University of Toronto Health & Wellness Clinic 

How Patient Reminders automatically administered thousands of COVID-19 and mental health assessments 

In August of 2020, under the looming shadow of COVID-19, the Health & Wellness Clinic (HWC) at the University of Toronto was tasked with quickly implementing a COVID-screening program for international students returning to campus. During the mandatory 13-day quarantine period, students needed to be screened daily for symptoms of both COVID-19 and mental health concerns.

The Challenge

As students started to return for the fall semester, screening assessments were handled over the phone, with a nurse documenting patient responses in the chart. But what began as a trickle of 12 – 18 students escalated very quickly.

“The biggest challenge for us was that we didn’t know the volume of students coming in – until they were here,” says Janine Robb, Executive Director of the Health and Wellness Clinic. “By the beginning of September, the numbers got very high, and we realized we had a problem.”

At the height of the quarantine, clinic staff were monitoring 500+ students and making 14,000 calls per week. The onerous task had nursing staff working 16 hours a day – even on weekends.

The HWC required a solution that would enable daily screening of students, reduce the number of manual calls, and alleviate the administrative burden on the medical services team.

With timing a critical factor, the HWC turned to CognisantMD to help them find a solution.

The Solution

It was determined that the best tool to support the COVID-screening program would be the Ocean Platform with its automated reminders solution and patient forms technology. A studies module was also enabled to track the results of the program in a centralized, anonymous database.

“We already had a history with CognisantMD and their Ocean products, and knew the capability of the platform,” says Robb. The HWC had been utilizing Ocean Tablets for new patient intakes for two years. Each patient completes forms on a secure tablet, and the patient’s file is automatically updated in HWC’s Accuro EMR, a process that reduces manual data entry, improves accuracy and saves time for administration staff.

How It Works

Here’s how the HWC Quarantine Full Program with the Ocean Platform works:

  • A nurse makes initial contact with the student to schedule a virtual visit or phone call for the next day.
  • The nurse creates a dedicated appointment type in the EMR, indicating the beginning of the quarantine period.
  • At the same time, an email schedule is triggered in Ocean, which sends the student a reminder email with a secure link to two Ocean forms: a COVID-19 symptom checker and mental health questionnaire. This occurs for two days at a time.
  • Every three days, the student receives a call from the nurse instead of an email.
  • Over the 13-day quarantine period, the student receives 12 surveys and 5 calls.
  • Data from completed forms is automatically imported into the patient’s chart, clearly signalling if a COVID-19 symptom or mental health concern was identified. No manual data entry is required.
  • Results are displayed on a single-screen dashboard providing nursing staff with an at-a-glance view of all patients with red flags and prompting a phone call to determine next steps.

Ocean Outcomes

Students like the mix of personal calls and emails

Student response to the program has been very positive. They appreciate that surveys can easily be completed at the students’ convenience using any device with a browser such as a smartphone, tablet or computer.

Sandy Chang, Assistant Director at the Health & Wellness Clinic, says the combination of emails and personal contact proves to be a nice mix for students. “They like that the first contact is an in-person call or video session, and they like being able to answer survey questions when they have time.”

Robb adds that it’s a good balance because human contact is also very important for those who are far from home. “They can feel very alone, so a friendly voice checking in on them from time to time is always welcome.”

Mental health screening is essential

If attending university in a country far from home isn’t isolating enough, placing students in quarantine for two weeks can only amplify emotional distress. That’s why an important component of the COVID-19 screening process is mental health assessment.

“These students can’t have any social contact unless it’s virtual,” says Robb. “We are mindful that this group is vulnerable and at the age when serious mental illness onsets. Our nurses are very good at interviewing the students and looking for clusters of symptoms that identify more serious cases. But we wouldn’t know about some of the struggles they face without our Ocean survey reminders,” she adds.

Quick and painless implementation

The Ocean Platform tool was implemented in just three weeks, which included the customization of forms, configuration of the daily screening, and training of staff.

While the compressed timeline did mean a few wrinkles initially, it didn’t take long to smooth them out. HWC feels that CognisantMD really stepped up to create a product that supported the work that needed to be done.

Chang credits Haley Gush of CognisantMD for her responsiveness and persistence. “Haley worked very hard to understand our challenges. She stayed on the job to implement and test the solution thoroughly before we went live. And she was very involved with training our users.”

The EMR-integrated Ocean Platform with automated reminders and patient forms reduced the administrative workload of the HWC, enabling them to return to a normal 7.5 hour work day – Monday to Friday. It also allowed the small team to conduct wide-scale healthcare screening, without reducing quality of care. By the end of February 2021, the HWC had completed over 2,300 assessments using the Ocean Platform solution.

Looking ahead, the HWC is undergoing a space and program redesign to help realize its goal of being as paper-free as possible. Robb is confident that Ocean technology will continue to be an integral part of the clinic’s vision for the future.


  • 500+ patients screened
  • 2300+ assessments completed
  • 1000s of automated reminders sent
  • Hours of admin burden saved for nursing staff
  • Overall better patient care

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