What do I do if I see "Warning from Ocean: Notes Require Download"?

Every Monday morning, Ocean sends out automatic notifications to site clinic administrators if it finds any patient notes or eRequests that may require a manual export or download to the EMR.

 

eRequests

If there are any eRequests that have not been exported, the email will tell you how many are pending removal and how to review them. Even if you are processing the eRequests as part of the initial "acceptance" workflow, it's a good idea to heed these warnings and export them for audit purposes (i.e. a spreadsheet saved in a secure place).

 

Patient Notes

For clinics using Ocean Tablets or Ocean Online, the email contains the EMR ID and the Ocean reference number of patients that have not been marked "downloaded to the EMR". We call these "orphaned notes" since the EMR has not claimed them promptly.

These notifications can be confusing. See below for a few quick FAQs. 

What circumstances would lead to an orphaned note?

The PS Suite and OSCAR EMR integrations (as of 2017) are only able to download notes when the chart for a particular patient is open and connected to Ocean. If the patient's chart isn't open or the chart doesn't know about the Ocean note, the note can remained orphaned.

Notes can be orphaned for three common reasons:

  1. A web questionnaire was sent and the patient's chart hasn't been opened for months. Ocean has a configurable expiry date (default of 100 days), after which it will remove the patient, note and all. If you send out web questionnaires months in advance (e.g. a pediatrician sending an intake package to newly pregnant women), then this time period may expire before the chart is opened to download the note.
  2. The Ocean custom form was removed from a chart in PS Suite before a tablet session or web questionnaire is complete.
  3. A tablet session was completed and the initial note was downloaded, then the same ref was used to load the tablet again for the same patient. In this case, the Ocean custom form would be deleted after the first tablet session completed -- the notes associated with subsequent completions will be orphaned since the link to the EMR chart is broken.

Note that if you are only using tablets (and not web questionnaires), most likely any "real" missing notes would be noticed at the time of the appointment and you can ignore the notifications.

Why does Ocean bother me about it?

Since Ocean is not an EMR, it is unable to retain private patient health information for prolonged periods. Consequently for privacy reasons, it removes patient data as soon as it's not strictly required. Notes that are orphaned for months must eventually be removed, even if they contain important clinical notes. Hence we notify you with a warning email and ask you to manually review the notes before they are deleted.

What should you do about these orphaned notes?

Log in to the Ocean portal. Go to the patients tab and review the notes by searching by Ocean reference. The first time, you will need to enter your shared encryption key to see the encrypted data. A quick scan will usually give you some indication whether the notes are real or not. If appropriate, copy & paste the note into your EMR patient chart and remove the Ocean patient record afterward.

Hint: if you want to pull a note back into PS Suite, simply insert the Ocean custom form as you would normally for that patient, click the generated 3 or 4 digit number and update it to the Ocean reference you want to import -- within a few seconds the note and any demographic changes will be downloaded and applied automatically.

Finally, how do you reduce the number of times this happens?

It depends on why you are getting orphaned notes. If the leading cause is early-sending of web questionnaires, you can either act on the completion notification and download the note then, or extend the expiry date on the invitation to more than 100 days. If the leading cause is testing, the warnings ought to settle down after a while. Finally, if the leading cause is staff miskeys -- i.e. removing the custom form or re-entering the Ocean reference on the tablet after the patient is complete -- a recap on training might be appropriate. 

However, the root cause of these issues may be something else specific to your workflow or process. If you think that you are getting too many orphaned notes, let us know at support@cognisantmd.com to see whether we can help.

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