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

J Am Med Inform Assoc. 2020 Jun 1;27(6):860-866. doi: 10.1093/jamia/ocaa051.

Authors

Timothy J Judson^{1

2}, Anobel Y Odisho^{3

4}, Aaron B Neinstein^{1

3}, Jessica Chao², Aimee Williams², Christopher Miller³, Tim Moriarty³, Nathaniel Gleason^{1

3}, Gina Intinarelli⁵, Ralph Gonzales^{1

2}

Affiliations

¹ Department of Medicine, University of California San Francisco, San Francisco, California.
² Clinical Innovation Center, University of California San Francisco, San Francisco, California.
³ Center for Digital Health Innovation, University of California San Francisco, San Francisco, California.
⁴ Department of Urology, University of California San Francisco, San Francisco, California.
⁵ Office of Population Health and Accountable Care, University of California San Francisco, San Francisco, California.

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.

MeSH terms

Academic Medical Centers
Adult
Appointments and Schedules*
Betacoronavirus*
COVID-19
Coronavirus Infections* / diagnosis
Coronavirus Infections* / epidemiology
Diagnostic Self Evaluation*
Humans
Medical Records Systems, Computerized*
Pandemics*
Patient Participation*
Patient Portals*
Pneumonia, Viral* / diagnosis
Pneumonia, Viral* / epidemiology
SARS-CoV-2
San Francisco
Self Care
Telemedicine / organization & administration
Triage / methods*