Using eForms

When you create an Ocean eForm of your own, by default, it is included in our shared public directory of forms. Therefore, any Ocean community will have access to your form and will be able to import the eForm into their own Ocean site to customize and/or use themselves. If you want to hide your eForm from the Ocean library, follow the steps below:

There are over 2000 Ocean eForms in our core eForm library, available for all Ocean users to use. You can view the forms in our Clinical Resource Library or the eForms area of the Ocean Portal.

The Ocean eForm Library contains core library eforms and customized eforms listed by other Ocean users. If an eForm is listed in the directory, it can be searched and imported into your own Ocean Library.

Search and Import eForms

Edit

Opens the eForm editor where you can make changes to the form.

Duplicate

Creates a copy of the form.

Sever

Breaks the linkage between the eForm on your Ocean site and the original source site.

Sync

If the original source site makes changes to the eForm, you can update your form with those changes.

eForm History is a powerful feature in the eForm Editor that allows you to review changes made to a form and/or restore the form to any earlier saved versions.

• • eForm History can be found within any eForm in the “Action” menu located in the top right corner of the eForm Editor.
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  • You can view your form's eForm History by selecting “View EForm History” from the dropdown “Action” menu.
  • From the dialogue box that appears, you’ll be presented with a list displaying the entire revision history of the eForm, from its initial creation to the latest edit.
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  • Note: A new entry is added every time the “Save Changes” button is clicked.
  • Each entry lists a creation timestamp, the user who made the changes, and two buttons: “Preview” and “Revert” (as described below).

• Preview

  • This will open a new window showing a preview of what the eForm looked like at the selected version. You can walk through and test the eForm from the perspective of a patient, as well as see what the resulting clinical notes will look like in your EMR (in the floating blue box).

• Revert

  • This will reset the eForm back to the selected version. Once this button is pressed, a dialogue will appear to allow you to confirm your choice. Keep in mind that any subsequent changes made in newer versions will be overwritten once a reversion takes place.
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You can add eForms to your website for patients to complete using Website Forms.

To learn how to set up a Website form, please refer to our Website Forms Set-Up Guide.

Ocean eForms cannot be used to obtaining physical signatures; however, many sites use eForms for obtaining informed consent.

Here are a few examples that you may customize as needed:

• Opioid Treatment Agreement
• Variant of Sunnybrook's Email Consent Form
• Joint Injection Consent Form
• General Procedure Consent Form
• AI Scribe Consent

These above agreements are consistent with the CMPA's guidelines on obtaining informed patient consent.

Note that the CMPA's policy does not in fact require a physical or "wet" signature from the patient when obtaining consent. A signature is neither necessary nor sufficient for obtaining informed consent. Instead, the CMPA policy expects clear documented evidence that all of the risks, benefits, and alternative treatments have been explained to the patient, and that the patient has had a chance to ask questions regarding the procedure.

Sending eForms to patients ahead of their appointment creates an ideal environment for the patient to review this information in advance, without feeling rushed to comply with the physician waiting in the room.

As with any eForm, the generated note associated with these consent forms is completely customizable using the eForm Editor.

If a physical signature is nonetheless felt to be necessary for your clinic, the old-fashioned pen and paper approach is tough to improve upon. In this case, it may be more helpful to let your EMR vendor set your clinic up with a streamlined paper scanning workflow.

Ensuring Trust and Accountability in Digital Clinical Workflows

In Ocean, clinician signatures serve a critical role in ensuring that certain actions taken — including sending an eReferral, eConsult, or eSubmission — are authentic, traceable, and compliant with healthcare and privacy legislation. Unlike scanned “wet” signatures or stylized marks, Ocean’s digital signature process is identity-based: the true validation lies in who is signed in, what they did, and when it occurred

This model is consistent with modern digital signing frameworks such as DocuSign, and with electronic medical record (EMR) standards used across Canada’s healthcare systems.

Authentication and Identity Validation

Clinician identity is the foundation of signature integrity in Ocean.

Each clinician:

• Authenticates through a unique Ocean account tied to their organization and site.
• May enable two-factor authentication (2FA) for additional security.
• Can connect their Ocean account to a federated identity provider such as ONE ID (Ontario), ensuring the account corresponds to a verified healthcare professional.

Once signed in, all clinician actions — such as approving a referral or completing a consult — are automatically digitally signed using the clinician’s authenticated credentials. Ocean captures a complete record including username, timestamp, and site ID.

Ensuring every action is:

• Authenticated (the clinician’s identity is verified)
• Authorized (the action is permitted for that role and site)
• Immutable (the record cannot be changed once written).

This design ensures that each signature represents a legally defensible attestation of the clinician’s actions.

The Signature Font: A Visual Confirmation, Not the Validation

When a clinician’s signature appears on an Ocean form or document, it is typically rendered using a signature-style font. This font acts only as a visual cue — a clear indicator to others that the form has been signed — but not the actual security mechanism.

The true signature is captured through the clinician’s secure, authenticated session and recorded in the Ocean audit log, complete with username, timestamp, and site information. These details are written back to the EMR/EHR as part of the permanent medical record. This mirrors DocuSign’s “intent and authentication” model, where the legal validity of the signature derives from the verified identity and immutable audit trail.

Non-Repudiation and Audit Logging

Ocean’s audit subsystem ensures that all clinician actions can be verified and are legally defensible. Each record includes username and site information (serving as the digital signature), timestamp, and action type.

Audit logs are stored online for 60 days for reporting, then archived securely for a minimum of seven years. All logs are immutable, meaning no record can be altered or deleted once written.

Ocean’s infrastructure undergoes regular penetration testing and security audits, ensuring compliance with PIPEDA, PHIPA, and other Canadian privacy frameworks.

Alignment with Industry Best Practices

Ocean’s digital signature framework aligns closely with recognized standards for electronic signatures and healthcare information systems:

Ocean eForms that are available for use with Ocean Studies are identified by the presence of an icon next to the name of the eForm.

If an eForm that has been made available for use in an Ocean Study is sent to and completed by patient, but no corresponding Ocean Study has first been created in your Ocean Site, a new Ocean Study will be automatically created and ad-hoc study fees will be incurred by your Ocean Site.

If you wish to use an eForm that has been made available for use in an Ocean study without automatically creating a new Ocean Study and incurring subsequent ad-hoc study fees, follow the steps below:

1. Access your form's eForm Properties.

   • Open the form in the eForm Editor.
   • Choose "Form Properties" from the Action Menu.
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2. Access the Data Security Mode settings.

   • Navigate to the "Form Memory & Data Storage" tab, locate the "Store form answers as" setting, and disable both checkboxes.
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   • Click "OK" to exit out of the "Form Properties" window.

3. Save the eForm.

   • Click the "Save Changes" at the bottom right corner to prevent your changes from being lost.
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   • Your eForm can now be used without automatically creating a new Ocean Study and incurring subsequent ad-hoc study fees.