As national lockdowns began to ease, governments around the world raced to build out comprehensive contact tracing systems in a bid to reduce the spread of the COVID-19 virus. The idea of ‘track and trace' isn't a new one and has been known to be an effective tool in the fight against epidemics - and yet many countries are building out these systems for the first time, as the reality of the deadly Coronavirus appeared to take many by surprise.
Contact tracing works by attempting to identify anyone that has come into close contact with someone that has tested positive or has symptoms of COVID-19. All these traced contacts are then urged to self isolate, with the hope of reducing continued spread.
Scotland is approaching 20,000 known Coronavirus infections to date and 2,500 known deaths. However, thanks to an extended lockdown, a less concentrated population and an approach that focuses on identifying local outbreaks, Scotland thus far has had greater success in controlling the virus compared to its neighbours south of the border.
We got the chance to speak to Deryck Mitchelson, Director of Digital and Chief Information Security Officer at NHS National Services Scotland, about how the country is hoping to continue to stay on top of COVID-19 with its contact tracing programme, which it built in just four weeks using ServiceNow.
Mitchelson explained that the programme is built on a two tier system - both focused at a national level, as well as making use of local level health experts. The national team does the "heavy lifting", whilst the local team provides local expertise. The task which was asked of Mitchelson's team was to build a digital solution that pulls all testing and tracing together in one place.
However, Mitchelson added that Scotland didn't want a technology-first approach, rather one that focused on human support. He said:
The approach in Scotland was very much around the human expertise and the human aspect. This is different to England, which is focused on automation. We were very much trying to focus on the expertise and human element, with the digital system sitting behind that.
We've got hundreds of contact tracers at the moment, there's a lot of them at a national and local level now. The critical thing is that we're using one system, with all the test results flowing into that system and all the contacts getting added into that system as well.
Scotland's contact tracing system also collects data on venues and settings, as well as provides management information on the efficiency of the service and identifies Coronavirus hotspots throughout the country.
Building an MVP
NHS Scotland thought it was important to set expectations for how the contact tracing system would develop - rather than create an end-to-end product with a ‘Big Bang approach', it focused on building a MVP over a few weeks and adding features as it learnt more. The MVP was built over a period of four one week sprints (four weeks in total).
The first week of the sprint was focused on carrying out the service design work, where it engaged with some third parties that had worked on contact tracing systems in Europe, in order to bring in some expertise and knowledge. The remaining three weeks focused on implementing changes and creating the data catalogue, the integration into the data exchange layer, and establishing a user group of professional health consultants to advise on what was needed to make it a success.
By and large, the programme has thus far been successful. Mitchelson said:
It went incredibly smoothly. There were some complications around trying to integrate into things like telephony, we've got a lot of these contact tracers working from home and we wanted an end-to-end service, so some of that was more complex than we initially thought. But we did manage to get there within the four weeks.
NHS National Services Scotland (NSS) decided to build the system using ServiceNow as the platform. Mitchelson said that this decision was made because of NHS Scotland's experience with ServiceNow and that it could take advantage of skills in-house. He explained:
We had ServiceNow at NSS anyway. It's used across a lot of the NHS in Scotland, in particular for the ITSM capabilities. Then at NSS we very quickly started using a lot of the workflow functionality and started building a lot of our business processes on the back of ServiceNow. So before we even started using it for contact tracing, we had actually already started using it for managing a lot of the PPE supply and demand. We have got a very good ServiceNow team at NSS too.
It just felt like a good fit after the success of some of the business and PPE work. When we were asked to do the contact tracing and deliver something in four weeks, it just seemed natural to me that we could take the development team we've got and concentrate on the configuration and implementation of the product. Obviously under the hood of ServiceNow you get a lot of that digitisation, a lot of the workflows, and a lot of that's already there for you. It was less for us to build, which is how we managed to do it in four weeks, because we were using a lot of that core functionality we got from the ServiceNow modules.
The go live
According to Mitchelson, by and large the contact tracing programme has been a success. NHS Scotland is getting 50% of its test results from the UK government's Lighthouse Labs, of which there is a base in Glasgow. And then the territorial health boards are delivering the rest of the results from their own labs, where they are testing NHS staff, care home workers and also some members of the public. Mitchelson added:
We put all those test results into the integration hub and then it goes into the ServiceNow instance. Once it's in ServiceNow, if it's a positive test result we will have a look at who it is and then we will contact them to start tracing. Who have you been in touch with? How many members are there in your family? Are there any key workers? Everything is off the back of that positive test result.
We are going to start bringing in things like proximity applications as well, so that we can start to understand who has been in contact with people that have potentially had COVID-19. And then we will be pushing that back into the content management system that ServiceNow has worked with us on and we will be using that to contact trace as well.
The service went live at the end of June and Mitchelson said that the "feedback has been great", both from a usability and performance perspective. So much so that NHS Scotland plans to invest in the platform for the future. He added:
The good thing is that the boards understood this was an MVP and have been working with us on the improvements as we try to bring more automation into it, which is critical as well. We see this as a legacy system that we've ended up building for managing test results, pandemics and crises. This isn't a system that we see ourselves switching off, we see this as a system we would use for any other outbreaks that might happen in Scotland.
The team is now looking at integration with its data science platform too, so that it can better drill down into demographic information and hopefully spot COVID-19 clusters before they turn into growing hotspots. In addition to this, NHS Scotland is looking at self service functionality that would allow people to go and input a lot of the tracing information themselves, such as details about their family members and colleagues.
Mitchelson couldn't divulge too much information about the success rates for the contact tracing system just yet, as the data is being handed to the Scottish Government this week to assess. However, he did say:
This week we have started assuring our figures for those that have been traced and those that have failed. It's a very positive figure, I think it is consistently higher than some of the other contact tracing services that are in place across the four nations. If you look at the data around the contact tracing we did in Aberdeen and how quickly we've done that, it's a very efficient service.