Until it was eclipsed by New York in mid-April, the state of Washington had the highest absolute number of COVID-19 cases in the United States.
Under orders from Gov. Jay Inslee to rapidly accelerate COVID-19 drive-through testing, case investigations and contact tracing, the Washington State Department of Health (WSDOH) contacted Microsoft in early March for help in setting up a cloud-based informatics platform.
Microsoft, in turn, reached out to the REDCap team at Vanderbilt University Medical Center. Within two weeks, thousands of nasal swabs were being collected and reported from REDCap-supported drive-through testing sites across the state.
Since then, Washington’s COVID-19 count has dropped to the bottom half of the 50 states thanks to a variety of factors, including testing and social distancing.
“That amazed me, looking back — going from zero to a fully functioning, used system in a matter of two weeks,” said Krisandra Allen, MPH, molecular epidemiologist in the WSDOH Office of Communicable Disease Epidemiology, who helped design and implement the drive-through testing registration system.
“It was really a beautiful thing to watch three teams with no history of working together assemble quickly to solve a very important problem,” added REDCap’s creator, Paul Harris, PhD, professor of Biomedical Informatics, Biomedical Engineering and Biostatistics at Vanderbilt University.
Since the Vanderbilt Institute for Clinical and Translational Research (VICTR) launched it in 2004, REDCap (short for Research Electronic Data Capture) has become a wildly popular Web-based application for building and managing online databases used by public health departments and universities around the world.
The need for rapid and comprehensive collection of easily accessible health care data only became more urgent as the COVID-19 pandemic accelerated. Of the 4,500 institutional partners in 138 countries that have adopted REDCap, close to 700 signed up since January, said REDCap technical lead Rob Taylor.
Health departments and researchers around the world are using secure REDCap surveys and other data collection tools to test treatments and monitor symptoms of people exposed to COVID-19.
This spring REDCap-powered contact tracing enabled the Arkansas Department of Health to identify 35 confirmed cases of COVID-19 among 92 people who attended events hosted by an Arkansas church.
But what made the request by officials of the Washington State Department of Health unique was the sheer magnitude of their challenge and the breathtaking speed by which that challenge was met.
“They were building the train while we were laying down the tracks,” said REDCap’s support lead, Brenda Minor.
Traditionally, case investigations and contact tracing of people exposed to communicable diseases have been conducted in-person and on paper. That all changed with COVID-19. For the safety of both the public and the interviewers, public health employees would now conduct their inquiries from home and over the phone.
“We knew that we were not only going to have to do a lot of case interviews with a lot of different interviewers that we were pulling in rapidly and training rapidly, but we were going to need to have them entering their data electronically,” Allen said.
Perhaps the biggest challenge was implementing a drive-through testing registration system to make it easy for people at highest risk of being infected to get tested without having to wait in their cars for hours in huge lines because testing stations were overwhelmed.
As a first step, county health departments provided the state with a list of testing times and places and the maximum number of people who could be accommodated during each testing “slot.”
With Minor’s help, Allen set up an online registration system that offered appointment times at various locations only until the maximum number of registrants was reached.
Registrants filled out an online form that requested information about their risk status. Once they were assigned to a specific appointment, they were emailed an identifier number that they presented when they checked in for testing.
Registration for drive-through testing began on March 21. Eventually, five counties implemented the system, which so far has administered 13,000 tests without long lines or backups.
Initially VUMC hosted the testing data on its REDCap servers, which run the REDCap software, surveys and other tools.
Once its new electronic capabilities were up and running, the Department of Health planned to transfer them to “the cloud,” a virtual server that shares software and resources through a network maintained and controlled by a cloud provider — in this case, Microsoft.
But first Microsoft and VUMC would have to work out an NDA (non-disclosure agreement). “We have a very specific set of rules that allow us to share or not share the REDCap code,” Harris explained.
Alan Bentley and Peter Rousos in the Vanderbilt Center for Technology Transfer and Commercialization helped implement the NDA, and Taylor, working nights, weekends and even over the of July 4 holiday, helped transition the system to Microsoft’s cloud.
Other members of the REDCap team who worked on this project were Laura McLeod, Michelle Fernandez, Adam Lewis, Natalie Stanley, Veida Elliott and Lindsay O’Neal.
The best part of the project was that it didn’t stay in Washington State. Allen, who shared the system with the REDCap public health working group, said at least one other state has used it as a model to implement their own system.
“Krisandra was a wonderful collaborator,” Minor said. “She helped us develop some things that we could share with other people.”
“It’s really helped REDCap,” Taylor added. “It’s even faster now, and more secure.”
REDCap’s main appeal is its transferability. “People can build these tools in REDCap and easily share them,” he said. Health care institutions don’t have to start from scratch, spending weeks or months working with programmers to build and perfect a system that has already been created somewhere else.
“It puts power into the hands of the users,” Taylor said.
Allen agreed. “REDCap and its people at Vanderbilt really exemplify my favorite part about public health, which is the free exchange of products and ideas to help everyone,” she said. “It was really inspiring to see their public health commitment.”
