Integrating contact tracing into Norway’s complex health information ecosystem: A case study of flexibility and redundancy in the information system response to COVID-19

Abstract

The importance of a robust, yet responsive health information ecosystem has proven crucial with the COVID-19 pandemic. As contact tracing became a resource intensive task posing major challenges for the Norwegian public health system, the information flow between systems gained more importance, to reduce time-consuming processes and ensure data for well-informed decision making. In lack of an integrated system the contact tracing teams in the municipalities were prone to strain and overtime; focused on tracing outbreaks to get index cases in isolation and close contacts in quarantine, as well as having an important role as data collector with the increased pressure for timely and high quality data for national disease surveillance. However, introducing systematic changes to improve interoperability during a state of emergency can be risky with respect to personnel resources, timeliness of data and ultimately patient safety. Thus, tackling the integration challenges and increasing data quality, without decreasing data timeliness critical to quick outbreak response has been key, demanding flexibility from the health information ecosystem. In the context of information system integration and standardization related to the data flow of test results the following research question has been explored: What is the role of flexibility and redundancy when integrating digital contact tracing in a complex national health information ecosystem? A holistic approach aligned with interpretive qualitative methodology has been used, considering stakeholders in the operational and the strategic level of the health sector. The practical contribution is the identification of key pressure points and dependencies which may halt the ability to adapt in a complex health information ecosystem. The theoretical analysis argues that flexible standardization is useful but may fall short in a complex ecosystem where quick adaptation is needed. A bottleneck concerning the observed complex integration processes has been the lack of standardization. However, the dependencies behind what is making the standardization process hard should perhaps attain more focus. Redundancy has a supportive role in complex transitions like these.