"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

We've now talked to many of the providers for whom, on their behalf, we submitted quality data to PQRI (via Cielo Clinic). All of the providers we have spoken with have received their reimbursement! Reimbursements have ranged from hundreds of dollars to thousands of dollars, but since it is a formula on allowed charges, of course the amounts will vary. We've also received comments from people that have previously done the very-manual claims submission process for PQRI that registry submission is the "only way to go". Remember, just by using our product in the normal course of care delivery, we are taking care of capturing the data needed for reporting and, at the appropriate time, doing the data uploads. That's pretty simple and that's how it should be. 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

I'm going to go out on a limb here and comment on a request we hear often: "can we just use your registry to upload to CMS to get our PQRI money?" Answer: yes, you can. But, think about this. If you do the minimum 30 chart pulls, abstract the data, key it in and upload it, you're probably looking at about a $1,000 expense. And, I haven't budgeted for the software yet. The average reimbursement from PQRI is $600. Your and your staff's time is VERY expensive, and valuable. Is this really the way you want to invest your time and money? Now, if you use a clinical quality management system to manage all your patients for all their needs, you not only get PQRI $$s, you get the value of any other pay-for-performance program, you build the base for your patient-centered medical home, and you prepare yourself for any other quality program that comes in the future. Your patients are better cared for, your practice is operating more efficiently and you may just be generating more revenue in your practice as you keep your patients up to date on their screening, prevention and chronic disease management needs. Shortcuts sound great, but they unfortunately don't work. And, in this case, I think they actually cost you more than doing things the right way. 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

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

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

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