Brigham & Women’s Digital Innovation Hub Spins Up COVID Pass for Employee Screening
Health systems with innovation centers are finding out their value as teams rapidly spin up digital solutions to COVID-19 challenges. One example is the Digital Innovation Hub at Brigham and Women’s Hospital in Boston, which quickly iterated the development of a web-based, mobile-responsive app called COVID Pass to screen employees for COVID symptoms.
In a recent talk in the Harvard Clinical Informatics Lecture Series, Haipeng (Mark) Zhang, D.O., medical director of the Brigham Digital Innovation Hub, as well as of Digital Health Implementation at Brigham and Women’s Hospital, described their solution’s development. “My role is focused on developing web and mobile solutions for patients, clinicians and visitors. As COVID-19 has come, my work has transitioned to efforts at Partners for COVID,” Zhang said.
On March 17, the Commonwealth of Massachusetts ordered that any visitor to hospitals need to be screened at the door for symptoms, and on March 22 the hospital ordered that all employees must have face masks. Between the two dates, on March 19, the innovation hub received a request to explore a digital solution to streamline the process of employees attesting to not having any symptoms. “We looked at other verticall markets for ideas, and thought of a digital fast pass like a digital JetBlue ticket at the airport,” Zhang recalled. It would allow employees to attest that they are symptom-free and get a face mask as they enter clinical facilities.
If you do have symptoms, you get a message that you are not cleared for work and are told to call your manager and the occupational health COVID line. This also creates a log of symptomatic employees that is forwarded to occupational health to determine if they need testing.
Most employees, 85 to 90 percent, now use the app on a phone or computer. But 10 to 15 percent of the employee population either lacks a smartphones or speak languages other than English as their first language, so the team recognized they needed a manual mode to do attestations with screeners holding laptops at each facility.
The Digital Innovation Hub was able to respond to the March 19 request with a first version of COVID Pass within 72 hours. “We did a minimum viable product built on REDCap, which is designed to capture clinical data survey questions. Our initial requirements fit nicely into REDCap. We had a nice package to export data from the solution we built out of the box. It was a wonderful tool to validate this solution. Our initial team had an expert in REDCap development, who could update and refine the solutions as requirements changed.”
By March 23 they had the tool placed to in some facilities and were doing rolling pilots at the Massachusetts Eye and Ear Institute and Newtown Wellesley Hospital. “By observing how employees were using it, we learned places where there was friction and we could make refinements,” Zhang said. They streamlined the layout and changed the color bar at the top of the screen every day based on the day of the wek to make it easier for the in-person screeners.
Although the initial build on REDCap worked well, Zhang said they realized that there were underlying technology issues and new requirements that were outgrowing its capabilities. “We wanted an enterprise grade support structure as we scale across the organization, so thinking longer team, we decided to transition to .NET. We can combine self-attestation and the manual process into one application and database. We also had to add multiple languages. As new features come up, developing on .NET framework has been easier, because we have a larger team able to do it.
They have fully transitioned to .NET and scaled COVID Pass across the enterprise. “We have 25,000 employee logging in daily and have screened 500 employees with positive symptoms.”
Zhang says looking back now, the team got lucky. “The state and organization mandatory policies helped our COVID Pass become successful. We also made good decisions at an early stage. Pairing the app with distribution of face masks incentivized people to use it," he said. Using REDCap to build the first version in an agile development process and changing features almost instantaneously early on helped make it easier to use. Transitioning to a more durable and scalable platform later was another key to success. On the roadmap now is adding new languages. Spanish is live, Haitian Creole and Portuguese are coming soon. He said they are looking to make the .Net code and REDCap resources accessible to all other hospitals who might find it useful.
