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As we continue navigating through the fog of curing novel Coronavirus, the practice of contact tracing has been a sturdy lighthouse for nation-wide public health departments.  

Many of us have heard about the concept of contact tracing in the news but, because of its rapidly evolving nature, aren’t entirely certain what it means or how it can help us. As we continue doing our part in flattening the curve and protecting our communities, and especially as schools and universities strategize the safest reopening protocols, it’s vital that we understand not only just the opportunities available to us, but what is actually working 

To date, hundreds of millions of dollars have been poured into state-wide contact tracing initiatives only for the systems to crash and burn. Here at ImageSoft, we’ve dedicated a team to understanding what exactly is going wrong and how we can overcome it. Joining us for this bonus episode are two members of that team, Vince Hanson and Terry Chaudhuri, who have been on the frontlines of our contact tracing research. Tune in for this conversation as we define contact tracing and the tracers, explain how this concept differs from proximity tracing, deconstruct the most obstructive challenges to successful contact tracing and “trace the success” of what actually is working in several public health departments.  

Check out this episode!

Read the Transcript
Steve Glisky: Welcome to the Paperless Productivity podcast, where we have experts give you the insight, knowhow, and resources to help you transform your workplace from paper to digital, while making your work life better at the same time.
Tim Zarzycki: Thank you for joining us.

My name is Tim Zarzycki from ImageSoft, and I’ll be your host. Today’s podcast is going to discuss the current state of contact tracing being done here in the United States. We hope to shed some light on contact tracing, how it’s being done, various technologies being used, the success of different approaches and talk about our customers who are building automated tracing strategies in their local jurisdictions.

Joining me today, I have Vince Hanson and Terry Chaudhuri from ImageSoft, who have been on the front lines of understanding the current contact tracing solution, where they fit and how they’re being used. Vince and Terry plan to tell us a bit about the exciting tools that are being used in the fight of the spread of COVID-19. We’re going to cover a lot of ground today. So let’s jump in and talk about the technology being used to help public health departments during the pandemic.

Let’s start with the baseline of contact tracing. We hear this term all the time used. Please take a moment to really define what that is, and what that should mean to the listeners out there.

Vince Hanson: Yeah, thanks Tim. You know, in public health, contact tracing is really the process of identifying people who may have come in contact with an infected person, and the collection of further information about those contacts. By tracing the contacts of those affected individuals, testing them for infection, isolating them, treating them, and really tracing their potential exposures. Public health really aims to reduce infections in the general population.

And while we’re all dealing with the current pandemic with COVID-19, this really isn’t something new. It’s been used with other diseases like tuberculosis, measles, sexually transmitted infections like HIV, and bacterial infections. It was also used during SARS and H1N1 outbreaks most recently. The real goal of contact tracing is to really interrupt the transmission, and reduce the spread of the infection. The public health agencies are really looking to alert contacts to the possibility that they’ve been infected, and offer some type of information to them, some preventative service or care. In that diagnosis and counseling of those already infected individuals, they can identify whether it’s treatable, and how to prevent reinfection of the original infected patient. These epidemiologists are really also looking to learn just more about that specific disease, and how it affects a particular portion of the population.

Tim: Excellent, thank you. Terry, what are some of the biggest challenges with contact tracing in general?
Terry Chaudhuri: The biggest challenge is probably just managing that influx of data. So when something at the level of COVID happens, you get so much data coming in from all the different areas, and people just aren’t usually equipped to manage that much information.

So that’s number one, is getting a handle on that, and then having that reliable information so that they can make those good decisions and actually track things down. As Vince said about tracing all those contacts, that’s so crucial, but it’s also about getting back to the cause. Where did this start? Where are areas that we really need to focus on? And then once we understand more about that, we can obviously now look for focusing personal care, education to those people who really do need it.

Vince: Tim, so the other challenge, I think, is testing. As we try to reopen, we have more and more people taking tests.

Many have no symptoms, many have no exposures, some folks wake up and say, Hey, I think I will take a test today. And because we all so desperately want to go back to normal, it has stopped us from being able to react to the growing number of tests. Other frontline workers are being mandated to take tests in order to be able to return to work. And so, when we look at the stats, it’s staggering. We’re running somewhere around 700,000 in COVID tests a day. We may be maxing out the supply chain with the current types of tests that are available. Locally here in Florida, we’re experiencing some testing sites that can’t report for 10 plus days. Tons of questions remain unanswered after you take a test. Are you still contagious, do you go to work, do you go to school, do you have to quarantine, and for how long?

It’s really a confusing scenario for everyone, and adding delays on top of it just adds to that confusion and frustration. I’ve actually been reading about a group of epidemiologists who have this big idea on how to change testing, and they believe it could allow us to control the virus within a month, in three or four weeks, which seems unbelievable, right? To start with, the ultimate goal, as we previously talked about, is really to identify the sick, and then separate those sick people from the people who are well. And as a part of that testing, we then would focus the testing on the frontline workers, right? Folks in healthcare, law enforcement, teachers, folks working in grocery stores. Get them tested, since they are really critical for the country to run.

These epidemiologists then think to focus on a different type of testing. Remember, we’re processing close to 700,000 tests a day, and we’ve got those big delays in the results. They believe there are some other testing methods, the kind that are this thin paper strip. It’s very low cost to manufacture, and very low cost to distribute. It only requires a person’s saliva, and the results come back, not in 10 plus days, but in 15 minutes. Their idea is to produce these in masse, obviously it would require a large backing by the Federal government. Think almost like wartime production. But then, if these were produced in masse, anyone entering an office, anyone entering a movie theater, or even a target could take one of these tests, and in 15 minutes, we would know.

The beauty of this type of system, with the small strip, is that it doesn’t require a specialized system to read the results. And that’s what it’s taking all of the delays with the current testing that is going on right now. This strip would simply change color, and identify either a positive or negative result. So it’s really a fascinating area to look at of what the epidemiologists believe could be done differently than what we’re doing today.

Tim: Vince, what are some technologies being used for contact tracing today?
Vince: Yeah, I’d say there’s, there’s really two categories. One falls into the category of case management tools, and the other is really proximity and exposure notification tools. So let’s talk about the case management tools first.

These types of tools are really used by the frontline workers inside of public health departments. The nurses, the epidemiologist, and related staff. They really hope to streamline the electronic capture and management of the data on patients and contacts, through automation and contact notification and follow up with those patients. It really is meant to allow the patients and contacts to electronically self-report some of that crucial demographic and clinical data.

For example, there are a number of health departments that actually are using automated surveys that go out to get daily health status information. And then of course, those case management tools can integrate with state systems and also be used for reporting, so that there’s a lot of good information for those frontline workers, and really identifying what is critical for follow up from a priority perspective by each and every one of their staff.

When, when you start thinking about the proximity and exposure notifications, this is really a different set of tools. And while it may integrate with some of the case management systems out there, these are really smartphone applications. So something that might be on your iPhone or your Android phone, it’s a Bluetooth or GPS technology. Its voluntary users like you and me have to opt in, in order to use them. And it’s really used to try to identify the proximity and duration of someone’s exposure to, let’s say, a patient or a contact that’s been diagnosed with something like COVID-19. There’s really a limited amount of usage of these types of apps today, and the public health departments are still trying to understand the value of how that mobile application and technology can be used inside of the public health departments.

Tim: Great, thanks Vince. Terry, there’s a lot of people in the news you hear about called contact tracers, who are they and where do they fit into the whole picture?
Terry: Sure. The contact tracers are really people who are hired or volunteers, who just really help out with that tracing process. So really, they’re making phone calls to people who’ve reported it, or people who’ve potentially been in contact with these infectious diseases, and they’re trying to get information, and even help them or give them the education or other details and links they

And that’s what’s been done historically, is on larger scale cases and things that we’re dealing with, they would bring in more and more of these tracers to help because of the amount of people that would have to be notified or called. And as you can imagine, it’s just a very cumbersome process, and bringing in people isn’t always the best way to make things more efficient. So people aren’t really answering their phones as much as they would do in the past, so trying to get ahold of people through a telephone call has just been a challenge in itself.

Vince: SYeah. Somewhere around 40,000 contact tracers right now that are employed by different public health departments around the country. There are some projections that say we’re going to need maybe a 100,000 of these contact tracers, to effectively battle the pandemic. And you can imagine, right, for every positive infection, these tracers on average, generally need to contact 10 other people. The information they provide when they’re contacting people downstream is absolutely voluntary, and some people want to comply, and some people don’t want to cooperate. So they have a really, really tough job, and there’s a lot of them out there.
Tim: Great. So how did ImageSoft get involved with contact tracing?
Vince: Yeah, so we actually have a customer which is Ottawa County, and inside of their public health department, when the pandemic started, their staff started seeing this trend of a very large number of cases coming in as the initial news and the spread started to happen. So part of their daily routine is needing to perform the daily contact tracing. That is a requirement that they really have to reach out to each one of those potentially exposed people on a daily basis, and they are using a system inside of the state of Michigan, which is called MDSS. It stands for the Michigan Disease Surveillance System. That’s really the data that’s used to report to the CDC.

So they actually decided to create their own case management tool for the nurses and epidemiologists. So they actually import the data from MDSS and OnBase, and that’s where they manage all of the specific demographic information about COVID-19. The different cases, the contacts, health status, symptoms, exposures, location information. Instead of trying to get an army of people to make phone calls, they actually integrated a survey tool, which sends out two daily questions about the status of that patient, and that is done via text or email.

And the data, the survey information that comes back daily, gets integrated back into the case management application, and really prioritizes work for the nurses and epidemiologists. They did an incredible job here, because there’s actually correspondence letters that get sent out from the system to each one of the patients or contacts, and they actually have a very large bilingual community. And so, they have follow up correspondence that actually can be in English or Spanish, that go out at different stages for the case.

They also did something really cool for the public. They took a lot of their information about what they knew with exposures and positive cases, and they integrated that with a reporting dashboard on the Ottawa website. So they can actually report number of cases, hotspots within the County, and that’s with ESRI, which is a very popular county mechanism that’s used to map geographic information for a lot of counties, and a lot of states throughout the country. Just an amazing job of trying to automate a little bit of the process, and help prioritize the work for the nurses and epidemiologists as these cases just kept increasing and increasing.

Tim: That’s a great story. What types of capabilities have your customers implemented in helping them with the fight of the spread of COVID-19?
Vince: Yeah. Well, Ottawa had a lot of success. They actually configured and deployed this application within a couple of weeks of the pandemic starting. And so they started telling their story to other counties within the state of Michigan, and now there are 10 other counties in addition to Ottawa that are utilizing this technology. It’s something that can be deployed very quickly, it’s available in the cloud, and it really can be expanded to any State or any County that is currently having some challenges with their public health staffing, and trying to manage the data, just the voluminous data from the pandemic.
Tim: That’s great.

Hey Terry, have any technology has been deployed that are not being widely accepted by the public?

Terry: Yeah. Initially, when we started seeing people trying to combat this with technology, we’d see them maybe try to retrofit an ERP or a relationship management system that they’d already owned, and those just really didn’t track all the necessary information. They kind of lacked some of the reporting metrics needed for something like this, and they really just didn’t have a way to involve the public directly. So there was always a kind of need there.

And then with the kind of mobile community, obviously there’s these apps that they’ve put out with Apple and Google, into people’s phones out into the public where they could kind of report and add some information, but the adoption rate on that was just extremely low. People didn’t really know, there wasn’t a lot of education about what those were for. Getting people to use something that they didn’t really understand and stuff like that has been a challenge, and was unfortunately way lower than anticipated. So a lot of the detailed metrics weren’t coming in through those mechanisms.

Tim: These challenges are things that our customers are seeing all the time. What types of success have you seen from some of our customers who are using this contact tracing solution? Vince?
Vince: Yeah.

You know, I mentioned Ottawa a few minutes ago, and as of last month they had automated surveys going out, I believe over 20,000 surveys, with over a 91% response rate, which is pretty much unheard of. They estimated that it saved their staff almost 3,000 hours, which obviously makes a huge impact in the patient care, and just being able to respond when case counts are spiking and going up around the County, and really throughout the US. So just amazing statistics with the amount of information that they’ve been able to automate, so that they can give better patient care inside of the County.

Tim: Those surveys sound a great way to engage the public and make it a little easier for folks to respond back to the public health department, so that’s great. Are there other areas which are becoming a new focus for contact tracing since the pandemic start? Obviously fall is happening, schools are starting, are there other contact tracing focuses that are becoming into the primary focus?
Vince: Yeah, that’s, that’s absolutely right. My son started his first day of school yesterday, and so we’re starting to see a number of large school districts that are looking for their own contact tracing application, which obviously is going to be used to help protect teachers, students, and staff as the country is now, across the US, going to be going back for face to face instruction in all of our schools. So there’s definitely another area where the contact tracing is going to be very, very important to stop the spread of infection and try to protect folks as they go back to class.
Tim: That’s great. One last final question, if someone wanted to see how this technology works, and how it’s being used in their public health department, what should they do? Who should they contact?
Vince: Yeah, the team here at ImageSoft actually has a live demo. As I mentioned before, this technology has been deployed inside of public health, as well as in the cloud. We have the ability to take a health department through the application to see the types of data that can be managed, and how the process is automated, how it can be used for reporting statistics inside of the County. And we’re actually going to be hosting a webinar next month, about 30 days from now on September 24th. And there’ll be more information that we can show live, and obviously demonstrate this fantastic solution to help control the spread of COVID-19.
Tim: That’s great. Vince, Terry, thank you for joining us today. It’s been an educational session with our panel, trying to understand a day in the life of a public health department, and seeing how they’re responding to the many challenges we are all now living with on a daily basis.

If you’d like to learn more about ImageSoft, or our solutions for public health departments, please go ahead and visit our website at imagesoftink.com. We’ll be hosting an upcoming panel webinar on contact tracing in September, and hope you can join us for that session. This concludes today’s podcast. Thanks for attending, and have a great day.

Steve: Thanks again for joining us on this podcast. To learn more about ImageSoft, please visit imagesoftinc.com. That’s ImageSoft I-N-C.com if you haven’t already done so, be sure to subscribe to Paperless Productivity, where we tackle some of the biggest paper-based pain points facing organizations today. We’ll see you next time.
Patrick: Yeah. Because the data layer is basically a database … Again, when you look at an employee record, it’s just rows on a database. Because that all is just stored visually, OnBase has a really nice interface to be able to build the screens so that when you’re actually interacting with them, it’s a lot of just plug and play. You say, “I want to put my first name over here and I want to put dropdowns over here for the conflict values, so it’s a very plug and play, drag and drop interface.

You can, of course, go way beyond that and start developing scripts and things like that to do advanced things. But to get in there and to have just some information displaying on the screen to your users is a couple minutes. It doesn’t take very long to set up an application with a class and some attributes on it and then to get that data displaying is also very simple.

Steve G: Okay. Could you just give us an overview of the solution and what it does?