What do I do if I see "Warning from Ocean: Notes Require Download"?

The PS Suite custom form integration and the OSCAR EMR integration (for sites that are not on Cloud Connect, as of 2017) are only able to download notes when the chart for a particular patient is open and connected to Ocean. If the patient's chart isn't open or the chart doesn't know about the Ocean note, the note can remained orphaned.

Notes can be orphaned for three common reasons:

1. A web questionnaire was sent and the patient's chart hasn't been opened for months. Ocean has a configurable expiry date (default of 100 days), after which it will remove the patient, note and all. If you send out web questionnaires months in advance (e.g. a pediatrician sending an intake package to newly pregnant women), then this time period may expire before the chart is opened to download the note.
2. The Ocean custom form was removed from a chart in PS Suite before a tablet session or web questionnaire is complete.
3. A tablet session was completed and the initial note was downloaded, then the same ref was used to load the tablet again for the same patient. In this case, the Ocean custom form would be deleted after the first tablet session completed -- the notes associated with subsequent completions will be orphaned since the link to the EMR chart is broken.

Note: If you are only using tablets (and not web questionnaires), most likely any "real" missing notes would be noticed at the time of the appointment and you can ignore the notifications.

Since Ocean is not an EMR, it is unable to retain private patient health information for prolonged periods. Consequently for privacy reasons, it removes patient data as soon as it's not strictly required. Notes that are orphaned for months must eventually be removed, even if they contain important clinical notes. Hence we notify you with a warning email and ask you to manually review the notes before they are deleted.

1. Login to the Ocean Portal. If you aren't already in the Patients view, click the "Menu" button in the top left corner and select "Patients".
2. Review the outstanding notes by searching for your patients using their Ocean reference number. If this is the first time you are logging in to Ocean on your computer, you will need to enter your shared encryption key to see the encrypted data.
3. A quick scan of the notes will usually give you some indication whether they are real or not. If appropriate, copy & paste the note into your EMR patient chart and remove the Ocean patient and patient record from Ocean.

Hint: If you want to pull a note back into PS Suite, simply insert the Ocean custom form as you would normally for that patient, click the generated 3 or 4 digit number and update it to the Ocean reference you want to import -- within a few seconds the note and any demographic changes will be downloaded and applied automatically.

It depends on why you are getting orphaned notes.

• If the leading cause is early-sending of web questionnaires, you can either act on the completion notification and download the note then, or extend the expiry date on the invitation to more than 100 days.
• If the leading cause is testing, the warnings ought to settle down after a while.
• Finally, if the leading cause is staff miskeys (i.e. removing the custom form or re-entering the Ocean patient reference number on the tablet after the patient has completed their forms), a recap on training might be appropriate.

However, the root cause of these issues may be something else specific to your workflow or process. If you think that you are getting too many orphaned notes, let us know at ocean.tips/support to see whether we can help.