{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T04:55:18Z","timestamp":1768452918791,"version":"3.49.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2022,8,27]],"date-time":"2022-08-27T00:00:00Z","timestamp":1661558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Symptom checkers can help address high demand for SARS-CoV2 (COVID-19) testing and care by providing patients with self-service access to triage recommendations. However, health systems may be hesitant to invest in these tools, as their associated efficiency gains have not been studied. We aimed to quantify the operational efficiency gains associated with use of an online COVID-19 symptom checker as an alternative to a telephone hotline.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In our health system, ambulatory patients can either use an online symptom checker or a telephone hotline to be triaged and connected to COVID-19 care. We performed a retrospective analysis of adults who used either method between October 20, 2021 and January 10, 2022, using call logs, electronic health record data, and local wages to calculate labor costs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 15\u200a549 total COVID-19 triage encounters, 1820 (11.7%) used only the telephone hotline and 13\u200a729 (88.3%) used the symptom checker. Only 271 (2%) of the patients who used the symptom checker also called the hotline. Hotline encounters required more clinician time compared to those involving the symptom checker (17.8 vs 0.4\u00a0min\/encounter), resulting in higher average labor costs ($24.21 vs $0.55 per encounter). The symptom checker resulted in over 4200 clinician labor hours saved.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>When given the option, most patients completed COVID-19 triage and visit scheduling online, resulting in substantial efficiency gains. These benefits may encourage health system investment in such tools.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocac161","type":"journal-article","created":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T12:54:10Z","timestamp":1661518450000},"page":"2066-2074","source":"Crossref","is-referenced-by-count":11,"title":["Utilization patterns and efficiency gains from use of a fully EHR-integrated COVID-19 self-triage and self-scheduling tool: a retrospective analysis"],"prefix":"10.1093","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8376-6260","authenticated-orcid":false,"given":"Timothy J","family":"Judson","sequence":"first","affiliation":[{"name":"Department of Medicine, University of California San Francisco , San Francisco, California, USA"},{"name":"Center for Digital Health Innovation, University of California San Francisco , San Francisco, California, USA"},{"name":"Office of Population Health, University of California San Francisco , San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Logan","family":"Pierce","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco , San Francisco, California, USA"},{"name":"Center for Digital Health Innovation, University of California San Francisco , San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avi","family":"Tutman","sequence":"additional","affiliation":[{"name":"Office of Population Health, University of California San Francisco , San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Mourad","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco , San Francisco, California, USA"},{"name":"Center for Digital Health Innovation, University of California San Francisco , San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9774-7180","authenticated-orcid":false,"given":"Aaron B","family":"Neinstein","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco , San Francisco, California, USA"},{"name":"Center for Digital Health Innovation, University of California San Francisco , San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gina","family":"Shuler","sequence":"additional","affiliation":[{"name":"Office of Population Health, University of California San Francisco , San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph","family":"Gonzales","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco , San Francisco, California, USA"},{"name":"Clinical Innovation Center, University of California San Francisco , San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0975-0812","authenticated-orcid":false,"given":"Anobel Y","family":"Odisho","sequence":"additional","affiliation":[{"name":"Center for Digital Health Innovation, University of California San Francisco , San Francisco, California, USA"},{"name":"D , San Francisco, California, USA"},{"name":"epartment of Urology, University of California San Francisco , San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,8,27]]},"reference":[{"issue":"10","key":"2022111607595331400_ocac161-B1","doi-asserted-by":"crossref","first-page":"e21299","DOI":"10.2196\/21299","article-title":"Diagnostic accuracy of web-based COVID-19 symptom checkers: comparison study","volume":"22","author":"Munsch","year":"2020","journal-title":"J Med Internet Res"},{"issue":"1","key":"2022111607595331400_ocac161-B2","doi-asserted-by":"crossref","first-page":"e100187","DOI":"10.1136\/bmjhci-2020-100187","article-title":"Performance of national COVID-19 \u201csymptom checkers\u201d: a comparative case simulation study","volume":"28","author":"Mansab","year":"2021","journal-title":"BMJ Health Care Inform"},{"issue":"12","key":"2022111607595331400_ocac161-B3","doi-asserted-by":"crossref","first-page":"e1918561","DOI":"10.1001\/jamanetworkopen.2019.18561","article-title":"Association of use of online symptom checkers with patients\u2019 plans for seeking care","volume":"2","author":"Winn","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2022111607595331400_ocac161-B4","doi-asserted-by":"crossref","first-page":"h3480","DOI":"10.1136\/bmj.h3480","article-title":"Evaluation of symptom checkers for self diagnosis and triage: audit study","volume":"351","author":"Semigran","year":"2015","journal-title":"BMJ"},{"key":"2022111607595331400_ocac161-B5","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1038\/s41746-020-0280-0","article-title":"Chatbots in the fight against the COVID-19 pandemic","volume":"3","author":"Miner","year":"2020","journal-title":"NPJ Digit Med"},{"issue":"8","key":"2022111607595331400_ocac161-B6","doi-asserted-by":"crossref","first-page":"e027743","DOI":"10.1136\/bmjopen-2018-027743","article-title":"Digital and online symptom checkers and health assessment\/triage services for urgent health problems: systematic review","volume":"9","author":"Chambers","year":"2019","journal-title":"BMJ Open"},{"issue":"1","key":"2022111607595331400_ocac161-B7","doi-asserted-by":"crossref","first-page":"e14679","DOI":"10.2196\/14679","article-title":"Patient perspectives on the usefulness of an artificial intelligence-assisted symptom checker: cross-sectional survey study","volume":"22","author":"Meyer","year":"2020","journal-title":"J Med Internet Res"},{"issue":"4","key":"2022111607595331400_ocac161-B8","doi-asserted-by":"crossref","first-page":"100493","DOI":"10.1016\/j.hjdsi.2020.100493","article-title":"Digital triage: novel strategies for population health management in response to the COVID-19 pandemic","volume":"8","author":"Lai","year":"2020","journal-title":"Healthc (Amst)"},{"issue":"11","key":"2022111607595331400_ocac161-B9","doi-asserted-by":"crossref","first-page":"e22924","DOI":"10.2196\/22924","article-title":"Implementation of a self-triage web application for suspected COVID-19 and its impact on emergency call centers: observational study","volume":"22","author":"Galmiche","year":"2020","journal-title":"J Med Internet Res"},{"issue":"5","key":"2022111607595331400_ocac161-B10","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.5811\/westjem.2020.7.48217","article-title":"Development and usability testing of a web-based COVID-19 self-triage platform","volume":"21","author":"Schrager","year":"2020","journal-title":"West J Emerg Med"},{"key":"2022111607595331400_ocac161-B11","author":"Herriman","year":"2020"},{"key":"2022111607595331400_ocac161-B12","doi-asserted-by":"crossref","first-page":"h3727","DOI":"10.1136\/bmj.h3727","article-title":"Fifty million people use computerised self triage","author":"Wyatt","year":"2015","journal-title":"BMJ"},{"issue":"2","key":"2022111607595331400_ocac161-B13","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00004479-200004000-00003","article-title":"Digital health care\u2014the convergence of health care and the internet","volume":"23","author":"Frank","year":"2000","journal-title":"J Ambul Care Manage"},{"issue":"2","key":"2022111607595331400_ocac161-B14","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1136\/emermed-2020-209792","article-title":"Online forward triage during the COVID-19 outbreak","volume":"38","author":"Hautz","year":"2021","journal-title":"Emerg Med J"},{"issue":"1","key":"2022111607595331400_ocac161-B15","first-page":"9","article-title":"Facilitating patient self-management through telephony and web technologies in seasonal influenza","volume":"18","author":"Nagykaldi","year":"2010","journal-title":"Inform Prim Care"},{"issue":"4","key":"2022111607595331400_ocac161-B16","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1136\/amiajnl-2011-000382","article-title":"Triaging patients at risk of influenza using a patient portal","volume":"19","author":"Rosenbloom","year":"2012","journal-title":"J Am Med Inform Assoc"},{"issue":"3","key":"2022111607595331400_ocac161-B17","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.annemergmed.2010.04.005","article-title":"Web-based self-triage of influenza-like illness during the 2009 H1N1 influenza pandemic","volume":"56","author":"Kellermann","year":"2010","journal-title":"Ann Emerg Med"},{"key":"2022111607595331400_ocac161-B18","first-page":"860","article-title":"Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19","author":"Judson","journal-title":"J Am Med Inform Assoc"},{"key":"2022111607595331400_ocac161-B19","author":"Centers for Disease Control and Prevention","year":"2020"},{"key":"2022111607595331400_ocac161-B20","volume-title":"Telephone Triage Protocols for Nurses","author":"Briggs","year":"2015","edition":"5th ed"},{"key":"2022111607595331400_ocac161-B21","author":"U.S. Bureau of Labor Statistics. Employer costs for employee compensation summary","year":"2022"},{"key":"2022111607595331400_ocac161-B22","author":"Liu"},{"key":"2022111607595331400_ocac161-B23","doi-asserted-by":"publisher","year":"2022","DOI":"10.1377\/forefront.20220125.695159"},{"issue":"4","key":"2022111607595331400_ocac161-B24","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1093\/jamia\/ocaa311","article-title":"Clinical informatics during the COVID-19 pandemic: lessons learned and implications for emergency department and inpatient operations","volume":"28","author":"Hsu","year":"2021","journal-title":"J Am Med Inform Assoc"},{"issue":"12","key":"2022111607595331400_ocac161-B25","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1093\/jamia\/ocaa171","article-title":"Clinical informatics accelerates health system adaptation to the COVID-19 pandemic: examples from Colorado","volume":"27","author":"Lin","year":"2020","journal-title":"J Am Med Inform Assoc"},{"issue":"11","key":"2022111607595331400_ocac161-B26","doi-asserted-by":"crossref","first-page":"e20549","DOI":"10.2196\/20549","article-title":"Use characteristics and triage acuity of a digital symptom checker in a large integrated health system: population-based descriptive study","volume":"22","author":"Morse","year":"2020","journal-title":"J Med Internet Res"},{"issue":"1","key":"2022111607595331400_ocac161-B27","doi-asserted-by":"crossref","first-page":"e14512","DOI":"10.2196\/14512","article-title":"Back to the future: achieving health equity through health informatics and digital health","volume":"8","author":"Brewer","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"issue":"9","key":"2022111607595331400_ocac161-B28","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1111\/acem.13220","article-title":"Why do people choose emergency and urgent care services? A rapid review utilizing a systematic literature search and narrative synthesis","volume":"24","author":"Coster","year":"2017","journal-title":"Acad Emerg Med"},{"key":"2022111607595331400_ocac161-B29","author":"California Influenza Surveillance Program","year":"2022"},{"issue":"Suppl","key":"2022111607595331400_ocac161-B30","doi-asserted-by":"crossref","first-page":"S95","DOI":"10.3122\/jabfm.2021.S1.200237","article-title":"On the front (phone) lines: results of a COVID-19 hotline","volume":"34","author":"Margolius","year":"2021","journal-title":"J Am Board Fam Med"},{"issue":"Suppl","key":"2022111607595331400_ocac161-B31","doi-asserted-by":"crossref","first-page":"S170","DOI":"10.3122\/jabfm.2021.S1.200178","article-title":"Launching a statewide COVID-19 primary care hotline and telemedicine service","volume":"34","author":"Cheng","year":"2021","journal-title":"J Am Board Fam Med"},{"key":"2022111607595331400_ocac161-B32","author":"Eby","year":"2022"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jamia\/advance-article-pdf\/doi\/10.1093\/jamia\/ocac161\/45983326\/ocac161.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/29\/12\/2066\/47027819\/ocac161.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/29\/12\/2066\/47027819\/ocac161.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T08:00:39Z","timestamp":1668585639000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/29\/12\/2066\/6677674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,27]]},"references-count":32,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,8,27]]},"published-print":{"date-parts":[[2022,11,14]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocac161","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,12,1]]},"published":{"date-parts":[[2022,8,27]]}}}