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. 2020 Jun 1;27(6):860-866.
doi: 10.1093/jamia/ocaa051.

Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19

Timothy J Judson  1   2 , Anobel Y Odisho  3   4 , Aaron B Neinstein  1   3 , Jessica Chao  2 , Aimee Williams  2 , Christopher Miller  3 , Tim Moriarty  3 , Nathaniel Gleason  1   3 , Gina Intinarelli  5 , Ralph Gonzales  1   2
Affiliations

Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19

Timothy J Judson et al. J Am Med Inform Assoc. .

Abstract

Objective: To rapidly deploy a digital patient-facing self-triage and self-scheduling tool in a large academic health system to address the COVID-19 pandemic.

Materials and methods: We created a patient portal-based COVID-19 self-triage and self-scheduling tool and made it available to all primary care patients at the University of California, San Francisco Health, a large academic health system. Asymptomatic patients were asked about exposure history and were then provided relevant information. Symptomatic patients were triaged into 1 of 4 categories-emergent, urgent, nonurgent, or self-care-and then connected with the appropriate level of care via direct scheduling or telephone hotline.

Results: This self-triage and self-scheduling tool was designed and implemented in under 2 weeks. During the first 16 days of use, it was completed 1129 times by 950 unique patients. Of completed sessions, 315 (28%) were by asymptomatic patients, and 814 (72%) were by symptomatic patients. Symptomatic patient triage dispositions were as follows: 193 emergent (24%), 193 urgent (24%), 99 nonurgent (12%), 329 self-care (40%). Sensitivity for detecting emergency-level care was 87.5% (95% CI 61.7-98.5%).

Discussion: This self-triage and self-scheduling tool has been widely used by patients and is being rapidly expanded to other populations and health systems. The tool has recommended emergency-level care with high sensitivity, and decreased triage time for patients with less severe illness. The data suggests it also prevents unnecessary triage messages, phone calls, and in-person visits.

Conclusion: Patient self-triage tools integrated into electronic health record systems have the potential to greatly improve triage efficiency and prevent unnecessary visits during the COVID-19 pandemic.

Keywords: COVID-19; coronavirus; patient portal; self-triage; symptom checker.

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Figures

Figure 1.
Figure 1.
Adult COVID-19 patient self-triage protocol.
Figure 2.
Figure 2.
COVID-19 self-triage CONSORT diagram.
Figure 3.
Figure 3.
Coronavirus symptom checker use & disposition over time.
See this image and copyright information in PMC

References

    1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507–13. - PMC - PubMed
    1. Johns Hopkins Coronavirus Resource Center. https://coronavirus.jhu.edu/ Accessed April 18, 2020
    1. Moon S. The CDC has changed its criteria for testing patients for coronavirus after the first case of unknown origin was confirmed. CNN. 2020. https://www.cnn.com/2020/02/27/health/us-cases-coronavirus-community-tra... Accessed April 2020
    1. Reeves JJ, Hollandsworth HM, Torriani FJ, et al. Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. J Am Med Inform Assoc 2020; doi: 10.1093/jamia/ocaa037. - PMC - PubMed
    1. Keplinger LE, Koopman RJ, Mehr DR, et al. Patient portal implementation: resident and attending physician attitudes. Fam Med 2013; 45 (5): 335–40. - PMC - PubMed

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