM Breaking News, August 14, 2009

Views: electronic submission is good. We predict the constructs in place for registry reporting on PQRI will be used for meaningful use submissions. Therefore, a system already doing PQRI uploads, like Cielo Clinic, should have an advantage.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions LLC

Success!

2009-07-06T10:21:00.010-04:00

The success of a health care software product can be measured in many ways. As such, I'd like to point out two new stories that tell not only how our customers are using our product, but also reflect the ability of Cielo Clinic to impact care in very different care settings.

One

Jean Malouin MD, Assistant Chair, The University of Michigan Health System Department of Family Medicine, recently presented at the Blue Cross Blue Shield of Michigan Physicians Group Incentive Program Quarterly Meeting on the University's implementation of a Patient-Centered Medical Home (PCMH). In the presentation, she shares their PCMH implementation experiences and illustrates their population management strategies. This, of course, includes many references to their use of Cielo Clinic. I urge you to take a look, it's great educational material on how to implement a medical home and how Cielo can help. Click here to view the presentation from the the Blue Cross Blue Shield of Michigan web site, or click here to download them from this blog entry - /PGIP062009houseahome.pdf

Two

The Joy-Southfield Community Development Corporation runs a free clinic in the City of Detroit staffed by a wonderful group of people truly dedicated to better health care and community activism in the City. Check out their web site to learn more and if you can, please support them!

The free clinic uses Cielo Clinic to manage their patients' screening, prevention and chronic disease management needs. Recently, they completed a study on blood pressure control, hypertension management education and diagnostic profiling among African American women (the full study is described in the link below). Since installing Cielo Clinic (less than a year ago), they've posted some very impressive gains in care quality and the study tells the story! Blood pressure control among hypertensive patients is at 60% (the national goal is 50%). Hypertension management education access increased 143%. Patients with no lab profile is less than 5%. Great numbers, especially with a clinic staffed with volunteers. Much of this success is attributed to Cielo Clinic.

Click here to see their June 2009 Revitalizer Newsletter, which includes an article on the study - /JoySouthfieldRevitalizerJune2009.pdf

Summary

Our customer base consists of free clinics, federally qualified health centers, solo practitioners, group practices, rural providers, integrated health systems and academic health centers. In short, our product is being successfully in almost every conceivable care setting. There's lots of talk these days about usability testing for EHRs, I think the stories above and the breadth of our customer base reinforce what we hear over and over, Cielo fits into virtually any workflow, is simple to use, and drives results.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions LLC

Initial Lessons on Practice Transformation

2009-05-12T16:51:00.000-04:00

I haven't seen this covered in any of the daily health care newsletters I receive, but I certainly think it warrants great attention.

"Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home" is a paper published in the May/June 2009 edition of the Annals of Family Medicine. In it, the authors summarize the findings of the American Academy of Family Physicians' National Demonstration Project where a model of the patient-centered medical home was tested in 36 family practices across the US.

For anyone working toward or contemplating a Medical Home model, you really need to pay attention to the outlined Initial Lessons Learned and Practice Recommendations.

In summary, it shows that moving to a medical home is not easy, in fact, it's really hard to do. And it takes a huge commitment.

Regarding technology, there's a great quote in the paper "For example, it is possible and sometimes preferable to implement e-prescribing, local hospital system connections, evidence at the point-of-care, disease registries and interactive patient Web portals without an EMR." 1

In other words, Cielo Clinic with e-prescribing may be what you need for a medical home.

Cielo is a big proponent of the medical home model and our software supports what it requires. But, I also believe that the items in this paper regarding the transformation process are what's most important to consider if you are taking this journey.

I urge you to read this paper, it's in the Annals of Family Medicine, Vol 7, No 3, May/June 2009.

1 Annals of Family Medicine 7:254-260 (2009)

Dave Morin
CEO and Co-Founder
Cielo MedSolutions LLC

Great Story on the Impact of Billing Data

2009-04-13T13:22:00.000-04:00

A must-read by e-Patient Dave and his experience downloading his medical data from his hospital into Google Health.

http://e-patients.net/archives/2009/04/imagine-if-someone-had-been-managing-your-data-and-then-you-looked.html

And people still want to use billing data in their patient registry?

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

A Physician Group Focused on Quality

2009-04-07T09:00:00.000-04:00

Working and partnering with great physician groups is really important to Cielo MedSolutions.

Here’s a quick intro to our latest group:

Mercy~Physician Community PHO is a group of 31 primary care providers based in Port Huron, Michigan (a town about an hour north of Detroit). The PHO is led by Marianna Webb, their Executive Director and features a strong support team.

The PHO recently went through an extensive review of technology options and vendors to support their quality initiatives; specifically, Improving Performance in Practice (IPIP) and Physician Group Incentive Program (PGIP), a BlueCross BlueShield of Michigan pay-for-performance program. After that review, they selected Cielo Clinic as their clinical quality management system (registry, clinical decision support and population management).

The PHO will be using the product to track ALL chronic diseases, not just what’s required for their pay-for-performance programs, and utilizing centralized reporting to be proactive about screening, prevention and chronic disease management surveillance.

Interfaces are being put in place with their various other health information technology solutions. They have decided to adopt a train-the-trainer model and will have a PHO staff member training the practices on using the product. And, they will be measuring the impact Cielo Clinic is having on care quality.

Mercy~Physician Community PHO is doing all the right things to ensure success with our product. It’s wonderful to work with a group such as theirs that views quality improvement the way we do.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions LLC

Feedback on Data Integrity Issues

2009-03-29T15:43:00.000-04:00

It seems as if the interest level has risen rapidly on our argument that there are many shortcomings when using billing data and ICD9 for a quality improvement program. I've been involved in numerous discussions about this over the last month and they are, in general, in-line with our thoughts at Cielo; billing data and ICD9 are plain insufficient! Usually, the discussion is with a person that has already undertaken a quality improvement program and found this out after trying to work with their billing data.

To study this further, we are working with a few providers and comparing their billing files to their Cielo Clinic database to look at how a patient's diagnoses align in these two datasets. While I can't release our findings just yet, suffice to say the results of this work are eye-opening. Look for more to come from us on this topic.

FYI - I'd also recommend reading a very good article in the February 2009 article of Healthcare Informatics that discusses this topic.-

Dave Morin
CEO
Cielo MedSolutions LLC

Shortcomings of ICD9 and Billing Data for Clinical Quality Management Systems

2009-02-22T20:10:00.000-05:00

We were recently asked to summarize our thoughts on the shortcomings of ICD9 and billing data when used for diagnoses in clinical quality management systems. I thought I'd share our summary….

Specificity - ICD9, for many diagnoses, does not provide the required level of specificity required for evidence-based care guidelines. An example is asthma. ICD9 cannot differentiate between persistent asthma and intermittent asthma, an important distinction.

Scope – literature has documented that ICD9 can accurately represent approximately 50% of the conditions a primary care provider will encounter. When a condition cannot be properly documented, a provider must choose the “best fit”. This can be a major problem for clinical research and also affects the use of this data for care guidelines.

Accuracy – the needs of documentation for reimbursement leads to incorrect problem documentation. A common example is the need to document a diagnosis of asthma for a patient presenting with wheezing. If the patient is ultimately not asthmatic (which is usually the case), there is no way to “go back” and change their diagnosis on the billing data record. Therefore, when that billing data file is used in a registry, it inaccurately represents the asthmatic patient population. This inaccuracy can exceed 50%.

Completeness - Billing data does not document lifestyle issues like smoking and cannot capture clinical modifiers such as family history and risk factors. These elements are important for care guidelines and can be important data elements for clinical research.

We believe that these shortcomings are solved through the use of ICPC, the International Classification of Primary Care and through the use of clinician-verified diagnoses. A few prior blog entries talk about this and we'll be talking a fair bit more about it in the months ahead.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions LLC

The Road Traveled to PQRI Reporting

2009-01-15T21:18:00.000-05:00

I'm going to go out on a limb here and comment on a request we hear often:

"can we just use your registry to upload to CMS to get our PQRI money?"

Answer: yes, you can.

But, think about this. If you do the minimum 30 chart pulls, abstract the data, key it in and upload it, you're probably looking at about a $1,000 expense. And, I haven't budgeted for the software yet.

The average reimbursement from PQRI is $600.

Your and your staff's time is VERY expensive, and valuable.

Is this really the way you want to invest your time and money?

Now, if you use a clinical quality management system to manage all your patients for all their needs, you not only get PQRI $$s, you get the value of any other pay-for-performance program, you build the base for your patient-centered medical home, and you prepare yourself for any other quality program that comes in the future. Your patients are better cared for, your practice is operating more efficiently and you may just be generating more revenue in your practice as you keep your patients up to date on their screening, prevention and chronic disease management needs.

Shortcuts sound great, but they unfortunately don't work. And, in this case, I think they actually cost you more than doing things the right way.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions LLC

400% License Growth

2009-01-03T21:14:00.000-05:00

Happy New Year! I’m happy to report that we had a 400% growth in Cielo Clinic software licenses in 2008. In 2009, we will process our 1,000,000th patient encounter with our system.

This is great testimonial to the power of Cielo Clinic.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

What Diseases do you Support?

2008-12-23T21:09:00.000-05:00

A question we get asked a lot is "what diseases do you support?". The answer is : virtually all. This is the beauty of a table-driven rules engine (our rules engine is the technology that manages all the clinical guidelines you follow. Based on a patient's information, it generates reminders for their due services). All you do is fill out a web form; put in the diagnoses, co-morbid diagnoses or clinical indicators you want to build the guideline rule around and, voila, the guideline is in your system, ready to use. You can set a whole host of other attributes around the guideline, but again, you are just filling out a form. No programmer necessary!

Any disease management system that requires a programmer to "create the rule" is one that won't scale and will require dollars for support of that programmer each time a change is needed. "Next-generation" disease management systems are built with table-driven rules engines.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

Personal Health Records and Actionable Data

2008-12-04T21:03:00.000-05:00

Just read the executive summary of a great paper on the personal health record (iPHR) market written by Chilmark Research entitled "iPHR Market Report, Analysis and Trends of Internet-based Personal Health Records' Market". On page 1-13, the author notes that "iPHRs that serve simply as an online filing system for medical records will become irrelevant"1 and "adoption and ultimately ROI of iPHR solutions will be highly dependent on the ability of a given solution to deliver actionable information to the consumer promoting changes in behavior(s) that reduce health risk(s)."2

This fits nicely with our beliefs; a passive system that simply collects information is of limited use in healthcare. Technology must support the ability to drive positive change in the quality of care provided and must provide actionable data to help drive this change. Whether its in a clinical quality management system like Cielo Clinic or in a personal health record solution, this is a key attribute.

1, 2 Chilmark Research, "iPHR Market Report, Analysis and Trends of Internet-based Personal Health Records' Market", May 2008, pg. 1-13

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

International Classification of Primary Care

2008-11-24T15:17:00.000-05:00

If you've spoken to us in the past, you know we are ardent supporters of a classification system called the International Classification of Primary Care (ICPC). This system, we believe, does a much better job of documenting problems and reasons for encounter in primary care than ICD-9. It also provides an ability to create episode-of-care documentation.

Why would you use it? Well, for one, it will generate a more accurate problem list and allow you to be more effective in care delivery. Second, this accuracy will help you with pay-for-performance programs as we have found a more accurate problem list leads to better documentation and hence better pay-for-performance reporting. Third, accurate problem lists are the cornerstone of a patient-centered medical home and an ICD-9 problem list based on billing data is not an accurate problem list. Fourth, it provides a unique view into symptoms and problems - as documented here in "Characterizing Breast Symptoms in Family Practice".1

1 Eberl, Margaret M., Phillips, Robert L., Jr, Lamberts, Henk, Okkes, Inge, Mahoney, Martin C.Characterizing Breast Symptoms in Family PracticeAnn Fam Med 2008 6: 528-533

Dave Morin

CEO and Co-Founder

Cielo MedSolutions LLC

Use Cielo Clinic's Functionality Directly in an EMR or Physician Portal

2008-11-12T07:00:00.000-05:00

Today we announced something that we think is quite unique.

Many providers tell us that their electronic medical record system (EMR) or physician portal doesn't provide the chronic disease management functionality of Cielo Clinic and ask if we could "embed" Cielo Clinic into their existing technology solution to make it even more powerful.

Well, now we can! Cielo Clinic now provides an embeddable web service. For you non-techies, here's what this means:

Cielo Clinic's clinical decision support functionality can be integrated directly into another health IT application. (In other words, Cielo Clinic can run inside another application). This allows you to get evidence-based guideline clinical care reminders right inside your electronic medical record or physicial portal system. No need to utilize two separate applications to get care reminders!

We've already begun work with our first EMR vendor that wants to integrate our technology and have many more we are talking with. This is pretty unique stuff and we think it is important.

As we've said in the past, our goal is to make technology fit into your workflow and this certainly helps in that regard.

If you'd like to talk about how this can integrate into your EMR or physician portal, just give us a call or e-mail!

Dave Morin
CEO
Cielo MedSolutions LLC

2008-10-23T15:02:00.000-04:00

In case you missed it, please take a look at our letter to our colleagues:

Dear Colleagues,

The last few months have been quite busy here at Cielo MedSolutions. We continue to build a dynamic company that provides the very best technology solutions that are cost-effective, easy to implement, drive improvement and fit the needs of ambulatory care providers nationwide.
In parallel with growing our customer base by 450 percent this year, we've also achieved the following notable milestones:

Cielo Clinic Endorsed by TransforMED - Cielo MedSolutions and TransforMED are now Preferred Business Affiliates. TransforMED -a subsidiary of the American Academy of Family Physicians (AAFP)- provides support to primary care physicians and health systems that want to transform their practices into Patient-Centered Medical Homes. Cielo MedSolutions' customers will have access to TransforMED's practice transformation services, and TransforMED will encourage the use of Cielo Clinic's integrated patient registry, clinical decision support and population management tools by practices implementing a Patient-Centered Medical Home.
Cielo Selected for PQRI Reporting to CMS - Cielo Clinic has been designated by the Centers for Medicare and Medicaid Services (CMS) as qualified to submit quality data on behalf of eligible professionals for 2008 PQRI reporting. Providers can now directly upload their quality data to CMS for PQRI reporting using Cielo Clinic.
Cielo Awarded a National Cancer Institute Grant - We have been awarded a grant by the National Cancer Institute to study and design a next-generation chronic disease management system. This solidifies our research and development into the future needs of ambulatory care providers.
Cielo Studying LEAN Principles - Through our partner, Altarum Institute, we are studying and documenting the benefits of LEAN principles in relation to the use of Cielo Clinic. This work is being done at a customer site and the knowledge gleaned from it will translate into additional benefits for all Cielo Clinic users.
Cielo Participating in Innovation Study with Community Health Centers - Our hosting partner, the Michigan Primary Care Association, has been awarded a grant by HRSA to study innovation in the Community Health Center market. Four CHCs will be provided Cielo Clinic with tablet PCs and wireless networks to study disease management through the use of technology.
Cielo Success Story Published Online - One of the latest success stories on Cielo Clinic is featured in the Agency for Healthcare Research and Quality's Health Care Innovations Exchange (see http://cts.vresp.com/c/?CieloMedSolutions/6d4251a388/deec28db9b/0e2d81dc0c, keyword "cielo"), an online database of innovations that improve the delivery of care to patients. In this story, you will see how the University of Michigan Health System, Department of Family Medicine, managed thirteen quality measures to high levels of compliance using the product.
Cielo Drives Dramatically Higher Disease Screening Rates - The September 2008 issue of Medical Care, the journal of the American Public Health Association, includes a paper detailing a grant-funded study of using Cielo Clinic to improve colorectal cancer screening rates in twelve practices throughout the state of Michigan. Average screening rates at the beginning of the study were at 41.7 percent. By the end of the study, that rate had jumped to 66.5 percent.
Cielo Supporting Free Clinics - In support of our community, we are engaging with free clinics in the metro-Detroit area to improve care delivery to disparate populations and build a registry of clinical information on the uninsured.

In addition to the above achievements, we've also added a host of new functionality and a wealth of additional third-party interfaces to our software-as-a-service product offering. Much of this new functionality is a direct result of our customers' requests. And, we have an aggressive product roadmap and a new group pricing model, both of which we'd be happy to share with you.
Organizations work with us at Cielo MedSolutions not only for of our great technology, but also because of our dedication and our support for the overall success of their quality improvement initiatives. We continue to enhance our solutions by bringing together other technology partners, consultants and best practices to create turnkey solutions for successful pay-for-performance programs, patient-centered medical homes, quality improvement initiatives and clinical integration efforts.

Thank you for being a colleague of Cielo MedSolutions. Please stay tuned as we continue to build a dynamic company focused on the needs of ambulatory care providers. If you haven't had a chance to see Cielo Clinic in the last few months, I urge you to take a fresh look. Simply contact Mike Kleczka at 734-827-1000 x1 or mkleczka@cielomedsolutions.com.

Sincerely,

David J. Morin
CEO
Cielo MedSolutions LLC

It's all about the team!

2008-09-24T08:50:00.000-04:00

Those of you who have followed Cielo know our emphasis on not just providing excellent software to support primary care but also our deep belief that quality care is a team sport. That's why I'm so excited about our new partnership with TransforMED.

TransforMED (www.transformed.com) is a company that is linked closely to the American Academy of Family Physicians (AAFP) and efforts on the part of the specialty of Family Medicine to reform primary care practice along a team-based model of care. TransforMED began its work with a 2 year National Demonstration Project (NDP) during which it worked closely with practices across the country in an effort to both assist them in practice transformation, but to also learn from them what works. This work reaffirmed much of what is in the literature about primary care practices being complex systems, and needing a team approach. TransforMED is taking the lessons learned from the NDP to practices that are seeking to implement the Patient Centered Medical Home model endorsed by AAFP and other primary care specialty organizations.

Cielo's new business partnership with TransforMED affirms the common goals of our organizations to transform primary care practice around a new model of care with technology that is designed to support that new model.

Donald E. Nease, Jr, MD
Chief Medical Officer
Cielo MedSolutions, LLC

Patient-Centered Medical Home and the AAFP Scientific Assembly

2008-09-22T10:14:00.000-04:00

For me, a very solid theme emerged from the American Academy of Family Physicians (AAFP) Scientific Assembly. (Background: our team attended the Assembly, had a booth at the show and the management team had meetings with various industry leaders and Academy executives).

For primary care medicine, it's all about the Patient-Centered Medical Home. We engaged in more discussions on that topic with providers and practice staff than any other topic, by far.

I stopped by the TransforMED booth (TransforMED is a subsidiary of the AAFP and helps practices transform into Medical Homes) and heard from the TransforMED team that on the first day of the show alone they had more people stop by than during entire previous trade shows!

From the providers and practice staff that stopped by the Cielo booth - trepidation, excitement, confusion and a TON of questions. There is a lot of hope and a lot of valid concerns.

There is no doubt in my mind that this will be the topic of the upcoming year. That being said, I certainly see the need for leadership and education on the topic. There are large looming concerns (reimbursement is at the top) and they need to be addressed and managed now.

From a technology perspective, Cielo will deliver that leadership. We have very strong ideas that come from years of research completed by our Medical and Health Care Industry Advisory Boards and our own backgrounds in technology. Some of them are quite different (maybe a tad controversial) than what you are probably hearing, but they have been proven and they need to be talked about. Choosing the right underlying technology for a Medical Home is a critical decision. There are non-obvious issues that need to be understood.

Sadly, I can't even begin to count the number of providers that stopped by, told us their EMR can't support many of the elements of the Home and asked how we can help (we work alongside EMR and enhance it).

I/we would really welcome the opportunity to talk to you, either face-to-face, over a webinar or as a speaker at your next gathering, about our thoughts on technology for the Medical Home.

Dave Morin
CEO
Cielo MedSolutions

Cielo Clinic Qualified Registry for 2008 PQRI Reporting

2008-09-11T14:06:00.000-04:00

We are now officially qualified to submit quality data to CMS on behalf of eligible professionals for 2008 PQRI reporting. Our product, Cielo Clinic, went through two rounds of review by CMS and successfully submitted data during this review.

So, what does that mean for you?

Any Cielo Clinic customer may be able to submit data to the PQRI program for the year 2008.
Cielo Clinic customers need not use extra billing codes to capture the information required by PQRI, in fact, there is no additional data to collect outside of the normal information captured by our registry.
Cielo will work with customers to select the correct measures for submission.

There is much more to talk about regarding measures and reporting periods. Give us a call, we are happy to tell you much more about the program and how you can get started. This is a wonderful opportunity to take advantage of this pay-for-reporting program.

Chris King
Cielo MedSolutions

Computerized reminder system drove up colon cancer screening rates, U-M study found

2008-09-07T15:08:00.000-04:00

For those looking to adopt a clinical quality management system or registry, a new must read is available in Medical Care, September 2008 - "Impact of a Generalizable Reminder System on Colorectal Cancer Screening in Diverse Primary Care Practices: A Report From the Prompting and Reminding at Encounters for Prevention Project" (Medical Care. 46(9) Supplement 1:S68-S73, September 2008. Subscription required for fulltext).

This study, funded by the National Cancer Institute and Agency for Healthcare Research and Quality, implemented Clinfotracker (the technology on which Cielo Clinic is based) in 12 diverse practices in Michigan to drive improvement in colorectal cancer screening rates. An average 9% increase was achieved in just 9 months.

This paper studies the ability of a reminder system to improve care delivery and also reviews the ability of practices to adopt clinical technology. I think the second part of this study is just as important as the first part!

Dave Morin
CEO
Cielo MedSolutions

A Data Model for Quality Improvement

2008-08-26T17:40:00.000-04:00

If you are evaluating or researching the technology underpinnings of a medical home, you should take a look at wonderful piece (available on the internet) called "Health IT to Support the Patient-Centered Medical Home" authored by Michael Klinkman and Robert Phillips. This slide show accompanied recent testimony they gave to the National Committee on Vital and Health Statistics.

It's probably different than many of the other presentations you've seen on this topic, but what they have to say is very powerful.

Dave Morin
CEO
Cielo MedSolutions

Disclosure: Michael Klinkman is on the Medical Advisory Board of Cielo MedSolutions.

Our Grant from the National Cancer Institute

2008-08-07T15:31:00.000-04:00

We have begun work on our recently awarded grant from the National Institutes of Health, National Cancer Institute in partnership with the University of Michigan Health System Department of Family Medicine.

In this six month project we will be:

1. Investigating how, in existing implementations, Cielo Clinic impacts prevention and chronic disease care by examining changes in care delivery and clinical workflow, documenting the impact on patient, clinician and office staff satisfaction, gathering feedback from current end-users and researching current and future needs with regards to clinical quality improvement in primary and ambulatory care.

2. Designing a prototype of a next-generation clinical quality management system that is affordable and adoptable, built upon the principles of Cielo Clinic and tracks and manages activities and outcomes at all stages including screening, prevention, diagnosis and treatment, involving all care delivery participants, including patients and non-office care-givers, and delivers proactive prompts and reminders to clinicians regarding required services.

This is a very significant R&D opportunity for Cielo that will result in a state-of-the-art system that takes clinical quality management to a new level.

Dave Morin
CEO
Cielo MedSolutions

PQRI Data Submission Update

2008-07-27T17:33:00.000-04:00

I'm asked quite a lot about uploading clinical data directly to CMS to support the PQRI program. Along with the questions we often hear conjecture about the status of the project and what a provider can do. Today I will outline Cielo’s involvement in the programs.

CMS has put forward two programs related to Registries submitting data on behalf of practices for PQRI measurement. 1) 2008 PQRI Registry Test & 2) 2008 Registry-Based Data Submission. Cielo is involved in both the Test program as well as the Data Submission program. Goals of the Registry Test program are to validate a registries' ability to gather, calculate and report on PQRI quality measures. Goals for the Registry-Based Data Submission program are to enable physicians to participate in the 1.5% incentive payment portion of PQRI through an alternative reporting system (their Registry).

Cielo’s involvement in the two PQRI related projects:

PQRI Registry Test Program

The 2008 PQRI Registry Test program was initiated by CMS in early 2008. This program was a “test submission only” program in which no incentive payments were available. Cielo has been involved from the inception of this program including a meeting at CMS offices in Baltimore. As part of our test submission we captured, calculated and reported PQRI measure #1 (Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus). We were notified earlier this week that our first submission was validated without error and that we have met the requirements of the program.

Registry-Based Data Submission

In May of this year Cielo self-nominated to be accepted into the Registry-Based Data Submission program. There are NO approved vendors yet. Registries had until May 31 to submit their self-nomination and must go through an interview, documentation and testing process prior to the end of August. Around August 31, 2008 there will be an announcement from CMS listing the registries that qualify. Once selected a registry will be allowed to submit PQRI data to CMS in January and February 2009. Cielo has met all steps involved with this process and awaits an announcement of the selected vendors.

I think it should be noted, though, that there is quite a bit of "devil in the details" and would highly recommend reading about the projects at the CMS website. As usual, it’s never as easy as “just dropping in a registry”.

Chris King
Senior Vice President
Cielo MedSolutions

Health Care Software Delivery Through the Internet

2008-07-18T12:00:00.000-04:00

State-of-the-art software solutions are today architected as software-as-a-service ("SaaS"). This means the software solution is:

built from the ground up to be delivered via the internet - this is very different than a system delivered via application service provider ("asp"). An ASP-delivered system is one that wasn't built originally to support web delivery but is using additional technology overlayed on top of it to allow that to happen
hosted at a 3rd party data center
accessed by the user through a secure internet connection

If you utilize a SaaS product, what does it mean for you?

You don't need to buy additional hardware or systems software for your practice. You just need your PCs to be able to use an Internet browser and have Internet access.
You don't need to manage a server and its backups.
Updates are quickly available to you as they are simply installed by your vendor.
You'll get better tech and user support, as the vendor can securely get access to the system and its server.
Implementation is faster and easier because you don’t need to go through the effort of setting up all the hardware and doing all the installation of technology to use the product.

SaaS will certainly be the future delivery model for many software solutions. It eliminates many of the soft costs of a technology implementation (usually a 3:1 ratio relative to software costs - you will spend $3 on hardware, infrastructure, support, etc. for each $1 you spend on a software product) and ensures you keep current on the latest software release. For solutions such as Cielo Clinic, SaaS is the best way to get the product in a user's hands.

Dave Morin

CEO

Cielo MedSolutions LLC

Registries and Reminders - the Right Way to Implement

2008-07-08T00:32:00.000-04:00

Let's say you want to add a new point-of-care reminder to your registry, like lead screening for children in high-risk zip codes. You also want the value of that screening tracked in your registry, and if the result from the screening is out-of-range, add a "lead poisoning" condition to that patient's registry record.

If the generation of reminders from your registry is driven by a small computer program for each reminder, you'd ask your programmer to visit you and listen as to how this reminder needs to work. He/she would go back to their cubicle, figure out how to create the program, write it, test it, give it to you for final review and then get the new program out to everyone. Probably a couple of months effort end-to-end.

If the generation of reminders is driven through a rules engine that gets reminder information from a table, you'd just select the "Add New Reminder" button, fill in a few fields (just like you would fill out a form on any web site), click on "Save" and the new reminder rule would be in effect. Probably a couple of hour effort end-to-end.

I can't stress enough the importance of a table-driven rules engine (the second scenario described above). It certainly will save you a lot of money as you don't need to hire/pay a programmer for each reminder you want to generate.

More importantly, though, is gain from being able to implement reminders in a day - the sooner you can implement a reminder tied to a pay-for-performance program, the sooner you can start collecting on that program.

And, when reminders are really easy to implement, you'll find you can implement all sorts of them on a variety of conditions and really improve the care provided to your patients.

Dave Morin
CEO
Cielo MedSolutions

Ready for Healthcare Consumer Empowerment?

2008-06-30T14:46:00.000-04:00

Ready for Consumer Empowerment?

Back in the days when I was the Vice President of a publishing company, we started publishing email addresses of writers. People found this a very convenient way to write letters to the editors and writers and it was widely used. Many great e-conversations were had. But, there was also a very small group of people that wrote nasty, inflammatory emails to us. They wrote in ways they'd never converse with you face to face. It's very easy to be ridiculous when you are anonymous.

Consider that, in 2008, there are thousands of "rate my" sites out on the web, a ton of bloggers and the ability to post a comment on just about anything.

It's now coming to health care. Angie's List, Health 2.0, Rate my Doctor, etc… Anyone can post a comment about a provider or practice. 99% will be good and constructive. 1% will drive you crazy. They will be the ridiculous, anonymous ones that will write in manner that would not be expressed in a verbal conversation.

Someone having to wait an extra 5 minutes in a waiting room can tell the world about it. They don't care that you just had to deal with chest pain as a presenting condition for the patient before them, this person had to wait an extra 5 minutes and they're mad! I don't believe this wave will be stopped and I'm surprised it hadn't started sooner.

So, what can you do? Get ahead of the wave and go on the offense. Embrace the internet. Give people an outlet to communicate with you before flaming you on the web. Post your own statistics on your care delivery. Get people to post good and honest things about you .

Don't compromise your care delivery, but be cognizant of what's happening. You won't stop 'em all, but a little more interaction will go a very long way. And, you may find that the glowing reviews you will receive on the internet will be of great value.

Dave Morin
CEO
Cielo MedSolutions

Welcome PHRs!

2008-06-13T01:39:00.000-04:00

Type "personal health record" into your favorite search engine and you will be overwhelmed with the number of vendors offering such a solution.

I'm intrigued with the variety of stakeholders offering such solutions; software start-ups, employers, payors, EMR vendors and portal and search engine providers all have a PHR that they think you should be using. I'll bet there 100s of PHR solutions now available.

When evaluating these solutions, a few characteristics are key for adoption:

From the patient's perspective:

Ubiquity and Patient Ownership - the PHR record is ultimately the property of the patient. It must be transportable into every situation in which a patient needs it and it must be accessible by the patient at any time.
Adds Value - a record on it's own has value, but a PHR solution that can add value around the record is of great value. Care reminders, links to literature are all examples.
Is Correct - those that populate from claims data will be populated with data that was never intended for clinical documentation, only for reimbursement. If you diagnose that wheezing patient with asthma and that patient, who is ultimately found to NOT have asthma, sees he's asthmatic in his personal health record, might 1) decide this PHR can't be trusted and not use it or 2) call your practice in a panic asking why you never told him he was asthmatic (and have trust issues with you as a provider).

From the provider's perspective:

Easily accessed - and I mean "easy"! When the average visit is 16.5 minutes, even one minute to fumble through access of this record will make this a no -deal.
Complete Picture - a PHR that only tells a part of the story isn't of much value if the provider still has to go back and verify and document everything.
Is Correct- if it doesn't provide accurate clinical data, there's no reason to use it.

Any PHR vendor that would find any of the bullets above to not be in their best interest is probably one that won't survive. That leads me to think right now that vendors such as Google, Microsoft and Revolution Health probably represent the best strategies, IF they can provide the features above.

Dave Morin
CEO
Cielo MedSolutions

The Power of Simplicity in Health Information Technology

2008-06-05T14:47:00.001-04:00

If you haven't yet seen it, check out the Flip Video Camcorder. There an incredible amount of buzz surrounding the product yet it is one of the simpliest camcorders on the market.

Read "Simplicity: What’s Next in Business Software", a recent editorial on sandhill.com. The author argues that the new winners in the software market will focus on keeping their products focused and very ease-to-use and resist the temptation to add so many features they become virtually unnavigable.

Your cell phone now has more computing power than many of the first commercial computers. As such, your cell phone has a host of features that have nothing to do with calling someone. How many of these features do you really use? You probably use, 95% of the time, just the very basics - calling people and maybe texting them.

Why is it then that we think health care software needs to be feature-bloated to be the "right one"? Isn't a simple solution, targeted to the exact needs of a practice, truly the best? I've seen so many software evaluations that focus on how many features a product has, features that we know most users will never use, it concerns me that sight has been lost about why a software solution is needed in the first place.

Aren't our jobs complex enough that we don't need software to add to the complexity?

Quit worrying about "features" per se - worry about the problem you need to solve, worry about how quickly the product can be adopted by your practice, worry about investing in something that can easily carry you forward into the unknown future.

You will find the software answer to these questions is a product that is very focused, very easy to use and very malable.

The Flip camcorder has probably just 10% of the features of the newest, whiz-bang camcorders from the major vendors. It's inexpensive but not the cheapest.

I just searched "camcorder" on Amazon.com and sorted by "bestsellers" - the top 5 bestsellers were all Flip camcorders.

Hmmmmm...

Dave Morin
CEO
Cielo MedSolutions

Here's to the Free Clinics

2008-06-04T16:12:00.000-04:00

This morning I had the great pleasure of listening to a presentation from Charissa Shawcross, NP, of Joy-Southfield Health and Education Center and David Law, PhD, of Joy-Southfield Community Development Corp. Both are deeply involved in a free clinic in Detroit and with free clinics, in general, in Southeast Michigan.

What they presented is really scary. There are 47 million uninsured Americans, a number growing each day.

In Detroit:

1 in 4 residents do NOT have health care

there is 1 primary care provider for every 17,000 residents in Detroit

sudden infant death rates are two times the national average

and there's additional depressing statistics if you want them...

The Joy-Southfield Health and Education Center (a free clinic on the west side of Detroit) simply cannot grow fast enough to keep up with demand. There is an 8 week waiting period for new patients (many free clinics in Detroit cannot take ANY new patients) and this only gets worse each month.

The people I have met that support and work in free clinics are relentless, hard-working people that probably work over 70 hours each week to keep them running, funded and staffed.

These people need to be recognized; they are providing an unmeasureable benefit to a population without a voice and in many ways ignored by our politicians.

Running a free clinic isn't glamorous work, it's tough and probably quite stressful.

But I see, in the eyes of these people, a passion and determination that is unselfish and laudable.

The rest of us need to support their work and pay attention to the issues of the uninsured and underinsured because in the end we all end up paying for it in a lot of different ways.

Dave Morin

CEO

Cielo MedSolutions

Cielo Clinic in AHRQ Innovations

2008-05-23T16:58:00.000-04:00

We're proud of Cielo Clinic's inclusion in the AHRQ Innovations Database. The database documents the success of ClinfoTracker (the former name of Cielo Clinic) in simultaneously increasing quality on a variety of measures. It's a great testament to the power of the product.

See: http://www.innovations.ahrq.gov/content.aspx?id=1771

Dave Morin
CEO
Cielo MedSolutions

There's Data and Then There is Actionable Data

2008-02-29T17:05:00.000-05:00

Data is data, right? Facts and figures presented in some manner. More data is always better than less? Larger reports must always tell you more? Many a job has been justified on generating data. There are many to which generating data is the end-goal.

Each of us is drowning in data. And much of it really doesn't help you do what you do better. Shouldn't that be the point of getting data?

Actionable data is data that you can do something with. It answers not just "what" but "why".

An example: your clinical system generates a report that says your compliance rate with a guideline for measuring A1C levels every six months for diabetics is 50%. That tells you, for half your diabetic patients, you are meeting the goals of the guideline.

Cool! Now, you want to get that compliance rate to 60%.

What do you do? All the report tells you is that 50% are in compliance. You have no idea what's going on with the other 50%, you don't even know who they are. Good luck getting your compliance rate higher.

Here comes the need for actionable data! The data you need to get your compliance rate higher includes:

1. A list of the patients not in compliance.
Yep, this certainly is where you'd start, but this alone doesn't tell you why they are not in compliance. And, it needs to be all the patients not in compliance, even those you haven't seen in years.

2. Details as to why they are not complaint (like: have never been seen, have a lab req but never completed it, refused to do it, have not been asked to do it).
Cool. Now we know what to do for each patient. How do we take action to move forward?

3. Contact information for each of these patients.
Use this info for telephone calls, custom letters, emails, text messages, smoke signals, whatever it takes to reach these non-compliant patients and move them to compliance (Note: Cielo Clinic can generate letters and create call lists but cannot yet generate smoke signals). And, because you know the exact reason each patient is not in compliance, you can have directed communication with them to get to their exact needs.

4. Details on the actions you take.
Track the fact you made calls, sent letters, got more lab reqs out, etc… So, as you continue to work with these patients, you know exactly what you've done to be smarter about it next time around.

Got actionable data?

Dave Morin
CEO
Cielo MedSolutions

Your Choice: "Shelfware"... or a Long-Term Partnership?

2008-02-18T15:00:00.000-05:00

Admit it. We’ve all done it: purchased software licenses, whether for our workplace or for our own use, only to find, a year or two down the road, that we really never used it. If there was a user manual or disc, it ended up sitting on the shelf collecting dust –- earning this entire category of promising-at-first-but-never-used software packages the dreaded but apt moniker “shelfware.”

Although Cielo MedSolutions (www.cielomedsolutions.com) is relatively young, I’ve personally been in the software business longer than the kid who runs Facebook has been alive – whoa… now that’s weird – and I’ve not only seen lots of shelfware, but, to my dismay, quite a few shelfware VENDORS. It’s sad, but there are entire companies out there (and so, so many that have come and gone) who don’t particularly care what happens to the customer after she or he cuts the check and takes delivery of the software.

When you purchase Cielo products, you get so much more than just software (or, in our case, SaaS, software-as-a-service). You get a long-term relationship with a world-class healthcare IT partner.

We are committed to understanding your healthcare information technology challenges.

We are committed to staying on top of the myriad information-related challenges confronting the world of clinical care -- whether they be new clinical guidelines, new quality reporting initiatives, pay-for-performance or other reimbursement-related reporting challenges, or public scorecarding -- and to partner with our healthcare provider customers by delivering SaaS solutions that genuinely help them to simplify and make sense of it all.

We are committed to delivering Saas offerings to our provider customers that fit their clinical workflow, are easy to learn and use, and actually help them practice quality medicine.

We are committed to delivering Saas offerings to our provider customers that have a rapid financial payback and a high return-on-investment (ROI) -- something even your CFO or CPA can love!

We are committed to delivering hands-on user orientation and training, first-rate service, professional post-sales support and frequent software updates.

And, it goes without saying: We are committed to delivering ultra-reliant, HIPAA-compliant data-hosting and network delivery.

So, which sounds more appealing: shelfware, or a long-term partnership?

Jim Price
Chairman & Cofounder
Cielo MedSolutions

Why a coded, all-problem registry?

2008-02-14T08:45:00.000-05:00

As you know if you've spoken with us or spent much time browsing our website, we're big on the fact that Cielo Clinic contains a coded, all-problem registry. Here's a brief description of why that is so important.

Your registry is only as good as its accuracy.

Many registries are built off of billing data. Not a bad place to start you may say. Just take all those people with asthma or depression codes and dump 'em in! Not so fast... Billing data sits at one end of a long process that begins with a clinician thinking, "This patient is wheezing, but I don't have enough yet to make an asthma diagnosis." So the clinician either writes down "wheezing" which gets changed to a billable diagnosis of asthma, or they realize from the start that wheezing won't get paid for and they just write asthma. When that billing data gets dumped into the registry, the patient with wheezing is now part of the asthma registry, and becomes part of the reporting for which one is responsible. Whoops!

If you have a system that allows you to accurately represent with a coded problem what that clinician is thinking, "wheezing" doesn't become "asthma", and your quality improvement efforts are focused with precision on the patients that truly have asthma.

Cielo Clinic contains a rich set of clinical terminology that was built by having primary care physicians record problems using words that make sense to them. These terms are coded, and mapped to a classification system that allows accurate aggregation of the problems into disease categories for quality management. If your quality management system can't do this, you'll spin your wheels focusing on patients that don't have the diseases you're trying to impact.

If you build it they will come - Field of Dreams

OK, maybe it's a bit corny, but that's our reason for having an "all-problem" registry. Clinicians build it by recording the problems they are working with every day. Not just on a select set of patients, but all patients. A lot of work? Not if you are getting something in return. What Cielo Clinic gives you in return is an accurate problem list on every patient, using terms you understand, not up-coded to meet billing standards. Additionally, Cielo Clinic gives you back reminders based on those problems and the ability to "on-the-fly" respond when new guidelines emerge for conditions. Because you've been accurately recording the problems, you have already built the registry for any given clinical disease category.

You're building it, because those new guidelines will come!

Don Nease, MD
Chief Medical Officer
Cielo MedSolutions

How We Came Up With Our Company Name

2008-02-10T09:00:00.000-05:00

If you’ve been around us at Cielo MedSolutions (www.cielomedsolutions.com), you’ve probably heard us on more than one occasion belabor the pronunciation of our company name (“see EL oh”) –- which is a bit Americanized from the more proper Spanish pronunciation. But what you may not have heard is the meaning behind our name, which is kind of cool.

In Spanish, “cielo” translates to mean both sky and heaven. It’s from the Latin root of the same spelling and meaning. So in French (another Latin language), sky is “ciel,” and based on this we better understand the derivation of the word “ceiling” in English.

Well gee, thanks, Dr. Linguist, you may be thinking, what’s the point?

When Dave Morin (http://www.cielomedsolutions.com/about-leadership.asp) and I launched the business in 2005, we wanted a company name that was evocative of dramatic improvement in the field of healthcare. We were looking for a name that suggested a positive, upward-trending future. We felt that “Cielo” evoked that feeling beautifully, while the accompanying “MedSolutions” connotes that our company is in the business of actually solving real-world problems –- and substantively helping healthcare providers by delivering useful solutions to today's challenges in clinical quality management. We hope Cielo's simple sunburst logo ties it all together.

Jim Price
Chairman & Cofounder
Cielo MedSolutions

The Technology is Never the Point! (part 2)

2008-02-03T16:22:00.000-05:00

When we launched Cielo MedSolutions (www.cielomedsolutions.com) in ’05, we took a long, hard look at the healthcare IT space and realized the following:

1. that the country’s 360,000 primary care physicians were suffering… they were underpaid and overworked;

2. that commercial electronic medical record (EMR) or electronic health record (EHR) software wasn’t the entire answer for making those primary care clinicians’ lives better, partly because this software tended to be designed around the needs and the workflow of hospitals and inpatient medical care (as opposed to ambulatory care), and partly because it tended to record billing data (as opposed to clinical data) in the patient record; and,

3. that existing commercial software tended to be so expensive that the return-on-investment just wasn’t there for primary care providers.

As we scoured the market at the time, we were fortunate to find some existing web-based software –- an example of what we’ve come to call a “clinical quality management” application –- developed by leading clinical researchers at the University of Michigan’s Medical School by the Family Medicine Professors Don Nease, Mike Klinkman and Lee Green. They’d developed and already proven out this software, with the help of NIH grant funding, and were already field-deploying it to manage over 140,000 patient encounters per year in their geographically-dispersed clinics.

What we liked about what we saw with the UM software was that it was built around the needs –- and around the workflow –- of primary care clinicians, and actually helped each physician do a better job of keeping track of the myriad details associated with chronic disease management for her or his thousands of patients, both on the day of a patient visit as well as by facilitating proactive patient outreach.

So, to make a long story long... we ended up exclusively licensing this technology from the University of Michigan (http://cielomedsolutions.com/news-pr-cms-march2006.asp). But -- and we think this is much more important in the final analysis -- we've ended up forming deep personal and professional friendships with the key medical researchers involved. Today, we have the privilege of calling Dr. Don Nease our Chief Medical Officer at Cielo, and Drs. Klinkman and Green both energetically serve on our Medical Advisory Board where they continue to challenge our thinking and provide thought leadership (http://cielomedsolutions.com/about-advisory.asp). On the application software side of things, we've rapidly evolved and augmented the technology we licensed from UM, and the result today is known as Cielo Clinic, a commercial SaaS (software-as-a-service) application for clinical quality management in ambulatory care settings.

Jim Price
Chairman & Cofounder
Cielo MedSolutions

What the heck is a Clinical Quality Management System?

2008-01-31T17:19:00.000-05:00

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

The Technology is Never the Point!

2008-01-27T15:00:00.000-05:00

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)

Cielo Has Been a Contrarian Venture From the Start

2008-01-22T03:51:00.000-05:00

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)

Prevention and Electronic Medical Records

2008-01-18T14:44:00.000-05:00

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

Chronic Disease Management Software

2008-01-16T16:11:00.000-05:00

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

Cielo MedSolutions - Altarum Strategic Alliance

2007-12-05T18:11:00.001-05:00

Our newly-formed Strategic Alliance with Altarum is exciting. Altarum is a world-class organization devoted to solving complex health system problems and our goal of increasing the quality-of-care provided in primary care certainly falls under the "complex" category!

The roots of our flagship product, Cielo Clinic, lie in research and development completed at the University of Michigan Department of Family Medicine around the complex issue of driving change in the quality of care delivered by primary care providers.

This is a wonderful alignment of interests and is going to result in stronger Cielo technology solutions and products that improve the quality of care delivered by providers, in a manner that is affordable and adoptable by physicians while delivering benefits to all stakeholders; providers, payers and patients.

Stay tuned to see what develops. We're confident that this will further the innovation you will see come from Cielo.

Dave Morin
CEO
Cielo MedSolutions

Billing Data and Clinical Quality Improvement

2007-09-11T22:38:00.000-04:00

AHRQ (Agency for Healthcare Research and Quality) recently published a wonderful paper entitled "Health Information Technology for Improving Quality of Care in Primary Care Settings". The paper looks at "the link between health information technology and quality improvement in a range of primary care settings"1.

To see the document: http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_661809_0_0_18/AHRQ_HIT_Primary_Care_July07.pdf.

There are many insights and recommendations documented in this piece; if you are looking into technology and best practices to support improving quality of care, it is a must-read. But, there is a specific issue highlighted in the report that "hits home" because we constantly talk about it. Specifically:

1. Page 18 - "another aspect of data structures that continues to restrict improvement activities is the billing and reimbursement coding mindset that permeates much of health care data. For example, in many health IT systems, patients with asthma do not have a diagnosis of asthma; they have a data history of billed visits with a billing diagnosis of asthma. For visits to the clinic that did not involve their asthma (and hence no billing code of asthma was issued), there is no way to relate that visit to their chronic condition of asthma. Additionally, an asthma billing code is often used for a patient who arrives wheezing (whether they have a diagnosis of asthma or not). This may not look like a data problem on the surface, but if you ask the health IT system how many asthmatics are in a panel, the numbers are far from reality."
2. Page 19 - "data structures for billing and documentation are often very different from the data structures that support improvement"
3. Page 13 - "data that are constrained to billing codes may make it very difficult to track the progress of a chronic diagnosis over time"

The paper also discusses that it may be difficult to solve this problem - but we think we have solved it through the use of clinician-verified diagnoses built from a thesaurus of coded clinical terms. We do not rely on billing diagnoses; clinicians capture patient diagnoses at the point of care based on the true conditions of a patient and Cielo Clinic stores and utilizes these diagnoses. This capture is a very simple effort and has a very small time impact on a provider.

Of course, it is quite simple for our system to take a billing file and use it to pre-populate a patient database with diagnoses; we offer to do this during every Cielo Clinic installation. But, we rarely do diagnoses pre-populations as most practices are not comfortable with these data sets for clinical quality improvement.

We feel strongly that a quality program built on billing data will not be successful. Bottom line, billing data serves a different purpose than quality of care data. Billing data was never constructed to support quality of care initiatives. A different data set is needed, period. It needs to be coded, clinician-verified and uncoupled from billing diagnoses. It isn't difficult to build this data set, especially with a tool such as Cielo Clinic, and build it to the benefit of all stakeholders; providers, patients and payors.

Dave Morin
CEO
Cielo MedSolutions

1: Langley J, Beasley C. Health Information Technology for Improving Quality of Care in Primary Care Settings. Prepared by the Institute for Healthcare Improvement for the National Opinion Research Center under contract No. 290-04-0016. AHRQ Publication No. 07-0079-EF. Rockville, MD: Agency for Healthcare Research and Quality. July 2007. Page 1.

Technology and the Health Care Provider

2007-09-06T22:09:00.000-04:00

Every time an account manager at Cielo makes a presentation on Cielo Clinic, they highlight the fact that a provider can access our software either through a paper or web-based Encounter Form. For those not familiar with our product, the Encounter Form is the interface a physician uses to know what services, screening and counseling are due for a patient at the time of their visit. This Form can be delivered either via a web interface from a device connected to a network or can be delivered by a printed piece of paper. The web-based Encounter Form was designed to be extremely simple, easy to use and requires just a few clicks of a mouse by a provider.

The next item our account managers highlight is that 100% of the providers utilizing Cielo Clinic access it via the the paper form and not the web interface. This includes environments that have laptops and wireless networks in exam rooms and can easily make use of the web interface. It also includes providers of all ages, even the "young ones". No one dismisses the value of the web interface, they just think that the paper form works best for their workflow.

In most cases, the people at the presentation strike a curious look at that statistic and are either 1) shocked and challenge it, 2) insistent that this will not happen at their practice(s) or 3) humored by it and make some sort of dumb joke.

This predisposition to use of paper in the exam room is not something that should be challenged and dismissed but instead something that should be studied. I am a big believer that the value technology can deliver is often confused by people who see it as an end result versus a means of achieving an end result. Our software is not a product that lets a physician use a laptop in an exam room, it is a solution for providing better quality of care to patients. The technology facilitates the ability to deliver this increased quality of care, but, in the end, it is the provider delivering the care, not the technology. Many people jump too quickly to the conclusion that, if only the provider used the technology "correctly" (read: uses a laptop to access everything), they would be much more effiicient and productive.

What we need to learn more about is why providers feel the paper Encounter Form works best for their workflow. Does the use of a laptop or other device take away from physician-patient interaction? Is juggling a laptop in an exam room just too much effort when a simple piece of paper will suffice? Is there an emotional connection to a piece of paper that is just hard wired into humans? Is reading off a screen too difficult? There's lots of questions that can be asked, but I think we will find it all boils down to a few fundamental issues.

We're studying it further and have begun to collect responses. I'll be sure to share what we find.

Dave Morin
CEO
Cielo MedSolutions

Our Philosophy

2007-08-30T09:27:00.000-04:00

Clinical Quality Management is a team sport.

We're finding that is somewhat of a radical concept. Unfortunately, as the administrative burdens of medical practice have evolved, there has evolved a separation of folks who have patient care responsibilities and those that manage the business side. Naturally, the people working on the business end are those who are in closest contact with payers and are seeing the potential or feeling the pressures of pay for performance. Because of the artificial separations between patient care and the business side, there may be some attractiveness to quality solutions that require little or no participation of those on the patient care side.

We take a different approach. We believe that fundamentally, everyone involved in healthcare from the reception desk to the clinicians to the administrative side are there to take the best possible care of their patients. Cielo Clinic is designed to let everyone play a part in improving care. Our problem lists are clinician verified so they are clinically optimized, as opposed to being optimized for payers. We provide action lists at encounters that clinicians, nurses and medical assistants can use to see: What is this patient due for today? We provide call lists so that nurses or others in the office can reach out to remind patients of their needed services. We provide reports that administration can use to determine not only what percentage of patients have not had their needed services, but who has services that have been ordered, refused or discussed.

If you believe, like us, that it's time to get everyone back on the same page so you can focus together on quality, Cielo Clinic is designed with that goal in mind. Fundamentally we believe, Clinical Quality Management is a team sport.

Don Nease, MD
Chief Medical Officer
Cielo MedSolutions

About Cielo MedSolutions

2007-07-31T00:58:00.001-04:00

Cielo MedSolutions (pronounced “see EL oh,” Spanish for “sky”) is a leading provider of healthcare software and information technology services. Founded in Ann Arbor, Michigan in 2005, Cielo helps ambulatory care physicians improve quality-of-care, optimize practice efficiency, and increase physician revenue. The company’s web-based Cielo Clinic™ software helps to improve, document and report on clinical care.