Scenario: Analog/Digital-Divide

Debora Weber-Wulff & Stefan Ullrich

Matthias and Melanie have known each other since college. While Matthias was studying medicine, Melanie was studying computer science. They met while working on university committees and soon moved in together. After graduation, Matthias took a job in public health for altruistic reasons. Melanie has an excellent job as a software engineer, so money is not a problem for them.

Since the start of the Corona virus, Melanie has been working from home, but Matthias has increasingly been called into the office to work. With all the attendant paperwork, the sheer volume of cases is growing exponentially. Matthias does his best, but many things just don’t get done. He’s totally frustrated by the slow pace of everything. You’d think people would figure out pretty quickly whether or not they were infected. He’s even been known to help out the medical and technical assistants and spends several hours at a time clad in protective gear collecting samples. He and the whole team must be meticulous in filling out the forms to be legible. And it must be done by hand in blue ink—only the QR code on the sticker they affix to the top is digitized. The samples are sent to various laboratories, but it takes days, sometimes weeks, before results are processed and the chain of infection can be traced.

One evening, while sitting on the balcony sharing a glass of wine, Matthias complains about how slow everything is going. Melanie needs help understanding the problem: why does everything take so long? The testing only takes a few hours to complete, and labs are now working three shifts daily.

“What’s the problem?” she asks.

“Unfortunately, I can’t tell you exactly what steps are involved because everything we do at the office is strictly confidential.” His department head has repeatedly told him: “What happens at the office stays at the office.”

“Don’t be silly,” says Melanie. “I don’t care who’s been tested or what the results are. I’m just trying to get behind what’s up with your office and why it takes so long to get results. Process optimization is my specialty. Maybe I can help.” Matthias pours himself another glass of wine and starts talking. “Don’t laugh,” he says, “and please don’t tweet this out. Each lab has its own paperwork to complete for orders and results. We rotate labs regularly to distribute the workload more evenly. And since we don’t have the equipment to do anything digitally on-site, we manually fill out all the forms—hand-written in blue ink; that way, the administration can more easily distinguish between the original and black-and-white copies. Samples and forms are placed in a post box, and when it’s full, a courier comes to pick up the samples and forms and deliver them to the lab.”

“Well, that’s a good stopgap solution. Of course, digitizing everything from the get-go would be better, but okay. That takes time. What does the lab do with the results?” asks Melanie.

“They type the data from the requisition form into their system for tracking test results and billing, then enter the results and fax them back to us here at the health department.”

“They FAX them!?” Melanie snorts. “Ooooo-kay, then. It sounds like we’re getting closer to the bottom of it!” she chuckles.

“It’s not as dumb as it sounds. We deal with confidential personal data that shouldn’t be sent online.”

“True, but you can overdo it. I can see how no one in your office would be able to handle setting up an encryption infrastructure, especially not one designed for external communications. But still, it’s all good—you should still be able to get the results the next day … by fax.”

“No, it’s not that simple. The computer we use to receive faxes saves them with the filename ‘Telefax.pdf.’ At least they’re numbered sequentially, but we still have several thousand files with the same name—a thousand each day! So, someone has to sit there renaming the files so we can file them in the proper folders. They have to open each file, check its reference number, see whether it’s positive or negative, and then save the files in different directories, depending on the result. You can imagine that sometimes mistakes are made with the manual renaming of the files or in sorting, and then we have to contact the lab to fix it. Only now that we’re processing so many tests daily have we realized how much of a time-suck manual data processing is. Here,” he pauses for a moment, “everything’s falling apart.”

Melanie can scarcely believe her ears. “You can’t be serious! What kind of computer are you using, and with what software?”

“I don’t know exactly, but we can’t connect it to the internet because its operating system is so old. But it’s good enough for receiving faxes—just not when we’re not in the middle of a pandemic!” Matthias replies.

Melanie shakes her head. “Why don’t you just go to MegaMarkt and pick up a fax machine? The new ones can send files straight to your PCs, even if you work from home. And pick up some OCR software while you’re at it. That way, you can read the results and file them where they belong, all at the same time! Unlike humans, machines don’t make mistakes!”

“Great, but we aren’t allowed to use such equipment. Everything has to go through procurement and the IT department—it must be some data protection thing—I don’t know what it’s called. Then, there’s the bit about protecting patient health information. And everyone has to go through the necessary training. It takes at least six months—if not more—for anything like that to go through!”

Melanie gulps down another big swig of wine and says: “Tell you what. We will buy one of those machines, and I’ll set it up over the weekend. My fees are too high for you to pay, but I’d be willing to do it for free because I want these tests done faster! You have to get tested regularly, too, and I want you to know whether you’ve been infected as soon as possible. What do you say?”

Matthias is unsure whether he should accept the offer. In Melanie’s telling, it is tempting and sounds easy enough.

Questions:

1. Is it necessary to keep standard operating procedures at the health department confidential?

2. Might there be a moral reason to violate confidentiality under certain circumstances?

3. Was it okay for Matthias to tell Melanie what he did about the office procedures at the health department?

4. Is there anything wrong with the laboratory faxing the results to the health department?

5. Morally, would it make a difference if the OCR software made a mistake instead of a human mislabeling something?

6. Is Melanie being too careless with networked devices?

7. Matthias has voluntarily committed to working extra hours at the expense of family time together. How should this be assessed in moral terms?

8. In most cities, the lab only notifies the health department about positive cases. Does this change your assessment of the situation?

Published in Informatik Spektrum 43 (5), 2020, S. 352–353, doi: https://doi.org/10.1007/s00287-020-01308-w

— Translated from German by Lillian M. Banks