"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

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

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

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

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

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