Report 2020-612 All Recommendation Responses

Report 2020-612: California Department of Public Health: It Could Do More to Ensure Federal Funds for Expanding the State's COVID‑19 Testing and Contact Tracing Programs Are Used Effectively (Release Date: April 2021)

Recommendation #1 To: Public Health, Department of

To better leverage contact tracing as a tool to limit the spread of COVID-19, Public Health should, by May 15, 2021, reevaluate its contact tracing plan and update it to incorporate technological and medical advances in order to redefine how many tracing staff California needs and for how long it will need them.

The California Department of Public Health (CDPH) Contact Tracing (CT) Program collaborated with state and local Public Health partners and utilized CT staff calculators developed by national expert organizations to determine a new California CT staffing estimate through March 2022. These models incorporated current scientific knowledge, actual data from the first twelve months of California's COVID-19 CT response, and national epidemiology estimates for projected potential COVID-19 case numbers in California during the remaining months of 2021. The inputs utilized in these models considered technology innovations in place in California that save staff time and expand local workforce capacity, including automated case and contact surveys as well as data portals that enable external partners (e.g., schools, businesses) to share case and exposed contact data with their local health jurisdictions (LHJs). The new plan averages 4 separate modeling results and includes estimated workforce needed within the primary staffing roles that implement community CT activities, specifically: case investigators (CI), contact tracers (CT), and CT team supervisors. Of note, this new model does not include projected staffing needs for CT in prisons and other settings that are not supported by Public Health's community CT Program and workforce, nor does it include projected staffing needed for investigating and managing outbreaks which require additional and more advanced staff. The program projects a need for 2,731 CI, CT, and supervisors. An additional 1,091 trained and experienced CI, CT, and supervisor staff should be available within local and state staffing reserves in case of an unanticipated case surge.

California State Auditor's Assessment of Status: Fully Implemented

Recommendation #2 To: Public Health, Department of

To better leverage contact tracing as a tool to limit the spread of COVID-19, Public Health should, by June 15, 2021, create and implement an updated plan, in partnership with local health jurisdictions, to hire, train, and retain the number of tracing staff it determines is necessary to limit the spread of COVID-19, including expanding the pool of reassigned state employees functioning as tracing staff.

Many California local health jurisdictions (LHJs) already have in place the base plus reserve Case Investigators (CI), Contact Tracers (CT), and supervisory staff numbers determined necessary by the revised staffing plan estimate for the most likely scenario of daily maximum COVID-19 case numbers projected in California over the next six months. Most LHJs are also currently using federal funding to support the hiring of additional needed local Case Investigators and Contact Tracers (CICT) staff. The CDPH CT Program will continue to supply local workforce capacity as needed, to bridge the gap for those LHJs that are unable to meet their local COVID-19 CICT staffing requirements. The CT Program will ensure this supply using either CDPH-hired or CDC-Foundation-supplied CICT staff, either through the extension of a reduced number of state-redirected staff, or through staffing supplied via a new California Public Health Reserve Corps that has been developed to create an infrastructure of trained CICT and supervisor staff that can be activated rapidly in the event of a moderate or more extreme surge in cases. Additionally, the CDPH CT Program has partnered with UCSF/UCLA to launch a new two-year California Public Health Corps Training and Pathways Program which is supporting 45 entry-level communicable disease control staff who have been placed in 38 host LHJs across the state for on-the-job training after completion of an initial intensive training curriculum. In partnership with the UCSF/UCLA Virtual Training Academy and LHJ partners, the CDPH CT Program will continue to ensure that the CICT workforce statewide is sufficiently trained to effectively perform contact tracing duties.

https://cdphcontacttracers.powerappsportals.us/PHReserveCorpsApplication/

California State Auditor's Assessment of Status: Fully Implemented

Many California local health jurisdictions (LHJs) already have in place the base plus reserve CI, CT, and supervisory staff numbers determined necessary by the revised staffing plan estimate for the most likely scenario of daily maximum COVID-19 case numbers projected in California over the next six months. Most LHJs are also currently using federal funding to support the hiring of additional needed local CICT staff. The CDPH CT Program will continue to supply local workforce capacity as needed to bridge the gap for those LHJs that are unable to meet their local COVID-19 CICT staffing requirements. The CT Program will ensure this supply using either CDPH-hired or CDC-Foundation-supplied CICT staff, through the extension of a reduced number of state-redirected staff, or through staffing supplied via a new California Public Health Reserve Corps that is being developed to create an infrastructure of trained CICT and supervisor staff that can be activated rapidly in the event of a moderate or more extreme surge in cases. Additionally, the CDPH CT Program has partnered with UCSF/UCLA to launch a new two-year California Public Health Corps Training and Pathways Program which is supporting 45 entry-level communicable disease control staff who have been placed in 38 host LHJs across the state for on-the-job training after completion of an initial intensive training curriculum. In partnership with the UCSF/UCLA Virtual Training Academy and LHJ partners, the CDPH CT Program will continue to ensure that the CICT workforce statewide is sufficiently trained to effectively perform contact tracing duties.

California State Auditor's Assessment of Status: Pending

The majority of California LHJs already have in place the needed base CI, CT, and supervisory staff determined necessary in the revised staffing plan estimate, as well as local reserve staffing that can be activated in the event of an increase in local case numbers. The CDPH CT Program will partner to supply local workforce capacity as needed to meet the projected needs of the COVID-19 response for those LHJs that are unable to meet these base and reserve staffing requirements. The CT Program will ensure this supply using either CDPH-hired CICT staff, or, if needed, through the extension of a reduced number of state redirected staffing. In partnership with the UCSF/UCLA Virtual Training Academy and LHJ partners, the CDPH CT Program will continue to ensure that the CICT workforce is sufficiently trained to effectively perform contact tracing duties. Additionally, the CDPH CT Program is partnering with UCSF/UCLA to launch two new staffing programs that will provide enhanced support to LHJs with their local contact tracing efforts: (1) the California Public Health Corps Training and Pathways Program will support a two-year training program for 45 entry-level communicable disease control staffing who will be placed in host LHJs across the state for on-the-job training upon completion of an initial intensive training curriculum; (2) a new California Public Health Reserve Corps is being developed to create an infrastructure of already experienced and trained CI, CT and supervisor staff that can be reactivated rapidly in the event of an unanticipated surge in cases.

California State Auditor's Assessment of Status: Pending

Recommendation #3 To: Public Health, Department of

To better leverage contact tracing as a tool to limit the spread of COVID-19, Public Health should, by June 15, 2021, and in collaboration with local health jurisdictions, determine what barriers exist to contact tracers successfully identifying and contacting people who may have been exposed to COVID-19. After studying those barriers, it should share best practices with the jurisdictions and encourage them to implement those practices that will be successful at overcoming the barriers.

The CDPH CT Program is continuing to utilize data and information collected via California's contact tracing data management system (CalCONNECT), and reported by LHJs through monthly Epidemiology and Laboratory Capacity (ELC) Contact Tracing Performance Measures reporting and in various organized meeting forums, to identify current and evolving key barriers that hinder successful contact tracing efforts. The CT Program gathers information shared by LHJs via facilitated learning collaboratives, town halls, standing and ad-hoc check-in meetings, and CalCONNECT LHJ Governance Council meetings, as well as information shared by other states, the Centers for Disease Control and Prevention (CDC), and national partners, to identify best practices for mitigating these barriers. The CT Program, in collaboration with contracted partners from the UCSF/UCLA share these best practices with California LHJs through regular town halls, learning collaboratives, LHJ-specific technical assistance, reference documents, trainings, and a variety of other standing and ad-hoc forums and resources, and works with the LHJs to create mechanisms to facilitate implementation of these best practices using CalCONNECT system enhancements, workforce training and development opportunities, community engagement strategies, health promotion efforts, and other methods identified as important to implementation.

California State Auditor's Assessment of Status: Fully Implemented

Recommendation #4 To: Public Health, Department of

To ensure that it has all the necessary planning information in place related to the allocations it has made to the local health jurisdictions, Public Health should, by April 15, 2021, review and approve all initial work plans that it has received.

There were 58 workplans submitted to Public Health for the ELC Enhancing Detection application. As of March 23, 2021, Public Health has approved all 58 workplans.

Most recently, Public Health released the ELC Enhancing Detection Expansion grant and has a team in place to collect and review those application documents. Already, Public Health has seen a huge improvement in the review process and timeline. Public Health has developed a strict timeline to follow for its internal review process ensuring timely approval of applications in an effort to maximize the local health jurisdictions planned activities.

Public Health has included the workplan tracking tool for Enhancing Detection to support the completion of this recommendation.

California State Auditor's Assessment of Status: Fully Implemented

Recommendation #5 To: Public Health, Department of

To ensure that it is performing necessary oversight and can provide local health jurisdictions with guidance to improve their activities using the ELC COVID-19 funding, Public Health should, by April 15, 2021, put in place procedures to ensure that it receives all required quarterly work plans and expenditure updates from local health jurisdictions to which it made grants.

As of February 3, 2021, internal procedures for collecting progress reports and expenditure reports were in place. These procedures also included a detailed process for reviewing the reports once received at Public Health. Public Health issues reminders to the LHJs on a regular basis to ensure submission of progress and expenditure reports each quarter. Public Health is happy to report that it received all 58 quarter 3 progress reports from the LHJs. Additionally, Public Health was able to utilize the internal review processes and procedures to put together a useful summary of the progress to date at the local level.

Public Health has included the 1) progress report tracking tool, 2) internal review process and procedures, and 3) the summary that was developed from the quarter three progress reports for Enhancing Detection to support the completion of this recommendation.

California State Auditor's Assessment of Status: Fully Implemented

Recommendation #6 To: Public Health, Department of

To ensure that the State has accurate COVID-19 data and to help mitigate the risks it caused by not having IV&V during the development phase of the CCRS project, Public Health should direct its IV&V consultant to monitor system performance and Public Health's data validation efforts and to provide regular reports on the system's reliability until the IV&V contract expires in December 2021.

This recommendation is fully implemented. Independent Verification and Validation (IV&V)consultants monitored system performance and Public Health's data validation efforts and provided monthly reports on the California COVID Reporting System's (CCRS) reliability. Monthly reporting continued through December 2021.

Monthly IV&V CCRS Performance Monitoring reports were submitted to CDPH for the August 2021 through December 2021 reporting period. The report covers the following areas:

1. CCRS Data Validation and Quality: Data validation and quality checks are performed when the Electronic Laboratory Record (ELR) is first received by CDPH. The process consists of three main activities: Confirm the file format is correct, perform further checks on individual messages, and confirm the message is not a duplicate.

2. CCRS System Performance: Monitoring focuses on the reporting databases and capabilities used by CDPH Data Scientists to create COVID-19 disease and vaccination status reporting. The performance of the CCRS system is enhanced by a robust Change Request (CR) management process that ensures change requests are reviewed and analyzed for impacts before approval, prioritization and placing in backlog of existing CRs.

3. CCRS System Reliability and Availability: Monitoring is focused on the CCRS system reliability and availability compliance to the contractual Service Level Agreements (SLAs) outlined in the Optum contract and amendments. System reliability and availability metrics are based on CCRS system availability and incident response.

To foster continuous improvement of CCRS, the IV&V Contract was extended for an additional year and will continue to require IV&V consultants provide monthly CCRS Performance Monitoring reports.

California State Auditor's Assessment of Status: Fully Implemented

This recommendation is fully implemented. Independent Verification and Validation (IV&V)consultants monitored system performance and Public Health's data validation efforts and provided monthly reports on the California COVID Reporting System's (CCRS) reliability. Monthly reporting continued through December 2021.

Monthly IV&V CCRS Performance Monitoring reports were submitted to CDPH for the August 2021 through December 2021 reporting period. The report covers the following areas:

1. CCRS Data Validation and Quality: Data validation and quality checks are performed when the Electronic Laboratory Record (ELR) is first received by CDPH. The process consists of three main activities: Confirm the file format is correct, perform further checks on individual messages, and confirm the message is not a duplicate.

2. CCRS System Performance: Monitoring focuses on the reporting databases and capabilities used by CDPH Data Scientists to create COVID-19 disease and vaccination status reporting. The performance of the CCRS system is enhanced by a robust Change Request (CR) management process that ensures change requests are reviewed and analyzed for impacts before approval, prioritization and placing in backlog of existing CRs.

3. CCRS System Reliability and Availability: Monitoring is focused on the CCRS system reliability and availability compliance to the contractual Service Level Agreements (SLAs) outlined in the Optum contract and amendments. System reliability and availability metrics are based on CCRS system availability and incident response.

To foster continuous improvement of CCRS, the IV&V Contract was extended for an additional year and will continue to require IV&V consultants provide monthly CCRS Performance Monitoring reports.

California State Auditor's Assessment of Status: Fully Implemented

Independent Verification and Validation (IV&V)consultants continue to monitor system performance and Public Health's data validation efforts and provide monthly reports on the California COVID Reporting System's (CCRS) reliability. Monthly reporting will continue until the IV&V contract expires in December 2021.

The monthly IV&V reports, addressing Recommendation #6 of the State Auditor's Report, were submitted to Public Health for the August 2021 through November 2021 reporting period. The IV&V CCRS Performance Monitoring report covers the following areas:

1.CCRS Data Validation and Quality: The data validation and quality check is performed when the Electronic Laboratory Record (ELR) is first received by Public Health. The process consists of three main activities: Confirm the file format is correct, perform further checks on individual messages, and confirm the message is not a duplicate.

2.CCRS System Performance: System performance monitoring is focused on the reporting databases and capabilities used by the Public Health Data Scientists to create COVID-19 disease and vaccination status reporting. The performance of the CCRS system is enhanced by a robust Change Request (CR) management process that ensures change requests are properly reviewed and analyzed for impacts before approval, prioritization and placing in backlog of existing CRs.

3.CCRS System Reliability and Availability: System reliability and availability is focused on monitoring the CCRS system reliability and availability compliance to the contractual Service Level Agreements (SLAs) outlined in the Optum contract and amendments. The system reliability and availability metrics are based on CCRS system availability and incident response.

California State Auditor's Assessment of Status: Pending

Independent Verification and Validation (IV&V)consultants continue to monitor system performance and Public Health's data validation efforts and provide monthly reports on the California COVID Reporting System's (CCRS) reliability. Monthly reporting will continue until the IV&V contract expires in December 2021.

The monthly IV&V reports, addressing Recommendation #6 of the State Auditor's Report, were submitted to Public Health for the April 2021 through July 2021reporting period. The IV&V CCRS Performance Monitoring report covers the following areas:

1. CCRS Data Validation and Quality: The data validation and quality check is performed when the Electronic Laboratory Record (ELR) is first received by Public Health. The process consists of three main activities: Confirm the file format is correct, perform further checks on individual messages, and confirm the message is not a duplicate.

2. CCRS System Performance: System performance monitoring is focused on the reporting databases and capabilities used by the Public Health Data Scientists to create COVID-19 disease and vaccination status reporting. The performance of the CCRS system is enhanced by a robust Change Request (CR) management process that ensures change requests are properly reviewed and analyzed for impacts before approval, prioritization and placing in backlog of existing CRs.

3. CCRS System Reliability and Availability: System reliability and availability is focused on monitoring the CCRS system reliability and availability compliance to the contractual Service Level Agreements (SLAs) outlined in the Optum contract and amendments. The system reliability and availability metrics are based on CCRS system availability and incident response.

California State Auditor's Assessment of Status: Pending

Public Health directed Independent Verification and Validation (IV&V) consultants to monitor system performance and Public Health's data validation efforts and provide monthly reports on the California COVID Reporting System (CCRS)s reliability until the IV&V contract expires in December 2021.

The first IV&V report, addressing Recommendation #6 of the State Auditor Report, was submitted to Public Health for the April 2021 reporting period. The IV&V CCRS Performance Monitoring report covers the following areas:

1. CCRS Data Validation and Quality: The data validation and quality check is performed when the Electronic Laboratory Record (ELR) is first received by Public Health. The process consists of four main activities: Confirm the file format is correct, perform further checks on individual messages and confirm the message is not a duplicate.

2. CCRS System Performance: System performance monitoring is focused on the reporting databases and capabilities used by the CDPH Data Scientists to create COVID-19 disease and vaccination status reporting. The performance of the CCRS system is enhanced by a robust Change Request (CR) management process that ensures change requests are properly reviewed and analyzed for impacts before approval, prioritization and placing in backlog of existing CRs.

3. CCRS System Reliability and Availability: System reliability and availability is focused on the monitoring the CCRS system reliability and availability compliance to the contractual Service Level Agreements (SLAs) outlined in the Optum contract and amendments. The system reliability and availability metrics are based on CCRS system availability and incident response.

California State Auditor's Assessment of Status: Pending

All Recommendations in 2020-612

Agency responses received are posted verbatim.