The opportunity to build COVID-19 Test Repository (CTR)

As COVID-19 spread, Singapore embarked on massive COVID-19 testing in the foreign worker community in the dormitories. The Joint Task Force (MOH, MOM and MINDEF) and medical teams highlighted a pressing need for quick access and near real-time view of an individual's laboratory test results to detect the outbreak at the dormitories and respond with contact tracing and quarantine measures.

At the national level, to aid the calculation of downstream capacity required to contain and support subsequent testing strategies, there was also a pressing need to digitise and consolidate an aggregated view of the COVID-19 test results status that is both comprehensive and timely to ensure minimal information gap for accurate analysis and reporting.

COVID-19 Test Repository (CTR) At a Glance

The COVID-19 Test Repository (CTR) serves as a one stop repository and single source of truth for COVID-19 test results. It automatically aggregates test results from many sources, minimizing the need for manual compilation and removing bottlenecks in the workflow. It also includes a dashboard of composite COVID-19 test result data to support operations planning, management reporting and analytics.

COVID-19 Test Repository (CTR) The Solution

To meet the needs mentioned above, the COVID-19 Test Repository (CTR) was developed to consolidate test results from all public health care institutions and MOH assigned private laboratories that conducts the laboratory tests. To do that, it was key to establish data pipes for the ingestion of test results from the various laboratories. This was achieved by integrating with the National Electronic Health Record (NEHR) to pull and centralise tests results contributed to NEHR by connected systems – public healthcare institutions, Quest, Innovative and Parkway laboratories.

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DATA SOURCE

 
Public Health Institution (PHI) Laboratories
• AH                    • CGH
• KKH                  • KPTH
• NTFGH             • NUH
• SGH                  • SKH
• TTSH & NCID

Private Laboratories
• Innovative       • HTX*
• Quest              • Project Stronghold*
• Parkway          • Lucence*
• DSO                • Raffles Diagnostic*
• NPHL              • NTU LKC Med School

 *Upcoming

CTR also incorporates data from MOH assigned private laboratories, including the upload of data from manual Excel spreadsheets for the laboratories which are not ready for system integration. To date, CTR has completed development of data pipes in receiving and displaying COVID-19 test results from 14 laboratories, and is working closely with MOH to bring onboard test results from new and upcoming MOH-licenced private laboratories.

Racing against the increasing number of testing conducted in the foreign worker community, the CTR was developed in an agile manner and quickly deployed as a minimum viable product (MVP). Adapting with the COVID-19 situation, the CTR team collaborated with multiple stakeholders from the Joint Task Force (MOH, MOM and DSTA) and rapidly evolved and rolled out new features and functions in the CTR system with incorporation of users' feedback.

Expanded role as single source of truth to support increasing COVID-19 testing efforts, containment measures and deterrence plans for clinicians and cross ministries operations.

Initially developed to support testing verification and contact tracing operations efforts of laboratory test results, the CTR has quickly evolved to become the Single Source of Truth (SSOT) for COVID-19 laboratory test results and outcomes being used by clinicians and operations task force personnel. Additionally, CTR is now the SSOT of COVID-19 test results integrated with other cross-ministries systems to support COVID-19 containment measures and deterrence plans for clinicians and cross ministries operations as the economy reopens.

Use cases of CTR include the medical teams supporting the dormitories swab operations to access test results to determine the interventions for affected cases; GovTech utilising CTR to support the planning and expedited process of contact tracing; the Joint Task Force using CTR in conjunction with their Command and Control (C2) system in the monitoring and early detection of COVID-19 among foreign workers; the Testing Ops Centre (TOC) using CTR to support the active mass community swabbing including pooled and serology testing, and Acute Respiratory Infection (ARI) system tapping on test results from CTR to validate swab test done by patients and notification to MOH, patients and clinicians.

Within the CTR solution, there are 2 user-facing components – CTR Viewer and CTR Dashboard

 
CTR Viewer
The CTR Viewer is a browser that allows access to test results of individuals to support day-to-day ground operations in incidence tracking of positive, negative and potential cases which require re-testing, and to support expeditious contact tracing. The first release of the CTR Viewer was delivered on 24 April 2020 after five intense days of work. With its introduction, the CTR Viewer removed the bottlenecks in the results verification process as approved users can now access the repository themselves to identify affected individuals and locations requiring management and intervention.
 

Additionally, the CTR Viewer minimised the need for manual compilation of the test results from the various laboratories – a task that was previously performed by MOH staff via Excel spreadsheets. It helped to streamline the laborious process of manually compiling COVID-19 test results from the various laboratories, sieving out the positive, negative and potential cases that require re-test and subsequently the manual communications to the operations task force and medical teams covering the on-site testing operations. Freed of these time-consuming tasks, staff could be redeployed to support other operations.

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Since its first release, multiple iterations were delivered to add new functions based on user needs to ensure comprehensiveness and timeliness of the COVID-19 test results. The CTR was enhanced to support the inclusion of historical data (i.e. test results prior to the conception of CTR), ingestion of data from more private laboratories, the display of address of swab locations, additional search by swab location function, as well as additional mass persons search and export functions for authorised CTR users.

"My role was to compile swab test results from our labs for our JTF colleagues. The process was very tedious, and I'm elated that the CTR has been developed to automise the process. It really helped in providing, timely and accurate essential information to better manage this outbreak. Thank you for the solution!"
 Lee Wei Yann, Joint Task Force, Deputy Director, Manpower Standards & Development Division, Ministry of Health

CTR Dashboard
The CTR Dashboard is a visualiser of composite COVID-19 test result data to support operations planning, management reporting and analytics. It helps to close information gaps, providing insights to the evolving COVID-19 testing situation with the display of tests and results completed by each laboratory and each healthcare facility. This data helps in calculating the estimated downstream capacity required and facilitates planning for upcoming testing strategies.
 
The first MVP of the CTR Dashboard was delivered within 3 days from the commissioning of the project on 23 April 2020. Like the CTR Viewer, the CTR Dashboard has since released multiple updates to adapt to and support the operational and analytical needs. These include new metrics to provide insights into the number of patients who have gone through multiple swabs, support 7-day moving averaging trending, and a date filtering option so that data analysts can zoom in on specific dates of interest. The CTR Dashboard design also went through multiple updates to improve the data presentation and averaged a new release almost every week.

"We're glad to work alongside all the CTR users to support and improve their work in the nation's testing strategies against COVID-19. The development of the CTR in such a short period of time and its constant improvement is a testament to the display of collaboration with them as well as the multiple teams in IHiS and MOH. Our team is committed to continuing to deliver comprehensive, timely and useful features to support the fight against COVID-19."

Christina Tan, Director, Product Management & Delivery Group, IHiS
 
CTR continues to adapt as SSOT for COVID-19 results and outcome nationally
As the functionality and usefulness of the CTR grow amid the active mass testing strategy for the wider population, more healthcare facilities and clinicians are tapping upon CTR to access COVID-19 test results to manage their patients. The number of users subscribed grew from an initial group of 40 MOH and Joint Task Forces users to more than 500 users.
 
The CTR now supports users from the Joint Task Forces, public healthcare institutions, MOH, Ministry of Manpower, Health Promotion Board and the Singapore Armed Forces. The team is also actively working together with MOH to onboard users from the private and community healthcare institutions.