Case Study

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Potomac Physicians

Potomac Physicians, P.A., was fighting chaos at all of its offices—too much time wasted looking for patient charts and managing administrative chores. The practice decided it was time to invest in electronic health records (EHR) to bring the chaos under control.

Dr. Carol Reynolds, the Medical Director and managing partner, says, “We’re a practice that values productivity. So we established four primary criteria for our new EHR: it had to be easy to learn, easy to use, easy to teach to new staff, and easy to customize. It had to be good for patients and good for business at the same time.” After evaluating and comparing systems, they selected the Aprima EHR.

Beginning fall 2006, Potomac Physicians gradually rolled out Aprima to its seven offices. The first surprise for Dr. Reynolds was how rapidly the physicians and support staff grew comfortable, then enthusiastic, about Aprima. Even those who started the project saying, “I don’t think I can do that,” quickly found success.

Surprise: Significant ROI

Dr. Reynolds hadn’t been expecting any significant return on investment. “We didn’t believe anyone’s ROI claims; that wasn’t one of our reasons to buy,” she says. They were surprised but delighted to see a 25% improvement in financial performance.

The dramatic ROI resulted from several factors:

  • Improved charge capture
  • Accurate coding
  • Increased tests and follow-up visits
  • Efficient office processes, with less back-and-forth
  • Increased patient throughput as physicians grew more efficient
  • Support staff attrition was offset by increased efficiency, leading to lower payroll costs
  • Lower overhead costs because the practice needed to rent less and buy less paper

Dr. Reynolds discusses coding, for example, “Our physicians were very cautious about coding. It’s difficult and there was a fear of being audited. But the Aprima system suggested codes based on the components and duration of an exam, which doctors could accept or change. As we all grew more comfortable with the system, we learned more about coding based on those suggestions, and we also felt more comfortable that this system is audit-proof.”

Improvements in Patient Care

The clinicians discovered that charting is easier, faster, and complete using the Aprima EHR solution. The details of each patient’s visit are recorded during the exam. If a doctor wishes to flesh out her notes later, the charts can be accessed electronically from anywhere.

As the doctors grew comfortable and experienced with the software, they saw that Aprima offered opportunities to provide more proactive care. Dr. Reynolds noticed that staff were having fewer conversations about workflow problems and more about patients.

“Can we really get a report that lists all our patients with high A1c’s?” “Will Aprima really send me a message when a patient’s test results are overdue?” “Is it really that easy to track all my referrals?”

After exploring Aprima’s capabilities, Potomac Physicians realized that it could use the program to help qualify for recognition in a new NCQA program, the “Physician Practice Connections– Patient-Centered Medical Home” (PPC-PCMH). These standards emphasized improved patient safety, extensive use of data, follow-through, and patient communication. As the doctors began reviewing the emerging standards, they realized, “It sounded like us.”

“We didn’t tell Aprima at the beginning that we were thinking of [becoming a PPC-PCMH],” Dr. Reynolds recalls. “Fortunately, Aprima did everything we needed it to. Turns out that Aprima had been working on PCMH capabilities separately.”

Aprima: The Perfect Tool for a Patient-Centered Medical Home

The PPC-PCMH standards, which were finalized in January 2008, focus on using data to provide proactive, personalized care. Most of the required elements could not be accomplished without an advanced EHR: referral tracking, data-driven diagnosis, patient reminders for preventive care, e-prescribing, and performance reporting. Potomac Physicians was the first practice in the U.S. to be recognized as an NCQA PPC-PCMH.

Potomac Partners was fortunate that Aprima EHR has the capabilities to support a PPCPCMH. Clinical decision support, test and referral tracking, care management, and performance reporting have all been built into Aprima from the beginning.

Tracking Orders and Referrals

Aprima stores information about referrals and lab orders, sending reminders to the nurse when labs are late or missing. Results go straight to the doctor’s Aprima dashboard, where they’re highly visible, instead of being piled on a desk. The system can also generate a Pending Report listing the patient, provider, test, date ordered, reason ordered, and lab or physician receiving the referral; that report makes it easier for staff to follow up on missing results.

Care Management

The PPC-PCMH recognition requirements require Potomac Physicians to use evidencebased guidelines. Aprima integrates those guidelines into the charting function, so the information is visible when it’s needed.

“The doctors know what to do,” Dr. Reynolds says, “but a reminder is helpful. When a patient comes in with a sore shoulder, it’s helpful to be reminded that he’s due for a tetanus shot or an A1c. We like that.”

Aprima pop-up reminders include basics such as immunizations and retinal exams for patients with diabetes. Potomac Physicians can run a report to generate a list of patients who need to be called with reminders.

At Home with a New Kind of Practice

Aprima did more than help Potomac Physicians improve its efficiency; it gave the practice the tools it needed to improve the quality of care it provides to more than 230,000 patients in the greater Baltimore area and the recognition it deserves as the nation’s first NCQA Patient- Centered Medical Home.