Provider Network FAQ

Patient Notification Emails

Provider Notification Emails

Automatic provider email notifications contain only an English version of the status update message at this time.

Yes, you're able to filter and save your own view in the eReferrals & eConsults area of the Ocean Portal to show referrals sent only by a specific Referring Clinician(s).

This is valuable for Ocean Sites that have a large number of clinicians that send referrals, as it offers the ability for users to focus their view to only referrals that are relevant to them, and minimizes the amount of patient health information shown to users within the Ocean Site.

How do I use the filter?

The Referring Clinician filter is available within all 'Sent' status folders. Once the filter is saved, it applies across all 'Sent' folders. This is a user-specific filter, meaning it applies only to your own Ocean user account.

Applying the Filter for the First Time

View with the Filter Applied

Modifying the Filter

No matching referrals?

You can easily find a specific Referral Reference (referralRef) value within the relevant referral's Event Log.

This value is a unique reference number for the referral in Ocean, which can be helpful for troubleshooting and/or or tracking purposes.

What is HRM®?

Health Report Manager (HRM®) is a digital health solution developed by OntarioMD that enables clinicians using an OntarioMD-certified EMR to securely receive reports electronically from participating hospitals and independent health facilities. This transfer of information typically occurs near the end of the referral lifecycle when a specialist is sending a consultation report/letter back to the referring clinician.

Clinicians in Ontario using the Ocean Provider Network can send and receive consultation reports for eReferrals using HRM's integration with Ocean and their OntarioMD-certified EMR.

Ocean-HRM Message Sender Configuration

Sender Approval

To send messages and documents in Ocean via HRM, clinicians must obtain a 'UPI' identifier from the OntarioMD service desk by calling 1-866-744-8668 or emailing support@ontariomd.com.

Once the 'UPI' identifier has been obtained, clinicians must send it to the OceanMD Support team for backend configuration in Ocean. You will be notified when your Ocean site has been approved to send HRM reports.

Sender Configuration

Ocean-HRM Message Receiver Configuration

Receiver Approval

To receive messages and documents via HRM, clinicians must first be approved by OntarioMD. OntarioMD periodically provides a list of approved receiving clinicians to OceanMD to update in the Ocean platform.

This list is used by Ocean to determine whether a clinician should receive a message via HRM in addition to the existing eReferral message and email notification mechanisms in Ocean.

If you are interested in becoming an approved HRM receiver, contact the OntarioMD service desk by calling 1-866-744-8668 or emailing support@ontariomd.com.

Receiver Configuration

Sending Messages via HRM

Once you have fulfilled the 'Ocean-HRM Message Sender Configuration' requirements outlined above, you are able to send HRM messages within an Ocean eReferral.

Receiving Messages via HRM

If you have completed the 'Ocean-HRM Message Receiver Configuration' requirements outlined above and an HRM message is sent to you via an Ocean eReferral, you will be notified via the standard messaging and email notification mechanisms in Ocean.

You will additionally receive the HRM message in your OntarioMD-certified EMR. The core content for all HRM messages is standard across all OntarioMD-certified EMRs, containing: report category (LOINC), report body, author, date, etc.

An example is shown using the PS Suite EMR below, for reference:

Example of a typed HRM message

Example of a file attachment include in HRM message.

Troubleshooting & Support

For all troubleshooting inquiries please contact the OceanMD Support team.

Some helpful troubleshooting tips are provided below:

• If you attempt to send an HRM message and no status icon appears to the right of the message within the eReferral, this means Ocean made no attempt to send the message via HRM. Verify that at least one referral stakeholder is live on HRM, and registered as an HRM receiver in Ocean using the verification process outlined above.
• If you attempt to send an HRM message and the red failure icon appears, click on the icon for additional details.
  • If available, take note of the 'Transaction ID' value and the corresponding error message and send them to the contact the OceanMD Support team

The eReferrals & eConsults area of the Ocean portal is used to view, manage, and action the different requests your Ocean Site receives. For certain statuses and request types, Ocean modifies the colour of the text for quick reference.

Colour Coding

Definitions

The terms "Health Service Categories" and "Health Service Offerings" are often used interchangeably, however it is important to truly understand the difference in their meanings.

What are Health Service Categories?

Health Service Categories are a defined list of terms that are used in the Ocean Healthmap to support simpler searching, filtering, and Directory Listing creation. This defined taxonomy is used to help categorize the Health Service Offerings on a Directory Listing in the Ocean Healthmap.

A complete list of the defined Health Service Categories is available here.

What is a Health Service Offering?

A Health Service Offering is a customizable, searchable description of a service that is listed on the Directory Listing in the Ocean Healthmap. Health Service Offerings are mapped to the most appropriate Health Service Category.

In many cases, a Directory Listing may simply use a defined Health Service Category as their Health Service Offering, however, the option for full customization is possible using Health Service Offerings.

Why do they both exist?

The Ocean Healthmap is a comprehensive, map-based directory that makes it easy to search and access health care services. This is made possible through the use of a defined list of possible health care services - namely Health Service Categories. The defined list of Health Service Categories allows for discrete categorization of services offered by all health care providers on the Ocean Healthmap. This ensures that when a specific health care service is being searched for, the applicable providers of that service are properly accounted for in the search results.

However, it is important to acknowledge that a single defined list of possible health care services will not always capture the nuances of the service(s) being provided. This is addressed through the use of Health Service Offerings. The Health Service Offerings presented on a Directory Listing in the Ocean Healthmap can be customized to reflect greater accuracy of the specific name or nuance of the health care services being offered.

For example, a clinic offering dermatological services could add the specific 'Dermatology' Health Service Category as a Health Service Offering on their Directory Listing, but only offer a subset of specific services or programs. To communicate this nuance to potential referrers browsing the Ocean Healthmap, they can customize the name of the offering for accuracy - such as renaming it to 'Pigmented Lesion / Mole Clinic' if they only offer these specific dermatological services.

Referrers who are browsing the 'Dermatology' category on the Ocean Healthmap would see the clinic's Directory Listing with the 'Pigmented Lesion / Mole Clinic' Health Service Offering, since it is truly the 'Dermatology' Health Service Category with a customized Health Service Offering name.

What if I can't find the exact Health Service Category for my Directory Listing?

If you are unable to locate a Health Service Category in Ocean that exactly matches the services you offer, we recommend adding the most similar Health Service Category as a Health Service Offering on your Directory Listing. You can then customize the name of the offering to more accurately reflect the specific services you offer.

How do I customize the name?

You can customize the name of your Health Service Offering by following the steps below:

Can I request additional Health Services Categories?

No, you cannot request that additional Health Service Categories be added as they are a standardized and defined list in Ocean. Under certain circumstances, additional synonyms for Health Service Categories may be added to enhance the searching and filtering capabilities within the Ocean Healthmap.

If you work with an MOA, receptionist, nurse, resident, or student who will be sending eConsults and/or eReferrals on your behalf, you will want to invite them to create an Ocean user account and set them as your clinical delegate.

1. Add your delegate(s) to your Ocean account

   • Log into the Ocean Portal.
   • 
   • Click your name in the top right hand corner and select My Account from the menu.
   • From the User Settings page of your account, select the "Edit Delegates" button.
   • 
   • On the Delegates page, click the "Add Delegate" button and select the username(s) of the user that you want to add as your clinical delegate(s). You can add any number of delegates to be associated with your Ocean user account.
   • 

2. Set a Primary Delegate (optional)

   • You can select one of your delegates to be your Primary Delegate. The Primary Delegate will be covered under your Patient Messaging license (if applicable.)
     
     
     Note: The delegate user must be assigned one of the following clinician types: MOA/Secretary, Nurse, Resident, Physician Assistant or Other.
   • Under the "Actions" column, click the "Make Primary Delegate" button.
   • 
   • Once set, the "Actions" column will read "Primary Delegate." This confirms the chosen delegate is now associated with your Patient Messaging license.
   • 

What is a Rapid Access Clinic?

Rapid Access Clinics (also known as Assessment Centres) are commonly used in the Musculoskeletal care (MSK) pathway. Patients referred to these listings are booked in for an assessment with an advanced practice physiotherapist (APP), who determines whether surgery is appropriate for the patient and may forward the referral downstream (e.g, to a surgeon/specialist). This configuration allows for a special set of "assessment" analytics to be captured on referrals that are directed to, and booked at, these listings.

What makes a Rapid Access Clinic unique in Ocean?

There are three main elements that differentiate Rapid Access Clinic sites from standard Ocean sites:

Directory Listing Configuration

Rapid Access Clinic sites have unique Directory Listings that are specifically configured by OceanMD. The 'Listing Type' field is set to 'Rapid Access Clinic'.

Forward Button

Analytics

Sites designated as a Rapid Access Clinic on their Directory Listing capture additional analytic values. Please see the 'Rapid Access Clinic Analytics' section at the bottom of this article for in depth information.

How do Rapid Access Clinics receive referrals?

Since the Rapid Access Clinic (RAC) concept was developed specifically for the musculoskeletal (MSK) pathway, RACs typically receive referrals that have been forwarded from a Central Intake site.

While it is technically possible for a RAC site to exist and receive referrals from non-Central Intake sites (e.g., an independent healthcare provider referring directly to a RAC via the Ocean Healthmap), there are currently no sites or organizations using such a process.

The typical flow for a referral reaching a RAC is as follows:

Original Referral Sender --> Central Intake (triaging occurs) --> Rapid Access Clinic (in-depth assessment occurs with APP to determine best course of clinical action) --> (If applicable) referral is forwarded to a Surgeon/Specialist for more invasive procedure.

Rapid Access Clinic Process

Rapid Access Clinic Analytics

Core Analytics

When a Directory Listing is configured as a Rapid Access Clinic, Ocean makes use additional data columns in the eReferral analytics report. A full breakdown of all analytics can be found in the Supporting Analytics in eConsults and/or eReferral eForms article.

The following analytics are automatically captured for listings configured as an RAC:

initialAssessmentDate

The date/time of the initial assessment if the referral is booked at an assessment centre.

initialAssessmentSite

The name of the initial assessment site listing.

initialAssessmentSiteNum

The site number of the initial assessment site the referral was directed to.

initialAssessmentSiteRef

The unique listing consult and/or reference id of the initial assessment site.

initialAssessmentOfferingRef

The unique Health Service Offering (HSO) reference assigned to the referral, at the time it was sent to the RAC.

forwardDateFromAssessmentSite

The date the referral is forwarded from a listing of type Rapid Access Clinic.

Additional Analytics

Rapid Access Clinics use customized 'Outcome Assessment Forms' (an eForm wit the ref = 'referralNotes') used with the 'Review' functionality in the referral to generate the Review note. Outcome Assessment Forms used by RACs often include eForm items with the following item references to populate additional fields in the analytics report.

Common item reference examples used in RAC Outcome Assessment Forms include the following:

• ax_surgicalCandidate
• ax_assessmentOutcome
• ax_assessmentOutcomeMedicalSpecialist
• ax_assessmentOutcomeCommunityProgram
• ax_assessmentOutcomeSelfManagement
• ax_patientPreference
• ax_consultOutcome
• ax_decisionToConsult (Note: Important as this column is used in wait time calculations.)

Keep in mind that the semantics behind each is arbitrary and you can "co-opt" them for the purposes of a particular pathway as long as the consumers of the analytical data understand the data values.

Manual Forward Policy

If an Ocean Site decides to forward a referral following an assessment, they have the option of forwarding to a listing that is accepting eReferrals on the Ocean Healthmap, or they can choose to manually forward the referral (e.g. via fax) to a service provider who is not accepting eReferrals.

While this functionality has been purpose-built for the MSK pathway in which the RAC is the third sequential stakeholder in the referral process, this functionality technically applies to any Ocean site that is: 1) the third site to handle the referral and 2) manually forwards the referral.

How do I add handout files?

A Clinical Delegate has the ability to send eReferrals on behalf of another Ocean user. Depending on the Clinician Type selected in your Account Settings, your experience when sending an Ocean eReferral as a Clinical Delegate will be different. As the scope of practice for each user on your Ocean site varies, the sending experience and wording of an eReferral changes to reflect the relevant scope.

Special Considerations

Due to the possible variation in the scope of practice of users on your Ocean site, additional features have been implemented to meet this consideration.

Physician Assistants

Nurse Practitioners

By default, a single EMR instance should always be associated with a single Ocean site. This approach eliminates the risk of numerous issues that can arise when an EMR instance is associated with multiple Ocean sites. These may include technical, billing, and usage concerns.

There are some limited cases where an exception may be made, allowing a single EMR instance to be associated with multiple Ocean sites under extenuating circumstances. Special attention and consideration must be given when determining whether or not an exception should be made for a specific practice and/or EMR instance.

The series of questions below walks through the factors that must be considered before deciding to create an additional Ocean site(s) for a single EMR instance. Please ensure that you complete the entire series of questions to determine whether or not multiple Ocean sites are appropriate.

1. Can your EMR support multiple Ocean sites?

Only certain EMRs are capable of being associated with multiple Ocean sites.

• OSCAR Pro
• Med Access

• PS Suite
• Accuro

If the clinic is using either PS Suite or Accuro, please proceed to the following question.

2. Are staff shared between clinics/practices?

This includes administrative staff, physicians and allied health staff.

• Staff are shared among clinics/practices/sites

• Staff are not shared among clinics/practices/sites

If staff are not being shared among clinics, please proceed to the following question.

3. Specific EMR Considerations

There are certain EMR-specific considerations that must be taken into account when deciding if multiple Ocean sites are feasible for a single EMR instance. Please expand the appropriate EMR tab below.

Ocean uses a popular, powerful search engine called Elasticsearch [https://www.elastic.co/what-is/elasticsearch] to find relevant health service directory listings. Elasticsearch allows Ocean to use multiple criteria when searching for listings, including text keywords, location, distance, wait time, subspecialty information, and other properties.

Search Criteria
The primary search criteria is usually typed by the user, such as "cardiology" or "North Toronto Medical", similar to how Internet searches like Google work. These searches perform a keyword-based search that scans the listing's title, description, and service offerings for matches. Users also have the option of selecting a specific value from an automatic dropdown list, such as "MRI", to precisely find listings that are specifically tagged as offering these services.

Users can add additional constraints on top of this primary search, such as spoken language, using the "Advanced Search". To avoid returning distant results, the search uses the currently-visible map boundary as an initial constraint. After an initial search, a user has the option to search the "whole directory", which removes this map boundary constraint. Similar to Google Maps, users may also click to drag the map around, then click the button in the new area of the map to "Search This Area."

Sorting
When a user triggers a search in the healthmap, Ocean uses a default sort preference that relies on the relevance "score" provided by ElasticSearch, which may be guided by factors such as keyword matching. In addition, Ocean applies a simple weight to the score to ensure the following listings are prioritized, in the following order:

• User favourites
• Site favourites
• Government central intakes and rapid-access clinics (as designated by Provincial Ministry of Health)
• Listings that are currently accepting eReferrals or eConsults
• Listings that redirect to a central intake eReferral site
• Other listings

Users also have the option to use the drop-down sort option to further sort the default results, which will impact the order of results. Ocean offers a sort by distance (shortest distance measured from the patient's home or the central map pin, if the patient's address is unavailable), or by the shortest Wait Time (Wait 1 / Wait 2). After a sort order has been applied to a search, it is retained for subsequent searches in the same session.

Please Note: As a matter of policy, Ocean does not make individual adjustments to promote or demote listing results. Search order results may change at any time, based on the ElasticSearch relevance calculation.

When including attachments on eConsults/eReferrals, there are certain file size and type limitations that providers should be aware of.

The inboxes in the eReferrals page are used to manage your site's eConsults and/or eReferrals. Each inbox is described here to help you process and manage incoming and outgoing consults and/or referrals.

• General Inboxes

  • Needs Review

    Any consults and/or referrals that have been flagged for review.

    For Me

    Consults and/or Referrals that have been flagged for your review using the "Notify" feature.

    Recently Viewed

    Any consults and/or referrals that you have recently viewed, within the past 48 hours.

  • 

• Received Inboxes

  • New

    Consults and/or Referrals that have been received and have not yet been accepted or declined.

    Accepted as eConsult

    Consults that have been reviewed and accepted.

    eConsult in Progress

    Consults that have been responded to.

    Pending Booking

    Accepted referrals that have not been booked for appointments.

    Booked Unconfirmed

    Any accepted referrals that include appointments that have not been confirmed by the patient.

    Booked Confirmed

    Any accepted referrals that include appointments that have been confirmed by the patient.

    Awaiting Reply

    Any consult and/or referral that you have followed up with the referrer for additional information and are currently awaiting reply.

    Walk-ins

    Any consults and/or referrals that have been accepted as a walk-in appointment.

    All Received

    All consults and/or referrals that your site has received regardless of their current status.

    Completed

    Consults and/or Referrals that have been marked "Complete" following their appointment date.

    Forwarded (All)

    Any consults and/or referrals that your site has received and you have forwarded to another site.

    Declined

    Consults and/or Referrals that you have declined.

    Cancelled

    All canceled consults and/or referrals.

    Externally Managed

    Any consults and/or referrals that have been marked as Managed Externally.

  • 

• Sent Inboxes

  • Sent (All)

    All consults and/or referrals that have been sent from your site.

    Incomplete

    Any outgoing consults and/or referrals that have been saved for later completion (have not been sent yet). These referrals are only saved in Ocean for 30 days before they are automatically deleted.

    Awaiting Response

    Any consults and/or referrals that you have sent that have not yet been accepted by the recipient.

    Accepted as Walk-In

    Any sent consults and/or referrals that have been accepted as a walk-in appointment by the recipient.

    Accepted as eConsult

    Any sent referrals that have been accepted as an eConsult by the recipient.

    Pending Booking

    All referrals that have been sent from your site that are accepted and awaiting to be booked by the recipient.

    Booked Unconfirmed

    All referrals that have been sent from your site and include appointments that have not been confirmed by the patient.

    Booked Confirmed

    All referrals that have been sent from your site and include appointments that the patient has confirmed.

    Completed

    Consults that have been marked as completed after an eConsult response, and referrals that have been marked as completed following their appointment date(s).

    Declined

    Your sent consults and/or referrals that were declined.

    Cancelled

    Your sent consults and/or referrals that were canceled.

    Externally Managed

    Any sent consults and/or referrals that have been marked as Managed Externally.

  • 

• Other Inboxes

  • Deletion Warnings

    Consults and/or Referrals that are approaching deletion.

    Actions

    Use this menu to create an inbound request, view the directory, export consults and/or referrals, update wait time, or view a patient's referral history.

    Support

    Click here to contact the CognisantMD helpdesk.

  • 

When managing incoming eConsults and/or eReferrals from the eReferrals page in the Ocean Portal, you may encounter icons or buttons that you are unsure of. Below is a list of the various icons and buttons that may appear and their meaning.

Icons within the eReferrals page

Icon	Definition
	Column currently being sorted (and direction – ascending or descending).
	There is a message associated with the eConsult and/or eReferral.
	View this patient's previous eConsults and/or eReferrals.
	There is an attachment associated with the eConsult and/or eReferral.
	This patient's chart in the EMR cannot be found and Ocean is waiting for the EMR.
	A backup copy of the eConsult and/or eReferral has been exported from Ocean.
	The notes for this patient have been downloaded into the EMR.
	This patient has notes that are ready to be downloaded into the EMR.
	The eConsult and/or eReferral has been electronically forwarded to an eReferral recipient.
	The eConsult and/or eReferral has been manually forwarded to a fax recipient.

Icons within the eConsult and/or eReferral

Icon	Definition
	Edit patient level details (email, phone, address).
	A component of the eConsult and/or eReferral requires review (message, referral note, etc.).
	A component of the eConsult and/or eReferral that was previously requiring review has been reviewed.
	Add a canned note or Review/ Triage form to the eConsult and/or eReferral. Select a canned booking comment when scheduling appointments. Select a canned message in the eConsult and/or eReferral messaging pane.
	Send a patient note or resend patient appointment notification email.
	Add a new note to the master eConsult and/or eReferral (while viewing a child eReferral).
	The eReferral will be included in wait time calculations, because a date booked comment has not been chosen.
	Delete an attachment that has been added to the appointment notification email.

Buttons within the eConsult and/or eReferral

Button	Definition
	Accepts the eConsult and/or eReferral. If an appointment time is entered, the eReferral will move to your Booked Unconfirmed inbox (or Booked Confirmed if the Confirmed checkbox is selected). If no appointment time is entered, the eReferral will move to your Pending Booking inbox.
	Moves the eConsult and/or eReferral from the Awaiting Reply inbox to the appropriate inbox based on the eReferral status.
	Indicates that the eConsult and/or eReferral as complete and not requiring any further follow up. Will move the referral to your Completed inbox.
	Declines the eConsult and/or eReferral and moves it to the Declined inbox. Clicking this will prompt you for the reason and an optional message that will be sent to notify the sender.
	Forwards the eConsult and/or eReferral to the selected site for further follow up. Moves the consult/referral to your Forwarded (All) inbox.
	Acknowledges that you have read and accept the text that is in the window.
	Indicates that the component requiring review has been reviewed. Will move the eConsult and/or eReferral to the appropriate inbox based on the status.
	Sends the message and any attached files to the sender.
	Closes the window without saving any changes and returns to the previous screen.
	Saves changes made. Note: The window will remain open when this option is selected.
	Saves changes made and closes the window.
	Saves changes made and closes the window. Will move the eConsult and/or eReferral to the Awaiting Reply inbox. Note: This option appears in a dropdown menu beside Done when a message is sent from the eConsult and/or eReferral.
	Notifies the selected provider that an eConsult and/or eReferral requires their attention when flagging for review. Note: The consult and/or referral must be saved in order for the notification to be sent.

Sender and Receiver Actions

Download Referral Record

Opens a PDF document of the complete record in a new browser tab where it can be printed and/or downloaded, OR it downloads a TIFF file (dependent on the site's settings configured here). This record includes all scheduling information, notes, messages, and attachments included on the Ocean eConsult and/or eReferral.

Download Referral Note

Opens a PDF document of the note in a new browser tab where it can be printed and/or downloaded, OR it downloads a TIFF file (dependent on the site's settings configured here). This summary document only includes the patient, recipient, and referrer/sender information, as well as the contents of the note.

Download Patient Handout

Opens a PDF handout in a new browser tab that can be printed and provided to the patient. This handout includes patient information, recipient information (including a map of current consult and/or referral location), future appointment information for the patient, as well as any booking attachments added to the eConsult and/or eReferral.

Download Status Notification Sheet

Opens a PDF document in a new browser tab where it can be printed and/or downloaded. This document is directed to the sending/referring provider, and can be used to notify them of any status updates if they are not yet on Ocean. It contains patient, recipient, consult and/or referral status information, and any scheduling information present on the eReferral. 

Import into EMR

Triggers a new import of the consult and/or referral into the integrated EMR.

Export

Opens up a consult and/or referral summary that can be copied and pasted into the patient's EMR. For integrated EMRs, this summary will be stamped automatically into the patient chart notes at the time of sending/receiving the consult/referral.

View Event Log

• Opens up an event log of the various actions that have occurred on the consult/referral. The log includes the event type, date and time of occurrence, the user who actioned it, and the Ocean site and listing it was actioned from. The Event Log is also where the  reference is found, and the purge date.
• 

View Patient History

Used to review a patient's referral history. These include any consults and/or referrals sent or received by the same Ocean site, for the same patient. If there are no previous consults and/or referrals for that patient to review, you will not see this option in the Action menu.

Reclaim Ownership of Referral

When a consult and/or referral has been revoked from a site, or declined at a site, the site will have the opportunity to reclaim ownership back to their site if they need to action on it further.

Resubmit

This option will be found on Cancelled or Declined consults/referrals, and can be used to resubmit them to the site they were previously cancelled from, or declined at.

Sender Specific Actions

Cancel Referral

Used to cancel a consult and/or referral. This option should only be chosen by the sender when a consult and/or referral to the current provider is no longer necessary. When clicked the user is prompted for a reason for cancelling, and the consult/referral is moved to the Cancelled folder of the sender site. The consult/referral is also flagged for review by the recipient site, and can be found in their "Needs Review" tab with an automated message informing the site the consult/referral was cancelled.

Note: This option will be called Cancel eConsult, if the referral has been responded to as an eConsult.

Receiver Specific Actions

Forward

• This action allows you to forward the consult and/or referral to another target, belonging to the same or different Ocean site. When clicked, the user is prompted to choose a listing from the Forward Referral pane, that pulls in listings from the Ocean Healthmap. Once the desired listing is selected, and the consult/referral is forwarded, it will move to your site's "Forwarded (All)" folder where you can continue to access and receive updates regarding it.
• 

Note: The consult and/or referral can be electronically forwarded to listings on the Ocean eReferral Network (designated by the green arrow), or manually forwarded. If manually forwarded, you will be prompted to print and fax the consult/referral before selecting the Forward option in Ocean.

Revoke Forward

This action is only available on Forwarded consults and/or referrals. If it was forwarded in error, or it simply needs to be directed, you can revoke it back to your site. The action of revoking will move the consult/referral back to your site's New tab. At the recipient site the consult/referral will be flagged for review, with an Ocean automated message stating that the consult/referral was revoked and the reason why, in both the Messaging and Notes pane. Any PHI will be scrubbed from the consult/referral at that time.

Notes: if you attempt to revoke forward a referral that already has been scheduled at the receiving site, you will be prompted to ask the site to remove the appointment information before doing so, to prevent any booking confusion in the future. If you attempt to revoke forward a referral that has already had a subsequent forward, you will be prompted to reclaim ownership of that referral instead. This will also send an automated message to the recipient site, flagging the referral for review and informing them the ownership was reclaimed.

Add Related Referral

This allows you to create a copy of the consult and/or referral, that can be assigned it's own health service offering and description, and be managed separately from the original. 

Await Reply

This moves the consult and/or referral to the "Awaiting Reply" tab, where it will sit until you receive the required information from the sending site (usually requested in a message on the consult/referral), and can action on the consult/referral further.

Mark as Test/Unmark Test

Used to flag whether this is a test consult/referral or not. When marked as test, it is excluded from the site's analytics.

Most Ocean eConsults and/or eReferrals are stored for 12 months after they are initiated. However, some are stored for shorter or longer based on their status. These special cases are listed below:

Saved for Later

eConsults/eReferrals that have been 'Saved for Later' will be stored for 30 days.

Pending Booking

If an estimated wait time longer than 12 months has been specified, the referral will be stored for the full duration of the estimated wait time + 60 days.

Booked Unconfirmed & Booked Confirmed

If the appointment is outside of the 12 month period, the eReferral will be stored for 30 days after the patient's booked appointment time.

Booked at a Rapid Access Clinic

If the referral is sent to a Rapid Access Clinic (assessment centre) and booked, the eReferral will be stored for 12 months after the initial assessment date.

Forwarded (New)

If the consult and/or referral is forwarded to another listing, the eConsult and/or eReferral will be stored for 12 months after the latest forward date.

Assigned for Review

If review is requested by another user at the site, the eConsult/eReferral will be stored for 12 months after the date the review was requested.

Attachments have the same retention period as the consult or referral they are attached to.

How long are 'Completed' eReferrals/eConsults stored in Ocean?

An eReferral/eConsult is retained in Ocean after it has been marked as 'Completed' for the longest duration out of the timeframes below:

• 30 days after the last appointment
• Referral Sent Date + 365 Days
• Referral Forward Date + 365 Days (if applicable)
• Referral Review Request (Needs Review) Date + 365 Days (if applicable)
• Referral Sent Date + Estimated Wait 1 or Wait 2 + 60 Days

Deletion Warnings

Incomplete, Processed and Completed eConsults/eReferrals don't trigger Deletion Warnings.

An eConsult and/or eReferral with any other status will be moved to the "Deletion Warnings" folder 14 days in advance of being removed from Ocean. A Deletion Warning email notification will also go out to all Ocean Sites with access to the shared record.

• Storing an eConsult and/or eReferral past scheduled removal

  • If you would like Ocean to continue storing an eConsult and/or eReferral with a Deletion Warning you can click the refresh symbol (circular arrow) at the end of the row to keep storing the consult or referral for an additional 60 days.
  • 

• Checking when an eConsult and/or eReferral will be removed

  • If you would like to see the date that any consult or referral is scheduled to be removed from Ocean, you can click on the "Action" menu and choose "View Event Log". The purge date will be displayed at the bottom of the event log.
  • 

Note: Your site may receive a "Deletion Warnings" email, only to find that there are no consults or referrals in the "Deletion Warnings" folder. This could be the case if another user or stakeholder proceeded to "Complete" or "Process" the consult or referral, or refresh the consult/referral to extend the purge date. 

For sites receiving eReferrals, it may be valuable to know if the patient has been referred to your site before, and some details of the previous referral(s). Fortunately, you can view a patient's "Referral History" directly from the eReferrals & eConsults View of the Ocean Portal.

Note: A health number and birth date must be included in the referral, in order for Ocean to identify the patient's referral history. This is because these two values are used to generate a unique patient identifier that is stored in Ocean with the referral.

Similar to referral analytics, because this referral history contains no patient health information (PHI), this data is not purged from Ocean over time. This means that if you were to receive a referral for a patient today, their referral history can still be viewed ten years from now.

If a previous referral is still in Ocean at the time that it's viewed, this referral can be selected from the "Referral History" window. This will open the referral, allowing you to view further details about this referral.

There are three methods to view a patient’s previous referral(s) (i.e. "Referral History"), as outlined below.

Automatic email notifications are triggered for both patients and senders whenever a consult and/or referral  status is changed from "New" to "Booked"/"Cancelled"/"Declined", or a referral's appointment date or time is changed.

Simply "Accepting" an eConsult and/or eReferral does not typically send an email notification (unless you are in the uncommon scenario that the eReferral is submitted under an eRequest specifically configured to do so).

Determining which email address(es) notifications are sent to depends on the conditions under which the consult/referral was sent and the nature of the notification.

Notification Email Rules

You must be an Admin user at your Ocean site to configure these settings.

If you are a receiving site that accepts eConsults and/or eReferrals and imports them into a non-integrated system, you may want change the file format of the downloaded consult and/or referral to one that is compatible with your system. Ocean currently supports two file options to choose from: PDF or TIFF

If the patient’s email address and consent to receive eReferral notifications via email was provided at the time the eReferral was sent, the patient will receive email notifications when any of the following changes are made to their referral.

• Sent Referrals

  • When the eReferral is first sent, the patient will receive an email informing them that a health referral was sent for them, and they will be notified when an appointment is booked.
  • 
  • If the eReferral is sent for a walk-in health service, the patient will receive the following email notification instead.
  • 

  Forwarded Referrals

  • When the patient’s referral is forwarded from a site such as central intake to another site, they will receive an email notifying them of this action.
  • 

• Booked Referrals

  • When an appointment has been booked for the patient's referral, or booking comments have been updated by the referral recipient, the patient will receive an email notifying them of their appointment booking with the option to confirm the appointment.
  • 

• Rescheduled Referrals

  • If the appointment booking date, time, or medium for a referral is changed, the patient will receive an email, notifying them of this scheduling change, again with the option to confirm the appointment.
  • 

• Appointment Reminders

  • If the referral recipient site has activated Appointment Reminders, for their referral appointments, the patient will receive a reminder notification a certain number of days before their scheduled appointment.
  • 

• Declined Referrals

  • If the referral is declined by the referral recipient, they can choose to notify the patient of this declination. A referral may be declined for various reasons, such as if the receiving site determines that it is not appropriate or if it is incomplete.
  • 
  • If the referral decliner chooses to notify the patient, the patient will receive an email, notifying them of this declination (booking comments will vary based on the reason for declining the referral).
  • 
  • If the referral decliner chooses not to notify the patient, the patient will not receive an email.
  • Note: In the case that a referral is forwarded from one recipient to another (e.g., specialist to specialist, or Central Intake to specialist), and the latter recipient declines the referral, the patient will not receive a notification that the referral was declined. Only the stakeholder which forwarded the referral will receive a notification that the referral was declined.

• Cancelled Referrals

  • If the referral is cancelled by the referring provider, they can choose to notify the patient of this cancellation.
  • 
  • If the referral canceller chooses to notify the patient, the patient will receive an email notifying them of this cancellation (booking comments will vary based on the reason for cancelling the referral).
  • 
  • Note: A referral may be cancelled likely because it has already been booked or the patient/referring provider has changed their mind about requesting the referral.

You must be an Admin user at your Ocean site to configure these settings.

If you are a receiving site that accepts eReferrals, and would like to configure your site to automatically close booked referrals, follow the steps outlined below. This will allow your site to automatically move referrals to the Completed folder without having to manually open and mark them as Complete.

You must be an Admin user at your Ocean site to configure these settings.

If you are a receiving site that accepts eReferrals and would like to configure the appointment time options that appear in the referral's scheduling pane, follow the steps outlined below. This will help mitigate appointment scheduling-related errors and make it easier to pick the time of the appointments.

As Ocean eReferrals are purged from the Ocean Portal over time, it is recommended that you keep a backup of the referrals received at your site. This can be done on a weekly basis, by following the steps below: 

Final Comments

The referral export(s) will contain patient health information and should be stored somewhere securely at your site.

Any time a user presses the 'Export' button, an audit log entry (EXPORTED_REFERRALS) is automatically generated documenting the date, time, and user that performed the export.

Referral information pulled in the export includes; referral reference, patient name, description, status, referral date, booked date (if present), referring site, recipient site, clinician, professional ID, patient phone number, patient email, internal comments, referrer comments, and the entire contents of the referral note.

The API also provides access to this referral information. For more details, please refer to: "Ocean Open API".

If your Ocean site receives referrals that are not imported directly into an EMR, you can download or print pdf copies of them using the referrals' Action Menu. In some workflows, it may be easier to batch print multiple referrals within a list at once. This can be done using Ocean's batch print function, and the following steps:

When setting up a listing, that has been claimed to your site, one of the key steps will be to add the Health Service Categories provided by the listing. Each category should be listed separately to allow consult and/or referral senders to locate you better on the Ocean Healthmap.

Health Service Categories can be added or removed at any time from a listing. These changes are made in the Admin Settings page in the Ocean Portal, by clicking Directory Listings. The table below outlines all the categories that are currently available in Ocean. If you have customized eForms, the Health Service Reference column may be helpful for form programming or back-end analytic work.

If your health service is not listed below, try searching for it directly in the map-based directory. You may find that Ocean links you to one of the health services below using one of the stored synonyms or keywords.

If you are unable to locate a direct match or synonym, you will likely be able to locate a similar or generalized version of your health service category in the list below.

Note that once you have added a health service category with one of Ocean's standard health service categories, you can assign a custom title to the offering to provide more context (such as renaming your category's title from "Ultrasound" to "Ultrasound - Abdomen").

Adding a Catchment Area

To add a catchment area to your Directory Listing, navigate to your listing's settings in the Ocean Portal, and complete the steps below.

Using a GeoJSON file for Direct Catchment Area Import

If you use a service such as Google My Maps, you can create your own catchment areas that can be exported as GeoJSON files that can be uploaded directly into Ocean.