Charité recently reported on an app that allows people to take a questionnaire to determine their personal risk of becoming infected with the novel coronavirus (SARS-CoV-2). Those in need of testing can then show a QR code with their answers at the testing site to speed up the examination process. The app was programmed by a fellow at the BIH Academy, where for about a year now the Berlin Institute of Health (BIH) has been offering the Digital Clinician Scientist Program. The program is funded by the German Research Foundation (DFG). As a result, the BIH is enabling young doctors doing their residency at Charité – Universitätsmedizin Berlin to combine specialist clinical training with scientific research, just as its renowned and proven Clinician Scientist Program has been doing for many years. The Digital Clinician Scientist Program focuses on preparing tomorrow’s physicians for the digitalization of healthcare.
Dr. Alexander Thieme, a radiation oncologist, treats cancer patients and conducts research into targeted therapies at Charité’s Department of Radiation Oncology and Radiotherapy. Since radiation often destroys not only the tumor but also the nearby healthy tissue, the physician and computer scientist had already developed an app that allows patients to record cancer treatment side effects while at home. “While the success of a cancer therapy is tangible – for example, a longer survival time – the situation with side effects is considerably more complicated,” Dr. Thieme explains. “Side effects can arise years after the treatment is completed, manifesting themselves in various different symptoms and with varying severity, and can significantly reduce quality of life.”
Electronic reporting of side effects
A procedure in which patients themselves document the effects of a therapy is known as patient-reported outcomes, or PROs for short. In order to make the app more user-friendly for patients, Dr. Thieme employed QR code technology in his solution. A quick response (QR) code is a two-dimensional code that contains information easily readable by a smartphone camera. The technology is already widely used in industrial applications. A key innovation in Dr. Thieme’s app was the incorporation of this technology into the electronic reporting of PROs. Last year Dr. Thieme received an award for this idea from the German Society for Radiation Oncology (DEGRO).
In just three days, the first version was up and running
Dr. Valerie Kirchberger heads up the PRO project at Charité. “As the number of people infected by Sars-CoV-2 continued to rise, I had the idea to ask Alexander Thieme if the solution he developed for cancer patients could also be used in the corona crisis,” explains the physician, who is also an adviser to Charité’s Chief Medical Officer, Professor Ulrich Frei. “Many citizens were worried that they had been infected, and the testing sites at Charité had already become overburdened.” Professor Frei liked the idea and freed up Dr. Thieme to work on the app. After the first meeting of the Corona Working Group, which, along with Dr. Kirchberger and Dr. Thieme, included physicians in the outpatient clinic and representatives from Data4Life, and once the specifications had been defined, it took only three days for Dr. Thieme to program the first fully functional version of the CovApp. Based on users’ answers to questions about symptoms like fever, coughing and fatigue, about whom they have come into contact with and their recent travel to high-risk areas, and about their underlying health conditions, smoking status and age, the CovApp makes a recommendation: If there is a certain combination of risk factors, the CovApp recommends the user to visit an examination center where he or she will be tested if necessary. It also creates a QR code that can be taken to the clinic and scanned there to save valuable time during the patient interview, thus allowing more patients to be examined.
“We need to direct the flow of patients into the right channels in order to optimally utilize the capacity of our healthcare system and to help as many people as possible,” Dr. Kirchberger explains. “And the CovApp helps us to do just that.” According to initial estimates, millions of people across German have already used the CovApp to complete the questionnaire. “We are updating the CovApp almost daily,” Dr. Thieme reports. “The Robert Koch Institute, for example, has several times expanded its list of high-risk areas, and on multiple occasions we have had to revise the questions about symptoms as well as the decision logic for determining the risk profile.”
Shaping the digital transformation of healthcare
Professor Duska Dragun, director of the BIH Academy, is proud of “her” Digital Clinician Scientist Program: “When we launched the program a year ago, we were able to draw on the considerable experience we have gained from our Clinician Scientist Program. We also knew that the DFG-funded Digital Clinician Scientist Program would fill an important gap. After all, the digitalization of healthcare is a major step toward the future. We are supporting young medical doctors in shaping the digital transformation by enabling them to pursue innovative research projects during their residency training. I am, of course, very pleased that in the first cohort of doctors we were able to support a project of such crucial importance not only to Charité, but to all of Germany. Dr. Thieme’s project is a perfect example that the world of academic innovation can produce excellent examples of translational medicine.”
Further optimization and translation into other languages
The current version of CovApp was conceived and designed in collaboration with the nonprofit organization Data4Life, and the app is being developed further. “We plan to publish the algorithms online so that anyone interested in the app can view and further optimize them,” Dr. Thieme explains. Several hospitals in Germany and even some overseas, like the renowned Mount Sinai Hospital in New York City, have expressed interest in the CovApp, which is why translations into other languages are planned.
Dr. Kirchberger was originally tasked with digitalizing the various processes in the corona examination center – when the pandemic began, everything was still done on paper. A crucial step forward has been taken with the CovApp. “Throughout human history, there have unfortunately always been pandemics, but this is the first time that we can use modern information technology to help people in such a situation,” Dr. Thieme asserts. And Dr. Kirchberger adds: “We are pleased that our work is making a difference.”