JMIR Publications

ABSTRACT

Background:

The U.S. COVID-19 pandemic response has required contact tracing and symptom monitoring at an unprecedented scale. The Centers for Disease Control and Prevention and several partners created the text illness monitoring (TIM) platform in 2015 to assist U.S. public health jurisdictions with symptom monitoring for potential novel influenza virus outbreaks. Since May 2020, 142 federal, state, and local public health agencies have deployed TIM for COVID-19 symptom monitoring.

Objective:

We evaluated the utility, benefits, and challenges of TIM use to help guide decision making for improvements and expansion to support future public health emergency response efforts.

Methods:

We conducted a brief online survey of previous and current TIM administrators from November 28, 2020 through December 21, 2020. Closed- and open-ended questions inquired about the onboarding process, decision to use TIM, groups monitored with TIM, comparison of TIM to other symptom monitoring systems, technical challenges and satisfaction with TIM, and user support. A total of 1,479 users were invited to participate.

Results:

Ninety-eight administrative users from 43 agencies responded to the survey. Most users represented the Indian Health Service (36.7%), state health departments (26.5%), and local or county health departments (18.4%), and almost all were current users of TIM (90.5%). Among the agencies represented by respondents, 25.6% (11/43) reported using TIM to exclusively monitor staff, 30.2% (13/43) used TIM to monitor community members, and 44.2% (19/43) reported monitoring both groups. Agencies most frequently used TIM to monitor symptom development in contacts of cases among community members (65.1%, 28/43), followed by symptom development among staff (62.8%, 27/43) and among staff contacts of cases (55.8%, 24/43). Agencies also reported using TIM to monitor patients with COVID-19 for the worsening of symptoms among staff (48.8%, 21/43) and community members (41.9%, 18/43). When asked to compare TIM to previous monitoring systems, 78.4% (40/51) of respondents rated TIM more favorably than their previous monitoring system, 19.6% (10/51) said there was no difference, and 2.0% (1/51) rated the previous monitoring system more favorably than TIM. Most respondents found TIM favorable in terms of time burden, staff burden, timeliness of the data, and the ability to monitor large population sizes. TIM compared negatively to other systems in terms of effort to enroll participants and accuracy of the data. Most (89.4%, 76/85) reported they would highly or somewhat recommend TIM to others for symptom monitoring.

Conclusions:

This evaluation of TIM showed that agencies used TIM for a variety of purposes and rated TIM favorably compared to previously used monitoring systems. We also identified opportunities to improve TIM; for example, enhancing the flexibility of alert deliveries would better meet users’ varying needs. We also suggest continuous program evaluation practices to assess and respond to implementation gaps.