2. What’s New with Axium
Ryan Brandon

3. hIGHLIGHTS New Treatment Planning module
Meaningful Use program launched
Faculty qualify for incentives
MU Dashboard
DoctorAccess product prototype
axiUm Dental Hygiene Edition
axiUm SOA refactor underway
ADA describes axiUm as the leader in evolution of EHRs in oral health care
Seahawks win Superbowl

4. Evolution of the axiUm EHR
Data Collection and Input
Intuitive, efficient and highly usable interface
Promote data quality and accuracy
Multiple authors contributing
Assistance with selection of appropriate term
EHR
Data Collection
Report
Share
Utilize
Reporting and Research
Open database (non-proprietary)
Structured and accessible data
De-identified data for research
Promote standardization of systems, methods and code sets
Requirements often drive changes to the data collection process
Data Sharing
Interoperability with other EHRs
Open APIs to read/write data
Securely transmitted referrals
Patient accessibility
Employer, Insurer, Lab, Pharmacy access
Data Utilization
Measure and assess outcomes
Decision support
Interventions
Insurance billing
Improve quality of care and safety

5. Axium PRODUCT GOALS Providers Delivering Improved Healthcare
Patient Access and Engagement
Open and Integrated Systems
Putting this another way, I do think about the delivery of medicine 5 years from now.
OPEN and INTEGRATED SYSTEMS
Open platforms, like they have in most every other industry, will be successful.
Closed systems that inhibit innovation and restrict information liquidity will be left behind.
PATIENT ACCESS, ENGAGEMENT and EMPOWERMENT
I think that patient access, engagement and empowerment are key to the EHR evolution.
Patient’s consumption of mobile technology and tracking innovations will contribute to more accurate and comprehensive health records.
PROVIDERS DELIVER HEALTHCARE; NO LONGER DATA ENTRY CLERKS or COMPUTER USERS
Time to tip the scales so that Providers get much more out of EHR than they put into it.
There will be less burden on the provider for data entry.
More complete and accurate health information and improved technology, the provider will be able to focus on delivering appropriate healthcare. 

6. OPEN and INTEGRATED OPEN and INTEGRATED SYSTEMS WIN THE DAY
axiUm will connect into the HIE to share and collect data from the superhighway
Open application program interfaces (APIs), interoperable systems and standards will allow the seamless transition of healthcare data to patients and providers throughout the network.

7. Patient Engagement PATIENT ACCESS, ENGAGEMENT and EMPOWERMENT
The information will flow from personal devices over the cloud to the healthcare provider.
Providers will connect with patients through technology to update care plans and monitor health outcomes.
More self-service options through PatientAccess

8. HEALTHCARE IMPROVEMENTS
Providers delivering appropriate healthcare
Reduced data entry
Evidence-based dentistry
User experience driven
designs
PROVIDERS DELIVER HEALTHCARE; NO LONGER DATA ENTRY CLERKS or COMPUTER USERS
Data coming from other sources (patients, HIE)
Big Data will provide the evidence to support appropriate decisions
S/W will focus on utilizing this to give providers exactly the information they need at the point of care and not deluge them with tabs and folders they must fumble through electronically while a patient stands in front of them.
The simple, effective and purposeful technology designs we have come to expect everywhere else in our lives are the goal for healthcare.

9. Axium 5.20 Highlights August 2013 Released to SIU in August
Seeing as there are still quite a few of you not updated,
going to review a few of the key features in that 5.20 release.

10. TREATMENT PLANNING
Completely re-developed module with user-experience design

11. TREATMENT PLANNING Developed in collaboration
Simplified User interface
Improved Diagnostic Terminology
Integrated Decision Support
Working with COHRI team
Simplified/All-in-one user interface
Improved entry of terms with text matching
Supports new Dx options
Synonyms, assistance
Decision support for proper Dx and Tx selection

12. OPERATORY MONITOR Monitor status of appointments in the clinic
Follow patients through visit:
Sign in, check-in, seated, checked-out
Alert to providers needing assistance
Keep providers with their patients
Improve Faculty coverage and responsiveness
Create a system to monitor the status of appointments and alert faculty/admin to providers in need of assistance
Summary of benefits:
Keep providers with their patients (instead of leaving to go track down help)
Reduce Faculty needed to monitor the clinic
Reduce response time to critical issues
Prevent non-urgent issues from jumping the queue
Track and Report out
Critical issue response time
Clinic efficiency with the transition of patients through a visit
Provider requests for assistance

13. Provider Notifications
Provider sets indicator to notify of need
Needs are defined with level of urgency and color
Quickly set through Status Bar
Replaces call-light system

14. Info manager EXPORT TO EXCEL Single step process
Quickly perform calculations, sorting and grouping
REPORT SHARING IMPROVEMENTS
Access to individual or multiple users/levels
Read-only access option
PREVIEWED REPORTS
Leave open while working

15. OTHER FEATUREs EHR FORMS “Don’t Know” option for Yes/No questions
Prompt for additional info when answer Yes, No or Don’t Know
SPELL CHECKING
Clinical Notes and Messenger
ROLODEX
Additional columns to display and search

16. Axium 5.30
Coming soon!!!

17. Axium 5.30 Service-Oriented Architecture (SOA)
HITECH Certification and Meaningful Use 2014
Comprehensive Auditing
Many New Features
Coming Soon…

18. Technology Evolution
1985 DOS
Internet
Workstations
Windows
1992
Thin Clients
Broadband
Cloud
SaaS
Browser
2004
Wifi
Devices
Mobile
Social
2007
Hybrid Cloud
Big Data
PaaS
2014+
Post-PC
Internet of Things
For those of us that have been around for awhile, we’ve seen this before.
Technology direction is changing (just like Windows replacing DOS); don’t want to be left behind 
Time to reinvest in our solution to ensure that you all can continue to use this product 5-10 years from now when technology demands it.
… Unless someone out there is stockpiling Windows PC’s

19. NEXT generation of axium
Browser Based
Service Based
Security Based
User Based
Why should we do this and why we will succeed!
Tech and UI reasons
- obviously the technology is pushing this, but we’re also in a great position to build new UI
Have the resources (to collaborate with), the commitment to deliver and the experience to build this new interface
We’ve selected a low risk incremental refactor process:
Not a rewrite with limited functionality
No data conversion or migration to new system
Be able to continue to build core system functionality
Collaboration Based

20. WHERE ARE WE NOW?
Hybrid state – just like car switching from gas to electric, we’re starting with the changes under the hood.
- bridge the gap from client server to SOA/cloud w/o rewriting everything.
The system will look and function as before, but it has been re-architected to use web-service calls from the windows client thru IIS.
The service-oriented architecture will support the usage of axiUm across WANs
Refactor some slower performing/chatty areas - immediate benefits
Where are we headed? … next

21. NEXT STEPS Browser Based Service Based Security Based User Based
FUTURE
Refactor some slower performing/chatty areas - immediate benefits
User experience driven re-design of UI
Create utilities as web services running on IIS to streamline current processes
Provide APIs to improve interoperability with other systems
Hosted solution to allow organizations to focus on your business rather than software
No order to next steps, no time lines, etc.
They all make up components of the future vision and deliverable.
You could call out a few specifics but it is what will strategically drive our multiyear roadmap?
User Based
Collaboration Based

22. CollaboratE on design
Tx Plan taught us, we have access to large group of experts
create a more usable and efficient next-gen system
Work with Customer Advisory Groups
Share ideas and plans
Validate designs, prototypes and products
User experience driven re-design of UI
Dentrix Ascend – research into their UI
HS - feedback from 100,000+ customers
- work with their dev team as a idea group
- share ideas ; if there is a good idea for Dentrix, then we will know
Provide the best clinical interface bringing Dentrix and axiUm together

23. Back to 5.3
Now back to the 5.3 features

24. Capture Patient Demographics
Standardized entry for:
Primary Language
Race
Ethnicity
Frees up Patient Custom fields
Standardized Entry method across customers
Frees up custom fields
Properly handle patient who declines to answer 24

25. Reassign Patients Bulk reassignment through Patient Assignments
Quickly reassign a group of patients after graduation
multi-select
Filter on discipline, date ranges 25

26. Advanced Auditing Audit all actions on health information: Adds Edits
Deletes
Views
Prints
Tamper resistant audit log
Auditing of all modifications, access/views and printing of patient health related data is stored in a single log file.
Solution replaces the old Pt Access view logging, adds new Print logging and amalgamates all modifications into the same log.
Log is stored encrypted to make it tamper resistant.
Does this solve all of your auditing problems? It should solve the HIPAA/PHI ones. 26

27. Start checks Conditional requirements by: Provider Clinic Patient Type
Procedures
Other custom-coded conditions
No more start checks for typodonts or screening. 27

28. Copy Perio Chart Use previous exam data to start a new perio chart
Select from any previously charted values
Clear selected conditions to reset
5.30 28

29. Medical ALERTs Allergies and Problems Text matching and assistance
Terms mapped to SNOMED-CT codes
Three Alert Types:  Alert, Allergy, Medical Problem
Intellisense search feature when typing in the Alert field.
Additional context information when hovering over each item in the drop down
All items are mapped to SNOMED.
New “Onset” date field
Medical Alert items can be added via EPR forms (i.e. based on form answers)

30. Online Health Information Library
axiUm InfoButton available for:
Medications/Prescriptions
Allergies
Medical Problems
Provides information & decision support through on-line dictionary
For data entry and explanation of current conditions
Medline Plus, Elsevier ClinicalKey and others
MEDLINE Plus is a free solution funded by the US federal government.
[Configuration]
Accepts codes as parameters (RxNorm codes for Drugs, SNOMED for Medical Problems, and LOINC for Labs) and displays the appropriate Web page for that.
[Clinical Advantage]
Further understanding or clarification of medications, allergies and medical problems prior to data entry.
Results in accurate assessments and treatments.
Accurate discussion between Provider and Patient

31. eRX Axium Erx INtegration Medications Prescriptions Problems List
Allergies List
Problems List
Allergies List
[Clinical Advantage]
Eliminates redundant work to have “same data” between two systems
eRx systems interfacing with axiUm receives/shares patient data
Accurate patient snapshot between systems

32. Clinical decision support Notifications
Alert to conditions requiring attention
Notifications based on structured data
Triggered on common events
CDS Intervention Notifications
Preface with evolution of EHR: collect and store data, report on data
CDS Encompasses:
Computerized alerts & reminders
Patient data reports and summaries
Enhance decision in clinical workflow
Use data on hand to proactively alert user to assist with healthcare
User Level based. Similar to Status bar indicators
Alerts Trigger on:
Select Patient
Open EHR Module
Check In Patient
Check Out Patient
Open Ortho Manager
Open Perio Module
Open “Patient Prescription Entry” (non-eRx)

33. CDs Notifications Notification events are recorded: Triggered
Displayed
Dismissed
Verify that a provider received and dismissed a warning.
Based on severity level may not be able to dismiss the warning
[Clinical]
axiUm CDS Interventions currently implemented:
Check current Medications for un-reviewed items
Awareness of blood pressure and age of the patient
Check current Medical problems for un-reviewed items
Alert for missing/outdated Patient vitals (Height, Weight, Blood Pressure)
[Financial]
Alert on “no Coverage” on date of the appointment

34. TRANSITIONS OF CARE Process Pt Referrals and Visit Summaries
Integration of C-CDA
Export to other HIS
Import as an attachment or reconcile data into axiUm patient record
New system to process patient referrals or provide visit summaries with other EHR.
Through the export/import of HL7 standard C-CDA formatted files
The feature allows you to export a visit/encounter summary and/or patient summary from axiUm to be transmitted to another system. 
For importing, axiUm can take a “file” from another system and import it as either an attachment (readable summary of the information) or into the patient record.
Communicate healthcare-related patient data
-     Pt demographic – birthdate, gender, race
-     Problem list
-     Medications list
-     Allergies
-     Vitals
-     Smoking Status

35. Sample export file

36. Meaningful Use UPDATE axiUm CE certified in February 2012
All State Medicaid programs open
Many dentists have registered and collected Year 1 funding with axiUm CE:
$21,250 per provider
Faculty authorizing work in clinic can qualify based on encounters with students
Faculty can qualify for $21,250
Faculty only qualify for Year 1 funding and this has been debated in a few states.
CPOE requirement makes it impossible to qualify for Year 2+ 36

37. Meaningful Use 2014 MU Program changed Jan 1, 2014
Much more comprehensive with UCD req’d
New measures and objectives
Stage 2 includes dental measures
Children who have decay
Children receiving fluoride varnish
For Stage 3, Exan validating dental measures
Care continuity
Use of Dental Sealants
New Stage 2 rules in effect
MU Stage 1 focused on data collection and reporting.
Stage 2 is much heavier and has added a usability component (UCD/SED) that has ended the cert for many co’s
Stage 1 had approx.: 1200 certified EHRs. Stage 2 has less than 100
New measures and objectives for anyone going into Year 3
But, Dentistry is becoming a part of it
Headway with ONC/CMS
Care Continuity Children who receive a comprehensive or periodic oral evaluation in two consecutive years \
Sealants for 6-9 year olds: Children aged 6-9 years who receive sealants in the first permanent molar
Stage 3 delayed to 2017

38. Meaningful Use 2014 axiUm 5.30 CE 2014 certification
EHR Module certified in December
“Base” EHR certification in process
axiUm MU 2014 package
Workflow changes will be required
New MU Dashboard
Where are we at?
EHR Module certified in December
Base EHR certification – explain what it is and will be ready by Mar 1
Year 2+ will require install 5.3
Year 3 will require Base+ more for sure
Final steps in Base EHR completed with UCD testing process on Sunday
DrFirst failed to deliver
UCD testing at Summit
Certification tests scheduled
Working with new certification body as CCHIT closed
MU 2014 Implementation
requires changes to workflow from 2012

39. Meaningful Use dashboard
For clients ready for Year 2 MU, Exan has evolved the MU Reports to create the MU Dashboard:
Monitor eligibility status per Eligible Provider
Supports both Stage 1 & Stage 2 Meaningful use.
Web based product that uses axiUm user accounts
[Clinical Advantage]
Generate MU reports outside of axiUm
EPs have the ability to track their progress without having to close their current axiUm window
Allows for real time assessment of MU
Summarized and up to date assessment of MU Progress

40. Meaningful Use dashboard
Review the details of each MU Objective and Clinical Quality Measure
View the definition of every Meaningful Use measure and Clinical Quality Measure.
Help provider understand what needs to be done.
You can use the provided content or customize it to explain your own workflows.

41. Meaningful Use dashboard
Report and export measures for reporting period
Calculate for provider and/or faculty
Quickly view your Clinical Quality Measures for any reporting year, and export them in the XML format required for submission.
Calculations based on work performed as provider or approved as faculty.

42. PT ACCESS

43. PAtIENTaccess Self Registration
Pt self-registration for PA account; no more handing out login/pwd or answering phone call
Eliminates overhead in front desk administrators spending time activating with patients
Don’t need this
Patient self-registration is all performed on the patient’s side
Patient receives an to confirm registration
Provide DOB, Name and
Sends custom to patient
Patient clicks link in
Provides username and password
Gets another confirming the account created
Now when log in, must accept terms and conditions
CMS aspects of change (Self-Registration section)
settings (including subject, body, html format), text settings for screen
Securely register without administration

44. PAtIENTaccess Password reSET
Does this ever happen to you?
Eliminates overhead in front desk administrators spending time re-activating accounts with patients
Patients can reset their passwords securely by
Prevent the patient from having to contact the clinic if they forget their password

45. PAtIENTaccess Authorized Representatives
Authorized representatives can securely access sensitive patient data in PatientAccess
Allow patients to designate authorized representatives who can access PatientAccess on their behalf, with full auditability.

46. PatientAccess Secure messaging
Part of the patient engagement
Bi-directional messaging involving PatientAccess (Patients) and axiUm (Providers)
Exchange safe and secure messages with your patients using axiUm’s Messenger module.
Messages are encrypted and secure SHA-256 (AES)
[Clinical Advantage]
Discussion on next appointment requirements (i.e. Fill out forms, availability, etc)
Follow up on appointment and patient conditions

47. FUTURE PLANS
2014 and beyond

48. New Odontogram Anatomical shaped teeth (thanks HS)
Chart Class V (root surfaces)
Unerupted teeth solution
Occlusal restorations w/ different materials

49. New Odontogram Anatomically shaped teeth
Chart root caries and restorations
Support unerupted teeth
Occlusal restorations with different materials
Anatomical shaped teeth (thanks HS)
Chart Class V (root surfaces)
Unerupted teeth solution
Occlusal restorations w/ different materials

50. PAtIENTaccess online billing
Another patient engagement, kind of
Process:
Run Info Manager report, send statements to PatientAccess:
- generates to patient that statement is available
- adds statement to PatientAccess
- Patient logs in, reviews statement and submits payment through secure interface
- payment is added directly to axiUm account for next day

51. Patient COMMUNICATION
Notifications sent to patients or representatives
Link to secure information in PatientAccess
Statement or balance owing
Claim paid/insurance; balance owing
Upcoming appointment to schedule or confirm
Due for recall
Medical History or other form needs to be updated
- schedule appointments (81%)
- request prescription refills (68%)
- access lab results (62%)
- fill out medical forms (59%)
- pay medical bills (53%)
- ask care-related and administrative questions (51%)

52. Family of Web Products - New addition
On Family Day, appropriate that were adding a new member to the family of successful web-based solutions
Introducing …

53. DOCTORAccess For Students and Providers
Mobile and Tablet versions (BYOD)
New product for Student and Faculty Providers
Access information from your Smartphone from anywhere (not just within school)
Browser-based and will work on any device

54. DOCTORAccess Scheduler
View schedules and rotations
Access appointment and patient details

55. DOCTORAccess SECURE Messaging
Secure messaging integrated with:
axiUm
PatientAccess
FacultyAccess
Allow provider to keep in touch with the school, patients and faculty.

56. DOCTORAccess Try it out
For Mobile:
For Browser:

57. Looking Ahead Exciting times Commitment to Success New markets
New people
New technology
New products
New potential
Commitment to Success
CLOSING/CONCLUSION
Look back to that UBC implementation 17 years ago and how exhilarating it was to take a school live in a weekend. There hasn’t been a dull moment since.
Looking ahead, we are at an exciting point
New markets: Dental hygiene and DSO
New people: Clients, Exan staff and mgmt. and (new friends) HS
New technology: service oriented and web-based
New products: DrAccess
New potential: make Healthcare improvements and help achieve that Triple Aim
Just like that Friday when Dr Stich threw his old server out on the front lawn, we had to come through that weekend.
we’re committed to helping you succeed
providing the best software for you today, tomorrow and well into the future.

58. THANK you