Co-designing and developing the National Notification and Digital Tracing Service to support test results delivery for people in Scotland.
The Challenge
On 11 March 2020, the World Health Organization declared the outbreak of a global pandemic and in the same week the Digital Health & Care Innovation Centre was commissioned by the Scottish Government to support Scotland’s digital response. We collaborated with Public Health Scotland, NHS National Services Scotland, NHS Greater Glasgow & Clyde, NHS Lothian, Storm ID 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 Objectives
Partnership and Collaboration - Developing the National Notification and Digital Tracing Service would require several partners to work collaboratively and at pace. Collaboration was key to ensure 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 needed 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 needed 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 NHS Boards. A key part of this was to expand on DHI’s co-design findings to date – focusing on how the people of Scotland could help to co-manage their own contact tracing digitally, improving the efficacy and sustainability of the contact tracing effort.
The Insight
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 efforts 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. Interim findings show that 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 service is currently undergoing a full evaluation by the University of Glasgow.
The Technology
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.
The Methods
DHI has been developing the DHI Exchange - a new demonstration and simulation environment to support the de-risking of new digital services while leveraging common, person-centred data-sharing infrastructure. The methods involve rapid co-design, prototyping and system integration activities to help get from an idea to an integrated proof of concept quickly.
These methods were put to the test for this Covid-19 response with the National Notification Service moving from idea through procurement, scoping, funding approvals, co-design, service mapping, prototyping, integration, full production development, full governance (clinical safety, information governance, data protection, equalities impact, security) and into production for every NHS Board in Scotland in 51 days end to end.
This has provided DHI and its partners with the confidence that we can digitally transform a national service swiftly when the environment is conducive. DHI now looks to build on this to support health and care service remobilisation into 2021 and beyond.