"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

I am very pleased to introduce the latest member of the Cielo team, Mr. Dale Hunscher.  Dale is the company's new Chief Technology Officer and he brings a tremendous amount of expertise to the company. Dale has spent over 25 years in software engineering and software design management roles.  For the last seven years, he served in various healthcare informatics roles at the University of Michigan and was widely published during that time.  Prior to the University, Dale was the CEO of an Ann Arbor software design company. His blog, FutureHIT, examines the future of health information technology and is widely read in the healthcare informatics circles. Dale's expertise in healthcare software design and architectures further ensures that Cielo will continue to lead the market in internet-delivered solutions for clinical quality management. Dave Morin Co-Founder and CEO Cielo MedSolutions LLC

Nice piece published by the George Washington University School of Public Health and Health Services on data warehouses and quality improvement - "Health Center Data Warehouses: Opportunities and Challenges for Quality Improvement". The Michigan Primary Care Association is truly a leader in this concept and this paper highlights the pitfalls and promise of using a data warehouse for QI, a must-read if you considering this. Dave Morin Cielo MedSolutions

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 article Joe 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.

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

If you are evaluating or researching the technology underpinnings of a medical home, you should take a look at wonderful piece (available on the internet) called "Health IT to Support the Patient-Centered Medical Home" authored by Michael Klinkman and Robert Phillips. This slide show accompanied recent testimony they gave to the National Committee on Vital and Health Statistics. It's probably different than many of the other presentations you've seen on this topic, but what they have to say is very powerful. Dave Morin CEO Cielo MedSolutions Disclosure: Michael Klinkman is on the Medical Advisory Board of Cielo MedSolutions.

If you haven't yet seen it, check out the Flip Video Camcorder. There an incredible amount of buzz surrounding the product yet it is one of the simpliest camcorders on the market. Read "Simplicity: What’s Next in Business Software", a recent editorial on sandhill.com. The author argues that the new winners in the software market will focus on keeping their products focused and very ease-to-use and resist the temptation to add so many features they become virtually unnavigable. Your cell phone now has more computing power than many of the first commercial computers. As such, your cell phone has a host of features that have nothing to do with calling someone. How many of these features do you really use? You probably use, 95% of the time, just the very basics - calling people and maybe texting them. Why is it then that we think health care software needs to be feature-bloated to be the "right one"? Isn't a simple solution, targeted to the exact needs of a practice, truly the best? I've seen so many software evaluations that focus on how many features a product has, features that we know most users will never use, it concerns me that sight has been lost about why a software solution is needed in the first place. Aren't our jobs complex enough that we don't need software to add to the complexity? Quit worrying about "features" per se - worry about the problem you need to solve, worry about how quickly the product can be adopted by your practice, worry about investing in something that can easily carry you forward into the unknown future. You will find the software answer to these questions is a product that is very focused, very easy to use and very malable. The Flip camcorder has probably just 10% of the features of the newest, whiz-bang camcorders from the major vendors. It's inexpensive but not the cheapest. I just searched "camcorder" on Amazon.com and sorted by "bestsellers" - the top 5 bestsellers were all Flip camcorders. Hmmmmm... Dave Morin CEO Cielo MedSolutions

Data is data, right? Facts and figures presented in some manner. More data is always better than less? Larger reports must always tell you more? Many a job has been justified on generating data. There are many to which generating data is the end-goal. Each of us is drowning in data. And much of it really doesn't help you do what you do better. Shouldn't that be the point of getting data? Actionable data is data that you can do something with. It answers not just "what" but "why". An example: your clinical system generates a report that says your compliance rate with a guideline for measuring A1C levels every six months for diabetics is 50%. That tells you, for half your diabetic patients, you are meeting the goals of the guideline. Cool! Now, you want to get that compliance rate to 60%. What do you do? All the report tells you is that 50% are in compliance. You have no idea what's going on with the other 50%, you don't even know who they are. Good luck getting your compliance rate higher. Here comes the need for actionable data! The data you need to get your compliance rate higher includes: 1. A list of the patients not in compliance. Yep, this certainly is where you'd start, but this alone doesn't tell you why they are not in compliance. And, it needs to be all the patients not in compliance, even those you haven't seen in years. 2. Details as to why they are not complaint (like: have never been seen, have a lab req but never completed it, refused to do it, have not been asked to do it). Cool. Now we know what to do for each patient. How do we take action to move forward? 3. Contact information for each of these patients. Use this info for telephone calls, custom letters, emails, text messages, smoke signals, whatever it takes to reach these non-compliant patients and move them to compliance (Note: Cielo Clinic can generate letters and create call lists but cannot yet generate smoke signals). And, because you know the exact reason each patient is not in compliance, you can have directed communication with them to get to their exact needs. 4. Details on the actions you take. Track the fact you made calls, sent letters, got more lab reqs out, etc… So, as you continue to work with these patients, you know exactly what you've done to be smarter about it next time around. Got actionable data? Dave Morin CEO 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