Making of the coronavirus symptom checker

On 12th of March 2020, and order came from the Ministry of Social Affairs and Health to carry out a national coronavirus symptom checker as soon as possible. The need was urgent because healthcare organizations across Finland were drowning in contacts related the coronavirus. Five days later, the completed symptom checker was in production, and already in the first day it had more than 100,000 users.

Just a week earlier, it was still unclear as to how strongly the novel coronavirus would affect Finland: there had been only a few dozen infections in the whole country. However, there was already worrying news from many European countries, and the situation in Finland was deteriorating rapidly.

Working on the coronavirus symptom checker interrupted almost all other work. Non-urgent tasks were canceled and acute tasks were re-prioritized.

It was very fortunate that the Omaolo service had been in active use for over a year and it could be quickly harnessed to fight the pandemic.

Duodecim Publishing Company is responsible for the development of Omaolo’s medical content and it had already produced 15 other symptom checkers for the service. The lessons and experience gained in the development of these proved to be invaluable when a new symptom checker was to be produced in record time. The typical development timeline for a symptom checker is usually several months, including precise quality management processes for manufacturing medical devices. Now the same processes had to be executed in days, without compromising on the end result. We still wanted to maintain quality and patient safety as guiding principles for the development.

Occasional remote work had been commonplace in the Duodecim’s Integrated Services unit for years, but to move the entire team to home offices was a new situation. Collaboration needed to be urgently reorganized by creating new workspaces, ways of working, and communication channels. Working from home many found themselves balancing between the needs of the work and family. The development of the symptom checker required extra effort and overtime from the whole team and this was certainly reflected at home as well.

The design of the symptom checker was guided by clear objectives. The most important of these was to prevent the spread of coronavirus as effectively as possible.

In order to achieve this, it is important to strive to find not only serious cases requiring hospitalization, but also cases with mild symptoms. This way, they can be instructed to stay in isolation if necessary and additional infections can be prevented.

Design objectives for the symptom checker:

  • Ensuring rapid access to treatment for people with severe symptoms
  • Giving necessary instructions to persons working in hospitals, care units and home care in order to prevent institutional epidemics
  • Getting the elderly and those at risk to have a professional assess their symptoms by telephone
  • Instructing those with a high probability of disease to stay in voluntary quarantine
  • Reducing unnecessary contacts to health care units by giving everyone else the necessary personalized instructions

These objectives were intended to ensure that everyone would receive appropriate care and that reliable and up-to-date information would be always readily available to citizens. In this way, valuable healthcare resources could be used more efficiently to treat patients and the need to instruct patients, for example by telephone, would be reduced.

After less than a week of joint efforts, the first version of the coronavirus symptom checker was released for production on March 16, 2020 in both Finnish and Swedish.

As a result of successful communication, the symptom checker received hundreds of thousands of users in the first week. This was also reflected in a significant reduction in the number of calls in health care units.

During the first month, six updates were made, as feedback, usage data, and experiences were obtained from the operation of the symptom checker. English version was introduced in mid-April. Starting in May, data collected through the symptom checker was being sent for national Corona-map service by the Finnish Institute for health and welfare. This service is used to help get and overall picture of the national pandemic situation. At the end of August, the symptom checker was integrated into the Koronavilkku contact tracing application. Those who have received an exposure notification through the application are directed to complete the symptom checker in Omaolo service. To date, more than 1,000 users have received an exposure notification and have been referred to the symptom checker.

With the coronavirus symptom checker, the use of Omaolo’s other symptom checkers has also increased. In particular, symptom checkers of corona like diseases, i.e., respiratory tract infection and sore throat, have been used more. However, in the current pandemic situation, it is advisable to try first the coronavirus symptom checker as not all other symptom checkers have been modified to identify the coronavirus disease.

After almost a month of constant efforts, the need to develop the symptom checker has gradually decreased. Now, updates are made as needed alongside other work. A joint meeting is held weekly with experts from DigiFinland and the Finnish institute for health and welfare. The latest update introduced a summary text of the patient’s situation for healthcare professionals. This is hoped to speed up documenting patient’s information to electronic health records and make it easier for professionals to identify important issues. To date, 16 updates have been made to the symptom checker addressing the identified shortcomings and keeping it in line with changing national guidelines. The symptom checker has already been used almost 2 million times and more than 80,000 patients have been referred for a more detailed assessment.

The best result is achieved through cooperation

The coronavirus symptom checker has been commissioned by the Ministry of Social Affairs and Health (STM) and is being developed in collaboration with experts from the Finnish Institute for health and welfare (THL) and the state-owned company DigiFinland. Software development and analytics for Omaolo-service is provided by Solita Oy and Mediconsult Oy. Duodecim would like to thank all those involved in the develpment of the symptom checker.

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