The State of Rhode Island is a Trailblazer

The State of Rhode Island is a Trailblazer in Testing and Contact Tracing Efforts

 

“When the pandemic started, our top priority was and remains ensuring Rhode Islanders are safe and healthy,” said Bijay Kumar, CIO for the State of Rhode Island, “which meant that even though we didn’t know the size or the scope of the problem, we would still need a comprehensive response strategy to support the Department of Health and frontline workers. We needed a ‘catch all’ without the luxury of knowing what a ‘catch all’ would entail.”

Rhode Island’s state government is responsible for protecting the health and well-being of its residents in the face of a public health crisis like the COVID-19 pandemic -- a mission that has forced leadership to make some exceptionally tough decisions. Like many states across the country, Rhode Island took a straightforward approach to responding to novel coronavirus in its community; it shut down whole sectors of the economy, asked large groups of people to shelter in their homes, and had to respond to new or changing information as it was discovered or validated by the healthcare industry in real time.

“As our knowledge of the disease continues to evolve, we’re trying to be more pinpointed with our approach,” added Chirag Patel, Chief of IT Enterprise Applications “This calls for more testing, quicker case investigation, and robust contact tracing.”

Contact tracing is key to a safe return to work.

Contact tracing is a very detailed — and oftentimes a very manual — process often conducted by departments of health. When someone tests positive for certain diseases, the trained state, city, or county health staff will get in touch with him / her / them and record any interactions with people or places that took place during the infectious period. The department then follows up with the primary and secondary contacts of a person who tests positive.

And while it is not a new concept within the public health community (it has been used to track H1N1, Ebola, and so on), it is a now a household term with the onset of COVID-19. Departments of Health, Governors, Mayors, and more have asked their residents to keep a diary of the people and places they have come in contact with so that the state might have an easier time retracing the public’s steps.

“The virus doesn’t take a break,” said Kumar, “which means this process has to be faster and more flexible in order for us to gain ground on the spread and make reopening the state possible.”

Rhode Island moves its testing and contact tracing system to the cloud.

Kumar, Patel, and team transitioned its contact tracing system from an on-premise solution to Salesforce’s Customer 360 for Government. It gives the Rhode Island Department of Health a comprehensive record of each and every COVID-19 case across the state, and allows for a more integrated and adaptable solution to the pandemic. It also is compliant with applicable privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA).  Here’s how it works:

A Rhode Island resident starts experiencing COVID-19 symptoms and they call their healthcare provider. If the patient’s symptoms warrant a test, the physician can log into an online portal built on Community Cloud and Lightning Scheduler, look through available days and times at nearby testing sites, and schedule accordingly. Relevant details, such as symptoms and basic demographics, are captured in a profile-like record in Health Cloud at the time of test-scheduling, allowing the team to potentially have a fuller picture of how positive and negative results are broken down within the community. The system also allows Rhode Islanders to ‘self-schedule’ tests.

Rhode Island is beginning to leverage built-in API capabilities of Salesforce to feed laboratory test results into the system. If the results are positive, they are added to the workflow of Rhode Island Department of Health case investigators, who then follow up with the individual to explain that they need to enter isolation and see if they would be open to participating in the state’s contact tracing effort.  For those who are willing, case investigators can sign up the individuals up for automated symptom monitoring which will let the individual know when they are ready to end isolation. This triggers a daily SMS text message containing a survey (sent via a third-party system), which individuals can use to report any changes in symptoms and request services such as housing and food support to help ensure they can succeed with isolation. The results are integrated within Salesforce, and built in logic helps drive the functionality. Every day the list of individuals needing quarantine or isolation support services is provided to RI’s local United Way 211 to help connect the individual with the support they need; efforts are underway to integrate this process electronically.

“The work we do is important only in how much it helps,” said Patel. “It’s easy for technologists to look at this kind of project as 1’s and 0’s, but the resulting impact has meant so much more.”

Quick wins and early results point to meaningful impact.

The initial version of the platform was live within just one month and specific features (such as test scheduling) were able to be brought live within just one week, replacing semi-electronic processes with the kind of automated, digital experience departments and agencies need in order to scale their resources to address this crisis. Laboratory ordering through a state-based portal also allowed for Rhode Island to more carefully monitor and provide directed testing in a time that test kits and PPE were in short supply.

Additionally, the team consolidated multiple workflows into a single platform, which (A) eliminates tasks like duplicate data entries which are typically time consuming and prone to errors and (B) reduces the amount of time it takes to contact someone after they have either tested positive or been exposed to someone who tested positive – the ultimate goal of any contact tracing effort.  

In a desire to continuously improve the response, the state is starting to also measure the number of cases, how long it takes to process a case, testing of the workforce, and so on. The number of users can be ramped up or ramped down, giving Kumar, Patel, and team a solution that can flex with waves in the virus. And, since the platform is built in the cloud, this can all be done via a remote work environment.

“This strategy gives us the tools to keep pace, the data to evolve, and the ability to do more in fighting this crisis,” said Kumar, “It gives us a foundation that has an immediate impact as well as lasting impact on how we respond – not react – to the future.”

 

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