Public Health Professionals

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Frequently Asked Questions

Updated on January 26, 2021.

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).

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™ is disease-independent, which means that it can be used for any disease. This will offer an enduring capability beyond the current pandemic. The current national instance of Sara Alert (as of December 2020) is in use for COVID-19.

How does Sara Alert™ work?

For Monitoring Individuals Exposed to an Infectious Disease like COVID-19
Sara Alert™ enables public health professionals to enroll individuals who are 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 via email, text, or phone call, providing public health professionals real-time insights. The information is stored in a secure database and displayed on monitoring line lists so that public health professionals can quickly and efficiently identify individuals requiring care coordination or follow up for non-response.

For Monitoring Individuals with an Infectious Disease like COVID-19
Sara Alert™ enables public health professionals to enroll individuals exposed to or infected with an infectious 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 via email, text, or phone call, providing public health professionals real-time insights into disease spread. Sara Alert contributes to the contract tracing process. Once a person is an identified contact, health departments can then follow up and ask the contact to report their symptoms to Sara Alert. Sara Alert can alleviate some of the burden associated with the follow-up to contact tracing. The information is stored in a secure database and displayed on monitoring line lists so that public health professionals 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 of an infectious disease, like COVID-19, leading to earlier containment and reduction of burden on public health resources.

How can our jurisdiction get more information or sign up for Sara Alert™?

Please contact the Sara Alert™ Team at sarasupport@aimsplatform.com if you are interested in finding out more information Sara Alert.

Is there a cost associated with use of the application?

Sara Alert™ is available free of charge to public health authorities. 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 does MITRE ensure the application would meet the needs of public health authorities?

MITRE worked closely with internal and external public health professionals to develop a standards-based, open-source tool that meets public health monitoring requirements, maintains privacy and security, and facilitates rapid response. The close collaboration with federal, state, tribal, local, and territorial public health professionals allowed for the application of “lessons learned” and multiple perspectives during the development process. MITRE meets regularly with public health users of Sara Alert™ to gather feedback about the system and to understand current needs and priorities as the pandemic shifts.

What languages does Sara Alert™ support?

Sara Alert™ is currently offered in English, Spanish (including Puerto Rican Spanish), French, and Somali for daily symptom reports sent to monitorees. Support for additional languages is planned for future releases.

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.  

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 privacy policy for monitored individuals can be found at Saraalert.org.

The application was designed to comply with privacy and data use laws and policies. Sara Alert collects the minimal amount of information from individuals exposed to or infected with the disease of interest, in this case, COVID-19. The application also has 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 is hosting the Sara Alert™ monitoring database?

Sara Alert™ for public health is hosted on the Association of Public Health Laboratories’ Informatics Messaging Services (AIMS) platform that 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 authorities 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. Sara Alert™ automatically deletes personally identifiable information after a brief period following the monitoring period. The monitoring period may end:

  • after a specified time since a person’s last known exposure to someone with COVID-19
  • if a person has symptoms and has completed the necessary period of quarantine or isolation
  • at a time that corresponds to another term specified by the public health authority, such as a semester in a school setting

Sara Alert saves de-identified demographic data, such as age, sex, race and ethnicity to allow public health providers to assess community needs and trends. Identifying information such as name, date of birth, and contact information is not retained.

I am a Sara Alert™ user. Where can I learn more about how to use the system?

To learn more about how to use the tool:
Please see our comprehensive User Guide, Quick Start Guides, and Data Dictionary at saraalert.org/public-health/guides/ or view our Tutorial Videos at saraalert.org/public-health/tutorial-videos/.

For login assistance and questions that cannot be answered by the User Guide:
Contact the Sara Alert™ helpdesk by filling out the online form at saraalert.org/contact.

Importing

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™ currently offers a function that allows a public health user to import monitoree information from another system in two 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®.

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

Epi-X Notification Spreadsheet
In Spring 2020, the ability to import data from the spreadsheets distributed to jurisdictions via Epi-X notifications was introduced to Sara Alert™. 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. Please contact the Sara Alert team at sarasupport@aimsplatform.com if you are interested in the specific data elements that are supported and the required format to import Epi-X notification spreadsheets.

Exporting

Is there an exporting function?

Yes, Sara Alert™ allows jurisdictions to export all monitoree 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 records prior to them being purged from the system to comply with jurisdiction record retention policies.

Interoperability and API

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’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 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 Sara Alert to partner with jurisdictions to securely support data exchanges and integrate with other tools. The latest documentation on Sara Alert’s API can be found on the GitHub Repository. You can also contact the Sara Alert team at sarasupport@aimsplatform.com for more details on how we can continue developing the API to help meet your needs, and for access to the current iteration of the API.

 

Notifications

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 request that an email digest is sent to public health users summarizing monitorees who have recently reported symptoms. This is an opt-in feature that jurisdictions can choose to enable.

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.

Customization at the Local Level

Can a jurisdiction customize the symptom list?

Yes. State, tribal, local, or territorial 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 in the latest Council of State and Territorial Epidemiologists (CSTE) position statement. State jurisdictions can add additional symptoms to the minimal set and local jurisdictions can add additional symptoms to the set defined by their state.

Can a jurisdiction customize messaging for monitorees?

Yes. State, tribal, local, or territorial jurisdictions can provide customized language and contact information that is displayed to monitorees who report by weblink after the monitoree has completed their daily symptom report.

Transfers

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 using Sara Alert and you will need to complete manual transfer of the record (e.g., encrypted message, fax).

 

Concurrent Use for Different Diseases

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 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. 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. 

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

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