The Victorian COVID-19 Test Tracker Story

Image Credit - National Contact Tracing Review www.health.gov.au/resources/publications/national-contact-tracing-review

The one system in DHHS that I was most pleased with during the pandemic was the COVID Test Tracker. This was a system that solved a critical problem in the end-to-end test-trace-isolate process by collecting data at COVID testing sites across the state and tracking the samples through to 19 pathology labs and then into the COVID contact tracing systems.

The system was created by the Business Technology and Information Management (BTIM) team of the Department of Health and Human Services (DHHS) using its in-house SaaS Digital Solution Platform on Microsoft Azure. Test Tracker evolved iteratively in 45+ weekly agile sprints using automated dev/ops deployment. The agile approach enabled the system to be launched in weeks and then to adapt flexibly as the pandemic evolved and as feedback was received from users on the COVID testing front-line. Because this was public sector intellectual property, DHHS was able to share the system at no cost with SA, WA and Canberra Health.

The system is still in use daily and has processed over 8.5 million tests.

To me this was a shining example of the power of the Platform+Agile approach – affordable, adaptive, highly secure, sustainable and capacity building.

The system reused existing microservices assets and itself created new reusable assets that will be leveraged by future systems. This story illustrates the digital fitness that is enabled by the Platform+Agile approach and the use of in-house teams empowered by cloud services and agile methods to successfully deliver innovative projects in complex and challenging circumstances.

The Test Tracker Story ...

This article was written in late 2021 as a nomination for the IT News Benchmark Awards.

The Goal

Remember mid 2020? The first wave of the COVD-19 pandemic was in flight and we were all scrambling to work out how best to adapt to the challenges of the rapidly changing situation. Until there was a vaccine, the only effective control over the virus was to minimise transmission. The aim of the Test Tracker program was to enable more, faster, testing and to support faster contact tracing and isolation of positive cases and close contacts to reduce community transmission. Test Tracker addressed a critical need in Victoria's Test-Trace-Isolate Strategy for better collection of information from citizens at the point of testing and more streamlined processing and tracking of test samples through the pathology labs and uploading of test results into the COVID-19 case and contact management system.

The Test Tracker Program

A program of work started in May 2020 to implement digital solutions to streamline the collection of data at COVID-19 testing sites across Victoria.

A wide range of different systems were being used for testing, with paper forms in use at most ‘pop up’ testing sites. This was slow and frustrated the collection of data that was crucial for efficient and scalable contact tracing and outbreak management activities.

The Test Tracker program sought to develop digital solutions to streamline and speed up testing and improve data quality and reporting.

The digital program of work comprised six main streams:

• Rapid Screening Form – an online form to enable self-completion of personal and demographic data while waiting in a queue at a COVID-19 testing facility. A QR code enabled patient records and test samples to be matched and tracked accurately during testing and subsequent processing and reporting.
• Door-to-Door Community Testing Form – an online form for department staff to record information about testing ‘door knocks’ in community outbreak hot-spots. This enabled allocation of visits and tracking and reporting of community door knock activity to facilitate testing.
• Test Tracker System – the forms applications evolved to an integrated system that fully supported testing operations and reporting. New functionality included ‘Copy to GP Lookup’ for accurate entry of GP names for test results, industry-specific pre-filling of detail in forms and SMS messaging of information and results to patients. This system was ultimately used for all testing outside of hospitals – including shopping centres and community and industry hot-spots associated with specific outbreaks. Test Tracker transactions peaked at a seven-day rolling average of around 3,800 tests per day.
• Pathology Lab eRequest Integration – HL7 compliant eRequest messaging to enable tests initiated in Test Tracker to be sent directly into pathology systems. This removed the need for paper slips and data entry and reduced data issues arising from poor hand-writing and incomplete fields in over 220,000 test requests.
• Electronic Lab Reporting (ELR) - electronic reporting of lab results into DHHS to replace faxed delivery of test results. Over 2.4 million reports were processed, peaking at 14,500 per day from the largest lab.
• End-to-End Processing Times Reporting – analysis and reporting of the time interval between testing, reporting of results and contact tracing follow up.

Victoria's Test Tracker system was profiled on page 70 of the National Contact Tracing Review. Over 28 agile sprints had been completed at that time to iteratively refine the system. Agile delivery was ongoing as COVID testing demand and requirements continued to evolve.

Strategy Context

The Test Tracker system was a key initiative of the Digital Cell of the department’s COVID-19 Public Health Response division – created to lead Victoria’s public health COVID programs.

A Test-Trace-Isolate Strategy was developed in collaboration with Australia’s Chief Scientist Dr Alan Finkel to provide the rationale, vision and roadmap for an end-to-end integrated suite of digital solutions.

The primary goal of the strategy was to save lives and reduce the economic damage created by the duration of the State of Emergency and the state-wide lockdown of business activities and social interactions.

The strategy comprised five project streams:

1. PHESS stabilisation – urgent tactical improvements to improve the operational performance of the Public Health Event Surveillance System (a Conduent Maven system).
2. COVID-19 Test Data Collection & Tracking – to be used at testing locations to record patient data and enable tracking of tests through the pathology labs.
3. COVID-19 Case and Contact Management – to receive test report data and enable efficient and rapid contacting and case management of positive cases and close contacts.
4. COVID-19 Outbreak Management – to enable efficient and timely investigation and management of outbreaks and positive case/close contact clusters:
5. COVID-19 Operations Dashboard – to provide real time reporting on the conduct of testing, case management, contact tracing and outbreak management activities and outcomes.

Evolution

Initial development of the online forms applications was very much a ‘bottom up’ activity led by the IT teams in response to urgent requests from staff on the front-line of the pandemic response from May to July.

The rapid and successful delivery of useful solutions led to growing awareness and demand from executives for more sophisticated capabilities to support the escalating scale of the state-wide COVID testing program.

Ongoing development of the Test Tracker System was then part of a major state-wide program of COVID testing operations and community engagement activity that involved many hundreds of people and delivered millions of tests during the 2nd and 3rd waves of the pandemic in Victoria.

Outcomes 

Test Tracker enabled both more streamlined testing processes as well as the ability to report accurately on the time intervals between testing, contact tracing interviews and notification of close contacts. This reporting ability was an important enabler of continuous improvement in contact tracing and outbreak management.

The system enabled a reduction in the time from testing to notification of close contacts of more than 20 hours over September and October. This was a catalyst for process and system improvements that enabled Victoria to achieve the national target of 48 hours for this important measure of contact tracing throughput performance.

On 23 November 2021, the DHHS Secretary, Professor Euan Wallace, commented in the Parliament of Victoria’s Inquiry into the Victorian Government’s COVID‐19 Contact Tracing System and Testing Regime that “I just want to remind the committee that it is literally all about every minute counting”.

In the National Contact Tracing Review, the review panel observed that, “Test Tracker has saved valuable hours in notification of confirmed cases and contact tracing”.

Test Tracker made a material contribution to the implementation of Victoria’s Test-Trace-Isolate Strategy and its ability to bring the 2nd wave of the COVID-19 pandemic under control. The system processed over 220,000 tests – many thousands of cases per day at the peak of the 2nd wave.

The National Contact Tracing Review further noted that, “Test Tracker already plays an important part in Victoria’s end to end contact tracing system, with the aim of having 85% of COVID-19 tests in digital format by the end of the year. Test Tracker also provides future opportunities to extend beyond COVID-19 and create a practical legacy across pathology services.”

The Test Tracker System was provided under license to the health departments of West Australia, South Australia and Canberra Health.

Implementation approach

The implementation of the Test Tracker program was a complex and difficult change management exercise. Victoria’s health services sector and testing operations were very decentralised, comprising many organisations with different processes and systems (30+ testing provider organisations, hundreds of dynamic testing sites in a wide range of community settings and locations and 19 pathology labs performing COVID-19 testing analysis).

The early streams of work were implemented in a chaotic environment at the start of the pandemic, with testing operations being established at speed and everyone ‘learning on the job’.

In this environment, the ability of the in-house teams to collaborate closely with the front-line teams and quickly deliver minimum viable product systems was vital for winning staff over to the new digital solutions. Many staff, under pressure, were convinced that paper forms were the simplest and most reliable approach.

Success was achieved by user-centric design, by rapid delivery of systems that were easy and safe to use and by being responsive to user feedback.

As the program scaled up extensive engagement and training of site managers and users was provided and a SharePoint site used to distribute information about the system, training guides and release notes etc.

Technology

The systems were all bespoke developed in-house using the department’s well proven Platform+Agile digital transformation approach, rigorous Agile Project Operating Model methodology and automated Dev/Ops tooling.

Development was in the department's Microsoft .NET application development framework leveraging reusable microservices on the Microsoft Azure PaaS platform. Azure DevOps streamlined project delivery. Source control workflows and rules enabled peer-to-peer code reviews. Continuous integration and Continuous delivery processes enabled automated build, unit test, deployment, regression and cyber security testing.

The system has scaled seamlessly to process high transaction volumes. Test Tracker has processed over 8.5M tests - 58,899 on the 27th of December 2021 - the peak testing day. Tests processed are averaging around 50,000 per week in March 2022.

User access was via secure multi factor authentication. Reporting dashboards were created in Power BI. A SharePoint site provided system information and user training materials.

The in-house SaaS platform that enabled Test Tracker has now supported the creation of 25+ systems. We now call it the Digital Solution Platform (DSP) ... but that, as they say, is a story for another day ... :-)

Stop Press! Here is an article that describes the Digital Solution Platform.

The Team

• Brigitte Wong, Manager – System Solutions & Proposals, System Solutions Unit, Business Technology & Information Management Branch
• Andres Hernandez, Executive Director – Testing Data & Intelligence, COVID-19 Community Engagement & Testing Command
• Ray Baird, Director System Solutions Unit, Business Technology & Information Management Branch

COVID-19 Community Engagement & Testing Command Team

• Kristian Gleeson, Senior Project Manager, Product Lead/Manager
• Jackie La, Product Owner
• Stephanie Worsteling, Change Lead
• Tal Levitas, Change Manager
• James Lipari & Alex Rothnie, Rollout Leads
• Alka Gaindhar and Aileen Taylor, Senior Change Specialists
• Thai Ngan, Program Support Manager
• Costa Skiadas, Program Director
• Caroline Nichols, Project Officer

BTIM Team

• Huy Tram, Sandeep Bade - Project Managers
• Dylan Volhardt - Scrum Master
• Sadjad Abdoli - Application Architect
• Erika Fitzwater, Gavin Coulter, Jose Talavera - Analysts
• Diego D'Orazio, Naveed Kharadi, Sivakumar Mahalingam, Satinder Varma, Mohamad Ali - Developers
• Paras Kumar - Report Developer
• Selva Nakuladeva, Craig Parsons, Maxima Smith - Testers
• Sam Sharma, Dean Hansen - Laboratory Co-ordination
• Stephen Anning - Health Services Data Acquisition Co-ordination
• Abhendra Singh – Cyber Security.
• Jose Talavera – Business Analyst
• Gavin Coulter – Functional Analyst