Increase percentage of shared positive test results

joelucid commented 2 years ago

Current Implementation

Currently only a small percentage of all positive PCR test results are registered with corona-warn-app to notify potential contacts (see https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/WarnApp/Archiv_Kennzahlen/Kennzahlen_18022021.pdf?__blob=publicationFile - currently it's 59% of all people which have been issued TANs or QR codes). Since people requesting the option of notifying via app are likely not opposed to sharing results this points to a process weakness.

Due to a risk notification in the corona warn app I went to a Centogene test lab today to get a (tax payer funded) free PCR test. I selected the "share with app" checkbox but was not handed a QR code. I asked the person performing the test how I could get a QR code - but he had no idea how that worked. Maybe I will receive one with the result. But that's too late. At that point users will have many other things to consider and often won't be ready to spend any time on communicating the results.

Note that I needed to opt in to share with app. Opt in vs opt out is often a difference of 90% vs 15% acceptance.

Suggested Enhancement

The test process needs to be optimized to maximize registered warnings in the app. Test centers should actively present QR codes to customers unless they decline. Test result communication should generally happen via the corona warn app unless people explicitly choose another mechanism. Positive test results should automatically be used to warn contacts via warn app unless the user explicitly opts out.

This is desirable for all tests - but certainly tax payer funded free ones should be run this way. If the tax payer funds the tax payer should get the benefit of notification.

Expected Benefits

With all the millions the German government spends on this app it would be desirable for its use to be optimized towards fulfilling the epidemiological goals it was contracted for. In particular the vast majority of app users should warn other users of their test results.

Internal Tracking ID: EXPOSUREAPP-11240

joelucid commented 2 years ago

Btw my daughter just got tested 2 days ago and got her positive result today. I just called her and she hasn’t yet shared her results since she couldn’t figure out how to. She would have never declined to share the result. It was just a process weakness.

larswmh commented 2 years ago

Thanks for your suggestion @joelucid. We have created an internal ticket for it and will raise this topic internally. Internal Tracking ID: EXPOSUREAPP-11240

Corona-Warn-App Open Source Team

joelucid commented 2 years ago

A couple of ideas after sleeping on this:

Introduce a "Automatically share positive test results" setting in the app and default it to on. On first start of the app tell the user that positive test results will automatically be shared unless he disables this feature in settings.
For PCR tests following an "Increased Risk" app warning the test center needs to verify that the app shows the warning anyway. Have the app generate a QR code which is scanned by the test center and then functions as QR code for the test to communicate and share test results. The user then doesn't have to deal with any QR codes and the test center doesn't have to create one. And every test done due to "Increased Risk" warning will have its result communicated to the app.
For other PCR tests also allow the test QR code to be generated in the app and scanned by the test center. This avoids the extra step of scanning for the customer and ensures quick and secure test result delivery. Communicate the benefit of test result data privacy this mechanism provides to the user. Much better than having test results float around in email.
Any positive test result gets immediately shared without any user interaction during background app refresh if the automatic sharing setting is enabled. The app notifies the user that this has happened or asks to share if the setting is disabled. Not only does this increase how many results get shared - it also critically reduces the time between test result and its sharing. Which is critical to reduce spread.

Importantly the whole complexity of dealing with test QR codes would become responsibility of the test center. This makes a lot of sense since test centers perform hundreds of tests every week. Users (hopefully) only share a positive test result once. Let's make it as simple as possible for them to do so!

dsarkar commented 2 years ago

Hi @joelucid,

Thanks for the report.

If your test center is integrated into the CWA infrastructure, it should have provided you a QR code to be scanned with the CWA. If this is not the case, and they claim to be included in the CWA infrastructure, we would need the name and adress of the test centre, please.
Once a test was registered and you have received a positive result via the app, the app will offer you automatically to share anonymously the result on a voluntary basis and warn in this way others. This will not happen automatically because is is based on a voluntary basis.
Should you happen that you did not receive the positive PCR test result via the app, either because it was never registered via the app, or due to another problem, you still can warn others using the TAN procedure, see https://www.coronawarn.app/en/faq/#qr_test

Best wishes, DS

Corona-Warn-App Open Source Team

joelucid commented 2 years ago

@dsarkar when I ordered the test on Centogene's website I was presented with a check box to request notification to CWA. I checked that box. But I wasn't presented with a QR code when the test was performed.

This happened Sunday afternoon, 9.1.2021 in Testzentrum Wedding, Müllerstraße 143, 13353 Berlin. https://www.berlin.de/sen/gpg/service/oft-gesucht/artikel.1135347.php lists it as "Landeseigene Teststelle" - so I would be very surprised if they are not integrated into the CWA infrastructure.

I assume that no QR code was generated for me or that the QR code will get sent in the test result email. My wife and daughter also did not receive a QR code there.

Note that even test results with QR codes are only shared in 58% of all cases. So the changes I suggested above to the process seem like important improvements over voluntary sharing after notification.

Ein-Tim commented 2 years ago

@dsarkar

AFAIK CWA automatically warns when a test is registered and it comes back positive, but if the user has declined to this (either in the OS pop up or by turning a switch off in the CWA).

dsarkar commented 2 years ago

@joelucid, thanks for the feedback.

dsarkar commented 2 years ago

@Ein-Tim I will check that ...

Ein-Tim commented 2 years ago

@dsarkar

Thanks! See e.g. https://github.com/corona-warn-app/cwa-app-ios/issues/2840.

dsarkar commented 2 years ago

@joelucid So you received the result via mail, and there was no QR code included in the email, alltough you check the box, that you request to get the result via CWA, correct?

joelucid commented 2 years ago

Quick update:

I just received an email notifying me that results were ready. Had to log into a test portal to retrieve the results. The test result document does include the QR code for registering the test in CWA.

In my mind the problem with this process is evident: when a patient receives a positive test result he will be in a state of agitation - thinking of everything he now needs to do and how it all works (reporting to Gesundheitsamt, quarantäne, notifying contacts etc). It's very likely that he won't scroll down in the test result doc to find the QR codes and register the test in CWA.

joelucid commented 2 years ago

We want the test to get registered into the app when the test is performed.

dsarkar commented 2 years ago

@joelucid I understand that there might be issues with process and room for improvements. Besides this, I still didn't understand if you received eventually the CWA QR code (at the end of the email)?

Many thanks for your feedback.

joelucid commented 2 years ago

@dsarkar I did receive the QR code in the test results pdf which I downloaded.

joelucid commented 2 years ago

Just found this: https://apo-schnelltest.de/images/pdf/210420_CWA%20Schnelltest_3rd_Party_Info_kurz_1.1.pdf.

It's for Rapid Tests but I'll assume the guidelines are similar for PCR tests. So apparently receiving the QR code with the result is one of the recommended options. I'm surprised that this process is not optimized better to maximize registered tests and result sharing. I've always wondered why CWA test result sharing was such a low percentage of all positive test results - now I understand. Hope you will consider some of the suggestions I have made above.

MikeMcC399 commented 1 year ago

@joelucid

The problem which you describe should be solved by the new CWA 3.0 version released yesterday, Jan 18, 2023:

Version 3.0: CWA warnings now possible after positive self-test

"Previously, an official positive rapid or PCR test in the CWA was required in order to initiate a warning via the Corona-Warn-App. With version 3.0, the Corona-Warn-App (CWA) has a new feature: Warnings are now also possible after a positive self-test. Users with a positive test result can initiate a warning through the CWA by themselves. This applies both to positive results of PCR tests and rapid antigen tests officially issued in testing centers that have not been transmitted to the CWA, and to positive results of point-of-care PCR tests (rapid PCR tests) and self-tests."

This doesn't follow your suggestion, but the end result is what you wanted, in that it is now much easier for people to warn others when they have a positive test result. This is independent of any QR code or TAN.

joelucid commented 1 year ago

This is a good feature. But it doesn't address the core problem with the "Befundkommunikation" method: burdening the user/patient with extra effort at the worst possible time and in the form of an "opt-in" instead of "opt-out". If test results were primarily communicated via CWA and if future automatic sharing of positive test result were agreed to at the time of taking the test - when linking the test into CWA and as "opt-out" choice I can guarantee you'd have at least 5x the sharing rate of results.

It looks like this pandemic is on its way out. Maybe this can be done for the next pandemic? Seriously I hope there will be a post mortem on missed opportunities with CWA during Covid. In that case the process design around sharing test results deserves detailed discussion as that is one of the biggest missed opportunities.

How do we categorize this issue for such a discussion?

corona-warn-app / cwa-wishlist