Use Case - Phone Screening Triage

Actors – Community Health Center / FQHC healthcare provider, patients
Stakeholders – Patients, Public Health Agencies, CDC, etc.
Primary Actor – Staff person without medical decision-making such as front desk, MA or reassigned individual like dental assistant, pharmacy tech, etc
Preconditions – COVID-19 reported cases in the area / community
Triggers – Patients concerned about health-related issues from COVID-19
Main success scenarios [Basic Flow] – Patients who are negative on phone screening, with no follow-up call or subsequent health center visit within a timeframe
Alternative paths [Alternative Flow] – Positive for CDC Patient Under Investigation (PUI) Clinical Criteria for COVID-19.

Primary Actor: Frontline workers

HIT Preconditions:

1. Perform critical services (whether clinical, delivery, or public safety) throughout a pandemic (e.g. COVID-19)

2. Balance risks of exposure with performance of clinical duties.

3. Use of an electronic clinical decision support (CDS) tool (vendor-driven vs. platform-agnostic)

4. Availability of patient-driven triage solutions, interoperable with EHR or open-source/agnostic

5. Data Dictionary, unified registry for centers with adequate HIT network infrastructure

6. Supply chain and inventory management system

7. Patient portal, mHealth, SMS, other basic forms of telecommunication policies

Triggers: Pandemic (e.g. COVID-19)

Main success scenario:

1. Negative phone screening from a combination of solutions:

• Provider-side (electronic script workflow / CDS tools - predictive modeling(Bayesian)-prognostication-risk stratification)

• Patient-driven (self-administered survey[push & pull methods e.g. QR], wearable devices (those with co-morbidities), remote telemetry, risk assessment) solutions.

Considerations: multiple methods?

• Phone screening by non-clinician

• Self-screening by web link?

• CDC self screening?

Alternate Paths:

1. Possible positive cases → automated telehealth consult forwarding → telehealth consult workflow

2. High risk / Urgent → automated 911 call forwarding

Open

Open

Modifications to CDC list:

Exposures:

• Close contact with Special Populations-- combine with special populations questions in workflow?

• Notified of a possible exposure or contact with known COVID patient

• Ask about travel and if you have stayed away from home (your address on file)?

Symptoms:

• Chills

• Sneezing

• Loss of taste

• Loss of smell

• Poor feeding and Poor appetite

High Risk Conditions:

• Hypertension

Special Circumstances:

• Add essential workers, migrant workers/processing workers

• Add nursing mothers?

• Housing insecurity/homelessness

1. PRE-CALL: Review the following for the patient: A) query for high risk conditions/diagnoses- categorize patient as high risk if appropriate B ) symptoms or chief complaint that match COVID screening questions

• If no information is available: new patient, should there be a separate high risk screening? – consider referral to telehealth visit? b) create or find a high-risk evaluation module and optionally add it to base screen

2. Symptoms:

• Can you tell me again why you are coming into the clinic and what symptoms you are experiencing today? → have screener check the symptoms patient endorses then ask about negatives

• Do you have any severe symptoms: SOB, lightheadedness, blue lips, hemoptysis: refer to immediate telehealth evaluation or EMS

• Do you have any:

  • remaining symptoms

• Need criteria for skipping remaining symptoms and moving to next phase: fever or cough plus one or more?

3. Exposures:

• Are you or do you have close contact with an essential or healthcare worker, someone who is homeless or living in a group facility? (screener guidance – OK to break question into 2)

• Have you been notified that you or a close contact has been exposed to or positive for COVID-19?

  • If yes, Have you been tested for COVID-19 and when?

4. If positive for SOB, lightheadedness, blue lips, hemoptysis: refer to immediate telehealth evaluation or EMS

5. If positive screen: refer to telehealth/sick clinic if available

• If yes, Have you been tested for COVID-19 and when?

If negative screen: document that and provide safety instructions for clinic visit

Possible Implementation Approaches:

• Web form

• Application

• EHR implementation

Next Steps:

• Test with potential users-- Mindy, Julia, Raymonde

• Create an Invitation to Participate: COVID-19 Phone Screening Tool

• Mindy to update process for advancing Phone Screening Tool

• Julia to touch base with Leo and Bijan re: Friday handoff