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

If an eReferral/eConsult is flagged for scheduled removal and upon reviewing it you discover that the appointment date has passed and the patient has been seen, you can click the 'Completed' button within the eReferral/eConsult.

This updates the referral status to 'Completed' for all stakeholders involved in the referral, and indicates that the lifecycle of the referral has come to an end. Accordingly, once marked as completed, the referral will be removed from Ocean as per the scheduled removal date.

If an eReferral is flagged for scheduled removal and upon reviewing it you discover that no appointment date has been specified within the referral (e.g., you plan on seeing the patient, but have not yet provided an appointment date), you can add an appointment date within the 'Scheduling' area of the referral.

Once an appointment date has been specified in the referral, the referral's scheduled removal date may* be adjusted to a minimum of 30 days after the last appointment date.

If an eReferral is flagged for scheduled removal and upon reviewing it you discover that no appointment date has been specified within the referral (e.g., you plan on seeing the patient, but have not yet provided an appointment date), but you are not immediately able to specify an exact appointment date, you can add an 'Anticipated Wait Time to Appointment' within the 'Scheduling' area of the referral.

Once an anticipated wait time has been specified in the referral, the referral's scheduled removal date may* be adjusted to a minimum of 60 days after the latter estimated wait time value.

If an eReferral is flagged for scheduled removal and upon reviewing it you determine that it requires the attention of another user on your Ocean Site, you can assign it to them for review.

Once it has been assigned for review by a particular user, the referral's scheduled removal date may* be adjusted to a minimum of 365 days after the date that the review was requested.

If an eReferral is flagged for scheduled removal, you can locate it in the 'Deletion Warnings' folder within the eConsults & eReferrals area and click the refresh symbol (circular arrow) at the end of the row to extend the scheduled removal date by 60 days from the current date (i.e., the date that the refresh symbol was clicked).

The PS Suite Custom Form integration and the OSCAR Classic EMR integration (i.e., Ocean Sites that do not use Cloud Connect) 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 remain orphaned.

Notes can be orphaned for a few reasons:

• For an Ocean Site not using Cloud Connect, 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.
• For an Ocean Site using the PS Suite Custom Form integration (i.e., not Cloud Connect), the Ocean Custom Form was removed from a chart in PS Suite before a tablet session or web questionnaire is complete.

• 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.

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.