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Frequently Asked Questions

Digital referrals & orders

The following challenges were identified through extensive engagement with care providers, administrative staff, and patients from across BC:


  • Fax-based referral and ordering processes are inefficient and subject to errors, creating significant work for physicians and admin staff
  • Patients and requesting physicians have little or no visibility into the status of referrals and orders
  • Referrals/orders often lack sufficient/appropriate information, causing rework and potential delays
  • Significant overhead in managing forms (referral, diagnostics, etc.) and keeping up with changes

The Digital Referrals and Orders (DRO) program is intended to address the above issues, creating a seamless, efficient experience for patients, health care providers, and administrative staff.

Extensive consultation took place with care providers across the province to better understand the challenges they faced in delivering care.


As part of the Digital Health Strategy Refresh, workshops were scheduled by Doctors of BC in summer 2022 to gather input and requirements for a Clinical Service Request for Proposal (RFP).


Several physicians and other clinicians were actively involved throughout the RFP process, including evaluating and selecting the chosen vendor, Ocean.

 

The DRO program is currently approving user licences for receiving clinics in the lower Vancouver mainland.


Sending providers do not need a license and so can be located anywhere in the province, however implementation is currently focused in the same geographic area.


The program will begin adding licences in more regions over the coming 12 – 24 months. The DRO Program is planning to implement eReferrals across the province.

 

The benefits to specialists include streamlined referral process, reduced use of fax, tracking of referral status for sending and receiving providers, secure messaging between providers/clinics, and the ability to update and maintain digital referrals and automated referral status updates.


Specialists (receivers) who participate in the DRO program will also receive access to the patient engagement tools for (optional two-way) secure patient communication, online patient forms/questionnaires and soon Ocean website forms.

 

Enables sending sites/providers to receive real time status updates about the referrals they send and seamless communication and information exchange with receiving sites.


The system also enables patients to consent to receive automatic updates about the status of their referrals. Sending sites also have access to a dashboard to manage all referrals.


The Healthmap will also always have the most up to date referral form and so sending sites will no longer need to manage changes or updates to forms in their EMR.

 

Currently there are approximately 300 Ocean users in BC, using the Ocean Patient Engagement platform at their own cost.


eReferrals, eOrders and eConsults will be available to all community providers at no cost.


Ocean Patient Engagement tools will also be available at no cost to providers who are receiving referrals using the DRO Program.

 

There are many resources available to explore. A good place to start is with these videos.

 

To send eReferrals, users must have an Ocean account.


Receivers require a listing on the Ocean Healthmap and a license to participate in the program.


The DRO team is working strategically to build capacity in specific geographic regions to increase the available network to send and receive referrals.

 

Currently eReferrals listings for receiving locations are being implemented in the Vancouver Lower Mainland area.


If you use one of these integrated EMRs or are willing to use the Ocean web portal to send or receive eReferrals, please contact us at: DRO.Program@phsa.ca.

 

Yes, Ocean is mobile ready.

 

There is no cost for providers, administrative staff, or patients to use this platform as it is funded through a provincial contract via Ministry of Health.

 

Specialty working groups

The DRO Program powered by Ocean is promoting a digital referral standardization approach to deliver value to providers early while addressing core referral workflow issues.


The DRO program is supporting the eReferral creation by speciality area through Specialty Working Groups (SWGs), whose members:


  • Provide clinically rooted direction-setting
  • Define build requirements, design, and development for provincial digital referrals
  • Are comprised of subject matter experts (SMEs) from both the sending and receiving side of the speciality referral and their office assistants
  • Can articulate their needs, offer workflow insight, formulate usability considerations
  • Evaluate the build prior to release into production

The Doctors of BC are supporting the identification of physicians to these working groups and will also cover all sessional fees for participating for DoBC members.


Over time, the DRO program will develop a repository of digital referrals that embody the same look and feel and take advantage of the full capability of the Ocean functionality.


Digital referrals will be maintained by the DRO Team to ensure they are up to date.

Specialty working groups (SWG) are supported by Doctors of BC which is helping facilitate physician involvement and input and provides funding for Doctors of BC members and staff to participate.


If you are a Doctors of BC member interested in participating in a SWG, please contact the Doctors of BC Digital Health team at digitalhealth@doctorsofbc.ca. You can also learn more about Doctors of BC’s digital health advocacy and upcoming engagement opportunities.

Most specialty working groups take between 8-10 weeks to complete and will require between 1-3 hours of your time each week to participate in virtual meetings or review information between meetings. Some working groups may be shorter or longer depending on complexity.


Digital Referrals & Orders facilitators will help the group navigate the discussions to develop a digital referral that balances the needs of both senders and receivers.


The aim is to create a digital referral that is both efficient and effective for both sides of the referral process and leverages the benefits of the platform.

Once the digital referral is created and published in the PHSA digital referral library, a receiver that wishes to use one of the available digital referrals may be implemented with Ocean.


During implementation, the clinic will be supported to create a directory listing on the Ocean Healthmap.


At this time, implementation is limited to geographic areas in the lower Vancouver mainland however, these restrictions will be lifted gradually over the course of 2024 and 2025 as the program expands across the province.


All providers are encouraged to participate in the process to create digital content for the system so that its ready for your site/service/program when the system is being implemented in your area.

As part of the PHSA Digital eReferrals Library, a Standard Referral is available immediately for any receiving site to use.


This referral contains essential information and is specialty agnostic; it can be leveraged by any specialty either on a permanent basis or until a specialty/service focused referral can be developed.


This will enable faster deployment across the province while the DRO program continues to build up the BC Ocean Library of digital referrals.


The currently available PHSA referral forms in the library are:

More eReferrals will be added as they are created through specialty working groups.


Please note these links show the referral content, but do not show the standard header (patient demographic and contact information) or footer (sender information) that are standard for every eReferral.


Standard header:

screenshot of header


Standard footer:

screenshot of footer

eReferral forms are stored in Ocean’s central repository of clinically validated documents. The DRO team is responsible for updates and maintenance. Any changes to these forms get updated instantly for all clinics using the form. Therefore, all forms visible on the Healthmap in Ocean are always the most current version.

The DRO team will work with providers to consider the best solutions for the eReferral for their listing. Digital forms provide different functionality than static paper forms. eReferrals in Ocean use logic and can require specific fields and reminders for attachments.


PHSA is committed to creating a BC library of digital referrals that developed by users with a consistent format to streamline workflow on both the sender and receiver side.


Some of the benefits of consistent eReferrals are improved user experience, reduced cognitive burden, ability to support best practices, and capability to gather analytics.


Development of a manageable library of digital referrals will also enable more rapid implementation provincially.


Integration with Ocean

Ocean allows providers to submit a referral by clicking on an Ocean eReferral link embedded in their EMR (Accuro, Oscar Pro or Med Access) while viewing the patient’s EMR chart.


The patient’s information automatically populates into the Ocean eReferral.


Once the referral is submitted, a copy of the referral will be imported into the patient’s EMR chart.


Patients and referring providers also receive updates via email, including once an appointment has been scheduled and any notes following their completed booking.‎

 

Ocean is currently integrated with several EMRs; notably in BC this includes OSCAR Pro, Telus Med Access and QHR Accuro.


Ocean has a free and open FHIR API (R4 compliant) allowing EMR vendors to integrate easily.


The DRO team has analyzed EMRs in use in BC and is actively pursuing key integrations. Integration with hospital based Clinical Information Systems (CISs) is planned, with current planning for CST Cerner underway.

 

Ocean and Cerner are compatible although not currently integrated.


Integration is on the roadmap and work is underway to be finished in 2024.

 

eReferrals can be used without an integrated EMR. Ocean is also accessible via web portal.

Ocean is a separate platform from the various EMRs used in BC. Ocean connects providers via their various systems to support patient care.


It uses HL7 FHIR standards to access and share information, including eReferrals. Centralizing data exchange through a single network supports system-level improvements and more equitable care.

eReferrals allow the digital creation and management of referrals, while CareConnect provides a view only health record.


Provincial Digital Referrals & Orders is part of the larger Digital Health strategy that encompasses the Longitudinal Record Access (LRA), that will serve as a gateway to allow clinical systems to “talk to one another” and share clinical data from a variety of sources securely.


Health Toolkit is another important initiative enabling integrated tools and mobile apps to access health data when and where they need it.


Health Toolkit works with the LRA making information accessible and easier to use.

 

eReferrals allow the digital creation and management of referrals, while CareConnect provides a view only health record.


Provincial Digital Referrals & Orders is part of the larger Digital Health strategy that encompasses the Longitudinal Record Access (LRA), which will serve as a gateway to allow clinical systems to “talk to one another” and share clinical data from a variety of sources securely.


Health Toolkit is another important initiative enabling integrated tools and mobile apps to access health data when and where they need it.


Health Toolkit works with the LRA making information accessible and easier to use.

 

Privacy and security

PHSA and the BC Ministry of Health are fully committed to protecting the privacy of patients’ personal health information and completed a Privacy Impact Assessment (PIA) prior to selecting the Ocean tool.


The Ocean Platform was built to keep patient health data private and secure, using client-side patient encryption technology. It uses the same 256-bit AES encryption that is used in online banking.

This agreement is between the organization or user and PHSA.


PHSA is the contract holder with Ocean and is offering this platform at no cost to private practice and health authority locations.


This agreement ensures that the appropriate privacy, security, access and use controls are in place to protect confidential patient information.

This is an agreement between the vendor, Ocean, and you as an individual.


Ocean requires this of all users of their system. It outlines the terms of use.


PHSA does not have any control over this agreement. It is used by the vendor across Canada.

This agreement was written to avoid the need to change or update its content in the future.


As a result, any of the policies, terms or supporting material for the agreement that might change in the future are referenced in the agreement but up to date versions are maintained below.


If there were any major or material changes to any of this information, all sites and users will be notified before these changes are finalized.

The PPN is a separate initiative and is not a pre-requisite to use eReferrals.


Ocean allows a user to switch between different Ocean sites on different EMRs, while retaining single sign-on (SSO). Your unique user-to-EMR account relationship is logged and eliminated the need to maintain multiple accounts.


eReferral data remains encrypted on the client-side, meaning even system administrators cannot view personal health information. More information about Ocean security and encryption can be found here.

All data is stored in Canada in secure data centres. All personal health information (PHI) is encrypted on the client side, meaning that only users who use their encryption key can access patient data.


All patient data is encrypted end-to-end with the industry standard 256-bit Advanced Encryption Standard. Encryption keys are not accessible by Ocean employees.


Even if Ocean servers are compromised or data intercepted, no unencrypted PHA is accessible.

 

All involved servers, including Ocean’s, are stored in Canada.


A Privacy Impact Assessment (PIA) and associated response plan was developed with legal counsel from Provincial Health Services Authority to ensure FOIPPA compliance.

 

As per the Freedom of Information and Protection of Privacy Act (FOIPPA) s. 30. sites are responsible for proactive and reactive auditing.


Audit reports can be run by Ocean site admins.


A guide that provides the information required for accessing your site’s audit logs and provides guidance on how to review the logs can be found here.

 

For additional questions or to learn more about the Digital Referrals & Orders program, please email dro.program@phsa.ca.


SOURCE: Frequently Asked Questions ( )
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