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
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
Labels: patient centered medical home
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 Labels: patient registry, pay for performance, pqri, pqri measurement
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 MedSolutionsLabels: disease registry, e-prescribing, patient centered medical home, patient registry
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 Labels: Clinical Quality Improvement, electronic health record, electronic medical record, telehealth
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 articleJoe 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. Labels: health care information technology
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 VocabularyFrom 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, 2009Views: 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 Labels: Billing Data, coding, electronic health record, HITECH Act, ICPC, patient registry, registries
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.pdfTwo
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
Labels: clinical quality management system, free clinics uninsured disparities, health care information technology, patient centered medical home, patient registry
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 LLCLabels: clinical decision support, clinical groupware, patient centered medical home, registries
|
CUSTOMER LOGIN
