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.

Simple maintenance: Some tablet models blocked automated Google Play Store upgrades of the OceanConnect tablet app, which meant that clinics needed to upgrade OceanConnect manually. Cloud Connect is upgraded by CognisantMD system administrators so you don't need to worry about it and will always be on the latest EMR integration code for your EMR.

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

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.

Prerequisites

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

For Accuro Users

Access the Accuro Crosshair main menu> Users > Manage Security > System Settings > General > EMR Settings sub-heading > Check "Enable Document From Field". 

Setting Up 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).
    • 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".
    • Note: You can now securely store your Share Encryption Key in Cloud Connect for future reference. From the summary screen, click “View Shared Encryption Key” to view and/or update your existing key. Note that Cloud Connect simply stores your Shared Encryption Key and therefore, you cannot change your Shared Encryption Key within Cloud Connect.
  3. Set Up your EMR integration.

    • Select the EMR you would like to integrate with and then select “Next”.
    PS Suite & Med Access Accuro
    • 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. This should only take about 20 to 60 seconds to complete.

Configure your Cloud Connect settings.

PS Suite & Med Access Accuro
  • 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 you 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 and inspecting the Patients tab.
    • If there are any errors with the configuration, an alert will be displayed on the main summary screen, in the "Sync Status" panel.
  2. Ensure that Cloud Connect is activated in your Ocean Portal.

    • Log in to the Ocean Portal and navigate to the Admin tab.
    • In the "Site Features" section, make sure the "Enable Ocean Cloud Connect" checkbox is checked off.
  3. Disable OceanConnect (OceanConnect users only.)

    • If you have previously been using a dedicated tablet running the OceanConnect app as your connection between Ocean and your EMR, you can safely de-register this tablet after completing the above Cloud Connect set-up.
    • For more on how to de-register tablet(s), please refer to: "Deactivating Tablets".
  4. Uninstall OceanConnect (OceanConnect users only.)

    • If you have previously been using a tablet running both the Patient Tablet and OceanConnect applications, you will want to uninstall OceanConnect from your device after fully configuring Cloud Connect.
    • Perform the following steps to uninstall OceanConnect from your tablet:
    • Locate the OceanConnect application on the Android menu screen
    • Press and hold the application icon until a dropdown menu appears
    • Select "Uninstall" from the list of options
    • In the window that appears, click "OK" to confirm removal

For alternative methods of deletion, please refer to this Play Store Support guide: Delete or disable apps on Android

Upon successful uninstall of the OceanConnect application, the Patient Tablet app may become de-registered as a security precaution. If this occurs, you will need to re-register your tablet. For help registering, consult the support guide Register Your Tablet(s) Through the Patient Tablet App.


Customize your Cloud Connect Configuration

  • 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.

See the chart below for details about each setting. For more information about settings not covered here, please consult the full Setting Up Ocean Cloud Connect guide.

    • Schedule Days to Sync
      For most clinic environments, the default value of 7 days is sufficient. If your clinic has a high volume of providers and appointments, lowering this value to 1 or 2 days is recommended, since it will reduce Internet network traffic at your clinic.
      However, if your clinic is using Ocean Reminders, you must ensure that the "Days to Sync" exceeds the largest lead time you wish to configure. (For example, if your site wants to send form reminders 3 days in advance of a patient visit, then a minimum of 4 days' synchronization is required.)
    • Note: More internet bandwidth is required for longer time intervals for appointment synchronization.
    • 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).
      Walk-In Provider / Walk-In Create Appointments at
      To learn how to set up your kiosk to accept walk-ins, please refer to "Set Up Ocean to Support Walk-In Patients".
    • Sync Appointments From
      If you do not want to synchronize the appointment schedule for all of your providers, you can select which providers' calendar(s) you would like to sync appointments by clicking on the "All providers" button and checking off providers, as appropriate.

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 (in the Admin tab of 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 are connected to the new Ocean API and have been asked to update and re-authenticate Cloud Connect. 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
    • 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. This should only take about 20 to 60 seconds to complete.

Re-configure your Cloud Connect settings.

PS Suite Med Access Accuro
  • 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.