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Tracking COVID-19 isn't just of interest to public health entities. Healthcare systems are also investing in efforts to monitor the virus.
One such effort is contact tracing, an infectious disease control method that has been around for decades and remains largely manual. The idea is to identify relationships between those who are infected and those they've been in contact with while contagious. Making individuals aware of a potential exposure can help slow the spread of the virus.
Tech companies are building platforms that digitize some contact tracing methods. Apple and Google recently released a draft version of their Bluetooth-enabled Exposure Notification API, aimed at helping public health entities notify individuals of potential exposure through apps and detail next steps. Other vendors are taking a different approach to contact tracing. Sentinel Healthcare, for example, has created a HIPAA-compliant platform to monitor individuals exposed to COVID-19.
Regardless of the methodology, the potential for tracing a COVID-19 exposure brings up concerns for healthcare CIOs and public health systems alike, including patient privacy and getting user buy-in. Yet keeping track of the virus will be essential to reopening healthcare systems, as well as the economy.
Contact tracing at UT Health Austin
UT Health Austin in Texas, the clinical practice for the Dell Medical School, is using Sentinel Healthcare's platform to monitor both healthcare workers and patients who have been exposed to COVID-19.
Aaron Miri, CIO at UT Health Austin, said the Sentinel Healthcare platform provides home monitoring and contact tracing capabilities for COVID-19 patients. He decided to invest in tech as a way to manage the patient population during the COVID-19 crisis.
Sentinel Healthcare platform users can access the platform via a mobile app. The app prompts users to regularly record their symptoms and temperature. Exposed individuals can be provided a digital thermometer that integrates with the platform.
Algorithms within the platform keep tabs on the data and can detect when an individual's symptoms worsen. Real-time alerts are then sent to appropriate medical professionals, who decide if the patient needs to go to the hospital or should receive care in another way, such as a telehealth visit. The app also tracks diagnostic labs for patients from drive-thru testing sites.
Once the health system confirms that a patient has been diagnosed with COVID-19, a remote call center workforce reaches out to anyone the patient had recently been in contact with.
Forrester Research healthcare analyst Jeffrey Becker said tools healthcare CIOs invest in, like the Sentinel Healthcare platform and infectious disease monitoring tools from major EHR vendors, can make the contact tracing process more efficient.
"There are tools for creating that list and then it's still just a manual call center," Becker said. "This should be seen as enhancing an existing capability, not introducing a net new capability."
As UT Health Austin collects data on COVID-19 patients and who they've been in contact with, Miri said data exchange becomes critically important.
"A lot of it is workflow," he said. "What data do you need to capture that goes into the CDC forms, what data do you need to capture that goes into Austin public health forms, what questions should you be asking, being mindful of things like HIPAA? … All of that stuff has to happen and work to make contact tracing work."
Jeffrey BeckerHealthcare analyst, Forrester Research
Miri isn't alone in his efforts to monitor COVID-19 within a health system. Cletis Earle, CIO at Penn State Health and Penn State College of Medicine in Hershey, Pa., is also looking at tools that can help digitize parts of the contact tracing process, particularly as the country begins to think about reopening. Reintroducing healthcare workers who have been working remotely back into the healthcare system to conduct normal operations makes it critical to have some way to keep track of employees and potential exposure to COVID-19.
"We're trying to look at different solutions that will be able to help track our own employees to ensure they remain healthy and safe throughout the extended component of this pandemic," he said.
Becker said contact tracing is beneficial for healthcare systems because it goes a step further than traditional disease surveillance and aims to capture person-to-person instances of contact lasting longer than 15 minutes. With contact tracing, healthcare systems can identify exposed clinicians if a patient is diagnosed with COVID-19.
"For hospital systems, the real value is monitoring the spread of COVID within the organization," Becker said. "It's protecting workers; it's preventing the spread of COVID-19 from patient to patient, worker to worker."
Digital contact tracing on a national scale
Healthcare systems see an immediate benefit to implementing their own tools to help with contact tracing, but the benefits of a national, public health contact tracing effort are mostly theoretical because widescale diagnostic testing for COVID-19 and a comprehensive program for contact tracing don't exist yet, Becker said.
Tech companies are hoping to change that. Google and Apple, for example, have developed an Exposure Notification API, a contact tracing initiative geared to public health agencies. Public health departments can use the API to build contact tracing apps that notify users when they've been exposed to someone who has been diagnosed with the virus, something that would typically be done with a phone call. However, it would be up to individuals using the app to confirm whether they've tested positive for COVID-19.
Becker said the capability would be valuable as the economy reopens and people begin to travel, go back to work, use public transportation and interact with the general public.
"Six months from now, you might be sitting on an airplane within six feet of nine people you don't know," Becker said. "So there is value in creating technologies that will allow your phone to passively capture identifying information from those people you are around that you don't know. With diagnostic testing and a comprehensive contact tracing program, we can begin to reopen the economy and have a plan in place that will still allow us to isolate the virus."
But, for a digital contact tracing program to work effectively, it would require widespread use so that it can capture as many encounters between an infected person and a non-infected person as possible. For that to happen, Becker said it would require significant engagement from citizens, as everyone would have to opt in and have the contact tracing app enabled, as well as submit whether they've tested positive for COVID-19. Getting individuals to buy in to this sort of monitoring will be a barrier to widescale adoption and a barrier to the effectiveness of the technology, Becker said.
"If you're only getting 20% of the population to use the app, you're only getting 20% of the transmissions," Becker said. "If you're only getting 20% of the transmissions, it's not an effective strategy to reopen the economy."
Another challenge facing adoption of such tools is privacy, Becker said. For patients who have been diagnosed with COVID-19 but later return to work, anyone in the workplace who has the app downloaded would be lighting up with notifications if that individual also has their app running.
"It's a real-time process, very invasive," Becker said. "People that are diagnosed that don't have a choice about being in the community are just going to turn it off and opt out because otherwise they're going to be walking around the community in real time watching as people are notified that they've been exposed."
In the first phase of Google and Apple's initiative, users will be able to download contact tracing apps onto their phone. In the second phase, the tech giants plan to build the capability directly into the device's OS to help ensure broad adoption, but users would still have to opt in.
Becker said he's interested to see how adoption of such apps pans out in the U.S. -- something he doesn't believe will get very far unless it's mandated.
"I think at that level, it's not going to be the silver bullet that is being attributed to it," Becker said. "Unless there is some way in which it becomes mandated, which would never fly in the United States … it's going to stay an opt-in [option] and it's going to receive relatively low adoption and the impact will be pretty significantly diminished."