A choice between Mazda and Porsche: Development of digital COVID-19 infection tracking

A decentralised outbreak registry built to fulfil multiple stakeholders´ needs, has enhanced the burden for frontline workers, disabled data timeliness, correctness and utility for multiple purposes.

Background: Efficient contact tracing during an epidemic is dependent on timeliness, correctness and comprehensiveness of information. During the COVID-19 pandemic a digital contact tracing system (CTS) was used to assist municipalities in contact tracing and managerial tasks. The aim of this study was to investigate how the three stakeholder groups experienced the use of the CTS and its output data.

Methods: This paper used mixed methods in six municipalities with two rounds of semi-structured interviews on system needs and usability with three different stakeholders in Norway: seven municipal contact tracers, five chief municipal physicians and two senior advisors at Norwegian Institute of Public Health (NIPH).

Results: Contact tracers use the CTS to register infected persons and their close contacts, and use the data to instruct, follow up and keep an overview of those in quarantine and isolation. Chief municipal physicians need aggregated contact tracing data for advising, monitoring and follow up and reporting purposes. NIPH envisages the use of aggregated contact tracing data for surveillance and research. The interviewees found the CTS system architecture to be flexible and facilitated easy integration with other health information systems and potential data sharing between involved stakeholders. NIPH and the municipalities needed a national CTS but were challenged by scarce resources. There was a discrepancy of needs for mandatory data fields, resulting in open, structured, and automated data fields. However, contact tracers express that the CTS was counterintuitive, and time consuming to learn to use it. To NIPH, ´country of birth` was an important variable, but contact tracers found it uncomfortable, and some refrained from asking.

Conclusions: The three stakeholder groups had different information needs not entirely supported in the CTS. The one solution fit for all, contributed to inefficiency and workload burden for the contact tracers, and lack of timely data for NIPH´s work.