Key findings from this Pivot Point Perspective:
- The COVID-19 pandemic has triggered interest in digital tools to support large-scale contact tracing efforts and expectations are growing around digital contact tracing technologies.
- Contact tracing solutions — primarily mobile applications — are being developed by a variety of public and private entities, and no clear market leader has emerged.
- Digital contact tracing tools differ in objective, functionality and complexity. Public health staff have varying contact tracing needs making a one-size-fits-all solution improbable.
- The Centers for Disease Control and Prevention (CDC) has released preliminary criteria for evaluating digital contact tracing tools and is conducting a landscape analysis to better guide public health agencies (PHAs) when selecting solutions.
History of Contact Tracing
In public health, contact tracing is the long-standing practice of identifying people who may have come into contact with an infected person (“contacts”) and subsequently collecting further information about these contacts. By tracing the contacts of infected individuals, testing them for infection, treating the infected and tracing their contacts public health aims to reduce infections in the population.
Contact tracing in the general population is performed by state and local PHAs, while contact tracing within healthcare organizations is commonly performed by occupational health personnel. It is a labor-intensive process requiring large numbers of contact tracers. Emerging digital tools, however, may add value to traditional manual contact tracing efforts by:
- Improving the efficiency and accuracy of data management and automating tasks
- Reducing the burden of data collection on public health staff by allowing electronic self-reporting by cases and contacts
- Using location data to identify community contacts unknown to the case to look at possible exposure
Digital contact tracing tools first appeared in the late 2000s, but were first deployed on a global scale during the COVID-19 pandemic.
The CDC divides digital tools into two categories, based on their primary purpose:
- Case management tools: capture data on cases and contacts; some allow for automated notification and follow up
- Proximity tracking tools: use Bluetooth or GPS technology to track an individual’s exposure to cases; these are used in conjunction with contact tracing case management tools
Digital contact tracing tools vary in purpose, features, complexity and public health staff have differing contact tracing challenges making a single solution unlikely. This CDC information sheet describes aspects to consider when selecting a tool for contact tracing.
The CDC is conducting a landscape analysis and evaluation of contact tracing tools and has developed preliminary minimum and preferred criteria for evaluating digital contact tracing tools for COVID-19. Although the criteria reference connection of the tools to PHA information systems, the criteria are very high-level and do not address interoperability with electronic health record systems (EHRs), including the ability to match patients. Additionally, although these digital tools hold promise, there are myriad privacy issues that must be navigated and the effectiveness of these solutions will rely on mass population adoption.
The solutions landscape is a patchwork of tools developed by public and private entities. These include, but are not limited to (in alphabetical order by solution name) *(Inclusion in this list does not indicate evaluation or endorsement by Pivot Point Consulting):
- CoEpi: Community Epidemiology in Action (private group)
- COVID-19 Exposure Notification API (Apple, Google, CDC)
- CovidSafe (Microsoft volunteers, University of Washington)
- Covid Watch (private group, Stanford, University of Waterloo)
- Epic Bugsy (Epic) – monitors inpatient infection risk within the Epic EHR; includes reporting support and integrates with Epic Beaker, the company’s hospital laboratory information system (LIS)
- NOVID (Carnegie Mellon University)
- Private Kit: Safe Paths (MIT, Harvard University)
- Patient and Staff Tracker (Health Catalyst) – proximity tracking within health care facilities
- Sara Alert (MITRE) – used by the Pennsylvania Department of Health
- “Mayo Clinic EHR Tool Runs Contact Tracing Among Hospital Staff” (Epic)
- “San Francisco Launches Innovative Contact Tracing Program to Strengthen Coronavirus Response” (Dimagi)
- Bloomberg: “The World Embraces Contact-Tracing Technology to Fight Covid-19″
- Contact Tracing: Get and Keep America Open: Supporting states, tribes, localities and territories
- Digital Contact Tracing Tools for COVID-19 (info sheet)
- Preliminary Criteria for the Evaluation of Digital Contact Tracing Tools for COVID-19: COVID-19 Contact Tracing for Health Departments (info sheet)
- Gartner: Healthcare Technology Innovations for Identifying and Managing COVID-19 Patients
- Healthcare IT News: “Congress must tackle patient matching amid COVID-19, says Pew Charitable Trusts”
- Johns Hopkins University: “Review of Mobile Application Technology to Enhance Contact Tracing Capacity for COVID-19″
More Recommended Resources:
- MIT Technology Review: “Five things we need to do to make contact tracing really work”
- Office of the National Coordinator for Health Information Technology (ONC): ONC Interoperability Proving Ground: List of COVID-19 interoperability projects
- American Medical Informatics Association (AMIA): “Maximizing Health IT, Modeling, Tracking, Tracing, and Other Public Health Tools during the COVID-19 Outbreak” (presentation) Slides (see particularly 52-64) | Recording
- 2015 Annual Review of Public Health: “Uses of Electronic Health Records for Public Health Surveillance to Advance Public Health”