Cielo MedSolutions’ Company Blog

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Three great questions

noreply@blogger.com (Don Nease, MD) — Thu, 22 Apr 2010 15:14:00 +0000

Last week I was on a call with one of our sales team. The call was with a major healthcare organization, who I won’t name but suffice it to say you would recognize them not only by name, but also by their having an extremely large EHR installation.

Up front our sales guy asked why they were interested in talking with Cielo, leaving unsaid the obvious point that they are big EHR users. What came back was remarkable:

We’re asking ourselves some questions...
- How does or could a registry fit into our care process?
- Does or would this have value for our physicians?
- Could we roll up the data from our various practices and what value would that have?

What was remarkable was what was missing, namely the technical types of details like: do you interface with XYZ, can you do reporting for ABC, etc. Instead this group was squarely focused on how a registry might positively impact care delivery, improve the work of their clinicians and provide the ability to look at data across the organization.

While we could certainly argue about the details, I think that if a product like ours can’t provide those features, you should move on to another option. These sound exactly like the principles we had in mind when we started building Cielo.

It’s great to hear insightful questions from the marketplace, especially from such a large organization. It makes me hopeful about where we are headed in general with health information technology, and it validates what we’re trying to do here at Cielo.

Don Nease, MD
Chief Medical Officer
Cielo MedSolutions, LLC

The SAT, iPad, EHR's and what's next

noreply@blogger.com (Don Nease, MD) — Mon, 12 Apr 2010 00:31:00 +0000

Anyone remember those old SAT questions:

"Hand is to palm as foot is to ____?"

Reading the recent paper (1) in April’s Health Affairs detailing one group’s struggle with their EHR and their efforts to implement a medical home made me think of this. Bear with me... If you haven’t had a chance to read it or can’t access the full article, the abstract gives you the idea. Quite simply, rather than finding that their EHR enhanced or facilitated their medical home their experience was that the technology got in the way. This is consistent with the findings of the UMDNJ group which was published in the March/April issue of the Annals of Family Medicine (2). Technology, i.e. EHR’s, was not positively associated with high Patient Centered Medical Home scores.

What’s going on here? Aren’t EHR’s and HIT critical to PCMH? Yes, they should be, but they haven’t been designed for that purpose. To quote Fernandopulle and Patel:

“Our system and others like it seem primarily driven by the imperative to allow doctors to document, code, and bill visits at a more intensive—and thus higher-paying—level. Although these features allow for increased practice revenue in a fee- for-service setting, they do nothing to improve care. Indeed, they lead to notes that are cluttered with marginally useful pieces of information to support a higher charge, but relatively little useful clinical information to improve future care.”

Now to the iPad... I’m in the camp that believes the iPad represents a significant advance in our use of information technology. Just over a week into sales, Apple is on track to sell a million iPad’s sometime this week. The key to this success, I believe, is that Apple started with a clean slate in moving to the tablet form factor. They had the courage to not try to morph their existing MacOS X desktop metaphor to the tablet.

Starting from a clean slate is exactly what we’ll be doing over the next few months. We’re beginning to build our next generation product, which I firmly believe will facilitate quality patient care and medical homes in ways which EHR’s have so far been unsuccessful. Some of you will have the opportunity to give us input as we move forward with our work, and I’m really looking forward to hearing from you.

Now for the punch line... Back to the SAT analogy question...

The desktop computer is to the iPad as Cielo Clinic is to ________? Stay tuned!!!

Don Nease, MD
Chief Medical Officer

Cielo MedSolutions, LLC

(1) Fernandopulle and Patel. How the electronic health record did not measure up to the demands of our medical home practice. Health Aff (2010) vol. 29 (4) pp. 622-8

(2) Ferrante et al. Principles of the patient-centered medical home and preventive services delivery. Annals of Family Medicine (2010) vol. 8 (2) pp. 108-16

Welcome our new CTO, Dale Hunscher

djmorin@gmail.com (Dave Morin) — Mon, 29 Mar 2010 01:48:00 +0000

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

Continued Growth in 2009

djmorin@gmail.com (Dave Morin) — Sun, 14 Feb 2010 20:51:00 +0000

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

A Medical Home in Action

djmorin@gmail.com (Dave Morin) — Mon, 25 Jan 2010 22:19:00 +0000

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

PQRI Registry Submission is Working!

djmorin@gmail.com (Dave Morin) — Wed, 06 Jan 2010 19:30:00 +0000

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

Cielo's Partnership with DrFirst

djmorin@gmail.com (Dave Morin) — Fri, 04 Dec 2009 14:09:00 +0000

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

Health Center Data Warehouses

djmorin@gmail.com (Dave Morin) — Sat, 03 Oct 2009 15:48:00 +0000

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

MyCareTeam

djmorin@gmail.com (Dave Morin) — Thu, 17 Sep 2009 08:00:00 +0000

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

Getting it Right

djmorin@gmail.com (Dave Morin) — Wed, 16 Sep 2009 18:46:00 +0000

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.

Cielo’s HITECH Act Update, August 30, 2009

djmorin@gmail.com (Dave Morin) — Sun, 30 Aug 2009 20:28:00 +0000

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

Success!

djmorin@gmail.com (Dave Morin) — Mon, 06 Jul 2009 14:21:00 +0000

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

Initial Lessons on Practice Transformation

djmorin@gmail.com (Dave Morin) — Tue, 12 May 2009 20:51:00 +0000

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

Great Story on the Impact of Billing Data

djmorin@gmail.com (Dave Morin) — Mon, 13 Apr 2009 17:22:00 +0000

A must-read by e-Patient Dave and his experience downloading his medical data from his hospital into Google Health.

http://e-patients.net/archives/2009/04/imagine-if-someone-had-been-managing-your-data-and-then-you-looked.html

And people still want to use billing data in their patient registry?

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

A Physician Group Focused on Quality

djmorin@gmail.com (Dave Morin) — Tue, 07 Apr 2009 13:00:00 +0000

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

Feedback on Data Integrity Issues

djmorin@gmail.com (Dave Morin) — Sun, 29 Mar 2009 19:43:00 +0000

It seems as if the interest level has risen rapidly on our argument that there are many shortcomings when using billing data and ICD9 for a quality improvement program. I've been involved in numerous discussions about this over the last month and they are, in general, in-line with our thoughts at Cielo; billing data and ICD9 are plain insufficient! Usually, the discussion is with a person that has already undertaken a quality improvement program and found this out after trying to work with their billing data.

To study this further, we are working with a few providers and comparing their billing files to their Cielo Clinic database to look at how a patient's diagnoses align in these two datasets. While I can't release our findings just yet, suffice to say the results of this work are eye-opening. Look for more to come from us on this topic.

FYI - I'd also recommend reading a very good article in the February 2009 article of Healthcare Informatics that discusses this topic.-

Dave Morin
CEO
Cielo MedSolutions LLC

Shortcomings of ICD9 and Billing Data for Clinical Quality Management Systems

djmorin@gmail.com (Dave Morin) — Mon, 23 Feb 2009 01:10:00 +0000

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

The Road Traveled to PQRI Reporting

djmorin@gmail.com (Dave Morin) — Fri, 16 Jan 2009 02:18:00 +0000

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

400% License Growth

djmorin@gmail.com (Dave Morin) — Sun, 04 Jan 2009 02:14:00 +0000

Happy New Year! I’m happy to report that we had a 400% growth in Cielo Clinic software licenses in 2008. In 2009, we will process our 1,000,000th patient encounter with our system.

This is great testimonial to the power of Cielo Clinic.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

What Diseases do you Support?

djmorin@gmail.com (Dave Morin) — Wed, 24 Dec 2008 02:09:00 +0000

A question we get asked a lot is "what diseases do you support?". The answer is : virtually all. This is the beauty of a table-driven rules engine (our rules engine is the technology that manages all the clinical guidelines you follow. Based on a patient's information, it generates reminders for their due services). All you do is fill out a web form; put in the diagnoses, co-morbid diagnoses or clinical indicators you want to build the guideline rule around and, voila, the guideline is in your system, ready to use. You can set a whole host of other attributes around the guideline, but again, you are just filling out a form. No programmer necessary!

Any disease management system that requires a programmer to "create the rule" is one that won't scale and will require dollars for support of that programmer each time a change is needed. "Next-generation" disease management systems are built with table-driven rules engines.

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

Personal Health Records and Actionable Data

djmorin@gmail.com (Dave Morin) — Fri, 05 Dec 2008 02:03:00 +0000

Just read the executive summary of a great paper on the personal health record (iPHR) market written by Chilmark Research entitled "iPHR Market Report, Analysis and Trends of Internet-based Personal Health Records' Market". On page 1-13, the author notes that "iPHRs that serve simply as an online filing system for medical records will become irrelevant"1 and "adoption and ultimately ROI of iPHR solutions will be highly dependent on the ability of a given solution to deliver actionable information to the consumer promoting changes in behavior(s) that reduce health risk(s)."2

This fits nicely with our beliefs; a passive system that simply collects information is of limited use in healthcare. Technology must support the ability to drive positive change in the quality of care provided and must provide actionable data to help drive this change. Whether its in a clinical quality management system like Cielo Clinic or in a personal health record solution, this is a key attribute.

1, 2 Chilmark Research, "iPHR Market Report, Analysis and Trends of Internet-based Personal Health Records' Market", May 2008, pg. 1-13

Dave Morin
CEO and Co-Founder
Cielo MedSolutions

International Classification of Primary Care

djmorin@gmail.com (Dave Morin) — Mon, 24 Nov 2008 20:17:00 +0000

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

Use Cielo Clinic's Functionality Directly in an EMR or Physician Portal

djmorin@gmail.com (Dave Morin) — Wed, 12 Nov 2008 12:00:00 +0000

Today we announced something that we think is quite unique.

Many providers tell us that their electronic medical record system (EMR) or physician portal doesn't provide the chronic disease management functionality of Cielo Clinic and ask if we could "embed" Cielo Clinic into their existing technology solution to make it even more powerful.

Well, now we can! Cielo Clinic now provides an embeddable web service. For you non-techies, here's what this means:

Cielo Clinic's clinical decision support functionality can be integrated directly into another health IT application. (In other words, Cielo Clinic can run inside another application). This allows you to get evidence-based guideline clinical care reminders right inside your electronic medical record or physicial portal system. No need to utilize two separate applications to get care reminders!

We've already begun work with our first EMR vendor that wants to integrate our technology and have many more we are talking with. This is pretty unique stuff and we think it is important.

As we've said in the past, our goal is to make technology fit into your workflow and this certainly helps in that regard.

If you'd like to talk about how this can integrate into your EMR or physician portal, just give us a call or e-mail!

Dave Morin
CEO
Cielo MedSolutions LLC

djmorin@gmail.com (Dave Morin) — Thu, 23 Oct 2008 19:02:00 +0000

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