TELUS PS Suite

To generate PDF attachments, the Ocean Attachment Exporter makes use of the 'Default Regular Printer' as defined within the TELUS PS Suite EMR preferences, or your computer's default printer. In cases where these preferences have been misconfigured, attachments created by the Ocean Attachment Exporter may render in a cropped or unusable format.

For example, if the 'Default Regular Printer' within PSS or your computer's default printer has been set to a device that is typically used to print physical labels, the resultant Ocean attachments may appear extremely narrow and cropped, rendering them unusable. To remedy this issue, follow the steps below:

Ocean allows patients to submit their contact information using a tablet, kiosk, or online form. When connected to an integrated EMR, this contact information is usually automatically inserted into the demographic section of the patient chart. For example, a mobile phone number can be updated automatically and inserted in the appropriate area in the "Patients" window.

However, as a safety precaution, Ocean will not change the following fields automatically if they are already populated:

• Surname
• First name
• Health number
• Birth date
• Sex

These fields are left as-is to avoid the unintentional overwrite of a chart, which could potentially lead to difficulty finding it later.

Instead, the Ocean custom form sends a message to the clinic's secretary group instructing them to update the field manually (after ensuring the change is appropriate).

PS Suite uses the special target "secs" as the initials of the default secretary group, which ensures the message shows in the inbox of all clinic secretaries. 

To change this default message group:

• Click on the Settings button of the Ocean custom form:
  • 
• Sign in to Ocean if you are prompted to do so.
• Click "Advanced..."
  • 
• Change the "Secretary Message Group" to the initials of the desired secretary user
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Why are my initials on this message?

Due to a security restriction, PS Suite forces all messages to be associated with the user account signed in. If a user with "abc" happens to open the chart, it will trigger the message and PS Suite will automatically assign "abc" as the sending user.

For PS Suite Users

 
1. Sign into your PSS instance and click "Settings" > "Preferences".
2. Navigate to "Clinic Identification".
3. The value in the field "Site Number" is your TELUS PSS ID.
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For Med Access Users

Your client ID is the first 6 letters on the URL that you use to login to your EMR.
For example, if your login is https://abcdef.med-accss.net, ABCDEF is your CLIENT ID.

To verify and correct this problem, try the following steps:

1. Choose a provider that is missing from Cloud Connect's list. Let's call this Provider1.
2. In the Appointments window in PS Suite, choose the Appointments Menu, then Change Provider to Provider1.
3. Take note of the "Billing MD" field for Provider1 (third field from the top). If the Billing MD is empty, it is likely that this particular provider would have appeared in Cloud Connect. However, if the Billing MD is set to, e.g., Doctor1, then we need to ensure Doctor1 is linked to an accessible location.
4. If possible, change to Doctor1 as your current Billing Doctor. Choose Settings and edit Doctor1's billing information. Take note of the "Doctor Number": it should be a six digit number. Let's call it DocNum1.
5. Open the Settings, then edit the Users dialog.
   1. Find the user that theoretically maps to Doctor1. Let's call this DoctorUser1.
   2. Verify that DoctorUser1's six-digit physician number matches DocNum1.
   3. Take note of the Accessible Locations for DoctorUser1 by clicking the corresponding field (3/4 toward the bottom in this Edit Users dialog).
   4. Find the user that theoretically maps to the Ocean Cloud Connect device. Let's call this OceanUser.
   5. Take note of the Accessible Locations for OceanUser by clicking the corresponding field (3/4 toward the bottom in this Edit Users dialog). Ensure that all of the accessible locations for DoctorUser1 are checked ON for OceanUser.
6. Open Settings, select the Preferences dialog and choose the Mobile tab.
7. Ensure that the "CognisantMD / SIS" or "Cloud Connect" device is associated with the OceanUser identified above.
8. If you made any changes, proceed to Cloud Connect.
   1. Trigger a new synchronization of the appointments.
   2. Click the "Reconfigure EMR"" button to see whether the schedule is now visible.

If the above steps failed to identify any possible issues that could lead to an inaccessible location, try the following experiments:

1. De-register and re-register the Cloud Connect device in the Mobile tab, then proceed to "Reconfigure EMR" in Cloud Connect with this new device registration (Step 8).
2. Blank out the "Billing MD" field for Provider1 and complete Step 8 again.

If the schedule appears with a blank Billing MD, you can conclude that the schedule is indeed missing due to an inaccessible location. You may be able to leave the Billing MD blank if the schedule doesn't need to be linked for billing purposes (some clients have decided to simply leave it blank). However, if leaving the Billing MD blank is not an option and the first set of steps in this article failed to correct the problem, there may be additional configuration or workarounds necessary requiring TELUS' and our assistance.

To change the Ocean Site which your PS Suite Ocean Toolbar is connected to, follow the steps below:

Ocean Site not listed?

1. Add the new Ocean Site

2. Authenticate the new Ocean Site

New Features

The TELUS API integration will enable features for an improved user experience, including (but not limited to):

Check-in Kiosk Improvements:

• Scheduled patients are automatically uploaded in Ocean, eliminating the need to manually insert the Ocean custom form.
• Real-time patient health card sync enables support for walk-in patients with queue for non-scheduled patients.
• Expired health cards (with real-time validation check with the Ministry of Health database) will not allow check-in.

Ocean Online Message Enhancements:

• Clinics can now set up automated, customized appointment reminders with forms based on the scheduled reason for visit (requires a sitewide Ocean Online licence).

Ocean Toolbar/Custom Form Changes:

• The new Ocean Toolbar has enhanced functionality that provides live status updates and direct links to Ocean. As a result, you can now add forms for a patient or send patients a message from the Ocean Toolbar, without loading the Ocean custom form into the chart. This eliminates the risk of orphaned or outdated Ocean custom forms being left in patient charts taking up space.

Preparing to Upgrade

1. If you are a current Ocean user who would like to get connected to the new TELUS API, please consult Step 1 of the Upgrade Instructions for Existing Clients guide to determine what type of connection request your site needs to complete. If you are unsure of how to proceed, please consult our support team via ocean.tips/support.
2. Using the TELUS API requires you to replace your existing Ocean Toolbar with the new, improved version. Please be aware that if you have customized your Ocean toolbar, those customizations will be lost.
3. Your site will need to be configured for 4-digit patient refs. Instructions to make this change can be found in "How do I increase the number of digits for patient refs?".
4. When moving to the new API, we recommend making the change outside of clinic hours if possible.
5. Before moving to the new API, we recommend communicating with your clinic staff to let them know that they can expect to see the following minor changes:

Changes to How PS Suite and Ocean Work Together

• Following the upgrade, they will see a new Ocean Toolbar with enhanced functionality to allow staff to interact with Ocean (eg. add forms or send a patient message) right from the toolbar. Clicking on the Ocean logo will open a pop-up window with the same features and functionality as the traditional Ocean custom form.
• The Ocean custom form will no longer appear directly within patient charts in the notes view, providing a cleaner, less cluttered user experience.
• If a patient chart is left open while the patient is completing a form in Ocean, the chart may need to be updated using the "Chart Out Of Date" refresh prompt in the top right corner.

To confirm the currently installed versions of the Ocean Toolbar and Custom Form on your PS Suite instance, follow these steps:

• • Open a test patient's chart in PS Suite.
  • Click on the Ocean logo on the Ocean toolbar to access the Ocean Custom Form.
  • 
  • From the Custom Form window, select the "Help" option.
  • In the Help window, the current versions of the Toolbar and Custom Form will be displayed.
  • 

Note: If you do not see version numbers listed in the Help window, your Custom Form version is below 3.97 and should be updated immediately. For instructions on updating, please refer to the following guide: Download & Install the Ocean Custom Form and Toolbar

The new TELUS API integration allows Ocean to read and update values for patients within the EMR, without requiring the user to open the patient's chart. Although this API provides some great new functionality for Ocean users (such as automated kiosk check-in), it has some limitations that require workarounds, outlined below.

Background

Unfortunately, some important data elements in the API are not currently accessible to Ocean (see tablet below). As a result, these fields cannot be pulled from the EMR and displayed on the tablet (or an Ocean eForm), nor can they be updated by Ocean when a patient changes it.

The ability to update some of these fields is important for certain Ocean workflows, such as when a patient updates their demographic on a kiosk or when a patient fills out a form that is mapped to a PS Suite custom form (e.g. perinatal questionnaire).

Fortunately, enhanced functionality of the Ocean Toolbar has been developed to work around this limitation. The Ocean Toolbar can set these missing values automatically for users, but only once the patient's chart is opened.

Mechanism of Action for the Ocean Toolbar to Detect and Update PS Suite Fields

When Ocean sees a field update request for one of the fields that the API does not support, it places it in a special "Ocean Temporary Note". This note contains the value of the field in a structured format. Once the chart has been opened, the Ocean Toolbar will detect and interpret this temporary note and proceed to automatically set the field value in PS Suite directly.

In the case of a custom form that should be populated based on answer to an Ocean eForm, the Ocean Toolbar will detect that a custom form or other form is desired, automatically inserting the custom form into the chart and populating its values.

Some other fields, such as surname, are not updated automatically for safety reasons. However, the Ocean Toolbar can instead automatically send a message ("yellow sticky") to the administrative team to request the field update.

Note: An important side effect of this workaround for PSS's limitations is that the PS Suite user initials recorded for the insertion of these extra notes are recorded as the user opening the chart (i.e. the user to triggered the change), rather than the initial instigator of the change (such as the user who sent the referral or queued the Ocean form). In reality, there is no actual user responsible for the change, but PS Suite's current design enforces that it record something. This has led to some concerns from some users when reviewing "change logs" when the chart-opening user's initials are found.

Fortunately, after consultation with multiple privacy officers across many different PS Suite clinics, this side effect has not been felt to be a significant medico-legal risk, since it is still straightforward to determine conclusively who-did-what when additional scrutiny is required at the database auditing level. Furthermore, the actions recorded in this case are merely mechanical administrative "clean-up" tasks that are determined by earlier clinical entries in the audit logs, rather than clinically-meaningful events themselves. Nonetheless, the issue has been raised with TELUS as part of the wider request to address these API limitations. In the interim, clinics are free to avoid using the Ocean Toolbar in light of this issue. We encourage its use due to the substantial benefits that its integration provides and the widespread acceptance of this behaviour across the PS Suite community.

Summary of TELUS API Field Limitations

This is a temporary note generated by Ocean. Use the Ocean Toolbar to import the following information into PSS. @OceanData: -
Ocean Data Awaiting Import: { "tobaccoUseUpdate" : {"cigsPerDay":"15-20","smoker":"Y"}, "alcoholUseUpdate" : {"drinksPerWeek":"5-8”}}

The above note is generated by Cloud Connect when it sees a field update request for one of the fields that the API does not support. This note contains the value of the field in a structured format, which is needed for the Ocean Toolbar to set the field value in PS Suite directly.

Therefore, the Ocean Toolbar (or the "Ocean Toolbar - Minimized" toolbar) must be visible in the patient's chart in order for the temporary note to successfully be converted into an automatic PS Suite update.

To ensure that your Ocean Toolbar is installed and visible in your PS Suite, please refer to: "Download and Install the Ocean Custom Form and Toolbar" and "Create a Reminder Trigger for the Ocean Toolbar".

To learn more about the limitations of the TELUS API, please refer to: "Limitations of the New TELUS API and Workarounds Using the Ocean Toolbar".

Troubleshooting

If you see an Ocean Temporary Note that doesn't immediately (or nearly immediately) disappear, please check the following:

• Ensure that you have installed the latest version of the Ocean Toolbar.
• Ensure either the Ocean Toolbar (Standard) or Ocean Toolbar (Minimized) is not only installed but also activated (visible) within the current patient's chart (see above for details).
• Confirm that the patient chart is not "checked out" on another computer (e.g. another user or another terminal has made edits to the chart without finishing)
• Try closing and re-opening the patient chart.

If the previous tips do not solve the issue, please copy and paste the entire contents of the Ocean Temporary Note and send it to our support team (after you have selectively removed any personal health information).

CognisantMD's Clinical Resource Library resources are designed for use with TELUS PS Suite EMR (PS Suite), unless specified otherwise.

A few small steps are required to import them into your EMR system:

1. First, find the resource you like, click on the form name to see the expanded form details, and click Download.
2. A pop-up window will open requiring you to sign in to your Ocean account.
3. The download will start once you are logged in. Wait for the download to finish and then check the name of the file.
4. The extension of the file (the part of the file name that comes after the ‘.’) determines the type of PSS resource.
5. Open PS Suite EMR and navigate the main EMR window.
6. Follow the instructions below to upload the resource in PSS.

Select the extension the resource file ends with:

To load forms into Ocean using the Ocean custom form, a user needs to be able to access the patient's chart with permissions to at least see and enter their own notes (because the Ocean custom form is technically a note in PS Suite).

Most roles have these privileges by default. However, some sites may have restricted their receptionist and data entry clerk role permissions.

To use Ocean, these users need to at least have their "View Privileges" set to "Only Profile, Own Notes and Messages" (to be able to view the Ocean toolbar, Ocean-generated notes, and messages) and their "Action Privileges" set to "Notes" (to be able to edit Ocean notes).

Note: This is only applicable for PS Suite users who are not connected to the TELUS National API. (For those users who are on the API, the initials will match the initials of the user linked to your Ocean Connect or Cloud Connect account, which is typically "OCN")

PS Suite will use the current user's initials with a "/OCN" suffix. For example, if receptionist Bob adds the Ocean custom form, and social worker Sally Smith opens the chart after the patient is done, the note will be added with the initials "SS/OCN".

There is an option in the PS Suite Ocean custom form "Advanced" settings to disable automatic note downloads for online questionnaires. In this case, the above rule would still apply, but now, a user can open the chart without triggering the download for online questionnaires. The user who clicks "Download" will have their initials attached to the note.

PS Suite automatically detects and records vitals typed within free-text chart notes. There are standard vitals and you can also create your own custom vitals. All vitals can be searched, queried in a reminder, graphed, embedded within flowsheets, and/or extracted for research/quality improvement purposes.

Built-in, standard vital tags include: BP, HR, T, Ht, Wt, HC, BMI.

To make a custom vital, put an @ symbol in front of a tag and use the same answer format for that tag. PSS will log anything in this format as a custom vital. For example, @MyCustomVital: OneWordResult. Be careful to watch out for spaces!

• Capturing eForm Answers as a Custom Vital

  • In order to ensure that your value is captured in PS Suite as a custom vital, simply format the clinical note associated with the question you want to track in custom vital format.
  • 
  • Note: If only "@MyCustomVital" is appears in the clinical note, it won't be logged as a custom vital. You can still search for this text within the chart, but it may be more useful to invent a simple value to place after a vital, such as: @MyCustomVital: Done. Also note that custom vitals can only be a single word - you can't have any spaces in the value.

As part of the email consent process, we have developed a way to easily view email consent status in the patient record in the EMR. The email consent toolbar for TELUS PS Suite allows physicians to see at a glance if a patient has provided email consent. When used with the 'Email Consent Long Form ' Ocean eForm, the patient status is automatically updated as soon as the patient provides consent. The toolbar can also be used to manually track email consent in PS Suite independent (by selecting the "Grant" or "Deny" options).

You can view a screenshot of the toolbar below. The full toolbar can be downloaded from our Clinical Resource Library and installed into your PS Suite by following the instructions outlined in "Ocean Clinical Resource Installation Instructions". To have the toolbar automatically appear in patient charts, you can create a Reminder Trigger in PS Suite - simply select the Email Consent Toolbar rather than the Ocean Toolbar when choosing the custom form to be triggered.

If a specific user has "Data Entries Require Review" selected in their PS Suite user settings, any notes they write will get blue barred and assigned to their supervising doctor for review. This would include Ocean notes, if that user happens to be the first one to enter a patient chart when an Ocean note is ready to download. As the user's initials are getting tied to the downloaded Ocean note, the note gets blue barred and sent to their supervising doctor for review.

Follow the steps below to prevent these blue-barred notes from downloading when a user with this "needs review" setting enters a patient chart.

If you are downloading clinical tools (e.g. PS Suite Custom Forms) from the CognisantMD Clinical Resource Library and they arrive on your desktop as .zip files, this is due to a quirk in the way certain versions of Internet Explorer download .cfm files.

It's easy to work around this issue:

• You can import the files into PS Suite as-is (they will work fine, even as .zip files), or
• You can rename the file to have a .cfm as the suffix of the file name, instead of .zip.

After a patient completes an Ocean eForm, the resultant clinical note should auto-populate into their chart in PS Suite.

If you find that the notes are not auto-downloading into the patient's chart, you may need to enable the auto-download settings in your Ocean custom form by following the steps below.

There are several options for automatically queuing eForms from PS Suite.

Ocean "Add Form" and "Add Favourite" Custom Forms

Search in our Clinical Resource Library to download and install the following custom forms in PS Suite:

Ocean - Add Form - phq9|gad7

this form can queue a list of individual eForms

Ocean - Add Favourite - PHE

this form will queue an Ocean favourite

To learn how to install a custom form in PS Suite once it's been downloaded, please refer to our Ocean Clinical Resource Installation Instructions.

Once imported, you can insert these custom forms into a patient's chart in PS Suite, which will instantly insert the Ocean custom form and queue the corresponding eForms or favourites and then automatically remove itself from the chart.

Configuring the Custom Form to Add Specific eForms

If you would like to configure the "Ocean - Add Form" custom form to add specific eForms, simply rename it and add the eForm references ("refs") to the name at the end. eForm refs can be found in the eForm's URL when previewing it.

Example

For example, the eForm URL for the PHQ-9 is: https://ocean.cognisantmd.com/questionnaires/preview/QuestionnairePreview.html?ref=phq9; therefore, its eForm ref is "phq9". So, if you wanted to automatically add the PHQ-9, change the form's name to "Ocean - Add Form - phq9". If you'd like to add more than one form, use the pipe ("|") character to separate the multiple eForm references.

If you want to add one of your favourite eForms, called "My Favourite", change the "Ocean - Add Favourite - PHE" form to "Ocean - Add Favourite - My Favourite".

Adding Ocean Forms from Encounter Assistants

If you would like to be able to add these forms automatically from an Encounter Assistant (EA), add an 'Action' item to the EA to "Insert Form", and point it to your custom form configured above.

Our Clinical Resource Library contains several downloadable clinical resources, including custom forms.

Once you've downloaded and imported your desired custom form(s) into PS Suite, you can start using them for any of your patients.

Follow the steps below to insert a custom form into a patient's chart.

1. Insert the Ocean custom form into a test patient chart.

   • Open a patient chart (preferably a "dummy" or test chart, or an empty chart).
   • Insert the Ocean custom form into the chart by clicking the Ocean logo on the Ocean toolbar.
   • 
   • The custom form should open in a pop-up window. Check to ensure that you are running a current version (look for v.3.86 or later).

2. Test out an Ocean feature.

   • On the Ocean custom form, you should see a bold three or four-digit code (e.g. 855). This number is a temporary access code to access the patient in Ocean.
   • Now that the patient is in Ocean, you can perform a number of different actions:
     1. Add Ocean forms for the patient to complete.
     2. Enter the numeric code on an Ocean tablet to retrieve this patient.
     3. Click "Email Patient" to send this patient an email invitation to complete a questionnaire securely from home.
     4. View health services in the patient's region and/or send an eReferral by selecting "Find Health Service".