Data and Digital Information Sessions - Regional Coordination Centre Session 6 - Week commencing 14

COVID-19 Care in the Community

Data and Digital Information Session Regional Community Coordination Centre Session 6 Week Commencing 14 March 2022

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

Agenda Item

1

Introduction

2

Current State

3

Release Timeline

4

Risks and Issues

5

Question and Answer Session

6

Next steps and close

Current State and Release Timeline

COVID-19 Response Omicron response

3

Three overarching goals Minimise impact by slowing transmission

Changes to isolation periods: • Cases and household contacts: 10 days (unchanged as of today)

Protect at risk communities and individuals

• All other contacts do not have to isolate but need to monitor symptoms and get if symptoms develop

Maintain critical infrastructure services

RATs now primary form of community testing: • Rapid antigen tests (RATs) will be available at community testing centres, pharmacies, and GP practices.

Three phase Omicron response Each phase has different settings for: •

Testing

•

Case investigation

•

Isolation

•

How we manage cases.

1

2 We are here

Key features of phase 3

3

• Critical workers will continue to be able to use RATs to return to work under the Close Contact Exemption Scheme.

Enabling self-management in the community: Most cases will able to self-manage in the community with support from online tools and primary care. Local care coordination hubs will coordinate health and welfare support for those who need more support.

Vaccination remains a priority: • Boosters.

• Paediatric.

• Influenza.

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 Risk Score for Call Prioritisation Self-serve positive case contact tracing reminder text message

Last Week My COVID Record – Report On Behalf Isolation Release Notification Automatic NCTS Case Closure and removal of record from CCCM Clinical portal access in CCCM Targeting this week Disabling of Disease Contacts in CCCM from NCTS My COVID Record – Third Party Reporting Probable case creation in CCCM Updated Case Contact Tracing (Case Self Service) Form v2.0 Future / WIP

Enhanced digital daily checks of Covid cases for those on active management GP Covid Dashboard – Visibility of GPs Covid patients from CCCM (in PMS)

COVID-19 Care in the Community Changes to Isolation Requirements The high number of cases and contacts, and isolation requirements, associated with the Omicron outbreak have had a wide impact on society. The reduction in the isolation period for cases and household contacts will ensure we maintain a balance between controlling the outbreak effectively and minimising the impacts of our response measures.

•

Cases are required to isolate for 7 days

•

The case’s Day 0 is from symptom onset, or day test taken, whichever came first.

Key Messages

•

Cases isolate for 7 full days, and they are free to return to normal activities on what is effectively day 8.

•

•

The period following recovery from COVID-19 during which a person will not be considered a household close contact, has been increased from 28 days to 90 days.

The isolation requirements for cases and their household contacts has been reduced from 10 days to 7 days.

•

•

If a recovered case develops symptoms at any stage after their release from isolation, they should seek a further RAT test.

Household Contacts will take a self-administered rapid antigen test (RAT) test on day 3 and day 7 of the case’s isolation period.

•

You may continue to have some symptoms beyond day 7. If new or unresolved symptoms at day 7 or day 8, stay at home until 24 hours after symptoms resolve. If your symptoms get worse, seek medical advice

•

•

Update of the planned isolation end date and case closure for existing people in NCTS and BCMS will be started Monday, to ensure system stability.

The period following recovery from COVID-19 during which a person will not be considered a household close contact, has been increased from 28 days to 90 days.

•

You may still see records appearing to be open in the NCTS and CCCM while this transition is underway. Be aware that these individuals will likely have received their release text already.

COVID-19 Care in the Community Changes to the MSD referral process As case numbers have increased, the system referral process through NCTS hasn’t been as consistently smooth or quick for people and whānau needing support. People have shared with us that they have experienced repeat contacts and it’s taking longer than it needs to for them to get the help they need.

•

•

Most people and whānau who need welfare support while isolating are either calling the COVID Welfare Line, or completing the MSD form linked from the online form they get sent with the positive test text message.

This has been working well, and MSD have been able to meet people’s needs – either by helping them directly or connecting them to a community provider.

•

Until now, another option for people to get welfare support was through the National Contact Tracing System directly into MSD’s welfare support system.

•

This change will make public messaging clearer – if you need welfare support, complete the online form or call the COVID Welfare Line.

•

Calls to the COVID Welfare Line are prioritised by the MSD contact centres, with current wait times about 10 minutes.

•

Many welfare needs can be met directly while the person is on the phone (e.g., a food grant). This one-touch service is much better for people isolating.

•

This change will also mean MSD will be able to help more people, as their contact centre team won’t be making outbound calls that aren’t answered.

Key Messages •

At Monday 14 March at 5pm, the electronic referral process is being turned off from NCTS.

•

People can complete the MSD welfare form, linked through the online contact tracing form sent to them in the positive test text message.

•

People can also call the Welfare Support line.

•

GPs, primary health care providers and others with access to the COVID Clinical Care Module, the IT system that is used to support people with COVID-19, can still flag a welfare need through this system -

COVID-19 Care in the Community Care in the Community – New User Onboarding Below are the key steps for user training and onboarding across CCCM (aka BCMS) and NCTS to support Care in the Community in your region.

•

Important: You do not need to request CCCM access if you are a GP / Care Provider, and your PMS is active and working. The PMS version of CCCM does not require a login and can be accessed via Healthlink Forms on your PMS.

•

Important: New user requests MUST come from an approved coordinator and will not be accepted if they come from anyone else or are CC’d. Please follow the instructions on the instruction document provided.

•

Submitting NCTS and CCCM New User Requests to: NCTS.Servicedesk@health.govt.nz - please allow 2 working days for these accounts to be created.

Raised Issues Sector feedback generated features and updates

COVID-19 Response Included in Sprint 22.6 – Approx. delivery w/c March 28th with minor releases in-between.

The Update GPs will be able to launch CCCM from their PMS and ‘Create a Probable Case’ in order to enter a record when one doesn’t already exist.

Enable CCCM access via Clinical Workstations.

Where the BHR is managed as a case, allow CCCM access from HealthLink to an NHI/BHR that has been discharged less than 2 weeks of today’s date. The patient context banner should also show the date of discharge.

What does this mean for me as a CLOUD user?

What does this mean for me as a ‘CCCM HealthLink in Context View’ user?

Status

I will be able to create a CCCM record for a probable case and carry out my standard activities e.g. health checks and initial assessments,

In progress

I will be able to access CCCM via clinical workstations to view and maintain COVID Case records.

I will be able to continue accessing my patient's CCCM record after their NCTS case been closed, for a certain TBD period of time, SO THAT I am able to access, maintain, and update COVID clinical records as required when providing care for my patients' COVID related illnesses.

In progress

Waiting Development

I will have a list of potential reasons for why this error message is occurring, and have a clearer starting point to resolving the issue.

The CCCM via HealthLink error message for a NHI with no active record will be updated to provide suggested reasons for why ‘no active case was found’

Stop GPs who are accessing CCCM via HealthLink from receiving constant script errors.

Such reasons include 1) delay in record creation since reporting a RAT; 2) Patient has been discharged recently; 3) You need to have an HPI set up on your profile in your PMS; 4) There is an issue with your username and password, or set up within your PMS.

I will no longer receive constant script errors when accessing CCCM via HealthLink.

Waiting Development

Waiting Development

COVID-19 Response Included in Sprint 22.6 – Approx. delivery w/c March 28th with minor releases in-between (dates TBC).

The Update

What does this mean for me as a CLOUD user?

What does this mean for me as a ‘CCCM HealthLink in Context View’ user?

Status

An easy-to-access link from within CCCM to up to date training materials and release notes

I will be able to access a ‘help’ menu that provides me with access to release notes, CCCM user manuals, and a redirection link to ‘Contact Support Team’. I will be able to help myself solve issues before needing to escalate them.

Waiting Development

The address field on page 3 of the ‘Person Information’ tab will be updated to enable a search box that validates the provided address with eSAM.

As a CCCM user, I will be able to search for and apply an address to update a Case’s location of isolation and have that provided back to NCTS

Waiting Development

Enable users to change the patient’s care plan via the main dashboard or the patient context banner, as well as in the regular health check.

The saved care plan will also be triggered back to NCTS, written in the note timeline as a Clinical Notes, and will be reflected in the next regular health check as the new default.

I will be able to assign someone to Self or Active Mx outside of/without having to complete a regular health check.

Waiting Development

The discharge/full summary will be refreshed to be made more legible and appropriate to community care of COVID.

I will be able to receive an appropriate/user friendly discharge/full summary for my patients in my PMS Patient Outbox.

Waiting Development

The update will enable medications prescribed in the last 6 months from NZePS to be listed in the initial assessment.

As a care provider, I will be able to see NZePS data about my patient pre-populated into the initial assessment, saving me time.

Waiting Development

Questions & Answers Session

COVID-19 Care in the Community Key Questions Questions relating to RATs

Drop in and Training Session

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

Covid Clinical Care Module Virtual Training Sessions (General Practice Specific)

Date / Time

Tuesday 12:00pm-1:00pm (weekly)

Access

Hosted via Teams: HERE

Session Type Date / Time Covid Clinical Care Module Virtual Training Sessions (General Practice Specific)

Tuesday 12:00pm-1:00pm (weekly)

Access

Hosted via Teams: HERE

Session Type

Covid Clinical Care Module Virtual Training Sessions (General Practice Specific)

Date / Time

Access

Tuesday 12:00pm-1:00pm (weekly)

Hosted via Teams: HERE

Date / Time

Access

Tuesday 12:00pm-1:00pm (weekly)

Hosted via Teams: HERE

Session Type

Covid Clinical Care Module Virtual Training Sessions (General Practice Specific)

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

Northern Regional Coordination Centre session Southern Regional Coordination Centre session Te Manawa Taki Regional Coordination Centre session

Central Regional Coordination Centre session

Date / Time

Tuesday 11:00-11:30 (weekly)

Wednesday 11:30- 11:00 (weekly) Thursday 11:30 - 12:00 (weekly)

Friday 11:30 - 12:00 (weekly)

Access

Hosted via Teams: HERE

Hosted via Zoom: HERE

Hosted via Zoom: HERE

Hosted via Zoom: HERE

COVID-19 Care in the Community Training Materials Training Material Description

The Quick Reference Guide provides an overview of the key tasks you will complete the CCCM.

The Full Training Guide provides a detailed step by step guide of the tasks you can complete within the CCCM.

Care in the Community NCTS User Guide

Access

CCCM Quick Reference Guide

CCCM Full Training Guide

CitC Hub Training Guide

Next Steps and Close

Appendix

COVID-19 Care in the Community Performance Issue Update A primary focus has been on improving the consistency of system performance.

Product / Issue

Description

Assisted RATs

Issues with handling of assisted RATs

Resolved

Status

NCTS and CCCM

Interface issues

Resolved

SMS Service

The SMS service was down on Saturday, 5th March.

Resolved

CCCM Tasks

Tasks not saving in CCCM

Resolved

Request a RAT website

A number of Cases with mobile numbers are not being sent the text message advising that they are positive and sharing the COVID-19 Contact Tracing Form link in a timely manner, resulting in them ending up in the queue for Cases who have not been informed Users have reported intermittent issues with the Request a RAT site

Error with Incorrect Day Zero

We have received reports that the Day Zero date was showing incorrectly in CCCM

Resolved. Monitoring.

Contact Phone Number

Instances where contact phone numbers were not coming through and displaying on CCCM but were available on the NCTS

Resolved. Monitoring.

CCCM Queuing

Performance issues were impacting the speed of CCCM records being created from an NCTS case and resulted in a queue

Case Events not creating Cases

Case Events are not auto-creating Cases for PCR tests

Fixed applied, Performance has improved. Monitoring Fixed applied, Performance has improved. Monitoring Fixed applied, Performance has improved. Monitoring

Duplicate Household Contacts

Duplicate Household Contact records being generated from the completion of the COVID-19 Contact Tracing Form

Fix in progress.

COVID-19 Contact Tracing Form Errors

Reported difficulties accessing or using the COVID-19 Contact Tracing Form

Fix in progress.

Infectious periods are being calculated incorrectly

Fix in progress.

In some instances, new Cases are being auto-assigned to PHUs instead of Reach Aotearoa

Fix in progress.

Cases in ‘Not Informed’ Queue

CCCM Dashboard Performance

COVID-19 Contact Tracing Form Errors New Cases mistakenly autoassigned to PHUs

Notes

We are managing ongoing reports of Tasks not being removed from the Dashboard once they are marked as Completed. We are actively working on resolving this issue and will provide an update in due course.

Resolved Resolved Day Zero cannot be updated through CCCM, and any changes to this will have to be updated in the Symptom Onset field in NCTS by a Hub team member.

We continue to monitor this and if any issues arise, the workaround is manual Case creation.

This may occur when there are multiple Cases within the household completing the form.

Work is underway to clear the duplicates and the teams are working to resolve this issue going forward.

Support lines have been advising people to ensure they notify their contacts and workplaces/education settings that they are a Case, to continue isolating, to refer to the Health Hub for further guidance, and to seek medical or welfare support if they need it.

The NITC is working to move these Cases through the system according to their relevant pathways.

COVID-19 Care in the Community Overview of System Information Flow

COVID-19 Care in the Community Care coordination hubs Coordinating wraparound support

48 hubs around the motu

Local care coordination hubs coordinate wraparound healthcare and welfare support, following a manaaki first approach putting the individual and their whānau at the centre.

DHBs set up hubs coordinating in four regions:

Healthcare

• Northern • Te Manawa Taki • Central • Southern

• Assessing whether cases can self manage, need help selfmanaging, or need active clinical support.

• Escalate and de-escalate care when appropriate.

• Refer cases to healthcare providers where necessary.

Welfare

Interagency collaboration Local DHBs, Ministry of Health, Ministry of Education, Oranga Tamariki, Ministry of Social Development, Whānau Ora (Te Puni Kōkiri).

• Assessing what welfare support needed to isolate.

• Coordinating welfare support across government and nongovernment providers, including: • Accommodation and food • Income support • Senior services • Paying for essential utilities and other urgent costs • Community support

Local providers Range of local community health and welfare providers such as Whānau Ora providers, iwi, food banks, and accommodation providers.

Over 300 full-time community connectors around the country to support the welfare needs of individuals and whānau while isolating.

COVID-19 Care in the Community Assessing healthcare needs Case notified/ confirmed by text and initial instructions

Primary care notified by Healthlink

Online selfassessment • Clinical assessment • Contact tracing • Welfare needs

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

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

Selfassessment

Active clinical management

Primary care assessment

Positive test

New CCCM case

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

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

Hub coordinated assessment

Assessment and documentation in CCCM whether case can continue self managing or needs active clinical management

De/Escalating as needed by telehealth, primary healthcare, or acute care

Escalation and deescalation as needed

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