Review existing workflows and infrastructure to identify where investments in new technologies will be needed (versus where your current solution will be sufficient).
Call center and triage
Symptom reporting for isolated cases and contacts
Establish a case management system and case reporting with the following features:
2.a: Automatic flagging and correcting of common errors in case reports
Technologies that enable patients to register electronically during or before their visit to the lab will help ensure that data seen by contact tracers is accurate
2.b: Integration and processes to get data from providers directly
Probable cases, such as patients diagnosed based on clinical/epi criteria and who were never tested or whose test results are pending, will enter the case management system through this mechanism
2.c: Integration with state lab database
Ingest lab reports from the state-level database automatically to speed efficiency of creating index cases
Auto-clean the data for duplicates and other criteria
2.d: Automatic flagging of what cases should be interviewed
Database and processes will need to handle patients getting tested more than once, with multiple types of tests that mean different things, at many different locations
2.e: Prioritize cases
Data helps guide prioritization among positive patients. Examples of data useful (beyond “test results negative vs positive) include:
Date of test
Type of test
Date of symptom onset (might not be available in lab data, but is helpful for determining infectious period & original date of infection)
Other test results for the same patient
Other risk factors
2.f: Contact tracers have necessary access for outreach
Contact tracers need access to the database of cases to know who to reach out to. This does not need to be the same database the health department uses.
If using separate systems, figure out how to get data from the department database of cases into any database/technology being used by contact tracers
Identify which of these databases is the “source of truth” on COVID-19 cases.
If it is the department database: develop a process or integration that allows contact tracers to flag things that are “off” about COVID-19 patient information, such as a disconnected phone number or an email that bounces back, and ensure that information can be corrected in both the database that contact tracers are using and the database being used by the department for the tracking and management of COVID-19 cases.
Contact tracers need access to data for cases that allow them to perform their functions.
Consider what other functions contact tracers are responsible for (such as, assessing needs for social and clinical supports, delivering test results), and ensure relevant data are accessible
Other risk factors
Plan for short-term setup costs
Plan for long-term contract costs for maintaining system
Consider choosing open-source tools to reduce long-term costs
Consider using technology solutions to facilitate the process of case interviews, contact elicitation and contact investigation.
Technology can deliver of COVID-19 test results and instruct positive patients on which contacts to notify and how to notify them.
Technology to notify patients that an official person will contact them by phone soon, to increase acceptance of calls.
Technology can facilitate case interviews and contact elicitation, by having cases fill out an online form about their close contacts and recent activities and prompting them to remember contacts or possible exposures.
Resolve to Save Lives is developing digital tools to facilitate rapidly finding and sharing such contact information. More information on these products and how to connect soon.
Consider using technology solutions to facilitate the process of prioritizing and notifying contacts.
Technology can help sort through and prioritize contacts based on risk. For example:
Contacts with high risk of being infected
Contacts with high risk of infecting others
Contacts with high risk of developing serious illness
Technology can provide contact tracers with templates for outreach that they can use for manual emailing or texting of contacts.
This can also be done by automatically alerting contacts using pre-set templates (e.g. the software sends the text message rather than the contact tracer using their own phone), or with automated (IVR) calls to contacts.
These interactions can be tracked or automated in a CRM (customer relationship software such as Salesforce or Amazon Connect) or in your case management platform, enabling contact tracers to easily see that status of outreach to contacts.
Technology can help with connecting the contact to testing and/or care, by linking to COVID-19 testing location finders or telemedicine services.
Consider using technology solutions for daily follow-up and monitoring of cases and contacts during isolation or quarantine.
An increasing number of technologies are being developed to support this, such as CommCare or Sara Alert.
Consider using technology solutions for enabling patients to notify their own contacts (if they know their identities).
Anonymous and confidential peer-to-peer mass partner notification systems already exist for STDs and are beginning to be adapted to support COVID-19 peer-to-peer notification (e.g., Tell Your Contacts).
Templates could make it easier to figure out what to say and automated suggestions based on timing of test results and symptom onset could make it easier to decide who to notify.
Technology could enable automated information distribution to contacts about where/whether to get tested, symptom education and monitoring, guidance on isolation/quarantine, and available support and services.
Consider using technology solutions for supporting rapid scaling up of the contact tracing workforce, including for:
7.b Workforce training
Online learning platforms will help train the workforce
ASTHO/NCSD: Making Contact: A Training for COVID-19 Contact Tracers is an example of how technology can be used to rapidly train entry-level COVID-19 contact tracers.
Consider digital tools to help cases and contacts to isolate successfully and access social services.
Websites and apps that connect to social services and support
Resolve to Save Lives is developing digital tools to provide isolation and quarantine support. More information on these products and how to connect soon.
Consider using Bluetooth technology solutions (i.e. "exposure notification" or "proximity tracing") to automate portions of contact tracing, by notifying others who were in proximity to the case during the infectious period.
For privacy purposes, this technology relies on a “double opt-in”, meaning that both diagnosed and contacts would have to opt in to be traced or notified.
This technology has potential yet it is in its early stages. It is not recommended that Bluetooth technology solutions replace traditional contact tracing work for several reasons:
Coverage is limited to those who choose to participate.
Coverage will be biased, with lower adoption in vulnerable populations due to language barriers and limited technology access.
Accurate proximity algorithms are still under development, and issues of false positives and margins of error are unknown.
Ensuring privacy in practice (vs in theory) is unknown.
Security protections need to be built into all technologies and processes. Each person who has access to the system should only have access to the information that is relevant to their particular role.
One technique to help ensure privacy is a log that shows every person who has looked at any particular record. This can be audited, and anyone can ask for a copy of their log record at any time.
Protections need to be even more stringent for frontend software of apps for use by the public.
Workforce training should explicitly include privacy protection training.
Explore if there are potential legal issues with integration to get data from providers. A specialist lawyer may need to advise on whether EMR or labs or coroners are allowed to share data directly with contract tracers under current law, especially without consent from the patient.
Explore if there are legal issues around sharing information back to another facility or feeding it into another database. There need to be strict protections that limit how far the data can go.
Apply CDC’s Data Security and Confidentiality Guidelines to all technologies and processes.
Criteria for evaluating contact tracing apps to ensure privacy
Data security and privacy guidelines
Core privacy principles of contact tracing programs