When choosing a tablet to use with Ocean, there are a few things to consider.
- Ocean Tablets need to run on Android 5.0 or higher (i.e. any current generation Android tablet).
- For the sake of accessibility, we also typically recommend screen sizes of 9″ or more. However, we do have clinics using high resolution 8″ tablets as well.
- Finally, clinics that plan to use an Ocean Kiosk for patient check-in (with a health card swipe reader) are limited to two supported tablets – the Samsung Galaxy Tab E 9.6″ or the Samsung Galaxy A 10.1″.
Other than that, it’s really personal preference.
You do not need an external keyboard and getting a cheap protector case is a good idea, just to make it easier to grip and more likely to survive a drop to your waiting room floor. For more tips about tablet security, check out this series of blog posts.
Tablet brands that we recommend...
Both Samsung Tabs and ASUS Transformers consistently perform well, are very reliable, and have very nice screens. They also almost never die unless they get dropped. However, they are more expensive than some other Android options on the market. We’ve heard clients say that Lenovo Yoga tablets have a great battery life, have a reasonable price, and seem to be reliable, but have not tested them ourselves, here in our office.
Tablet brands to be wary of...
Be careful with some "budget" tablet brands (e.g. Neutab, Hipstreet). Unfortunately, we've heard a growing number of complaints about these lower-end models, ranging from WiFi connection issues to screen issues.
The one budget tablet manufacturer you should definitely avoid is Azpen. These tablets cycle through a pool of “mac addresses”, which are supposed to be unique, permanent hardware identifiers used for networking. These may cause much grief for your networking team since they may configure their firewall using mac addresses.
To delete a tablet rule, you will need to have administrative privileges.
1. In the Ocean Portal, navigate to the Tablets tab.
2. Find the tablet grouping you want to make changes to and select the "Edit" option.
3. This will open the Tablet Settings window. Select the "Rules" tab.
4. To DELETE a rule, click on the cog icon to the far right of the rule row and select "Remove" from the drop-down that appears.
5. To CHANGE a rule, edit the trigger script in the white field for that row. You can learn more about tablet rules here.
You can install the OceanWave Launcher to replace the default home screen on Android with a big "OceanWave" button that simply relaunches the Ocean app. It hides all the other apps.
Installing the OceanWave Launcher
To install the OceanWave Launcher, your tablet must be configured to allow downloads from "unknown sources". (You can do this by going to your tablet Settings -> Security -> turn Unknown Sources ON.)
To install the launcher, enter the Ocean Tablet app and tap the cog or Ocean logo in the bottom left corner of the keypad screen. Enter your credentials and pick "Install Launcher" from the administration menu.
Once the OceanWave Launcher is installed, you'll need to tap the "home" button and tell Android to use the OceanWave Launcher "always" to handle the home button action.
Then, tap and hold the "home" button and drag your finger towards the Google/search icon that pops up above the home button. Again, as above, tell Android to use the OceanWave Launcher "always" to handle this long hold home button action, as well.
Uninstalling the OceanWave Launcher
If you wish to uninstall the OceanWave launcher, enter the Ocean Tablet app and tap the cog or Ocean logo in the bottom left corner of the keypad screen. Enter your credentials and pick "Remove Launcher" from the administration menu.
Note: Technically, the launcher doesn't prevent very clever patients from installing apps or surfing the web but it will make it quite difficult. The most important advice for managing tablets in your waiting room is always to keep your personal data off them: no Google Play account information, no credit cards, etc.
Although we don't use Ocean tablets for obtaining physical signatures, many of our sites use the tablets for obtaining informed consent.
- Opioid Treatment Agreement
- Brock's Confidentiality Agreement
- Brock's Clinic Policy
- Variant of Sunnybrook's Email Consent Form
- Joint Injection Consent Form
- General Procedure Consent Form
These above agreements are consistent with the CPSO's guidelines on obtaining informed patient consent.
Note that the CPSO's policy does not in fact require a physical or "wet" signature from the patient when obtaining consent. A signature is neither necessary nor sufficient for obtaining informed consent. Instead, the CPSO policy expects clear documented evidence that all of the risks, benefits, and alternative treatments have been explained to the patient, and that the patient has had a chance to ask questions regarding the procedure.
The tablet provides an ideal environment for the patient to review this information in advance, without feeling rushed to comply with the physician waiting in the room.
If you need to document a specific audit trail, you can augment the eForm's note with a template for the doctor or nurse document to indicate that he/she was present during the agreement to answer questions. As with any eForm, the generated note associated with these consent forms is completely customizable using the eForm Editor.
If a physical signature is nonetheless felt to be necessary for your clinic, the old-fashioned pen and paper approach is tough to improve upon. In this case, it may be more helpful to let your EMR vendor set your clinic up with a streamlined scanning workflow.
You can make eForms appear automatically, based on a patient's information, by either adjusting your tablet settings (by adding a completion survey or setting up tablet rules) or by using eForm Actions. These automatically appearing forms will get added into the queue along with any forms that have been explicitly loaded for the patient (through the EMR or the Ocean web portal).
If you just want to add a patient experience survey to the end of the patient's tablet session, you can use the survey invitation feature, which is located in the Preferences tab of the tablet settings. Simply check the "Display a survey or other form after all other forms are complete" checkbox and select the appropriate survey by searching in the "EForm to Show" box. This is easy to set up, but not that versatile because you can't add in clinical forms.
The most useful method is to set up tablet rules. For any given tablet settings group, you can configure rules using the Ocean scripting language to show a specific eForm if a patient meets a certain set of conditions. For example, you could show the Menopause form for females over the age of 55 (shown below). You can have as many tablet rules in a tablet group as you want. Please click here for examples of other commonly used tablet rules.
You can also use "eForm Actions" to trigger eForms to be added for a patient, based on their answer to a certain question on a different eForm. These can be set up using the eForm Editor. Click here for more details on how to set up your eForm Actions.
For an example of an eForm Action in action, check out the PHQ-9 and the follow-up suicidal ideation questionnaire that shows up if the patient answers question #9 in a manner that is consistent with suicidal ideation.
Skip On Demand EForms
Checking off the "Skip On Demand EForms" at the bottom right corner of the tablet rules tab is typically applicable for Ocean kiosks, and will prevent showing any eForms on the kiosk that have been manually-queued by a staff member (i.e. forms where you have to enter the 3-digit code into the tablet before handing it to the patient to complete). This is useful because clients and patients, alike, often prefer to have these more detailed and/or private forms show up on a separate tablet that they can hold. When "Skip On Demand EForms" is selected, a "(DISABLED)" label will appear beside "On Demand EForms".
Prioritizing / Rearranging Tablet Rules
You can prioritize and apply conditions in the Rules tab of the tablet settings window. Note that you can drag and drop the rules relative to each other. You can also position the rules in the queue, relative to the manually-queued forms by dragging and dropping them, as appropriate.
Minimizing Forms Required for First-Time Patients
- ScriptUtil.queueSize() == 0
- ScriptUtil.queueSize() == 0 && firstTime
Autofill is a common default setting on a number of tablets found in the keyboard options. Having this option activated may result in some patients being able to see information typed in by patients who used the tablet before them.
To turn off autofill on Samsung tablets:
1. Go into the tablet's Settings app.
2. Select "Language and input". Click on "Samsung keyboard".
3. Select "Smart typing". Toggle the "Predictive text" switch to the left to disable predictive text.
Other tablets should have similar settings.
Note: If autofill continues to be a problem, it may be useful to download the Google Keyboard ("Gboard") from the Google Play Store and use that instead of the default Samsung keyboard.
Autocorrect is also a common default tablet setting that can be frustrating if a patient is required to type in free text.
To turn off autocorrect:
- Go into the Settings app.
- Select "Language & Input".
- Select the keyboard that you are using (most likely the Google keyboard, i.e. Gboard).
- Select "Text Correction".
- Toggle the "Auto-correction" to the left to turn it off.
In general, you won't need to upgrade anything in your clinic at any particular time, especially if things are going well. We upgrade the Ocean web portal every week but we are very careful to avoid breaking connectivity with EMRs and tablets.
That being said, there are reasons that you might want to update your tablets or EMR integration code (like the PS Suite custom form). Maybe you've heard about a new feature you'd like to use. Maybe you've run into a bug (perish the thought). Or maybe you are trying to use a clinical form that requires a newer version. In any case, we've made upgrading tablets and EMR integration code fairly easy for large and small clinics.
If you do want/need to upgrade your Ocean tablets, there are a few "best practices" that we recommend if the situation allows:
- Don't upgrade them all at once; upgrade one or two near you physically and make sure everything is still smooth. There are too many moving parts to go with a "big bang" upgrade, particularly with EMR integrations at different versions.
- If you are a large site upgrading many tablets at once from an old version, let us know.
- Generally speaking, first thing in the morning is a bad time to change anything.
There may be times that CognisantMD staff will remote update your tablets or force you to update your EMR integration code before using Ocean again. We generally only do that with you on the phone although we might do it without warning if we find a security issue or other urgent bug that warrants it.
As always, don't hesitate to contact us with questions about the upgrade process.
Android tablets, like all technology devices, can - to use a technical term - "flake out" sometimes. This can take result in a number of symptoms that are usually pretty clearly not related to the Ocean app. But if there's any doubt, try to access a standard website from a web browser on the tablet (i.e. Chrome). If you can't access to a standard website like cbc.ca, then the issue is not related to Ocean.
If this is indeed the case, we recommend the following steps to try to get it working again:
- Put the device in airplane mode in the settings, and then take it out of airplane mode.
- Try powering off the device and restarting it.
- Take a paperclip, unbend it and stick the end into the "reset" hole, assuming there is one. There is a hidden button in that hole that will clear more than a simple reset.
- Reset to factory settings and reinstall Ocean (steps to reset the factory settings are here).
- Take it back to the retailer (particularly if it's still under warrantee, but even if its not, sometimes retailers like Best Buy will be able to help you with an exchange). You can also call the manufacturer's support line (i.e. the usual stuff).
The Ocean Tablet has a security feature to detect new app installations and unauthorized upgrades. This feature is designed to protect against a number of things:
- Patients (or their children) installing games without your permission
- People installing nefarious software such as keyboard trackers to compromise PHI
- Patients upgrading software without clinic consent
- Removal of apps that have been deliberately installed by IT people (e.g. asset tracking apps, geolocation lockdown apps, etc.)
If the Ocean Tablet detects any changes to the installed app list, it considers itself compromised. It deletes its authentication token and the encryption key as a security precaution since it can't tell whether a change was innocuous.
Before reactivating the tablet, you should first review the app changes and make sure that they are benign. You might need to do some Googling to understand the "package names" that were installed or uninstalled. If you aren't sure, you should reset your tablet to factory conditions and reinstall the Ocean app.
If the changes are benign, you can simply re-enter your Ocean user password and encryption key to re-register the app.
Note that one frequent cause of "false positives" is auto-updates to Android. Those are often enabled if you have a Google Play user account on the device (a very bad idea). You can generally disable auto-updates in Android settings in any case by going to the Settings options in the Google Play Store, clicking "Auto-update apps" and selecting "Do not auto-update apps".
Yes, you can easily deactivate a tablet that you no longer wish to use.
To deactivate your old tablet:
1. Log into the Ocean portal.
2. Navigate to the Tablets tab.
3. Find the tablet(s) that you would like to deactivate, click on it and select "De-register". The tablet(s) has now been deactivated.
To set up your new tablet:
1. Follow the usual steps to set up Ocean on your tablet (please see here for detailed instructions).
2. Log in to the Ocean portal.
3. Navigate to the Tablets tab.
4. Ensure that your newly set-up tablet is under the right settings group in the Ocean portal. New tablets are automatically added to the "Default" settings group. If you want to change this, drag and drop the new tablet into the correct tablet group.
Some versions of Android won't launch an APK file from the Downloads app or straight from the browser downloads.
Assuming the file looks valid (i.e. more than 1MB in size), you should be able to install it by opening the file from the "Downloads" app on your tablet (or the "My Files" app if you are using a Samsung tablet):