Larimer County, CO is a Trailblazer
Larimer County, CO deploys an agile, comprehensive, COVID-19 emergency response management system on the cloud
Meet Larimer County
“COVID-19 was this emergent need that we as a team have to take action on right away at each and every step,” said Joseph Schreurs, Application Services Manager, Larimer County Information Technology Department. “So we started off by managing processes and data collection via Google Docs. As you can imagine, when there's one or two cases, sure, that can work, but it doesn't scale well. We would have had to double, triple, or quadruple our staff just to meet the workload demanded.”
But it takes time to hire double or triple staff, and it takes budget – two things departments and agencies do not have the luxury of when managing a crisis. Instead, Schreurs and team got creative and shifted employees from roles that had come to a standstill into new, high demand positions. They turned restaurant health inspectors into contact tracers and office managers into clinic operations leads, “which meant we in IT had to find a way to enable new programs and train a new workforce with no time to spare,” Schreurs continued.
Enabling new people and new processes, overnight.
On the people side, Schreurs and team needed to give staff the right tools and information to take action on public health direction. They needed to consolidate information from various Google Docs into a personalized case record, and then make that available in real-time without sacrificing compliance requirements so that staff track the case and could meet service level agreements. “If the county is going to guarantee that we will notify people of their test results in 24 to 48 hours, we need to enable that at the system level, otherwise staff can’t make that happen” said Schreurs. "We had to give them the tools to simplify the navigation process so that they could focus on the mission-critical work.”
On the program side, Schreurs and team needed to translate public health needs into an actionable workflows. “Early on, it become very obvious that our non-English-speaking populations were going to especially struggle with this crisis,” said Katie O’Donnell, Public Information Officer for Larimer County Department of Health and Environment. “Thus, we had to make data collection efforts and public service announcements available in multiple languages. The last thing we want is our more at-risk populations not understanding what we're asking them to do.”
As the pandemic continued to evolve, and we not only learned more about the virus but also the levers with which we could address the fallout, O’Donnell and team needed the tools and system used by their teams to be as agile. “We had to start collecting ethnicity data and race data because that's required by the State of Colorado for testing. And then as we’ve continued that for vaccines, we’ve had to be able to pull and report on our own data so that we could answer questions like ‘are we equitably distributing doses?’ and ‘how at risk are our communities?’”
Introducing a 360-degree emergency response management system.
Before the pandemic hit, Larimer had deployed a comprehensive application on Salesforce for the County’s criminal justice department that had several similarities to the system requirements demanded by COVID-19. “We had cases and portions to show public data for the jail population, and saw that contact tracing really followed very similar principles and practices. So we got the team together, used their spreadsheets to identify inputs and outputs, and built a model. Then we met with outbreak management and did the same exercise, and then the vaccine distribution team…and a week-and-a-half later, we went live.”
Schreurs, O’Donnell, and team launched a comprehensive COVID-19 Response Management System on the FedRAMP-authorized Salesforce Platform. It is an agile emergency response management system that Larimer County is using to manage communications, testing, contact tracing, outbreak response, vaccine distribution, clinic staffing, reporting, and location operations and logistics. Here’s how it works:
Communications
- Larimer County residents start with the public website where they can look up information, like the number of cases or hospitalization rate that has been aggregated from contact tracing records, in English or Spanish and determine current level of risk. “Let’s say I decide the risk is low enough and I go ahead and go to the grocery store. And, wouldn’t you know it, two days later I am not feeling so great,” said Schreurs.
Testing, tracing, and outbreak management
- Joe can return to the same website and register for a COVID test. He fills out the screening questions (what symptoms he is experiencing, which store he went to, and so on), enters his data on his demographics, enters his contact information, notes any onsite language requirements, and selects a testing appointment from a list of open time slots available at the locations nearest his house. Joe’s information is captured in a personal profile record, and he receives a ticket via a print-ready prompt and email.
- Once Joe arrives onsite for his testing appointment he presents his ticket and gets checked in. His sample is collected and sent to the lab for processing. Once his results are available, the lab uploads them into Joe’s profile record and the system notifies Larimer County staff so that they can follow up accordingly. “I tested positive, so they send me an isolation order. I also get a call from a contact tracer within 24 hours to find out who else I may have come in recent contact with so that the team can issue quarantine orders,” said Schreurs.
Vaccine management
- Joe recovers, and later learns he is now eligible for a vaccine after receiving an automated email notification from Larimer County that used his same profile information to flag him and assign a PIN. “PINs have been really important to us because they give us a little more control over ensuring eligible people are the ones registering for vaccine appointments,” said O’Donnell. “If someone tries to register with a PIN that doesn’t match the email address with which that PIN was issued, the system won’t allow them to book an appointment.”
- Joe returns to the same website and uses his PIN to book a vaccine appointment. The system sends you an automated email reminder complete with check-in ticket, following the same user experience that Joe went through for scheduling his COVID test a while back.
- Once Joe arrives onsite for his vaccine appointment he presents his ticket, gets checked in, answers a series of vaccination-specific screening questions which are captured in the same profile record, and receives his first dose.
- When Joe arrives back home, he finds an email notifying him that his second appointment was booked automatically in the recommended time frame, triggered when the onsite staff confirmed his first vaccination event as successful. Joe can either confirm that appointment or reschedule as needed. Joe’s second appointment is managed in the same way – email reminders, contactless ticket check-in, and vaccination data entry.
How did Larimer County accomplish this?
Impact comes from real-time data and expanded partnerships.
Three weeks after going live, Larimer’s onsite staff was fully enabled to take action and collected data all in one place. “This gives us the ability to track where we are at in terms of overall level of risk, rate of spread, rate of vaccination, and more. We can also pinpoint where our bottlenecks are and address them right away. For example, we brought our contact tracing response time down to just under the 24-hour mark,” said Schreurs.
“At the larger, emergency response management level we can also track our no-shows, look for patterns as to why that might be happening, increase the number of reminder emails, report on whether or not we hit our thresholds, and more – data that would have otherwise been anecdotal,” added O’Donnell. “At the more granular, program-specific level we can see this all in real-time, program by program, which means we can watch a running tally of no-shows throughout the day and contact the next eligible people to try and come in as we go. We're not waiting ‘til the very end of the day to try and rush 50 people in all of the sudden.”
To date, Larimer County’s system has managed over 31,300 contacts. The team is also expanding its partnerships beyond its own staff, reassigned from paused departments to include health care providers and school districts. Those groups are each running their own clinics in the same environment, extending the team’s ability to get more targeted and more timely with their response efforts. Most recently, FEMA and the State of Colorado also onboarded with the system, using it to run their mass-vaccination clinics they stood up in Larimer County.
“We’ve taken this big, complex problem and broken it down in a way that enables everyone to take action and help us in this fight,” said Schreurs.
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