The top 7 questions HR should ask when choosing a COVID-19 app

Kyle Tretina, Ph.D.

Kyle Tretina, Ph.D., Genomics Application Scientist

Tracking a pandemic of apps

With the ongoing tide of COVID-19-related apps, it can be an overwhelming task to find the right tools to help your employees get back to work. The information that your employees put into these apps can be very personal and sensitive, and finding the right balance between respect for employees’ privacy and effectiveness at preventing disease spread in your organization is complicated. Fortunately, we’ve compiled a list of symptom tracking apps and interviewed medical health experts to find the app features that actually matter when designing your back to work protocol.

Is the app “HIPAA compliant”?

HIPAA (the Health Insurance Portability and Accountability Act) is a legal document that covers a lot of topics related to health insurance, but has one main goal of protecting personal health information (PHI), such as COVID-19 test results and employee symptom tracking records. It connects a variety of governmental and other organizations to enforce the requirements for a secure system to handle PHI, such as medical symptoms and COVID-19 test information. A key part of your health privacy rights[1] under HIPAA is to be able to access your PHI, check it, and know everyone who has had access to it. While certain information is required to be collected and sent to the Department of Health and Human Services[2], depending on the app, your employee PHI could be passed to a variety of physicians, pharmacies, laboratories, hospitals, insurance companies, programmers and others. In order to protect your employee PHI, make sure that it is under their control within the app and not shared with anyone other than the designated medical professionals by asking if the app is HIPAA compliant.

Which symptoms does the app track?

A ‘core’ set of symptoms are being used by medical doctors as most important for diagnosis, as listed by the Center for Disease Control (CDC) as COVID-19 symptoms[3]. However, not all symptom checking apps check the same set of symptoms (Figure 1). The reasons underlying these disagreements vary, but part of the answer is that these symptoms can appear in many combinations[4] typically within 2–14 days after exposure, and there are many unlisted symptoms that are generally more rare. Generally, fatigue, cough and fevers tend to be the most common symptoms, with loss of taste or smell as the most informative[5], so you should at least check to see if your app is checking for those symptoms and making sure that it is only checking for symptoms that are relevant to COVID-19 infection.


Figure 1. An example comparison of symptom tracking app features.


Does the app do contact tracing?

COVID-19 symptom tracking apps being offered in some countries[6] will actually use location data from your phone to discover people who have been in contact with COVID-19+ patients, a process called contact tracing. Maybe employers and employees in the USA have privacy concerns[7] about these kinds of apps, particularly when these apps are made by large companies such as Google and Facebook[8]. There is mathematical[9] and observational data from China[10], South Korea[11] and other countries suggesting that contact tracing can effectively fight the pandemic, however. Since the SARS-CoV-2 virus can stay on surfaces for hours to days[12], an understanding of where employees are at various times is important for any contact tracing effort. From the employer’s perspective, there are two ways that apps have tried to maintain employee privacy while still giving employers the ability to contact trace. First, informal contact tracing can be implemented by giving employees a daily survey as part of the symptom tracking app (“Survey”) by asking them if they have been in contact with a COVID-19+ person, which can be effective if used in the context of a comprehensive testing program. Second, the app can use a location-based system where employees have to check in to each designated work location using a unique code in the app (e.g. a QR code). This allows the employer to have a temporal map of the employee distribution in the workplace, while not tracking employee movement throughout the entire day.

Does the app help coordinate a testing program?

Some apps integrate with COVID-19 viral and/or antibody testing programs and are custom-fit to only interoperate with the testing program offered by the same company, while others can integrate with your own custom testing program or a program run by another company. If you already have a contract with a testing company and just want an app to help coordinate test protocols and symptom tracking in one place, this could be important for you.

Does the app give employers a summary of their company’s data?

While there are several apps that are useful for collecting data for scientific research, or as a tool to help employees know whether they should contact their primary care physician or get tested, what employers actually need is a way to easy visualize which employees are following the back to work protocol, who should be allowed back to work, and an anonymized summary of their company COVID-19 testing results. This is the kind of data that can not only inform employer decisions about shutting down or reopening various work sites, but also know how to redirect resources and effort to prevent an outbreak.

Does the app help enforce compliance with the back to work program?

Beyond just knowing how many of their employees are complying with the back to work program, employers need a systematic approach to regulating work site re-entry to prevent infected or potentially infected employees from returning to work. Without an app that has this feature, keeping track of employee symptoms and requiring employees with symptoms or who have tested positive for COVID-19 to stay home could require a lot of effort for administrators or managers on a daily basis. An elegant answer to this is to assign each employee a unique QR code in the app, which can be scanned at the worksite and provides a red (do not go to work) or green (go to work) flag for that employee. This can both let employees and employers know who should have worksite access.


Table 1. A comparison of features offered by various symptom trackers on the market.

How accessible is the app on PC, iPhone and Androids?

Depending on the company, there could be a wide range of technology literacy and access to smartphones, laptops, PCs, tablets and other devices for viewing the app. That is why the best apps are available both as a web app and a downloadable that is compatible with any browser or operating system. Web design that considers both PC and mobile viewing is an art form that should not be considered an afterthought, so you should test the app for every use case in your company to make sure that it would work well on every possible device that is relevant to your situation.

An app can’t replace expertise

Whether you pick a COVID-19 symptom tracking app described in Table 1 or another more recent app that comes out, it’s important to consider where that app is coming from. You need to be able to trust the app providers to give you correct and relevant information at the right time and to take care of your health information securely. Does this company have a clinical network or a thought leader in clinical work to help design their workflows? Do they have access to a sufficient number of tests for the size of your company? Do they have an epidemiological model to inform their testing protocol? Do they have a brain trust of clinicians and scientists on staff? Not all apps are equal and not all app providers are equal, so consider who you trust because the health of your employees may depend on it.

References

1. HHS. YOUR HEALTH INFORMATION PRIVACY RIGHTS. In: HHS.gov [Internet]. [cited 26 Jun 2020]. Available: https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/consumer_rights.pdf

2. HHS. COVID-19 Pandemic Response, Laboratory Data Reporting: CARES Act Section 18115. In: HHS.gov [Internet]. [cited 26 Jun 2020]. Available: https://www.hhs.gov/sites/default/files/covid-19-laboratory-data-reporting-guidance.pdf

3. CDC. Coronavirus Disease 2019 (COVID-19) — Symptoms. In: Centers for Disease Control and Prevention [Internet]. 25 Jun 2020 [cited 26 Jun 2020]. Available: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

4. Drew DA, Nguyen LH, Steves CJ, Menni C, Freydin M, Varsavsky T, et al. Rapid implementation of mobile technology for real-time epidemiology of COVID-19. Science. 2020;368: 1362–1367.

5. Menni C, Valdes AM, Freidin MB, Sudre CH, Nguyen LH, Drew DA, et al. Real-time tracking of self-reported symptoms to predict potential COVID-19. Nat Med. 2020. doi:10.1038/s41591–020–0916–2

6. O’Neill PH. A flood of coronavirus apps are tracking us. Now it’s time to keep track of them. In: MIT Technology Review [Internet]. MIT Technology Review; 7 May 2020 [cited 26 Jun 2020]. Available: https://www.technologyreview.com/2020/05/07/1000961/launching-mittr-covid-tracing-tracker/

7. Bond S. Your Boss May Soon Track You At Work For Coronavirus Safety. In: NPR.org [Internet]. NPR; 8 May 2020 [cited 26 Jun 2020]. Available: https://www.npr.org/2020/05/08/852896051/your-boss-may-soon-track-you-at-work-for-coronavirus-safety

8. Romm T, Dwoskin E, Timberg C. U.S. government, tech industry discussing ways to use smartphone location data to combat coronavirus. In: Washington Post [Internet]. The Washington Post; 17 Mar 2020 [cited 26 Jun 2020]. Available: https://www.washingtonpost.com/technology/2020/03/17/white-house-location-data-coronavirus/

9. Ferretti L, Wymant C, Kendall M, Zhao L, Nurtay A, Abeler-Dorner L, et al. Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. doi:10.1101/2020.03.08.20032946

10. Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. The Lancet Infectious Diseases. 2020. doi:10.1016/s1473–3099(20)30287–5

11. Park SY, Kim Y-M, Yi S, Lee S, Na B-J, Kim CB, et al. Early Release — Coronavirus Disease Outbreak in Call Center, South Korea — Volume 26, Number 8 — August 2020 — Emerging Infectious Diseases journal — CDC. [cited 26 Jun 2020]. doi:10.3201/eid2608.201274

12. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382: 1564–1567.



Kyle Tretina, Ph.D.

Kyle Tretina, Ph.D.

Kyle has extensive research expertise and interest in the area of genomics, microbiology and immunology. He received his Ph.D. from the University of Maryland, Baltimore working at the Institute for Genome Sciences and came to Meenta from a postdoc at Yale University.