Electronic Health Reporter

By Brad Bostic, CEO, hc1.

When I founded hc1 a decade ago, I believed that every patient should be treated as a unique individual. We built the hc1 Platform because we saw that if every individual’s laboratory data–which drives 70% of the diagnostic and therapeutic decisions–could be organized intelligently, we could unlock an unprecedented level of clinical decision support to personalize and improve care for all patients.

We knew that the platform would effectively lay the foundation for targeted pharmacogenomics and precision prescribing techniques. What we did not know at the time was that the decision to place our stake in the promise of lab insights would ultimately help drive an improved public health response to an unprecedented crisis: the COVID-19 pandemic.

A Coalition Is Born

From the earliest days of the pandemic, demand for greater transparency into COVID-19 data was high while the fluid nature of public health reporting impacted the ability to make well-informed decisions. As a result, local public health and healthcare officials were simultaneously overwhelmed with data and underwhelmed with the timely information and critical insights to help ensure optimal decisions around mitigation strategies.

The reality is that the state and national data relied upon by many public health officials offers limited proactive insight into the ebb and flow of the virus at the state and local levels. This remains as true today as it was in the earliest stages of the pandemic.

Consider the following:

• On July 24, 2020, Florida’s statewide COVID-19 cases increased by approximately 10,000. Yet Okaloosa county in Northwest Florida reported just 3 positive new cases that day, while Polk County in central Florida reported 55 and Broward County in Southeast Florida reported 29
• On Jan. 29, 2021, California recorded 20,138 new cases. Of those, 6,452 were reported in Los Angeles County. Meanwhile, San Mateo County reported just 277 new cases and Contra Costa County reported just 323.

In both instances, the local response in counties with higher infection rates should be quite different from those with significantly lower rates. Yet without insights offering public health officials a glimpse into the future, the default response was often cookie cutter actions guided by state-level decisions.

What we recognized early on was that the hc1 Platform and its reach representing up to 40% of the nation’s COVID-19 lab tests—one of, if not the, largest centralized samples available—could be leveraged to fill the information void. To make it happen, a coalition of commercial and health system laboratories and technology partners was quickly convened to create the CV19 Lab Testing Dashboard powered by hc1.

The complimentary dashboard, CV19Dashboard.org, equips public health agencies and healthcare organizations on the front lines with detailed lab testing insights from more than 20,000 ordering locations. It drills down to state, county, and sub-county views of COVID-19 testing rates, de-identified test results and key demographics. It also provides the industry’s only side-by-side view of COVID-19 viral and antibody testing, as well as local-risk and age-group trending.

Data from the dashboard also informs the hc1 Local Risk Index (LRI), which identifies communities where local resources may be strained in the next five to 21 days, allowing for a proactive response. In contrast to commonly used lagging indicators, such as mortality rates, ICU capacity and ventilator availability, LRI data trends can promote optimal decision-making, such as mask mandates and small-crowd compliance measures, possibly stopping an outbreak before it starts.

Putting Insights to Work

Examples abound of how the insights derived from the CV19 Lab Testing Dashboard and LRI are informing—or could have informed—local COVID-19 responses and adding to the base of knowledge needed to guide future responses.

For example, in May 2020, many states began easing lockdown restrictions, giving thousands the opportunity to gather in large groups while celebrating the long Memorial Day weekend. In early June, the LRI began trending upward, pointing to emerging coronavirus hot spots in South Florida, Arizona, Texas, and California, providing an early warning that intervention was needed to prevent a hot spot. By late June/early July, lagging indicators such as ER visits and hospitalizations were skyrocketing in these same regions/states. Unfortunately, the window of opportunity had already passed for enabling proactive measures that could have prevented the spikes that were already ravaging these regions.

The CV19 Lab Testing Dashboard has also paved the way for additional solutions to help mitigate the spread of COVID-19. For example, another aspect of the nation’s public health response to viral outbreaks is ensuring employees and students can safely return to work and school. hc1 Workforce Advisor™ addresses this by measuring and reporting the risk of COVID-19 infection not only at the workplace, but also in the communities where employees reside.

The return-to-work solution leverages insights from the dashboard and LRI, and then integrates real-time lab test results with local risk and symptoms. The information is aggregated into the hc1 CV19 Command Center, which drills down into office PUMA LRI, PUMA LRIs for the home addresses of all employees, and real-time identification of building, floor and wing of any reported employee that tests positive for coronavirus. Should the LRI begin trending upward in an employee’s or student’s home community, decisions can be made including social distancing or quarantine to limit exposure.

Further, once an employee tests positive, the solution transmits the data directly from the lab information system (with the employee’s permission) to the Command Center, alerting administration of a positive test. Armed with near real-time information, the employer can initiate rapid removal of an infected employee/student from common areas to minimize the potential of further infection to others. An optional Digital ID component enables entrance control and exposure notice for rapid deployment of contact tracing when needed.

The Power of Lab Insights

Currently, more than 2,500 registered users are utilizing the CV19 Lab Testing Dashboard with new users registering each day. The dashboard’s insights are powered by more than 30 million COVID-19 viral test results and over 3.5 million COVID-19 antibody test results, numbers that grow daily as results are received in real-time from the laboratory partners that make up the dashboard’s coalition.

By leveraging existing capabilities to address the real-time public health crisis presented by COVID-19, hc1 and the CV19Dashboard.org coalition have demonstrated that the value of lab insights extends beyond the traditional boundaries of healthcare to address the extreme challenges presented by a pandemic—challenges that force extraordinary responses at the local and micro-community levels.

In short, CV19 Lab Testing Dashboard and hc1 Local Risk Index have accomplished an important goal of providing granular insights that are critical to flattening the curve, saving lives, and influencing future national and local responses.