The first case of COVID-19 was confirmed at Penn Medicine in early March. Since then, the Center for Health Care Innovation has partnered with clinical and executive partners from across the health system on numerous efforts to combat the pandemic. If you are interested in learning more about any of the projects below, please reach out to Deirdre Darragh at email@example.com.
The COVID-19 pandemic presents immediate challenges for creative problem solving and innovation. In addition to launching new projects, we have ramped up staffing and support for projects in our portfolio that are especially relevant in light of the new normal - interventions that leverage telemedicine, remotely monitor patients to keep them safe at home, or move care into the home altogether.
Penn Medicine OnDemand
In 2014, we launched a pilot program offering virtual care services to Penn Medicine employees. By leveraging a temporary structure – or fake back end – we were able to quickly validate feasibility and demand for the program and learn about user preferences. The pilot results were promising – we observed improved access and satisfaction, a sizeable reduction in the use of emergency department services by employees, and an uptick in the connection of patients to primary care providers at Penn Medicine. Based on the success of the pilot, we collaborated with partners from across the health system to move from a fake back end to jump-starting Penn Medicine OnDemand - a fully scaled virtual care telemedicine practice operated by the Center for Connected Care. OnDemand is now one of the primary tools our health system is using to keep patients and providers safe amid the ongoing COVID-19 pandemic. At the outset, the team adapted in real-time to handle increased volume. With daily calls skyrocketing from 50-60 to more than 400, primary care physicians joined up to support telehealth services. Since March, the team has grown from seven providers to over 150. Individuals who feel sick can use OnDemand to obtain a virtual evaluation, and patients with upcoming appointments can participate in virtual visits with physicians or advanced practice providers on the platform. The OnDemand team is also providing support for patients with urgent COVID-19 symptoms through partnerships with Penn Medicine’s COVID-19 Hotline, pre-appointment symptom screening programs, and COVID Watch.
Related news: Calls for medical advice increase as number of coronavirus patients grows, Doctors Moving Toward Telemedicine, These Philly doctors have COVID-19, but they’re still treating patients — virtually, Surge in patients overwhelms telehealth services amid coronavirus pandemic
CHCI staff: Krisda Chaiyachati | Partners: Penn Medicine Center for Connected Care
COVID Watch and COVID Pulse
COVID Watch enables patients who are confirmed or likely to have COVID-19 but not sick enough to need hospitalization to be monitored at home. Penn Medicine clinicians can enroll patients in the program directly from the electronic medical record. From there, Way to Health utilizes twice-daily automated texts to remotely monitor patients, with protocols for escalation to telemedicine or hands-on care when necessary. Expanding on the COVID Watch model, we recently launched COVID Pulse. Patients enrolled in the COVID Pulse program receive a home pulse ox device and teaching prior to discharge in addition to remote monitoring once they are back at home.
CHCI staff: Neda Khan, David Asch, Mohan Balachandran, David Do, Doreen Lam, Krisda Chaiyachati, Christianne Sevinc, Kyle McGrogan, Michael Kopinsky, Mike McAllister, Cathy Reitz, Cat Reale, Caitlin McDonald, Jessica Sung, Rachel Djaraher, Michael Fortunato, Samantha Coratti, and Smriti Shah | Partners: Bill Hanson, Kevin Volpp, Nina O’Connor, Ann Huffenberger, Susie Day, and Anna Morgan
Designing drive-through testing sites
Drive-through testing was identified as an early priority for patient care and community health — with the additional need that suspected COVID-19 patients not congest emergency departments where they could create contagion. Within 48 hours, drive-through testing sites were established in West Philadelphia and Radnor. The setup for these sites required immense design and logistical support. Members of our team created workflows for intake and lane protocol, introduced a walk-through option adherent to social distancing guidelines, and produced signage. We also launched an Agent dashboard to track patient flow and a registration process to minimize face-to-face contact. The registration process, powered by Way to Health, enables patients to navigate the process, receive guidance, and stay informed about next steps following testing via text. Since the sites launched in mid-March, more than 3,000 patients have been tested for COVID-19.
CHCI staff: Kathleen Lee, Lauren Hahn, Christina O’Malley, Katherine Choi, Damien Leri, Stephanie Brown, Aaron Leitner, and Michael Kopinsky | Partners: Pat Sullivan, PJ Brennan, Maureen Rush, Capt. Leddy, Holly Auer, Hannah Messinger, Roger Osbourn, Gary Ginsberg, Frank Stein, Robert Russell, Robert Fisher, Katie Delach, Frank Cloud, Michael Dolan, William Gaffney, Wayne Smith, Deb Mincarelli, Damien Leri, Eugene Gitelman, John Donahue, Katie Deschaine, Mike Restuccia, Tracey Commack, Brieana Downs, and countless others
A virtual bridge clinic for patients with opioid use disorder
The Center for Opioid Recovery and Engagement (CORE) provides comprehensive peer support for individuals struggling with opioid use disorder (OUD). COVID-19 puts OUD patients at significantly higher risk as many of the services they depend on (drop-in clinics, group meetings, etc.) have been severely scaled back or stopped entirely. In addition, CORE’s primary sites for patient engagement – hospitals and emergency departments – have changed dramatically. We are developing a virtual bridge clinic to enable providers to engage, monitor, and deliver care to patients remotely. Certified recovery specialists (CRSs) will provide support and connections to ongoing treatment as they would in-person. And, thanks to temporarily relaxed regulations surrounding the prescribing of buprenorphine or methadone in medication-assisted treatment, CORE providers will be able to issue prescriptions over the phone. This work is possible thanks to a generous contribution from the William Penn Foundation Special Gifts Program.
Remote monitoring for patients with chronic obstructive pulmonary disease
BreatheBetterTogether (BBT) is a hospital to home transition program that uses a customized inpatient dashboard to identify high-risk hospitalized patients with chronic obstructive pulmonary disease (COPD) and enroll them in daily monitoring program powered by Way to Health. The program prompts patients to share information about their symptoms daily. If a clinical decline is suspected, information is escalated to the care team, and personalized interventions are enacted. COPD patients are among the most vulnerable to COVID-19 infections. They are more likely to develop severe cases that require ICU-level care. In light of this, we have ramped up staffing and support for the BBT program to prepare for a likely increase in patient volume.
CHCI staff: Mike Begley and Tim Delaney | Partners: Vivek Ahya, Mike Sims, Colleen Cain, Scott Crespy, Steven Gudowski, Matt Walker, Margie Pierce, Kathy McCauley, and Geoffrey Bass
Moving cancer care into the home
We are expanding home-based chemotherapy treatments in light of the COVID-19 outbreak. A team led by Justin Bekelman, director of the Penn Center for Cancer Care Innovation, began work to move low-complexity infused and injectable cancer drugs to the home setting in November. Around 100 patients at Penn Medicine currently get their cancer treatments at home. The number is expected to increase several-fold in the coming weeks.
CHCI staff: Mike Begley and Tim Delaney | Partners: Justin Bekelman, Callie Scott, Lindsey Zinck, Jennifer Braun, Sandra Jost, Sarah Johnson, Cassandra Redmond, Rebecca Trotta, Donna Capozzi, Maura Weikel, Beth Gilbert, and Amy Laughlin
Protecting emergency departments from COVID-related surges
Members of our team provided design, regulatory, and coordination support to stand-up surge capacity in tents adjacent to emergency departments (ED) at the Hospital at the University of Pennsylvania and Penn Presbyterian Medical Center. The surge model aims to protect EDs from COVID-related volume surges, separate patients suspected of infection from others, and provide efficient and targeted care explicitly designed for the COVID-19 population (e.g., all staff ready in personal protective equipment, COVID-19 swabs and portable chest x-rays available, etc.). A Way to Health registration program was designed to facilitate virtual registration during a “high capacity status,” utilizing text messages rather than face-to-face interaction. Patients would be prompted to text pictures of their insurance card and ID, and responses would be entered into the patient’s chart remotely. Designated for surge scenarios in the emergency state, this virtual service would reduce overall throughput time, encourage social distancing, and decrease potential exposure to fomites.
CHCI staff: Kat Lee, Christina O’Malley, Lauren Hahn, Mike Serpa, Becca Pepe, Damien Leri, Stephanie Brown, and Vivian Williams | Partners: Ben Sun, Chris Edwards, Phil Okala
Enabling digital discharge
In conjunction with emergency department (ED) nursing leadership, we are designing a remote discharge process to deliver digital after visit summaries (AVS) to patients, utilizing automated text messaging and myPennMedicine. Originally conceptualized for discharging patients in a mass surge scenario, this remote discharge process will reduce contact and exposure between patients and staff. Upon discharge, patients receive a text message with a link to their digital AVS located within their myPennMedicine account, allowing all patients to view their AVS on their personal device while nurses perform discharge education remotely via phone call or tablet. This virtual discharge process will be simulated at select EDs before a technical and operational rollout at EDs across the enterprise.
CHCI staff: Kat Lee, Christina O’Malley, Lauren Hahn | Partners: Ben Sun, Chris Edwards, John Flamma, MPM, EHR Transformation
Implementing emergency department discharge pathways for suspected or confirmed COVID-19 patients
Members of our team supported the implementation of three emergency department (ED) discharge pathways for suspected or confirmed COVID-19 patients: 1. COVID Watch 2. COVID Pulse, and 3. Home Health - an existing service with broadened enrollment criteria for COVID patients.
- COVID Watch and COVID Pulse patients receive twice daily, SMS-text check-ins with as-needed, timely escalation to a clinician.
- Patients enrolled in COVID Pulse or Home Health receive a home pulse ox device and teaching prior to discharge.
- Home Health patients receive twice-daily video visits, complete vital sign monitoring, and daily physician case review with in-person services as needed through Penn Medicine at Home.
After bringing clinical leads for each of these programs together to define clear enrollment criteria, the team developed enrollment decision trees and role-specific action sheets to support on-the-ground implementation. Working with ED ASAP partners, the team also drove the required IS build and associated staff training.
CHCI staff: Kat Lee, Christina O’Malley, Lauren Hahn | Partners: Penn Medicine Academy, Anna Morgan, Nina O’Connor, Chris Edwards, John Flamma, Ed Dickinson
Penn Med With You
Researchers from the Center for Digital Health have developed a virtual support tool to ease the minds of patients and community members during the COVID-19 pandemic. Individuals enrolled in Penn Medicine With You receive a weekly check-in and support resources via text message. Resources include COVID-19 updates, information about social support resources, and lighthearted articles and memes. The team plans to collect self-reported mood and well-being scores from users longitudinally. Participants will also be asked to rate the quality of the information and resources they receive. Individuals interested in participating in the program can text the word JOIN to (215) 461 – 3199.
CHCI staff: Lauren Southwick, Rachelle Schneider, Anish Agarwal, and Elissa Klinger| Partners: Emergency Department staff at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center
An e-consult is an electronic version of a "curbside" consult between two providers where the initiating provider can ask a short, specific question to the consultant. E-consults help prioritize specialty referrals to enhance access for our sickest patients and minimize unnecessary visits. We have been piloting and iterating on e-consult workflows and capabilities for more than a year. In April, e-consult services were activated in all primary care practices and departments to help providers manage patients while reducing face-to-face contact during the COVID-19 outbreak. Providers can now enact e-consults with specialists in cardiology, endocrinology, diabetes, cardio, rheumatology, renal, genetics, sleep, and GI. The team plans to add several other specialties over the coming weeks.
CHCI staff: Katherine Choi and Nicole Giampapa | Partners: Matt Press, Marcie Ordowich, Sebastian Haines, Jill Lentz, Jonathan Glick, Aby Mathew, and Philynn Hepschmidt
Telemedicine and remote monitoring for prenatal and postpartum care
We are expanding telemedicine and remote care capabilities to keep patients receiving prenatal and postpartum care safe at home. By alternating between clinic and telehealth visits, we can decrease exposure risk for patients and providers. The programs under this umbrella leverage digital tools and remote monitoring to manage and support patients at home.
- Pregnancy Watch is a remote monitoring intervention for pregnant patients exhibiting COVID-19 or influenza-like illness symptoms. Leveraging the model for COVID Watch, automated text messages are sent twice-daily to patients who are sheltering at home and tracking symptoms. Patients experiencing worsening symptoms like shortness of breath are escalated immediately to a pool of OB/GYN providers. This program is currently being offered at the Hospital of the University of Pennsylvania and Pennsylvania Hospital.
- THEA enables pregnant patients to monitor their blood pressure at home and report it to physicians via text – eliminating the need for multiple in-person appointments.
- Healing at Home prioritizes discharge to get new mothers out of the hospital sooner and delivers patient-centered support services in the home using an augmented intelligence (AI) chatbot.
- Heart Safe Motherhood (HSM) improves postpartum care for women diagnosed with hypertension. Patients receive automated, real-time feedback to self-reported blood pressure readings based on a provider-determined algorithm, and the platform alerts providers to values that require intervention. Providers are also able to prescribe antihypertensive medications remotely before the development of morbidity. In response to COVID-19, we are supporting additional care teams to implement HSM to reduce the amount of time patients spend in the hospital and minimize follow-up visits in the early postpartum period.
CHCI staff: Abbie Lund, Ryan Schumacher, Davis Hermann, Neda Khan, David Asch, Mohan Balachandran, Christianne Sevinc, and Doreen Lam | Partners: Anna Graseck, Kirsten Leitner, Sindhu Srinivas, and Adi Hirshberg
Homegrown platforms for innovation like Agent and Way to Health have enabled our team to rapidly test, refine, and implement technology solutions for patients at Penn Medicine and the community at large.
COVID-19 chatbot and patient triage tool
We have designed a public-facing chatbot in partnership with Google to provide appropriate and timely responses to questions about COVID-19. The bot also risk-stratifies patients so that they can be connected to the right level of care at Penn Medicine. Content for the chatbot comes from the COVID-19 FAQ, an interactive app constructed by Krisda Chaiyachati, built out and continuously updated by students at the Perelman School of Medicine, and validated by experts from infectious disease, occupational medicine, women’s health, operations, and oncology. As COVID-19 numbers continue to increase, the chatbot and patient triage tool will make it faster and easier for patients to get answers while simultaneously reducing call center volume – offloading work from frontline clinicians and shortening wait times for patients.
CHCI staff: Roy Rosin, Kevin Volpp, Krisda Chaiyachati, Mohan Balachandran, David Asch, Kat Lee, and Vivian Williams | Partners: Google, Verily, UCSF, Maguire Herriman, Elana Meer, Susie Day, Anna Morgan, Nancy Aitcheson, Erica Weinstein, Anne Norris, Sam Takvorian, Amy Behrman Glenn Fala, Kevin Van Horn, Todd Kirkes, Tim Jones, Aaron Johnson, Jake Moore, Colleen Mallozzi, John McGreevey, Christine Vanzandbergen, Phillynn Hepschmidt, Susan Regli, Ann Huffenberger, Danielle Werner, Bill Hanson and many more
COVID-19 palliative care app
The COVID-19 palliative care app enables providers to view the age and comorbidities of patients under investigation or positive for COVID-19 at each Penn Medicine entity, sorted by mortality risk. This data helps local teams flag patients who could benefit from a palliative care consult as well as proactively identify patients likely to require critical care or a ventilator. The COVID-19 palliative care app was released for use across the health system in March.
CHCI staff: Eugene Gitelman | Partners: Penn Medicine Data Science and Nina O’Connor
Critical staffing app
COVID-19 presents an ongoing need for intensivists - board-certified physicians who provide specialized care for critically ill patients. The critical staffing app enables administrators to view the COVID-19 status, availability, and competencies of intensivists at multiple sites across the health system. Employees are prompted via text messages twice a week to update their information. Administrators are currently using the app in the Pulmonary, Allergy, and Critical Care Division to make decisions about staff deployment. Plans are in place to scale to other services soon.
CHCI staff: David Do, Damien Leri, and Eugene Gitelman | Partners: Vivek Ahya
Virtual visit switchboard
Many health care encounters are being conducted virtually to reduce COVID-19 exposure risk for patients, providers, and families. Video conferencing can help enhance virtual interactions in the hospital and outpatient settings. We have created a virtual visit switchboard to enable consulting providers to organize and securely join private video visits using BlueJeans. Features include:
- Desktop and mobile-friendly platform
- No BlueJeans sign-in required
- Dashboard view of daily appointments with encounter-specific links
- Ability for practice staff to view multiple provider schedules at the same time
- Message builder to enable easy sending of texts and emails to patients
- Monitoring of meetings in progress, meeting duration, and participants
- Option to export meeting details to Outlook
- Integration with Haiku, Canto, and Doximity Dialer
- QR code for easy hand-off of video call to phone from desktop
On the patient side, a Way to Health texting campaign helps patients set up BlueJeans on their phone and share information with family members who wish to join from other locations. After a successful pilot with inpatients at the Hospital of the University of Pennsylvania and outpatients at the Perelman Center for Advanced Medicine Heart and Vascular Center, the switchboard is being scaled for system-wide use. At scale, approximately 6,000 telemedicine visits will be routed through the switchboard on a daily basis.
CHCI staff: Srinath Adusumalli, Damien Leri, Katherine Choi, Eugene Gitelman, and Catherine Shi | Partners: Liz Deleener, Neha Patel, Bill Hanson
COVID-19 Twitter map
Researchers from the Center for Digital Health have launched a tool to track self-reported COVID-19 symptoms and real-time sentiment trends on Twitter. The dashboard, created in partnership with the World Well-Being Project, pulls between four million and five million coronavirus-related tweets a day using the Twitter API. Users can view confirmed COVID-19 cases and deaths per capita, top symptom mentions, changes in language about stress, anxiety, and overall sentiment of the pandemic, and more. The dashboard aims to provide actionable information for patients, providers, health systems, and policymakers. New content will be added as the pandemic progresses.
CHCI staff: Sharath Guntuku, Emily Seltzer, Arthur Pelullo, Daniel Stokes | Partners: World Well-Being Project
Step Up is a self-service web application that seeks to match volunteers from the University of Pennsylvania and Penn Medicine with COVID-19 initiatives in need of support. Users can create project listings to recruit helpers or sign up as helpers by detailing their skill set and availability.
CHCI staff: Damien Leri and Katy Mahraj, Mike Dong, Andrew Parambath, and Maryam Alausa | Partners: Anna Delaney, Suzanne Rose, and Cindy Christian
The COVID-19 report aggregates information from multiple sources, enabling health system executives to monitor actionable data in real-time. In a sleek dashboard format, users can view the number of confirmed inpatients with COVID-19 by entity, patients under investigation, pending test results, telemedicine visits, hospital and emergency department occupancy rates, ventilator availability, and more.
CHCI staff: Damien Leri, Eugene Gitelman, and Mike Dong
COVID-19 FAQ app
COVID-19 FAQ is an interactive app. Its mobile-friendly, searchable interface makes the latest COVID-19 guidelines quickly accessible to frontline clinicians. Users can up-vote content, flag answers for issues, and submit new questions. The content, constructed by Krisda Chaiyachati, built out and continuously updated by students at the Perelman School of Medicine, and validated by experts from infectious disease, occupational medicine, women’s health, operations, and oncology, serves as the source of truth for clinicians answering patient and employee questions over the phone. It also serves as the backbone for a chatbot and patient triage tool that is currently in development.
CHCI staff: Damien Leri, Krisda Chaiyachati, Roy Rosin, Kevin Volpp, Maguire Herriman, and Elana Meer | Partners: Susan Day and Ann Huffenberger
Penn Medicine is dedicated to the health and wellness of all staff. In addition to exploring production and distribution pathways for personal protective equipment, we have launched numerous efforts in partnership with Penn Medicine’s Workforce Wellness Committee to support mental health during this difficult time.
Prototyping personal protective equipment
We are working with industry leaders to develop and test prototypes for personal protective equipment (PPE). Efforts include validating best practices for cleaning and sterilizing supplies in stock; development of a face shield that does not allow air or moisture to pass; and development of origami-based masks made with readily available components that offer micron-level filtration, droplet protection, and breathability. Over the course of only three weeks, the team moved from ideas to prototypes to user-testing to production. All plans are open-source so that other health systems can learn from these discoveries. This groundbreaking work was featured in the New York Times.
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CHCI staff: Mohit Prajapati | Partners: Mark Yim, Penn Engineering; Matt Bell, NextFAB; Eric Suglaski, Archimedic; Jon Keil, Solution Medical; Shu Yang, Penn Engineering; Vanessa Chan, Penn Engineering
The PennMedicineTogether website provides a wide variety of resources to help faculty and staff from across Penn Medicine take care of their physical health, access life necessities, and care for their families. In the first five days, the website was viewed more than 5,000 times.
CHCI staff: Kelley Kugler, Franki Abraham, and Dakota Marine | Partners: Workforce Wellness Committee
PennCOBALT is a web-based platform that provides curated behavioral health and wellness content as well as group and individualized support for Penn Medicine employees. After answering a few questions, users receive personalized recommendations for articles and exercises most relevant to them. Users can also participate in sessions focused on mindfulness and anxiety reduction or schedule a time to connect one-on-one with mental health coaches and clinicians. To date, more than 2,000 employees have created accounts on the platform.
CHCI staff: Kelley Kugler, Koty Marine, Avanti Rangnekar | Partners: Workforce Wellness Committee
Gallery of Gratitude
For those working extra hard in the face of COVID-19, knowing how much that work is appreciated can give a much-needed boost to help them keep going. Members of our team launched a “Spread the Love” campaign in March to collect notes of gratitude for frontline staff at Penn Medicine. Since launching, more than 1,000 messages have been submitted. The words of encouragement are displayed in the Gallery of Gratitude on the PennMedicineTogether website, and on screens in Penn Medicine hospitals.
CHCI staff: Cathy Reitz, Caitlin McDonald, and Jessica Sung | Partners: Workforce Wellness Committee
Resilience coaches are now readily accessible to Penn Medicine employees for one-on-one virtual sessions through PennCOBALT. Coaches, recruited from across the health system and the Perelman School of Medicine, are trained in evidence-based psychological first aid. They seek to support individuals to engage in adaptive coping, provide targeted resources, and establish connections to higher levels of care when needed. All coaches have access to licensed clinicians for emergencies.
Program development: Kelley Kugler and Avanti Rangnekar | Coaches: Joe Harrison, Rachelle Schneider, and Haley McCalpin | Partners: Workforce Wellness Committee
Nourished is a meal delivery platform that enables hospital staff to safely and efficiently order affordable meals from a curated list of local restaurants via text message. Individually packaged meals are transported directly from the restaurant’s kitchen to a controlled hospital access point for contactless delivery to prevent the possible spread of COVID-19. Thanks to the enthusiasm of local restaurant partners and generous donors, we were able to get Nourished up and running in less than two weeks. The initial pilot took place at Penn Presbyterian Medical Center and then scaled to the Hospital of the University of Pennsylvania and Pennsylvania Hospital. Since the launch of the program, close to 4,000 meals have been safely delivered to frontline staff at Penn Medicine. In addition to serving frontline staff, Nourished helps local restaurants stay open and continue their operations during what has become a challenging time for the Philadelphia food industry.
CHCI staff: Ryan Schumacher, Davis Hermann, Cathy Reitz, Caitlin McDonald, Jessica Sung, Mike Begley, and Christianne Sevinc | Penn partners: Workforce Wellness Committee | Engineering partners: Chariot Solutions, Accenture, Way to Health, Icon Interactive, Syncro Medical, DXC Technology |Participating restaurants: Cafe Ynez, Baology, On Point Bistro, Pumpkin, and El Merkury | Donors: Fuel the Fight and Frontline Foods
Helping providers return home safely
Returning home after a shift can be stressful for frontline staff. Through in-depth interviews, we identified specific journey points driving anxiety and uncovered clever solutions providers are employing to reduce the risk of transferring COVID-19 to those around them. We used these insights to create a practical Return Home Safely guide for Penn Medicine staff. The guide goes beyond basic guidelines for social distancing and practicing good hygiene to offer tips on what to bring to work, best practices for leaving the hospital, and suggestions for reducing the risk of spread when arriving home. It also provides a worksheet for providers to scope out personalized plans. The tool has been distributed to employees via the PennMedicineTogether and PennCOBALT websites.
CHCI staff: Dave Resnick, Davis Hermann, Franki Abraham, Mike Dong, Nicole Giampapa, Avanti Rangnekar, Kelley Kugler | Partners: Workforce Wellness Committee
Taking substance abuse support virtual
The team at the Center for Opioid Recovery and Engagement (CORE) is partnering with the Center for Addiction Medicine and Policy to host weekly, anonymous support forums for employees coping with substance use in their families or themselves. Meetings are hosted by CORE’s well-known certified recovery specialists who are gifted listeners and facilitators and tremendous resources for substance use recovery. Penn employees interested in participating in substance abuse support sessions can learn more here.
CHCI staff: Davis Hermann | Partners: CORE team