Following Up on Overdue Secure Messages and Questionnaires

Ocean's patient questionnaires and secure messages often require clinically important responses from patients. For example, a secure message may be sent to a patient asking them to check their blood pressure and report back to the clinic. As a result, it is important to have a systematic mechanism for following up these messages at your clinic.

Unlike plain emails or voice mails, Ocean provides an integrated safety feature to prevent overdue responses from "falling through the cracks".

Setting Due Dates for Questionnaires and Secure Messages
  • When you send a questionnaire or secure message, you can request to be notified if the patient hasn't responded within a specific time frame (using the "Notify me if no response after" features). You can adjust this setting in the Security Information panel in the dialog used to send an online message or questionnaire.
  • Later on, if the patient has not confirmed receipt of this message, either by completing the questionnaire or clicking the checkbox to confirm that he or she has received the secure message, then their response will be considered overdue.
  • Note: You do not need to use the "Allow Reply" feature in order to track these messages. Messages that do not have allow for replies will still present a checkbox for patients to confirm receiving the messages. For more information about secure messages features, please refer to Ocean Online Message Settings.

Ocean Online Message Templates

You can update the template for your online message or questionnaire to remember the notify/overdue setting so that you don't need to set it each time. For more information on configuring your templates, please refer to Ocean Online Message Templates.

Email Notifications Regarding Overdue Responses
  • Some sites prefer to receive a nightly digest of all patients in Ocean with overdue responses, even if a reminder notification email for these patients has already been sent.
  • Other sites prefer to avoid receiving repetitive notification emails each evening when they have already been notified about these specific overdue responses.
  • You can customize these setting within the Admin tab of your Ocean Portal (i.e. the "Overdue Secure Message Notifications" field in the "Site Features" section). You can choose between the following:
    Include all patients with overdue messages
    For a nightly digest.
    Limit to patients with newly overdue messages
    For specific overdue responses only.
Reviewing All Overdue Responses in the Ocean Portal
  • Regardless of your email notification setting, we recommend that you designate someone at your site (usually a receptionist) to follow up on all patients with overdue responses. Individual clinicians may also choose to manually follow up their secure messages.
  • To view all patients with overdue messages, go to the Patients tab in the Ocean Portal and click on the search box under "Find Patients" to choose the search option for "Patients with overdue responses".
Determining the Reason for an Overdue Response

Patient responses may be overdue for the following reasons:

  • The patient hasn't checked his or her email recently
  • The patient's email is incorrect (which may or may not have bounced)
  • The email was spam-filtered (fortunately Ocean's emails are generally deemed legit by mail clients and are usually not spam filtered, but it can still happen)
  • The patient failed to read or open the email
  • The patient read the email, but wasn't sure whether it was spam or phishing, and consequently ignored it
  • The patient is having technical difficulties opening the message
  • The patient opened the message, forgot or chose not to confirm receiving it
  • The patient accessed the message, but is having technical difficulties viewing or confirming the message

A patient is considered to have accessed the message if he or she has clicked on the email link.

In order to actually confirm receipt of the message, the patient must click on the corresponding checkbox and submit their response. Ocean tells the patient to click on this checkbox, and it even "nags" the patient if they try to close the window without doing so.

Unfortunately some patients still forget to click this checkbox, or don't notice it, despite Ocean's best efforts. When this happens, medico-legally speaking, your clinic cannot be sure the patient read and understood the message, and thus their response is still considered to be pending. However, if you know that the patient has accessed the message, you at least know that they clicked on the email link, and you also have a clue that they very likely saw the response.

To determine the reason for the overdue reply, start by checking whether the patient has at least accessed the message. You can determine the Accessed Date from the notification email. In the portal, the patient's status icon and status message will indicate whether the message was accessed (view the status message by hovering the mouse cursor over the status icon under the Status column in the Patients tab).

Following Up on an Overdue Response

Regardless of the reason for the delayed reply, it is likely clinically necessary to follow up with the patient using your traditional means of communication: phoning, leaving a voicemail, texting, or discussing the next time they return for a visit. You may want to inquire why they didn't receive the message so that you or they can take steps to handle the next attempt successfully.

An Example From Dr. Kavanagh's Clinic

Dr. Kavanagh's administrative staff will often follow up by calling patients when a secure message or questionnaire is overdue for a response. If the patient's voicemail is encountered, the secretary simply leaves a message asking the patient to check their email for the message sent on a particular date. This technique is helpful because it not only follows up the concern related to the notification, but also "trains" the patient to ensure similar messages are received successfully in the future. Individual clinicians may follow this approach by sending a task/message to their secretary in their EMR, asking them to do the same.

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