PROVIDENCE, R.I. (WPRI) – Rhode Island has entered into a contract with Salesforce.com to create a mobile app that connects COVID-19 patients to services and helps public health officials track down their contacts, locations and symptoms, according to a Target 12 review of the deal.
The agreement with the San Francisco-based software company – made through a reseller company called Carahsoft Technology Corp. – offers a window into how the state is trying to automate its current system of providing services, scheduling tests and tracking down people who might have contracted the disease from the infected, a response tactic known as “contact tracing.”
“What we are doing is taking a paper-based system and replacing it with one that is more efficient,” Health Department spokesperson Joseph Wendelken wrote in an email. “We have to do this because the response has grown so large.”
Rhode Island started COVID-19 contact tracing when the first positive case was announced on March 1. As of Saturday, positive cases had grown to 2,349, and the number has been trending upward at a faster clip since testing has become more widely accessible.
When someone tests positive for the disease, Health Department employees collect information about those individuals’ travel history and who they have interacted with. After collecting the personal information, health officials try to reach out to those contacts to determine whether testing or quarantine is necessary.
The Salesforce agreement marks a major shift away from the state’s in-person strategy to an app-based program administered by a third-party vendor.
The app-based program is designed to make the process more efficient, but the idea of automating contact tracing using mobile phones – a strategy already deployed in other countries – has raised privacy concerns among civil liberty advocates including Jennifer Sista Granick and Jay Stanley of the American Civil Liberties Union.
“Policymakers must have a realistic understanding of what data produced by individuals’ mobile phones can and cannot do,” Granick and Stanley wrote in a white paper called “The Limits of Location Tracking in an Epidemic.”
“As always, there is a danger that simplistic understandings of how technology works will lead to investments that do little good, or are actually counterproductive, and that invade privacy without producing commensurate benefits,” they added.
Salesforce has agreed to a six-month contract to set up and provide support for the program and app for free. The estimated value of the work is $280,486, according to the contract. And while Salesforce, the Health Department and the state’s information technology team continue ironing out the specifics, the general objective is relatively straightforward.
“The State of Rhode Island engaged Salesforce to support their COVID-19 response management activities and enable a statewide system for ubiquitous testing, contact tracing and effective quarantining,” Salesforce representatives wrote in the contract. “The goal is to reduce infections by preventing exposed people from spreading COVID-19.”
Based on the contract, the app will offer public health officials digital tools to monitor patients’ symptoms and track down contacts. The effort will be made possible through interviews, gathering contact information and collecting “related organization and location information,” according to the deal.
On the support side, the app will help people schedule tests and offer those in quarantine and isolation access to services such as food delivery and telehealth, Gov. Gina Raimondo explained during one of her daily news briefings last week.
The platform could also help public health officials forecast future spread of the illness and offer other analytical tools, which could help better inform the state’s response effort and future containment strategy. Based on current state-based modeling – which hasn’t been shared publicly – the pandemic isn’t likely to peak in Rhode Island until the end of the month at the earliest, according to Raimondo.
That means state leaders are still heavily focused on responding to the disease, but the Salesforce deal shows Raimondo is beginning to put more focus into developing a containment strategy for the future. Without a vaccination or approved treatment currently in place, government leaders across the country are grappling to find a way to both protect the health of citizens and also let them out of their houses and back to work.
“If I am going to reopen this economy it has to be more automated and scalable, so we have been working hard to build a system,” Raimondo said about contact tracing on Wednesday.
The Rhode Island economy is getting pummeled, with COVID-19 related unemployment claims topping 135,000 since early March.
Harvard University economist Nicholas Mankiw, who served as the Council of Economic Advisers chairman under President George W. Bush, suggested employment could snap back into place if the pandemic is somehow contained. But he warned that closures for months would likely mean businesses would shutter for good, translating into fewer jobs for people looking to re-enter the workforce.
“This decline might have a rapid rebound,” Mankiw said during a discussion with Brown University President Christina Paxson last week. “That’s going to depend on how quickly the pandemic goes on.”
The emerging strategies of how to open the economy without a vaccine or properly vetted treatment include ubiquitous testing and retesting – along with some level of surveillance to help with contact tracing, quarantine and isolation.
Harvard researchers suggest an effective testing strategy would require retesting the entire population roughly once every three to four days to control the disease, while another group said targeted contact tracing using technology such as Bluetooth could prove more efficient.
“There are strong arguments for using digital contact tracing in combination with other technological interventions to battle COVID-19, and reasons to believe that large-scale privacy sacrifices are not necessary to make this technology work,” the researchers wrote.
Other countries – including China, South Korea, Spain and Thailand – have all implemented some type of location tracking, both mandatory and voluntary, that appear to have worked with varying levels of success.
Whether something similar might emerge in Rhode Island in the future isn’t entirely clear, but state leaders are giving their assurances that whatever information is ultimately collected will be protected under federal health care privacy laws that would also apply to Salesforce.
“The Salesforce platform is the conduit,” Wendelken said. “There are confidentiality rules and requirements that are associated with this technology, in the same way that there are when any third party processes sensitive information or health information for the state.”
Currently, there’s no mention of Bluetooth technology in the contract with Salesforce. And “GPS upload and automation” is outside of the scope of work that the company has agreed to do for the state. But the contract makes it clear that such work could be done if requested.
Chirag Patel, chief of enterprise applications and IT agency at the state’s information technology division, is heading the development effort for Rhode Island. He told The Providence Journal last week that GPS tracking wasn’t currently part of the mission. Raimondo earlier told reporters it was too early to tell. When asked for clarification, Raimondo spokesperson Josh Block said both statements were true.
“The current planning does not involve the use of GPS tracking technology,” Block wrote in an email. “That said, it’s too soon to say if this is something we may consider exploring as this situation evolves.”