Ocean Server Release Notes

The Ocean release scheduled for tonight at 9:00 includes the following:

• A dedicated registration page for new Accuro clients (in partnership with QHR)
• Look-and-feel changes throughout, particularly for new user signup
• Default font size changed to 14 for better adherence to accessibility guidelines (note that you can always shrink the text via "zoom out" on your browser)

On June 3rd at 10:30PM ET we released a patch to address a few urgent issues:

- The May 31st Ocean release had a regression bug that prevented new Ocean sites from saving web questionnaire/secure message templates, and prevented any Ocean site from updating their default template. This has been resolved.

- Another regression bug from the May 31st release: older versions of the PSS Ocean custom form could not longer import Ocean eRequests. This has been resolved.

(Note: another minor patch was applied June 5th at 10:30PM to address a secondary aspect of the first issue missed in the first patch.)

The Ocean Server release scheduled for May 31, 2016 at 9:30PM contains the following changes:

• The eForm Editor got a makeover to make confusing functions simpler: the form properties dialog has been reorganized, JavaScript now has some handy "autocomplete" logic and it's now easier to create diagrams and empty lines. We also merged the "section" tab items into the other tabs to simplify note formatting (particularly how notes are separated).
• Users sending web questionnaires will now be warned if they update a template with a different list of forms from the original template (it was easy to mess up templates with different forms if you weren't careful previously)
• Fixed tablet settings favourite layout tile "remove" button
• Added check to ensure that date fields (like birth date) can only be used for date pickers in an eForm to avoid date formatting messiness.
• EULA updated with clause for QHR Accuro support escalation process.
• Added a warning in tablet rules editor if you are referring to a form memory variable for a form without it enabled.
• The system will no longer allow eReferrals without a health service (to simplify things for wait time analytics)
• Added a safety check to ensure that old TELUS PSS custom forms won't download an eRequest note (could happen if patient object was removed from server and Ocean reference was reused for an imported eRequest).
• Fix to French translation of "proceed" button in secure messaging module.
• Fix to bug that would sometimes prevent importing a linked set of eForms into an Ocean site.
• More stylistic improvements throughout app.

The Ocean Server release scheduled for tonight (May 10) at 9:30PM ET includes the following improvements.

General:

• New tablet rules are now inserted before the "on-demand" form break, which provides better legacy tablet support (since older versions of the tablet simply ignore all the rules after the on-demand form break).
• The system will now send out nagging alerts for studies that have had recent updates to the associated eForm. This is to prevent accidentally "breaking" a study form (e.g. a bad script in the form or something like that) without notice. To reset the "alarm", you simply need to export the study data to indicate that you've tested the change.
• Fixed a bug that occasionally would cause the "remove eForm" function to fail for a patient record in the Ocean web portal.
• WebQ template eForms now get inserted before any other forms in the patient's form queue instead of after. This is a more natural approach and it allows clinics to use the template eForms as introductions or informed consent forms for clinician-chosen forms.
• Lots more look-and-feel improvements.

Referrals:

• You can now search the archived referral database for all previous referrals for a patient
• You can now export referral analytics data for your Ocean site, including wait times and other metrics.
• The default has been changed to include the patient's email address from the referrer's EMR. (The referrer is warned about collecting informed email consent anyway prior to sending.)
• The "export referral" feature has been cleaned up to produce a nicer looking export (particularly with respect to CC'ed clinicians).
• Some fixes around central intake referral forwarding functionality (e.g. email notifications to referral recipients).
• Fixed a bug that caused an error exporting referrals with self-referrals included.

The Ocean release for April 27 at 9:00pm ET contains the following:

• The EForm Editor will now track the history of changes to an eForm, and allow you to revert to any version in the past. (We have a complete history from the beginning of time in the audit logs, but this is not end-user accessible.)
• We improved the presentation of overridden forms in the eForm Browser. Now the "blue" forms are shown once, and the overridden "black" form is hidden. A nice icon helps cue the user that the form is a customized global form.
• It's now more intuitive to enable form memory for a form via the form properties dialog (a new drop-down menu instead of a simple trigger expression)
• You can now see users that have pending invitations to join a site (previously, these would disappear when you went back to the admin tab, even though the invitations were still valid).
• Clinics can now accept eRequests from patients without accepting eReferrals from other clinicians (previously those were tied together).
• We added a feature to easily export a referral for copy-paste into non-integrated EMRs.
• Anonymous kiosk mode will now properly set the first and last name in the patients tab if the patient completes fields with associated EMR field mappings
• You can now set up tablet rules that fire before and/or after the forms manually chosen for a patient.
• Fixed a bug that occurred when completing a hybrid form in online mode.
• New users now require valid emails upon signup.
• EFormActions fired in web questionnaires will now appear next in the queue as opposed to the end of the form queue (brings consistency with a similar change made to the Ocean Tablet a few months ago).
• Fixed a bug that caused status icons to disappear sometimes in the patients tab.
• Accuro Ocean encounter notes are now separated for each form completed online.
• Added new health services for diabetes education and spinal surgery.
• Minor look-and-feel styling improvements throughout.

The Ocean server release scheduled for April 12th at 9:00 PM ET includes the following changes:

Patient Engagement:

• Adds the ability to show OceanConnect installation status and provide remote update functionality for tablets running OceanConnect
• New users must now validate their email accounts before logging in
• Fixed a bug that would fail to import secure patient message 'read receipt' into the EMR in some cases.
• Fix to prompt user to update Ocean Online Web Questionnaire templates when secure message changes (e.g. to make it easier to update secure message templates for common things like negative lab results)
• Fix to set user's full name to referral comment notifications for anonymous EMR users
• Fixed height of eForm Browser for sites with many favourites
• Fixed a bug that would sometimes cause a new eForm addition to a favourite to be added to the wrong favourite
• Fixed a problem that caused user table in site admin tab to render improperly after certain actions
• WebQ subject lines now include brackets around 'send date' to make it a little more sensible to patients
• You can now use any form as a completion form in the tablet settings dialog (not just study forms)

eReferrals:

• You can now refer patients for a health service from the patients tab via "Find Health Service"
• Health service providers can now redirect referrals to a central intake organization
• Central intake organizations can forward referrals to another referral destination
• Fixed bug in new user signup page in midst of referral target claim
• 'Refugee care' is now a health service in the directory
• Referrals now automatically insert referral follow-up forms in PSS automatically to gain many of the benefits of quick referral forms

The Ocean server release scheduled for 9PM tonight includes the following changes:

New Features

• EForm Editor will now (finally!) provide auto-complete suggestions for adding eForms when adding eFormActions, so you no longer need to figure out the eForm references.
• Tablet language support is now at the tablet group level, so you can have different tablet groups with different languages. Particularly useful for clinics running refugee clinics.
• More minor look-and-feel improvements, including some UI architecture changes to make the web portal more mobile friendly.
• Support for additional smoking risk factor fields cigar and pipe (currently implemented in PS Suite only).

Bug Fixes

• Fix to eForm Editor bug that would hide formula fields with null captions and no explicit showIf expression from the editor display (you could see this with the falls prevention screen fall risk score).
• Fixed bug that prevented users from creating new sites if they were not a site administrator for their previous site.
• Fix to Accuro Day Sheet view to refresh provider drop-down based on displayed appointments.

The St. Patrick's Day release of Ocean, scheduled for March 17 at 9:00PM ET, includes the following features:

General & Patient Engagement

• Added support to online questionnaires (i.e. launched from the EMR) to choose between the patient's language and the default (generally English)
• Continued improvements to the application look-and-feel, including a newly designed signup page.
• Minor improvements to UI to improve loading speeds.
• "Generate Invoice" function has been moved to the site "Admin" page, as we continue to make the billing a bit more intuitive. Now if you want to see the account balance for your site, you can simply click this button.
• OceanPlus status is now a checkbox on the users tab in the site "Admin" page, making it easier (actually possible) for a site administrator to see and control OceanPlus subscription status for users. You can only toggle OceanPlus subscription status for a user from the user's default site. 
• Added support for searching for doctors with or without middle name in the search string.
• Fixed a bug that would display study forms with the same ref as an enrolled study for a site in the eForm browser (even though those study forms were unrelated and not used within that site)
• Server-side support for additional smoking risk factor fields in PSS such as cigar and pipe smoking.

EReferrals

• Ocean Health Service directory is now mobile friendly! Clinicians can now search for health services using a smartphone.
• Server-side support for preventing duplicate Ocean Study submissions from tablets (note that you need Ocean Tablet v118 or higher as well).
• "OK" button on eReferral review panel in inbox is hidden if "reviewed" is an option.
• Added sex to the eReferral display panel.
• Fix to bug that would freeze the browser if the shared encryption key was required during send.
• Add support for Alberta terminology (PCN, professional ID) for referring physicians.

EMR Integration Work

• Fix to Accuro Day Sheet to eliminate duplicate providers in drop-down menu.
• Fix to searching for Accuro patients by HN/PHN from Patients tab.
• Added code to display OceanConnect installation status on the Tablets tab so you can see which of your tablets have it installed.
• Online support for new PS Suite "preferred contact" field.
• Early (incomplete) support for marking patients "arrived" in PS Suite.

The Ocean Server release scheduled for 9:00PM ET on Tuesday March 1st includes:

Patient Engagement (Tablets, Ocean Online, eRequests)

• The introduction of the daysheet view (currently supported for Accuro clients). This provides an "at-a-glance" view of a provider's schedule for the day in order to simplify the process of adding forms and view status. It can be found in the patients tab in the Ocean web portal.
• The Tablets tab will now show more information about registered tablets, including when they were last used, the Ocean version number and the Android version. Note that this data is only submitted by Tablets running v118 or higher (scheduled for March 2, 2016), so you may need to upgrade your tablets to see the new information.
• Added proper support for Arabic and Armenian to the site settings configuration as part of the Cognisant Cause program for Syrian Refugees. You can enable these languages if you are running Ocean Tablet version 118 or higher.
• The patients tab now shows colourful icons instead of text for patient status.
• Changed the wording of the embedded link for an Ocean Online Secure Message (previously it would show "Complete Questionnaire" even if there was no questionnaire but only a message for the patient).
• A fix to order of column headers in the form completion audit report
• A fix to an occasional web portal redirect problem that can result in a blank page appearing.
• A fix to a problem that would sometimes use a previous session locale/language when previewing or completing an eForm online.
• We've added logic to prevent the redundant import of Study eForms, and, conversely, prevent acceptance of a Study invitation if the same form has already been imported. Study forms are automatically available to participating sites.
• Fixed a bug that prevented Ocean Tablets from rendering the appropriate "translated image" (e.g. for images that had text in them, e.g. Nipissing instruction pages) in an eForm in a different locale.
• New validators in eForms have a more sensible default for "allow empty".

EReferrals

• Secure messaging log between GP and specialist will now appear in printed receipt of referral for referral recipients. We've also improved the layout of the printed referral receipts.
• Appointments can now be booked in either 24h or 12h time, and the system will show the "other" time format to reduce likelihood of error. Also fixed a timezone bug that made it hard to clear booking times if you were not in ET.
• A few new "canned" booking comments are available.
• Fixed a bug that would cause map markers to be left in place after the search changed.

The Ocean Server upgrade scheduled for 9:00 on February 24th includes the following changes:

• Added explanation/warning when increasing the number of Ocean reference digits for a site (i.e. you can "left zero pad" existing chart Ocean references)
• Minor fix to referral deletion in case where changes are pending
• Accuro: now appointment times and providers are uploaded from OceanConnect for upcoming "day sheet" feature for quick form adding to patients.
• Some changes to billing logic for eReferrals to align with new published pricing.
• A number of email notifications have been updated slightly to cleanup login links to Ocean.
• A minor fix to session management in Ocean for users with access to multiple sites.

The Ocean release scheduled for Feb 17 at 9:00 includes the following fixes and enhancements:

EForm Editor

• Improvements to validation configuration user interface to make it more intuitive to add validation to an item. We've also (finally) exposed the ability to set a custom validation error message, which has been long supported in the XML eForm definition but not available in the editor.
• Study export preview table now omits columns that are never actually exported as part of CSV exports, e.g. columns for labels, pictures, etc.

Ocean Online

• Made it easier to work with Ocean Online templates. You will now be prompted to save changes to secure message and web questionnaire templates after making a change.
• Now skips the validation screen for the patient if there are no validation fields selected in the invitation.

OSCAR Integration:

• Added integration code support for measurement mapping from Ocean eForm notation (@myVital) to an OSCAR measurement defined in a flowsheet.

Ocean eReferrals

• The "region" field has been removed in favour of a single address box.
• Tweaks to zoom logic in the map.
• Minor fixes to new advanced search feature in OceanHealthLinks.ca (wait times, etc.) 
• Clicking through to a referral from a notification email to a GP will present the main login page instead of the pop-up login dialog.
• Fixed bug that caused referral event logs were display cancellations and received events twice.
• Fixed referral initialization bug for successive referrals.
• Fix to timezone bug that could result in birth dates in referrals being off by one day.

Other

• Site page loading performance improvements.
• Email notifications will be sent for sites with >60% possible patients given number of reference digits. This will allow sites to bump the number of digits before Ocean starts to run out. We will also prevent file uploads that would put a site past 60% of capacity. (Adding more digits can be done in the admin tab any time.)
• Minor fix to edge case of symmetric encryption key handling in browser when browser's key does not match site footprint key
• More aesthetic improvements
• Fix to study site invitation form preview link
• Some performance improvements to account billing calculations (sites with many coupons were waiting 5-10 seconds in some cases to see credit balances in the admin page). It will be much faster now.
• Fix to clean up minor bugs with site switching for users with access to multiple sites
• Notification email field in the admin tab now support multiple email addresses

The Ocean server release scheduled for 9:30 on Feb 2 contains the following:

General

• The Ocean Platform now supports cross-EMR measurement updates via a new mapping framework. You can, for example, map a standard phq9 score in the Ocean form to your own "PHQ-9" measurement. Our current reference implementation is for OSCAR (PS Suite already benefits from this feature) and we'll be working to provide similar support for other EMRs in the near future.
• Secure messaging is no longer in beta. We've added support for viewing date/time of patient's view of message in the EMR chart and fixed a bug that could cause older messages to be re-displayed in certain cases.
• More look-and-feel changes to reflect our new UI theme.
• Fix to a bug that occasionally triggered sign-in dialog for anonymous clinicians during quick referrals.
• Fix to bug that affected new sites relating to the primary encryption key not being set on initial load.
• Users can now create new sites from the "view my account" page. This should make life easier for our partners (like QIDSS people, ecosystem partners, etc.) since they can create sites for other people without having to sign up a separate user account.

Directory, eRequests and eReferrals

• Support for search/display of wait times for specialists and other service providers (previously, the wait times were only visible in the health service detail for a provider)
• Focused-practice designation is not restricted to health services that make sense
• Fix to ConsultConduit interface for new sites
• Adding "close" button next to the "Decline" button in the pending contact state to avoid users accidentally declining eRequests

EForm Editor

• The prepopulate value will now autocomplete keywords (like caption)
• You can now set min/max acuity on approximate durations (this was always available, but hidden from end-users)

Billing

• Coupons are now visible on the site admin page. This will make it simpler for users with access to multiple sites to see available credit in each site.
• Fixes to the new coupon transfer feature
• Added a default expiry of one year for purchased coupon credits (this will be active going forward)
• Bill item report now includes the subsite reference for items if there is one

The Ocean server release scheduled for Jan 26 at 9:30PM includes the following changes.

Overall

• First whack of aesthetic changes to update to our new colours and fonts.
• We've exposed controls for some "hints" for rendering sections that have been supported in the XML eForm format for a while. Now you make sections grey, white and add a border. Great for referral forms and online questionnaires (also works on the tablet).
• Added support for Armenian for our Syrian Refugee Cognisant Cause program.
• Improved the UI for building tablet rules. Creating new rules is more intuitive.

OSCAR Integration

• Added early support for the new OSCAR measurement mapping framework. Next week, we expect to add support for arbitrary collection of OSCAR measurement data points in Ocean forms, e.g. PHQ9 scores, etc.

PS Suite Integration

• More backend support for a next-generation top-secret PS Suite integration project.

Billing Features

• Sites can now view credit coupons applied to their sites via "view my account". For example, if you send us a cheque, you will see a corresponding credit now and you can see the balances. We've also (for the first time) exposed the credit assigned to individual subsites, which should clarify matters for complex billing setups for some clients.
• Sites can now transfer coupons. This is in "beta", but the idea is that clients can purchase a large block of credit as a central authority (a research group, public health group, LHIN, PCN, FHT with multiple sites, etc.) and transfer some credit to individual Ocean sites at a later point. Previously, CognisantMD would administer these arrangements on behalf of large clients but this will empower clients to manage this themselves.

Minor Fixes

• Fixes to handling of primary shared encryption keys for multi-site users.
• Fixed a bug that would sometimes cause failure of prepopulation for initially hidden items in forms (e.g. metformin question in diagnostic imaging referral form).
• Some improvements to file upload error reporting.

The Ocean release scheduled for Jan 19 at 9:00 EST includes the following features and fixes developed over the past two weeks:

eReferrals/eRequests

- New referrals will show up in the inbox automatically (without refresh)

- eReferral emailed notifications to GP will automatically contain the EMR ID again (e.g. patient ID) to make it easier to identify the patient

- Comments added to "new" referrals will trigger same GP notification as done for referrals in "pending contact".

- Weekday added to printed referral receipt

- GPs can now edit and resend cancelled referrals

- Clinics can now pick the timezone to use for patient appointment booked notifications

- Added support for "quick referral form" in PS Suite to add referrals visible in an Ocean site's referral outbox.

Editor

- Minor fix to slider editing to avoid blank labels when label text is cleared (value will appear instead)

- The warning for switching an eForm from a study form will no longer appear on first update to form properties

- Fix to a bug that could cause an item caption to update to match a section caption into which it was dragged

OSCAR Integration

- Removed use of dummy email address in favour of new (March 2015) support in OSCAR for retrieving email via OSCAR keyword

Other

- Now you can export up to 30 days of 'form completion' audit data to analyze raw Ocean usage data beyond what you can do with the usage report. This is available as a new tab under the Admin tab. Note that only most recent 60 days of data is kept online and therefore the audit report is restricted to this date range.

- Adding ability to inspect specific CPP item data in Online forms and web questionnaires (e.g. immunization history)

- Adding ability to display next appointment date/time in WebQs and secure messages

- Fixes an issue in which a patient could have an eFormAction triggered and add a form in an online questionnaire and, after refreshing or otherwise resetting the session, not see the form in queue anymore. It is now posted to the server as well in case of such a disruption.

- Tweak to wording of completion of a web questionnaire: now it will tell the patient very clearly that the answers were submitted successfully.

- Enhancements to beta secure messaging support: now multiple secure messages can be sent to a patient; the messages will be shown in the EMR along with status (e.g. viewed); the patient will be prompted to print the message as it will not be available after session ends.

- Fixes to the handling of encryption keys for users with access to multiple sites with different encryption keys. This will address a confusing situation in which the encryption tab complains that there is no primary encryption key set, but the data is decrypted in the browser (it occurs when the encryption key exists but isn't the primary).

- Fix to bug that prevented deletion of studies

- Fix to patient tab polling logic that would cause flood of requests after network outages

- Fix to colour-picking for favourites layout in tablet settings

- A few more fixes to ensure that eForms are always rendered from the current site when the same form is found in other sites

The Ocean release scheduled for 9:00 on January 5th 2016 contains the following:

Ocean Online features:

- PS Suite users can now use a "next appointment time" keyword to insert the patient's next appointment time in an email, subject line, eForm or a secure message. Note that you'll need the not-yet-release Ocean custom form 3.1 to enable this feature.

- Early server support for batch loading notes from an Ocean Online cohort, e.g. for cancer screening or bulk loading notes into charts. This will be broadly available in an upcoming release.

Improvements to EForm Editing and Management:

- Added logic in EForm Editor to automatically remove invalid non-non-empty mandatory validators (ask us if you really want to understand this one!)

- Added ability to add/update hyperlink items in the EForm Editor (see SMH Health Equity Assessment for an example)

- Performance improvements around loading eForm lists.

- Improvements to the formatting of notes using the new prefix, postfix and delimiter values from the eForms tab. Also added a quick "preview" example note that illustrates the effect of your new configuration.

- Internationalization of a global eForm will no longer (confusingly) complain that the eForm must be saved to the user's site first. This is now automatic.

- You can now export a tab-delimited file of translation strings from the "string translations" dialog in the editor to ease the translation process: you can now simply email the file to a translator.

eRequest/eReferral fixes:

- Added an event log for referrals to show various lifecycle changes for that referral, including the user, timestamp and type of event. This is in addition to the existing auditing and intended to provide a user-friendly snapshot of the state changes for that referral. The log can been viewed from the action menu in the referral and it is also shown on the printed referral.

- For advanced referral management users, the "review" workflow is improved to account for users viewing referrals without actually "reviewing" in a clinical sense. Now the "reviewed" button is gone and the "edit..." button has been replaced by a "review..." button for clarity.

- A number of referral cancellation improvements: email notifications are now sent with a referral is cancelled by the recipient, the referrals now show up in a cancelled tab in the GP's outbox, cancelling a referral now prompts for a reason and cancellations by the sender now properly reset the reviewed flag.

- Added a warning to referral sender (GP) to verify that the patient has granted email consent prior to sending a referral with patient's email address.

- Adding separate tabs for booked and confirmed eRequests for basic eRequest clients, as it existed previously only for advanced referral management clients. This functionality is now available to all clients and will make appointment requests easier to manage.

- Add support for tracking offline notifications of referral status changes in cases that the referring GP has not provided an email address for notification. The user will be prompted for offline notification preference, which is logged as part of the new event log. The system will also offer to generate a report that can be faxed to the CP.

- New health service definition for memory clinics.

- Referral printouts time display is fixed.

General/minor bug fixes:

- Fix to bug that caused forms to be added twice to a favourite.

- Fix to bug that could cause session timeouts for new user signups and improve the handling of expired EMR single-sign-in tokens.

- Aesthetic fix to eRequest dialog to render more smoothly.

- Added some warnings when you change the data security mode for an eForm in the editor to help prevent study misconfigurations.

- Improvement to tablet authentication and registration logic to improve performance and handle some edge cases with tablets that change mac addresses (Azpen tablets), particularly around potential for duplicate billing (since such tablets appear as different hardware from time to time).

- Previewing and loading forms for a study anonymously (i.e. on a public survey link, where the patient is not identified as part of a particular Ocean site/clinic) will now always show the correct form even if the same form reference exists in multiple sites.

- The "help" button will be hidden in some cases to avoid blocking important buttons in the web portal

The Ocean release scheduled for Dec 8 at 9:30 includes:

• Refactor of eForm tab to support editing of automatic prefixes, postfixes and delimits for Ocean notes, as well as make the screen more intuitive for new users. For example, when you create or edit a favourite, it will now update on the server immediately -- you no longer have to click save explicitly.
• OSCAR integration: fixes issue reporting status for secure messages to patient in the encounter screen. "Invite patient" has also been renamed to "email patient" to imply that you can secure message as well as invite the patient to complete a questionnaire.
• Fix to bug that caused the eForm Editor to lose the coloured selection highlighting of items after a dialog box was opened.
• Added validation to prevent EForm XML files from being uploaded without QUESTIONNAIRE section.
• Some changes to support the new OceanConnect tablet app.
• Tablet minimum version is now 106.
• More support for Syrian Refugee project; you can now hyperlink to an Arabic online questionnaire by adding "&locale=AR" for example.
• Adding ability to lock patients from deletion in the portal's patient tab when patient is encrypted (previously, you could only lock the patient if the data was decrypted)
• Fixes to referral cancellation logic and it will also now notify in cases of cancellation.
• Hid eReferral categories that aren't used for sites that send but do not accept eReferrals (leaving only "sent" and "faxed failed").
• Improved wording in patient eReferral/eRequest notification email subjects
• Fix to internationalization logic to preserve English clinical notes when the caption is used as the default (or more accurately, the default language)

The Ocean release scheduled for 9:30 tonight (Nov 24th) includes the following general features and fixes:

- Keyword support for secure patient messages. Now all the same keywords that are available (and documented on this support site) are available to include in any secure message. For example, you can start your secure message as "Dear @ptPreferredName".

- Tablets that are deactivated automatically due to security reasons (e.g. the tablet tamper-proofing) will maintain their tablet settings group when re-registered. This will make life easier if you are managing lots of tablets across multiple tablet settings groups.

- More robust support for "reusing" patient objects (both in OSCAR and PS Suite) via the archiving of downloaded notes. This work will make the status display more sensible in cases where the patient uses Ocean more than once in a short period of time.

- Renamed button label "Upload New eForm" to "Upload eForm XML" for clarity.

- New button to deauthorize a web browser by clearing the shared encryption keys.

- OSCAR integration: removed unnecessary code relating to a flowsheet used for measurement updates.

In addition, there were a number of minor fixes/improvements in the eRequest/eReferral module:

- Referral recipients can now add private comments to a referral.

- Added new screen to summarize "sent" referrals for GP's records upon completion of referral (for EMRs without Ocean integration).

- Fix to ensure "sent" eReferrals will appear in the appropriate folder.

- Fixed referral cancellation bug.

- Referral comments now include the date and time in the display.

- Better error handling for Consult Conduit interface in Ocean Health Service Directory.

- Eliminating need to sign-in to print referral from quick referral form.

- Better support for multiple referrals for a single patient (service description is provided in EMR message).

- Support for midnight appointments (previously, you could not book an appointment at midnight due to the date/time control).

This release, planned for 9:30 EST tonight, will include the following:

- Fix to PS Suite batch file importer to fix an issue related to Internet Explorer

- Minor improvements and fixes to the new secure messaging module. Now the "notify me when patient views" checkbox only appears if the current user is a Ocean user. Multiple messages to the same patient are now handled properly. Also fixed an issue that meant that bulk sent secure messages weren't properly flagged as viewed.

- Fixed a bug that caused the patient removal warning report email to be overly inclusive, including patients not scheduled for deletion for much longer than a week.

- Added an in-memory cache to improve authentication time for EMRs checking patient statuses. This should remove a processing bottleneck that caused a service interruption on November 16th.

- Added validation to eForm XML upload to prevent invalid validators from being created.

- Update to OSCAR integration to allow non-SSL OSCAR servers (not recommended though; Ocean connection will be via SSL in any case).

- Fixed bug that caused incorrect encryption key to be used for EFormAction-linked Study eForms.

The Ocean release for Nov 10th includes the following features and fixes.

• BETA RELEASE OF SECURE MESSAGING: Ocean now supports secure messaging to patients. We've added functionality to allow a web questionnaire to contain a secure, private message for a patient. The patient chart will show both the message and a confirmation that the patient received it.
• We've removed the dedicated medication reconciliation module on the Ocean Tablet in favour of the more flexible medication reconciliation eForm, which has been updated to work as an emailed web questionnaire as well as a tablet eForm.
• We've added early support for "anonymous survey" mode for tablets, a third mode of using Ocean Tablets to support even more ways to use your tablets. Clinics will find this mode particularly useful for dedicated patient experience survey kiosks. This replaces the keypad entry screen with a simple "start" button and language picker. You'll need to yet-to-be released v110 of Ocean Tablet in order to leverage this new mode. As part of this change, the "kiosk mode" checkbox, which was previously hard to find in the tablet settings, has been replace by a drop-down menu featured prominently above the tablet settings tabs when you edit tablet settings.
• We've added Italian and Chinese Simplified support for web questionnaires (you will likely need to translate specific forms before this is useful but the core product has been translated).
• Added a warning message to the Ocean web portal if a user is using (the ancient and MS unsupported) IE8.

This release marks a return to our regular major release schedule. It contains more than the normal number of enhancements and fixes because it's been a few weeks since a full release.

Ocean core changes:

- Bumping minimum acceptable Ocean Tablet version to 102.

- Formulas in Online eForms will now calculation on initial render, which will fix edge cases around showing and hide sections or items on load based on a formula value.

- Newline characters within a keyword in an eForm will now prevent keyword matching.

- Web Questionnaire health number validation will now strip dashes and spaces from health number entered by patient prior to validation.

- Fix to phone number validation in Ocean Online for longer than acceptable phone numbers.

- Server-side support for "tamper-proofing" tablets. An upcoming tablet release (109) will allow you to snapshot the current configuration of a tablet upon registration and automatically deregister tablets that have had new or different software installed on them.

- Patient removal warning emails now contain the modification date of the patients.

- Miscellaneous styling/aesthetic fixes, including notably making the eRequest forms much narrower (since many clinics were simply opening the forms in new tabs/windows and they were stretching quite wide on big monitors).

- Server-side support for maiden name and address line 2 type EMR fields (i.e. demographic fields).

- Adding support for Arabic health questionnaires for the Syrian Refugee Cognisant Cause program.

EMR integration improvements:

- Some server side changes to prepare for upcoming change to allow PS Suite custom form to reuse Ocean patient objects (to bring behaviour inline with OSCAR integration behaviour).

- OSCAR patient upload now hashes health numbers as well so that the tablet can be used in Kiosk mode at OSCAR clinics (bringing parity with TELUS PS Suite and Accuro).

Improvements to the Ocean Health Service Directory and eReferral system:

- Server side changes to allow the PS Suite Quick Referral Form to resend referrals, enable 2-way messaging notifications via email, send secure attachments and summarize all messages about the referral as a progress note when the referral appointment is complete. It will also capture the Ocean referral ID in the progress note for audit purposes.

- Fixes to eReferral/eRequest export. We've also changed the behaviour to only export the eReferrals and eRequests that are visible according to the current inbox filter. If you wish to export all as per current behaviour, just choose "all" from the filter first.

- Printed referral receipt now shows the sending physician, reviewer (at referral site) and sender Ocean site name.

- Added hospitalist specialty as a health service in the Ocean Health Service Directory.

Performance fixes that came out of the instrumentation and analysis of the recent outage:

- Performance improvement in the Ocean Online form rendering (likely only noticeable on longer eForms).

- Removed the credit display when sending a web questionnaire. This simple display of available credits (which was nice) involved complex billing and caused a material load on the server every time a web questionnaire was sent. We are eliminating it for now. 

- Default radius for Ocean Directory search dropped to 5km to reduce load on server in default scenario. The radius will be saved as a cookie for convenience.

We are doing another small patch tonight:

- Bumps the minimum acceptable tablet version to 99; clients running older versions of the tablet will be forced to upgrade. This is a "part-way" measure since the version scheduled for our standard Tuesday night release bumps the minimum to 102. We are trying to stagger the number of upgraded clinics.

- Increases the number of days that patients are held in Ocean without any forms in queue (and no un-downloaded notes) to 7. This is intended to support sites that are batching up loads of patients for the tablet "kiosk mode" at the beginning of the week and allowing the tablet rules engine to drive the encounter.

We are again forgoing the normal release this week in favour of another patch to further isolate the issues relating to the outage. This patch allows us to measure and capture the server response times to client "RPC" calls and adds operational alerting for calls that exceed a threshold.

This patch was released tonight to address a couple of issues found during the recovery of recent outages:

- corrected a bottleneck in the authentication of tablets and EMR modules that caused such requests to be serialized; this meant additional slowness after a server restart and possibly timeouts as tablets and EMRs tried to reconnect

- changed the scheduled job timing to prevent the patient removal job from running immediately upon startup

This week, we elected to release a patch release to address two bugs:

- Changing OSCAR smoking status update to use the intake form instead of measurements to workaround a bug in the OSCAR measurement entry code (related to allowed values)

- Patient-facing eRequests were not resolving site-specific forms if the form ref matched a global form

Next week, we'll be back to the full release schedule.

This week's release includes the following:

- tablets will be forced to update to version 97 or higher (part of our longstanding efforts to keep people from being on *really* old tablet versions)

- eRequest editing keyboard shortcuts are now available for quicker processing of eReferrals and eRequests

- eRequest management screen now shows eRequests received across all listings (referral targets) in single view, making it easier for central intake to process eRequests/referrals for multiple sites/doctors.

- users can no longer send messages in an eRequest if the sender has not provided an email address and recipient is more obvious in the appointment scheduling panel

- claiming a Directory listing is simpler if you are already logged in; it simply claims the listing for your site

- "needs review" flag re-added to the eRequest management page

- fix to bug that sometimes prevented upload/encryption of file in an eReferral

- fix to diagram scaling in Ocean Online questionnaires (sometimes checkboxes would not line up properly)

- set a default line separator of newline ('/n') for new eForms; this will make notes more intuitive (you can override the note separator with commas or semi-colons at a lower level in the section hierarchy if desired)

- fixed an issue that caused eRequest numbers to be underreported in usage report; reported numbers will be correct in future usage reports for new eRequests

- miscellaneous minor aesthetic fixes to online questionnaires, directory, etc.

Due to a very busy conference schedule, instead of a full release, we released four isolated bug fixes last night:

- Adding back the MRN field to the referral dialog (was hidden accidentally as part of Advanced Referral Management changes last week)

- Fixed a bug relating to appointment confirmation via quick referral form due to security constraint

- Fixed an issue opening Ocean forms from Telus PS Suite, in which session is shown to have timed out for browsers that have not been authenticated with the encryption key

- OSCAR smoking risk factor update fix: removing cigs/day mapping to "SmkS"

We'll return to a full release cycle next week.

In this release, we excited to announce that Ocean sites may now claim multiple directory listings in Ocean Health Links ("referral targets") instead of just one. This represents a fairly major architectural change although it should be transparent for clients using eRequests today.

If an Ocean site claims a second referral target, a drop-down menu will appear in various places in the Ocean portal to choose the referral target. For example, in the eRequest inbox, you can choose the appropriate referral target to review referrals. In the listings panel, you can choose the listing to update.

This change will be particularly useful for two groups. Firstly, clinics that are chains can now have all referrals received in a single site irrespective of the map listing through which they were sent by the GP. Secondly, individual specialists that are listed in the directory can have their referrals sent through a central booking site (such as a department in a hospital). In both cases, the main advantage is that clinicians can take advantage EMR integration with their primary site.

Other changes in this release:

• We've rearranged the admin tab to be more intuitive by breaking up the security tab into a dedicated "user" tab and a dedicated "encryption" tab.
• It's now easier to activate eReferrals/eRequests from the admin tab
• Usage report now includes eRequests (although note that this will only show eRequests received after the release, so the numbers will seem low initially for existing eRequest clients)
• Fix to OSCAR to avoid network timing issue that would sometimes cause loading problems for the encounter screen
• Re-adding the old PS Suite file importer as "legacy" importer for backwards compatibility
• Improving phone number validation rules in Ocean Online & eRequests (now more phone formats are allowed)

This week's release contains the following changes:

• Family doctors can now receive consult reports from physiotherapists and other allied health professionals via the Ocean Directory
• Removed white background to eRequest pages, allowing for more integration flexibility in websites
• Fixes to PS Suite file uploader so that you can simply import a file from PS Suite search export (to CSV) without removing columns, reformatting dates, etc. Note that the old file format will not be supported.

Some minor fixes as well:

• A few minor fixes to online questionnaire formatting, including fixing font-size changes associated with <b> and <i> tag usage, incorrect scaling for images when rendered on smartphones, centering Ocean logo and loading icons
• Fixed prescription shorthand translation logic (e.g. qid -> 'four times daily'), used in forms such as the medication reconciliation form
• Revising medication reconciliation eForm to hide warning message on current tablet versions now (now warning will only show up on old tablet versions)
• Restricting "edit..." clinical triage button on eRequest to be limited to Advanced Referral Management module (as originally)
• Some billing enhancements to support site-wide OceanPlus licenses
• Fixed EForm Editor XML generation for forms containing diagrams
• Fixed EForm Editor to protect against saving a new eForm into a different site if both sites are open in tabs; now it will only save into the originating site
• Minor enhancements to progress note formatting to make note separation a little easier (sections will inherit parent note separators)
• Fixes to sign-on logic to ConsultConduit

Features and bug fixes scheduled for tonight's release:

• eRequests: fixed the criteria so that the "send" folder doesn't include patient generated eRequests
• eRequests: adding support for ConsultConduit eConsults in the Ocean directory as demonstrated at eHealth 2015 conference
• eRequests: added warning for GPs referring to non-validated referral targets
• eForm Editor: fixed bug clearing rememberIf, rememberTag fields
• OSCAR integration: now Ocean will update the patient object when the OSCAR eForm is opened for a patient already loaded into Ocean
• Minor cleanup of code around tablet settings dialog in the web portal
• Fixes for some edge case rendering of numeric scales in Ocean Online
• Fixed eFormAction "send email"; now an eForm can send an email to a patient automatically
• "Invite Cohort" is now labelled "Email Cohort" in the patients tab for clarity (since you can use it to blast emails to patients as well as web questionnaires)

Some interesting eForm content this week:

• Dictation Assistant: we built an Ocean form to help docs using Dragon Dictate, which doesn't work nicely with Java-based EMRs. This Ocean eForm allows you to dictate into an Ocean form (in a web browser) instead of the Java app, and the notes will go into the chart like any other Ocean note.
• Some improvements to cancer and other screening forms to use custom vitals to help in reminder/search logic for preventative screening programs
• Additional pain tools and exercise assessment tool (IPAQ)

Features and bug fixes scheduled for tonight's release:

• Now you can filter eRequests in the inbox by eRequest link (e.g. so you can view new patient registrations without the prescription renewals or appointment requests/cancellations)
• Conversation/Messaging panel in eRequest dialog will be hidden for patient-generated eRequests for the time being (it will still appear for GP referrals for messaging with the GP). We intend to reintroduce this panel for emailing directly with patients from the referral dialog.
• Fix to eFormAction dialog box in the EForm Editor to avoid phantom eFormActions from being created (this was causing some "email send" eFormActions to be saved unintentionally)
• Fixes to query that drives the usage reports, which have been failing intermittently due to data volume on the system
• Fixing error handling and simplifying deployment for new OSCAR Ocean integrations (including automatic validation of encryption key, similar to the TELUS PSS integration)
• Adding stroke care and neurorehabilitation as separate health services in the Ocean eReferral Directory
• Minor fix to geocoding logic for the Ocean eReferral Directory
• Small change to the way the fee warning on the Ocean Online form completion to further clarify pricing options
• Sending Web Questionnaires now shows you the number of credits remaining (this was broken a few weeks ago)
• Minor fixes to Accuro integration, e.g. fixing Ocean logo display
• Fixed drag-and-drop issue for favourites configuration on tablet