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4 New Technologies and Data Systems
Pages 107-148

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From page 107...
... . These include innovations for digital contact tracing, symptom reporting and monitoring, digital health certificates, digital data collection, data dashboards, and novel surveillance capabilities that have been developed and implemented at various scales and in different locations around the world since the outset of the COVID-19 pandemic.
From page 108...
... In addition to ethical considerations, the adoption of disease surveillance and monitoring technologies faces logistical challenges. Although incorporating digital technologies may allow the DGMQ to improve its capability to collect health data from travelers, trace transmission, and alert travelers of exposures, adoption depends on the public's trust and confidence in these interventions.
From page 109...
... Coupled with advances in machine learning, AI, and other advanced analytical techniques for operationalizing the data, these new digital technologies and novel data streams provide public health authorities with a more powerful set of tools for surveillance and response than ever before. They also offer a range of opportunities for the DGMQ to leverage these innovative approaches to mitigate scale limitations of the current processes for implementing health screening and data collection at U.S.
From page 110...
... . Digital contact tracing and proximity tracking technologies1 can mitigate certain barriers to manual contact tracing by leveraging the ubiquity of data collected from smartphones to support efforts to control the spread of infectious diseases.
From page 111...
... a health care provider or test provider can report confirmed cases to the service operating the application, or (3) public health agencies or other authorities can input lists of individuals with confirmed infection (Ada Lovelace Institute, 2020)
From page 112...
... . Beyond case and contact identification, proximity and location awareness technologies on personal smartphones, as well as cameras, can also be used for monitoring individuals during isolation or following up with individuals who have traveled to settings with high risk of infectious disease transmission (Mbunge, 2020)
From page 113...
... . Examples of Digital Contact Tracing and Tracking Technologies during the COVID-19 Pandemic During the COVID-19 pandemic, multiple countries worldwide introduced digital contact tracing and proximity tracking using mobile devices to support efforts to curb the transmission of SARS-CoV-2.
From page 114...
... . However, subsequent reviews have suggested that if certain barriers related to ensuring data privacy, increasing effectiveness, encouraging population uptake, and addressing technical limitations are surmounted -- discussed later in this chapter -- the implementation of digital contact tracing and tracking efforts can be an effective component within a suite of public health infection control measures (Elmokashfi et al., 2021; Grekousis and Liu, 2021)
From page 115...
... Wearable digital technologies are associated with relatively fewer privacy risks than digital contact tracing and tracking, the data collected still need to be appropriately and robustly protected, particularly if they are collected in a centralized system (Ada Lovelace Institute, 2020)
From page 116...
... Other technical limitations include digital technologies' imprecision in consistently and accurately detecting distance,2 the ambiguity in defining what constitutes a "contact" at risk of transmitting or acquiring for a given infectious pathogen, inability to detect and trace contacts of asymptomatic patients, the potential for smartphone location or proximity technology to be deactivated or inaccurate, the need for skilled expertise to implement and maintain the system, the need to integrate complex security algorithms to ensure data protection and guard against fraud and abuse, and lack of supporting information and communication technology infrastructure and electronic health policy (Ada Lovelace Institute, 2020; Mbunge, 2020)
From page 117...
... the technology is effective in reducing the transmission of infectious disease and (2) the use of the technology does not compromise privacy, autonomy, or any other human rights and liberties (Ada Lovelace Institute, 2020; Nuffield Council on Bioethics, 2020; The Lancet Digital Health, 2020; WHO, 2020)
From page 118...
... Novel Digital Data Streams To support detection, monitoring, and public health decision making during an outbreak, these novel streams of data can be used to improve situational awareness at the early stage of a disease outbreak and to evaluate the risk of introduction of new pathogens through data dashboards, models, simulations, and other novel surveillance approaches to bolster rapid epidemic intelligence. In addition to those described in the previous section, other novel digital data streams that are increasingly being leveraged for public health surveillance of infectious diseases include online news websites, news aggregation services, internet search queries, video surveillance, participatory web platforms for self-reporting symptoms, and other streams of open-source and crowdsourced data (Aiello et al., 2020; Mello and Wang, 2020)
From page 119...
... Early warning systems and other core capacities for surveillance can be strengthened by leveraging -- in an effective and ethical way -- the wealth of information that can be gleaned from novel data streams to augment traditional surveillance strategies. Early warning systems can be bolstered by rapid epidemic intelligence, which mines open-source data in tandem with traditional surveillance methods to detect early epidemic signals.
From page 120...
... . Other key examples of dashboards that leverage novel data streams to support rapid epidemic intelligence and the dissemination of information include: 4 More information about the Global Public Health Intelligence Network is available from https://gphin.canada.ca/cepr/aboutgphin-rmispenbref.jsp?
From page 121...
... 8 • The International Society for Infectious Diseases' Program for Monitoring Emerging Diseases (ProMED) 9 Crowdsourcing Surveillance Innovations implemented during the COVID-19 pandemic demonstrated the value of crowdsourcing surveillance efforts in strengthening situational awareness, even before digital tracing and tracking applications or symptom reporting platforms were made available.
From page 122...
... . Another innovation in epidemiological surveillance spurred by the COVID-19 pandemic is epidemic "nowcasting" -- or "predicting the present" -- to enhance situational awareness and inform response efforts during a rapidly evolving outbreak or epidemic by synthesizing real- or near-real-time data from novel data streams (Greene et al., 2021; Wu et al., 2021)
From page 123...
... supporting the clear and transparent communication of border policies. INTEROPERABILITY OF DATA SYSTEMS To effectively control a major infectious disease event by breaking the chains of transmission, a broad range of individuals, businesses, and institutions require up-to-date public health information about the epidemiology of the outbreak.
From page 124...
... . Ideally, various digital contact tracing and tracking applications, regardless of their respective platforms, would be interoperable and easily integrated into health information systems to allow for rapid exchange of critical and timely information (Mbunge, 2020)
From page 125...
... If the API supports the data standard that the two systems can read, it can be used for the exchange of information. Data Exchange Platforms During an infectious disease crisis, the ability to share data on clinical outcomes from electronic health record (EHR)
From page 126...
... To report cases of infectious disease, health care providers can utilize a system called electronic case reporting (eCR) , which facilitates the automated, real-time exchange of case report information from EHRs to public health agencies.
From page 127...
... . Electronic Laboratory Reporting Data exchange between laboratories and public health agencies utilizes a system called electronic laboratory reporting (ELR)
From page 128...
... A Quarantine Station or headquarters staff member enters these reports into the Quarantine Activity Reporting System (QARS) and consults with medical officers and Quarantine Branch Aviation Activity staff to determine whether the case meets CDC criteria to initiate a contact investigation.
From page 129...
... Lack of interoperability between EHR systems and reliance on outdated and siloed technologies, such as email and fax, reduces the quality and efficiency of care coordination to successfully track, diagnose, and treat infectious diseases. The Office of the National Coordinator for Health Information Technology (ONC)
From page 130...
... Finally, the fundamental point-to-point interoperability is supported by standard FHIR APIs, which allows push and pull of data in certified EHR systems with the additional ability to integrate decision support with passive triggers for important patient or public health events of interest. Crowdsourcing Solutions to Interoperability Challenges Like crowdsourcing epidemiological surveillance, crowdsourcing research and development of solutions to difficult technological challenges can be an effective strategy.
From page 131...
... Foundational Ethical Principles The committee identified a set of foundational ethical principles that warrant close consideration by the DGMQ regarding the use of data collected via innovative digital technologies, novel data streams, and interoperative public health information systems for infection control measures. These principles include (1)
From page 132...
... With regard to digital contact tracing, informed consent is 18 More information about the Decentralized Privacy-Preserving Proximity Tracing reposi tory is available from https://github.com/DP-3T/documents (accessed February 22, 2022)
From page 133...
... Different social groups have varying degrees of access and capability to use digital technologies -- that is, the "digital divide." For instance, use of applications for digital contact tracing often requires a smartphone, internet access, and technological acumen, which may exclude groups that are already vulnerable from participating in and realizing the benefits of digital contact tracing efforts (WHO, 2020)
From page 134...
... During an infectious disease emergency, the pressure to roll out digital technologies at high speed can undercut time needed for appropriate testing and evaluation, increasing the potential for errors in identifying individuals and communities at high risk; subsequent unnecessary public health measures, such as lockdowns, can have substantial social and economic consequences. Additionally, some sources of information in new digital datasets -- for example, internet news sources, social media posts, self-reported symptoms -- will inevitably be less reliable than traditional sources, which could contribute to the dissemination of misinformation (Mello and Wang, 2020)
From page 135...
... Similarly, a recommendation made in a review by the Ada Lovelace Institute maintains that assessments of necessity and proportionality should consider not only the effectiveness of an intervention in achieving its objective, but also whether the aim could be achieved by less intrusive measures (Ada Lovelace Institute, 2020)
From page 136...
... . Protecting Privacy Previous recommendations focus heavily on the critical need to protect the privacy and confidentiality of personal data collected via digital technologies and novel data streams (Ada Lovelace Institute, 2020; WHO, 2020)
From page 137...
... . Promoting Equity Previous studies recommended that measures should be taken to promote equity and avoid exacerbating existing inequities (Ada Lovelace Institute, 2020; Nuffield Council on Bioethics, 2020; WHO, 2020)
From page 138...
... . Ensuring Public Engagement, Transparent Accountability, and Strong Governance Previous recommendations highlight the importance of ensuring robust public engagement, transparent accountability, and strong governance in implementing digital technologies for disease control (Ada Lovelace Institute, 2020; Mello and Wang, 2020; Nuffield Council on Bioethics, 2020; WHO, 2020)
From page 139...
... . The DGMQ needs to design and implement clear, inclusive, and trustworthy public communication strategies to explain the rationale for implementing digital technologies for the common good, as well as providing justification for the collection and use of personal data (Nuffield Council on Bioethics, 2020; WHO, 2020)
From page 140...
... Investments in data system interoperability can be life saving during a pandemic, would improve day-to-day care coordination, and could generate financial benefits to the United States. Conclusion 4-4: The use of digital technologies, novel data streams, and interoperative public health information systems holds enormous potential for infectious disease control.
From page 141...
... As health information technology developers continue to increase functionality in mobile health applications and electronic health records, the DGMQ should identify gaps and op portunities in legislation and regulation to support the proper use and transfer of information across data systems.   Recommendation 4-3: The Division of Global Migration and Quaran tine (DGMQ) should ensure that all uses of digital technologies, novel data streams, and interoperative public health information systems follows a careful consideration of their ethical aspects and that all actions are in accordance with existing regulations for the protection of personal data.
From page 142...
... 2020. Digital contact tracing technologies in epidemics: A rapid review.
From page 143...
... 2020. Quantifying SARS-CoV-2 transmission suggests epi demic control with digital contact tracing.
From page 144...
... 2021. Digital contact tracing, community uptake, and proximity awareness technology to fight COVID-19: A systematic review.
From page 145...
... 2021. Ethical framework for assessing manual and digital contact tracing for COVID-19.
From page 146...
... 2021. A population-based controlled experiment assessing the epidemiological impact of digital contact tracing.
From page 147...
... 2020. Early evidence of effec tiveness of digital contact tracing for SARS-CoV-2 in Switzerland.
From page 148...
... 148 IMPROVING THE CDC QUARANTINE STATION NETWORK'S RESPONSE Wymant, C., L Ferretti, D


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