Secure Monitoring and Reporting for Public Health
Sara Alert serves as a force multiplier that supports governmental public health response to emerging disease threats that may include active monitoring and home isolation for disease containment or mitigation. The open source tool allows public health resources to be directed where they are most needed. Sara Alert is available, free, to state and local public health departments and serves as an enduring resource easily configured for the next public health outbreak.
The Benefit of Increasing Monitoring Capacity
The tool allows remote monitoring of individuals at risk, either because of travel or through exposure to a confirmed case in the U.S., providing the following benefits:
RAPID IDENTIFICATION of a person requiring
medical assistance, allowing a local health department to arrange a medical visit with minimal additional exposure.
EFFICIENT EXCHANGE of information with
opportunities to provide updates and receive data in real time.
IMPROVED MONITORING of individuals through
REDUCED BURDEN because public health
professionals will be able to more quickly triage
individuals based on disease risk rather than spend time with every person of concern.
How Sara Alert Works
What is Sara Alert?
Sara Alert is an open-source application designed to support effective monitoring of patients at risk of developing novel Coronavirus Disease 2019 (COVID-19).
Who uses Sara Alert?
Sara Alert is designed for use by federal, state, and local public health workers and leadership, as well as the subjects being monitored.
Is Sara Alert designed for COVID-19 only?
No. The capability is disease-independent so it can be adapted for future outbreaks.
How does Sara Alert work?
Sara Alert enables public health officials to enroll individuals at risk of developing a COVID-19 infection, for example, individuals from affected areas or contacts of known cases. Once enrolled, individuals can enter their (and household) symptoms daily through multiple platforms (e.g., mobile, desktop, text-based, voice), providing public health departments real-time insights. The information is stored in a secure database and used to monitor so that public health officials can respond quickly and efficiently for care coordination or non-response follow-up.
What are the benefits of Sara Alert?
Sara Alert modernizes the public health monitoring and response system by providing increased efficiency in tracking potential cases, leading to earlier containment of the virus and reduction of burden on public health resources.
When will Sara Alert be made available?
Sara Alert will be made available to public health officials at the state, local, and federal level following initial testing and piloting.
Is there a cost associated with use of the application?
Because of MITRE’s unique position as a not-for-profit that operates federally funded research and development centers, Sara Alert will be made available in the public domain, free of charge, to public health agencies.
How did MITRE ensure the application would meet the needs of public health agencies?
Sara alert was rapidly developed side-by-side with key public health partners to ensure the application reflected the monitoring, security, and privacy needs of local, state, and federal entities that monitor, detect, and respond to public health threats.
Security & Privacy
How will Sara Alert ensure privacy of the individual?
Sara Alert will collect the minimal amount of information from potentially exposed individuals. The application will also have very granular access control, at the single record-level, single user level to meet data use laws and policies.
What organization will host the Sara Alert monitoring database?
The Sara Alert monitoring database will be hosted by the Association of Public Health laboratories (APHL). APHL works to strengthen laboratory systems serving the public’s health in the United States and globally. APHL represents state and local government health laboratories in the United States. Public health laboratories monitor, detect and respond to health threats.
Where will the data be stored following the monitoring period?
The information will be purged from the Sara Alert database following the incubation period and transitioned to the appropriate state public health agency following the designated monitoring timeframe.
Is there an importing option for uploading information (e.g., a line-list of travelers)? What format is required for each if applicable?
The Sara Alert team is actively working on the import function and anticipate it will be available at the beginning of March.
How are you designing the initial import file format requirements?
The initial import file format requirements will be designed to work with the spreadsheets distributed to jurisdictions via Epi-X notifications. We understand that the format may change, and we will finalize the import feature once the format has reached a steady state. Alternatively, if there are other standard formats that should be supported, please email a template to email@example.com so that we can capture those requirements. If you have feedback on the mappings below, please email us.
The current field names in the spreadsheets sent via Epi-X map to existing Sara Alert enrollment fields:
|Epi-X Fields (as of 2/17)||Sara Alert|
|Flight No||Flight or Vessel Number|
|DGMQ ID||CDC ID|
|Arrival Date||Date of Arrival|
|Arrival City||Port of Entry into USA|
|Last Name||Last Name|
|First Name||First Name|
|Date of Birth||Date of Birth|
|Permanent Street Address||Home Address 1|
|Permanent City||Home Town/City|
|Permanent State or Country||Home State|
|Postal Code||Home Zip|
|Temporary Street Address 1||Destination in USA Where Monitored Address 1|
|Temporary City 1||Destination in USA Where Monitored Town/City|
|Temporary State 1||Destination in USA Where Monitored State|
|Temporary Postal Code 1||Destination in USA Where Monitored Zio|
|Phone Number 1||Primary Telephone Number|
|Phone Number 2||Secondary Telephone Number|
|Email 1||Email Address|
|Countries Visited with Widespread Transmission in Past 14 Days||Exposure Location|
|Departure Date||Date of Departure|
|Lived in Same Household or Had Other Contact with a Person Sick with disease in Past 14 Days||Close Contact with a known case|
|Worked in Health Care Facility or Laboratory in Country with Widespread Transmission in Past 14 Days||Was in Health Care Facility with Known Cases|
Is there an exporting function?
Export functionality will be available in the next version of Sara Alert, anticipated to be released in March.
What will the exporting capability support?
The Sara Alert team is actively working on the export function and anticipate it will be available in March. The export capability will include:
- A user assigned the public health or public health enroller role can:
- export a .csv file of each line list (e.g., symptomatic, non-reporting, asymptomatic, and close)
- export a .png file of dashboard visualizations
- A user assigned the analyst role can:
- export a .png file of dashboard visualizations
If there are other standard formats that should be supported, please send an email to firstname.lastname@example.org so that we can capture those requirements.
Will you be able to export just the line list or all data (including all symptom data reported)?
Initially, Sara Alert will only export the line list data. Because we are designing this application to support your workflow, please let us know what is valuable to you. For example:
- Would you like to be able to export all available data fields for each monitoree in each line list (e.g., symptomatic, non-reporting, asymptomatic, closed)?
- Would you like to export all data for all monitorees across line lists (e.g., symptomatic, non-reporting, asymptomatic, closed).
- What fields do you need to be supported in an export?
You can provide your feedback and preferences by sending an email to email@example.com so that we can capture those requirements.
What are the alerts for individuals who have not reported their signs and symptoms for the day?
Currently individuals who have not reported within a defined timeframe (e.g., 24 hours) will appear on the yellow “non-reporting” line list (see Figure 1. Below). Users can view this line list and prioritize follow-up. Similarly, individuals who reported symptoms on their last report appear on the red “symptomatic” tab. The line lists can be further sorted by clicking on column headers (e.g., Latest Report).
Does this design meet your needs? Would you expect in-system alerts or push-notifications? Please send an email to firstname.lastname@example.org so that we can capture those requirements.
Customization at the Local Level
Is the symposium list customizable within a jurisdiction?
In the next version of Sara Alert, expected in March, users will be able to add symptoms to the minimal set of symptoms through the admin panel. Each jurisdiction will be required to work with the minimal set of symptoms (fever, cough, shortness of breath), as defined by CDC guidance. From that minimal set of symptoms, state users will be able to add additional symptoms to the minimal set. Local jurisdiction users will be able to add additional symptoms to the set defined by their state.
For transferring jurisdictions, what if the receiving jurisdiction isn’t using the Sara Alert application?
If a jurisdiction does not participate in Sara Alert, that jurisdiction name will not appear in the jurisdiction drop-down list. Thus, you will not be able to transfer the record to that jurisdiction using Sara Alert. A manual transfer will need to be completed.
Concurrent Use for Differet Diseases
If a measels outbreak occurs at the same time we are monitoring for the coronavirus, can Sara Alert support both diseases?
Sara Alert is configurable for different diseases, but each instance can only support one disease at a time. If a separate database is stood up, the Sara Alert functionality could be used to support a different disease. Establishing a separate instance of Sara Alert for a different disease would require identification of resources and support for the separate instance.
If I want to test the tool, who do I contact?
How do I provide feedback after I test the tool?
Feedback can be captured on the Sara Alert User Testing Feedback form provided to testing organizations or you can obtain a feedback form by request at SaraAlert@mitre.org. Please send your feedback form upon completing your testing to SaraAlert@mitre.org.
Who do I contact if I have a question during testing?
Are the records in the demonstration system for real patients?
The tool is using synthetic data for testing purposes. No data used during testing is real data.
Approved for public release. Distribution unlimited. Public Release Case Number 20-0261.