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

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

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

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

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

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

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

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

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

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

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