Aim
When COVID-19 began to spread in early 2020, the San Francisco Department of Public Health issued orders that every health institution needed to screen its employees for symptoms of the disease, as well as risks of exposure, before allowing them to enter the facility each day.
UCSF’s initial efforts involved questioning people individually, which took hours. The people in charge of administering the order, as well as making sure that UCSF employees and visitors were safe and the University and its clinics would not cause a spread of disease, sought SOM Tech’s help to build a more efficient, digital solution.
Partners
Ralph Gonzales, MD, MSPH, Associate Dean for Clinical Innovation and Chief Innovation Officer for UCSF Health. Because of his experience with respiratory illness, as well as his work with digital technology, Gonzales was asked to lead the clinical side of the guidance and the technology innovation that backs it up. “I oversee the policies we put into place, how long people stay out, what testing we need, and what to do if there’s an outbreak,” he says.
UCSF deployed a large COVID Response Team to tackle issues including access to campus and clinics. Among the team members who worked with SOM Tech on the Daily Health Screener was Lara Bellingham, who had been the in-patient manager at UCSF Benioff Children’s Hospital San Francisco. Since the pandemic began, Bellingham has served as UCSF’s Covid 19 clinical manager in the Office of Population Health.
Approach
UCSF had been working with a private company on an influenza screener, on a much smaller scale, when COVID hit. The company pivoted and worked on a health screener through the early months of the pandemic.
The early efforts were time and labor intensive. “It was not an efficient process,” Bellingham says. “I remember thinking, how are we going to screen thousands of employees to make sure everyone is safe on site?”
UCSF sought a digital solution and ultimately brought the project in-house to the SOM Tech team. “It was kind of a mess when I picked that project up,” says Tom Manley, SOM Tech’s project manager on the endeavor. Manley met with many high-level people from across the UCSF campus and came to realize “there were two separate sets of requirements being tracked by two people and no consensus on which was accurate or what we should be working toward.”
Manley worked to clear up the confusion and achieve consensus on a vision. “It’s the project manager’s job to avoid unpleasant surprises and make sure we’re all on the same page,” he says.
After working on it for a couple weeks, Manley says everyone arrived at consensus fairly quickly, and SOM Tech could move on to building a solution.
In creating a website or app, SOM Tech needed to make sure it protected people’s personal health information, and maintained bedrock systems of safety, security and authentication. “We needed to wrap the survey in something that would be safe and secure as well as deliver daily reports and reportable figures, so if somebody self-reports that they have COVID, we want to be able to look at the buildings they’ve been in so we can alert the right people that they may have an exposure.”
Solution
The system was first rolled out for visitors to UCSF. Each person would take a brief survey, typically on their smartphone. Depending on their answers, they would get either a green symbol on their phone, which they could show at a door and gain admission, or a red symbol, which meant they could not enter.
A system for employees was built using the same software code, Manley says. “It's a different survey and a different sort of authentication mechanism, but it’s basically the same sort of thing,” he says. “We can't guarantee that everybody is COVID-free when they come on campus but we want them to at least attest that they probably don't have COVID.”
SOM Tech didn’t write the survey questions, but left those to Gonzales and his team. “The University has people who are as good at this as anybody in the world,” Manley says.
The screener was also produced in five languages, to remove any obstacles to taking the survey.
People were asked if they had certain symptoms, if they had traveled recently, and if they had been exposed to somebody who has COVID. “The survey itself is fairly in-depth and is entirely designed by people who know the science and the medicine,” Manley says. “The survey keeps evolving over time.”
Employee adoption was slow at first. The screener allows workers to open the door and get to their office, with a reminder to fill out the survey within their first hour at work. “If they haven't submitted the survey in an hour, we email their boss,” Manley says. “Compliance shot way up in the week when we turned that on.”
Yet the screener also changed to allow some flexibility. Someone may be rushing into a building for a meeting and not have time to screen, which is why it gives an hour grace period. Someone may also get a false positive, and now they’ll have a chance to work out the issue from their desk, rather than disabling their employee badge. The designers did not want to create something cumbersome or punitive that would discourage compliance.
The app also gives employees plenty of resources, including where to get tested, and where to get treatment if necessary. It also linked to UCSF’s comprehensive COVID resource website. And it reminds them of rules as they shift, whether on masking, distancing, or vaccines and boosters.
Early in the pandemic, Gonzales says, UCSF worked hard on contact tracing.” We had nurses who were dedicated to calling everybody up who was positive to find out where they had been and where they could have gotten it,” he says. “Those calls would take 45 minutes or so.”
No more. “We were able to streamline that questionnaire and then embed it into the screener,” he says. “Now those questions get asked (digitally) and we have an algorithm that we built on the back end to determine the most likely source, and then that gets sent to the correct response team. No one has to call and spend 45 minutes on the phone.”
Another major advantage of the screener is that people can take it while they’re still at home, so they don’t get to work and get turned away at the door. “I would do it before I got out of bed at 4:30 am,” says Bellingham. Users can also have the screener send them a daily text message at a time of their choosing to remind them to answer the survey. “This is so nice,” she says.
“What a smart way to leverage technology, to get people to work on time, and address the COVID concerns,” Bellingham says.
Success story
Gonzales says the screener has helped UCSF keep COVID from spreading in the workforce.
“It helps reminds people that they need to be checking their symptoms every day,” he says. Often people don’t report minor symptoms, as they hope it’s just allergies or something minor. Yet once they test positive for COVID, they might admit having symptoms days earlier. “People misinterpret their symptoms,” Gonzales says. “We really encourage them to get tested for any symptoms. It doesn't matter if they think it's their old symptoms or new symptoms.”
In addition, he says, the screener “facilitates the pathway to testing. If you had a COVID exposure, you're at high risk for turning positive. You're often infectious for two days before you develop something. We want to identify those people.
“So we let people come back to work with the virus exposure, but we have them tested every day or every couple of days,” Gonzales says. “We think that has helped identify people early before they get symptomatic, or if they don't have any symptoms and are just silent spreaders. If they're answering honestly about their exposures, then we are screening those people out.”
The screener also helps UCSF reduce the toll that COVID has on the workforce. It provides “the ability to get tested quickly and to have ready access to guidance for how to get back to work as soon as possible,” Gonzales says. “We're eliminating any of those barriers to getting back to work.”
Written by Dan Fost for SOM Tech (2022)