Making Digital Contact Tracing a success in the UK

Nathan Baranowski

We all have been impacted by the reality of COVID19. The response from across the globe to aid and support humanity to reduce the continued impact and allow us all to return to normal, whatever that may be in the new paradigm, has been herculean. Our attention now turns to using digital to help us. How do we make it a success?

Healthcare

We all have been impacted by the reality of COVID19. The response from across the globe to aid and support humanity to reduce the continued impact and allow us all to return to normal, whatever that may be in the new paradigm, has been herculean.

Back in March a research paper in Science identified that through an app there is greater possibility to manage the epidemic. Rightly the paper identifies ethical considerations that will make or break any digital response including user adoption, trust, data privacy and openness.  

The paper has been seized upon by governments across the globe and contact tracing apps have been developed at significant rates, including  Google and Apple coming together to support the race to find a solution. At the same time critics/observers have grasped the opportunity to raise the alarm over data privacy and direct the tech debate on how best to approach the response in order to deliver a successful contact tracing app in the UK.   

This week it was announced that the NHS Contact Tracing app is being released for testing in the Isle of Wright and could signal a national deployment of an App and offer one of many tools to aid our return out of lock down and offer one of many tools to aid our return out of lock down.   

What is Contact Tracing?  

Contact tracing is a process to slow the spread of COVID19. When someone contracts a virus, it enables you to identify and contact those people that the person has been in contact with to ensure they self-isolate, get tested and/or seek medical assistance as needed. Traditionally this would be done through interviews via phone and email using standard procedures by Public Health England or the local health provider in response to an outbreak. Digital contact tracing is about using your mobile device – either the cellular phone signal or Bluetooth to enable this. The UK app has been developed by NHSX the digital arm of the NHS with the aim of supporting its test, track and trace strategy.  

How Does the NHS App Work?  

Rory Cellan-Jones got his hands on the app early and explains in his report that the app asks for the first characters of your postcode and to enable the permissions – Bluetooth enabled always and push notifications.  The app simply focuses upon reporting symptoms and if you do show symptoms, advising isolation and to call for a home testing kit.   The main aim is to push notifications to those you have been in contact with to take precautions whilst a test is completed.  If your test returns positive it will notify those people to self-isolate as someone they have been in contact with tested positive.  The app has also been developed with a risk scoring process to ensure the right level of notification is sent to those you are most in contact with over those you may not be so close to.     

Finally, there is a nice feature in the app according to the BBC that prompts those wearing PPE to turn off Bluetooth whilst wearing protection.   

The Challenge 

The first challenge is that the app only applies to those with a mobile phone that is BLE capable.   For the app to be successful it needs to be downloaded by at least 60% of the population. Reportedly Australia and Singapore have failed to reach this magic number.typically these countries have great success with apps. 

Secondly, Bluetooth technology may not be up for the job of providing consistent responses at the level of data needed to support proximity responses and causes issues with mobile phone battery life.  

User Adoption of any app comes down to necessity and stickability which results in a sense of I can’t live without it. The challenge when delivering apps at pace is balancing functionality over quality.  Overriding this would be the consideration of Minimal Viable Product (MVP) – what the app must do (contact trace) – over what the app should or could do (provide information). This is important as users may download the app today as COVID19 is a clear and present danger, but may simply delete the app in following weeks as the sense of the new normal becomes a reality - where the risk is perceived to have gone  resulting in the app no longer serving its perceived purpose as the population drop it from use 

The app however will be a roaring success or flop on a simple element of trust and understanding.  In simple terms where is my data, what do you hold and who has access to it?  The government and NHSX have been very open with their approach and open to scrutiny and debate over the app from an early stage. It is reported that US Silicon Valley has been involved in the development of the “data store” for the app and significant concerns have been raised in relation to mission creep and using such an app could result in managing social movements or other purposes the app was not intended for. A significant challenge to the UKs approach is that NHSX decided to opt for a centralised model over that favoured by Apple and Google of keeping data local on the device.  Centralisation of the data means it cannot be deleted and although anonymous at point there must and has to be a means within the app of linking it to NHS records in order to correlate a user reporting symptoms, being tested and being reported as positive and contacting those who the user has been in contact with. The data stored centrally therefore falls within the restrictions of storing personal sensitive data under GDPR regulations.   

How Can We Make it a Success?  

The reality is that any app is going to be helpful and provide significant benefit in the response to living in a world where COVID is present. For the app to succeed, trust is needed. We have all seen the impacts of unintended use of data in the past and the models shown from ChinaA simple change to the app to ensure users understand and consent clearly to a privacy policy and GDPR regulations are adhered to as part of the app would enable many to feel comfortable and appropriately consent to the use of the app. In addition, the government could legislate that the data cannot be used for any other purpose than that of COVID19 contact tracing. Any user research on user adoption would have most likely picked this up.  

Moving beyond MVP the app needs to have purpose to ensure it isn’t deleted. The opportunity, no matter how many downloads, to provide information and support in relation to COVID19, helping with social distancing guidance and highlighting people to the possible risks based on rates of infection within areas.  For example, if I was travelling to London what is the practice and guidance for being on a train, are there pockets of high infection and should I be wearing a face mask?  

We have seen during this crisis the ability for the nation to come together and collectively support and manage in lockdown. Our response to the app needs to one that is done together and enables us all to feel safe, that we can use it with trust and that we encourage others to download it too. After all it will be down to us to decide individually and collectively whether the app works.   

 

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