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  3. Advanced eReferral Features in Accuro

Advanced eReferral Features in Accuro

Learn how to best use eReferrals with your Accuro EMR.

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Accuro: EMR Notifications for Sent eRequests

Note:

This article reflects the functionality available during the early release phase of EMR Notifications in partnership with Nova Scotia.

EMR Notifications for sent eRequests allows providers to receive automated notifications directly within their EMR when key status updates occur for eRequests they have sent through the Ocean Provider Network.

Prerequisites

Before setting up EMR Notifications for Accuro, a user with Site Admin access to your Ocean Site must complete the following prerequisite steps:

Configuration

EMR Notifications for sent eRequests are configured on a user-by-user basis. Users can perform this configuration themselves, or a user with Site Admin access can perform the configuration on behalf of users.

Any changes made by an Site Admin to a user's EMR notification settings are immediately reflected in that user's Ocean account. Likewise, if the user updates their own notification settings, those changes will also appear in the Site Admin's view.

User Self-Configuration Site Admin Configuration on behalf of Users

To configure EMR Notifications for sent eRequests for your own Ocean user account, follow the steps below:

  • After logging in to the Ocean Portal, click your name in the top right corner and select 'My Account'.
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  • Click 'Edit EMR Notifications for Sent eRequests'.
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  • For each Ocean Site you belong to, select the desired EMR User to be notified for each eRequest event under the 'EMR User' column. These settings apply to eRequests that are sent by you or on your behalf (e.g., by a Clinical Delegate).

    For events where no EMR notification is desired, set the EMR User to 'None'.

    Your changes will be automatically saved and apply to both new and existing eRequests.

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How Sent eRequest Notifications appear in Accuro

Expand the tabs below to see how each Sent eRequest EMR Notification appears in Accuro.

New eRequest messages

 

Note: The 'Reason for referral:' portion of the notification will only appear if the optional 'ax_reasonForReferral' analytic value has been populated for the eRequest.

Declined eRequests

 

Note: The 'Reason for referral:' portion of the notification will only appear if the optional 'ax_reasonForReferral' analytic value has been populated for the eRequest.

Frequently Asked Questions

How do EMR Notifications for Sent eRequests work for Ocean users associated with multiple Ocean Sites?

EMR Notifications for Sent eRequests work on a site-by-site basis for Ocean users associated with multiple Ocean Sites.

  • When the user accesses the self-configuration area as outlined above, they will be able to configure their notifications for each Ocean Site they are associated with that support EMR Notifications for Sent eRequests.
  • EMR Notifications configuration for multiple sites 
Is there a log showing when EMR Notifications for Sent eRequests are created?
  • Yes, when EMR Notifications for Sent eRequests are created successfully (or fail to be created), it is logged as an event within the respective eRequest's Event Log.
  • EMR Notification event log 
What happens to EMR Notifications for Sent eRequests when the Ocean user is removed from the Ocean Site?

When an Ocean user who has configured EMR Notifications for Sent eRequests is removed from an Ocean Site, Ocean will stop generating EMR Notifications for any referrals that were sent by (or on behalf of) that user from that site.

I am receiving error notifications, what should I do?
  • If you are seeing EMR-related error notifications in Ocean (such as “EMR user unavailable” or “Invalid EMR user(s)”), this usually indicates that one or more EMR user accounts are no longer active or properly synchronized. 

    These notifications appear when Ocean detects that an EMR user linked to your configuration has been removed, deactivated, or is otherwise unavailable. 

    For step-by-step guidance on identifying and resolving these issues, please refer to the article: Quick Troubleshooting Guide: EMR Notifications for Sent/Received eRequests. 
  • UI error popup 

Accuro: EMR Notifications for Received eRequests

Note:

This article reflects the functionality available during the early release phase of EMR Notifications in partnership with Nova Scotia.

EMR Notifications for received eRequests allow providers to get automated alerts directly within their EMR when key status updates occur for eRequests sent through the Ocean Provider Network.

Prerequisites

Before setting up EMR Notifications for Accuro, a user with Site Admin access to your Ocean Site must complete the following prerequisite steps:

Configuration

EMR Notifications for received eRequests are configured in the 'Directory Listing'. Only users with Site Admin access can perform the configuration on behalf of users.

How Received eRequest Notifications appear in Accuro

To configure EMR Notifications for received eRequests, follow the steps below:

  • After logging in to the Ocean Portal, open the 'Menu' and select 'Admin'.
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  • Click 'Directory Listing'.
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  • Select the 'Manage EMR Notifications' button.
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  • Three tables will be displayed: 'New eRequests', 'Cancelled eRequests, and another for 'New eRequest Messages'.

    For each Directory Listing, select the desired EMR User to be notified for each eRequest event under the 'EMR User' column.

    Your changes will be automatically saved and apply to both new and existing eRequests.

    Note: When the drop-down arrow next to the Directory Listing name is selected, additional customization options become available for individual Health Service Offerings.

  •  

How Received eRequest Notifications appear in Accuro

Expand the tabs below to see how each received eRequest EMR Notification appears in Accuro.

New eRequest

The notification will appear as an Active Task in the respective patient chart and be assigned to the EMR User as selected in Ocean.

 

Note: The 'Reason for referral:' portion of the notification will only appear if the optional 'ax_reasonForReferral' analytic value has been populated for the eRequest.

New eRequest messages

The notification will appear as an Active Task in the respective patient chart and be assigned to the EMR User as selected in Ocean.

 

Note: The 'Reason for referral:' portion of the notification will only appear if the optional 'ax_reasonForReferral' analytic value has been populated for the eRequest.

Cancelled eRequests

The notification will appear as an Active Task in the respective patient chart and be assigned to the EMR User as selected in Ocean.

 

Note: The 'Reason for referral:' portion of the notification will only appear if the optional 'ax_reasonForReferral' analytic value has been populated for the eRequest.

Frequently Asked Questions

Is there a log showing when EMR Notifications for Received eRequests are created?
  • Yes, when EMR Notifications for received eRequests are created successfully (or fail to be created), it is logged as an event within the respective eRequest's Event Log.
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I am receiving error notifications, what should I do?
  • If you are seeing EMR-related error notifications in Ocean (such as “EMR user unavailable” or “Invalid EMR user(s)”), this usually indicates that one or more EMR user accounts are no longer active or properly synchronized.

    These notifications appear when Ocean detects that an EMR user linked to your configuration has been removed, deactivated, or is otherwise unavailable.

    For step-by-step guidance on identifying and resolving these issues, please refer to the article: Quick Troubleshooting Guide: EMR Notifications for Sent/Received eRequests. 
  • UI error popup 
What happens if an EMR Notification must be generated but the patient doesn’t have a chart in the EMR?

  • When an EMR notification needs to be generated and no matching patient chart exists in the EMR, Ocean automatically creates a full patient chart to ensure the notification can be properly generated and associated with the correct patient record.

    As part of this process, an additional PDF document titled “Awaiting Initial Review” is added to the newly created chart. This document indicates that the patient record was created due to an incoming referral and did not previously exist in the EMR.

    The referral notification will appear as an Active Task within the new patient chart and will be assigned to the EMR user selected in Ocean. The status “Awaiting Initial Review” confirms that the referral requires action and has not yet been accepted or declined.

Does Ocean still create the chart if the referral doesn’t include a Health Number?
  • Yes. If Ocean needs to generate an EMR Notification and no chart exists, chart creation will still succeed even if the referral does not include a Health Number.
What happens in the EMR when the eRequest is declined?

  • Ocean imports an updated referral record PDF into the corresponding patient chart showing a Declined status.

    When a new patient chart is generated to facilitate an EMR Notification, it is important that the Task/Document title includes the word “Declined” . This allows EMR users to leverage their EMR’s querying tools to identify charts that were created solely to facilitate an EMR Notification where the eRequest was later declined, and to bulk remove them if needed.

Accuro Automatic eReferral Document Assignment

Accuro EMR users can customize Ocean Cloud Connect settings to have sent or received eReferrals enter the EMR as a Document rather than an Encounter Note.

  • When set to 'Documents', eReferral documents enter the EMR with the 'Document Provider' set to 'Unassigned' by default.
  • To have Ocean automatically assign a Document Provider, Accuro users can enable the 'Automatically assign Referral Documents to providers in Accuro' setting in Cloud Connect.
  • Once enabled, a 'Fallback Provider' can be specified. This will be the assigned Document Provider if no provider match is found earlier, as per the logic documented below.
  • If no Fallback Provider is specified, and no provider match is found as per the logic documented below, the Document Provider will be 'Unassigned'.

Document Provider Assignment Logic

Sent eReferrals

  • When an eReferral/eConsult is sent and the 'Automatically assign Referral Documents to providers in Accuro' setting in Cloud Connect is enabled, the Document in Accuro is assigned to the relevant EMR user based on the information in the 'Referrer's Information' section of the referral form.

Ocean does this by first evaluating the Billing #, Professional ID, and Last Name fields, and assigning the Document to the provider in Accuro that matches at least 2 out of the 3 fields.

If no match is found, Ocean will re-attempt to match based on the referrer's First Name and Last Name. If there is more than one provider with the same first and last name, the Fax Numbers will be used to distinguish each unique provider.

If still no match is found, Ocean will assign the Document to the 'Fallback Provider' specified in the Ocean Site's Cloud Connect settings.

If no 'Fallback Provider' is specified in the Ocean Site's Cloud Connect settings, the Document will enter Accuro with the Provider being 'Unassigned'.

Received eReferrals

  • When an eReferral/eConsult is received and the 'Automatically assign Referral Documents to providers in Accuro' setting in Cloud Connect is enabled, the Document in Accuro is assigned to the relevant EMR user based on the information in the 'Clinician Information' setting of the Directory Listing that the referral was sent to.

Ocean does this by first evaluating the Billing #, Professional ID, and Last Name fields, and assigning the Document to the provider in Accuro that matches at least 2 out of the 3 fields.

If no match is found, Ocean will re-attempt to match based on only the recipient's First Name and Last Name.

If no match is found, or there is more than one provider in the EMR with the same first and last name, Ocean will assign the Document to the 'Fallback Provider' specified in the Ocean Site's Cloud Connect settings.

If no 'Fallback Provider' is specified in the Ocean Site's Cloud Connect settings, the Document will enter Accuro with the Provider being 'Unassigned'.

Sending eReferral Appointment Notifications from Accuro

Before following the steps in this guide, ensure you have set up the Send Appointment Notifications CDS link. Click here for setup instructions.

Ocean allows referral recipients to continue to schedule any eReferral appointments within their Accuro scheduler, and then simply launch a CDS button or link to update the referral appointments within Ocean. Steps to do so are outlined below.

  • Select the patient in Accuro for whom you wish to update the referral appointment.
  • Make the desired changes to the patient's appointment(s) in the Accuro scheduler (book, cancel, or reschedule an appointment, etc.)
  • When ready, select the Send Appointment Notification CDS link or button.
  • The Patient Dashboard will launch in a new window, and you will be prompted to choose the referral to update. Click View beside the referral that is associated with the appointment notification.
  • In the scheduling pane of the referral, click on the appointment you wish to add to the referral.
  • Quick Tip: All of the patient's future appointments from the Accuro scheduler will be listed. If more than one appointment is related to the referral, you can click each applicable appointment. Alternatively you can click the "+" icon to add a second appointment slot to the referral scheduling pane, then choose the second appointment listed to populate the newly added slot.
  • Add any desired booking comments and/or attachments to the scheduling pane of the referral. Then choose Done to save and close the referral. This will trigger a booking email notification to the referring provider, and one to the patient, IF the patient consented to email notifications.
  • Note: If would like to cancel an appointment on an eReferral, follow steps A to D above. The recently cancelled appointment will be listed in the scheduling pane with an 'X' beside it. Select it to remove the appointment from the Ocean eReferral. Click 'Done' to save and close the referral. Appointment notifications will be triggered to the referring provider and the patient, IF the patient consented to email notifications.

Attaching a Clinical Note or Document from Accuro to an Ocean eConsult and/or eReferral

Ocean can search for Generated Letters with attachments, in a patient chart in Accuro, and upload them directly to Ocean. The file can then be automatically included in an eConsult and/or eReferral sent through Ocean.

Initiating an eReferral/eConsult with an Attachment:

Prerequisite

  • Select the patient in Accuro that you wish to generate an attachment in Ocean for.

  • If you do have an Encounter Note Template and corresponding Quick Action Button configured, use your Quick Action Button to create a new Encounter Note.

    If you do not have an Encounter Note Template and corresponding Quick Action Button configured, create a new blank Encounter Note in the patient chart.

    Tip: You can use the 'CTRL+F11' keyboard shortcut to create a new note from any section of Accuro, as long as you have the patient selected first.

  • Specify a filename for your attachment by using the 'Title' field in the bottom left, and then click Generate Letter.
  • Ensure you have the correct 'From:' Provider selected in the top left, then go to the Attachments pane and click the green plus icon to add an attachment.

  • In the Select Attachments window, choose the items from the patient chart that you would like included, and then select OK.

  • The list of selected attachments will appear on the left. Click the Save for Ocean button.
  • An Encounter Note and the Generated Letter will be created in the patient chart.

  • Use the 'Send eRequest / Find Health Service' CDS link or action button to launch into the Ocean Healthmap.

    Ocean will look in the Accuro chart for any unused Generated Letters with the current date to upload and automatically include as an attachment on the referral form.

  • You can preview your attachment by clicking on the purple eye icon, or remove it by clicking on the red 'X' icon.

Adding Attachments to an Existing eReferral/eConsult

If would like to include additional attachments to an existing eConsult/eReferral, first follow steps A to G above, and then follow the steps below:

  • Click the 'View Patient Summary' CDS link or action button.
  • From within the Patient Summary, select the relevant eReferral/eConsult.
  • Within the 'Messaging' area, click the 'Add Attachments' button.
  • Choose the relevant attachment(s) from the list of queued attachments.
  • Optionally include a message with your attachment, and then press 'Send'.
  • The attachment will be sent as a message within the eReferral/eConsult.

Save Sent or Received eReferrals/eConsults as a Document Instead of an Encounter Note

  • Ocean makes it easy to configure where eConsults and/or eReferrals, either sent or received to your site, are downloaded and saved in the patient's EMR chart. By default, consults and referrals are saved in the Encounter Notes section of the patient chart.
  • However, you can choose to save them as a Document in the patient's Virtual Chart, with a custom Folder or Sub-Folder Type. This functionality is set within your site's Cloud Connect settings.

  • Note: To ensure that any file attachments are automatically imported to Accuro, we strongly recommend that eReferral users select the 'Documents' option for both sent and received referrals.

Configuration

Prerequisites

  • You must have Site Admin access to your Ocean Site to configure your Cloud Connect settings.
  • Click the Edit Settings button in the Sync Status window.

  • Under the 'Referrals' heading, set the 'Save Sent Referrals as' and 'Save Received Referrals as' settings to 'Documents'.

    Specify the desired Accuro document folder (mandatory) and subfolder (optional) for each.

  • Click 'Save'.
  • Consults and/or referrals sent or received through Ocean will now download as a document under the specified Folder or Sub-Folder type.

  • Quick Tip: Cloud Connect accesses your EMR's existing list of folders/subfolders. If you would like to add a custom folder for sent or received Ocean eReferrals/eConsults, you must do so within Accuro first.

    You can do this by opening a patient chart, selecting 'EMR', opening the 'Virtual Chart', and clicking 'Upload Document'. Next, open the 'Destination Folder' dropdown and select '--Manage--' at the top. This will open the 'Manage Patient Folders' area, where you can add/delete/edit document folders in Accuro.

Naming Conventions for Downloaded Accuro Documents

  • For Recipient Ocean Sites, Ocean will automatically download the referral record PDF and any attachments as separate documents in the patient's Virtual Chart. This is to allow the attachments to be further categorized, if desired. The name of each document will be prefixed with "eReferral -" for the referral record PDF, and "eReferral Attachment -" for the attachments.
  • For Recipient Ocean Sites, once an eConsult and/or eReferral is marked as 'Completed' in Ocean, the entire consult or referral record PDF (including any additional notes, messages, or attachments), will re-download as a single document in the patient's Virtual Chart. The prefix for this document will be "eReferral Completed -".
  • For Referral Sender sites, when an eConsult and/or eReferral is sent through in Ocean, the entire consult or referral record (including attachments), will download as a single document in the patient's Virtual Chart. The prefix for this document will be "eReferral -".

Automatic Document Provider Assignment

To have Ocean automatically assign the Document Provider for each Document, Accuro users can optionally enable the 'Automatically assign Referral Documents to providers in Accuro' setting in Cloud Connect.

Create a CDS Link to Launch a Specific Consult and/or Referral Target in the Healthmap

If your Accuro site commonly consults and/or refers to a specific destination in the Ocean Healthmap, you can set up a CDS link to launch directly to that destination. In order to do so you will need to generate a new CDS link URL by taking the following steps:

  • Log in to the Ocean Portal and navigate to the Admin Settings page. Click "Manage Credentials", and click to "Configure Accuro CDS Links".
  • Find and copy the link for "Send eRequest".
  • Go to the Ocean Healthmap and search for the listing you would like to launch directly from your Accuro EMR. Once selected, hover over the listing name to pop up the unique consult or referral target reference in tooltip text. Copy this reference.
  • Edit the "Send eRequest" URL by inserting the text "&rtRef=" followed by the listing reference, in between the "action=refer" and "&siteNum" portions of the URL. Your final URL should look something like the following, once compiled.