Use of Electronic Health Records (EHRs) and mobile Health (mHealth) technology: a Novel Approach in COVID-19 Surveillance in I.R. of Iran

In response to the coronavirus disease pandemic, Iran’s Ministry of Health and Medical Education launched a National Campaign to fight COVID-19 at the beginning of March 2020.

Use of Electronic Health Records (EHRs) and mobile Health (mHealth) technology: a Novel Approach in COVID-19 Surveillance in Islamic Republic of Iran

Report from: Zahedan University of Medical Sciences, Vice Chancellery for Health
Published on: 15 April 2020

In response to the coronavirus disease pandemic, Iran"s Ministry of Health and Medical Education launched a National Campaign to fight COVID-19 at the beginning of March 2020.

Despite the rising number of cases, a vast majority of those infected by the virus suffer mild symptoms, hence go undiagnosed and they can spread the disease. The aim of the campaign was to increasethe coverage of disease surveillance at the community level, to detect, test, isolate and treat every case and trace every contact, and also to ease the huge burden on hospitals.

Using Electronic Health Records (EHRs) and mobile Health (mHealth) technologies, the household screening and follow up via mobile phone has been considered as an important measure in early detection of suspected COVID-19 cases and preventing the spread of the disease.

In this campaign, screening of individuals at the community level has been done in two ways: 1) an online COVID-19 self-assessment website and 2) active phone screening of the population by healthcare workers using Electronic HealthRecords (i.e. SIB portal).

Coronavirus disease self-assessment website

Iran"s Ministry of Health has launched a coronavirus self-assessment website (salamat.gov.ir).The goal of Coronavirus (COVID-19) Online Test is to help people know whether they need to go to a medical center for the COVID-19.

All members of the community are invited to register on this web-based portal to self-assess for the coronavirus disease. After logging in on the website and answering a number of screening questions, and entering their mobile phone number, they will receive a text message about their current health condition.

If a person is identified as a suspected case of COVID-19, the patient"s information will be sent to healthcare workers via SIB portal, for further follow up and assessment.

The health care worker is responsible for contacting the suspected cases and inviting them tovisit outpatient "16 hours Infectious Diseases Screening Centers" for further examination by trained medical doctors.

Active phone screening of the population by healthcare workers using SIB portal

Healthcare workers stationed at rural and urban health units also have been asked to proactively contact the households under their coverage via phone numbers recorded in the household Electronic Health Records and complete an electronic COVID-19 screening questionnaire. There is a special focus on the screening of high-risk groups in the householdsincluding: the elderly, pregnant women, and patients with underlying diseases such as cardiovascular diseases, diabetes, cancer, chronic asthma and bronchitis, etc.

All suspected cases identified through phone screening will be referred to the "16 hours Infectious Diseases Screening Centers". Testing services for COVID-19 are also provided bythese centers.

After a thorough medical assessment by medical doctors in the infectious disease screening centers and confirming that the patient is apossible case of COVID-19, the information will be sent to the expert in charge of communicable diseases control at the district level.Depending on the patient"s general condition, they can either receive treatment on an outpatient basis or they will be referred to hospital for admission.

The health officials at the district level are obliged to dispatch an assessment team to the place of residence and the workplace of the suspected cases for contact tracing and disinfecting the residence area.

A total of 437 health units affiliated with Zehedan University of Medical Sciences (ZAUMS) have been operating the campaign, involving 1197 Healthcare workers. As of 6 April 2020,and by the end of the first phase of the campaign, a total of 1289,000 individuals (99.3% of the total population covered by Zahedan University of Medical Sciences) were screened for COVID-19. The second phase of the campaign will be continued with a focus on 100% contact tracing, and the screening of high risk groups.

Table 1. Key Performance Inidicators for National Campaign to Combat COVID-19, ZAUMS, April 2020