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.

About Ocean Cloud Connect

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 (i.e. dedicated OceanConnect tablet) is needed to keep Ocean and your EMR synchronized and active.

Setting Up Ocean Cloud Connect

1. Sign in to Ocean Cloud Connect.

   • Go to Ocean Cloud Connect in a web browser.
   • Go to Cloud Connect
   • Sign in using your Ocean credentials (i.e. the same credentials as the Ocean Portal).
   • 
   • Note: Despite using the same 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).
   • Once you've logged in to Cloud Connect, you’ll be able to connect Ocean with your EMR. Click the "Integrate with your EMR" button to begin.
   • 

2. Store your Shared Encryption Key in Cloud Connect.

   • Enter your Shared Encryption Key and then select "Save and Continue".
   • 

3. Set Up your EMR integration.

   • Select the EMR you would like to integrate with and then select “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.

   • Click on the "Connect with Accuro" button.
   • 

   • Enter the following details, supplied to you by QHR:

     • Tenant ID
     • API username
     • API password
     Reminder: If you are connecting multiple Ocean sites to the same EMR instance, please ensure QHR has provided you unique API usernames and passwords for each site before proceeding.
   • 

   • Select "Log in" and then approve Ocean's third party access to the Accuro API.

     The Ocean and Accuro servers will then connect to authenticate the integration. This may take a few seconds to initialize.

   • 

   • To finalize your integration, enter your UUID (also supplied by QHR) and select "Save and Continue".
   • 

   Log Out of OSCAR Pro

   Please Note: Before proceeding, ensure that you are fully signed out of your OSCAR Pro EMR in any other browser windows or tabs. We recommend clicking the 'Log Out' option in the top right of the EMR to ensure the session is fully signed out.

   • In the 'OSCAR Credentials' window, enter your OSCAR Server URL, Client Key, and Client Secret. Enter the OSCAR username and password for the newly created "Ocean Connect" user you created in step 3.

     Note: Ensure that your OSCAR Server URL includes your EMR directory (e.g., the '/oscar' or equivalent component at the end of the URL).

     Please also ensure there is no trailing slash at the end of the server URL - i.e. /oscar is correct, while /oscar/ is incorrect.

   • 

   • Enter the username and password for the 'OceanConnect' EMR user that you created earlier.

     Please do not enter your personal EMR login credentials into these fields. If your browser pre-fills these fields with your personal details, please fully erase those values and enter the proper “OceanConnect” EMR user credentials.

   • Once all credentials have been entered, click the blue 'Connect with OSCAR' button.

   • On the following screen, please re-enter your “OceanConnect” details, in addition to the pin number, and sign in.

     You will be brought to a page where you will be asked to confirm Ocean's request to access your OSCAR EMR. Ensure the box next to EMR Access is checked. Click the blue 'Authorize Ocean' button.

   • A window will prompt that you have successfully authenticated with OSCAR. Click 'Save and Continue'.

Configure your Cloud Connect settings.

• 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".
   • 

2. Ensure that Cloud Connect is activated in your Ocean Portal.

   • Log in to the Ocean Portal, click the "Menu" button in the top left corner and click "Admin".
   • 
   • In the "Site Features" section of the Admin Settings page, verify the "Enable Ocean Cloud Connect" checkbox is checked off.

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.

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 enabled and a patient fills out multiple Ocean eForms in one sitting, all resultant notes from those eForms will go into one single task note in the patient's chart in Med Access (vs. each form creating a separate task for each Ocean eForm completed).

Automatically Import Attachments to EMR

This checkbox is enabled by default, and ensures that Website Form submissions, file attachments included in a Patient Authenticated Website Form submission, and eReferral/eConsult records with their respective file attachments will be automatically imported into the EMR in PDF format. It is strongly recommended to keep this setting enabled.

Please note that it is important to understand the impact of disabling automatic attachment imports, particularly for eReferrals. eReferral users should keep the checkbox enabled to ensure that they receive referral attachments.

Note Status

Control whether certain Ocean notes will import into Med Access as Active or Completed tasks. See Ocean Note Tasks for more detailed information.

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.

Verify the 'Document From Field' in Accuro is Enabled

• Before configuring how Ocean notes are saved into Accuro, please verify that Ocean has sufficient permission to access Accuro Document folders by:

  Accuro Crosshair menu > Users > Manage Security > System Settings > General > EMR Settings sub-heading > verify 'Enable Document From Field' is enabled.

  Press 'Save Settings'.

• 

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.

Sync Appointments For Office(s)

Ocean will automatically provide a list of Accuro Offices from your EMR. This setting allows you to further filter or exclude certain Offices, 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 encounter note in the patient's chart in Accuro (vs. each form creating a separate encounter for each Ocean eForm completed).

Letter Type

Select the letter type that all Ocean-generated Encounter Notes will enter as in Accuro. Letter types are customizable in Accuro by using the Template Wizard (Tools > Template Wizard > Manage Option in the Type selection list at the top center of the Template Wizard screen).

The letter type is shown under the 'Type' column in the patient's Virtual Chart, and in the 'Type' field at the bottom of the Encounter Note window. If you create new letter types in Accuro, they will appear as a selectable option in the dropdown list.

Save secure message note as

Control where secure messages to and from patients will save in Accuro. If "Documents" is selected, you must select a folder and you will have an option to select a subfolder.

Custom Fields

Use Custom Fields

Use this checkbox if you are planning to map any Ocean eForm fields to Accuro custom fields (e.g. custom demographics, lab values). For more about custom fields, please refer to: Mapping Answers from an Ocean eForm to a Custom Demographics Field.

Ocean Reminders

Appt Reminder Sent Custom Status Name

Optional. If you created a custom status in Accuro to identify when an Ocean reminder has been sent, you must enter the custom status verbatim in this field. Refer to Set Your Custom Status in our Accuro set up guide for more information.

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.

Referrals

Save Sent Referrals as

Control where sent referrals will save in Accuro. If "Documents" is selected, you must select a folder and you will have an option to select a subfolder.

Save Received Referrals as

Control where received referrals will save in Accuro. If "Documents" is selected, you must select a folder and you will have an option to select a subfolder.

Please note that it is important to understand the impact of selecting Encounter Notes vs Documents, particularly for eReferrals. eReferral recipients should select the Documents option to ensure that they receive referral attachments.

Website Forms

Save Website Forms as

Control where Website Form submissions will save in Accuro. If Documents is selected, you must select a folder and you will have an option to select a subfolder.

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

Save secure message notes as:

Control where Secure Messages to and from patients will save in OSCAR Pro. If Documents is selected, the note will be imported as a PDF Document into the patient's chart. If Encounter Notes is selected, the note will be imported into the Encounter Notes area of the patient's chart.

Save eForm notes as:

Control where completed eForm notes save in OSCAR Pro. If "Documents" is selected, the note will be imported as a PDF Document into the patient's chart. If "Encounter Notes" is selected, the note will appear in the Encounter Notes are of the patient chart in plain text without font, colours, or formatting.

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.

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.

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

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.

Re-Authenticating Ocean Cloud Connect

1. Sign in to Ocean Cloud Connect.

   • Go to Ocean Cloud Connect in a web browser.
   • Go to 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.

   Please refer to these instructions only if you have specifically been directed to do so by CognisantMD Support.

   • Enter your Mobile Activation Code.

     If you are unaware of how to acquire a Mobile Activation Code, please refer to our Instructions for PS Suite or Instructions for Med Access.

   • 
   • Note: Please select “Copy Manual Code" when copying the code from your EMR to Cloud Connect to ensure that the code is copied correctly and in a format that is acceptable to Cloud Connect.
   • Once entered, the Ocean and TELUS servers will connect to authenticate the integration.

   • Click on the "Connect with Accuro" button.
   • 

   • Enter the following details, supplied to you by QHR:

     • Tenant ID
     • API username
     • API password
     Reminder: If you are connecting multiple Ocean sites to the same EMR instance, please ensure QHR has provided you unique API usernames and passwords for each site before proceeding.
   • 

   • Select "Log in" and then approve Ocean's third party access to the Accuro API.

     The Ocean and Accuro servers will then connect to authenticate the integration. This may take a few seconds to initialize.

   • 

   • To finalize your integration, enter your UUID (also supplied by QHR) and select "Save and Continue".
   • 

   • Enter your OSCAR Server URL, Client Key, Client Secret. Enter the OSCAR username and password for the "Ocean Connect" user you created in step 3 of your initial EMR integration.

     Note: Ensure that your OSCAR Server URL includes your EMR directory (e.g., the '/oscar' or equivalent component at the end of the URL).

     Ensuring that you are fully signed out of your OSCAR EMR in any other browser tabs, click Connect with OSCAR.

   • 

   • You will be brought to a page where you will be asked to confirm Ocean's request to access your OSCAR EMR. Ensure the checkbox next to EMR Access is checked. Click Authorize.

   • A window will prompt that you have successfully authenticated with OSCAR. Click Save and Continue.

Re-configure your Cloud Connect settings.

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.

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.