Review of Axxess Software

I admit this review is long overdue.

I’ve been seeing Axxess being utilized in the majority of agencies that I’ve visited as both a surveyor and consultant. As it turns out, it is because they have over 1800 home health clients since their inception in 2011. That’s pretty impressive.

I had a long chat and demo with Diane Cahill, whom I found more than knowledgeable about the many functions of the application and I started the phone call with a few “bones to pick” regarding the way I’ve seen the software utilized in the agencies I’ve visited. You know I come to every demo with my own agenda! (by the way, I’m told it rude to show up at someone else’s meeting with your own agenda…but their agenda is usually boring lol)

If you read my earlier post about the QA craziness, I had identified that today’s software programs force every single stinking document to QA (or somewhere) for review! The agencies I’ve seen, especially those with over 100 patients had several FTEs that did nothing but hit that approve button! So Diane endured a bit of my rant and then led me gently to the settings where that function can be turned off.

Now mind you, it is turned of by user, not by document. That could make sense if I am reviewing a new employees charting as part of their on-boarding to the agency. However, if you want to use that sweet function where you decide to just look at a sample (say 10%) instead of every single stinking note you will only see the documents created by clinicians that have not been “turned off”. That’s not as helpful in a lean, green QA program.

Note to Axxess: Beautiful QA function,. but give us the option  look at a sample of documentation across the board regardless of the review by QA setting under each role. It may also be worth considering having the option to turn off this QA review function by document in addition to user.

A real game changer for me was the ability for a nurse or owner who is involved in more than one agency has to sign on only once to have access to all the agencies they are involved in!.

An unfortunate trend in home health is that nurses are working for more than one company and I think it is a terrific advantage (and recruiting benefit). If I MUST work for more than one agency, I can at least document on the same system with one log in. No bleed-over, you have to choose the agency when you log in and don’t need to worry about charting or emailing the wrong agency about a patient.

Note to Axxess: Consider consolidating the scheduling feature, what a boon that would be! As a clinician I can see my actual schedule across all agencies. I would recommend that scheduling of a patient for one agency be viewed only as “unavailable” by other agency employers so they will know that person is not available due to a scheduled visit for another agency.

An underused feature that would be of great benefit is the OASIS scrubber. Have the nurses check it and complete the corrections…another way to stop the QA madness.

Speaking of QA, Axxess maintains all your QA surveillance in the system. (donate those binders to schools that need them!) There are incident surveillance reports (they are not a part of the actual patient record, they are just stored in the system and cannot be access except through reporting. Similar to the paper version in which they cannot be accessed except through picking up the binder.

Note to Axxess: Make quarterly reporting on this surveillance data meaningful. Trend it quarter to quarter or month to month with automatic percentages based on the census. In other words, it’s one thing to know I had 10 infections and 2 incidents this quarter, but what percentage is that? The number of occurrences may have gone up or down, but so has my census. The data is useless without that denominator. The census data is in the system, there should be a way of automating that instead of staff having to run the reports (and you know they are going to either get the parameters wrong or not run it the same way every time). Allow us to visualize the percentages in graphs (just like the outcomes on home health compare.)

There were many features that I had not realized were available in Axxess, because most of the agencies aren’t using them. I love that the calendar/schedule flows to payroll (no more rout sheets)

There are mobile apps with gps verification. It only marks the visit verified if someone signs that signature pad, but depending on your policy it does not have to be the patient. (Remember that Medicare, nor CHAP requires patient signatures and if you think you are validating their visits with those signatures, you are naïve!)

Note to Axxess: Make that signature optional while maintaining the gps validation. Is that possible?

Another BIG bone to pick! parameters on the 485 must be completed on every single patient, what a pain. The medical profession has long had standard parameters for normal vital signs, Axxess, please pre-populate them, but give us the option to change them according to the physician’s expectation for the patient. 99 times out of 100, the parameters will be based on best practices.  OASIS completion is hard enough without adding the work of entering parameters.

Note to Nurses: Please complete the OASIS assessment during the visit. There are far reaching clinical and financial implications associated with that document and you cannot possibly remember a thorough 21 page assessment for entry later at home.

Note to Owners: Invest in a 4g device large enough to document the OASIS assessment. Yes, they may use it for personal use, the point is they can do a better OASIS assessment which contributes to your reimbursement and the speed of cash flow.

Now for the deets: There is no long term contract. There is a written agreement for 12 months with a 90 day out. New and small agencies can take advantage of paying by census 1-25 census is $499/month. This is especially beneficial since you will probably have more part time users than your larger competitors. Larger agencies can pay by users: 1-5 users is $499/month. If you choose the census option, you can have unlimited users. If you choose the user option you have unlimited patients.

A Private Duty application is due to be released live this spring and while they have plans to do hospice. I’m going to bug the crap out of them until they get that done! They are located near my home in Dallas, so I will go down there if I have to!

 

PROS

 

 

CONS

Cost! No built in best practice parameters
True Paperless Potential Care plan options generic and sometimes inappropriate (placing services provided on first visit in 485 is not good practice)
Built in payroll (no redundant route sheets) QA surveillance data does not trend
Mobile apps Can’t QA a true sample of agency documents unless agency has selected to review EVERY clinician
Encrypted in-application email Can’t turn off “Send to QA “ by document (by user only)
Schedule options (by clinician or scheduler) Generic interventions and goals (utilize best practices, probable care plans based on data from the experts (American Heart Association, American Diabetic Association, American Association of Heart Failure Nurses
Single sign on for multiple agencies Does not populate visit note with interventions and goals that can prompt nurse as to what is expected according to the care plan and address progress towards goals. (We’ve had this ability since 1999)
Can turn off that stinking QA review process  
Can be accessed anywhere with internet connection on any device

 

OPPORTUNITIES

 

Very intuitive interface (I’ve never received training, but I love to just push buttons and see what happens More focused care plans
Free training—Free CEU’s Populating the interventions and goals to each note so they can be addressed
Recruiting potential as utilizers of most popular software in the small/mid-size agency Add ability to report on interventions and goals that have not been addressed as part of final audit
Integrated Human ResourcesTrack requirements in Axxess instead of addl applications. Add parameters based on best practices to 485 with option to individualize.
Built in OASIS guidance—throw away the books. Hover over the question and it describes what Medicare xpects Get rid of that patient signature (or at least give option to turn it off)
OASIS Scrubber function for RN’s to analyze PRIOR to submission (when you’re ready to cut the QA apron strings) Provide option to skip QA by documents

 Final impressions:

I understand why it is such a popular product. I’m anxious to see what they will do next.

I wonder if a circling back with the training would be worthwhile to maximize the features of the application, improving not only satisfaction amongst users but improved clinical and financial outcomes.

Home Health Owners: Get your money’s worth out of any software, but especially with Axxess. Of all the times I’ve heard “Axxes won’t let you do that” I’ve learned that it is not an Axxess issue, it’s a settings issue.

Profit margins are getting slimmer and slimmer. It is imperative that we spend our money wisely. Revising QA processes is one, using your technology to reduce redundancy and allow your nurses (who are in short supply) to do the things that only they can do!

To that end, to those of you who are maintaining paper charts as well as electronic charts you are not only  wasting the cost savings intended with the adoption of technology. It costs money to manage paper, maintain clinical files, store clinical files, review clinical files. Reconsder this practice! Choose a software solution that not only takes the place of clinical records but personnel records, agency logs, and communication via email notes and communication notes added to patient records as well.

Axxess is a smart choice. Learning as much as you can and utilizing to its fullest potential is genius.

To schedule a demo or learn more about the features, visit www.axxess.com. Diane Cahill does a terrific demo, but she assures me that the entire staff is more than capable of presenting a comprehensive demo.

Any current Axxess users are welcome to respond to this post. Post a comment, anonymously if desired. Just remember my mama reads this (supposedly) so keep it clean folks.

I would love to hear especially about the features you find most useful, obstacles you’ve been unable to overcome and any experience with customer service.

 

 

 

 

 

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