Public Health Professionals

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Frequently Asked Questions

Updated on October 5, 2020.

General

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 public health monitoring and reporting of individuals exposed to or infected with COVID-19 (or any infectious disease).  It was developed by public health experts for public health.  Sara Alert™ is available in the public domain, free of charge, to public health agencies. As an open source tool, Sara Alert is available for public and private use and is easily integrated into other tools.

Who uses Sara Alert™?

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

Is Sara Alert™ designed for COVID-19 only?

No. The capability is disease-independent, so will offer an enduring capability beyond the current pandemic.

How does Sara Alert™ work?

For Monitoring Exposed Individuals
Sara Alert™ enables public health officials to enroll individuals who are ill or at risk of developing COVID-19 (e.g., individuals from affected areas or contacts of known cases). Once enrolled, individuals enter their (and other members of their household) symptoms daily through their preferred platform (i.e., web browser via mobile or desktop, text-based, voice), providing public health officials real-time insights. The information is stored in a secure database and displayed on monitoring line lists so that public health officials can quickly and efficiently identify individuals requiring care coordination or follow up for non-response.

For Monitoring Ill Individuals
Sara Alert™ enables public health officials to enroll individuals who have developed a disease, like COVID-19, who need to be monitored to determine when it is safe to discontinue isolation. Once enrolled, individuals enter their symptoms daily through their preferred platform (i.e., web browser via mobile or desktop, text-based, voice), providing public health officials real-time insights. The information is stored in a secure database and displayed on monitoring line lists so that public health officials can quickly and efficiently identify individuals who may discontinue isolation.

What are the benefits of Sara Alert™?

Sara Alert™ modernizes the public health monitoring and response system by providing increased efficiency in tracking both active and 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™ is available now and in use by several pilot jurisdictions. Please contact us if you are interested in finding out more information about Sara Alert™ at sarasupport@aimsplatform.com .

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™ is 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?

MITRE worked closely with internal and external public health experts to develop an application that meets public health monitoring requirements, maintains privacy and security, and facilitates rapid response. The close collaboration of representatives from state, local, and federal public health experts allowed for the application of “lessons learned” and multiple perspectives during the development process.

What languages does Sara Alert™ support?

Sara Alert™ currently supports English and Spanish translations for daily symptom reports sent to monitorees. Other languages are planned for future releases.

Does Sara Alert™ have a “location tracking” feature?

Sara Alert™  does not have a “location tracking” feature. We made this decision early and intentionally.

Security & Privacy

How will Sara Alert™ ensure privacy of the individual?

Careful attention to privacy has been a hallmark of the Sara Alert™ capability from the start of the effort. To ensure privacy and compliance to HIPAA, the data is encrypted at rest and in flight and is protected in a FISMA-Moderate and FedRAMP compliant environment. 

The application was designed to comply with privacy and data use laws and policies.  Sara Alert will collect the minimal amount of information from individuals diagnosed with an infectious disease and from  those who are potentially exposed to the infectious disease. The application will also have granular access control and encryption at the single record-level.  Different roles are available in the system that restrict access to individual level information; this follows the best practice of restricting access to information to only users who require it.  A user may also only access records that belong to their assigned jurisdiction.

What organization will host the Sara Alert™ monitoring database?

Sara Alert™ is hosted on the Association of Public Health Laboratories’ Informatics Messaging Services (AIMS) platform provides cutting edge data management and messaging services to the public health community and its data exchange partners. AIMS’ secure, cloud-based environment provides shared services to aid in the transport,  validation, translation and routing of electronic data.  Public health laboratories and agencies at all levels of government, federal agencies,  health care providers, hospitals, first responders and others rely on AIMS technology,  infrastructure and services for critical public health initiatives.

Where will the data be stored following the monitoring period?

The data collected is only what is needed to support public health operations and the information will be purged from the Sara Alert™ database following a specified amount of time after monitoring has ended .

Importing

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

Yes, Sara Alert™ currently offers the ability to import monitoree information in two formats.

Sara Alert Format Spreadsheet
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®.

The most current import template formatting guidance is available in the user interface.

Epi-X Notification Spreadsheet
Sara Alert™ can import data from the spreadsheets distributed to jurisdictions via Epi-X notifications. The Epi-X notification spreadsheet import populates a limited subset of Sara Alert™ enrollment data elements noted in the FAQ below. After import, enrollment can be completed by public health user adding additional information.

Exporting

Is there an exporting function?

Yes, Sara Alert allows users to export all monitoree record data (including enrollment data elements, symptom report assessment history, lab result, 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 records prior to them being purged from the system to comply with jurisdiction record retention policies.

Interoperability and API

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

Yes, Sara Alert™ Application Programming Interface (API) allows us to partner with jurisdictions to securely support data exchanges and integrate with other tools. Check here for the latest API documentation. You can also contact the Sara Alert™ team on how we can continue developing the API to help meet your needs, and for access to the current iteration of the API.

What is an API?

An Application Programming Interface (API) is a mechanism that enables systems to interoperate by sharing data. It describes an agreed-upon way two or more systems share data. Sara Alert’s™ API connects to other health systems and applications. It is open source, free to use, and secure.

What platform does the API Use?

Sara Alert™ has built a SMART on 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.

What is SMART on FHIR? 

Substitutable Medical Applications, Reusable Technologies (SMART) on Fast Healthcare Interoperability Resources (FHIR) is a standards-based, interoperable application platform for electronic health records that allows Sara Alert™  to interface with health systems. Sara Alert’s API (Application Programming Interface) is SMART on FHIR compliant and allows authenticated users to read and write records. It is open source, free, secure, and an industry standard for exchanging healthcare information electronically.

Notifications

What alerts are generated for system users?

The Sara Alert™ system does not send notifications to public health about the status of records. To view records that require follow-up, a user can log-in to view the monitoring dashboards.

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 officials can review this line list and prioritize follow up to collect missing reports.

Similarly, individuals who reported symptoms on their last report appear on the red “symptomatic” line list. Public health officials can review this line list and prioritize follow up to investigate if the individual who reported symptoms is 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 officials can review this line list and prioritize follow up to collect missing reports.

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

Customization at the Local Level

Is the symposium list customizable within a jurisdiction?

Yes. State, territorial, local, or tribal jurisdictions can add symptoms to the minimal set of symptoms assessed on the daily report by working with the Sara Alert™ administrator. Each jurisdiction will be required to include the minimal set of symptoms as defined by CDC guidance. From that minimal set of symptoms, state jurisdictions can add additional symptoms to the minimal set. Local jurisdictions can add additional symptoms to the set defined by their state.

Transfers

What if I want to transfer a record to a jurisdiction that 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 of the record (e.g., encrypted message, fax) will need to be completed.

Concurrent Use for Different Diseases

If a measles outbreak occurs at the same time we are monitoring for COVID-19, 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. Additional resources and support would need to be identified to support a separate instance of Sara Alert™. As an open source project, the code-base is available for use if an organization would like to setup a separate instance.

Have a question?  Submit to sarasupport@aimsplatform.com.

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