Agile Implementation of Innovative End to End Technical Solutions for Respiratory Testing in the COVID-19 Pandemic

The COVID-19 pandemic required rapid implementation testing at large scale. We describe our approach to creating an efficient and highly scalable end-to-end testing and reporting workflow. We utilized a combination of consumer-driven workflows, a consistent ordering and data collection EMR user interface, an EMR independent entry point for affiliated providers, and rapidly evolving automation of screening, registration, patient identification, curbside specimen management, and prioritization logic. Our agile approach allowed us to transition from people-driven processes and gain efficiencies utilizing previously developed informatics infrastructure, new solutions and emerging consumer digital tools. We supported over 1,000,000 tests with >200 prioritization logic changes without requiring education or changing the provider ordering workflows, handled patient-driven screening, data collection, and ordering of up to 9 patients/minute while decreasing curbside specimen collection from more than 39 to less than 17 minutes per patient. The approach supported texting consumers and standards-based reporting to public health agencies.