A Web-Based, Mobile-Responsive Application to Screen Health Care Workers for COVID-19 Symptoms: Rapid Design, Deployment, and Usage

Abstract

Background As of July 17, 2020, the COVID-19 pandemic has affected over 14 million people worldwide, with over 3.68 million cases in the United States. As the number of COVID-19 cases increased in Massachusetts, the Massachusetts Department of Public Health mandated that all health care workers be screened for symptoms daily prior to entering any hospital or health care facility. We rapidly created a digital COVID-19 symptom screening tool to enable this screening for a large, academic, integrated health care delivery system, Partners HealthCare, in Boston, Massachusetts. Objective The aim of this study is to describe the design and development of the COVID Pass COVID-19 symptom screening application and report aggregate usage data from the first three months of its use across the organization. Methods Using agile principles, we designed, tested, and implemented a solution over the span of one week using progressively customized development approaches as the requirements and use case become more solidified. We developed the minimum viable product (MVP) of a mobile-responsive, web-based, self-service application using research electronic data capture (REDCap). For employees without access to a computer or mobile device to use the self-service application, we established a manual process where in-person, socially distanced screeners asked employees entering the site if they have symptoms and then manually recorded the responses in an Office 365 Form. A custom .NET Framework application solution was developed as COVID Pass was scaled. We collected log data from the .NET application, REDCap, and Microsoft Office 365 from the first three months of enterprise deployment (March 30 to June 30, 2020). Aggregate descriptive statistics, including overall employee attestations by day and site, employee attestations by application method (COVID Pass automatic screening vs manual screening), employee attestations by time of day, and percentage of employees reporting COVID-19 symptoms, were obtained. Results We rapidly created the MVP and gradually deployed it across the hospitals in our organization. By the end of the first week, the screening application was being used by over 25,000 employees each weekday. After three months, 2,169,406 attestations were recorded with COVID Pass. Over this period, 1865/160,159 employees (1.2%) reported positive symptoms. 1,976,379 of the 2,169,406 attestations (91.1%) were generated from the self-service screening application. The remainder were generated either from manual attestation processes (174,865/2,169,406, 8.1%) or COVID Pass kiosks (25,133/2,169,406, 1.2%). Hospital staff continued to work 24 hours per day, with staff attestations peaking around shift changes between 7 and 8 AM, 2 and 3 PM, 4 and 6 PM, and 11 PM and midnight. Conclusions Using rapid, agile development, we quickly created and deployed a dedicated employee attestation application that gained widespread adoption and use within our health system. Further, we identified 1865 symptomatic employees who otherwise may have come to work, potentially putting others at risk. We share the story of our implementation, lessons learned, and source code (via GitHub) for other institutions who may want to implement similar solutions.

Association of Self-reported High-Risk Allergy History With Allergy Symptoms After COVID-19 Vaccination

“…Employees were directed via email or a hyperlink on an existing custom COVID-19 symptom-check application 17 to record and report their own postvaccination symptoms daily for 3 days after vaccination using a web-based survey (REDCap; Vanderbilt University) (eMethods in the Supplement ). For employees without computer or smartphone access, symptom checks were conducted by hospital staff by telephone call or text message.…”

Deploying digital health tools within large, complex health systems: key considerations for adoption and implementation

“…For example, to comply with Wisconsin-specific vaccine distribution and prioritization criteria, ThedaCare (a Wisconsin-based health system) turned to their EHR vendor to build a customized tool 18 . The Mass General Brigham health system (Boston, MA) internally developed a tool to comply with specific guidance from the Massachusetts Department of Public Health (MDPH) on screening visitors and employees for respiratory symptoms before entering healthcare facilities (Table 1 ) 20 .…”

“… No tool that met this need was offered by the EHR or other existing vendor, so the tool was initially developed by an internal digital health team that used an existing application development tool supported by the organization. Given the need to scale a robust solution within a very large organization and the continued need for custom features, the internal team quickly moved to a custom.NET Framework application solution 20 . Financial value What framework does the tool leverage to generate financial value, and does it outweigh the costs associated with deployment and maintenance?…”

“… Prior literature shows that increased OR utilization rates at other health systems has resulted in higher rates of surgeon-reported satisfaction, lower surgeon burnout rates, and faster OR access for emergent procedures. The impact of the tool was measured in terms of the number of symptomatic individuals successfully prevented from entering the facility, the fraction of individuals tested for COVID-19 within 14 days of a positive screen, and the fraction of individuals with a positive screen who truly had a COVID-19 infection 20 , 24 Data assets Does the health system have access to the data necessary for tool functionality? Is the tool interoperable with the health system’s IT infrastructure?…”

COVID Pass: A Case Study for Clinical Informatics

“…COVID Pass 1 is a comprehensive web-based COVID-19 screening and scheduling platform at our multi-institutional academic medical center. It demonstrates several key components of Clinical Informatics: digital apps, clinical workflows, people management, electronic health records, improving quality and safety, data infrastructure, analytics, communication and collaboration among interdisciplinary teams, and leadership.…”