HIMSS10 – Aprima

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Michael Nissenbaum, CEO of Aprima and Dr. Eric Fishman speak about the Aprima product line at HIMSS10. Currently, there are over 2,200 providers using the Aprima EHR/PM product. Mr. Nissenbaum reviews the history of Aprima, and its target market that is mostly 1-10 physician practices. Mr. Nissenbaum further discusses the Aprima EHR, which is not template based, but rather based on speed and usability. It was built at Stanford University using the input and direction of 18 physicians. The product is unique in that it is chief complaint driven, with 400,000 relevant terms.

Mr. Nissenbaum and Dr. Fishman talk about Aprima’s connectivity with different technologies, such as the new Patient Portal, Patient Kiosk, Speech Recognition, dictation, etc. The discussion closes with Mr. Nissenbaum’s projections for the EHR market in 2010, and affirmations that Aprima is well positioned to remain a strong industry leader.

Category: HIMSS10, Tradeshows
Date: March 12, 2010
Views:21,416 views

Dr. Eric Fishman: This is Dr. Eric Fishman for EHRtv at HIMSS10 and today we're speaking with Michael Nissenbaum, CEO of Aprima. Michael, thank you very much for taking the time today and sitting and chatting with me. I know you've got a lot to say about the industry in general. You've been in it for many, many years in a number of different positions so maybe let's start by having you tell us about yourself first and then we'll get to Aprima.

Michael Nissenbaum: Well, I've been fortunate enough to be in this industry now for about 12 years initially with a company called Millbrook which was a practice management application which we sold to GE in 2002 which is now Centricity Practice Management.

A number of us spent some time with GE - about 18 months - and we reassembled to take over a company called iMedica in June 2004. That was an EMR only with a very limited install base at the time. The product needed a total overall, it needed a practice management system so it took two and half, three years to put it back together and come into market. Today, we have grown it to well over 500 practices, well over 2200 providers using the application as we speak in practices ranging from 1 to 130 physicians throughout the United States.

Dr. Eric Fishman: And that’s the Aprima product?

Michael Nissenbaum: That's the Aprima product.

Dr. Eric Fishman: It is a combined EHR practice management system?

Michael Nissenbaum: It is a single data-base application offering both sides of the equation - practice management and EHR. The policy though is that if you have a PM today and you want to continue using your PM, we will interface with your PM

Dr. Eric Fishman: That's any PM?

Michael Nissenbaum: Any PM as long as it's HL7 messaging.

Dr. Eric Fishman: Of course.

Michael Nissenbaum: Conversely, if you have an EHR and want to use our PM or our revenue cycle management application, you can do that as well.

Dr. Eric Fishman: I spoke with Chuck Jaffe yesterday from HL7. He said that essentially, every single product on the floor today is HL7 compatible.

Michael Nissenbaum: Isn't that wonderful to see after all these years?

Dr. Eric Fishman: Tell us who in particular do you propriate as a user of Aprima.

Michael Nissenbaum: Well, again, we focus on the 1 to 10 physician space because, let's face it, they're 64 percent of the practicing physicians n that space.

Dr. Eric Fishman: That's what the RECs are focusing on. Do you have any strategy with respect to regional extension centers?

Michael Nissenbaum: We have reached out to a number of the regional extension programs. They are still waiting funding, they're still waiting final orders. When those are forthcoming, they will start going through their RFPs and making a determination. We hope to be present in a number of situations throughout the United States.

.Dr. Eric Fishman: Very good. Tell me about some of the differentiating factors with Aprima.

Michael Nissenbaum: Well, Aprima was always based on speed. It is not a template based application. The beauty of this applications is in its origins. It was built at Stanford University back in 1998 using 18 physicians to provide a knowledge-base of over 900 chief complaints. It's chief complaint driven because patients don't come to you with a diagnosis, they come to you with a complaint. Therefore, attached to these 900 chief complaints - which are easily modifiable and addable at the site, no IT necessary - there are about 400,000 relevant clinical terms. So if I show up with a cough on my full note composer, the first thing that shows up is cough and then, how long have you had it, exacerbating factors, location, all the relevant terms a physician would normally ask. It's into the system and logical for a physician to check through to build the note.

Dr. Eric Fishman: Thank you. Michael, you know that I have a particular interest in speech recognition for instance. Can you tell us how physicians tend to put in the historical data, their history of present illness? What are the options? I imagine there's quite a number of them.

Michael Nissenbaum: There are quite a number of options to put in the past histories. First of all, there's a full document generation, document scanning capability, document linking.

Dr. Eric Fishman: Does that have OCR?

Michael Nissenbaum: But it's not discreet data. We also have the ability to dictate any history. We have a Patient Portal. They can add data on any type of history that they want as well as a kiosk in the front office. There's numerous ways to get the history into the application.

Dr. Eric Fishman: Tell me about the Patient Portal because I have a particular interest in that. It shocks me that physicians don't use them as much as they could because it certainly lowers the cost to a physician.

Michael Nissenbaum: Absolutely

Dr. Eric Fishman: Do you have the data as to how many of practices are actually actively using patient portals?

Michael Nissenbaum: We have just begun rolling out the Patient Portal about six, eight weeks ago. We have about 22 practices on it and we have a number that are in the queue to be implemented. We will be approaching all of our practices with this opportunity. We've spent about six months testing it and then with our meaningful use application coming out later this year in the second quarter of this year, we are going to further expand the information available in the Patient Portal to comply with the meaningful use requirements.

Dr. Eric Fishman: I'll be interested in hearing how that works over time. Tell me what you see as the future. What's going to happen between now and the next year. Certainly, in the last year the changes have been dramatic. What do you see happening in the next year?

Michael Nissenbaum: Well, again, it's a turf war. It's a lot of representation by different people and what they can do, what their applications can do. We're all going to be meaningful use certified or else you're not going to be in the business. That's going to be a market clearing mechanism. Where we have 350 EHRs in the market today, last time, we had 80 practices that were CCHIT certified - 2008 I recall.

Dr. Eric Fishman: Eighty EMRs were certified and they skipped '09 and skipped (inaudible).

Michael Nissenbaum: So happens to the other 270?

Dr. Eric Fishman: You know, I publish a magazine, EHR Scope. Not to plug that, but we had well over 200 products listed in the Spring 2000 edition and late in 2009 I took out at least 100 companies that I couldn't find their phone number or URL anymore.

Michael Nissenbaum: Exactly. You're going to see, I believe that whittle down. There'll be some aggregation between vendors. We have no intention of aggregating with anyone else.

Dr. Eric Fishman: But you are an expert in that field.

Michael Nissenbaum: Fortunately or unfortunately, yes, with our history with some other companies but we see a very bright future. We have a tremendous install base, a very good reference base. We do virtually every specialty except for oncology, anesthesiology and right now we don't do ophthalmology but we're looking at doing it later this year.

Dr. Eric Fishman: Michael, thank you very much.

Michael Nissenbaum: Eric, good seeing you.

Dr. Eric Fishman: It's been a pleasure chatting with you. This is Dr. Eric Fishman for EHRtv. We've been speaking with Michael Nissenbaum, CEO of Aprima. Thank you.

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