CCCM 3. Question and Answer Session_CinC Omicron Response-Technology Planning & Delivery 18Feb22

COVID-19 Care in the Community Q&A Omicron Response – Technology planning & delivery Regional Hub Session 3 Week commencing February 21st 2022

Questions and Answers

COVID-19 Response Q+A’s Question What is the national Healthpathways definition of Vaccination Status?

Answer For the purposes of assignment to self-monitoring or monitored care, use the following definitions of vaccinated: Up to Date: • Primary course plus booster; • Primary course doses with last dose ≤ 4 months ago.

Partially vaccinated: • Primary course incomplete or completed < 7 days or > 4 months ago.

What is the Acuity Rating?

Note: a primary course consists of 2 doses for most people or 3 doses for those with immune compromise.

The Acuity Score (occurs either through self-service or on first clinical assessment and is escalated if symptoms change) is your (GP) clinical assessment of the person after having completed the initial assessment and regular health check. The score can then be updated during the regular health checks if the patient's condition changes.

The national guidance on how to assess a person's acuity rating is currently being built into CCCM/BCMS. The score ranges are: • 1-4 = the person is able to self-manage.

• 5-6 = the person is ill and unable to self-manage.

Please note that the acuity rating is your overall assessment. It is not an automatically generated / auto-populated score based on the regular health assessment responses.

How will patients without cell phones or internet access be able to access the system(s)?

With automated notifications via SMS texts, what public cyber awareness will there be to prevent scams/phishing?

All systems will come with assisted channels i.e. call centres, to support patients with digital access barriers.

This is a widely acknowledged risk and where possible, is being mitigated. Most notably, we are making sure we have the right tools and security checks in place such as, having the same short code for all SMS text messages. There are also other official channels for patients to ring for any other queries.

COVID-19 Response Q+A’s Question What protections are in place to prevent misuse of the self-service contact tracing form links?

Answer The key security feature is that people are sent unique links with an access code that needs to be validated along with their date of birth in order to begin the self-service contact tracing form.

Furthermore, if a person believes that they have erroneously received an SMS message (e.g. wrong person), there is an 0800 number at the end of the SMS message for them to call.

If a patient is in CCCM/BCMS/BCMS under active management and is moved to secondary care, is there a way to suspend their regular health checks (CCCM/BCMS/BCMS) while they are in secondary care?

The regular health checks are not mandatory, so while the patient is in secondary care, the GP does not need to complete the regular health checks. It is recommended to make a note on the whiteboard that the patient is in secondary and do not require regular health checks until they are discharged back to community care.

How are postcodes currently assigned to patients?

Postcodes are currently assigned as per the postcode associated with the patient's NHI.

Why can't I access the CCCM through my PMS system yet?

If you are unable to access CCCM through your PMS system, it could be due to: 1. No foundation accreditation 2. No active cases 3. No CPN (HPI number)

Which patients is the CCCM/BCMS for?

The CCCM/BCMS is meant for managing both positive cases and people who are self-isolating.

Are all household contacts linked to each other in CCCM/BCMS?

Provided that household contacts were appropriately triaged and set up in NCTS, they will presented as being part of the same bubble in CCCM/BCMS.

COVID-19 Response Q+A’s Question

Answer The provider dashboard in CCCM/BCMS, when accessed via PMS HealthLink or by filtering patients by eDI when using the full web version of CCCM/BCMS, will bring up the dashboard view of all the patients assigned to the practice.

How can I view a list of all the patients at my GP practice that needs contacting?

We have now moved to automating the creation of Border Health Record (BHR) for patients (Case) when they test positive for COVID-19 (along with the auto-allocation of a Case to a Community Care Hub based on criteria of the DHB associated with the Case's NHI, if they are a prioritised ethnicity for that DHB, and/or postcode). BHRs are automatically assigned to a Health provider (General Practice Team) and therefore the Allocation field in CCCM/BCMS is populated with the GP Practice Name. BHRs are also available in CCCM/BCMS from the point of Case Creation in NCTS.

There is currently a lag between a person testing positive for COVID and when their results are uploaded in the system - why is this happening?

Currently the process of uploading a positive test result is manual - we aim to go live with the automatic process in Week 3 February.

How long do GPs have to complete the initial assessment once the positive test results are received.

Ideally within 24 hours.

Can Registered Nurses release patients from isolation?

Yes

Why am I (GP) not prompted to conduct a regular health check after completing a patient's initial assessment? Can I generate a welfare referral immediately after completing the initial consultation?

If a person has a positive RAT, does that confirm a case?

A patient's initial consultation is a combination of the initial assessment and a regular health check (symptoms, includes the option to generate a welfare referral).

After completing a patient's initial assessment, the system will automatically bring up the regular health check to complete, in which a welfare referral can be generated.

A positive RAT does NOT confirm a COVID-19 case. The person will then need to get a PCR test to confirm their diagnosis.

COVID-19 Response Q+A’s Question Is there the option to partially complete i.e. save progress and return later, on the self-service contact tracing form?

What languages are currently available for both the self-service contact tracing form and the portal?

What is the COVID-19 Health Hub? How is a person's NHI being matched to their self-service form?

Is there currently the option to fill out the self-service form on behalf of someone else, as their caregiver or proxy?

[NCTS] In Phase 2 of the omicron response, will the information in the case details still need to be completed for everyone?

[NCTS] How do we close cases in NCTS?

Who creates the initial CCCM/BCMS record?

Answer There is currently no 'save progress' option. At the moment, no information is saved until the person completes the entire form and clicks 'submit'.

This is a priority for the next major release.

Currently all content is only available in English.

It is a high priority to translate the form and the portal into the 10 most common non-english languages.

The COVID-19 Health Hub is a single authoritative source for close and household contacts and those who test positive with COVID-19 that is readable, actionable, consistent, relevant, mobile optimised, and accessible.

The current process is that once the ESR éclair record is sent to NCTS, the person's NHI is pulled and then the SMS text message is sent.

There is currently no 'on behalf of' option, but it is a priority for development.

There are also assisted channels via the 0800 number to help people fill out the form. Ultimately, if a person does not respond to the self-service form within 24 hours, they will go onto the queue for contact tracing to manually follow-up.

Yes - everyone in NCTS should have their case details completed. The workload is hopefully alleviated through the use of the self-service forms, which will enter the case details for those who use the form.

What should happen is that once a patient is ready for clinical release, the GP managing the patient will confirm during the regular health check that the person is 'eligible for clinical release from isolation/quaratine', and the confirmation will send a notificaiton to NCTS so that the PHU can close the case and release the person from isolation.

From here, the person's case that is relevant to NCTS will be closed. Any exposure events or direct contacts will remain open as necessary.

When a person tests positive, it creates a case record in NCTS. Then the person is triaged and advanced to follow-up, which will create a follow-up record and then a border health record (BHR) will be created and then this will be pushed to CCCM/BCMS. This process is now automated, but as a GP, you will still receive a notification in your inbox when a patient is assigned to your practice.

COVID-19 Response Q+A’s Question When a patient is first allocated to the GP practice, who conducts the first assessment?

Who do I contact when I have questions?

Answer Patients may or may not get an initial triage in NCTS - usually it is the GP who conducts the initial assessment, but if there are workload issues, registered nurses can conduct the initial assessment as well.

For Care in the Community (CCCM/BCMS/BCMS and NCTS) please email citc@contacttracing.health.nz - this is now our official support email address and will be monitored during business hours Monday - Sunday.

For Urgent Queries, please contact the NCTS Service Desk (below).

For Managed Isolation (CCCM/BCMS or NBS) related queries during business hours Monday - Sunday, please sign up to use our Support Portal by registering at https://moh-c19-support.atlassian.net/servicedesk/customer/portal/5.

Alternatively, you can email the Border Apps Support team on border-apps@contacttracing.health.nz.

Urgent queries and outages, password resets, account unlocks, or similar issues contact NCTS service desk 24/7 - call 0800223987 or email NCTS.Servicedesk@health.govt.nz.

[NCTS] Can lists of tasks be pulled from both CCCM/BCMS and NCTS? Are the data sets linked?

How is information in CCCM/BCMS written back to PMS? How does MSD receive a welfare request?

Do RAT results for close contact who are critical workers appear in CCCM/BCMS? Who has access to all the patient information in CCCM/BCMS? Who would you advise to use the full web-version of CCCM/BCMS?

The CCCM/BCMS and NCTS task lists are separate - they are intended for different teams and are different tasks.

Clicking 'Complete Session' in CCCM/BCMS will push a summary report to the PMS outbox.

Complete the 'welfare and mental health review' in the regular health check section in CCCM/BCMS. Welfare requests will be sent through to MSD who have access to a lite version of NCTS - they will only be able to see the relevant information to provide welfare. Adding in notes into the 'further information' box will also be viewable, so further details provided e.g. require baby formula, will assist MSD in responding to the welfare request.

RAT results uploaded in My Covid Record or ESR Éclair at the moment are not displayed in CCCM/BCMS.

However, you (a GP) can enter a RAT results directly into CCCM/BCMS off the bubble screen.

Only authorised people involved with their clinical care are able to access patient information in CCCM/BCMS. There are roles and groups in place to limit clinical information to be only available to clinical roles (nurses and doctors) who are also the only people who have access to patient records in PMS. It is mostly for hub teams needing the overarching view of patients being managed in CCCM/BCMS.

COVID-19 Response Q+A’s Question Will GPs be able to view the patient self-service form responses?

If GPs are managing cases in the community, are we also able to provide 'release from isolation' letter certificates?

What happens to positive case notifications over the weekend?

Do GPs need to enrol them in order to access CCCM/BCMS to document contact as the practice providing care?

[NCTS] For clinical staff and whomever else is running a shift at The Hub, will they need access to NCTS? Is there a lag between when a positive test result is confirmed, to when the GP is notified?

Who contacts new cases or close contacts WHO DO NOT USE THE SELF-SERVICE CONTACT TRACING FORM that are needed to be followed up with?

Is there a flag in BCMS/CCCM to indicate to the clinical team (GP, Nurse) which patients are selfmanaging?

Answer The self-assessment completed by the patient will auto populate certain fields in the CCCM/BCMS initial assessment, and GPs will be able to see this relevant information.

Yes, GPs can continue to provide 'release from isolation' letter certificates. However, as it does take up precious clinician time and resource, the MoH Data and Digital team are in the process of developing an automated SMS message to release people from isolation.

There is also work being done with MBIE to ensure that employers are aware the SMS message will be sufficient validation of release.

Different regions have different out-of-hours processes, so check with your local hub.

Most groups doing out-of-hours coverage will being using the full web version of CCCM/BCMS, so they will be able to pick up all the new positive cases there.

It is advised that at least 1-2 people at The Hub have access to NCTS. There are release processes (still manual) and reports that can be pulled down, that are accessible in NCTS. The messaging speed from when a positive test result is confirmed, and when the GP is notified is gated by HealthLink messaging speeds.

GPs will be messaged directly from either ESR Éclair or the lab and takes approximately 15 minutes. On the other hand, the link between Lab to ESR Eclair to NCTS only takes a matter of seconds.

This will be done by NCTS/Reach Aotearoa. Community Hub staff are not expected to be doing the calling.

There is currently no flag for this, but the feature is coming. The acuity score does reflect this to an extent (the lower the score, the lower the assessed clinical risk).

COVID-19 Response Q+A’s Question

What defines the Day 0 field in BCMS/CCCM? (From 25th Feb Onwards)

What defines the Day 0 field in BCMS/CCCM? (Until 24th Feb)

Answer For a Case: • Predicted Isolation Start Date (Day 0 in CCCM/BCMS) is the Day 0 calculated off EITHER the date the PCR test sample was collected OR (if null) the Case Notification creation date OR the Case Creation date. This process is being automated so that the date is as close to the real Day 0 as possible.

• Predicted Isolation End Date (Earliest Release Date in CCCM/BCMS) is calculated from the Predicted Isolation Start Date + Case Default Isolation Days.

For a Contact: • Last Exposure Date (Day 0 in CCCM/BCMS) will match the associated Case Start Date. Every contact will have this from creation now. Note that if another household contact turns positive, the exposure date WILL NOT change. If a contact becomes a Case, then Day 0 will become as above but all previous BCMS/CCCM contact, health checks, vital etc. will remain in the system.

• Planned Quarantine End Date is calculated based upon the Last Exposure + 10 days. This will therefore match the Case Predicted Isolation End Date.

The process is currently still manual. For a Case: • Isolation Period Start Date = Day 0 field in CCCM/BBCS. • Nothing is sent to the Earliest Release Date.

For a Contact: • Quarantine Start Date = Day 0 field in CCCM/BBCMS, if these details are already entered into NCTS • Earliest Release Date = Planned quarantine end date