"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

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 Vocabulary From 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, 2009 Views: 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

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

I found Dr. Don Nease's recently posted article on the potential of EMRs to impact prevention and early detection quite informative. We agree that there is great value in an EMR, but also agree with Dr. Nease's views as our customers and prospects come to us talking about the gaps in functionality in areas of prevention, screening and chronic disease management. Cielo Clinic fills that gap and works alongside your EMR, bringing better overall value to your entire health information technology investments. Read at: http://www.preventcancer.org/iDialogue/ Dave Morin CEO Cielo MedSolutions