Use Case - Phone Screening Triage
Baseline Phone Screening Use case
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.
HIT-enabled Phone Screening Use Case (Parsed Sample from @felix_chang and @Julia Skapik )
Primary Actor: Frontline workers
HIT Preconditions:
Perform critical services (whether clinical, delivery, or public safety) throughout a pandemic (e.g. COVID-19)
Balance risks of exposure with performance of clinical duties.
Use of an electronic clinical decision support (CDS) tool (vendor-driven vs. platform-agnostic)
Availability of patient-driven triage solutions, interoperable with EHR or open-source/agnostic
Data Dictionary, unified registry for centers with adequate HIT network infrastructure
Supply chain and inventory management system
Patient portal, mHealth, SMS, other basic forms of telecommunication policies
Triggers: Pandemic (e.g. COVID-19)
Main success scenario:
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:
Possible positive cases → automated telehealth consult forwarding → telehealth consult workflow
High risk / Urgent → automated 911 call forwarding
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
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