Memorial Health System leaders had a plan.
They knew new processes were needed to screen and triage patients worried about the novel coronavirus. So in March the Springfield, Ill.-based system started standing up respiratory-care clinics and drive-through testing sites, and established a dedicated nurse triage hotline to direct people to the appropriate place.
What didn’t system leaders expect?
“That single phone number just got flooded in the early days with a huge number of calls, a lot of which were the worried well,” said Jay Roszhart, president of Memorial Health’s ambulatory group, during a webinar hosted by Modern Healthcare on May 19.
As COVID-19 spreads across the nation, educating people about the virus while keeping low-acuity patients at home and away from others has proved challenging. Many have turned to digital technologies like artificial-intelligence chatbots and remote monitoring to inform and manage patient care.
To cope with its overwhelmed nurse hotline, Memorial Health launched a chatbot that provides users with a COVID-19 risk assessment and directs them to next steps.
“It replaced about 2,000 of 10,000 calls early on of those ‘worried well’ that were individuals seeking information, but really weren’t at the level where they needed that additional screening or testing,” Roszhart said.
As Memorial Health continues to build out its COVID-19 response, it looks at publicly available data on the virus’ spread to help inform where it might need to scale up or scale down its efforts.
But it can be difficult to get up-to-date insights into cases as they emerge, given the spotty testing that’s taking place across the U.S., said John Brownstein, an epidemiologist and chief innovation officer at Boston Children’s Hospital.
“Having contextual information about what’s happening in the community to understand capacity needs is so critical,” he said. “There are plenty of online tools that are combining data or, for those who have the tech capacity, you can start to integrate those data to create your own situation awareness tools.”
Brownstein co-founded COVID Near You, a crowd-sourced project to monitor and map COVID-19 that was developed with volunteers from tech companies like Amazon, Apple and Google.
COVID Near You uses syndromic surveillance, a method in which researchers monitor reports of symptoms of a disease before they’re confirmed. COVID Near You is hosted on a public website, so anyone can visit it and enter information like ZIP code and how they’re feeling to help researchers identify areas with a concentration of COVID-19 symptoms.
It’s designed to help identify emerging hot spots and the effect of local interventions. There have been more than 1 million submissions to the COVID Near You website since it launched in March.
OSF HealthCare in Peoria, Ill., designed a mainly digital response too.
“As the first case of COVID came to the United States, our digital health team started to think about ways that we could lead with a digital response,” said Jennifer Junis, senior vice president at OSF St. Gabriel Digital Health.
Patients concerned about COVID-19 risk can use a chatbot on the system’s website for screening and to direct them to resources like a nurse triage hotline. Patients with symptoms and other markers suggestive of COVID-19, such as a recent exposure to disease, may then be enrolled in one of multiple home-based care programs with remote monitoring.
That includes a program in which OSF delivers thermometers, hand sanitizer, tablets equipped with symptom-tracking apps and other supplies to the patient’s home. If a patient’s symptoms get worse—but the patient is still deemed low-acuity—they’re enrolled into a next level of care, where they get monitoring devices like blood pressure cuffs and pulse oximeters.
As of early May, OSF had enrolled 927 in its program for possible COVID-19 patients, called the Pandemic Health Worker program.
It had 169 patients in its next level of care program, called Acute COVID@Home.
Together, the programs are designed to be an “end-to-end solution set” for cases where it’s possible to keep patients at home, Junis said.