As Omicron took root in Massachusetts and cases of COVID-19 began to surge once more, Mass General Brigham’s Occupational Health Services (OHS) experienced another kind of surge: a tidal wave of incoming calls and requests from employees looking for help navigating COVID-19 related issues. Many of the questions revolved around when employees could return to work after testing positive or being exposed to COVID-19. With cases rising, so did the volume of incoming calls. OHS turned to colleagues from across Mass General Brigham for help.

“Our colleagues in OHS were facing a perfect storm,” said Raj Patel, MD, MPH, chief medical information officer at the Brigham. “Given the greater demand they were facing, we wanted to find automated solutions that could help relieve some of the pressure and provide employees with the answers they needed.”

Patel collaborated with the iHub, which serves as a center for digital health at the Brigham, to rapidly develop tools to help. In collaboration with multidisciplinary teams across the system (Occupational Health, Infection Control, Communications, Office of General Counsel, and Digital), they assessed, designed and implemented a chatbot to help employees navigate the requirements of the Return-to-Work policy and determine when they could return to work, or what testing was needed prior to return to work. The chatbot is one of several updates and tools that the team worked on in response to the surge. The chatbot is accessible from COVID Pass and employees across the system can use it. Since its launch, thousands of employees across Mass General Brigham have used the tool, with between 300 and 400 users a day at the height of usage.

Long Hours, Rapid Iterations

“I’m thrilled to be a part of the team that helped make this happen, contributing to this high value project,” said Jonathan Letourneau, a member of the iHub team who worked on the return-to-work chatbot. “It was an interesting project, one we were working on at lightning speed.”

Letourneau recalls meeting on a Saturday with Patel and colleagues from OHS who described some of the challenges they were facing. The team then began brainstorming ideas and looking for a solution. They determined that Azure Health Bot, a Microsoft cloud computing product, would give them the robust interface they needed to build a bot.

“This tool gave us the ability to rapidly prototype, iterate, and validate the chatbot logic,” said Letourneau. “We were able to codesign in real-time and confirm the updates worked instantly.”

Letourneau describes the chatbot working a bit like a decision tree — users enter basic information in response to questions about COVID test results, symptoms and dates, and the chatbot helps bring them to their appropriate return-to-work date. Building the tool required translating the Return-to-Work policy into a complex flow diagram.

As the chatbot began taking shape, Aaron Pikcilingis from iHub stepped in to help with its technical aspects.

“We know that reading through the Return-to-Work policy is complicated, and it can be frustrating when you need the answer quickly,” said Pikcilingis. “Our goal was to give people a guide that takes you through questions one at a time in an easy-to-use way, with the ultimate goal of ensuring employees get the information they need.

The team worked closely with Erica Shenoy, MD, PhD, associate chief of the Infection Control Unit at Massachusetts General Hospital, and Infection Control Lead for Mass General Brigham Digital eCare, to further test the chatbot.

“One of the challenges we’ve faced during the pandemic is communicating changes to policies – the more complex the policy or the more nuanced the requirements, the more challenging that can be, even if necessary due to changing public health recommendations,” she said. The Return-to-Work policy is a perfect example, which underwent major changes during the Omicron surge in response to changing public health requirements and expanded use of antigen testing.

Shenoy joined the team for validation sessions working through each possible employee scenario and remarked on the potential to adapt the chat bot as the policy continues to evolve. “The chatbot is another tool, in addition to written tip sheets and flow charts, that can help employees get the information they need, when they need it.”

Beyond Return to Work

The Mass General Brigham Digital Health Innovation (DHI) team is also working on solutions to relieve the burden on provider practices and the COVID Nurse Hotline. Practices and the hotline saw a surge in calls from patients asking about symptoms, exposure, masking, social distancing, boosters, appointment logistics and more. To help address these concerns, DHI worked with Patel to develop a separate, patient-facing chatbot that acts as a virtual informational assistant, helping to answer common COVID-19 questions. The online tool is available on the COVID-19 section of the Mass General Brigham website. The team is also working on a patient-facing voicebot.

Patel draws inspiration from the work that happens behind the scenes to make solutions like the chatbots possible.

“One of the most motivating things during the pandemic is seeing teams work together, often over weekends or long into the night, to learn a new skill without any hesitation,” said Patel. “With these experiences, we now have a lot of ideas for how to tap this resource to address non-COVID related requests.”