How Hawaii’s Reliance On ‘Labor Intensive’ Fax Machines Hampers Contact Tracing
UPDATED: Before asking to go on leave, the epidemiologist helping to lead the effort to identify how COVID-19 is spreading in the islands was trying to make the process more efficient.
Ever since the COVID-19 pandemic hit Hawaii, the state鈥檚 contact tracing program has relied on two fax machines to receive the thousands of new positive and suspected case reports pouring into its offices.
Recently, those machines have been overloaded with the new cases. Occasionally, they break down.
The decades-old technology, along with other IT inefficiencies, has consumed valuable time throughout the crisis and heaped duplicative data-entry work on an overburdened staff, according to Emily Roberson, who was recently leading the Department of Health鈥檚 Disease Investigation Branch.
鈥淧icture running a printer from the beginning of the day to the end of the day, without a break,鈥 she said.
Roberson was assigned to the branch chief role in July to help oversee the state鈥檚 struggling contact tracing efforts. On Wednesday, she asked for a leave of absence from DOH until the 鈥渟ignificant confusion鈥 over whose directives she should follow could be resolved.
Prior to her leave request, Roberson told Civil Beat she鈥檇 been working to fix inefficiencies, including the faxes, that were hampering the DOH contact tracing operation. Even her division鈥檚 core group of six to eight primary investigators has been doing basic administrative work throughout the pandemic, she said.
DOH leaders have been roundly criticized for not hiring more contact tracers fast enough to keep up with the pandemic鈥檚 recent surge. The state has now seen 9,202 reported cases, including 211 new cases Thursday. Hawaii has also endured 79 reported COVID-19 deaths.
“You can鈥檛 address the personnel without addressing that we鈥檙e highly dependent on fax machines that keep breaking,鈥 Roberson said Monday.
The faxed reports often have missing patient data, which University of Hawaii student interns and National Guard personnel have recently helped to clean up, she added. Dealing with obsolete IT adds time and labor, as staff moves spotty data from thousands of hard copies of paper into , the software DOH uses to manage its contact tracing strategy, she said.
Before Roberson arrived, staff with the Disease Investigation Branch would manually scan the faxed sheets of paper even though the system was already automatically scanning most of the faxes and placing them in a digital folder, she said.
鈥淚 don鈥檛 think they realized it was being scanned the first time,鈥 Roberson said. Only a couple of people had access to the folder, she said, adding that she didn鈥檛 know why that was.
The National Guard team assigned to help the branch now has access to the folder and the duplicative scanning has stopped, Roberson said.
Since Aug. 18, the team completed more than 12,000 data entry forms for the branch’s system, Roberson said. It also added nearly 2,200 missing data and corrected or cleaned up more than 6,200 existing data elements, she said.
“It鈥檚 still too labor intensive, but it鈥檚 better than the alternative,鈥 she added.
On Sunday, the Disease Investigation Branch unveiled to health care providers across the state a new, to report cases. The branch hopes that hospitals, doctors and providers will use the digital form to report new COVID-19 cases instead of faxes.
It will still take work to upload the data from those forms into Maven, however. Roberson said it鈥檚 been hard recruiting workers who know how to code in to make that upload a less time-intensive process.
For now, the branch has relied on an entomologist on loan from the health department鈥檚 who knows how to code in that language to oversee that effort, she said.
‘No End In Sight’
The state government鈥檚 heavy reliance on antiquated IT — and how that affects the quality of service and transparency to the residents it serves — has been well-documented.
But Roberson and other health officials say it鈥檚 actually the health care providers and the nation鈥檚 healthcare system that are more to blame in this case for all the faxes.
鈥淭hat鈥檚 how hospitals communicate these days鈥 said Dr. Ryan Roth, a physician who works at hospitals on Oahu, Kauai and Hawaii island. 鈥淭hat鈥檚 what we do is we fax paper back and forth. It鈥檚 nuts. It鈥檚 2020 and it boggles my mind.鈥
The problem, Roth explained, is that there鈥檚 no centralized database for hospitals in the U.S. to share patients鈥 records with one another. Hospital systems developed different electronic medical record systems, he said, 鈥渂ut they didn鈥檛 talk to each other.鈥
鈥淭he only way to do it is by fax,鈥 he said. 鈥淭here鈥檚 no end in sight. There鈥檚 no federal drive to do this.”
Nonetheless, she said she hoped local hospitals and doctors would report new COVID-19 cases with the new PDF form instead of faxes. But she said it’s “hard to get everyone to switch over at one time.”
Investigators Assigned To Write Letters
Beyond the fax and data problems, Roberson said she鈥檚 been trying to free the state鈥檚 limited team of disease investigators from administrative duties and responsibilities that land on their plate.
In recent weeks, as Hawaii鈥檚 COVID-19 case counts have spiked, those investigators have been getting phone calls at the branch from residents desperately trying to reach anyone within the health department for help with other social services, their plights exacerbated by the pandemic, she said.
When that happens, the disease investigators, who aren’t trained as case managers, nonetheless try and help those callers, Roberson said. In several instances, they鈥檝e bought meals for the person on the other end of the phone, she added.
鈥淥n the one hand, it鈥檚 very nice that you want to help people, but my investigators are burning out themselves. It鈥檚 very emotionally taxing,鈥 she said Tuesday, hours before requesting her own leave of absence.
Roberson said earlier this week that DOH was working to route such calls to its 鈥淭his needs to happen yesterday,” she said.
Those investigators also drafted thousands of letters informing COVID-19 patients and those who had been exposed to the disease when their quarantine and isolation periods were set to start and end, Roberson said.
Those letters should have been assigned to other agency staff without investigations expertise so that the investigators could focus solely on contact tracing, she added.
The branch is also looking to use the Maven software more efficiently to better prioritize which cases to focus on, given the surge of new cases and the limited staff. For instance, if a patient’s home address matches the address of a care home or nursing home, the system will flag that patient as a top priority, Roberson said.
The branch has developed similar matches in Maven to flag especially vulnerable patients or those at risk of spreading the disease. They include those who work at hospitals or correctional facilities, and those who live at homeless shelters, she said.
Asked whether her branch is getting the resources it needs, Roberson said “there鈥檚 always limitations, and I鈥檓 just doing the best to push back against limitations.” She declined to specify further.
She did add that she was grateful to the numerous staff members from other departments on loan to her branch.
Less than two days later, she put in her request for a leave of absence.
It鈥檚 not clear whether DOH leadership addressed the fax situation prior to Roberson’s arrival. However, Roberson said that state Epidemiologist Sarah Park, who’s taking a leave of absence effective Friday, brought her on board to seek ways to improve the contact tracing operation.
COVID-19 patients who need support or their service providers can call 832-3100 to reach Department of Health staffers.
