Basic Online Messaging Workflow

  1. Initiate your email message.

PS Suite Accuro OSCAR Other EMR
  • Select "Email Patient" from the Ocean custom form or toolbar.
  • This will open a message window in an internet browser. The message will be pre-populated with the patient’s email address (if available), as well as your site's default message template.
  • You can change this default message by overwriting it or by selecting a new template from the "Templates" menu at the top right corner.
  • To learn more about how to customize your online message templates, please refer to "Ocean Online Messaging Templates".
  1. Add your secure message, add attachments, and select notification alerts.

    • Include Secure Message:
      To include a secure, encrypted message, select the "Include Secure Message" checkbox and type your message in the text box.
      Choose File:
      You may opt to add attachments such as lab requisitions or test results by selecting "Choose File" and selecting the file from your computer.
      Allow reply:
      Secure messages are designed to be clinician-driven. A patient can only send you a secure message after you have sent one to them first. You can allow the patient to respond to your message only by selecting the "Allow reply" checkbox.
      Notify me when viewed:
      Selecting "Notify me when viewed" will provide you with an email confirmation when a patient opens a secure message.
  1. Add forms and select notification alerts.

    • Include eForms:
      To include a secure link to an eForm that patient can complete, select the "Include eForm" checkbox.
      Add eForm:
      To include a form for the patient to fill out at home, select "Add eForm" and search for the appropriate eForm. Click the title of the eForm to save it.
      Notify me when complete:
      Selecting "Notify me when complete" will provide you with an email confirmation when a patient has finished completing the eForm you sent them.
  1. Set security information to require your patient to verify their identity.

    • The Security Information section at the bottom of the window provides you with identifying information that will be used by the patient to access the secure message and form(s).
    • The options are a password (given to the patient in advance), the patient’s birthdate (pre-populated using data from your EMR), the patient’s health number (pre-populated from your EMR) or the patient’s chart ID number in your EMR (pre-populated from your EMR). You may select one or more of these options.
    • If you do not select any option, it will default to the patient’s birthdate.
    • You can also set Ocean to let you know if a patient doesn’t open a message within a certain period of time by selecting "Notify me if no response after".
  2. Send message, receive alerts, and view patient responses in your EMR.

    • You are now ready to send your message!
    • If you have requested email notifications related to the secure message or eForm, you will receive an email containing the patient’s chart ID number in your EMR, as well as their Ocean reference number.
    • The next time you access the patient’s chart, you will see a new encounter note that includes the message as well as any replies and eForms that were completed.
  3. Configure your email address for alerts (optional).

    • Ocean automatically requires users to log in to Ocean the first time they send a secure message. By default, Ocean will send email alerts and notifications to the email address on file for that Ocean user.
    • If you would like to assign a delegate email address to receive these notifications, you can do this by changing the "Clinical Delegate Email" from the “View My Account" section of the Ocean Portal (also accessible by clicking your name at the top right corner and selecting "View My Account".

For more details about all of the Ocean online message options, please refer to "Ocean Online Message Settings".


Ocean Online Message Settings

  • This article explains the different settings available in the Ocean Online Message builder. Ocean Online Messages can be used to send secure messages and attachments or Ocean forms to patients through a secure link, sent via email.

Templates Menu

This menu allows you to save a default template, save additional templates, or select a template to auto-populate the message. More information about templates can be found in "Ocean Online Message Templates".

Email Body

This area allows you to customize the message that the patient will see in their email inbox. The text “[weblink]” indicates where the link will appear for the patient to click on to access the message (the link will appear as “View Secure Message”, “Complete Questionnaire” or “View Secure Message and Complete Questionnaire”).

Include Secure Message

Checking this box will expand the secure message panel. Messages for the patient can be added in the text field.

Choose Files
Clicking “Choose Files” will open a standard file attachment window where you can attach any relevant documents for the patient.
Allow Reply checkbox
When checked, this option will allow the patient to type a response to the message. Patient responses are tracked in the patient record.
Notify me when viewed checkbox
When checked, a notification will be sent to the sender’s email or clinical delegate when a message is viewed.

Include eForms

Checking this box will expand the forms panel.

Add eForm
Clicking on this option will open a window to search for and select an Ocean Form or Favourite. Once a form is added, it will be listed in the panel. To remove a form, click on the form name.
Notify me when complete checkbox
When checked, a notification will be sent to the sender’s email or clinical delegate when a form is completed.

Advanced

In this panel, you can decide how the patient will be able to access their secure messages and/or forms. By default, Ocean uses birth date as the required validation method for patients to access secure messages or forms. But, you can change this to a password (given to the patient beforehand), the patient's health number or patient number.

Link expiry
This field determines the period of time during which the patient can access a secure message, attachment, or Ocean forms. If an Ocean form is opened, completed and submitted by the patient, it cannot be accessed again. However, secure messages and attachments remain available until the patient selects the checkbox saying, “I do not need to view this message again” or the link expires.
Notify me if no response after
This drop-down menu adds an alert if the patient does not open the message or complete the form within a set number of days.
When patient finishes, redirect to
This will allow you to redirect the patient to the URL of your choice once they've completed an online questionnaire (i.e. when they click the "Finish" button), instead of displaying Ocean's default message.
Note: Ocean's default finishing message states: "Please note that your healthcare provider will not routinely see your answers until the time of your next appointment. If you have an urgent medical problem, you must contact your healthcare provider directly or proceed to the emergency department." This message is important from a medicolegal perspective since it ensures that patients follow up urgent conditions appropriately. In the interest of patient safety, please ensure your redirect clearly delivers the same message.

Ocean Online Message Templates

If you often send a specific message and/or set of forms to patients or you are using Ocean Reminders, you may find Ocean online message templates to be very useful.

  • To edit your templates, navigate to the Patients tab in the Ocean Portal, select a test patient, and click "Email Patient...".
  • The default template will appear and you can edit it to your liking by making changes to the subject, email body, secure message, and eForms to send to the patient.
  • When you're done, you can use the Templates menu at the top right corner to either save this template as your default template ("Save as Default") or a new template ("Save Template").
  • Now, if you want to use a template you've previously saved, simply choose from dropdown list of previously saved templates located in the Templates menu at the top right. This will update the subject line, body, completion notification, and even the forms that you included when you originally saved the template.
  • If you want to edit a template that you've previously saved, select it from the Templates menu, make your changes, and then click "Update Template" button at the bottom of the window.
  • If you want to delete a template, select it from the Templates menu, and then go back into the Templates menu and select "Delete Template...".

To learn more about all the other available Ocean online message settings, please refer to "Ocean Online Message Settings".


Creating a PDF Attachment to Add to a Secure Message

PS Suite Accuro OSCAR or Other EMR

Ocean makes it easy to select and 'green bar' notes in a patient chart in PS Suite to be exported as a PDF file on the desktop. The file can then be uploaded to an Ocean Online secure message or eReferral.

  • Find the note(s) in the file that you want to generate as a PDF attachment.
  • Check the box next to the note to enable the "green bar".
  • Click on "Attach" link on the Ocean toolbar or the paperclip attachment icon on the Ocean custom form (next to “Email Patient”).
  • This will generate a temporary PDF file on your computer's desktop (the file will be removed after 5 minutes and/or when you exit PSS).
  • Once the PDF has been generated, it can now be opened, printed, and/or attached to a secure Ocean message.

Following Up on Overdue Secure Messages and Questionnaires

Ocean's patient questionnaires and secure messages often require clinically important responses from patients. For example, a secure message may be sent to a patient asking them to check their blood pressure and report back to the clinic. As a result, it is important to have a systematic mechanism for following up these messages at your clinic.

Unlike plain emails or voice mails, Ocean provides an integrated safety feature to prevent overdue responses from "falling through the cracks".

Setting Due Dates for Questionnaires and Secure Messages
  • When you send a questionnaire or secure message, you can request to be notified if the patient hasn't responded within a specific time frame (using the "Notify me if no response after" features). You can adjust this setting in the Security Information panel in the dialog used to send an online message or questionnaire.
  • Later on, if the patient has not confirmed receipt of this message, either by completing the questionnaire or clicking the checkbox to confirm that he or she has received the secure message, then their response will be considered overdue.
  • Note: You do not need to use the "Allow Reply" feature in order to track these messages. Messages that do not have allow for replies will still present a checkbox for patients to confirm receiving the messages. For more information about secure messages features, please refer to Ocean Online Message Settings.

Ocean Online Message Templates

You can update the template for your online message or questionnaire to remember the notify/overdue setting so that you don't need to set it each time. For more information on configuring your templates, please refer to Ocean Online Message Templates.

Email Notifications Regarding Overdue Responses
  • Some sites prefer to receive a nightly digest of all patients in Ocean with overdue responses, even if a reminder notification email for these patients has already been sent.
  • Other sites prefer to avoid receiving repetitive notification emails each evening when they have already been notified about these specific overdue responses.
  • You can customize these setting within the Admin tab of your Ocean Portal (i.e. the "Overdue Secure Message Notifications" field in the "Site Features" section). You can choose between the following:
    Include all patients with overdue messages
    For a nightly digest.
    Limit to patients with newly overdue messages
    For specific overdue responses only.
Reviewing All Overdue Responses in the Ocean Portal
  • Regardless of your email notification setting, we recommend that you designate someone at your site (usually a receptionist) to follow up on all patients with overdue responses. Individual clinicians may also choose to manually follow up their secure messages.
  • To view all patients with overdue messages, go to the Patients tab in the Ocean Portal and click on the search box under "Find Patients" to choose the search option for "Patients with overdue responses".
Determining the Reason for an Overdue Response

Patient responses may be overdue for the following reasons:

  • The patient hasn't checked his or her email recently
  • The patient's email is incorrect (which may or may not have bounced)
  • The email was spam-filtered (fortunately Ocean's emails are generally deemed legit by mail clients and are usually not spam filtered, but it can still happen)
  • The patient failed to read or open the email
  • The patient read the email, but wasn't sure whether it was spam or phishing, and consequently ignored it
  • The patient is having technical difficulties opening the message
  • The patient opened the message, forgot or chose not to confirm receiving it
  • The patient accessed the message, but is having technical difficulties viewing or confirming the message

A patient is considered to have accessed the message if he or she has clicked on the email link.

In order to actually confirm receipt of the message, the patient must click on the corresponding checkbox and submit their response. Ocean tells the patient to click on this checkbox, and it even "nags" the patient if they try to close the window without doing so.

Unfortunately some patients still forget to click this checkbox, or don't notice it, despite Ocean's best efforts. When this happens, medico-legally speaking, your clinic cannot be sure the patient read and understood the message, and thus their response is still considered to be pending. However, if you know that the patient has accessed the message, you at least know that they clicked on the email link, and you also have a clue that they very likely saw the response.

To determine the reason for the overdue reply, start by checking whether the patient has at least accessed the message. You can determine the Accessed Date from the notification email. In the portal, the patient's status icon and status message will indicate whether the message was accessed (view the status message by hovering the mouse cursor over the status icon under the Status column in the Patients tab).

Following Up on an Overdue Response

Regardless of the reason for the delayed reply, it is likely clinically necessary to follow up with the patient using your traditional means of communication: phoning, leaving a voicemail, texting, or discussing the next time they return for a visit. You may want to inquire why they didn't receive the message so that you or they can take steps to handle the next attempt successfully.

An Example From Dr. Kavanagh's Clinic

Dr. Kavanagh's administrative staff will often follow up by calling patients when a secure message or questionnaire is overdue for a response. If the patient's voicemail is encountered, the secretary simply leaves a message asking the patient to check their email for the message sent on a particular date. This technique is helpful because it not only follows up the concern related to the notification, but also "trains" the patient to ensure similar messages are received successfully in the future. Individual clinicians may follow this approach by sending a task/message to their secretary in their EMR, asking them to do the same.