An Insider’s Look at Contact Tracing Efforts in Hawaiʻi

In August 2019, I moved to Hawaiʻi and accepted a full-time teaching position at the University of Hawaiʻi-West Oʻahu (UHWO), a decision that was influenced by the collaborative spirit I experienced during my on-campus interview. Once in Hawaiʻi, our monthly health science faculty meetings were an excellent way to gather information on the college culture and build professional relationships. Our discussions in February and March centered on coronavirus, when it was becoming evident that there would be a significant coronavirus impact in the US. At the university, our health science faculty were chiefly concerned with the number of total hospital beds, total ICU beds, and the number of available respirators for all islands in the state. Another question was: what tools we, as educators, could provide for our students and the community? How should we respond to a major public health event that would impact Hawaiʻi in unique ways? What could be done beyond communicating information about the virus and instructions on how to self-monitor and quarantine?

Additionally, there was a concern given Hawaiʻi's geography about the other islands and the safety of people living on Kauaʻi, Molokaʻi, and Lanaʻi. To that end, Dr. Ric Custodio, MD, associate professor in the math, natural, and health science division and a practicing pediatrician, spearheaded the idea of developing a community-focused contact tracing program. He was joined by Dr. Camonia Graham-Tutt, assistant professor of community health, who has an extensive background in community health.

Meanwhile, the state of Hawaiʻi Department of Health (DOH) was working on a plan to recruit and train individuals with a clinical background to work as contact tracers. The UHWO program would focus on training individuals with a bachelor’s degree—preferably in healthcare or a health-related field—but wouldn’t necessarily require clinical experience. The unique aspect of the UHWO program was that the trainees would be members of the community or island that needed them to help tackle COVID-19. They would be a resident, a neighbor, a member of the ohana (family). This is important for several reasons, based on Hawaiʻi’s geography and the diverse cultures present in the state. Many of those cultures have behaviors and norms based on historical experiences that could make them resistant to talk to a “clinical” person about their ohana and any possible exposure to coronavirus. In addition to fighting the spread of coronavirus, in Hawaiʻi, cultural awareness is vital if you want to make a positive community impact.

Custodio and Graham-Tutt lead the training program planning, now called the Community Contract Tracer Training Program (CCTTP), which is a cohort model, with a six-week training timeframe that requires two public administration courses. Custodio and Graham-Tutt are the lead instructors for the two classes, guiding the content and reaching out to secure guest speakers from UHWO. Additionally, faculty members from the University of Hawaiʻi at Manoa and the John A. Burns School of Medicine (JABSOM) were tapped to provide additional expertise on topics such as epidemiology and infectious disease. The collaborative and aloha spirit shined through.

HIM and Contact Tracing

At UHWO, health information management (HIM) is a new academic degree program with the first course being offered in the Spring 2020 semester—yes, right in the middle of the pandemic. As a faculty member, I have been involved in the planning meetings for this training program. My role includes adding education around HIPAA, privacy, and confidentiality to the course content plan and more. Given the nature of HIM and what I saw as a needed element specific for CCTTP, I suggested adding team dynamics as an additional topic area. Given HIM’s expertise with electronic health records (EHRs), Custodio also asked if I would discuss digital tools for contact tracing—specifically, HealthSpace, the contact tracing app chosen by the Hawaiʻi DOH.

As I began to develop my portions of the training activities, I also included information on documentation. Why would I add this when most data can be captured electronically? In my brief time living in Hawaiʻi, I have experienced electricity going in and out often. On the outer islands of Hawaiʻi there cannot be an expectation that there will be enough connectivity to use the app to its fullest extent. Therefore, providing the trainees with some HIM 101 basics was important.

It is possible that at some point contact tracers will have to use a pen and paper to handwrite the information they gather to be uploaded or incorporated into a digital platform at a later date. Therefore, data quality and capture require a back-up plan to account for when technology is not accessible. No electricity means there is no connection to the internet and no ability to upload data to a health app.

For the teamwork module I developed, the focus is on emotional intelligence, leadership, communication styles, and how to work in virtual teams. In 2020, virtual work is prevalent. Contact tracers that live on Mauʻi, Molokaʻi, the big island of Hawaiʻi, and Kauaʻi would need this skill set to be effective when coordinating and working together and with the DOH located on Oʻahu. Of course, given the health concerns, contract tracers in any location could be working from home but still be guided with team dynamics.

My concentration was on creating and formatting my two guest lecture times for Custodio’s class. But HIM know-how was called on again. The DOH supports CCTTP but stated a need for an evaluation aspect, such as feedback from the trainees. Of course, an evaluation would be a best practice to include in this type of educational training. Custodio, based on his experience and perhaps our faculty meeting conversation, made a connection between HIM and data analytics. Further, having professional experience with program and curriculum evaluation, I was asked to lead this aspect. For this part of the project, I developed two feedback instruments: weekly feedback from the trainees and another feedback opportunity delivered at the end of their program. The training has begun, and just in time (hopefully), as the positive case rate is increasing in Hawaiʻi. Also, the size of the first cohort was increased from 30 to 50 trainees. The first cohort completed the training on July 24th.

The plan is to have cohorts through May 2021, with 250 total community contact tracers available for all of the Hawaiʻian Islands. The intention is to flatten the curve, and as the cases are quickly rising in the state, especially on the island of Oʻahu, the need for contact tracers is prominent. According to the New York Times, in the early days of August, the average number of cases for Hawaiʻi was 179 per day, increasing over 300 percent in two weeks.

My takeaway from this experience is that HIM professionals play a crucial role in the fight with COVID-19. With our expertise in various aspects of health data, we are an essential asset. HIM professionals, and our ability to focus on data quality, data analytics, and team dynamics, are needed as our nation and world fight COVID-19. .

Lynette Williamson, MBA, RHIA, CCS, CPC, FAHIMA (lwilliamson416@comcast.net), is an assistant professor and program director HIM, at the University of Hawaiʻi-West Oʻahu.