Read the following case study from Storm ID on the work they undertook during the pandemic to help develop Scotland’s National Notification & Digital Tracing Service, to support test results delivery for people in Scotland who had been tested for COVID-19.
The Chinese government first reported ‘cases of pneumonia of unknown etiology’ to the World Health Organization on 31 December 2019. One week later, the new virus responsible for the disease outbreak was identified.On 11 March 2020, the World Health Organization declared the outbreak a global pandemic and in the same week, the Digital Health & Care Innovation Centre (DHI) was commissioned by the Scottish Government to support Scotland’s digital response.Storm ID were approached by DHI to collaborate with Public Health Scotland, NHS National Services Scotland, NHS Greater Glasgow and Clyde, NHS Lothian and Sitekit to co-design and develop the National Notification and Digital Tracing Service to support test results delivery for people in Scotland who had been tested for COVID-19. The launch of the website means the public can search, filter and view the outputs of historic census data in new and dynamic ways.
Partnership and Collaboration – Developing the National Notification and Digital Tracing Service would require several partners to work collaboratively and at pace. We worked with the Digital Health & Care Innovation Centre, Public Health Scotland, NHS National Services Scotland and individual NHS boards. Collaboration would be key to ensuring that, within a matter of weeks, people would be able to receive test result notifications via digital channels.Secure Integrations – With pace being a priority, the National Notification and Digital Tracing Service would need to leverage existing technologies, services and capabilities to securely provide COVID-19 test result notifications to people who had been tested. It was agreed to focus on using the NHS National Services Scotland Integration Hub, the GOV.UK Notify service and the National Contact Tracing Management System.Channel Shift – From the outset, the National Notification and Digital Tracing Service would need to be architected for scale and flexibility so that it could respond to evolving public health requirements and meet the diverse needs of the public and the range of health boards.
The National Notification and Digital Tracing Service was developed at pace and was well received by tracing and clinical staff in 12 NHS Boards. Results were routed to dashboards developed for each NHS Board, allowing test result delivery teams to search and filter over test results.Feeds were set up by individual NHS Boards to allow them to control which people received notifications, excluding inpatients and those in care homes for example.Rules were established to automate results delivery to help speed up contact tracing effort with a manual option to address any exceptions.More than 2 million test results from UK Lighthouse Labs and Scottish Labs have been ingested by the service, resulting in more than 2 million page views of the citizen-facing web application.Responding to demand, the service was updated to give people the ability to share details of contacts they had come in to contact with, to help accelerate vitally important contact tracing work to slow and break transmission of the virus. For people who were notified of a positive test result, 45% went on to use the digital service to provide details of those they had been in contact with and of those, 75% self-reported their contacts and settings within 60 minutes of receiving their positive test result notification.
The National Notification and Digital Tracing Service leveraged the Lenus Health Platform that supports secure health data exchange and was developed using Microsoft Azure PaaS to allow for rapid delivery, agile infrastructure deployment and to support scale-out during peak demand for resources.Secure integrations with the NSS Integration Hub, GOV.UK Notify service and the National Contact Tracing Management System were vital.With these technologies and integrations in place, the National Notification and Digital Tracing Service acted as a vital bridge between NHS systems, data and an individual, providing information in a timely and secure way. This allowed each person to act rapidly on the result of a test in support of government and clinical guidelines to help control the spread of the virus during the pandemic.
Using cloud based PaaS services in addition to serverless technology in the form of Azure functions, the National Notification and Digital Tracing Service fully automated the process of receiving, processing and automatically sending out test result notifications that met agreed rules, helping to speed up results delivery to people and reduce the workload placed on contact tracing and clinical staff.
Secure Digital Service
From a user perspective the service sought to go beyond simply delivering the test result within a text message due to security concerns. Instead, the test result could be viewed securely by people within the National Notification and Digital Tracing Service from which guidance and support could be offered directly at the point the notification was received.
People received an SMS message with a unique token allowing them to authenticate with the National Notification and Digital Tracing Service where they could then view their most recent test result. A viewed notification would then be communicated back to each of the dashboards in the 12 NHS Boards, and from there, update the National Contact Tracing Management System, providing the trigger for contact tracing to begin.
Support for Hospitals and Care Homes
Individual NHS Boards could choose to deactivate test result notifications for certain types of people, or patients, such as those already being treated in hospital or being cared for in care homes.
The citizen facing web application was extended to allow people with a positive result to provide details of other people they believed they had been in contact with and the places they had visited. These contacts and places visited were then sent to the National Contact Tracing Management System, with the information made available to both national and local tracing teams.