When your Smart Flow is synchronized with Open VPMS you could encounter that data is not transferring to the invoice in EMR properly. At the same time, everything on the flowsheet functions as per normal and the billing items are showing up on the billing PDF correspondingly, however, they do not appear on the EMR invoice. In this case, the discharged sheets in the archive all show up with EMR synchronization errors exclamation marks (more about it you can find HERE).
The most likely cause is to do with an Azure Service Bus integration between OpenVPMS and Smart Flow.
If you are running OpenVPMS 2.0.2 or higher, you can monitor the status by going to the Administration - System and clicking on the Smart Flow Sheet Status button. This will show the time when an event was last received from the Azure Service Bus.
If this pop-up is blank as on the screenshot above then you should restart this interface by clicking the Restart button at the bottom of the window. This forcibly shuts down the Azure Service Bus client and restarts it. Once it's done the syncing issue should be solved.