CCCM 4. Omicron Response - Technology Update and Planning - Regional Coordination Centre Session 3

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

COVID-19 Care in the Community Purpose/ Agenda No.

Agenda Item

1

Introduction

2

Overview of CinC Omicron next release – Technology planning & delivery

3

Recent Releases – Automated Referral to Community Care

4

Risks and Issues

5

Question and Answer Session

6

Next steps and close

Overview of CinC Omicron next – Technology planning & delivery Edward Falloon Dr Lara Hopley

COVID-19 Care in the Community Omicron response phases

1

Phase 1

• Begin shift to self service and automation • Low proportion of positive cases using self service tools • Clinical care delivered by primary care teams, supported by the local care coordination hub • All steps taken to support cases to isolate in their usual place of residence, with alternative accommodation options across the regions identified and being utilised • Preparedness activities progressing, including scaling community connector service, bringing forward tagged provider funding where appropriate • Community providers designated as a critical workforce

2

We are here

Phase 2

3

Phase 3

• Transition to cases using self service and automation

• Majority of positive cases are self managed

• Other people with lower clinical risks, but with welfare needs may still require support through the welfare response

• Clinical care is focused on those with high needs

• Clinical care delivered by primary care teams, supported by the local care coordination hub for those with a requirement for ongoing clinical care • Support for positive cases to isolate in their usual place of residence. Alternative accommodation options across the regions are identified and being utilised, with some areas becoming stressed

• Wraparound health and welfare support services will focus on those with high needs • Support for positive cases to isolate in their usual place of residence and unlikely there will be alternative accommodation capacity available for cases that are unable to safely isolate at home

• Close engagement with all of government providers to ensure access to services is provided from a range of entry points

• Lower risk individuals and households with welfare needs may present through other channels/services (such as community providers) as case numbers reach very high levels

• Community providers designated as a critical workforce

• Community providers designated as a critical workforce

COVID-19 Response Omicron response Three overarching goals • Minimise impact by slowing transmission • Protect at risk communities and individuals • Maintain critical infrastructure services

Three phase Omicron response

2

Key features of phase 2 Changes to isolation periods: • Cases: 10 days (was 14) • Household contacts: 10 days

Note: Cases no longer need to be symptomfree for 72 hours

• Close contacts: 7 days (was 10 days) Increased use of RAT testing: • RATs used for surveillance in high-risk settings and Close Contact Exemption Scheme (testing asymptomatic critical workforce close contacts to return to work.

1

Situation: There are some cases in the community but containment appears possible

2

Situation: Sustained and substantial spread and focus on protecting the most vulnerable Objectives: Minimise and slow further spread and focus on protecting the most vulnerable

Text notification of positive result with link to online selfassessment of healthcare and welfare needs and contact tracing.

3

Situation: Widespread community cases, possibly via multiple and/or superspreader events

Vaccination remains a priority:

Objectives: Contain and eliminate outbreaks as quickly as possible

Objectives: Move to self-management, protect vulnerable, preserve critical services and infrastructure by targeting resources

• PCRs used for border workforce, symptomatic people and close contacts requested by PHU, and confirming positive RAT tests.

Enabling self-management in the community:

• Boosters.

• Paediatric.

• Influenza.

COVID-19 Care in the Community Assessing healthcare needs

Cases will self-manage by default but can escalate to active clinical management if indicated by their selfassessment, their primary healthcare provider’s assessment, or contact coordinated by their care coordination hub Key

Primary care notified by Healthlink

Primary care assesses their enrolled higher risk patients and enter details in CCCM

Primary care assessment

National Contact Tracing Solution COVID Clinical Care Module (was BCMS)

New NCTS case

Primary care Case notified by text of result and initial instructions

Patient journey

Online self assessment • Clinical assessment • Contact tracing • Welfare needs

Selfassessment

+ve Hub assigns case to provider who develops care plan based on information from: • Online self-assessment • Telehealth • Primary care

New CCCM case

Risk score based on: • Age • Ethnicity • COVID vaccination

Hubs coordinate contacting higher risk cases who haven’t been assessed by self or primary care

Hub coordinated assessment

Self-management • Patient continues to self manage • Patient can escalate if needed by telehealth, primary healthcare, or 111

Active clinical management De/Escalating as needed: • Automated • General practice • Public health • Hospital

COVID-19 Care in the Community Case management pathways Test

Notification

Supported selfmanaged pathway Local support over the phone or in person if online not an option

+ve

Notified of result by care coordination hubs or local healthcare provider

Most cases will able to self-manage and will follow the yellow and blue self-management pathways.

Cases requiring more clinical support will receive active clinical management following the red pathway.

Assessment

Supported assessment • Clinical assessment • Contact tracing • Welfare needs (flags to MSD)

Self-managed using online tools

Text notification of result with initial instructions

Release

Support escalates and de-escalates as needed

Release according to current public health guidelines

Can escalate care by: • Telehealth • Primary healthcare provider • 111

Release notification

Active clinical management

Self-management vs supported pathway Cases on self-management must be: • able to use online self-service AND • unlikely to need additional health support

Online selfmanagement pathway

Support

coordinated through care coordination hubs and local healthcare providers

Online self assessment • Clinical assessment • Contact tracing • Welfare needs (flags to MSD)

Can escalate care by: • Telehealth • Primary healthcare provider • 111

Release text

COVID-19 Care in the Community Technology to free up health sector capacity We are rapidly making changes to the technology of the Covid-19 response to address the challenges posed by Omicron. The table represents the key technologies and the target dates for readiness (subject to operational approval).

Operational use date

Deliverable

Process change

Impact

31 Jan

CCCM access for case management via PMS

GPs launch CCCM from their patient record to manage Covid-19 cases

Easier for GPs to access and update the clinical Covid-19 care record

3 Feb

Text message to inform close contacts

No phone call to close contacts with a mobile phone

Reduction in contact tracing effort

16 Feb

Self-service contact tracing (delayed from 9 Feb)

Contact tracing calls a case and offers a digital selfservice form

Significant reduction in effort for those digital self-serving

16 Feb

Automated text and self-service notification

Automated text message to positive test result with code for and links to self-service contact tracing forms

No contact tracing effort for those with a positive result that are using digital self-service

17 Feb

Covid Health Hub – Advice landing page

Single authoritative source for close and household contacts and those who test positive with Covid-19

Enables case with resources to self-manage.

18 Feb

1) CCCM (formerly BCMS) efficiency enhancements 2) Contact tracing self-service enablers

1) 2)

Operational improvements and automation

18 Feb

Automated case allocation to community care provider

Automated assignment of cases to community care hubs and providers

Reduction in effort to hubs and efficiencies for case clinical assessment in CCCM

18 Feb

Automated welfare notification to MSD

End of Feb

Text message for case closure

Self-managed cases will be sent a text to confirm that they are asymptomatic.

Eliminate the manual case release process for those in self-management

1 March

Changes to Case and Contact Management

Simpler system for users Features to enable automation

Recent Releases

COVID-19 Care in the Community Management of Omicron under high volumes Key Technology Releases: 18th February

• CCCM efficiency enhancements and contact tracing self-service enablers • Automated case allocation to community care provider • Manual Allocation to Hub for Unenrolled Patients

COVID-19 Care in the Community CCCM efficiency enhancements and contact tracing self-service enablers Improvement / Enabler

Description

What this means:

Change: Texts to Cases

Update to enable the combined ‘Notification of Infection’ and ‘COVID Contact Tracing Form’ text notification to Cases

Cases with valid mobile numbers will receive text notifications with the following information: • Confirmation of their positive test result • Link to the COVID Contact Tracing Form Cases will receive texts from the ‘2328’ number, which the public will already be familiar with as this number has previously been used for vaccine booking confirmations and texts to close contacts.

Full automation of Case Investigation via the COVID Contact Tracing Form

The COVID Contact Tracing Form, which has undergone a pilot with Reach Aotearoa, will be included in the text message to Cases

This self-service tool will empower Cases to input their own Case Investigation Information, including: • Infectious period • Symptoms and underlying conditions • Household Contacts • NZ COVID Tracer Diary and Bluetooth Data • Timeline of high-risk locations and close contacts • Information on how to access welfare support from the Ministry of Social Development Completing the online form takes approximately 30 minutes – this is significantly faster for the Case to complete than a phone interview.

Household Contacts Management Plan

Update to enable the combined ‘Notification of Infection’ and ‘COVID Contact Tracing Form’ text notification to Cases

Cases with valid mobile numbers will receive text notifications with the following information: • Confirmation of their positive test result • Link to the COVID Contact Tracing Form Cases will receive texts from the ‘2328’ number, which the public will already be familiar with as this number has previously been used for vaccine booking confirmations and texts to close contacts.

Updated Rainbow Chart

The ‘Guidance on community cases and contacts: categories and actions’ document – colloquially known as the ‘Rainbow Chart’ – has been updated to reflect the move to Phase 2, and is effective from 16 February 2022. This includes amendments to management pathways for Cases and Contacts. Management Plans in the NCTS will be updated to reflect these changes.

Update Disease Contact Letter

Letters for Close Contacts have been updated to reflect the move to Phase 2. Available Close Contact letters in the NCTS will now consist of: • Release Contact from Quarantine • Not a Contact Letter • Contact Employer Letter – Household • Guidance for Close Contacts – Household

Send email notifying persons of their change in Management Plan

Existing Close Contacts whose isolation periods will be shortened as a result of the change will automatically receive a one-off email advising them of the change to their isolation.

Guidance on community cases and contacts: categories and actions

COVID-19 Care in the Community Key change: Automated Referral to Community Care This functionality will enable the auto-allocation of a patient (Case) to a Care Coordination Hub (Facility) when they test positive for COVID-19.

In NCTS - when the GP Assignment field is ticked (based on the Care Coordination Hub Management Plan) the NCTS Room Number field will be populated with the patients GP Practice Name (recorded against their NHI).

In CCCM the allocation will display the Hub short code and GP Practice Name. This can be used to filter records in the CCCM dashboard by Health Provider.

Note: If a CCCM Clinical Acuity Score is recorded in CCCM, this will be visible on NCTS in the 'BCMS Clinical Acuity Rating' field, this indicates that contact has previously been made by a Health Provider from CCCM

Typo – Patient record will match

COVID-19 Care in the Community Key change: Automated Referral to Community Care This functionality will enable the auto-allocation of a patient (Case) to a Care Coordination Hub (Facility) when they test positive for COVID-19.

What impact will this have?

• Where a Case and BHR are created, a Care in the Community Hub will be automatically assigned based off the agreed, Regional Allocation Rules.

• This move to automation means that, NCTS Users are no longer required to complete the Advance to Follow Up step for a Case.

• Given that BHRs will automatically allocated to health providers, it is increasingly likely that a HCP (e.g. GP) may complete the first call. In order to determine whether a call has been made the NCTS users should look at the acuity rating and this will indicate that the initial assessment has already been completed by a HCP.

COVID-19 Care in the Community Key change: Manual Allocation to Hub for Unenrolled Patients This functionality will enable manual allocation of a Community Care Hub for patients who are un-enrolled.

Each Care Coordination Hub will have a list view where they can re-allocate people that do not have a General Practice.

They can then re-allocate to the Hub they use for un-enrolled patients if required (i.e. part of Hub’s process)

Risks and Issues Note: comprehensive list to follow next week

COVID-19 Response RAID LOG

Note: comprehensive list to follow next week Issue

Notes External

Current Status

AS A… GP who is managing patients in CCCM I WOULD LIKE TO…be able to access support information about the clinical acuity scoring tool

This issue is currently in progress. The solution will be an information icon "i" is displayed next to the heading "Acuity rating". Clicking on this will open a pop-up window display the scoring matrix for the acuity score.

In Progress

SO THAT…I can understand how to use it and apply it in clinical practice when managing COVID-19 positive patients in the community.

AS A…GP accessing CCCM via HealthLink I WOULD LIKE TO…have a (practice) dashboard view of all my assigned cases

This is a high priority issue that we are currently looking into. We will provide weekly progress updates to this issue.

In Progress

SO THAT…I can review all the patients have been assigned to me that I need to actively manage and/or monitor

AS A…GP managing COVID-19 positive patients in CCCM I WOULD LIKE TO…be able to define cases as being on either self management or active management pathways SO THAT…I can manage all my assigned cases and also feed this information back to NCTS

A flag for self-management vs active management cases is currenlty being developed and is scheduled for release on 24 February.

In Progress

COVID-19 Response RAID LOG

Note: comprehensive list to follow next week Issue

Notes External

Current Status

This feature is intended to be released on 24 Feb. The updates will be: 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 A…GP managing COVID-19 positive patients in CCCM as possible.

• Predicted Isolation End Date (Earliest Release Date in CCCM/BCMS) is calculated from the I WOULD LIKE TO…receive and display new dates from NCTS on isolation Predicted Isolation Start Date + Case Default Isolation Days. start and end dates for cases and contacts For a Contact: SO THAT…I can successfully manage the cases that have been assigned • Last Exposure Date (Day 0 in CCCM/BCMS) will match the associated Case Start Date. Every to me 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.

In Progress

AS A…Hospital-based clinician I WOULD LIKE TO…Access a patient-in-context link in Concerto/Clinical Portal (to CCCM) SO THAT…I can view the patient information in CCCM (from Concerto/Clinical Portal)

Getting a patient-in-context link into Concerto/Clinical portal is currently underway.

In Progress

COVID-19 Response RAID LOG

Note: comprehensive list to follow next week Issue

Notes External

Current Status

AS A…GP I WOULD LIKE TO…view patient clinical records in CCCM after they have This is a high priority feature that is currently being triaged and is prioritised for development. been discharged The solution has been identified to make patient records visible for 2 weeks after discharge.

SO THAT…I can do my required tasks and responsibilities.

Not Started

AS A…Clinical user of CCCM I WOULD LIKE TO…have the option to have 3 tab filter options

This is currently scheduled for release on 24 February.

In Progress

This is currently in progress to obtain sign-off from the MoH.

In Progress

SO THAT…I can further filter patients than by only 2 filters.

AS A…Team member/Decision maker in DHB Strategy, Planning and Architecture I WOULD LIKE TO…have access to the privacy impact assessments and security assessments that have been done in relation to the link between Concerto/Clinical Portal and CCCM SO THAT…my team can do our own due diligence before implementing the link.

AS A…GP managing COVID positive patients in the community I WOULD LIKE TO…Be able to clearly mark in CCCM when a patient has This issue is currently being triaged. been moved to secondary care SO THAT…regular health checks can be suspended while the patient is in secondary care.

Not Started

COVID-19 Response RAID LOG

Note: comprehensive list to follow next week Issue

Notes External

Current Status

AS A…GP conducting an initial assessment of a consumer

This issue is currently in development to create two labels: 1. A label for on the initial health check to highlight that the question for any welfare needed I WOULD LIKE TO…successfully complete a welfare referral to MSD DOES NOT link to MSD. 2. A label in the regular health check to highlight that the question(s) for any welfare needed SO THAT…patients who require welfare are definitely referred to MSD for DOES link to MSD, and that a GP will have to confirm this request. support.

AS A…GP managing patients in the community in CCCM I WOULD LIKE TO…have a clear consensus on what Yellow and Blue Flags are

Consultation with the regions is currently underway.

In Progress

In Progress

SO THAT…I can accurately create flags and alerts for a patient in CCCM. AS A… GP completing the initial assessment for a patient

I WOULD LIKE TO…not have to enter vaccination dates and locations for patients when completing the initial assessment

The 24 Feb release will change the 'Vaccination Date' field to optional.

In Progress

SO THAT…I can save time and reduce the time taken to complete the initial assessment.

AS A…person in the community completing the self-service contact tracing form

I WOULD LIKE TO…be able to save my progress throughout the form

This is currently being developed and is scheduled for 24 February.

In Progress

This is a high priority issue. Currently waiting for the English content to be confirmed and then translations will be made.

In Progress

SO THAT…I have the option to 'save progress' and return later to complete the form.

AS A…non-native english speaker in the community using the self-service contact tracing form, portal, and COVID-19 information hub, I WOULD LIKE TO…be able to select my preferred language option SO THAT…I can clearly understand the questions and information, and what is being asked of me.

Questions & Answers Session

Drop in and Training Session

COVID-19 Care in the Community Drop – in Sessions and Training Session Type

Date / Time

Access

Tuesday 12:00 -13:15 (weekly) Covid Clinical Care Module Virtual Training Sessions (General Practice Specific)

Hosted via Teams: HERE Wednesday 17:30 -18:15 (weekly)

CitC Hub End-To-End Training Sessions (CCCM and NCTS)

Wednesday 15:00-16:00 (weekly) Hosted via Teams: HERE Tuesday 15:00-15:30 (weekly)

Covid Clinical Care Module Support Drop-in Sessions

Hosted via Zoom: HERE Wednesday 10:00 -10:30 (weekly)

Thursday 10:00-10:30 (weekly)

Thursday 15:00 -15:30 (weekly)

COVID-19 Care in the Community Webinars and Q&A Sessions: Session Type

Date / Time

Access

Northern Regional Hub session

Tuesday 11:00-12:00 (weekly)

Hosted via Teams: HERE

Southern Regional Hub session

Wednesday 11:30- 12:30 (weekly)

Hosted via Zoom: HERE

Te Manawa Taki Regional Hub session

Thursday 11:30 - 12:30 (weekly)

Hosted via Zoom: HERE

MidCentral Regional Hub session

Friday 11:30 - 12:30 (weekly)

Hosted via Zoom: HERE

GP Webinar

Wednesday 19:00

PHO Webinar

Wednesday

Next Steps and Close