Case Study

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Upper West Side Family Practice

During Dr. Vincent Esposito’s 20 years of working in patient care, medical education and administration, he had designed “the perfect patient chart.” And that’s why, when he started Upper West Side Family Practice in 1999, he continued to use paper charts.

It’s not that he had ruled out making the transition to an electronic health record (EHR) system, but when he investigated the available systems, he decided that the industry needed more time to mature.

Preparing for 21st-Century Healthcare

After a few years of running his own practice, Dr. Esposito realized that even his perfected patient chart wouldn’t be enough for the 21st-century healthcare industry. He observed that the industry, market and payers were all pushing practices to computerize their records. “It’s a no-brainer,” he says. “The electronic medium combines all the information in one location; so it instantly organizes whatever has to be done for your patient.”

So he began investigating EHR systems — more than 30 of them. He created a matrix listing the features he needed most, compared programs, researched company reputations and looked at demos. In 2003, he witnessed the Aprima solution win the Documentation Challenge at the annual TEPR (Toward Electronic Patient Records) conference.

He noted that Aprima had the speed and flexibility he wanted for his practice. “I was impressed by Aprima’s performance,” says Dr. Esposito. “The most difficult thing for most EHRs is to capture the history as the patient tells it. Their descriptions of their symptoms are very colorful, and I wanted to be able to capture the flavor of what they’re saying. Aprima has the flexibility to do all that and do it quickly.”

The next thing that impressed Dr. Esposito was the Aprima staff. He says, “From the time I first called, every single person I met was such a professional; my confidence in the company grew.”

The Secret to an Efficient Practice

Upper West Side Family Practice installed Aprima in November 2005. At first, the practice used only the EHR component, keeping the practice’s older practice management (PM) system. Then in January 2006, it began using the Aprima PM component as well.

Although the practice has two locations, Aprima is the doctor’s secret to maintaining a lean, efficient practice. The integrated EHR and PM system has eliminated the copying, filing and labor associated with paper charts and made it easier for the doctor to see patients at both his main office and satellite branch without shuffling charts between offices. In addition, Dr. Esposito says, “The integrated system makes it much faster to get started with new patients and faster to document patient visits.”

In-house System – Outsourced Billing

Although the Aprima solution manages this practice’s scheduling, patient demographics, insurance, billing and collections, Dr. Esposito didn’t want to hire a billing staff. So he engaged a billing services company that also uses Aprima — Health Care Strategies — to handle billing and collections. When the doctor finishes charting a visit, Aprima automatically creates a superbill with the appropriate diagnosis and procedure codes.

A Cure for Piles

Dr. Esposito only has to look at the top of his file cabinet to appreciate how much his practice has changed with Aprima. His staff used to stack patient charts and lab results on the cabinet. The more that pile grew, the more he dreaded going through it.

With Aprima, the pile is gone. The doctor explains, “I don’t have to go searching for anything. It’s all right there! I can look at labs or patient history in a tenth of the time. And we’re providing faster care to patients: instead of taking days to look at labs, I can look at them in minutes.”

Aprima also frees up the doctor’s schedule, because a secure, remote connection allows him to work where and when he chooses. He can look up a patient chart at 2 A.M. or review labs from his living room on a Sunday afternoon. “That means so much to me,” he says.

Capture the History as the Patient Tells It

Family practices are the true test of any EHR: patients come in with a wide variety of multiple unrelated complaints. Capturing an accurate “history of present illness” is difficult with traditional template-based systems.

Aprima’s adaptive learning and intelligent navigation technology means that providers don’t have to follow an identical path through every visit. They can create as many “chief complaints” as necessary, without having to click back through multiple screens. And Aprima learns providers’ preferences as they work, getting faster and easier with every patient.

“I’ve laid out my physical exam in a different section than the default, so I can type detailed notes and make sketches for about 10 different kinds of physicals,” says Dr. Esposito. “I can pull one of those up with a click and then revise it to suit whatever I’m doing. If I want to add an observation because I looked in the nose, I just click on the nose (in the sketch).”

Aprima also lets Dr. Esposito capture his patients’ actual descriptions of their medical ailments, which, he says, “are very individual,” instead of selecting the corresponding clinical term. This flexibility allows the doctor to backtrack, sidetrack and jump around the same way patients do. Instead of a single path through a visit, there are multiple ways to modify any section of the chart quickly.

With documentation this easy, Dr. Esposito no longer has to stay in the office until 10 P.M. finishing patient charts and reviewing labs. He says happily, “By the time the patient leaves, I’m done!”

“I believe in the Aprima system — it’s the best choice now, and I’m sure it will also be able to meet future challenges. Aprima is so much better, it’s unbelievable. This is the way it ought to be,” adds Dr. Esposito.