Returning to the Workplace: NYU Langone Health’s Novel ‘Daily Symptom Check’ Technology
Safely reopening workplaces has been on the minds of many organizations during the COVID-19 pandemic. With ongoing developments in public health guidelines and new emerging science on the virus, there are no instant tests or sure-fire ways to guarantee that safety. As an academic medical center with six hospitals in the New York Area, 400+ ambulatory locations, and approximately 60k employees, ensuring our front-line workers’ and patients’ safety is imperative.
The COVID-19 pandemic presented us with many challenges. Our ability to innovate quickly to provide a viable solution to safely bring our staff back to work has been a top priority for our medical center IT teams. As part of those teams, we, Michael Mainiero, Senior Director of Digital Strategy, and Molly Woodriff, Digital Product Manager, want to share the story of how we confronted this challenge at NYU Langone Health and quickly innovated a solution — the Daily Symptom Check — to support a safer return to the workplace.
Read along as we discuss the iterative development process and cross-functional teamwork that led to the launch of the “Daily Symptom Check,” a daily screening tool integrated with our human resources systems and available to our workforce through our patient portal, text message, and interactive voice response, which generates a digital pass for onsite entry to NYU Langone Health buildings.
Day 1: The Problem to Solve
Michael: It’s my role, as Senior Director of Digital Strategy, to consider the new challenges the health system faces and work to quickly develop novel and reliable digital solutions to meet them.
On a Saturday in early May, I received a phone call from Nader Mherabi, the Chief Digital and Information Officer of NYU Langone Health. He frequently reflects on the challenges of digital health, but on this particular day, I could tell by the excitement in his voice that he had something promising he wanted to discuss.
Nader articulated a problem to me: how can our faculty and staff return to work and attest to factors that signal a COVID negative status on a daily basis prior to working onsite? How could we systematically ask them to report on things like their temperature or their travel history easily?
It was clear from the initial conversation that the screening system needed to be seamless, mobile-friendly, and device agnostic to support the diversity of workforce users.
As we unpacked the problem statement, Nader suggested an approach with natural language processing, IVR, and SMS. This system needed to be accessible whether you had a smartphone or not, real-time, and reliable.
How could we quickly design and engineer a scalable, integrated, digital tool that could facilitate the safe return of our staff to work? As with our more established tools, this innovation would need to be bulletproof from an engineering perspective. It also needed to integrate seamlessly with other systems like our human resources system, patient portal, and be such that staff checking temperatures onsite had minimal contact with those that underwent the pre-check.
Day 2: A Functional Prototype
Michael: Shortly after scribbling down notes from my call with Nader, I called one of our senior architects. I asked him to get a working prototype built in 24 hours. Like with most innovation, we knew we might not get it right the first time, but it was important to iterate quickly and learn.
Molly: I knew immediately something big had started! Work chat channels were active my technical counterpart had gone completely dark to focus on this.
Michael: In 24 hours, we sent our first iteration to Nader to test. It didn’t work for him — the horror! It was time to iterate and overcome.
Molly: After Nader provided early feedback, we got up to speed about the problem to solve, product goals and I began to support the team in improving the user experience and creating a lightweight agile structure — daily “standup” meetings and a Kanban board — to support the innovation process across the engineers and designers building the custom IVR and SMS screening tools.
“In a fear-based, failure-averse culture, people will consciously or unconsciously avoid risk. They will seek instead to repeat something safe that’s been good enough in the past. Their work will be derivative, not innovative. But if you can foster a positive understanding of failure, the opposite will happen.” — Ed Catmul, Pixar Cofounder
Day 3: Iteration and Team Building
We went back to the drawing board to address some of the friction points in the early prototype. We started honing the IVR system’s voice to speech recognition, tinkering with IVR and SMS natural language processing, exploring alternative architecture and integration, understanding facility logistics, and overall user experience began to take shape. At this point, this system took on legs.
Michael: Nader had been running daily calls with his leadership team throughout the peak of the COVID-19 pandemic in New York City. Often in scenarios when the health system needs to innovate or rapidly overcome a technical challenge, Nader assembles a cross-functional team, sort of like a special ops team. To address the problem of safely, and effectively, returning to work on-site during the COVID-19 pandemic, the “seal team, six” of digital health, was assembled. This team consisted clinical systems, custom engineering and digital product, strategy, and human resources technology.
Molly: Each daily meeting was also a chance to get alignment with the leadership team on key engineering and product decisions and learn critical information about new onsite operational workflows. This short feedback cycle allowed us to create and iterate new, better versions of the Daily Symptom Check system at a fast pace and get input from subject matter experts and end-users quickly.
Michael: With this ad hoc special-ops team, we had a well-gelled, cross-functional team that was open to change and critique. With this, we were able to swiftly adapt and deal with problems as they arose.
Week 2: A Robust, Stable Product
Step 1: Screening Using ‘Daily Symptom Check’
Taking into consideration the diversity of our workforce’s mobile devices, access to our patient portal, and preferences, we built three parallel workflows a user could choose to take their daily screening with and generate a Daily Symptom Pass:
1) By text message
2) By calling an Interactive voice response (IVR) system, or
3) By logging into the NYU Langone Health app and using MyChart.
Molly: Today, the majority of employees using the Daily Symptom Check choose to use the NYU Langone Health app to take their screening. The SMS and IVR systems are key for supporting vendors, contractors, and others who might not be full-time employees. We’ve ensured staff of all kinds (vendors, employees, contractors) receive relevant screening questions and guidance, and help ensure the onsite entry experience is as efficient, and smooth as possible.
Each had its own decision tree logic that included screening for temperature, COVID-19 symptoms and high-risk travel history. The three workflows allowed us to anticipate the needs of our diverse workforce and empower all of our staff with this tool, regardless of their tech-literacy or access to devices.
Step 2: Generating Your Daily Pass
No matter which method a staff member chooses to use — whether by phone call, text message, or MyChart–their attestation is updated in our ERP human resources database as a central source of truth. This database is scanned every few minutes by a Python algorithm, which generates a text message with their Daily Symptom Pass.
Michael: We drew inspiration for the design for the Daily Symptom Pass from digital boarding passes for airplanes and the new Metro North train line passes familiar to many New York City commuters. It was also designed to be easily recognizable from a safe distance away.
Step 3: Returning to Work Onsite
This effort required considerable interaction design planning for queues. Who knew digital health would face similar problems as airline queues? We need to map out the flow of onsite staff and visitors and work across operational leadership to help design the administrative experience.
When designing digital health, the best products focus on ALL users, not just the patient or the person interacting with the app.
So how did it work? Using their own mobile device, a staff member can easily present the Pass at the door for security staff to observe if they are cleared to enter. Reducing the time and effort required during this brief interaction was a design priority, and helped to prevent crowding and lines at the door, expedite staff entry and on-time arrival to shifts, and allow staff conducting checks to focus their attention on guests who require more screening support.
Green passes demonstrate that you pre-screened using the Daily Symptom Check, including confirming your temperature by thermometer, and are approved to come to work onsite. Yellow passes are a conditional approval; they demonstrate that you pre-screened yourself, but did not have a thermometer at home, or that you are a vendor. Anyone with a yellow pass, has their temperature taken onsite, prior to entry. A bar code is present on the Daily Pass to facilitate efficiently updating an individual’s report to work status, after an onsite temperature check. Those checking temperatures at the door can easily scan the pass, lookup the individual in our HR system, and document a new status based on the temperature check.
Anyone without a Daily Symptom Pass to display, requires a full screening onsite. Those who do not pass the Daily Symptom Check before reporting to work, are provided with guidance on next steps, such as scheduling a COVID-19 testing appointment or initiating a conversation with their manager about an absence.
By creating a uniform, integrated, easy to manage experience for all parties involved, we have made the return to work experience easier and safer for our staff members. By leveraging several technology stacks, from our electronic health record system, to our human resources system, to our messaging system for all of our automated phone and messaging capabilities, we were able to weave together a product that addressed this new challenge at scale across the NYU Langone Health system.
