Introducing Ocean Cloud Connect

At CognisantMD, we've been working hard over the past year to build our next generation EMR integration platform. We call it "Ocean Cloud Connect", and it replaces the OceanConnect tablet app that's in widespread use today. Cloud Connect migrates the same EMR integration modules (currently available for TELUS and QHR Accuro) to a cloud-based server.

Benefits of Migrating to Cloud Connect

We built Cloud Connect to address a number of issues that made it difficult to manage the increasingly large number of OceanConnect tablets providing this data bridge between EMRs and Ocean, including:

Reliability: Previously, the data bridge could only be as reliable as the underlying tablet hardware with OceanConnect tablet. So, if the clinic Wi-Fi or power was interrupted, the entire data bridge would go down. Also, Cloud Connect is much easier to monitor with our automated monitoring tools and allows us to troubleshoot EMR connectivity without remote access to a clinic tablet.

Cost: Cloud Connect eliminates the need to have a dedicated tablet for EMR connectivity. This is not a huge deal if your clinic has 10 tablets, but some clinics want to use Ocean only for referrals or Ocean Online and wouldn't normally purchase any tablets.

Speed: Cloud Connect eliminates "round trip" data flows to the clinic so it's many times faster -- where it could take 30-60 seconds to mark a patient as arrived via OceanConnect tablet (due to network latency), it's usually less than a second via Cloud Connect.

Functional Overview

From a functional perspective, there are more similarities than differences between OceanConnect and Cloud Connect:

  • Both hold EMR authentication tokens.
  • Both hold your clinic's encryption key so that PHI can be encrypted and decrypted, as needed, to bridge between Ocean and your EMR.
  • Both store EMR-specific preferences to allow you to tweak the way Ocean updates your EMR (e.g. combining progress notes from multiple Ocean eForms, selecting specific providers' appointments to sync, etc.).
  • Fundamentally, both play the role of a data bridge connection between Ocean and your EMR.

The main difference is the data flow changes:

  • Since the OceanConnect tablet app resided on your clinic's Wi-Fi network, it would live behind your firewall/router. As a result, OceanConnect would need to poll the Ocean server every 30 seconds for messages to be sent to your EMR (such as "add note to patient 123" or "mark patient 456 as arrived"), download those messages, handle them (e.g. download the update or mark the patient as arrived via the EMR API), and then acknowledge processing with Ocean.
  • Cloud Connect, in contrast, runs on a separate server maintained by CognisantMD. It receives these EMR-bound messages in real-time. This means that these messages are handled and processed as part of the initial action. We've also implemented a robust "message bus" in the Ocean server so that EMR actions can be retried in the event of an EMR connectivity issue.

Privacy/Security Impact

The Cloud Connect server is based in our Montreal data centre, but on a completely separate server from the main Ocean application. This separation ensures that clinic encryption keys are kept separate from the encrypted data itself. The communication between these two servers is done via SSL.

The authentication for Cloud Connect uses the Ocean Authentication Service, which validates user credentials during login to Cloud Connect. Access to Cloud Connect is limited to Site Admin users in Ocean.

We've also added the following additional safeguards to protect sensitive data:

  1. All access to Cloud Connect accounts are logged.
  2. Encryption keys are encrypted prior to being saved to the database.
  3. All access to a site's encryption key is captured in the Ocean audit log (via a shared Audit Service). Furthermore, any access to a site's encryption key generates an alert email to the clinic administrator.
  4. EMR access tokens are encrypted prior to being saved to the database.
  5. CognisantMD administrators and support personnel cannot access Cloud Connect accounts for Ocean sites and therefore, still do not have access to clinic encryption keys.

Next Steps

If you are currently running an OceanConnect tablet, you will be invited by the CognisantMD support team to migrate to Cloud Connect in the coming months. If you are interested in migrating to Cloud Connect earlier, please contact our support team directly, at ocean.tips/support.

We will continue to support OceanConnect tablet at least until Dec 31, 2018 (at which point, we hope to have all clinics migrated off of OceanConnect). However, new features, non-critical bug fixes and new EMR integration modules will generally be limited to Cloud Connect.


Setting Up Ocean Cloud Connect

PS Suite Med Access Accuro OSCAR PRO Non-Integrated EMR

About Ocean Cloud Connect

If you use an integrated EMR, Ocean Cloud Connect enables total configuration of your EMR integration from a secure instance in the cloud that is accessible from any internet-connected device. No on-site device acting as a server is needed to keep Ocean and your EMR synchronized and active.

If your EMR does not have an integration with Ocean or you do not use an EMR, Ocean Cloud Connect can still be used to safely store your Ocean Site's Shared Encryption Key. This enables you to take advantage of additional Ocean functionalities, including automatic appointment reminders based on booked eReferral appointment dates.

Prerequisites

PS Suite Med Access Accuro OSCAR Pro Non-Integrated EMR
  • Ensure you have completed Steps 1 through 5 of the TELUS PS Suite Integration Set-Up guide.
  • You must have Site Admin access on your Ocean Site in order to sign into Ocean Cloud Connect.
  • You must have EMR Administrator access in order to update EMR system settings.
  • It is highly recommended that you make use of an Ocean Credential Reference Card to record your relevant integration credentials for organization and safekeeping.

Setting Up Ocean Cloud Connect

  1. Log in to Ocean Cloud Connect.

    • Log in using your existing Ocean user account credentials. This is the same Ocean user account that you use to log in to the Ocean Portal.
    • Note: Despite using the same Ocean user account credentials, you must log in to Cloud Connect seperately. Being signed into the Ocean Portal does not automatically sign you into Cloud Connect (or vice versa).
  2. Store your Shared Encryption Key in Cloud Connect.

    Integrated EMRs (PS Suite, Med Access, Accuro, OSCAR Pro) Non-Integrated EMRs
    • After logging in to Ocean Cloud Connect, click the 'Integrate my EMR' button.
    • You will be prompted to enter your Shared Encryption Key. After entering it, click 'Save and Continue'.
  3. Setup Your EMR Integration.

    • After storing your Shared Encryption Key, select the EMR type you would like to integrate and then click 'Next'.
    PS Suite & Med Access Accuro OSCAR PRO
    • Acquire your EMR Instance ID and EMR Secret credentials by configuring your Ocean integration module.

      See module configuration instructions for PS Suite or instructions for Med Access.

    • Once entered, the Ocean and TELUS servers will connect to authenticate the integration.

Configure your Cloud Connect settings.

PS Suite Med Access Accuro OSCAR PRO
  • From here, you can customize your configuration options. However, in most circumstances the default configuration will be sufficient.

    For more details on configuration options, please refer to Customize your Cloud Connect Configuration.

  • Click the “Save” button to complete the setup process.
    • Note: If your clinic does not accept walk in patients, you can safely ignore the fields under the "Walk In" section of the configuration. For more information about walk ins, please consult our guide: Set Up Ocean to Support Walk-In Patients.

  1. Configuration is complete!

    • You will now return to the main summary screen.
    • The "Sync Status" panel on the left will show you if Ocean is synchronizing appointments with your EMR via Cloud Connect, when the last synchronization occurred, and when the next synchronization is scheduled for (full syncs will automatically occur once a day at midnight and appointment syncs will occur automatically every 30 minutes).
    • Once an initial sync has completed, feel free to verify patients are being uploaded correctly by signing into the Ocean Portal, click the Menu button in the top left corner and click Patients.
    • If there are any errors with the configuration, an alert will be displayed on the main summary screen, in the "Sync Status" panel. If this occurs, try clicking the arrow button next to "Sync Recent Appointments" and select "Sync Full Schedule". If the issue persists, contact the OceanMD Support team.
  2. Ensure that Cloud Connect is enabled in your Ocean Site.

    • Log in to the Ocean Portal using your Ocean user account credentials.
    • Open the 'Menu' in the top left corner and click 'Admin'.
    • From the Admin Settings page, click 'Site Features'.
    • Ensure that the 'Enable Ocean Cloud Connect' checkbox is enabled.

      Note: Ocean Sites with Non-Integrated EMRs will need to manually enable this checkbox. Ocean Sites that have completed an EMR integration will have this checkbox enabled automatically.


Customize your Cloud Connect Configuration

For instructions on how to set up Cloud Connect, please consult the full Setting Up Ocean Cloud Connect guide.

If at any time you need to make adjustments to your Cloud Connect configuration, you can click the "Edit Settings" button located under the "Sync Status" panel on the Cloud Connect dashboard.

PS Suite Med Access Accuro OSCAR Pro

General

Schedule Days to Sync
This setting will configure the number of days to sync appointments in Ocean's Day Sheet view. For most clinic environments, the default value of 1 day is sufficient.
Note: More internet bandwidth is required for longer time intervals for appointment synchronization.
Sync Appointments For Provider(s)
Ocean will automatically provide a list of providers from your EMR. This setting allows you to further filter or exclude certain providers, if needed.
Mark appointments as Arrived in the next(hours)
This field allows you to define the time range after a patient checks in at the kiosk, in which you'd like to mark their appointment(s) as arrived (e.g. if you set this to 2 hours, any appointments that a patient is booked for, within 2 hours of them checking in at the kiosk, will be flagged as arrived).

Clinical Notes

Combine Progress Notes
If this checkbox is checked off and a patient fills out multiple Ocean eForms in one sitting, all resultant notes from those eForms will go into one single note in the patient's chart in PSS (vs. each form creating a separate note in the patient's chart).
Automatically Import Attachments to EMR
This is an early access feature that enables Ocean to automatically import Website Form submissions, file attachments included in Patient Authenticated Website Form submissions, and eReferral/eConsult records directly into the patient's chart in PDF format. If you are interested in joining the early access program, please contact the Ocean Support team.

Walk In

All walk in settings
To learn how to set up your kiosk to accept walk-ins, please refer to Set Up Ocean to Support Walk-In Patients.

Making Changes to Your Cloud Connect Configuration

There are a few instances where you may need to return to Cloud Connect to make changes to your configuration:

  • Your EMR configuration changes
  • Your Secure Encryption Key has changed
  • EMR authentication has expired (i.e. PS Suite Mobile Activation Code)

If Cloud Connect detects an error with your setup, the email address specified as the Clinical Administrator Email for your Ocean site (located in the Admin Settings page under "Site Account" in the Ocean Portal) will be notified immediately, informing them to make the necessary changes.

If no Clinical Administrator Email has been defined, the user that created the Ocean site will be notified via email.


Quick Troubleshooting: Cloud Connect (Connection Issues)

Common Issues

“Cloud Connect credentials are not working.”

“Cloud Connect is not syncing.”

“Appointments are not syncing.”

“Cloud Connect has been deauthorized.”

“Specific provider’s appointments are not syncing."

Diagnosis Questions

Is it your first time setting up Cloud Connect?

Refer to Setting Up Ocean Cloud Connect.

Are credentials producing an error?

Verify that credentials are entered correctly. If your credentials are provided by an EMR vendor, contact your EMR representative to resend credentials.

Was Cloud Connect deauthorized?

Refer to Re-Authenticating Ocean Cloud Connect.

Is there a green or blue sync progress indication banner under the Sync Status window?

A green sync bar indicates a successful configuration. A blue bar listing the last scheduled sync also indicates success. If neither are visible, reconfigure Cloud Connect.

If a specific provider is not syncing, did you check the provider’s list to see if the provider is selected?

Have client sign into Cloud Connect > Sync Status > Edit Settings. The first dropdown menu, Sync Appointments For Provider(s), is the full providers' list for the instance.

Is the site still using OceanConnect?

Refer to Troubleshooting: OceanConnect (Legacy).


Re-Authenticating Ocean Cloud Connect

Please follow the instructions below if you need to update and re-authenticate your EMR's Cloud Connect API connection. This should take no longer than 5 minutes to complete.

Prerequisites

You must be an administrative user on your Ocean site in order to sign into or re-configure Cloud Connect.

Re-Authenticating Ocean Cloud Connect

  1. Sign in to Ocean Cloud Connect.

    • Sign in using your Ocean credentials (i.e. the same credentials as the Ocean Portal).
    • Once you've logged in to Cloud Connect, you’ll be able to connect Ocean with your EMR. Click the white "Reconfigure EMR" button under the EMR Integration section to begin.
  2. Re-Authenticate your EMR integration.

    • Select the EMR you would like to integrate with and then select “Next”.
    PS Suite & Med Access Accuro OSCAR PRO
    AML Activation Mobile Activation (Legacy)
    • Acquire your EMR Instance ID and EMR Secret credentials by configuring your Ocean integration module.

      See module configuration instructions for PS Suite or instructions for Med Access.

    • Once entered, the Ocean and TELUS servers will connect to authenticate the integration.

Re-configure your Cloud Connect settings.

PS Suite & Med Access Accuro OSCAR PRO
  • From here, you can customize your configuration options. However, in most circumstances the default configuration will be sufficient.

    For more details on configuration options, please refer to Customize your Cloud Connect Configuration.

  • Click the “Save” button to complete the setup process.
  1. Re-configuration is complete!

    • You will now return to the main summary screen.
    • From here, all of your Ocean services should continue to work seamlessly. If you experience any issues with your appointment synchronization, please feel free to reach out to us.

Ocean Credential Reference Cards

When setting up the Ocean integration with your EMR, please feel free to make use of the applicable Ocean Credentials Reference Card to keep track of all relevant site and integration details.

This file can be securely stored on a network drive at the clinic and/or printed off for reference so relevant staff have access to all Ocean credentials in case of an emergency.