Cielo MedSolutions’ Company Blog
"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
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 Labels: grant, NIH, patient centered medical home, pay for performance, registry
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 Labels: chris king, cielo, cielo medsolutions, cms, patient registry, pqri, pqri measurement, pqri registry test
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 Labels: disease registry, patient centered medical home, patient registry, software as a service
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 Labels: care reminders, patient centered medical home, patient registry
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 Labels: healthcare consumer, patient care, personal health records, PHR
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 Labels: Clinical data, electronic health record, personal health record, PHR
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