Pisarasi is aimed at freeing up those critical hours, minutes and seconds from the individual contact tracing interviews and tasks that health personnel need to complete, when they’d rather be caring for patients.
Contact tracing is crucial both during virus transmission periods as well as in the transition phase past the ‘peak’ of case numbers, when isolation mitigation is being relaxed and the ‘curve is being flattened’. Together with other mitigation strategies, it is society’s main line of defence in the battle of the coronavirus.
Our solution adds to the traditional face-to-face or phone interview approach: Pisarasi offers patients agency and greater control of their data during a worrying time when EU citizens’ concerns about democracy and data protection equal their desire for a return to normal life and economic activity, the need for healthy social interaction, learning and relationships.
Problems Pisarasi solves
Stretching health care to the limit
During the COVID-19 pandemic, especially at the peaks of the curve, health care workers and hospital infrastructures are under extreme stress in terms of resources: working hours for health care workers during the crisis are unspeakably overwhelming in most health care institutions. This results in either stretching individuals beyond their limits in the face of necessity and adversity and exposing front line workers to considerable risks [^1] or making compromises and having to prioritize care.
Taking hours to trace the contacts
An essential part of the global strategies in crisis mitigation is contact tracing and this is a time consuming manual process conducted by health care workers or trained professionals. ECDC estimates 9 hours of work for interviewing, creating a contact list and entering this into the system.[^2] It involves tracking complicated patterns of connections between people who have been in contact with other infected people. The complexity of the interconnected infection patterns increases exponentially. It is a long, arduous but necessary process of questioning patients, monitoring their movements and symptoms, and those of their close friends and family in the first instance.
Contact tracing has been conducted in some countries effectively as part of a hybrid strategy involving digital tools to help with the process, but the task has been overwhelming healthcare staff for most countries.
Digital solutions can be a barrier
Other solutions have focused on proximity tracing, mainly with use of Bluetooth, have been blasted by civil rights advocates and technologists alike in the press because of concerns voiced over a possible mishandling of locational data by governments storing the information into the future. Democracy itself is seen to be at risk. The Pisarasi solution is designed to address these valid concerns.
Singapore has been looked as a model for mobile app use in contact tracing, but it may not be working for them. Mobile applications need to be adopted by a wide userbase and that is simply not available for everyone. And the proximity tracing does not really solve the wider needs of effective contact tracing.[^3]
Pisarasi solution avoids a mass data grab without agency, and offers more.
Now that the public are aware of what a global pandemic entails, patients and citizens can choose
- to trace their own contacts, even before infection, for their own peace of mind in the privacy of their own home
- whether to share their information with healthcare staff once they are diagnosed for research or critical government response purposes
- to receive structured, reassuring support and monitoring remotely.
At a time when people are meant to be kept apart, it is important for support and authoritative guidance to be close at hand through the use of technology.
[^1]: Up to 10% of reported cases in China  and up to 9% of cases in Italy were among healthcare workers. ECDC Contact tracing guidelines, updated April 8, 2020
Pisarasi as a solution; how it is done
Pisarasi is a multilingual website-based platform which can be used anywhere in the world by health care workers, contact tracers and the suspected or confirmed patient.
Pisarasi has been in development for a month, and we have a working project team and structures for contribution. Our source code is MIT licensed and publically available for review. We are working hard on getting our Peer Review Board structure established, to create a transparent and secure development cycle with publically available security audits and regularly done penetration testing.
To get the biggest impact out of Pisarasi, localised versions of the application are made possible. Our application translations are open source too. Together with national institutions, we can always offer up to date information for follow up to contacts who might have gotten infected. We want to direct our users to verified health care information, with projects like CovApp or government services like the Finnish OmaOlo-service, which guide the user to the current information and instructions based on where they are.
Healthcare and Pisarasi
In the case of a COVID-19 suspicion, the potential patient is directed to start the contact tracing procedure by the contacted healthcare worker, by signing up on the Pisarasi website. The service then takes the user through an easy to use and simple form-based process where they fill in essential user data, information about their close contact circles and then proceed onto a day-by-day questionnaire about the users movements and human interactions or contacts from the possible 14 day transmission period. The day-by-day based ”diary" features memory enhancing and stimulating visual aspects such as weather reports and daily news headlines to help with remembering the events of the day.
There’s also the option of importing your Google Timeline data through the platform to automatically form the base of the diary, which the user can then modify and refine by adding specific known contacts or the amount of people sharing the space to each of the location events. By the end of the process, the possible patient will have a thorough list of possible transmission contacts ready to be processed by the professional doing the contact tracing.
Currently we rely on the user themselves delivering this information to healthcare, but in the future we want to make it possible for the user to directly send their diary and contact information to existing healthcare systems.
Giving agency to the user
We believe that everyone should have access to the data about them, especially when it can save lives. If your grocery store chain can track your store visits and times, why shouldn't you be able to use this data when it is necessary to save lives?
Pisarasi can support more than just memory and Google's location history. We give companies and public services an easy way to contribute by creating an API where their customers can identify themselves and bring their visits into their Pisarasi diaries. This will help with the contact tracing even further; companies and service providers can easily be alerted, preventive measures like cleaning can be initiated faster and assessment of exposure risk for others present can be done faster.
This becomes even more important as society and life returns to normal and people need to use public transportation, libraries, museums and gyms.
It's your data, you should choose how much you want to share
Using either personal abbreviations and nicknames, or listing places by address and contacts by name. Both are still time-saving and will help contact tracing. We will lose out on some of the possible wide scale impact, but allowing people to decide themselves and making it possible to maintain their privacy is the only right way to do this.
Healthcare still has the right to know, we just enable people to prepare for it, the way they choose.
What we did during the weekend
Customer journey and User Experience
We have identified our main user personas and their needs and how we could help them through this process. Our guided questionnare for filling out the diary was created based on the needs we identified and responds for the wider user-base; not everyone is familiar with digital tools. We have demoed how such a questionnare would work on Typeform. We will continue this work and flesh out our user personas and the flow of the questionnaire.
Security Assessment and Implementation Plan
While Pisarasi as a solution lets individual choose themselves how much information they want to include in their diary, we also make it possible for them to share more spesific data to further speed up the contact tracing process. It is extremely important to handle this data with care and in a secure manner.
Pisarasi already has existing framework for GDPR compliance and infrastructure with peer review and Open source codebase publically available, Now we also have a detailed plan for which standards and auditing tools to use and how we can scale this.
Research on ECDC contact tracing guidelines and current knowledge
From the original creation of Pisarasi solution, guidelines have been updated. We have now assessed our previous work against the updated information and noted where we need to modify our approach.
Information related to persons health and their symptoms is extremely important in contact tracing to narrow the timeframe, but currently Pisarasi can not offer this functionality in a GDPR compliant way, we must work together with healthcare who already have the legal basis for handling this sensitive data. This would be the best solution and does not need additional legislation changes.
WHO has Go.Data for the epidemiologist transmission chains mapping and we are looking into how we could make data sourced from Pisarasi something that can be easily included in Go.Data.
The solution’s impact on the crisis
Contact tracing is already an established and proved process, it has been done since the plague. It is an essential part of the way out and returning back to our lives. Sooner we can do that, the better. Isolation is affecting individuals on mental, social and economical aspects and the wider economic impact of this crisis remains to be seen.
Pisarasi can save healthcare resources, give agency to people and create a sustainable strategy for this epidemic and future ones.