Background
Ocean is not an Electronic Medical Record (EMR) system and does not store patient data long-term. This approach follows privacy guidelines that recommend minimizing the storage of personal health information.
Every Monday morning, Ocean checks for patient data that is scheduled for deletion and may require a manual export or download to an EMR. This includes online referrals, website form submissions, and patient notes. An automatic deletion warning email is sent to the Ocean site contact at that time to alert them.
Steps to Take
The deletion warning email includes a list of items that are due to be removed from Ocean. Ocean Sites should review these to determine if any action is needed. This may include a manual export or download of information to the EMR, extending the purge date, or allowing the information to be deleted.
eReferrals & eConsults
If there are any eReferrals/eConsults that are due to be removed from Ocean, the email will indicate those that are pending removal and how to review them.
Note: eReferrals/eConsults that are 'Completed', 'Processed', 'Externally Managed', or 'Incomplete' (i.e., Saved for Later), will not trigger deletion warnings.
Examples of potential actions for you to take when an eReferral/eConsult is due to be removed from Ocean include:
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.
Example: If a referral was sent on January 1st, 2024 and an 'Anticipated Wait Time to Appointment' of 14-18 months was specified in the referral, the referral would be scheduled to be removed 18 months and 60 days (i.e., a grand total of 20 months) after January 1st, 2024. This means that the scheduled removal date would be September 1st, 2025.
Notes
- It is important to recognize that when an 'Anticipated Wait Time to Appointment' is added, the anticipated wait time is specifically with respect to the date that the referral was originally sent (e.g., January 1st 2024 in the example above).
- Since most eReferrals are stored for a minimum of 12 months after the date they were originally sent by default, it is not guaranteed that simply specifying any 'Anticipated Wait Time to Appointment' within the referral will always extend the scheduled removal. For an anticipated wait time to extend the scheduled removal date, the anticipated wait time value must be greater than the referral's currently-calculated lifespan.
- For example, if a referral was sent on January 1st, 2024 and scheduled to be removed on December 31st, 2024, an anticipated wait time of 4-6 weeks would have no impact on the removal date (since the default 365 day retention period supercedes the (4-6 weeks + 60 days) timeframe.
- If needed, you have the option to update the 'Anticipated Time to Appointment' for multiple referrals at once.
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).
*Note
The examples provided above specifically use the term "may" when referring to the adjustment made to the scheduled removal date as a result of the action taken. This language has been purposefully used as it cannot be guaranteed that the action being taken is the sole contributor to a referral's scheduled removal date.
For more details regarding eReferral/eConsult storage in Ocean, please refer to this support article: How long will my eConsults/eReferrals be stored in Ocean?
Website Form Submissions
If there are any Website Form submissions that are due to be removed but have not been exported/downloaded, the email will tell you how many are pending removal and how to review them. Even if you are processing the submission as part of the initial "acceptance" workflow, it's a good idea to heed these warnings and export them for audit purposes.
You can do this by clicking the 'Import to EMR' button within the submission to trigger the download of the submission into your EMR (if your Ocean Site is integrated with your EMR), or you can manually download a PDF copy by opening the 'Action' menu within the submission and clicking 'Download Referral Record'.
You can then mark the submission as 'Completed', if appropriate.
Note: Website Form submissions that have been marked as 'Completed' do not trigger deletion warnings.
Patient Notes
For Ocean Sites that are not integrated using Ocean Cloud Connect, the email contains the EMR ID and the Ocean reference number of patients that have not been marked "downloaded to the EMR". We call these "orphaned notes" since the EMR has not claimed them promptly.
These notifications can be confusing. See below for a few quick FAQs.
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.
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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.
- 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".
- 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.
- 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.
Where do Deletion Warning emails get sent to?
Depending on the nature of the data due to be removed and the configuration of your Ocean Site, the deletion warning emails may get sent to different email addresses. The logic for deletion warning emails is outlined below:
- If only Website Forms/eReferrals/eConsults are due to be removed from your Ocean Site, the deletion warning email will be sent to the 'Default Incoming Referral Notification Email' configured in your Ocean Site's eReferrals & eConsults configuration area.
- If no 'Default Incoming Referral Notification Email' has been set, the deletion warning email will be sent to the 'Clinical Administrator / Ocean Support Contact' email configured in your Ocean Site's Site Account settings area.
- If no 'Clinical Administrator / Ocean Support Contact' email has been configured, the deletion warning email will be sent to the email address associated with Ocean user account set as the 'Payer' for your Ocean Site.
- If no 'Default Incoming Referral Notification Email' has been set, the deletion warning email will be sent to the 'Clinical Administrator / Ocean Support Contact' email configured in your Ocean Site's Site Account settings area.
- If Website Forms/eReferrals/eConsults and Patient Notes are due to be removed from your Ocean Site, the deletion warning email will be sent to the 'Default Incoming Referral Notification Email' configured in your Ocean Site's eReferrals & eConsults configuration area and the 'Clinical Administrator / Ocean Support Contact' email configured in your Ocean Site's Site Account settings area.
- If no 'Clinical Administrator / Ocean Support Contact' has been configured, the email address associated with Ocean user account set as the 'Payer' for your Ocean Site will be used as a substitute.
- If only Patient Notes are due to be removed from your Ocean Site, the deletion warning email will be sent to the 'Clinical Administrator / Ocean Support Contact' email configured in your Ocean Site's Site Account settings area.
- If no 'Clinical Administrator / Ocean Support Contact' email has been configured, the deletion warning email will be sent to the email address associated with Ocean user account set as the 'Payer' for your Ocean Site.