PennOpen Pass

A large-scale COVID-19 surveillance system

Opportunity

In May 2020, Penn and Penn Medicine leaders began exploring ways to safely reopen campus to nearly 70,000 employees, students, and others during the COVID-19 pandemic. In addition to social distancing, handwashing, and masking, symptom and exposure detection emerged as an essential layer of protection – one for which we did not have a plan.

It was determined that we needed to build a warning system that could help minimize COVID-19 spread. There was agreement that the system would need to prevent individuals with concerning symptoms or recent exposures from coming into contact with others and, when necessary, streamline access to testing, self-isolation guidance, contact tracing, and medical care. 

Intervention

PennOpen Pass is a large-scale surveillance system designed to reduce the risk of COVID-19 spread and manage those exposed or infected with patient triage and care coordination based on clinical algorithms.

After a one-time enrollment process, users are required to complete daily symptom and exposure checks using a mobile-friendly web application. Users who report no symptoms and no exposures get a Green Pass and clearance to proceed to campus. Users with concerning symptoms or exposures receive a Red Pass. Red Pass holders are guided through the Red Pass Management System (RPMS), an automated evaluation process backed by a team of trained clinicians who determine the user’s next steps tailored to their situation. RPMS supports include COVID-19 testing, self-isolation guidance, contact tracing, and medical care.

Impact

In concert with a suite of other mitigation measures, PennOpen Pass enabled Penn and Penn Medicine to safely resume academic, research, and clinical activities across campus in the fall of 2020, which, among other things, meant that life-saving research on COVID-19 and other diseases could continue amid the pandemic.

Between June 2020 and February 2021, over 4 million remote screenings were conducted on PennOpen Pass by more than 75,000 campus members. During this time, the program coordinated care for approximately 25,000 users who triggered a Red Pass.

By automating patient triage and care coordination, PennOpen Pass streamlined care for community members who tested positive for COVID-19 and resulted in significant cost savings for the University and the health system. The cost of operating PennOpen Pass with its current staffing model combined with technology costs is projected to be $0.9 million over 12 months. This figure is substantially less than the initial $3.8 million projected for a PennOpen Pass system without automation. Automating routine tasks also helped clinicians focus on providing humane care to those most in need.

While PennOpen Pass was created to mitigate the impact of COVID-19, the system provides a technological, operational, and clinical backbone that can be adapted after the pandemic for large-scale health and safety screening initiatives for other conditions for which the early detection of clinical decline is critical.

Phase 3: How we work
Collaborators
Penn Wellness
Penn Medicine Office of the CMO
University of Pennsylvania Information Systems and Computing
Penn Medicine Office of the CMIO
Clinical Practices of the University of Pennsylvania
Penn Medicine Center for Connected Care
Penn Medicine OnDemand
Penn Medicine Strategic Operations and Intelligence
Penn Medicine Information Services
Penn Medicine Administrative Fellows Program
Center for Health Incentives and Behavioral Economics
Penn Medicine Occupational Medicine
Penn Medicine Infection Control and Prevention
University of Pennsylvania Campus Health
University of Pennsylvania Student Health
Environmental Health and Radiation Safety
Center for Public Health Initiatives
University of Pennsylvania and Penn Medicine Chief Privacy Officers
University of Pennsylvania and Penn Medicine General Counsel
University of Pennsylvania and Penn Medicine Human Resources
Innovation leads
Katy Mahraj, MSI
Davis Hermann, MiD
Deirdre Darragh, MA
Mike Begley, MA
Krisda Chaiyachati, MD, MPH, MSHP
David Do, MD
Damien Leri, MS.Ed, MPH
Eugene Gitelman, MD
Roy Rosin, MBA
David Asch, MD, MBA
Kevin Volpp, MD, PhD
Mohan Balachandran, MA, MS
Platforms

Innovation Methods

Mini-pilot
High fidelity learning can come from low fidelity deployment.
 
Mini-pilots will allow you to learn by doing, usually by deploying a fake back end. You might try a new intervention with ten patients over two days in one clinic, using manual processes for what might ultimately be automated.
 
Running a "pop-up" novel clinic or offering a different path to a handful of patients will enable you to learn what works and what doesn't more quickly. And, limiting the scope can help you gain buy-in from stakeholders to get your solution out into the world with users and test safely.
Mini-pilot

Early on in the development of the PennOpen Pass web application, we piloted a beta version with a small group of researchers at the School of Engineering to see how it would work in practice. 

Running a mini-pilot helped us identify tweaks that needed to be made to the application and our communications materials. We made several changes based on user feedback during this two-week period. For example, we increased the size of the Green Pass font so that security guards could check passes while maintaining social distance and edited user directions to clarify that daily check-ins must be completed before reporting to campus, not at the building entrance.

Design for delight
Delight is a great concept to utilize when you're striving to create a breakthrough user experience.
 
Delight expresses a situation in which you've created an experience so compelling and emotionally resonant that people tell others about it, generating active word of mouth. 
 
Key drivers of delight include positive surprises, including the elimination of work and effort. So, key questions to ask include "What would users not expect in this service?" "How do we want users to feel when using this service?" and "What work can we remove or do on behalf of users?"
 
Examples of designing for delight include Zappos surprising customers with free overnight shipping on their first order or an Airbnb host creating an itinerary for you based on previously identified interests. 
Design for delight

To eliminate work for operational partners, we created an extensive implementation toolkit that included all of the materials needed to roll out the system. The toolkit included email templates to introduce the system, signage, scripts for security guards, implementation checklists, and more.

In addition to sharing the implementation toolkit, we hosted kickoff meetings with operational partners and office hours during the first two weeks of roll-out to answer questions and provide additional support.

These efforts made our operational partners feel supported and heard, helping us gain buy-in during roll-out as word of mouth spread that implementation was not as heavy a lift as some were expecting.