"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

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

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

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

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

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

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

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.