Note for Ontario Users: In Ontario, Ocean eConsults are currently in a limited release. For more information on eConsult in Ontario as part of the Ontario eServices Program, please review the Overview of eConsults in Ontario article.

How do I set a Clinical Delegate user for my Ocean user account?

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.

Note:  A Site Admin user can see and edit delegates for all users at their site in the Admin view. Refer to this article: Edit Delegates Page.

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What is a Central Intake?

What is a Central Intake?

A Central Intake is a special type of Ocean site that is used to coordinate referrals and make best use of a geographical region's resources. This special site configuration allows the Central Intake users to remain as stakeholders on the referrals, and see the status update as the referral is continued to be processed downstream. Healthcare providers within the region can choose to route their referrals to a Central Intake rather than referring directly to a specific service provider.

The Central Intake site can ensure completeness of the referral, transcribe faxed referrals, triage referrals, and manage other administrative aspects. They may forward the referral to an Assessment Center for additional investigation, or directly to another healthcare service provider who delivers the referred service.

What makes a Central Intake site unique?

Since the primary purpose of a Central Intake is to manage referrals within a region, there are unique functionalities that have been created in Ocean to assist with their workflows.

Directory Listing Configuration

Central Intake sites have unique Directory Listings that are specifically configured by CognisantMD. If you are interested in having your Directory Listing configured to be a Central Intake listing, please submit a ticket to our support team.

Forward Button

  • Once configured as a Central Intake site by CognisantMD, a 'Forward' button will appear in each referral received.
  • This provides Central Intake users with the ability to forward the referral to the appropriate service provider.

Forwarded Folders

  • Central Intake sites gain access to the 'Forwarded (New)' folder in the eReferrals area.
  • The 'Forwarded (New)' folder contains referrals that have been electronically forwarded by the Central Intake and are now waiting in the 'New' folder of the recipient site.

Processed Button

  • Once a referral has been marked as 'Booked' or 'Completed' by a recipient site (in the case of electronic forwarding), or has an appointment added to the Scheduling pane by the Central Intake site (in the case of manual forwarding), Central Intake users can then use the 'Processed' button within the referral.
  • This moves the referral into the 'Completed' folder for the Central Intake site, while keeping it in the existing folder for other referral stakeholders.

How do Central Intake sites receive referrals?

Central Intake sites receive referrals by either having referring providers send them directly to their Central Intake Listing on the Ocean Healthmap, or by having recipient sites automatically redirect their inbound referrals to the Central Intake Listing. Central Intake sites can also receive manually faxed referrals, and transcribe them into Ocean to take advantage of the digital functionalities.

  • The image on the right is an example of a Central Intake listing on the Ocean Healthmap which a referring provider could directly send to.
  • Referral recipient sites who would like to automatically redirect their referrals to a Central Intake can select the appropriate Central Intake site by searching for it in the 'Central Intake Listing' field within their own Directory Listing settings.

Central Intake Processes

Please expand the appropriate tab below for information on the different processes that Central Intake sites use to forward referrals.

Electronically Forwarding a Referral

The steps below can be used by Central Intake sites when they are forwarding a referral to a healthcare provider that is accepting eReferrals through the Ocean platform.

  • Locate the relevant referral within the 'New' folder, and click on it to open it.
  • Optional: Within the Notes area, click the speech bubble icon, and select 'Review...' to open the review form.

  • Optional: Complete the review form, and press 'Save' to stamp the note into the 'Notes' pane of the referral.

  • Use the 'Forward' button at the bottom of the referral to forward the referral.
  • Select or search for the desired referral recipient with a green icon. The green icon indicates that they are accepting eReferrals.
  • Review the recipient's listing information, and press 'Forward Referral' when ready.
  • The forwarded referral can now be found in your 'Forwarded (New)' folder, with a green arrow indicating that it was electronically forwarded to the recipient site.

    If the recipient site accepts the referral, it will move into the 'Pending Booking' folder.

    When the recipient site books an appointment for the referral, it will move into the appropriate 'Booked Unconfirmed' or 'Booked Confirmed' folder.

    If desired, the Central Intake site can mark a referral as 'Processed' once an appointment has been booked, moving it into the 'Completed' folder for only the Central Intake site.

Manually Forwarding a Referral

The steps below can be used by Central Intake sites when they are forwarding a referral to a healthcare provider that is not accepting eReferrals through the Ocean platform.

This involves manually faxing the referral outside of the Ocean platform, and simply updating the status within Ocean on behalf of the true referral recipient.

  • Locate the relevant referral within the 'New' folder, and click on it to open it.
  • Optional: Within the Notes area, click the speech bubble icon, and select 'Review...' to open the review form.

  • Optional: Complete the review form, and press 'Save' to stamp the note into the 'Notes' pane of the referral.

  • Use the 'Forward' button at the bottom of the referral to forward the referral.
  • Select or search for the desired referral recipient with a grey icon. The grey icon indicates that they are not currently accepting eReferrals.
  • Review the recipient's listing information, and press 'Print Referral' to obtain a printable file of the referral.
  • Print the file and manually fax the referral to the recipient using a fax machine.
  • Use the confirmation checkbox in Ocean to confirm that you have manually forwarded the referral to the recipient.
  • Press 'Forward Referral' to complete the process.
  • The referral is moved to the 'Pending Booking' folder, with a grey arrow indicating that it has been manually forwarded.

    Since the referral was manually forwarded to the recipient, the Central Intake site maintains the responsibility to update the referral and appointment scheduling information within Ocean.

  • If desired, the Central Intake site can use the 'Processed' button to move the referral to the 'Completed' for only the Central Intake site.

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Can I include handout files for patients on my listing in the Ocean Healthmap?
  • Yes, you can include patient handout files for each of the Health Service Offerings shown on your Directory Listing in the Ocean Healthmap.
  • The handouts are made available for download when the Health Service Offering is selected on the listing.
  • Additionally, when a patient is referred under a specific Health Service Offering, the email notification they receive (if applicable) will include the handout files.

How do I add handout files?

  • Log in to the Ocean Portal, open the 'Menu' and select 'Admin'. From the Admin Settings page, select 'Directory Listings'.
  • Within the appropriate Directory Listing, locate the 'Service Details' section and select the appropriate service offering.
  • Locate the 'Patient Handout' file uploader, and press 'Choose File'. Select the appropriate handout file from your computer.

    Note: You can add multiple handout files by uploading them one at a time.

  • Once the file(s) have been added, press 'OK'. The handout file(s) can now be found in your listing in the Ocean Healthmap, and will be included in the patient's email notification if they are referred for that health service.

Note: Since handout files are added to each individual Health Service Offering, you can attach different handout files for each of your offerings. Alternatively, you can add the same handout file(s) to all of your offerings.

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How can I communicate with an eReferral sender/recipient?
  • You're able to communicate with an eReferral sender or recipient by using the 'Messaging' area within an eReferral.

How do I send a message?

  • Within the 'Messaging' area of the eReferral, simply select the appropriate message recipient (if multiple parties are involved in the referral), type your message into the text box, optionally add an attachment, and press 'Send'.
  • For increased efficiency, you can also create canned responses for your Ocean Site that are easily selectable using the speech bubble icon.
  • The message recipient will receive an email notification that you have sent them a message.

Additional Message Functionalities

  • Once a message has been sent, additional functionalities can be accessed by clicking clicking on the message header.
  • Note: The 'Amend' and 'Delete' options are only available to the user who sent the message.

Download Addendum Letter
Downloads a PDF document containing basic eReferral information and the selected message.
Amend
Copies the selected message into the new message text field, to allow for additional information to be added.
Delete
Deletes the message.

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Can I add notes to an eReferral/eConsult?
  • Yes, the 'Notes' area within an eReferral or eConsult can be used for general documentation regarding the request.
  • Additionally, if you're taking advantage of the eReferral reviewal workflow, the note generated by the review form will be automatically stamped into the 'Notes' area.

How do I add a new Note?

  • To add a new note to an eReferral or eConsult, simply open the request and type into the 'New Note:' text field and press 'Save'.
  • Alternatively, you can use the speech bubble icon to select a short pre-worded note.

Additional Note Functionalities

  • Once a note is saved to an eReferral, additional functionalities are available by clicking on the note header.
  • Note: These functionalities are only available for Notes created by your own Ocean site.

Edit*
Allows you to modify the responses to the Review Form.
*Only available for the note created by the Review Form. For more information on Review Form notes, please see how to review incoming eReferrals.
Email Note
Emails a copy of the note to the original referring provider.
Download Note
Downloads a PDF document containing basic referral information and the selected note.
Make Private for This Site
Makes the note private, so only users on your Ocean Site can see the note. Private notes are shown in italics.
Delete
Deletes the note.

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Can I send messages and eForms to patients ahead of their referral appointment?

Yes, eReferral recipients can use Ocean's Patient Messaging functionalities to securely message patients and send them Ocean eForms to complete ahead of their appointment.

Please note that to use Ocean's Patient Messaging functionalities, a Patient Messaging & Reminders License is required. For additional information on the cost of Ocean's Patient Engagement products, please see our pricing page.

1. Set Up Patient Messages

Complete the steps in the Set Up Patient Messages guide to enable and configure patient messaging on your Ocean site.

2. Sending a Patient Message and/or eForms from an eReferral

  • Locate the relevant eReferral within Ocean, and click on it to open it.
  • Within the eReferral, expand the 'Patient's Note' tab by clicking on it, and then press the envelope icon.
  • Use the pop-up window to send a customized message and/or eForm to the patient, or select one of your existing templates for convenience. When your message is ready, press 'Send'.

    For additional information regarding the options in this window, please refer to Patient Messages Settings.

3. Patient Confirms Secure Message and/or Completes eForms

  • The patient will receive an email prompting them to view any secure messages, and complete any outstanding eForms.
  • After clicking the hyperlink in the email, patients will be able to view any secure messages, and press 'Next' to complete any outstanding eForms.

3. Review Patient's Note within the eReferral

  • After the patient completes their eForm(s), the generated eForm note can be found within the 'Patient's Note' area of the eReferral.

    Note: If your Ocean site is integrated with your EMR, the generated eForm note will automatically be added to the respective patient's chart.

    If your Ocean site is not integrated with your EMR, you will need to manually import the generated notes.

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How are eReferral resubmissions taken into account in analytic data and wait time calculations?
  • If an eReferral is cancelled or declined, it can be resubmitted at any time using the 'Resubmit' option within the 'Action' menu.
  • Ocean accounts for resubmitted eReferrals in both analytical data and wait time calculations.

When a cancelled or declined eReferral is resubmitted, both the original eReferral creation date and the latest eReferral sent date are recorded as analytics.

The date of the eReferral resubmission is recorded in the 'referralCreationDate' column of the analytics report, while the date of the original eReferral submission is maintained in the 'referralInitialCreationDate' column.

Ocean calculates wait times using the values in the 'referralCreationDate' and 'scheduledAppointment' columns, which ensures the accuracy of the wait time calculation using the latest iteration of the eReferral submission (i.e., not the date of the initial eReferral creation).

For additional information on wait time calculations, please see: How are wait times calculated and displayed in Ocean?

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How does my Clinician Type impact my functionalities as a Clinical Delegate sending eReferrals in Ocean?

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.

  • When sending a new eReferral as a Clinical Delegate, the dropdown menu in the 'Referrer's Information' panel allows you to select the referring provider, if applicable. The menu displays all providers for which the sending user is designated as a Clinical Delegate.
  • Ocean users with the 'MOA/Secretary' Clinician Type must select a referring provider from the dropdown menu. All other Clinician Types are also eligible to select themselves as the referrer.
  • After the eReferral has been sent, email notifications are sent to the 'Referral Notification Email' email address listed in referring provider's account settings. If there is no email listed, email notifications will be sent to the 'Clinical Delegate Email(s)' listed in the referring provider's account settings.
  • Note: Email notifications will not be sent to the delegate user who initiated the eReferral on behalf of the referring provider. The notifications will only be sent to the user selected in the 'Referrer's Information' dropdown menu.

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

  • When sending an eReferral on behalf of a physician as a Physician Assistant, the Referrer's Information panel is modified to clearly indicate that the eReferral is being sent by a Physician Assistant, on behalf of the referring provider.
  • This is recorded in the General pane of the eReferral, so the recipient can clearly see that it was sent on behalf of the referring physician.
  • After the eReferral has been sent, email notifications are sent to the 'Referral Notification Email' email address listed in referring provider's (i.e., the physician's) account settings. If there is no email listed, email notifications will be sent to the 'Clinical Delegate Email(s)' listed in the referring provider's account settings.

Nurse Practitioners

  • In the case that a Nurse Practitioner initiates an eReferral for a medical test/procedure which requires authorization from a physician, an 'Authorizing Physician' field is added to the Referrer's Information panel to select the authorizing MD.
  • Typing into the field searches the Ocean Healthmap directory for convenient selection of the authorizing physician.
  • Once the Authorizing Physician is selected and the eReferral is sent, it is recorded in the General pane of the eReferral, so the recipient can clearly see the physician who provided authorization.
  • After the eReferral has been sent, email notifications are sent to the 'Referral Notification Email' email address listed in Nurse Practitioner's account settings. If there is no email listed, email notifications will be sent to the 'Clinical Delegate Email(s)'.

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Can I modify the eForm used during the eReferral/eConsult reviewal process?
  • Yes, the questions presented in the 'Review' panel during the eReferral/eConsult reviewal process are customizable.
  • The questions in this panel correspond to a specific Ocean eForm (named 'Referral Notes') in your Ocean site. By modifying this eForm, it modifies the questions presented during the reviewal process.

Warning: Advanced eForm Editing

The Referral Notes eForm should only be modified by Ocean users who are familiar with advanced eForm editing. We recommend creating a backup version of your Referral Notes eForm before modifying it.

How to Modify the Referral Notes eForm:

  • Locate the 'Referral Notes' eForm in your eForm library. This eForm has the reference value 'referralNotes', which is the eForm reference value that Ocean will use in the 'Review' panel of an eReferral.

    In other words, the eForm which has the 'referralNotes' reference value will be shown in the 'Review' panel.

  • Select the eForm, and press 'Edit' to launch the eForm editor.
  • Within the eForm editor, you can modify or add additional questions that should be displayed within the 'Review' panel during the reviewal process.
  • The preview panel on the right hand side shows how the note will appear in the 'Notes' panel of the eReferral once it has been reviewed and saved.
  • Use the 'Save Changes' button in the bottom right corner to save your eForm when you are done making changes.

Important eForm Item References

Each item in an eForm is assigned a specific item reference value. Item reference values are often used to implement conditional logic into eForms, however they are also sometimes used to push information from the eForm into a specific area or functionality within Ocean.

  • For the 'Referral Notes' eForm specifically, the item references 'protocol' and 'priority' can be used to push information into the respective 'Protocol' and 'Priority' columns in the eReferrals area.
  • Expand the image on the right to see where the 'priority' item reference value is stored for the highlighted eForm item. The 'protocol' value is not present in the default version of the Referral Notes eForm, but it can be manually added.
  • The text value shown on each of the response choices represents the text value that would be pushed into the respective column in the screenshot above. These can be modified in the 'Menu Choices' tab.
  • Note: We highly recommend using an eForm item type that allows for discrete response choices (e.g., a Menu) to simplify the process within the 'Review' panel of the eReferral. This also ensures that the values pushed into the 'Protocol' and 'Priority' columns are standardized across all reviewed eReferrals.

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Can I assign an eReferral to be reviewed by someone on my Ocean Site?

Yes, Ocean has built-in functionality to allow you to easily assign an eReferral for review by another user on your Ocean site.

This is helpful for triaging, organizing, and actioning incoming eReferrals. An eReferral can be flagged for review at any time during the referral process, allowing for appropriate reviewal even before deciding to accept or decline it.

Please expand the appropriate tab below to learn more about each side of the assigning and reviewing process:

Steps to Flag an eReferral for Review
  1. Locate and Open your eReferral

    • Start by logging in to the Ocean Portal.
    • Navigate to the eReferrals area by opening the 'Menu' and selecting 'eReferrals'.
    • Locate the eReferral that you wish to flag for review by using the folder categories or the search bar. Open the eReferral by clicking on it.
  2. Flag the eReferral for Review

    • After opening the eReferral, locate the 'Needs review' field in the bottom left.
    • Clicking inside the text box presents a list of users on your Ocean site. Select the user that you wish to notify. Alternatively, type their name to automatically filter the list.
    • Once you have selected your desired user, the 'Notify' button will appear. Press it to send an email notification to the user you selected, indicating that their reviewal is required.

      Note: To assign an eReferral for review without triggering an email notification, simply press 'Save & Close' after selecting a user.

    • A confirmation message will appear on screen confirming that an email notification has been sent, and the email address that it was sent to.

      Note: The email notification will be sent to the Email Address listed in the reviewer's Ocean user account settings.

    • An example of the email that the reviewer will receive can be seen by expanding the image on the right.
    • Press 'Save & Close' to close the eReferral.
    • The eReferral will be moved into the site-wide 'Needs Review' folder. It will also appear in the 'For Me' folder of the assigned reviewer.
Steps to Review an eReferral Flagged for Your Review
  1. Locate and Open your eReferral

    • Open the assigned eReferral by clicking the 'View the eReferral' button in the notification email.
    • Alternatively, if the eReferral was assigned to you without an email notification, locate the eReferral in the 'For Me' folder.
  2. Review the eReferral

    • The 'Review' panel within the eReferral will automatically open for physician users. For non-physician users, this panel can be accessed by selecting the speech bubble icon in the 'Notes' area, and pressing 'Review...'.
    • Assign a priority level to the eReferral and any additional comments.
    • Complete the review process by selecting one of the options below:
1. Request Decline
Stamps a simple note into Notes pane indicating that the eReferral should be declined, and moves the eReferral into the folder it was previously in. The eReferral should then be manually declined by the next user actioning it.
2. Save
Stamps a summary note of the review into the Notes panel.
3. Reviewed
Stamps a summary note of the review into the Notes panel, completes the reviewal process, and moves the eReferral into the folder it was previously in.
4. Reviewed Arrow
Provides additional options for completing the reviewal.
'Review and Accept' completes the reviewal process, and moves the eReferral into the 'Pending Booking' folder. Note: This option is only available if the eReferral has not already been accepted.
'Review and Decline' completes the reviewal process, and moves the eReferral into the 'Declined' folder.

Quick Tip

  • The 'Enable Review Mode' toggle button in the bottom left corner can be used to expedite the process for reviewing eReferrals.
  • When review mode is enabled and there are multiple outstanding eReferrals for review, the 'Reviewed & Close' button in the bottom center of the eReferral is replaced with a 'Reviewed & Next' button, allowing you to quickly move into the next outstanding eReferral without having to manually close and open each time.

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Creation of Multiple Ocean Sites

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.

It is not possible for clinics using OSCAR Pro or Med Access to have multiple Ocean sites associated with their single EMR instance. Clinics using these EMRs can only have a single Ocean site.

  • 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.

PS Suite

Do you share computers/workstations?

If computers/workstations are being shared among staff under different clinics/practices, significant issues will arise during Ocean configuration.

  • Computers/workstations are shared
  • Computers/workstations are not shared

If computers are not being shared, please proceed to the next question.

Do you share physical space?

Physical space includes exam rooms, check-in areas, administrative workspaces, etc.

  • Physical space is shared
  • Physical space is not shared

If physical space is not being shared, the clinic is eligible to have multiple Ocean sites associated with a single PS Suite EMR instance.

Accuro

Do you share EMR schedules?

  • EMR schedules are shared
  • EMR schedules are not shared

If EMR schedules are not being shared, the clinic is eligible to have multiple Ocean sites associated with a single Accuro EMR instance.

Accuro Set-Up

Please note that if you're setting up your single Accuro Instance to multiple Ocean Sites you will need a different API and Username for each Ocean Site.

Sites will also need to be diligent when setting up their CDS links to ensure they are using the correct API Username and Password, as well as naming the CDS links clearly. We would also highly recommend setting up User Friendly CDS links.

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How does Ocean's health service directory (oceanhealthmap.ca) find and prioritize search results?

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.

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Can I send eReferrals from the Ocean Portal with pre-populated patient demographics?
  • For non-integrated Ocean sites, users can go directly to the Ocean Healthmap to send eReferrals. As the patient demographic information is not pulled in from an integrated-EMR, referring providers will need to manually complete this portion of the referral at the time of sending.
  • If these sites would like to have their patient information pre-populated, they can bulk upload a set of patients in to their Ocean site under the Patients View.
  • See the following support article for the various importer types and their sample templates that can be uploaded into Ocean. The General Importer is the sample containing all of the patient demographic fields on a referral form. Use this sample file to generate a list of your patients you would like to upload into your Ocean site.
  • Once your patient list is generated, go to the Action menu in the bottom left of Patients page and select "Upload Patients from File".
  • Select the file containing your list of patients, choose the General Importer from the dropdown, and provide a Cohort Id (a name to identify the patient set being uploaded).
  • Select "Upload". You will receive a confirmation prompt when the patients have been successfully uploaded into your Ocean site.
  • From there, referring providers can select the patient they would like to send a referral for, and then choose "Find Health Service". This will launch the provider into the Healthmap, pulling in the patient demographic information and prepopulating it on the referral form.

 

Note: Uploaded patients will be maintained in Ocean for 14 days before they are purged automatically from the site.

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Can I send the patient details about how and where their eReferral Appointment is occurring?

eReferral recipients can now specify the method for how appointments booked on their referrals will occur (in person, as a home visit, or a virtual visit by phone or video). This is done in the Scheduling pane of eReferrals in the Medium dropdown to the right of each appointment date and time.

  • To specify the appointment Medium, click on the dropdown to the right of the appointment time and select if the appointment will be In Person at the listing location, In Person at an alternate location, by Phone, Video Visit, or as a Home Visit.
    • Ocean will include the selected appointment medium, alongside the other scheduling details, in the booking email notifications automatically sent to the patient and referring provider.

Note: Medium is a mandatory field. It will default to "In Person" at the address of the directory listing the referral belongs to. If this is not accurate, please ensure the dropdown selection is changed before saving the booking details.

  • If you select "In Person (Alternate Location Specified in the Booking Comments)" please ensure the address details are included in the booking comments. If desired, you can configure the alternate locations as canned booking comments.
  • Details regarding the phone, video or home visits can also be configured and included in the canned booking comments.
  • If booking multiple appointments on the eReferral, you can select a separate medium for each appointment.
  • Patients who have consented to email notifications will receive the standard booking email with the appointment date and time, followed by the medium. See the following support article for further examples.

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FAQ: How to Manually Import a Sent eReferral into PSS

In the rare case that an Ocean eReferral Custom form, or the referral note summary, does not download into the patient's PSS chart after an eReferral is sent, users can re-trigger the download by following the steps outlined below.

  • Access the Ocean Patient Dashboard by selecting "View in Ocean" on the Ocean Toolbar in the patient chart.
  • Locate the sent eReferral that needs to be re-downloaded into the patient chart, and click it to open.
  • Once the referral opens, click the Action menu located in the top-right corner.
  • Select the "Import into EMR" option.

This action will trigger the entire referral form summary, as well as the Ocean eReferral tracking form, to download into the patient chart. Any internal PSS messages or Pending Tests/Consults, associated with the referral, will download as well.

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What happens when an eReferral is sent with more than one Health Service Offering requested? (eReferral Splitting)

In some referral pathways, such as the Diagnostic Imaging pathway, it is common for a patient to be referred to a listing with more than one Health Service requested (for example a referral for a CT and an Ultrasound).

In these cases, rather than having the referrer complete two separate referral forms (one for the CT and one for the Ultrasound), the referral form at the recipient site can be designed to allow both exams to be requested on the same referral.

  • Here's an example of a referral form where the referring provider can select more than one exam.
  • Note: Selecting more than one exam will assign more than one Health Service Offering to the referral form. This will give the recipient the opportunity to "split" the referral into separate referrals - one for each offering assigned.

The Splitting Policy

  • As the referral recipient, you can configure your listing to automatically "split" referrals into multiple referrals that can be managed separately within your Ocean site. This setting is configured from the Admin Settings page by clicking on Directory Listings. From here, scroll down to the eReferral Policy section, and you should see a box next to Splitting Policy.
  • If the Splitting Policy is enabled at the recipient site, the referral will automatically come into the New box as separate referrals. The sender will see the same thing occur in their sent folders.
  • If the Splitting Policy on a listing is turned off (left unchecked), the referral will come into the site as a single referral with multiple services assigned to it.
  • The recipient can review the referral first and choose to split it into multiple referrals (one for each service). This manual split can be done using the "Split" button displayed at the bottom of these referrals when opened.

The Relationship between Split Referrals

  • When referrals are split, a relationship is established between the original referral that was sent, called the "Source" referral, and each of individual referrals that were generated after the split. These individual referrals are commonly referred to as "Child" referrals. Both the Source Referral and each of the Child referrals can be found listed in the Related Referrals section, displayed at the bottom of each split referral.
The Source Referral
  • The Source Referral can be viewed if the referral sender or recipient would like to see a summary of the original referral that was submitted, and a list of each Child referral and their corresponding statuses.
  • The Source Referral can be accessed from the Action menu of each of the individual referrals.
  • Or it can be opened from the Related Referrals table, by clicking the "View Source Referral" link displayed on any of the individual Child referrals.
  • The Source Notes section on the Source Referral, can be used to add notes or information that is relevant to all of the related referrals.
  • Any notes added to this section will display on each of the Child referrals, separate from their Notes pane which captures notes specific to that individual referral.
  • Note: If there are no Source Notes added to the Source Referral, then this section will NOT display on the individual Child referrals.
The Child Referrals
  • When a Child referral is opened, any other Child referrals from the original split can be viewed, along with their status, in the Related Referrals section at the bottom of the referral view.
  • To navigate between these referrals, you can click on the name of the related referral, or click the "View Referral" link, in the right hand column of the Related Referrals table.
  • Note: After a referral is split, each of the child referrals will operate individually in Ocean, with its own appointments, status updates, email notifications, notes, and messages tied to it. 

The Referral Form Summary on Split Referrals

  • The Referral Form Summary is generated from the information filled out by the referring provider on the referral form. The Source Referral will display all of the information completed on the form, including sections that are applicable to each of the services selected.
  • In a standard referral split, that same Referral Form Summary will be displayed on each of the Child referrals that get generated. However, the referral form can also be designed at the recipient site to only display specific parts of the original Referral Form Summary on each of the child referrals. This is to help with the management, and triaging of each child referral. For example, when you view the Ultrasound child referral, you may only see the sections relevant to that service in the Referral Form Summary.
  • Note: Both the referral splitting, and the generation of these child referral form summaries, will depend on the design and configuration of the recipient's referral form and listing.

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What File Types and Sizes can be Added as Attachments to eConsults and/or eReferrals?

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

  • For example, Ocean will only accept attachments with a size limit of 10MB per attachment, and up to 50MB total for all attachments included on the eConsults and/or eReferral. If an attachment that exceeds this file size limit is added, the following error will appear:
  • Ocean also has a limitation on certain file types. Only attachments of the following types can be included: "jpg", "jpeg", "png", "tiff", "tif", "mp3", "mp4", "txt", and "pdf". If a non-compatible file type is added the user will be prompted with an error similar to the following:

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What does the "Copy of referral and status updates to" setting do on an eConsult and/or eReferral?

When a consult or referral is first sent or when it is updated, the user can specify additional stakeholders for the consult and/or referral. The stakeholders must exist as directory listings within the Ocean Health Map.

The "Copy of referral and status updates to" stakeholders can be automatically notified regarding important status changes, such as a booking or a cancellation.

The stakeholders are shown in the following areas:

  • The Referral Notification Sheet, which is used to help sites notify other offline sites via Fax
  • The Referral Record
  • The Referral Note
  • The electronic view of the consult and/or referral
  • The list of electronic message recipients in the Messages tab of the consult and/or referral (if the stakeholder listing has been claimed by an Ocean site)

When a status changes, Ocean determines how each stakeholder should be notified.

Stakeholder listings that have been claimed by an Ocean site are notified automatically via a notification email sent from Ocean, similar to how referrers/senders are notified in the Ocean eReferral Network.

Stakeholder listings that have not been claimed by an Ocean site cannot be notified via an Ocean email or be sent results electronically via Ocean. Consequently, the consult and/or referral and its associated information must be faxed to the listing or sent in some other manner. Similarly, when a consult and/or referral with one of these "offline" stakeholder listings is updated by a user, Ocean informs the user that a manual notification is necessary for the listing. Users can send these manual notifications by printing the "Fax Notification Sheet" and faxing it to the recipient.

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What do the different inboxes mean?

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 14 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.

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What do the icons and buttons mean?

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

Icons within the eConsult and/or eReferral

Icon Definition
Edit_patient_details.png Edit patient level details (email, phone, address).
Requires_review.png A component of the eConsult and/or eReferral requires review (message, referral note, etc.).
Reviewed.png A component of the eConsult and/or eReferral that was previously requiring review has been reviewed.
Message_in_referral.png 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_patient_note.png Send a patient note or resend patient appointment notification email.
Add_note.png Add a new note to the master eConsult and/or eReferral (while viewing a child eReferral).
Analytics.png The eReferral will be included in wait time calculations, because a date booked comment has not been chosen.
Delete_attachment.png Delete an attachment that has been added to the appointment notification email.

Buttons within the eConsult and/or eReferral

Button Definition
Accept.png 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.
Accept_Reply.png Moves the eConsult and/or eReferral from the Awaiting Reply inbox to the appropriate inbox based on the eReferral status.
Completed.png Indicates that the eConsult and/or eReferral as complete and not requiring any further follow up. Will move the referral to your Completed inbox.
Decline.png 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.
Forward_Referral.png Forwards the eConsult and/or eReferral to the selected site for further follow up. Moves the consult/referral to your Forwarded (All) inbox.
OK.png Acknowledges that you have read and accept the text that is in the window.
Reviewed.png Indicates that the component requiring review has been reviewed. Will move the eConsult and/or eReferral to the appropriate inbox based on the status.
Send.png Sends the message and any attached files to the sender.
Cancel.png Closes the window without saving any changes and returns to the previous screen.
Save.png

Saves changes made.

Note: The window will remain open when this option is selected.

Done.png Saves changes made and closes the window.
Done_and_Await_Reply.PNG

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.

Notify.png

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.

Note: From the eReferrals page in the Ocean Portal, hovering over each of the icons for a moment will also bring up a tooltip displaying the icon's meaning.

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What do the different Action Menu Items mean?
  • The Action menu on an eConsult and/or eReferral in the eReferrals View is used to action on and manage your site's consults and/or referrals. Each action menu item is described here to help you process and manage incoming and outgoing eConsults and/or eReferrals. 

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.

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How long will my eConsults/eReferrals be stored in Ocean?

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:

Incomplete
Incomplete eConsults/eReferrals 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.
Booking Uncomfirmed & Booking 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.

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. 

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Where do eConsult and/or eReferral notification emails get sent to?

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.

  • An example of the notification email provided to senders, receivers, and patients can be seen by expanding the image on the right.

Notification Email Rules

eReferral SenderseReferral ReceiversPatients

Email Notifications for Referrers

Notification emails are sent to the sender/referrer when:

  • An appointment date is booked, changed, or removed 
  • Booking comments are added or changed
  • The consult and/or referral is forwarded
  • The consult and/or referral is canceled
  • The consult and/or referral is declined
  • A secure message is sent to the sender/referrer (patients do not receive this message)
Notifications will be sent based on the following conditions:
An Ocean user is associated with the referral
  • Notifications will be sent to the first email address that is set, based on the following order of email addresses in the user's My Account page (found in the Ocean portal, clicking on your name at top right hand corner, and selecting "My Account"):

    • Referral Notification Email
    • Clinical Delegate Email
    • The Delegate's email address (if delegates have been added)
    • The user's Email Address
The referrer provided a specific notification email when sending the referral

The provided email will be used.

The referral was sent from an eReferral Custom Form in an EMR

Notifications will be sent to the referral notification email configured for the specific user within the EMR's custom form, or the site within the EMR's custom form.

Email Notifications for Referral Delegates

If a delegate user sends a referral on behalf of a referring provider, Ocean will use the provider's user settings to determine where the notifications are directed.

Therefore, the delegate user will NOT receive the notifications themselves, unless their email address is set as the "Referral Notification Email" in the provider's My Account page.

The conditions listed above in the "Email Notifications for Referrers" section still apply to determine which of the provider user's email address the notifications are sent to.

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Can I change the File Format for Downloaded Records and Notes?

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

  • Open the Menu and select the eReferrals option.
  • Click Settings button in the top right hand corner of the page.
  • Within the Referrals Settings, click to Configure Referrals.
  • Select the dropdown for Referral Records/Notes Filetype and choose between the default PDF files option or the TIFF files format.
  • Save changes.
  • Selecting the Download option in the Import window (which appears after the eConsult and/or eReferral is accepted), will now trigger the file to download in the format specified.
  • The Action Menu items for Download Referral Record and Download Referral Note will also download the consult and/or referral files in the format specified in the Site Features.

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What email notifications will patients receive regarding their eReferrals?

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.
    • 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).
    • Note: 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.
  • 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.

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Can Ocean Automatically Mark Booked Referrals as Closed at my Site?

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.

  • Open the Menu and select the eReferrals option.
  • Click Settings button in the top right hand corner of the page.
  • Within the Referrals Settings, click to Configure Referrals.
  • Within the Receiving Referrals settings list, select "Yes" under the "Automatically Close Referrals" setting. This will trigger Ocean to run a scheduled job every night to look at ALL referrals sitting in the Booked Confirmed and Booked Unconfirmed folder of your site, and close them.
  • When the above setting is enabled, Ocean defaults to closing referrals 7 days after the latest appointment. You can change the number of days for when you would like Ocean to close the referral, based on how long ago the latest appointment on the referral was.

Note: You will want to ensure the number of days chosen provides your site with enough time to appropriately update referrals as "No Shows", or add additional appointments/slots to referrals that will be booked again, before Ocean automatically closes them.

  • Save changes.
  • Once the scheduled job is run, closed eReferrals will be moved to the Completed folder of your Ocean site. An automated message will be added to the messaging pane to inform all stakeholders that the referral was closed automatically.
  • An "Automatically closed" event will be added to the Event log with the date and time that the scheduled job was run.
  • If any referrals were closed incorrectly, the "Mark Incomplete" button can be used to move them back to the Booked folders.

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How are wait times calculated and displayed in Ocean?

Introduction

Ocean uses appointment dates and other information stored in its referral database to automatically calculate and display up-to-date wait times within the health service directory at OceanHealthMap.ca.

The estimated wait times should serve as a useful consideration for referrers when deciding which health service provider is most appropriate for a patient.

For example, the wait times may assist primary care practitioners (PCPs) in finding an orthopaedic surgeon for a patient with a much shorter wait time for knee surgery when compared to the PCPs usual "go to" list of surgeons.

Currently there is no up-to-date, published information on wait times for most health services in Canada, making Ocean's reported wait times a very useful resource for referrers.

Terminology

Wait 1 is an industry-standard term that represents the time from the sending of the referral to the date of the first consultation with the health service provider.

  • Wait 1 may be divided into two smaller wait times, Wait 1a and Wait 1b, which are used when an initial assessment centre is involved prior to seeing the specialist (such as a knee joint assessment clinic).
  • Wait 1a is the time that elapses within Wait 1 between the sending of the referral and the initial screening assessment.
  • Wait 1b is the time that elapses within Wait 1 between the decision to proceed with a specialist consultation and the date of the consultation.

Wait 2 starts after the first consultation, when the decision occurs to proceed with a surgery or other intervention (a decision which happens usually, but not always, on the date of the consultation).

The wait times are sometimes manually adjusted to exclude certain date ranges that would negatively impact a wait time. For example, if a patient heads south for the winter and is unavailable for treatment, the wait time may be adjusted to exclude this time period. These date ranges are called Dates Affecting Readiness to Consult (DARC) and Dates Affecting Readiness to Treat (DART).

How the Calculation Works

The wait times are calculated entirely from the sample of referrals that are stored within Ocean. Some referrals included are true eReferrals, and others are faxed referrals that have had their dates manually entered by a central intake site.

Each night, Ocean looks at the collection of eligible referrals sent to every individual health service offering in the system.

Ocean uses these referrals to calculate an average Wait 1 and Wait 2 time for this service offering.

For example, an MRI offered at a particular hospital listing will have its own independent Wait 1 and Wait 2 time calculated, independent from the wait times for a CT offered at the same listing.

In addition, Ocean calculates a standard deviation and a 90% Within wait time for Wait 1 and Wait 2, to give stakeholders a sense of the variation in wait times for the service offering.

Referrals that are included in the sample (unless specifically excluded):

For a given health service offering at a listing, referrals are included in the calculation by default when the referrals:

  • are currently assigned to the specific service offering *
  • have a specified consultation date (for the Wait 1 calculation)
  • have a specified surgery or procedure date (for the Wait 2 calculation)

* A special case exists for Rapid Assessment Clinics: Referrals seen at a rapid assessment clinic are included in the rapid assessment clinic's Wait 1a and Wait 1b calculation, even when they have been forwarded on to the specialist listing.

Referrals that are excluded:

  • Referrals sent more than 180 days ago (6 months)
  • Declined referrals
  • Test referrals
  • Referrals that are tagged with a reason-for-wait-time-exclusion by the provider or central intake, e.g.:
    • An earlier appointment was offered but declined by the patient
    • The patient requested or rescheduled to a later date
    • There was repeated difficulty contacting the patient
    • The patient was a pre-existing client
    • The original referral was redirected

Caveats of Wait Time Calculations:

  • The wait time calculations above represent an average based on a (sometimes small) sample of referrals within the system. Consequently, the wait times' accuracy will vary significantly from service to service.
  • The calculated wait time does not guarantee in any way that a patient will be seen within a specific timeframe.
  • Individual wait times may vary depending on the nature of the specific service provided. For example, within a general MRI service offering, an MRI of the foot may have a longer wait time than an MRI of the brain.
  • The wait times may also vary based on the site's triaging. For example, referrals deemed to be urgent will frequently have shorter wait times than routine referrals.

    Sample Size Considerations

    For each independent wait time calculation, a minimum sample size of 6 is required prior to the presentation of any wait time value. Health service offerings with values less than this value will show "Unavailable" as the calculated wait time.

    Sample sizes less than or equal to 10 are flagged with an asterisk to alert users to the potential inaccuracy of the calculation due to sampling errors.

Implications For Providers:

Most of the work to calculate wait times is handled automatically by Ocean as part of the routine use of the system. For example, whenever an appointment is entered for a referral (which providers are incentivized to do for other reasons, such as provider and patient appointment notifications), the referral is included in the wait time calculation.

Wait Time Management:

Health service providers in Ocean should take the time to appropriately tag ineligible referrals for the exclusion reasons listed above. Otherwise, Ocean will include them in the calculation.

Providers should also enter DARCs and DARTs for referrals (when applicable) to ensure the recorded wait times reflect each referral's true waiting period; otherwise, the wait times will appear worse than they are in reality.

Providers should exclude outliers when appropriate. For example, referrals whose wait times are not determined by queuing, such as timed follow-ups, are usually excluded from the calculation.

For more information please see this article: Managing eReferral Wait Times

Disputes and Clarifications Regarding Wait Times

If a provider is concerned about referrers or patients receiving misleading information from these calculated wait times, we recommend the following:

  • Review the referrals at the provider's site to ensure outliers are excluded when appropriate.
  • Enter DARCs and DARTs to ensure referrals with artificially prolonged wait times are adjusted appropriately.
  • Set the site's "claimed" wait time within the health service offering's wait time dialog to match the provider's impression of the "true" wait time. This manually-entered wait time can help inform referrers when the calculated sample may differ from real-world referrals.
  • Provide a comment in the health service offering's wait time dialog for the service. This comment can provide important context, particularly when the listing's claimed wait time differs significantly from the calculation, or when specific protocols may influence the referral's wait time.

 

Please Note:

Ocean wait time calculations may differ from other system calculations such as WTIS.

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Can I Configure the Booking Time Options that Appear in the eReferral Scheduling Pane?

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.

  • Open the Menu and select the eReferrals option.
  • Click Settings button in the top right hand corner of the page.
  • Within the Referrals Settings, click to Configure Referrals.
  • View the Appointment Time Options section on the right hand side of the page.
  • Select the Time System to configure whether the times display as a 12 hour clock, 24 hour clock, or both.
  • Select the Time Interval dropdown and choose the number of minutes you would like the appointment times to be spaced out by.
  • Select the Time Range options to drill the list down to a range of appointment times that match your clinic's hours.
  • Preview the changes in the View Dropdown Values item to ensure the options reflect the desired update for the referral's scheduling pane.
  • Save changes.

Note: If you would like to schedule an appointment outside of the options provided in the dropdown, you can continue to do so simply by typing in the full appointment time, rather than choosing from the dropdown.

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Can I add multiple patient appointments to my eReferral?

Once you've accepted a referral and begin scheduling a patient's appointment, you may want to schedule more than one appointment time. You can do so within the eReferral window.

  1. Once you've accepted a referral, open your referral from the "Pending Booking" tab and navigate to "Scheduling". 
  2. To add an additional appointment, click the (+) button. Similarly, to remove an appointment, click the (-) button.
  3. You can select an appointment label depending on the appointment labels configured for your site. The appointment label is important as it will impact which appointments are saved to your referral analytics and used in wait time calculations. It is also what will be displayed in referrer and patient booking email notifications. To see how you can add appointment labels, and review these details, refer to Step 4 of this guide: Confirm Your eReferral Site Settings.
  4. Confirm the appointment time and details, save your changes. 

 

Note: If you are unsure of the exact appointment time, you can book a blank appointment slot which will place the referral back into "Pending Booking". This allows you to keep track of appointments to book in the future. Once you confirm the appointment, you can repeat the steps above.

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Can I make a copy of a received referral?

If your site receives a referral that needs to be managed in a couple different ways, or split into multiple health service offerings, you can use the Add Related Referral functionality. For example, perhaps your site receives an Orthopedic referral for a patient's right hip, but an assessment outcome determines the left hip should be treated as well. The related referral functionality allows the recipient to make a copy of the original referral for the right hip, so that the left hip referral can be forwarded or booked separately.

  • Open the referral you wish to make a copy of and select the Action menu. Choose Add Related Referral.
  • In the pop up window, choose the desired Health Service for the new referral.
  • If you would like to change the description of the original referral, add it to the Original Referral Description field. To add a new description to the copy of the referral, type in the Related Referral Description field.
  • Click Add. You will now see a copy of both referrals in the eReferrals page in your Ocean site, with their own unique descriptions. The referral note and information on each referral will be identical, but they can now be booked and managed separately. Ocean refers to each of these as "child" referrals.
  • Note: The inbox the original referral was sitting in will impact which inbox(es) the child referrals will be found in, after the related referral is generated. For example, if the original referral was in the Booked Confirmed inbox, it will maintain it's booking information and remain there after the related referral is added. The new related referral will be found in the Pending Booking inbox with a blank scheduling pane.
  • If you open one of the child referrals, you can view the status of the other child (or the related referral), in the Related Referrals section below the referral note. Click the blue text of the related referral to open it directly from the current referral.
  • When a related referral is added, a third referral, called the "source" referral, is also created and stored in the Ocean site. Updates made to the patient's information in the source referral will be pushed to all child referrals. You can also add Source Notes, which are notes that can be viewed on both child referrals. To open the source referral, click the "View Source Referral" link in the Related Referrals section of the child referral, or click "View Source Referral" from the Action Menu of any child referral.

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