Patient Messaging

Ocean Patient Messaging allows users to send secure messages, attachments, and Ocean forms to patients. It uses the following FHIR Resources:

  • Patient
  • Practitioner
  • DocumentReference
  • Any resources returned by the $everything operation
  • Task
  • Optional: Updates to Condition, Consent, Procedure

Sequence of Connections With FHIR Resources

1. Patient Upload Request

Users start by initiating a patient upload request to Ocean. The patient may be uploaded to Ocean in a variety of ways:

  • via a Schedule synchronization (see the Kiosk overview for details)
  • via a "Fetch Patient" request in the Patients app in the Ocean portal, where a health number is entered
  • via a SMART patient-contextual launch

Ocean starts by requesting the patient either via ID:

  • GET Patient/ Or via a health number search:
  • GET Patient?identifier=

Once the Patient resource is available, Ocean calls the $everything operation to request all the data that is relevant to Ocean for this patient:

  • GET Patient//$everything (see the everything operation for details)

The $everything operation allows Ocean to fetch information relevant for this messaging exchange with the patient. For example, the clinician may want to send the user a lab requisition, in which case the $everything endpoint could return a relevant DocumentReference based on a pre-selection process in the integrated system. As another example, the popular Medication Reconciliation form allows patients to quickly indicate which of their medications they are currently taking; this is only made possible by the $everything endpoint returning a MedicationStatement.

2. Secure Message Send

When a clinic user emails the patient a secure message, Ocean immediately records a transcript of the message in the chart:

  • POST DocumentReference - Uploads a note summary of the provider's secure message, LOINC 69730-0 ("Instructions", for lack of a better match) with an attachment of type text/plain

3. Secure Message / Form Response

When the patient responds to the secure messages and completes any required forms:

  • POST DocumentReference - Uploads a note recording the patient's typed reply, LOINC 51855-5 ("Patient Note") with an attachment of type text/plain
  • POST DocumentReference - Uploads a styled note reflecting Ocean's summary of the completed form, LOINC 51855-5 ("Patient Note"), with an attachment of type application/pdf
  • PUT Patient - For any changes made by the patient to contact or demographic information (only if an Ocean form was sent that requests these values)
  • POST Observation - For recording any 'tagged' values in the completed forms which were recorded as an EMR Field Mapping, e.g. a PHQ-9 depression score
  • POST Task (Optional) - For recording a follow-up Task for the clinic staff to review the patient's changes in a timely manner.
  • POST Condition (Optional) - For recording updates to the patient's medical history, only if the completed form had fields that were mapped to a CPP entry.