Aprima 2011 is a technologically advanced system for electronic health records (EHR) and practice management. The product is built on Microsoft’s .Net platform, which means that it is both modern and enduring. Aprima has highlighted this advantage as a key differentiator in a market where some other technologies are aging. The company has benefited as a result.
Beyond its modern technology, Aprima 2011 is also a very functionally advanced system. The company achieved 2011/2012 certification through CCHIT, which means that users of the system can become eligible for stimulus funds under ARRA. This is evidence that the system meets the rigorous functional requirements laid out by CCHIT and HHS. Importantly, the entire Aprima system is built on a single database, which allows users to seamlessly work across clinical and office workflows in one familiar system.
Aprima has also invested considerably in interoperability. The system can communicate with systems used by payers and hospitals, as well as a wide range of medical devices. The system’s .Net infrastructure has a lot to do with that, as .Net is designed to improve how systems communicate.
Aprima serves the range of primary care and specialty providers. From a size of practice standpoint, Aprima can function well for solo practices all the way up to groups with twenty-five physicians. While lesser known than some of the “big names” in EHR, Aprima is a smart choice for most provider’s short lists.
We have used Aprima since 2011. We moved from paper to electronic format using a staged process that I spearheaded as project manager. In November 2011, we implemented the PM system. In February 2012, we moved. I became Aprima PRM 2011 certified and began training physicians in May for a July and August implementation. I met with each of the physicians who were participating in the first of the three waves of go-lives beginning in May and started exposing them to the product. I began meeting with the second wave physicians in June. By July, three physicians were already using Aprima, even though their official Go Live date hadn't arrived. Five physicians were using it by the end of July. We ran a part-electronic/part-paper schedule, which we ramped up as the physicians felt comfortable. It took six months before all of our physicians were 100% electronic.
While the process of converting was difficult, we had almost no loss of patient volume. We did not cancel appointments or block off vast swaths of the schedule due to the implementation. The software was relatively easy to pick up for our physicians once it was configured administratively and once the physicians and staff became accustomed to the program's layout. Customer support has been pretty good and has only gotten better since we began with them. There were a lot of crashes early on, but those have been 99% fixed. We have submitted dozens of tickets and almost all of them were completely resolved within 24-48 business hours. Any emergencies were handled within a couple hours. If you do have a more complex issue that has to be passed on to a developer, though, you may be waiting.
We've actually seen an improvement in our patient flow and our ability to measure the practice's performance has vastly improved. We now have a number of fixed quantitative measures that we can follow for clinical, financial, and operational performance such as no show %, revenue per procedure, E&M coding averages, lab/task/phone message completion rates, etc. which we can map by provider, site, CPT, date, or whatever other dimension we wish. It's really crazy how flexible reporting can be with 3rd party software. I estimated the number of linear inches for a file rack for our existing chart storage before we moved them to their new home in the new medical records suite by retrieving the first letter of the last name of each patient that was seen since Aprima began and dividing it by the total number of patients, then multiplying it by the number of available inches to get the amount that should be allocated to the A's, B's, C's, etc.
We were able to reduce the medical records department from 4.6 FTE employees to 3.25 FTE employees. Our clinic is now distributed in separate offices. We were able to move our business office outside of the clinic into another suite in the building and our medical records department was moved out as well. This was not possible without Aprima. This made room for an additional physician who we onboarded just two months ago, and it positions us to expand even more. Our no-show rate has reduced from 4.5% in May 2012 to 0.9% in October 2013 due to appointment confirmation e-mails, calls, and text messages that were not possible before our conversion. We are saving thousands on paper, folders, inserts, envelopes, postage, and other materials. We have begun tapering off our off-site storage, which is a $1,000/month expense that will be reducing by $200/month every year for the next 5 years. Patients love being able to log on to our patient portal to look at their lab results, which has saved our staff from having to call or mail results when patient labs are normal.
Our physicians are seeing more patients per day on average than they ever have before. We are on our way to our highest-ever year when judged by total revenue. The physicians love being able to go home and remote into the office to do work. Our physicians are generally happier and more relaxed than they were when we were using paper. Staff are happier and more relaxed. The administrator and HR manager is able to focus on side projects because there are fewer conflicts.
All-in-all, Aprima has been a huge success, although it could use a number of improvements to speed and the overall design of the product.