Secure Text Messaging Research Articles

Drivers of Inpatient Subspecialty Consultation Among Pediatric Hospitalists: A Qualitative Study.

Inpatient subspecialty consultation is often medically necessary but in some cases may represent overuse. While pediatric consultation patterns have been described using observational data, qualitative methods may generate knowledge about contextual determinants of consultation behavior. Our objective was to understand how pediatric hospitalists make decisions about subspecialty consultation. This qualitative study took place at a large academic children's hospital as part of an explanatory sequential mixed-methods design (QUAN → qual). We conducted semistructured interviews with a purposive sample of previously identified high-consulting (top quartile) and low-consulting (bottom quartile) pediatric hospitalists. Interviews were conducted virtually, and audio recordings were transcribed. Two analysts coded transcripts using an integrated approach and established high interrater reliability (κ > 0.75). We organized findings using the Social Ecological Model. Participants (n = 12) included high-(n = 6) and low-(n = 6) consulting hospitalists. Our respondents identified considerations including patient characteristics, confidence in their own competence and that of their team, and perceived helpfulness of consultants. Participants viewed consultation requests as being strongly influenced by a desire to maintain relationships with families. Specific to this context, the hospital's elite reputation was believed to influence families to expect consultations. Other considerations included medicolegal risk, clinical pathways, and availability of secure text messaging to facilitate informal "curbside" conversations with subspecialists. Decision-making around pediatric subspecialty consultation is complex and influenced by factors unrelated to a patient's clinical need. Efforts to reduce low-value consultation must account for the social and organizational dynamics that promote consultation.

The Use of Text Messaging as an Adjunct to Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder in Youth: Secondary Analysis.

As an established treatment for major depressive disorder (MDD), cognitive behavioral therapy (CBT) is now implemented and assessed in internet-based formats that, when combined with smartphone apps, enable secure text messaging. As an adjunct to such internet-based CBT (ICBT) approaches, text messaging has been associated with increased adherence and therapeutic alliance. This study analyzed data from the intervention arm of a randomized control trial evaluating 24-week ICBT for MDD (intervention arm) against standard-care psychiatry (waitlist control). The aim of this secondary analysis was to assess MDD symptom improvement in relation to the frequency and content of text messages sent by ICBT participants to Navigator-Coaches during randomized control trial participation. Higher text frequency in general and in 3 conceptual categories (appreciating alliance, alliance building disclosures, and agreement confirmation) was hypothesized to predict larger MDD symptom improvement. Participants were young adults (18-30 years) from the Centre for Addiction and Mental Health. The frequencies of categorized texts from 20 ICBT completers were analyzed with respect to MDD symptom improvement using linear regression models. Texts were coded by 2 independent coders and categorized using content analysis. MDD symptoms were measured using the Beck Depression Inventory-II (BDI-II). Participants sent an average of 136 text messages. Analyses indicated that BDI-II improvement was negatively associated with text messaging frequency in general (β=-0.029, 95% CI -0.11 to 0.048) and in each of the 3 categories: appreciating alliance (β=-0.096, 95% CI -0.80 to 0.61), alliance building disclosures (β=-0.098, 95% CI -0.28 to 0.084), and agreement confirmation (β=-0.076, 95% CI -0.40 to 0.25). Altogether, the effect of text messaging on BDI-II improvement was uniformly negative across statistical models. More text messaging appeared associated with less MDD symptom improvement. The hypothesized positive associations between conceptually categorized text messages and MDD symptom improvement were not supported in this study. Instead, more text messaging appeared to indicate less treatment benefit. Future studies with larger samples are needed to discern the optimal use of text messaging in ICBT approaches using adjunctive modes of communication. Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.

Pediatric resident use, perceptions, and desires for improvement of a clinical secure messaging application

BackgroundHospitals are transitioning away from traditional pagers to secure text messaging (STM) applications. STM is perceived to improve efficiency and accessibility. There is limited research on user's impressions of how STM impacts patient safety, provider wellness, and quality of patient care. ObjectivesTo understand the use and perceptions of a clinical STM by pediatric residents at a free-standing quaternary care children's hospital. MethodsA survey was conducted of pediatric residents regarding their experience with Diagnotes®. Demographic data were obtained along with use patterns, ability to perform tasks, and perceptions of intended purpose. Further questions evaluated agreement with communication strategies and satisfaction with features. Three open-ended questions asked about experience where STM impacted (1) patient care coordination and (2) patient safety. A final question asked for any additional STM feedback. ResultsOf 169 surveys, there were 112 respondents (66.3 % response rate). Respondents unanimously endorsed daily STM use on their personal mobile devices with good knowledge of basic features. Respondents were overall satisfied with Diagnotes® (73.9 %) including the ability to communicate efficiently (84.8 %) and effectively (79.5 %). Yet only 32.1 % were satisfied with Diagnotes® training. Only 59.5 % believed Diagnotes® was appropriate for urgent patient care needs and only 43.2 % believed its purpose was to inform the team of patient emergencies. Key qualitative themes included improved coordination of patient care tasks through STM, but there were concerns raised around sending and receiving messages, the additional cognitive burden placed by STM, and differences in culture of use that created conflict. ConclusionsDiagnotes® is viewed positively including use for effective coordination of patient care and familiarity of functions of Diagnotes®. Barriers included unclear interprofessional expectations for use. Future research should incorporate a broad range of healthcare professionals' perceptions and co-creation of STM best practice guidelines for use, including around urgent or emergent patient care issues.

Differences in perceptions and use of remote patient monitoring technology in rural cancer programs.

1582 Background: While the benefits and acceptability of remote patient monitoring (RPM) during cancer care are well documented, barriers to implementation and use of these digital technologies remain. Feasibility may be particularly restricted in rural settings. The Association of Community Cancer Centers (ACCC) surveyed U.S. cancer programs, patients with cancer and caregivers in various geographic settings to illuminate the current practice landscape and perceptions regarding the use of digital technologies to monitor patients for adverse events and collect patient reported outcomes (PROs). Methods: ACCC convened an expert advisory committee and patient advocacy partners to guide development of two surveys, one for cancer program staff and the other for patients/caregivers. Surveys were distributed between December 2022 and January 2023 and included 25 closed and open-ended questions. Exploratory analysis was performed and responses were compared between rural, suburban, and urban settings for both groups, with comparisons made by two tailed Fisher’s exact test. Results: There were 128 cancer program staff and 162 patient/caregiver responses. Of staff respondents (52% physicians, 20% other clinicians, 21% administrators/managers), 58% work in urban, 30% suburban, and 13% rural settings. Of the patient/caregiver respondents (56% patients, 44% caregivers), 28% live in urban, 51% suburban, and 21% rural areas. 56% of rural, 24% of urban, and 26% of suburban respondents indicated that their cancer programs have not implemented and are not considering implementing RPM. Of rural program staff, 44% indicated they have no experience/familiarity with RPM, compared to 7% for urban and 13% for suburban staff (p<.001, p=.03, respectively). Fewer rural programs, as compared to urban, use secure text messaging (6% vs. 42%; p=.008) or automated phone surveys (6% vs. 34%; p=.03). More rural patients/caregivers compared to their urban/suburban counterparts indicated concerns about privacy (47% vs 27%; p=.02), concerns about the need to pay (44% vs. 19%; p=.004), and lack of strong cell service (5% vs 21%; p=.007) as barriers to RPM technology use. Conclusions: RPM is gaining momentum in academic and community cancer program settings; however, significant gaps exist in RPM experience and implementation for rural cancer programs. In addition to well-documented disparities in access to internet and cellular service for rural patients, perceptions about privacy and cost pose additional barriers. Secure text messaging and automated surveys are often used as example solutions to bridge digital literacy and access gaps, yet cancer programs in rural areas are less likely to use these technologies. Tailored patient/provider education, funding/reimbursement strategies, and advocacy for policies expanding technology infrastructure may be needed for cancer programs to equitably provide RPM technologies.

Implementation of free-draft text messaging to enhance care retention and satisfaction for persons living with HIV infection

ABSTRACT Eligible persons with HIV infection can receive client-centered case management to coordinate medical and social services. Novel mobile health interventions could improve effective case management and retention in care, an important goal to help end the HIV epidemic. Using a hybrid type I effectiveness-implementation design, we assessed whether access to bidirectional, free-draft secure text messaging with a case manager and clinic pharmacist could improve client satisfaction and care retention in a Southern academic HIV clinic. Sixty-four clients enrolled between November 2019 and March 2020, had a median age of 39 years, and were mostly male, single, and African-American. Heavy app users texted over 100 times (n = 6) over the course of the 12-month intervention while others never texted (n = 12). App usage peaked during months of clinic closure due to COVID-19. Most participants reported high satisfaction with the app and planned continued usage after study completion. Changes in clinic retention and virologic suppression rates were not observed, a result confounded by practice changes due to COVID-19. High usage and satisfaction of free-draft text messaging in case-managed HIV clients supports inclusion of this communication option in routine HIV clinical care.

Understanding Caregiver Burden with Accessing Sickle Cell Care and Their Perspective on Telemedicine

Background: Sickle cell disease (SCD) is associated with a wide range of complications. However, a multitude of barriers prevent SCD patients from receiving adequate healthcare, including difficulties with transportation and lack of provider knowledge about disease sequelae. Importantly, studies have demonstrated the benefits of telemedicine in addressing barriers to healthcare. Few studies have explored barriers which affect the pediatric SCD patient population in areas such as the Midwest, wherein the geographical landscape can prohibit healthcare access. Furthermore, few studies have established acceptability of telemedicine among caregivers and patients with SCD. The objective of this study was to increase understanding of barriers to care and perceptions of telemedicine by caregivers of pediatric SCD patients. Methods: An 88-item statewide survey was distributed to caregivers of children with SCD cared for at Riley Hospital for Children in Indianapolis, IN. Caregivers were contacted by the research team via secure text messaging or in-person. Questions for the survey were developed based on previously performed semi-structured interviews with caregivers and the validated Barriers to Care Questionnaire (BCQ). The survey included questions regarding their experience accessing care, including barriers and facilitators of care, as well as their perspective on the use of telemedicine in SCD. Responses were analyzed using t-tests or chi square tests where appropriate. Results: Of the 300 caregivers contacted, 101 completed the survey, resulting in a response rate of 34%. The majority had 1 child with SCD, with most having Hb SS genotype. Eighteen percent of families drove more than 1 hour to access comprehensive sickle cell care. Caregivers reported having a median of 2 other healthcare providers that their child regularly sees. However, nearly 10% did not have an established primary care provider. Caregivers identified a median number of 6 barriers to accessing SCD care, with other household responsibilities, childcare, lost time from work and school as the most common. About 20% of caregivers felt these barriers affected their and/or their child's well-being and/or mental health at times, yet less than half reported their healthcare team ever discussing ways to address these barriers. Approximately 40% felt having a child with sickle cell disease impacted their daily stress and/or mental health. Sixty-three percent of caregivers worried about others (e.g. school staff) caring for their child, and nearly 50% worried about the care and knowledge of medical providers other than their SCD team. Forty percent of caregivers had participated in some form of telemedicine, the majority being direct-to-consumer. Eighty-one percent were willing to participate in telemedicine visits sometimes or always. However, nearly half felt the lack of a physical exam was a negative for telemedicine, and about 25% stated it was harder to build trust via telemedicine. Willingness to participate in telemedicine was not associated with prior telemedicine use, perceived positives/negatives of telemedicine, caregiver worry about others caring for their child, or distance from SCD center. Conclusion: The experiences of caregivers accessing healthcare for their child with SCD suggests caregiver burden and barriers to care that may be unique to patients with SCD. Additionally, while the majority are willing to participate in telemedicine for future sickle cell care, the negatives of telemedicine that caregivers reported are significant. Future studies should evaluate models of telemedicine care adapted for this specific population.

Barriers to Adoption of a Secure Text Messaging System: a Qualitative Study of Practicing Clinicians.

Secure text messaging systems (STMS) offer HIPAA-compliant text messaging and mobile phone call functionalities that are more efficient than traditional paging. Although some studies associate improved provider satisfaction and healthcare delivery with STMS use, healthcare organizations continue to struggle with achieving widespread and sustained STMS adoption. To understand the barriers to adoption of an STMS among physicians and advanced practice providers (APPs). We qualitatively analyzed free-text comments that clinicians (physicians and APPs) across a large healthcare organization offered on a survey about STMS perceptions. A total of 1110 clinicians who provided a free-text comment in response to one of four open-ended survey questions. Data were analyzed using a grounded theory approach and constant comparative method to characterize responses and identify themes. The overall survey response rate was 20.5% (n = 1254). Clinicians familiar with the STMS frequently believed the STMS was unnecessary (existing tools worked well enough) and would overburden them with more communications. They were frustrated that the STMS app had to be downloaded onto their personal mobile device and that it drained their battery. Ambiguity regarding who was reachable in the app led to missed messages and drove distrust of the STMS. Clinicians saw the exclusion of other care team members (e.g., nurses) from the STMS as problematic; however, some clinicians at hospitals with expanded STMS access complained of excessive messages. Secondhand reports of several of these barriers prevented new users from downloading the app and contributed to ongoing low use. Clinicians are reluctant to adopt an STMS that does not offer a clear and trustworthy communication benefit to offset its potential burden and intrusiveness. Our findings can be incorporated into STMS implementation strategies that maximize active users by targeting and mitigating barriers to adoption.

Abstract 06: Feasibility Of Accelerated Code Team Activation With Code Button Triggered Smartphone Notifications

Introduction: In-hospital cardiac arrest mortality has improved only modestly in the past decade. Prior studies support the role of earlier defibrillation and epinephrine administration to improve outcomes. Timely code team activation facilitates expedient interventions and may provide an opportunity for quality improvement. We sought to accelerate the time to code team activation and increase the early distribution of patient-specific data to improve targeted treatments. Methods: We mapped code blue buttons present behind each patient bed to patient data through the Electronic Health Record. Use of the code blue button sent patient-specific data including admitting diagnosis, recent procedural history, presence of difficult airway, and most recent potassium, bicarbonate, troponin, and hemoglobin levels through a secure text messaging system to the code blue teams’ smartphones. Simultaneously, the code blue button contacted the hospital operator who activated the code blue team through traditional methods including overhead page and pager alerts. We piloted the system on four medicine inpatient units from November 2019 through May 2022. In our analysis, we evaluated the time from code blue button press to smartphone message receipt vs overhead page, time to epinephrine administration, and survival to hospital discharge. Results: There were 35 cardiac arrest events on the participating hospital units. The code blue button was the primary mode of code team activation for 12/35 (34.3%) of the events. The code team received smartphone notifications a median of 78 seconds (IQR = 47-127 seconds) before traditional notifications. The initial rhythm was non-shockable for 34/35 (97.1%) of the patients. The median time to documented epinephrine administration for codes activated with or without the code button was 2:57 and 4:00 (IQR = 0:34-6:07 vs. 2:07-4:30; p = 0.89). Survival to hospital discharge was 3/12 (25.0%) for codes activated with the code button and 4/23 (17.4%) when activated by other methods (p = 0.61). Conclusion: Implementation of a smartphone-based code button activated notification system reduced the time to code team activation by over one minute. Further evaluation in larger cohorts is necessary to assess the effect on patient outcomes.

Trends in secure mobile communication technology use among hospitalists in North America, 2016–2021

ObjectivesStructured communication is essential for hospital-based clinicians to effectively coordinate patient care. However, traditional one-way paging systems are an inefficient means of information transfer. In response to the limitations of paging systems, vendors have developed secure text messaging systems (STMS) that provide asynchronous, multi-way messaging between mobile devices. In 2016 we conducted a cross-sectional survey of a nationally representative cohort of hospitalists and showed that pagers were used more frequently than STMS for patient care-related communication. Despite the potential benefits of STMS, we know little about the degree of STMS adoption since that time. The objective of this study was to quantify how STMS use has changed over time. MethodsWe re-administered our secure communication survey to the original cohort of hospitalists who responded to our initial survey, with a response rate of 25.4%. We used paired hypothesis tests to assess how hospitalist use and organizational adoption of STMS have changed since 2016. ResultsIn 2021, more respondents received messages primarily via STMS than they did in 2016 (n = 36 vs n = 14, difference in proportions 0.23, 95% CI 0.13–0.34, P<.001). Conversely, fewer respondents received messages via pager in 2021 than they did in 2016 (n = 21 vs n = 47, difference in proportions -0.27, 95% CI -0.38 to -0.17, P<.001). ConclusionsWe found that STMS has overtaken paging as the most frequently used technology for patient care-related communication. In addition, many hospitalists use both STMS and paging systems, placing them at risk for communication overload. Public Interest SummaryDoctors working in hospitals still use pagers to communicate. However, paging (receiving a message on a pager and having to call someone back) is slow and can lead to errors. New text messaging apps have been developed to let doctors send secure texts on their smartphones, but when we surveyed hospital-based internal medicine doctors (“hospitalists”) back in 2016, there was very little use of this technology. Because there seem to be benefits to using secure texting over paging, we wanted to show how trends in use of secure paging are changing over time. Here, we repeated our initial survey on the same group of hospitalists. We show that secure texting is now more common than paging, but many hospitalists have access to both. We caution that having too many communication options could lead to communication overload, and we suggest that best practices to prevent this should be studied.

Resident and nurse perspectives on the use of secure text messaging systems.

As hospitals shift away from pagers and towardssecure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors. This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital. This was a qualitative study with focus groups. Participants were pediatric residents and nurses at Lucile Packard Children's Hospital. Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached. Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well-being. Three resident focus groups (n = 14) and three nurse focus groups (n = 21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face-to-face communication and frontline decision-making. (3) STMS can promote patient safety through closed-loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well-being through satisfaction and relationship building. (6) STMS can negatively impact clinician well-being through increased stress related to communication volume. Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.

Reporting Evaluation and Management Services Provided Through Online Digital Communication

Codes 99421–99423 are reported for evaluation and management (E/M) services provided by electronic communication such as communications by secure email, through a patient portal, or by secure text messaging.

Comparing Online and On-Site Cognitive Behavior Therapy in Major Depressive Disorder: Protocol for a Noninferiority Randomized Controlled Trial.

BackgroundThe incidence of mental health disorders in Canada is increasing with costs of CAD $51 billion (US $40 billion) per year. Depression is the most prevalent cause of disability while cognitive behavioral therapy (CBT) is the best validated behavioral depression treatment. CBT, when combined with mindfulness meditation (CBT-M), has strong evidence for increased efficacy. While randomized controlled trials (RCTs) have demonstrated online CBT-M efficacy, comparisons with in-office delivery are lacking.ObjectiveThe aim of this research is to assess whether online group CBT-M (with standard psychiatric care) is non-inferior in efficacy and more cost-effective than office-based, on-site group CBT-M at post-intervention and 6-months follow-up in major depressive disorder. The study will also assess whether digitally recorded data (ie, online workbooks completed, Fitbit step count, and online text messages) predict depression symptom reduction in online participants.MethodsThis single-center, two-arm, noninferiority RCT employs assessor-blinded and self-report outcomes and economic evaluation. The research site is the Centre for Addiction and Mental Health (Toronto), a research-based psychiatry institution where participants will be identified from service wait lists and through contacts with other Toronto clinics. Inclusion criteria are as follows: (1) aged 18-60 years, any ethnicity; (2) Beck Depression Inventory-II (BDI-II) of mild severity (score ≥14) with no upper severity limit; (3) Mini-International Neuropsychiatric Interview-confirmed, psychiatric major depressive disorder diagnosis; (4) fluent in English. All patients are diagnosed by staff psychiatrists. Exclusion criteria are as follows: (1) receipt of weekly structured psychotherapy; (2) observation of Diagnostic and Statistical Manual of Mental Disorders (5th Edition) criteria for severe alcohol or substance use disorder (in past 3 months), borderline personality disorder, schizophrenia (or other primary psychotic disorder), bipolar disorder, or obsessive-compulsive disorder; (3) clinically significant suicidal ideation (imminent intent or attempted suicide in the past 6 months); and (4) treatment-resistant depression. All participants receive standard psychiatric care, experimental participants receive online group CBT-M, and controls receive standard care in-office group CBT-M. The online group program (in collaboration with NexJ Health, Inc) combines smartphone and computer-accessed workbooks with mental health phone counselling (16 hours in 16 weeks) that coordinates software interactions (eg, secure text messaging and Fitbit-tracked walking). The primary outcome is BDI-II, and secondary outcomes are anxiety (Beck Anxiety Inventory), depression (ie, Quick Inventory of Depressive Symptomatology and 17-item Hamilton Depression Rating Scale), mindfulness (Five-Facet Mindfulness Questionnaire), quality of life (European Quality of Life Five Dimension), and pain (Brief Pain Inventory).ResultsBased on prior studies with the BDI-II and 80% power to reject an inferiority hypothesis with a 1-sided type I error rate of 5%, a sample of 78 per group is adequate to detect small-to-medium–effect sizes.ConclusionsThis study assesses online CBT-M efficacy and noninferiority in relation to in-person CBT, and the cost-effectiveness of both interventions.Trial RegistrationClinicalTrials.gov NCT04825535; https://www.clinicaltrials.gov/ct2/show/NCT04825535International Registered Report Identifier (IRRID)DERR1-10.2196/29726

The Rapid Implementation of Ad Hoc Tele-Critical Care Respiratory Therapy (eRT) Service in the Wake of the COVID-19 Surge

A 24/7 telemedicine respiratory therapist (eRT) service was set up as part of the established University of Pennsylvania teleICU (PENN E-LERT®) service during the COVID-19 pandemic, serving five hospitals and 320 critical care beds to deliver effective remote care in lieu of a unit-based RT. The eRT interventions were components of an evidence-based care bundle and included ventilator liberation protocols, low tidal volume protocols, tube patency, and an extubation checklist. In addition, the proactive rounding of patients, including ventilator checks, was included. A standardized data collection sheet was used to facilitate the review of medical records, direct audio–visual inspection, or direct interactions with staff. In May 2020, a total of 1548 interventions took place, 93.86% of which were coded as “routine” based on established workflows, 4.71% as “urgent”, 0.26% “emergent”, and 1.17% were missing descriptors. Based on the number of coded interventions, we tracked the number of COVID-19 patients in the system. The average intervention took 6.1 ± 3.79 min. In 16% of all the interactions, no communication with the bedside team took place. The eRT connected with the in-house respiratory therapist (RT) in 66.6% of all the interventions, followed by house staff (9.8%), advanced practice providers (APP; 2.8%), and RN (2.6%). Most of the interaction took place over the telephone (88%), secure text message (16%), or audio-video telemedicine ICU platform (1.7%). A total of 5115 minutes were spent on tasks that a bedside clinician would have otherwise executed, reducing their exposure to COVID-19. The eRT service was instrumental in several emergent and urgent critical interventions. This study shows that an eRT service can support the bedside RT providers, effectively monitor best practice bundles, and carry out patient–ventilator assessments. It was effective in certain emergent situations and reduced the exposure of RTs to COVID-19. We plan to continue the service as part of an integrated RT service and hope to provide a framework for developing similar services in other facilities.

Finding the missing millions: Integrating automated viral hepatitis screening in a hospital with care and treatment in a primary care setting.

108 Background: Rates of hepatocellular carcinoma (HCC) are rising in the US. Patients at Saint Barnabas Medical Cancer Center (SBMC) present with late-stage HCC at higher rates (29%) compared to the national (16%). Chronic Hepatitis C (HCV) and Hepatitis B (HBV) are major drivers of liver cancer, yet screening rates are low. Finding these missing millions is important to reducing rates of HCC. An automated emergency department (ED) viral hepatitis (VH) screening program was initiated in 2018 at SBMC. In January 2020, it was expanded to the inpatient setting and HCV screening was modified from cohort screening (those born in 1945-65) to a one time test for anybody 18 years or over, per updated Centers for Disease Control (CDC) and USPSTF (US Preventive Services Taskforce) recommendations. Methods: The electronic medical record (EMR) was modified to automate screening. HBV testing is triggered by a patient’s country of birth or race, and HCV testing is triggered by age over 18 and no previous testing. The automated HCV (HCV Ab with reflex to HCV RNA) or HBV (HBsAg) lab orders lead to an EMR notification to the nurses of patient eligibility and education is provided to patients. Alerts of positive results are sent to nursing staff, physicians, and the patient navigator (PN). The PN is sent a real-time secure text message and works individually with patients to arrange linkage-to-care (LTC) for evaluation and treatment. Results: From March 2018 - December 2020, 44,002 patients were screened for HCV and 884 (2.0%) were HCVAb+ and 242 (0.55%) HCV RNA+. For HBV, 21,328 patients were screened and 212 (0.99%) were HBsAg+. The expanded screenings accounted for 8,716 (19.8%) of the total HCV screenings. Individuals born outside the 1945-65 birth cohort (younger and older) made up 76.2% of those screened and 41% of the infected. The top 3 countries for HBV screenings were Haiti, Jamaica, and Ecuador. LTC rates, defined as attending first medical appointment or already in care, were 86.8% for HCV and 85.4% for HBV. Of those linked to care, 43 HCV+ patients were seen at a outpatient primary care practice part of SBMC, and of those, 39 initiated HCV cure therapy and 33 were cured (confirmed sustained virologic response at 12 weeks), and 35 HBV+ patients were seen and 6 initiated treatment. Conclusions: This automated program for VH has led to a significant scale up of screening with successful LTC and treatment of patients. Expansion to universal screening of all adults and to the inpatient setting found additional viral hepatitis patients who would have otherwise been missed. In addition to the automated screening, a multidisciplinary team including internists, pharmacists, and patient navigators were part of creating a primary care based program. Integration of viral hepatitis screening and care in a hospital system can be initial steps towards establishing liver cancer prevention program.

LB-14. CovidIQ- a Text Message-Based Symptom Surveillance Tracker that Predicts New Areas of Increased Incidence of Covid-19 Disease

BackgroundTesting for SARS-CoV-2 is limited, making it difficult to estimate the true prevalence of disease and control the spread of new cases. Therefore, finding other ways to diagnose new cases of Covid-19 early is essential for preventing further spread of SARS-CoV-2 to other people in the community and prevent further outbreaks from occurring.MethodsCovidIQ is a confidential and secure text messaging platform that works by collecting participants’ self-reported symptoms. Upon agreeing to participate, users are asked some basic demographic questions including gender, age range, ethnic background, and zip code. Participants are then queried via text message on a weekly or biweekly basis as to what symptoms they are experiencing: none, temperature >99.6F, cough, shortness of breath, headache, fatigue, loss of appetite, loss of sense of smell or taste, diarrhea, body ache, sore throat, and/or chills. The symptoms are further broken down into major and minor criteria, allowing presumptive cases to be identified with more accuracy. The major criteria include elevated body temperature, cough, and shortness of breath. If a participant has any 2 major criteria, 1 major or 2 minor, or 3 minor criteria, they are considered a presumptive positive case.While CovidIQ cannot be used to diagnose individuals, the combined results from many individuals show real-time changes in rates of infection for entire counties. Not all people who develop Covid-19 will need hospitalization. They may remain out in the community unaware of the risk they pose to others. And, because the official count of confirmed cases is delayed by 2–4 weeks from the time of actual infection, CovidIQ can sound the alarm much earlier when rates of infection begin to spike. Advanced warning can help communities and individuals make informed decisions about how they should conduct themselves.ResultsCovidIQ identified the spike in COVID-19 cases in Jacksonville/Duval County, Florida a full two weeks before it was reported by the Florida Department of Health and Johns Hopkins University.Prevalence of Suspected COVID-19 Cases Through the Use of the CovidIQ Platform in Relation to Dates of OfficiallyReported Cases, Duval County, FL ConclusionCovidIQ is a novel tool developed to augment the public health response to this ongoing crisis by informing the public sector of potential new hot spots before areas experience a surge as compared to the current reporting structure.Disclosures All Authors: No reported disclosures

Perception survey of crisis and emergency risk communication in an acute hospital in the management of COVID-19 pandemic in Singapore

BackgroundEmergency risk communication is a critical component in emergency planning and response. It has been recognised as significant for planning for and responding to public health emergencies. While there is a growing body of guidelines and frameworks on emergency risk communication, it remains a relatively new field. There has also been limited attention on how emergency risk communication is being performed in public health organisations, such as acute hospitals, and what the associated challenges are. This article seeks to examine the perception of crisis and emergency risk communication in an acute hospital in response to COVID-19 pandemic in Singapore and to identify its associated enablers and barriers.MethodsA 13-item Crisis and Emergency Risk Communication (CERC) Survey, based on the US Centers for Disease and Control (CDC) CERC framework, was developed and administered to hospital staff during February 24–28, 2020. The survey also included an open-ended question to solicit feedback on areas of CERC in need of improvement. Chi-square test was used for analysis of survey data. Thematic analysis was performed on qualitative feedback.ResultsOf the 1154 participants who responded to the survey, most (94.1%) reported that regular hospital updates on COVID-19 were understandable and actionable. Many (92.5%) stated that accurate, concise and timely information helped to keep them safe. A majority (92.3%) of them were clear about the hospital’s response to the COVID-19 situation, and 79.4% of the respondents reported that the hospital had been able to understand their challenges and address their concerns. Sociodemographic characteristics, such as occupation, age, marital status, work experience, gender, and staff’s primary work location influenced the responses to hospital CERC. Local leaders within the hospital would need support to better communicate and translate hospital updates in response to COVID-19 to actionable plans for their staff. Better communication in executing resource utilization plans, expressing more empathy and care for their staff, and enhancing communication channels, such as through the use of secure text messaging rather than emails would be important.ConclusionCERC is relevant and important in the hospital setting to managing COVID-19 and should be considered concurrently with hospital emergency response domains.

#SendHelpNow: Mental wellness and virtual connection in the age of coronavirus

Coronavirus, coronavirus disease (COVID‐19) and social/physical distancing are among the words that have become household names amidst this pandemic. Not only has our vocabulary changed, but also the ways we connect with others. We have become even more reliant on technological advances for business, education, pleasure and other activities. In fact, 93% of Americans report that an outage in internet or cellular service during the outbreak would cause problems in their daily lives (Pew Research Center, 2020).

COVID-19-A Guide to Rapid Implementation of Telehealth Services: A Playbook for the Pediatric Gastroenterologist.

COVID-19-A Guide to Rapid Implementation of Telehealth Services: A Playbook for the Pediatric Gastroenterologist.

Caring Collaborative Beyond Our Borders

Caring Collaborative Beyond Our Borders

Improving Critical Value Notification through Secure Text Messaging

Background: To improve communication between clinical providers and the laboratory, we recently implemented secure text messaging for our critical value notifications. This was done to communicate laboratory critical values (CV) to providers faster so changes to patient care could be done faster. Our previous method of communicating CV to providers was paging and relied on a call back to receive the critical value. Methods: We implemented delivery of CV through a secure texting application in which the CV was directly communicated to the provider on their smart phone device. Results: The mean pre-implementation turnaround time (TAT) was 11.3 minutes (median: 7 minutes, range: 0 - 210 minutes). The mean post- secure text messaging implementation TAT was 3.03 minutes (median: 0.89 minutes, range: < 1 - 95 minutes).When comparing pre- and post-implementation, there was a significant reduction in the TAT from using secure text messaging (p < 0.001). Of the 234 surveys sent out, 81 providers responded (35%). Of these responses, 85% reported that critical value notification by secure text messaging has increased their efficiency and 95% reported that critical value notification is more effective than a pager-phone-call based system. 83% of providers reported that they were able to provide better, faster care to their patients. Conclusions: Using secure text messaging (STM) to deliver critical values significantly reduces the CV TAT. Furthermore, providers noted they preferred to receive CV notifications through STM and reported that they were able to provide more effective care to their patients.