Orientation to Ocean Note Flags

Ocean's Note Flagging feature allows an eForm to tag a patient's response with a coloured "flag". These flags are intended to assist clinicians and their administrators with rapid triaging of responses.

The flags appear in the following three areas:

  • 1. The subject of the provider's notification email as a suffix (e.g., "Ocean Online Questionnaire Complete - Red"),
  • 2. The body of the provider's notification email ( e.g. "The response has been flagged as  Red ."),
  • 3. The status column in the Patients tab as a coloured asterisk icon (*)

Flag Types

The flags' meanings are intentionally left to the end-users to define. Below are a list of supported flag types and general meanings (in accordance with clinical documentation guidelines):

Flag types General meanings (in accordance with clinical documentation guidelines)
RED Red indicates an urgent or serious concern (e.g., suicidal ideation)
ORANGE Orange indicates a potentially urgent or serious concern (e.g., fever in an otherwise low-risk context)
YELLOW Yellow indicates something or concern without a specific urgency
GREEN Green indicates something reassuring (such as a negative COVID-19 screen)
BLUE Blue indicates something of general interest
PURPLE Purple also indicates something of general interest

Configuration

To create a noteFlag in a specific form and have it appear in an email notification:

  1. Edit the eForm

    • Locate the eForm that you would like to generate the flag in the eForms tab and open the editor.
    • Look for an existing inactive "noteFlag" item in case one already exists (e.g., the PHQ-9 has one but it is left inactive).
    • If there is no "noteFlag" item, add a new item type "Formula".
    • Set the caption to "noteFlag: $$" (this isn't strictly necessary, but makes it easier to troubleshoot).
    • In the item's Note Formatting tab, set "Create a note for this item" to "never" and set the "Populate answer for EMR Field" to "noteFlag".
    • In the item's Scripting and More tab, set the "Show this field if:" to "false" (to hide the field from patients). Set the formula to a script that reflects how you want the note flag to behave.
      • For example, in this PHQ-9 form, the flag is "RED" if the suicidal ideation question is "Y" and blank ("") otherwise. The formula should evaluate to either blank or one of the colour options listed above.
  2. Set "Notify me when viewed" when emailing the form

    • If you would like note flags with the notification emails, ensure that your email template is configured to send this notification email by checking the "Notify me when complete" checkbox
    • Note flags can still be useful without email notifications. For example, kiosk and tablet screening forms or Ocean Reminders will also generate note flags and display them in the Patients tab and the Daysheet as shown above.

Clinical Considerations when using Note Flags for Triaging Urgent Responses

Disclaimer:

Since the note flagging feature relies on ordinary email for notifications, it cannot be relied upon as the only means of providing a safe response for patients with worrisome symptoms. It should NOT be considered a substitute for in-person triaging, or direct instructions for patients. Clinical judgment is required to ensure safety when designing a triaging protocol and its associated eForm.

For example, a form that triggers a "RED" note flag for an acute risk for suicidal ideation should also clearly and unequivocally direct the patient to the emergency department.

Nonetheless, despite this important constraint, the note flagging feature can be a useful adjunct to improve the timeliness and quality of patient care when used appropriately.

Email Notification Management

Thanks to the intelligent filtering, rule evaluation, and triggering capabilities of modern web-based email platforms like Gmail, you may find it helpful to configure a rule to assist with advanced notifications involving note flags.

For example, using Gmail, you can create a filter to look for the " - RED" email subject and subsequently trigger a unique chime on a clinician smart phone for such events. Please refer to your email client's and smart phone's documentation for instructions on how to do this. Here are some sample articles that describe this process:

 

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