About Sara Alert™

What is Sara Alert™?

Sara Alert is a standards-based, open-source tool developed by MITRE in partnership with national public health organizations that automates the process of active symptom monitoring, enabling jurisdictions to use their resources more efficiently to conduct large-scale monitoring.

Who uses Sara Alert™?

Sara Alert is designed for use by federal, state, tribal, local, and territorial public health professionals as well as the individuals being monitored.

Is Sara Alert™ designed for COVID-19 only?

No. Sara Alert can be configured for future public health responses.

How does Sara Alert™ work?

For Monitoring Individuals Exposed to an Infectious Disease
Sara Alert enables public health professionals to enroll individuals at risk of developing a disease of interest, for example COVID-19. Once enrolled, individuals can report their symptoms (and their household members’, if applicable) through multiple platforms (e.g., mobile, desktop, text-based, voice), providing public health departments improved situational awareness. If an individual reports symptoms or does not submit a report, the record is flagged by the system so that public health can quickly and efficiently identify individuals requiring follow-up for care coordination or due to non-response.

For Monitoring Individuals with an Infectious Disease
Sara Alert also enables public health officials to enroll cases who require monitoring to determine when it is safe to discontinue home isolation. Once enrolled, individuals are sent a reminder to report their symptoms via text, email, or phone, providing public health departments improved situational awareness. If an individual report meets a recovery definition, or the individual does not submit a daily report, the record is flagged by the system so that public health can quickly and efficiently identify individuals requiring verificatation that it is safe to discontinue home isolation or non-response follow-up. The concept of operations and high-level workflow are shown below.

What are the benefits of Sara Alert™?

Sara Alert modernizes public health monitoring and response by providing increased efficiency to conduct large-scale monitoring efforts.

Is there a cost associated with use of the application?

As an open-source tool, Sara Alert is available on GitHub per the Apache 2.0 license for public and private use and is easily integrated into other tools. Open-source code users are encouraged to contribute updates and bug fixes to the GitHub repository.

How did the application meet the needs of public health?

Close collaboration with federal, state, tribal, local, and territorial public health professionals allowed for the application of lessons learned and inclusion of multiple perspectives during the development process to ensure the needs of public health were met.

Does Sara Alert™ have a location tracking functionality?

Sara Alert DOES NOT have location tracking functionality. This decision was made early and intentionally to protect individual privacy. Use of Sara Alert does not require the installation of an app on your phone or software on your computer.

Is there an importing option for uploading information from another system (e.g., a line list of contacts or cases)? What format is required?

Yes, Sara Alert offers a function that allows a public health user to import information from another system in the formats described below. If you are interested in automating this process, see Interoperability and API below for more information.

Sara Alert™ Format Template
Sara Alert can populate all enrollment data elements using the Sara Alert template. This functionality supports jurisdictions who wish to use Sara Alert and are currently maintaining case or contact information in other systems that can export to a .xlsx formatted file, such as REDCap^®.

Epi-X Notification Spreadsheet
Sara Alert can populate data from the traveler spreadsheets distributed to jurisdictions via Epi-X notifications. The Epi-X import feature populates a limited subset of Sara Alert enrollment data elements. After import, enrollment can be completed by a public health user by adding additional information.

SDX Notification Spreadsheet
Sara Alert can populate data from the traveler spreadsheets distributed to jurisdictions via SAMS Secure Data Platform (SDX) notifications. The SDX import feature populates a limited subset of Sara Alert enrollment data elements. After import, enrollment can be completed by a public health user by adding additional information.

Is there an exporting function?

Yes, Sara Alert allows jurisdictions to export all record data including enrollment data elements, symptom report assessment history, lab results, and record edit history. The exported data can be opened in Microsoft Excel, statistical software, or visualization software as needed to meet local analytical needs. This function also allows users to save record informations prior to being purged from the system to comply with jurisdiction record retention policies.

What is an API?

An Application Programming Interface (API) is a mechanism that enables systems to operate together by sharing data. It describes an agreed-upon way that two or more systems share data. Sara Alert offers a range of interoperability capabilities, which allows it to be securely integrated into workflows across jurisdictions.

What platform does the API Use?

Sara Alert has built a Substitutable Medical Applications, Reusable Technologies (SMART) on Fast Healthcare Interoperability Resources (FHIR) compliant API. SMART on FHIR is a standard that defines how applications can interoperate and share information seamlessly and securely. It is an industry standard for exchanging healthcare information electronically.

Can Sara Alert™ work with other contact monitoring and tracing tools?

Yes. Sara Alert’s Application Programming Interface (API) allows data exchanges and integration with other tools. The latest documentation on Sara Alert’s API can be found on the GitHub Repository. 

What alerts are generated for system users?

Sara Alert does not routinely send messages to users since the monitoring dashboards provide information on which records require follow-up. Jurisdictions may opt-in to an email digest that is sent to public health users summarizing individuals who have recently reported symptoms. 

For Monitoring Exposed Individuals

Individuals who have not reported within a defined timeframe (e.g., 24 hours) will appear on the yellow “non-reporting” line list. Public health professionals can review this line list and prioritize follow up to collect missing reports.

Similarly, individuals who have reported symptoms on a previous report appear on the red “symptomatic” line list. Public health professionals can review this line list and prioritize follow up to investigate if the individual who reported symptoms should be a case.

For Monitoring Cases

Individuals who have not reported within a defined timeframe (e.g., 24 hours) will appear on the yellow “non-reporting” line list. Public health professionals can review this line list and prioritize follow up to collect missing reports.

Similarly, individuals who have preliminarily met a recovery definition appear on the red “records requiring review” line lists. Public health professionals can review this line list and prioritize follow-up to determine if it is safe for the case to discontinue isolation.

Can a jurisdiction customize the symptom list?

Yes. State, tribal, local, or territorial jurisdictions can add symptoms to the defined minimal set of symptoms assessed on the daily report.

Can a jurisdiction customize messaging to enrolled individuals?

Yes. State, tribal, local, or territorial jurisdictions can provide customized language for the welcome notification sent to newly enrolled individuals who are eligible to receive notifications via SMS or email. Additionally, jurisdictions can provide customized contact information that is displayed to individuals wo report by weblink after the individual has completed their daily symptom report. Jurisdictions can also select to enable or disable the sending of end of monitoring messages to eligible individuals.

What if I want to transfer a record to a jurisdiction that isn’t using Sara Alert™?

If a jurisdiction does not participate in Sara Alert, that jurisdiction’s name will not appear in the jurisdiction drop-down list. Thus, you will not be able to transfer a record to that jurisdiction within Sara Alert and you will need to complete manual transfer of the record (e.g., encrypted message, fax).

If a measles outbreak occurs at the same time as the COVID-19 outbreak, can Sara Alert™ support monitoring both diseases?

Sara Alert is configurable for different diseases, but as of April 2022, each instance can only support one disease at a time. If a separate instance is stood up, the Sara Alert functionality could be used to support a different disease.