BACKGROUND: During the 2014 Ebola outbreak the Wisconsin Division of Public Health prepared for an influx of Ebola contacts requiring monitoring by configuring the Wisconsin Electronic Disease Surveillance System (WEDSS) to allow hospitals to monitor their own employees. The complexity of follow up monitoring caused hospitals to reconsider this approach. Fortunately Wisconsin did not see the volume of contacts other states had. Post outbreak, Wisconsin attended a presentation of Georgia’s Ebola Active Monitoring System (EAMS) and, using this as a model, developed our own monitoring solution.
METHODS: Initially the native features of WEDSS were explored to create user accounts for contacts to enter their symptoms. This approach was deemed too complex for the casual user; therefore an interface was developed to simplify the process. Instead of providing a username and password to the client we would initiate the self-reporting via email containing a secure link to a custom form created in WEDSS. Public health nurses get notifications of non-compliance as well as completed reports. High risk symptom alerts would be sent via the existing WEDSS functionality. The system has the ability to be used with any system that has an Application Program Interface (API) to import the collected data.
RESULTS: Supplementing the features of WEDSS we added a custom section to indicate a self-monitored client, the monitoring schedule and times the client was expected to record their symptoms. On the defined schedule clients were then emailed a URL with a lapsable token. When clicked the URL presents the form for the client to complete. If the client fails to report symptoms within the designated timeframe, the token expires. The application calls the WEDSS import API to send the data to the surveillance system. Though currently untested in a real outbreak, it is expected that self-reporting would reduce the burden of follow up and allow public health to focus their efforts towards high risk individuals.
CONCLUSIONS: Upon demonstrating the application, the Bureau of Communicable diseases provided us with additional use cases for the application. Some of these use cases are: enteric food surveys for group events where the attendee list was known, prenatal and postnatal surveys of mothers diagnosed with Zika virus, exposure events at schools to give parents a way to report to public health if their child was ill. Version 2.0 will support: additional languages, a dashboard report similar to EAMS, and an administrative tool to allow for configuration by WEDSS staff.