Larimer County builds award-winning outbreak management system using Skuid
Colorado’s Larimer County, located about 100 miles north of Denver, needed an agile way to respond to the COVID-19 crisis. With almost 400,000 constituents and 1,500 county employees, it’s among the ten largest counties in the state. Using Skuid to build user interfaces on the Salesforce Platform, the county created a sophisticated, award-winning outbreak management system for handling communications, contact tracing, testing and vaccine clinics, lab results, and volunteer management.
testing and vaccine clinics
innovation award won
We look to our Skuid/Salesforce solution set when time-to-market is a primary driver along with mobile integration to backend data sets.
Application Services Manager
When COVID-19 struck, Larimer County needed to streamline its outbreak management efforts, like so many other local governments. Its health department of roughly 100 employees was tracking cases in spreadsheets and wasn’t able to perform contact tracing for its constituents.
Katie O’Donnell, PIO of Larimer County Department of Health, reached out to Joe Schreurs, Application Services Manager at the county, for support. Her department needed a scalable way to easily identify cases and provide isolation and quarantine orders.
At the time, Joe and his team of developers had been using Skuid for about nine years to build a variety of applications.
“Prior to Covid, we were using Skuid for our Criminal Justice Services department,” Joe said. “Our Larimer Offender Information system (LOIS) was built using the Salesforce Platform and Skuid as the design layer.”
To respond to the county’s urgent needs, Joe and his team needed the ability to rapidly develop within Salesforce. So, Skuid was a logical fit.
For the health department, crisis communications were also critical. The county needed the ability to share information in a real-time, transparent way with the community. It was time to put Skuid to the test.
“We look to our Skuid/Salesforce solution set when time-to-market is a primary driver along with mobile integration to backend data sets.”
Joe Schreurs, Application Services Manager, Larimer County
To build CICM (contact information in case management), Joe and his team began with rapid requirements-gathering sessions. They conducted a design session with the health department, built and tested the app the following week, and rolled it out within the two-week mark.
The team built the app from the ground up using the Salesforce Platform and custom objects, leveraging Salesforce components via APIs where needed. They built all user interfaces (UIs) using Skuid.
“We were scrumming and sprinting every day. So we'd pick stories in the morning and we implement the next morning,” Joe said.
This method helped Larimer County build as quickly as it did. The team had one design system, worked on all stories (collections of features delivered within a sprint cycle) for four days, and delivered on the fifth day. They’ve since delivered roughly 600 stories.
The initial app rollout included contact tracing with some automated emails for communicating quarantine orders.
After each COVID test, the system would import lab results from the state laboratory reporting module that identified positive cases. From there, health department employees would call the COVID-positive patients and capture demographic information via interview questionnaire on a Skuid-built case investigation screen. Workers would identify secondary contacts, and the system would kick off isolation orders via email. Last, Larimer County would send all this data back to the state via API.
At the outset of the crisis, the entire team worked on Skuid page-building, while also playing to individual strengths.
Alex Lamont, Application Support Specialist, focused on coding and getting widgets to work with the system. LaRae Davidson, Senior Programmer Analyst, focused on interviewing stakeholders about their ever-changing needs as CDC requirements shifted frequently. Skuid helped the whole team pivot fast.
LaRae also worked on functionality to process Colorado State University (CSU) labs so that patients’ profiles were automatically updated in Salesforce. And Joe made sure that result letters would be sent the day after they were received in Salesforce.
When COVID cases surged in the county, the team used Skuid to conditionally hide portions of the caseworker questionnaire during periods of high-volume interviewing.
Since the initial app rollout, it’s evolved into a complete outbreak management system that includes testing and vaccine clinics. At the height of the pandemic, the county supported large outdoor testing clinics, processing anywhere from 1,000 to 2,000 constituents a day.
And while phase 1 of the system was for internal county use only, the app now supports the county’s constituents in registering for testing and vaccination. Again, using Skuid for all UIs.
The county uses both established and pop-up testing clinics, and the system facilitates contactless check-in via tickets once someone registers for a clinic online.
As for vaccines, once a constituent becomes eligible, they receive an automated email notification with a PIN, can book an appointment on the same website, and receive automated email reminders with their ticket information. They can also reschedule their appointments online if needed.
Throughout the pandemic, Larimer County was the single source of truth for its community. Even before letters were sent, patients could get real-time guidance from the call center. What's more, Joe’s team built a dashboard for the county’s website, updated in real-time with Salesforce data on hospitalization rates and contact tracing.
Constituents could also file complaints on the site and obtain receipts for orders, tests, and vaccines.
Also critical, the website accommodated volunteer scheduling across all clinics, complete with dashboards indicating where the most help was needed.
“Our departments that have used this solution set have been extremely happy, and we are planning to add on another agency within Larimer County.” - Joe Schreurs
Seven months after Larimer County’s outbreak management system was up and running, the state of Colorado released its contact-tracing system, Dr. Justina. Because Larimer County’s system was more robust (with features like SMS messaging of orders) and customized to its needs, it was allowed to continue using that. The county could also more quickly perform tests, send them to labs, and receive results within hours because it hooked itself directly to the state’s labs.
Additionally, FEMA used Larimer County’s system extensively in northern CO, parts of Wyoming, and Nebraska for vaccine scheduling and tracking vaccine quantities. The agency typically employs a paper process in the field but took advantage of Larimer County’s system because it was easier to use and reduced overhead behind the scenes.
In addition to helping on the federal side, Joe’s team also assisted Larimer County schools in implementing a record-keeping system that updated its own Salesforce instance with contact tracing data. This made contact tracing more accurate, and kept schools open as much as possible.
Given the sophistication of this outbreak management system, Larimer County has handled case data not only from within the county, but from CSU, Denver Health, and other parts of the state, too.
“If we were to stand up a custom application for our Covid response (contact tracing, outbreak management, volunteer management, vaccine clinic, testing clinics, and lab results), we would have expected a team about 2-3x the size of our 2.5 developers and our initial release would have been 3-4 months after start instead of a week,” Joe said.
All told, Joe’s team only spent $100,000 over a 2-year development period while logging 2,100 development hours. They also rolled out 1,000 features. Skuid helped substantially with cost savings since the team didn’t have to build UIs from scratch.
“Since we were able to bundle business logic easily within the Skuid pages, we didn't need to develop any Apex Code to handle changes to the rules,” Joe said. “This allowed our team to react to changes not only from the state and federal level but also real-time while we were running clinics.”
Currently, the team is working on a new module to implement whenever the county is in surge mode. Using Skuid as the front end, the system will send text messages to patients to see if they’ll complete the health interview themselves. They receive the same questions that a caseworker would ask them, and will also be able to share their contacts for tracing.
As part of this flow, the patient will get quarantine orders to share with their employer. And their contacts will get a message saying they’ve been exposed, along with orders to quarantine, and, if they have symptoms, instructions on how to test.
It’s no surprise that with sophisticated features like this, Joe and his team won a Pinnacle Award for Excellence in Government Web Design. NAGW Pinnacle Awards recognizes the best City/County, Federal, State, NGO, Microsite, and Custom websites. Entries are judged on content, organization, design, performance, flexibility, accessibility, standards, and interactivity.
When asked about the keys to success for this effort, Joe says to establish connections before a crisis starts. “Building relationships early with a low-code vendor like Skuid, and with your department and agency counterparts, is key to making an undertaking like this run as smoothly as possible.”