This morning, senior-focused digital health company CarePredict rolled out a new set of contract-tracing tools designed for senior living facilities. 

Named PinPoint, the new set of tools is broken up into four types of tracing: contact tracing, location tracing, path tracing and room traffic. The company said it used indoor location tech to identify where a staff member or patient was in the facility and who they came into contact with. 

“Once a suspected carrier has been identified, CarePredict PinPoint can indicate within seconds: everyone the infected individual had contact with in the facility, including the time of day, duration, and location (contact tracing), all the places within the facility the individual visited (location tracing), the exact path taken by the individual throughout the facility (path tracing) and anyone else that spent time in the same areas where the infected individual had previously spent time (room traffic),” Jerry Wilmink, Chief Business Officer of CarePredict, wrote in an email to MobiHealthNews.

WHY IT MATTERS 

Seniors in long-term care facilities have been some of the hardest hit communities in the coronavirus pandemic. For example, in Massachusetts more than 44% of deaths in the state are attributed to residents in long-term care facilities. 

“The risk of contracting the coronavirus in nursing homes and senior living communities is exacerbated by close living quarters, plus the fact that staff are coming into direct contact with multiple residents on a daily basis,” Wilmink wrote.  “Experts from Dr. Fauci and the CDC have identified contact tracing as a crucial step in stopping the spread of the virus, but manual contact tracing methods are slow and laborious. Also, because they rely on recollection – infected individuals identifying everyone they came into contact with over the past 14 days, where, and when they did so  – they can be ineffective among seniors, in whom the incidence of dementia, Alzheimer’s, and memory loss is higher."

THE LARGER TREND 

Contact tracing is a hot topic in the conversation around controlling the coronavirus. 

In mid-April Apple and Google teamed up to introduce health data-sharing and COVID-19 contact-tracing technologies to the lion's share of the smartphone market. The two companies committed to building a Bluetooth-based contact-tracing functionality into their underlying operating systems, noting that it will be designed as an opt-in functionality, but would open the door for more participants and deeper data integration with health apps and governments' public health initiatives.

Several different countries, including Singapore and South Korea, have developed tools to help trace the virus. In fact, just last week the UK’s NHSX collaborated with Google and Apple for a tracing project with the goal of being able to relax lockdown measures in the country. 

In late March the Government Technology Agency of Singapore (GovTech), the in-house IT agency of the Singapore public service, in collaboration with the Ministry of Health (MOH), launched a mobile app called TraceTogether, to help support and supplement current contact-tracing efforts in the nation-state, in an effort to reduce the spread of COVID-19.

CarePredict noted that its tool differed from ones that were put in place by big tech.

“Unlike the projects big tech is working on, CarePredict’s solution doesn’t rely on Bluetooth or smartphones,” Wilmink said. “Instead, it uses beacons and wearable bracelets to create precise indoor location tracking that can pinpoint exact locations where infected individuals may have visited. It can also identify other individuals that may have passed through these areas (risking exposure) but didn’t come into direct contact with the infected individual. This identifies candidates for testing and allows for disinfection, which is particularly critical since COVID-19 can live on surfaces for days.”

Telehealth technologies are often cited as opportunities to address disparities in care. Telehealth services that work alongside a school system's health providers are no exception. Getting these programs off the ground – let alone broadly utilized – is no simple feat.

"[These school-based interventions] fall into that health disparity use case, and often require multiple stakeholders to think about how best to sustain the program and what outcomes are most relevant for those stakeholders," Dr. Kathryn King, an associate executive medical director at Medical University of South Carolina (MUSC), said during a HIMSS20 Digital presentation. "It's particularly important for those programs to engage stakeholders early."

King, alongside MUSC executive medical director Dr. James McElligott, shared top-level recommendations for budding school-based telehealth initiatives based on the organization's experience since establishing its own telehealth center in 2013. Among the standouts were the needs to: develop a clear strategy, to engage appropriate stakeholders, to define outcome measurements relevant to the program's goals, and to design and support the program in a way that encourages utilization.

"[For our program] there's somewhere between 80 and 100 schools signed up at the moment, and growing, and the telehealth visits in this domain [are] increasing," McElligott said. "Getting utilization is still a primary focus of any school-based initiative, and I'd say in particular for school-based telehealth. So while we're in the hundreds of visits, and some programs in other parts of the country in more population-dense areas are getting thousands of visits, relatively speaking it still takes a lot of work to get utilization up and adopted by the community."

Both King and McElligott described widespread adoption as the greatest hurdle their program and those of other states face. To address it, MUSC's program looked to engage school nurses  – the "gatekeepers to utilization of these programs" – by designing an efficient workflow that doesn't have nurses waiting on the line when looping in a local provider.

Alongside prior workflows for scheduled or follow-up visits, the organization designed a tiered call pool. Once the nurse requested a telehealth visit, local providers would have a set amount of time to respond to the call. If no one could respond and the nurses were still on hold, a second tier of MUSC providers based in Charleston would be tapped to pick up the visit, with a third tier of program leadership also established if necessary.

"This became important because the local practices wanted to stay involved, but they often didn't have capacity or the utilization wasn't high enough that they would create a whole availability of practitioners just to manage a school program," McElligott said.

Local providers largely stepped up, with 93% of cases handled by the first tier of providers, 7% by the second tier and 0% by the third. Average provider response time was eight minutes and 52 seconds, while the visits themselves averaged 16 minutes and eight seconds, achieving the program's goals of providing timely nurse support, which allowed them to get back to their day.

Portions of MUSC's school telehealth program largely homed in on a few prevalent chronic conditions, such as mental health and asthma, so the team elected to demonstrate the program's value though metrics relevant to these conditions and their health disparity-minded stakeholders.

\King noted that roughly three-quarters of PTSD therapies delivered through its ongoing school-based telehealth program went to African American and hispanic children, who within their state have low access to mental health resources. To demonstrate changes in health services utilization driven by their later-stage program, King highlighted a 22% reduction in ED visits during the program's first three years for asthmatic children with access to the school-based program. This reduction was up to 35% in Williamsburg County, a particularly rural area that was an early focus of the program.

"School-based telehealth is feasible, and in fact effective," she said.