Clinical & financial intelligence for skilled nursing facilities
Axis Orenda reads the documents a facility already produces — referral packets, MDS assessments, charts, claims — and returns a structured, scored answer with every finding quoted back to the page it came from. Configured per facility: your acuity limits, your payer mix, your isolation capacity, your excluded diagnoses.
HIPAA-ready architecture · AWS BAA-covered services · Append-only audit log on every access
A sixty-page referral packet arrives by fax at 4:40 on a Friday. Someone has to read it against the acuity limits, the payer mix, the isolation beds and the diagnoses this building cannot take — and answer before the discharge planner calls the next facility on the list. The packet is not organised for that question. Nothing in it is.
The same pattern repeats all month. Items to verify before the assessment reference date closes. Charts to audit before the surveyor walks in. Claims to reconcile before the triple check. In each case the work that consumes the hours is not judgment — it is retrieval. Finding the one sentence on page thirty-four that settles the matter.
That retrieval is what Axis Orenda does, and it shows you the sentence. The recommendation is never the artifact you are asked to trust on its own; the quote, the page and the section travel with it, so the reviewer confirms in seconds what would otherwise take an hour to locate.
Each tool reads the same effective clinical record. Adding one does not fork your data or your workflow.
01 — INTAKE
Drop a referral packet. Receive a fit score from 0 to 100, an accept, review or decline recommendation, risk factors with severity, projected staffing impact, and cited evidence quoted to its page. Scored against your configured intake criteria — not a generic rubric.
02 — CASE MIX
A PDPM register across the census, MDS audits against the item sets, and assessment reference date review while the window is still open. Reimbursement is projected from the assessment you actually filed.
03 — SURVEY
Readiness measured across the building, and a working surface for answering a 2567: the citation, the plan of correction, and the evidence attached to each element.
04 — CLINICAL QA
The audit instruments your QA binder already specifies, run against the chart rather than transcribed onto a clipboard — falls, antibiotics, psychotropics, significant weight change, catheters, restraints, change of condition.
05 — BUSINESS OFFICE
Accounts receivable and additional documentation requests tracked to the resident and the claim, with pre-billing reconciliation handled in the triple check instead of a spreadsheet.
06 — DATA
PointClickCare’s FHIR R4 and Partner surfaces, with residents linked one at a time by a person. Inert until an operator sets credentials — the uploaded-packet path is unaffected either way.
01
Acuity ceiling, accepted payers, isolation beds, excluded diagnoses, staffing notes. Stored as a versioned record, so you can see which rules produced last quarter’s decisions.
02
The upload goes from the browser directly to encrypted object storage. Protected health information never passes through an application server or sits in its memory.
03
Text-native documents are read complete, layout included, without chunking. Scanned pages route through optical character recognition first. Output is forced to a fixed schema on every run.
04
Every finding carries its quote, page number and section. A reviewer verifies the source rather than taking the summary on faith, and the access is written to the audit log.
Specimen output
Each assessment returns the same fields in the same shape every time, so a decision can be filed, compared across months, and audited a year later. Nothing is parsed out of freeform text.
| Field | What it holds |
|---|---|
| Fit score | 0 – 100 |
| Recommendation | accept · review · decline |
| Risk factors | Factor, severity, clinical note |
| Strengths | What makes the placement work |
| Staffing impact | Nursing hours, therapy minutes, special requirements |
| Cited evidence | Quote, page, section |
| Confidence | Stated, not implied |
Security & compliance
The full HIPAA surface is wired in from the beginning, and every architectural decision assumes real patient data even where only synthetic data is being processed. Production runs on services covered by a single business associate agreement, so there is one vendor relationship to diligence rather than six.
Encryption in transit at TLS 1.2 and above. Encryption at rest with managed keys. Eight-hour session expiry. Roles for clinician, administrator and auditor, enforced per route.
PHI off application servers
Presigned upload straight to storage — documents bypass the API entirely.
PHI out of logs
Request logging records method, path and status. Never a body.
Append-only audit log
Who, when, what, from where — on every access. No update, no delete.
Tenant isolation
Every row carries its facility. Every query is scoped to the caller’s.
One BAA vendor
Model inference, storage, database, authentication and logging under one agreement.
Integration
Connectors for both PointClickCare surfaces ship in the platform and stay dormant until an operator supplies credentials. Start with the FHIR surface, which works from published documentation and a shared sandbox; the Partner API reaches further but requires a letter of authorisation per customer.
Recommended first
US Core 3.1.1 and 6.1.0. Shared sandbox, no per-customer letter of authorisation. Reaches progress, therapy, discipline and consult notes, vitals, weights, labs, orders, medications, immunisations, the care plan, coverage, encounters and the document list.
Deeper surface
Everything the FHIR surface carries, plus the medication administration record, CNA and activities-of-daily-living charting, and the MDS item sets. Enablement is driven per facility by the customer on roughly a two-week timeline.
By design
There is no bulk link and no name matching. A wrong link writes one resident’s chart into another’s record, and nothing downstream would catch it — so a person confirms each one.
Bring a referral packet — synthetic, or redacted from your own building — and we will configure your intake criteria and run it live on the call. Thirty minutes, no preparation required on your side.
Multi-facility operators: we will also walk the cross-building roll-up and the per-facility criteria model.