Community Testing Guidance

Community Based COVID-19 Testing
Guidance on Establishing Community-based COVID-19 Testing Clinics

Baltimore City Health Department (BCHD) aims to ensure testing for COVID-19 is:

  • Easily accessible and widely available for everyone in our community; and
  • Conducted in a safe and efficient manner

It is a primary goal of BCHD to ensure COVID-19 testing capacity is expanded to ensure access to all who need testing.

Many partners have reached out to express interest in hosting COVID-19 testing in their communities. We appreciate the amount of community support and look forward to working with our community partners to increase access to COVID-19 testing.

It is of upmost importance that all COVID-19 testing is conducted in a manner that is safe to patients and staff at a testing site. It is also imperative that all testing sites have plans in place for delivery of accurate results to patients in a timely manner.

These recommendations are developed for those who are interested in community based testing programs. They provide guidance on important considerations for COVID-19 testing in community based settings. We recommend that those who participate in community-based testing follow the guidelines below.

Please note that Maryland law requires that all laboratory tests require an order by a licensed professional, and that ordering providers are responsible for notifying patients of their lab results.

Clinical Partners

We recommend community groups considering providing COVID-19 testing work with a clinical partner who assume responsibility for testing and resulting processes. This includes, at a minimum:

  • A clinical provider with credentials to legally order medical tests in the state of Maryland. This provider assumes the medical and legal responsibilities of COVID-19 testing, including documentation of medical malpractice insurance covering the testing activity (see below);
  • Documentation of consent for testing;
  • A thorough process for providing results to tested individual that is efficient and HIPAA compliant;
  • Record of patients who are tested, the test result, and the status of patient notification of test results; AND
  • Expertise to ensure testing is conducted in a safe manner, including preventing the transmission of COVID-19 to staff, patients, or the public

Examples of eligible clinical partners may potentially include:

  • Community clinics such as Federally Qualified Health Centers
  • Private physician offices in a clinic setting
  • Clinical groups coordinating with community-based organizations (non-clinical settings)
  • Hospitals or hospital clinics
  • School health clinics
  • Pharmacies
  •  University/college health clinics
  • Drug treatment centers

We recommend clinical partners check with their malpractice insurance carrier to ensure COVID testing activities are covered under their policy.

Testing Criteria

Clinical entities are recommended test individuals in line with testing criteria and priorities established by the Centers for Disease Control and Prevention (CDC) and Maryland Department of Health (MDH). The clinical partner is expected to remain up to date with current testing guidelines, and follow these guidelines when providing tests.

Testing clinics are recommended to define whether they are open to all members of the public or will be focused on a specific group.

Testing clinics are recommended to define if they will be based on scheduled appointments or walk-up. This should be coordinated with infection control, requisition form completion, and resulting procedures.

Infection Control

Testing clinics should follow infection control best practices, as defined by the Centers for Disease Control and Prevention and Maryland Department of Health.

The clinical partner should designate an appropriate professional who develops and oversees the workflow to make all the infection control practices are met. This includes, but is not limited to:

  • Determining a safe location for testing that decreases likelihood of transmission during the testing session
  • Planning for social distancing for staff and patients at the site
  • Providing appropriate personal protective equipment (PPE) for all staff involved with COVID-19 testing
  • Ensuring staff are fit tested appropriately for PPE
  • Training to make sure all individuals staffing the clinic know how to don and doff PPE
  • Ensure quality control for infection control practices
  • Including a safety officer in staff models, to oversee infection control throughout clinic events

Isolation and Quarantine Guidance

Testing clinics are recommended to follow clinical best practices and provide thorough guidance and instructions at the time of testing on isolation and quarantine. Information can be found here:  https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine-iso... and here: https://coronavirus.baltimorecity.gov/information-clinicians-0#Isolation...

Specimen Handling

Testing clinics are recommended to have persons on hand knowledgeable in specimen collection, handling and transport, to ensure clinical integrity of samples.

Results Notification

The ordering provider for testing clinics are responsible for notifying individuals of results in a timely manner that is HIPAA compliant. This includes:

  • Completing test requisitions in a way that minimizes errors, complies with HIPAA, and allows for accurate resulting.
  • A record of individuals who were tested and ensuring test results are available for all those tested
  • Notifying individuals of test results in an efficient and timely manner
  • Procedures on
  • Record of individuals who were notified of results and when notification was made

HIPAA regulations apply to COVID testing and COVID results.

At the time results are provided, guidance should also be given about appropriate isolation (for those who are COVID positive) and quarantine (for their close contacts). Persons providing results should be knowledgeable about COVID-19 and able to answer questions individuals may have.

Reporting

Ordering providers are recommended to comply with COMARand report persons diagnosed with COVID-19 to the state and local health department.

Clinical Care

We recommend testing clinics have procedures in place to link individuals diagnosed with COVID-19 to medical care and support services.  Many patients who are COVID-19 positive experience a worsening of symptoms several days after symptom onset and may require clinical attention. We recommend patients are able to call a provider and/or receive provider follow up after a positive COVID-19 test, to ensure support until their symptoms improve.

Will Baltimore City Health Department supply test kits?

BCHD is developing policies to provide test kits to community based programs. A guidance and application process for test kits from BCHD for community-based testing will be forthcoming. The recommendations provided here will be the foundation for the application process.