Designing Test Logistics
How simple enhancements to experience design could improve COVID-19 testing center speed
Currently, the Omicron variant of the COVID-19 virus is ravaging the United States as the most dominant amongst infected individuals.
Additionally, there is a crisis involving testing. People are waiting in line for hours to receive a test, which for many is not sustainable with their schedules or socioeconomic status.
Having experienced multiple testing approaches, the time that it takes to receive a test is as much a logistics problem as it is a capacity problem.
We took some time to think about how we could make the testing process more efficient without excluding less technologically savvy individuals.
The challenge
We first needed to assume a set of constraints to keep our exercise grounded.
Testing capacity is finite. For the sake of this exploration, we assume that there is a finite number of tests that can be processed per testing site, per day. This forces us to not only address the speed at which we can move people through a queue, but also how to manage an effective appointment system.
Not everyone owns a smartphone. We want to create a solution that works for the greatest number of individuals, rather than relying on web browsers and apps as a blanket solution.
Most people have SMS. It is a fair assumption to believe that most patients, even many unhoused patients, have the ability to communicate with modern SMS.
We are concerned with the happy path. COVID-19 testing is inherently human, and therefore subject to human fear, hesitation, and lack of preparedness. These elements would all impact a comprehensive solution, but do not factor into this exploration.
Measuring success
We first needed to assume a set of constraints to keep our exercise grounded.
Limit human input at testing sites. Handwriting, typing, and pressing too many buttons are all contributing factors to a slow testing process.
Create reasonable expectations that appointment times are accurate. Given that we assume testing capacity is finite, we will rely on appointments to limit our testing audience. If we offer appointments, those appointments must be as accurate as possible.
Develop an accurate means by which to measure speed from check-in to completion. There should be no guessing about how long the testing process will take at any given time.
The transmission of data
Testing capacity aside, the bottleneck in the testing process is the transmission and shepherding of patient information.
Movement of information
[Patient Details] > [Testing Vial] > Result > [Patient] + [Government reporting]
While the flow of information appears relatively simple, inputting Patient Details and then connecting them to a vial is a non-standard process that can hamper testing speed. Here are two procedures that I have experienced.
The slowest procedure I have experienced
Input Patient Details online
Arrive at testing site
Provide Name + Date of Birth to find my record for check in (Name typed into search field)
Confirm name to find record for vial prep
Name and date of birth handwritten onto vial barcode + result access sticker
Barcode affixed to vial
Barcode scanned to connect vial to my patient details
Result access sticker given to me
Test administered
The fastest procedure I have experienced
Input Patient Details online
Arrive at testing site
Provide Name + Date of Birth to find my record for check in (Name selected from short list of appointments)
Barcode affixed to vial
Barcode scanned to connect vial to my patient details
Test administered
In both of these cases, I input my patient details online before arriving at the testing site, however, accessing those details and pairing them with a vial was inefficient.
We can get a visit down to two clicks on a scanner:
Check into the testing appointment
Print a vial label
The proposed approach
The key to success is creating a unique code for every patient that provides fast and easy access to their information. A testing provider can issue this code once, and the patient can use it repeatedly to make testing appointments, get tested, and access results.
To illustrate our proposed solution, we created a fictitious testing provider called Patter.
Creating a code is initiated via SMS
Jeremy is interested in getting tested, and knows that Patter provides tests close to his home. When driving by he saw that he can text “Get tested” to 728837.
Jeremy is on an iPhone, so he will choose to complete his patient enrollment online, however, the process can also be completed through a series of exchanges over SMS.
Once his patient information, and insurance details are complete, Patter issues a “Testing Identification Code’’ to Jeremy in the form of a QR code. He can add this to his digital wallet, much like a Starbucks card.
For patients who use SMS, they will receive a simple text-based code. A QR version can be shared via email, or potentially provided at the testing site.
One code to rule them all
This code is now Jeremy’s ticket to COVID-19 testing and results. He begins by scheduling a test, which was the reason he began this process in the first place.
Testing appointments are already connected to his code, but were he to request a test at another time, he would simply use his Testing Identification Code to get started.
Scheduling is also available via SMS, using his Testing Identification Code and birthdate to link the appointment with his account.
One click check in, one click test
Check in
The true power of the code is at the testing site. When Jeremy arrives, he presents his code for check-in. This does two things:
It confirms his attendance at his appointment.
It starts a clock that measures how long he is on-site, and therefore how long it is taking to receive a test at this site today.
Vial Prep
Once it is Jeremy’s turn to be swabbed, the test administrator again scans his code.
A vial label is automatically printed with his information, and the same code for internal sample tracking.
The timer is stopped, indicating that he is (nearly) complete with his test.
Swab
With the vial prep simplified to simply scan, print, stick, the time necessary for sample collection is minimized to the duration necessary to change gloves, sanitize, and swab.
Access to results
Once the samples are processed, Jeremy receives an SMS that his results are ready. Because his account is the only one associated with his cell number, he must only enter his birthdate to confirm his identity.
Here, Jeremy can review not only his latest results, but every previous result from Patter. While this test generates a unique URL, Jeremy can access his testing history at any time by navigating to patt.er/results and logging in with his testing ID and birthdate.
The wrap-up
This exploration envisions a solution to COVID-19 testing that benefits from two years of experience, and investment in technology that I’m sure providers hoped to never have to make. However, testing is, and will continue to be a crucial part of the response to this pandemic and those that (hopefully don’t) come in the future.
The lesson here is not only to look at the key problem at hand (“How do we test people”), but assess the human experience as well (“I have places to be”) in order to arrive at a solution that has the greatest potential for success.
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