How constraints and a sense of urgency can advance innovation

The development of PennOpen Pass, a symptom tracker and exposure alert system, offers a lesson on how challenging factors can focus the mind, enabling development of new tools that meet communities’ needs.

The COVID-19 pandemic has presented significant population health challenges to communities across the world. In our corner of the world, as a university and academic medical center, this was the particular challenge presented to us by university leadership.

While our essential healthcare facilities never ceased operations, most on-campus university activities were suspended. Students were sent home, classes were held remotely, and many university departmental and administrative functions were transitioned to remote work.

Although at first we were asked to find a way to ensure the safe return of our students, the scope of the problem quickly expanded to include all of our community members, across all campus facilities. This expanded community included students, faculty, staff, outside contractors, patients, and visitors to our university campus and healthcare facilities.

As a healthcare information services team, we realized that we could not solve this problem on our own. However, we did know that our ability to conceive and deliver effective digital technology solutions would be critical to successfully achieving the goal.

Since safety was such an important need for our community during the pandemic, we considered a broad range of potential solutions. 

We brainstormed about various technical approaches for detecting close interpersonal contacts and gathering information to support contact tracing that we could build ourselves or partner with others to build. We met with other organizations around the world who were facing similar challenges, to learn about their approaches to addressing this problem.

As we considered the technical feasibility of, for example, automatically detecting close contacts between people via their smartphone’s Bluetooth signals or by triangulating data from wireless networks, we were confronted by constraints on our possible solutions that were dictated by the “population” side of population health – our community members and organizational stakeholders.

The message we heard repeatedly was: Reach everybody. Privacy is paramount.

The need to reach everyone in our community meant that our digital solutions could not rely on everyone possessing the latest technology. Some members of our community lacked regular access to smartphones and computers, so we needed to design manual alternatives as part of the solution.

Privacy was often the biggest factor in deciding what we did or did not build. Solutions that collected location data or that documented human contacts that were acceptable in some parts of the world were determined to be too intrusive for our staff and students. 

To address those concerns, our privacy and legal team developed a “privacy statement” that explicitly stated our goals, and what we would do – and would not do – with the data that we collected. This helped make our efforts transparent to our community, and provided a framework for approving future technical changes and data uses.

These considerations drove and focused our efforts on what to build. We developed PennOpen Pass, a daily symptom and exposure survey tool, delivered via SMS text messages and web form surveys, that advised on next steps for those experiencing COVID-19 symptoms or who had exposures. 

We also developed tools to help staff manage the intensive follow up required on positive cases. Through real time APIs, our tracking and management solutions were able to interoperate with our EHRs and COVID-19 testing result systems. 

On a daily basis, we were able to understand how many people were experiencing COVID-19 symptoms, how many had potentially concerning exposures, and the numbers of staff and students that were asked to quarantine to limit future exposures. These efforts helped us achieve our goal of keeping our community safe as they resumed their on-campus educational, research, and healthcare activities.

As technologists we often view constraints on solutions as impediments to success. But those constraints can be very helpful to us, by providing the focus we need to more quickly zero in on solutions that truly meet the needs of our community.

Glenn Fala is an associate chief information officer at Penn Medicine.

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