How the City of Houston Health Department is using technology to speed essential contact tracing

In Texas, the state’s largest city is carefully getting back to business. And the responsibility for educating the public and helping slow the spread of the coronavirus falls to the Houston Health Department. Technology-enabled contact tracing is key to that effort.

Tracking and slowing the spread

“Contact tracing is a vital part of containing the spread of disease, preventing broader spread in our community,” said Houston Mayor Sylvester Turner. “Supplementing our traditional contact tracing efforts through Qualtrics gives our health department more resources to reach out to people who were potentially exposed to COVID-19, helping protect countless Houstonians.”

Contact tracing is an essential part of monitoring and controlling any outbreak. It is a complex but essential process that entails: identifying anyone who has tested positive for COVID-19, verifying where they’ve been and who they might have spread the virus to, and reaching out to those at-risk contacts to encourage them to quarantine and seek medical care for their own symptoms.

“As the state has opened up more and more and people have started interacting more and more, and we've gone through the end of May and into June, we've seen the number of cases reported to us on a daily basis continue to increase,” said Kirstin Short, the city’s Bureau Chief of Epidemiology. “It’s really about finding those people that may be sick and stopping them from making another round of people sick,” she said.

Historically, Houston has employed about 25 contact tracers to track down the roughly 80 diseases Texas state law requires to be monitored. But with the spread of coronavirus, the city’s health department needed more.

“Houston is the fourth-largest city in the nation. We have about 2.3 million residents that we are responsible for,” said Kirstin Short, the city’s Bureau Chief of Epidemiology. “For context, that's larger than probably about 17 states in terms of population. So it's a pretty serious challenge that we've got here.”

It’s really about finding those people that may be sick and stopping them from making another round of people sick.

Traditionally, contact tracing has been an intensely manual process, with contact tracers reaching out by phone or even in-person to contact everyone at risk. Short increased her contact tracers to 150 at the end of June and has plans to employ as many as 300 to keep up with the spread.

‘It’s like having a whole other team’

But contact tracing is also a challenge that can be improved with technology. Through the Qualtrics XM Platform™ the City of Houston Health Department is using an opt-in contact tracing solution to contact individuals who have tested positive or are at high risk of contracting COVID-19. Through a simple form, people can confidentially share locations they have visited and individuals with whom they have come into contact. The solution helps the city notify impacted individuals and instructs them on next steps so they can take the appropriate safety measures while maintaining individual confidentiality.

Qualtrics' contact tracing solution is both creating a better experience for the citizens of Houston, and making life easier for the Health Department employees too.

“The more cases we have reported to us on a daily basis, obviously the more resources we need to be able to reach out and contact those cases,” Short said. “Having another tool like Qualtrics is very, very helpful. It's like having a whole other team of people that are able to do some of that reach out for us.”

It's like having a whole other team of people that are able to do some of that reach out for us.

From a systems standpoint, the Houston Health Department is meticulous about tracking cases. Health care providers are required to inform the health department when someone tests positive for the novel coronavirus. The health department receives notices through electronic lab reports, faxes, emails, and even direct calls from providers. In every case, the department enters a new case in the Houston Electronic Disease Surveillance System (HEDSS).

Every day the health department pulls a list of positive-test patients from HEDSS and uploads the list to the Qualtrics platform. The health department owns and controls all the data from start to finish, and the Qualtrics XM Platform™ maintains the highest security certifications, including ISO 27001 and FedRAMP. Qualtrics is also HITRUST certified, which means its technology platform provides customers the tools they need to manage HIPAA compliance.

The patients who tested positive receive a health assessment through the Qualtrics system asking them to opt-in to report on their symptoms and to share contacts of people they have been in contact with in the 14 days prior to their test.

Within the first week, more than 2,000 queries went out to contacts who had potentially been exposed, saving the human contact tracers hundreds of hours of outreach and interviews.

“We're able to reach out to not only the people who have tested positive, but also people who have been exposed to these people who have tested positive,” said Mohammad Anjum Taj, a senior IT project manager for the health department.

“It brings in that kind of speed with them which is unprecedented,” Taj said “With manual processes, if you're trying to reach out to hundreds of people every day, you need a lot of people, and then you won't be able to reach out to all of them. So if you think people have been exposed, and if you're reaching out to them two weeks later, or a week later, then it's already too late.”

The automated outreach also brings other advantages, according to Short, including language preference. For now, if an individual prefers a language other than English, they will be automatically assigned a human contact tracer for assessment. The initial outreach also allows contacts to verify the information that was submitted about them. If it’s correct, they can stay in the automated system, but if anything is off, they can be assigned to a human contact tracer to correct their record.

It's like going from 25 miles to 100 miles an hour.

As the system went live, the daily count in the city averaged 200 new cases per day. Within the first week, more than 2,000 queries went out to contacts who had potentially been exposed, saving the human contact tracers hundreds of hours of outreach and interviews. The city also added 2,000 additional contacts that human contact tracers had not been able to contact after weeks of trying, said Taj.

The real advantages to the epidemiologists are the sheer number of people that can be reached and the speed. “With manual processes, if you’re trying to reach out to hundreds of people each day, you’re not going to get to all of them,” Taj said. “That whole loop, getting that information into the HEDSS system, and then that whole investigation, contact tracing -- I think we have expedited that process. It's like going from 25 miles to 100 miles an hour.”