HL7 FHIR eReferral Integration Setup Guide

Getting Started With the Integration

Service providers can manage Ocean eReferrals within their patient electronic medical record (EMR) or client management system (CMS) through integration with Ocean. The integration enables:

  • eReferrals to appear within the EMR/CMS without requiring initial activity within the Ocean portal
  • Status updates to the eReferral (e.g. accepted, booked, cancelled) to be sent to Ocean (which will result in a notification to the provider and patient)
  • Updates to the patient's core demographics to be sent to Ocean
  • Referral-related communication to be added to the referral (e.g. patient or provider instructions, attachments)

Ocean will be supporting two versions of the FHIR eReferral API: v0.10.0 and v0.11.1. New integrators are strongly encouraged to use the v0.11.1. Existing integrators that are expanding to new sites may continue to use v0.10.0.

Receiving Referrals from Ocean

The following setup guide is intended to provide software developers with the preliminary steps required to prepare an Ocean site for integration with an EMR/CMS.  Additional detail for each step is provided in the linked support articles. Completion of these steps will enable the testing of non-authenticated connectivity and receipt of the Ocean HL7 FHIR eReferral resource bundle.   

  1. Email Ocean Support with the email domain that you will be using during technical development and testing (e.g. to register new users, receive referral notifications, etc.).  Please identify the name of your company and integration project sponsor (e.g. a clinical or jurisdictional organization).
  2. Create an Ocean user account and site in test.cognisantmd.com
  3. Generate the site's Shared Encryption Key (SEK).
  4. From the Menu, select Admin and then select Site Features.   Activate the "Enable Ocean Cloud Connect" option.   This will trigger a dialog instructing you to set up Cloud Connect. Select the "Go to Cloud Connect" button.
  5. In Cloud Connect, select "Store my encryption key".  (Do not access the "Integrate with my EMR" option.)  Enter the site's SEK and select 'Save'
  6. Configure the API endpoint for your EMR/CMS - HL7 FHIR eReferral tab > Step 1
  7. Set up the service directory listing for your site - complete the basic details for the listing and under "eReferral Policy", enable 'Accept eReferrals'. 
  8. Establish a linkage between the service directory listing and the API endpoint - HL7 FHIR eReferral tab > Step 2.
  9. Add the Ocean test.cognisantmd.com IP addresses to your allow-list.
  10. If you would like Ocean to send you email notifications when it receives an error response from your endpoint, from the Menu, select Admin and then select Site Account. In the "Clinical Administrator / Ocean Support Contact" field, enter the email address(es) of the error notification recipient(s).
  11. Create a second site (by accessing My Account (top right menu) and clicking on 'Create New Site'.  (This is so that you can mimic the actual referral workflow of a referral being sent to and from one Ocean site to the 'service provider' site that is supported by your integration.  You only need to complete).
  12. In the second ('sender') site, search for the 'service provider' directory listing (of the first site) in the Ocean Healthmap and submit an eReferral.
  13. Follow these instructions to subscribe to the Ocean API Integration Update section to receive critical notifications specific to integration incidents.

You are now ready to receive eReferrals! 


Processing HL7 FHIR eReferral Message Bundles

  1. To learn about the use cases, integration flow, methods and profiling of the FHIR resources, please see the Ontario eReferral HL7 FHIR eReferral Implementation Guide v0.10.0, for the v0.10.0. To learn about the v0.11.1 beta, please see Ontario eReferral - eConsult HL7 FHIR Implementation Guide - Draft v0.11.1 
  2. To see how these are implemented by Ocean, please see our HL7 FHIR API documentation.
  3. An important companion to this documentation is our HL7 FHIR eReferral API Implementation Guidance article, which describes key concepts and considerations you should be aware of as you develop your integration.


Sending Referral Updates to Ocean

In order for the EMR/CMS to send updates to Ocean, the following additional setup steps are necessary. The HL7 FHIR APIs that support the eReferral messaging lifecycle are described in a separate API documentation.

  1. Set up the site-specific OAuth2 credentials to communicate with Ocean - HL7 FHIR eReferral tab > Step 3.



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