Busy walk-in medical offices, like the University Physicians Group (UPG) Treat & Release Center in Brooklyn, are a tough challenge for any electronic health record (EHR) system. The patients pour in, six days a week, with a wide and unpredictable mix of injuries and illnesses. Dr. Jeffrey Hyman of UPG and his two partners started looking for an EHR system that would allow them to give more attention to patients and less to paperwork — without changing the way they worked.
An EHR that Supports Patient Communication
As the center began searching for an EHR, Dr. Hyman realized that most of the offerings would require him to change the way he practiced medicine — the opposite of his goal. Most of the systems used templates for entering clinical data. The template idea sounded good at first, but he rapidly discovered that templates limit doctors’ options. Templates also make it hard to keep up with patient conversations as the topics changes. And as every physician knows, patients might add to their chief complaint at anytime during the visit, so the system must be quick to adapt.
Dr. Hyman says, “Template-based systems are out-of-date, cumbersome programs that force you to spend a lot of time looking at the screen. Frankly, I can’t imagine why anyone would choose templates, especially since they require more time for charting a visit than paper does.”
After studying 10 different clinical systems, the center selected Aprima, which offers a template-free program that allows these doctors to work the way they always wanted to. Aprima also combines the strengths of its award-winning EHR system with a full practice management (PM) system in one application on a single database.
Treat & Release Center installed the EHR components of Aprima in 2002, and then added the PM functions in 2005. The center has a mix of desktop and tablet PCs running on a wireless network. Aprima also fully interfaces with the practice’s own laboratory and billing systems.
Accelerating Your Day
Aprima’s adaptive learning and intelligent navigation make it remarkably fast and intuitive. Using unique expert-systems technology, these features enable Aprima to seemingly anticipate each doctor’s needs and habits.
Another advantage of this approach is that the center’s doctors don’t have to spend time customizing it because Aprima learns from them automatically.
As an example of adaptive learning, Dr. Hyman says, “All EHRs have a medication database, usually in a long list. But Aprima knows that if I just diagnosed this patient with acute bronchitis, I’ll be looking for a drug I often use to treat that disease. So those are the ones that come up first. In fact, no matter what I’m looking for, Aprima makes it easy to find — a quick tap takes me wherever I need to go, without clicking through layers of menus or closing and opening a bunch of windows.”
Maintaining Eye Contact
“As we observe the patient, the patient is watching us,” says Dr. Hyman. “We send messages through our words and our behavior. If my head is buried in the computer, it upsets the patient. That’s why I like using Aprima on the tablet so much. I can take notes with barely a glance at the screen, keep a calm, unhurried demeanor, and never have to divert my attention from the patient.”
In addition, the doctor-patient conversation is natural because Aprima does not use a templatebased approach that would force a doctor to follow a one-way path through the patient’s history. For example, a doctor can easily tap the screen with the stylus to see a patient’s drug list, history, and chief complaint — and then tap back again to document additional chief complaints as the patient reveals them.
Just What the Doctor Ordered
On a recent autumn day, Dr. Hyman reported that he and one of his partners “saw 99 patients today. Hypertensives and diabetics, sore throats and coughs presented, some trauma and some really weird stuff. Flu shots also trickled in. We charted every one of them completely and efficiently. We offered e-prescribing. We filled out our PQRI codes. We both got through all of our labs and call-backs. And we coded all our visits correctly. This is the best program out there.”
Aprima has transformed the whole picture of how the Treat & Release Center doctors operate, beginning to end. The doctors can see more patients, manage their time more efficiently, and achieve better compliance with HEDIS and pay-for-performance guidelines. They have more information at their fingertips and create better financial stability for the practice.