"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

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

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 MedSolutions

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

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 LLC

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

If you've spoken to us in the past, you know we are ardent supporters of a classification system called the International Classification of Primary Care (ICPC). This system, we believe, does a much better job of documenting problems and reasons for encounter in primary care than ICD-9. It also provides an ability to create episode-of-care documentation.



Why would you use it? Well, for one, it will generate a more accurate problem list and allow you to be more effective in care delivery. Second, this accuracy will help you with pay-for-performance programs as we have found a more accurate problem list leads to better documentation and hence better pay-for-performance reporting. Third, accurate problem lists are the cornerstone of a patient-centered medical home and an ICD-9 problem list based on billing data is not an accurate problem list. Fourth, it provides a unique view into symptoms and problems - as documented here in "Characterizing Breast Symptoms in Family Practice".1



1 Eberl, Margaret M., Phillips, Robert L., Jr, Lamberts, Henk, Okkes, Inge, Mahoney, Martin C.Characterizing Breast Symptoms in Family PracticeAnn Fam Med 2008 6: 528-533


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

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

For those looking to adopt a clinical quality management system or registry, a new must read is available in Medical Care, September 2008 - "Impact of a Generalizable Reminder System on Colorectal Cancer Screening in Diverse Primary Care Practices: A Report From the Prompting and Reminding at Encounters for Prevention Project" (Medical Care. 46(9) Supplement 1:S68-S73, September 2008. Subscription required for fulltext).

This study, funded by the National Cancer Institute and Agency for Healthcare Research and Quality, implemented Clinfotracker (the technology on which Cielo Clinic is based) in 12 diverse practices in Michigan to drive improvement in colorectal cancer screening rates. An average 9% increase was achieved in just 9 months.

This paper studies the ability of a reminder system to improve care delivery and also reviews the ability of practices to adopt clinical technology. I think the second part of this study is just as important as the first part!

Dave Morin
CEO
Cielo MedSolutions

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.

We have begun work on our recently awarded grant from the National Institutes of Health, National Cancer Institute in partnership with the University of Michigan Health System Department of Family Medicine.

In this six month project we will be:

1. Investigating how, in existing implementations, Cielo Clinic impacts prevention and chronic disease care by examining changes in care delivery and clinical workflow, documenting the impact on patient, clinician and office staff satisfaction, gathering feedback from current end-users and researching current and future needs with regards to clinical quality improvement in primary and ambulatory care.

2. Designing a prototype of a next-generation clinical quality management system that is affordable and adoptable, built upon the principles of Cielo Clinic and tracks and manages activities and outcomes at all stages including screening, prevention, diagnosis and treatment, involving all care delivery participants, including patients and non-office care-givers, and delivers proactive prompts and reminders to clinicians regarding required services.

This is a very significant R&D opportunity for Cielo that will result in a state-of-the-art system that takes clinical quality management to a new level.

Dave Morin
CEO
Cielo MedSolutions

State-of-the-art software solutions are today architected as software-as-a-service ("SaaS"). This means the software solution is:

• built from the ground up to be delivered via the internet - this is very different than a system delivered via application service provider ("asp"). An ASP-delivered system is one that wasn't built originally to support web delivery but is using additional technology overlayed on top of it to allow that to happen
• hosted at a 3rd party data center
• accessed by the user through a secure internet connection

If you utilize a SaaS product, what does it mean for you?

• You don't need to buy additional hardware or systems software for your practice. You just need your PCs to be able to use an Internet browser and have Internet access.
• You don't need to manage a server and its backups.
• Updates are quickly available to you as they are simply installed by your vendor.
• You'll get better tech and user support, as the vendor can securely get access to the system and its server.
• Implementation is faster and easier because you don’t need to go through the effort of setting up all the hardware and doing all the installation of technology to use the product.
  

SaaS will certainly be the future delivery model for many software solutions. It eliminates many of the soft costs of a technology implementation (usually a 3:1 ratio relative to software costs - you will spend $3 on hardware, infrastructure, support, etc. for each $1 you spend on a software product) and ensures you keep current on the latest software release. For solutions such as Cielo Clinic, SaaS is the best way to get the product in a user's hands.

Dave Morin

CEO

Cielo MedSolutions LLC

Let's say you want to add a new point-of-care reminder to your registry, like lead screening for children in high-risk zip codes. You also want the value of that screening tracked in your registry, and if the result from the screening is out-of-range, add a "lead poisoning" condition to that patient's registry record.

If the generation of reminders from your registry is driven by a small computer program for each reminder, you'd ask your programmer to visit you and listen as to how this reminder needs to work. He/she would go back to their cubicle, figure out how to create the program, write it, test it, give it to you for final review and then get the new program out to everyone. Probably a couple of months effort end-to-end.

If the generation of reminders is driven through a rules engine that gets reminder information from a table, you'd just select the "Add New Reminder" button, fill in a few fields (just like you would fill out a form on any web site), click on "Save" and the new reminder rule would be in effect. Probably a couple of hour effort end-to-end.

I can't stress enough the importance of a table-driven rules engine (the second scenario described above). It certainly will save you a lot of money as you don't need to hire/pay a programmer for each reminder you want to generate.

More importantly, though, is gain from being able to implement reminders in a day - the sooner you can implement a reminder tied to a pay-for-performance program, the sooner you can start collecting on that program.

And, when reminders are really easy to implement, you'll find you can implement all sorts of them on a variety of conditions and really improve the care provided to your patients.

Dave Morin
CEO
Cielo MedSolutions

We're proud of Cielo Clinic's inclusion in the AHRQ Innovations Database. The database documents the success of ClinfoTracker (the former name of Cielo Clinic) in simultaneously increasing quality on a variety of measures. It's a great testament to the power of the product.

See: http://www.innovations.ahrq.gov/content.aspx?id=1771

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

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

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

Every time an account manager at Cielo makes a presentation on Cielo Clinic, they highlight the fact that a provider can access our software either through a paper or web-based Encounter Form. For those not familiar with our product, the Encounter Form is the interface a physician uses to know what services, screening and counseling are due for a patient at the time of their visit. This Form can be delivered either via a web interface from a device connected to a network or can be delivered by a printed piece of paper. The web-based Encounter Form was designed to be extremely simple, easy to use and requires just a few clicks of a mouse by a provider.

The next item our account managers highlight is that 100% of the providers utilizing Cielo Clinic access it via the the paper form and not the web interface. This includes environments that have laptops and wireless networks in exam rooms and can easily make use of the web interface. It also includes providers of all ages, even the "young ones". No one dismisses the value of the web interface, they just think that the paper form works best for their workflow.

In most cases, the people at the presentation strike a curious look at that statistic and are either 1) shocked and challenge it, 2) insistent that this will not happen at their practice(s) or 3) humored by it and make some sort of dumb joke.

This predisposition to use of paper in the exam room is not something that should be challenged and dismissed but instead something that should be studied. I am a big believer that the value technology can deliver is often confused by people who see it as an end result versus a means of achieving an end result. Our software is not a product that lets a physician use a laptop in an exam room, it is a solution for providing better quality of care to patients. The technology facilitates the ability to deliver this increased quality of care, but, in the end, it is the provider delivering the care, not the technology. Many people jump too quickly to the conclusion that, if only the provider used the technology "correctly" (read: uses a laptop to access everything), they would be much more effiicient and productive.

What we need to learn more about is why providers feel the paper Encounter Form works best for their workflow. Does the use of a laptop or other device take away from physician-patient interaction? Is juggling a laptop in an exam room just too much effort when a simple piece of paper will suffice? Is there an emotional connection to a piece of paper that is just hard wired into humans? Is reading off a screen too difficult? There's lots of questions that can be asked, but I think we will find it all boils down to a few fundamental issues.

We're studying it further and have begun to collect responses. I'll be sure to share what we find.

Dave Morin
CEO
Cielo MedSolutions