Cielo MedSolutions’ Company Blog

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

It's all about the team!

noreply@blogger.com (Cielo MedSolutions) — Wed, 24 Sep 2008 12:50:00 +0000

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

Patient-Centered Medical Home and the AAFP Scientific Assembly

djmorin@gmail.com (Dave Morin) — Mon, 22 Sep 2008 14:14:00 +0000

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

Cielo Clinic Qualified Registry for 2008 PQRI Reporting

noreply@blogger.com (Chris King) — Thu, 11 Sep 2008 18:06:00 +0000

We are now officially qualified to submit quality data to CMS on behalf of eligible professionals for 2008 PQRI reporting. Our product, Cielo Clinic, went through two rounds of review by CMS and successfully submitted data during this review.

So, what does that mean for you?

Any Cielo Clinic customer may be able to submit data to the PQRI program for the year 2008.
Cielo Clinic customers need not use extra billing codes to capture the information required by PQRI, in fact, there is no additional data to collect outside of the normal information captured by our registry.
Cielo will work with customers to select the correct measures for submission.

There is much more to talk about regarding measures and reporting periods. Give us a call, we are happy to tell you much more about the program and how you can get started. This is a wonderful opportunity to take advantage of this pay-for-reporting program.

Chris King
Cielo MedSolutions

Computerized reminder system drove up colon cancer screening rates, U-M study found

djmorin@gmail.com (Dave Morin) — Sun, 07 Sep 2008 19:08:00 +0000

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

A Data Model for Quality Improvement

djmorin@gmail.com (Dave Morin) — Tue, 26 Aug 2008 21:40:00 +0000

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.

Our Grant from the National Cancer Institute

djmorin@gmail.com (Dave Morin) — Thu, 07 Aug 2008 19:31:00 +0000

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

PQRI Data Submission Update

djmorin@gmail.com (Dave Morin) — Sun, 27 Jul 2008 21:33:00 +0000

I'm asked quite a lot about uploading clinical data directly to CMS to support the PQRI program. Along with the questions we often hear conjecture about the status of the project and what a provider can do. Today I will outline Cielo’s involvement in the programs.

CMS has put forward two programs related to Registries submitting data on behalf of practices for PQRI measurement. 1) 2008 PQRI Registry Test & 2) 2008 Registry-Based Data Submission. Cielo is involved in both the Test program as well as the Data Submission program. Goals of the Registry Test program are to validate a registries' ability to gather, calculate and report on PQRI quality measures. Goals for the Registry-Based Data Submission program are to enable physicians to participate in the 1.5% incentive payment portion of PQRI through an alternative reporting system (their Registry).

Cielo’s involvement in the two PQRI related projects:

PQRI Registry Test Program

The 2008 PQRI Registry Test program was initiated by CMS in early 2008. This program was a “test submission only” program in which no incentive payments were available. Cielo has been involved from the inception of this program including a meeting at CMS offices in Baltimore. As part of our test submission we captured, calculated and reported PQRI measure #1 (Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus). We were notified earlier this week that our first submission was validated without error and that we have met the requirements of the program.

Registry-Based Data Submission

In May of this year Cielo self-nominated to be accepted into the Registry-Based Data Submission program. There are NO approved vendors yet. Registries had until May 31 to submit their self-nomination and must go through an interview, documentation and testing process prior to the end of August. Around August 31, 2008 there will be an announcement from CMS listing the registries that qualify. Once selected a registry will be allowed to submit PQRI data to CMS in January and February 2009. Cielo has met all steps involved with this process and awaits an announcement of the selected vendors.

I think it should be noted, though, that there is quite a bit of "devil in the details" and would highly recommend reading about the projects at the CMS website. As usual, it’s never as easy as “just dropping in a registry”.

Chris King
Senior Vice President
Cielo MedSolutions

Health Care Software Delivery Through the Internet

djmorin@gmail.com (Dave Morin) — Fri, 18 Jul 2008 16:00:00 +0000

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

Registries and Reminders - the Right Way to Implement

djmorin@gmail.com (Dave Morin) — Tue, 08 Jul 2008 04:32:00 +0000

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

Ready for Healthcare Consumer Empowerment?

djmorin@gmail.com (Dave Morin) — Mon, 30 Jun 2008 18:46:00 +0000

Ready for Consumer Empowerment?

Back in the days when I was the Vice President of a publishing company, we started publishing email addresses of writers. People found this a very convenient way to write letters to the editors and writers and it was widely used. Many great e-conversations were had. But, there was also a very small group of people that wrote nasty, inflammatory emails to us. They wrote in ways they'd never converse with you face to face. It's very easy to be ridiculous when you are anonymous.

Consider that, in 2008, there are thousands of "rate my" sites out on the web, a ton of bloggers and the ability to post a comment on just about anything.

It's now coming to health care. Angie's List, Health 2.0, Rate my Doctor, etc… Anyone can post a comment about a provider or practice. 99% will be good and constructive. 1% will drive you crazy. They will be the ridiculous, anonymous ones that will write in manner that would not be expressed in a verbal conversation.

Someone having to wait an extra 5 minutes in a waiting room can tell the world about it. They don't care that you just had to deal with chest pain as a presenting condition for the patient before them, this person had to wait an extra 5 minutes and they're mad! I don't believe this wave will be stopped and I'm surprised it hadn't started sooner.

So, what can you do? Get ahead of the wave and go on the offense. Embrace the internet. Give people an outlet to communicate with you before flaming you on the web. Post your own statistics on your care delivery. Get people to post good and honest things about you .

Don't compromise your care delivery, but be cognizant of what's happening. You won't stop 'em all, but a little more interaction will go a very long way. And, you may find that the glowing reviews you will receive on the internet will be of great value.

Dave Morin
CEO
Cielo MedSolutions

Welcome PHRs!

djmorin@gmail.com (Dave Morin) — Fri, 13 Jun 2008 05:39:00 +0000

Type "personal health record" into your favorite search engine and you will be overwhelmed with the number of vendors offering such a solution.

I'm intrigued with the variety of stakeholders offering such solutions; software start-ups, employers, payors, EMR vendors and portal and search engine providers all have a PHR that they think you should be using. I'll bet there 100s of PHR solutions now available.

When evaluating these solutions, a few characteristics are key for adoption:

From the patient's perspective:

Ubiquity and Patient Ownership - the PHR record is ultimately the property of the patient. It must be transportable into every situation in which a patient needs it and it must be accessible by the patient at any time.
Adds Value - a record on it's own has value, but a PHR solution that can add value around the record is of great value. Care reminders, links to literature are all examples.
Is Correct - those that populate from claims data will be populated with data that was never intended for clinical documentation, only for reimbursement. If you diagnose that wheezing patient with asthma and that patient, who is ultimately found to NOT have asthma, sees he's asthmatic in his personal health record, might 1) decide this PHR can't be trusted and not use it or 2) call your practice in a panic asking why you never told him he was asthmatic (and have trust issues with you as a provider).

From the provider's perspective:

Easily accessed - and I mean "easy"! When the average visit is 16.5 minutes, even one minute to fumble through access of this record will make this a no -deal.
Complete Picture - a PHR that only tells a part of the story isn't of much value if the provider still has to go back and verify and document everything.
Is Correct- if it doesn't provide accurate clinical data, there's no reason to use it.

Any PHR vendor that would find any of the bullets above to not be in their best interest is probably one that won't survive. That leads me to think right now that vendors such as Google, Microsoft and Revolution Health probably represent the best strategies, IF they can provide the features above.

Dave Morin
CEO
Cielo MedSolutions

The Power of Simplicity in Health Information Technology

djmorin@gmail.com (Dave Morin) — Thu, 05 Jun 2008 18:47:00 +0000

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