Vaccine Record on Phone..more

Would keeping a vaccine record on my phone be a healthy thing to do?

Airline passengers need to produce test results showing they have been tested for Covid. Are vaccination results next?
Covid records needed for travel. photo credit: International Airport Review

Dear Ms. Smartphone: If paper records can be forged, how about those on smartphones? I enjoyed last week’s column about digital record keeping. But then you mentioned that some passengers (mostly outside the U.S.) were using negative results from faked Covid tests to get travel access. I hope to start flying soon and want my plane to be Covid free. Are the same people going to fake getting the vaccine, and if so, would it be safer if the virtual record is kept on our phones?  Erin, Sausalito

Dear Erin: I didn’t mean to alarm people with the item about travel and counterfeit Covid records. I am not in public health but imagine that there is always some level of forged activity and behavior. But to your question: would it be safer to keep vaccination records on our smartphones? 

There is a precedent for paperless, digital certificates.  When you take an airline trip, you might be one of the millions who upload your boarding pass to a digital wallet. Behind the scenes as you board, the bar code in your wallet is ‘read’, transmitted to a central data base, and matched to the airline’s reservations file. You are fairly secure since the bar code has to match the record in the airline’s data base.  Yes, there are fraudsters who could facilely fake bar codes for phones  but they have to be highly sophisticated to hack into the airline’s data base. 

Digital Record Keepers

Since Covid began, companies like IBM, with its Digital Health Pass  have vied to develop platforms so that people can upload their health records and fly with confidence.  And, a Swiss non-profit called the Commons Project and the World Economic Forum, have partnered with many major airlines including United and JetBlue. 

I imagine there are similar protocols for vaccination records.  When you finish the (two) shots, then a  digital certificate, like a barcode, will be issued to your smartphone.

This week, LA County is piloting a smartphone record as they roll out the vaccine. But, it is administratively more complex than airline reservations as there is no central source for certification. Lot of different health organizations will administer the vaccine, from large retail pharmacies, pop-up vaccination centers in supermarkets to wellness centers. These sites have to upload vaccination records to a “platform.”

And then, assuming each one has that capacity, who will maintain the platform and the database to insure its integrity and accuracy? For example, might it be the platform provider, like IBM or Common Trust, or might it be the U.S. government’s Center for Disease Control? 

‘Opening Up’ Means UpLoading?

For this data base to be useful for reopening the economy, connectivity with the platform is essential. Say you need to show that you got the Covid vaccine to gain entrance to a big conference, rent a car, or get ticketed for a sports event. Your credentials would be checked by two-way communications between the bar-code on your phone and a centralized data-base. Note that if the data check was asynchronous, not done in real time, then it would be easier to create bogus entrance passes. 


In researching this topic, I learned that a business teamed up with US Customs and Border Protection (TSA is part of them) to create a mobile passport in 2014  without government funding. The digital passport on the phone cuts out the need to wait in line at customs. Pre Covid they had 30 airport locations and 7 million users. But, this type of  business model may now be subject to greater scrutiny. Customers and Border Protection had a large data breach in 2019 when facial imaging data was transmitted by a (private) subcontractor’s database.

Solutions?

We are in the early days of understanding what can and should be kept on phones when it comes to digital certification. There will not be an overnight solution because there will be further digital divides, perhaps digital chasms, between those with tech and those who lack smartphones and a data plan. While many of us continue to put money in our digital wallets and do banking online, health and travel records are tricky. 

On a personal note, my friends and family who have been fortunate enough to get Covid shots have all received, shades of grade school, yellow index sized cards or papers with the date of inoculation, the manufacturer name, lot number of the vaccine, and the health care site. Whether that piece of paper will satisfy the airlines, hotels, and public venues remains an open issue and whether those with phones ‘opt in’ to ‘get out.’

Vaccine Record on Phone

Vaccination record on old yellow form.
Phones are replacing paper as the receipt for vaccines.

Dear Ms. Smartphone: I am hoping to get the Covid vaccine soon along with other members of my family. I heard that when we get it we will need to keep a receipt for it on our phones. I have not done this before and am wondering if this is so necessary. Janine, TIburon

Dear Janine: The Covid virus has been a real shot in the arm (pun intended) for smartphones. Initially, contact tracing apps were rolled out for phones with a mix of opt-in, opt-out functionality.  Next, smartphones became a vital part of getting tested. Most of us have to sign up for a Covid test, reserve a spot, and learn the results through a combination of text, email, and web site. So, it’s not a surprise that the most important and anticipated element, the vaccine, is also intertwined with our phones. 

Phones Have Background!

Some background: Putting health records on phones is not entirely new but since the beginning of Covid, many firms  have vied to be first to issue or manage digital health credentials. Among the firms are IBM, a Swiss non-profit called the Commons Project Foundation, and Healthvana. The latter company teamed up with Los Angeles County. A county health official said they wanted to “give patients ownership of their records.” Phones were deemed to be particularly useful, since the calendar function and text can remind the public when it’s time to get the second dose of the two-shot regime.  Still, those getting the vaccine in LA County are also said to receive a paper card.

Paper has turned out to be a problem. During Covid there has been a booming market in creating fake test results. Back in November, a publication reported that international travelers (largely outside the U.S.) forged, and sold, negative test results. So, the idea has been to create a “digital health credential” on smartphones that is more secure and less susceptible to fraud. 


Of course, this could raise issues, and this might be at the heart of your question. Should we be worried about privacy and surveillance? The software developer, like Healthvana,  claim that the health pass does not share specific details-like where and when a user was tested. In due time, we can hope that members of the public will no longer need to show that they have been vaccinated in order to do everyday things. If they remember to do so, they can then delete the record from their phones.

VERILY & Apple FOR YOURS:

In the interim, airlines, schools, and employers may need to verify that people actually got the vaccine. And, it could be useful if you want to dine indoors at a favorite restaurant or get admission to say movie theaters and sports events.

If you have children, you will recall that you need to bring a paper certificate with a history of  vaccination records, before they enroll in day-care or school. Today, some doctor’s offices submit those forms digitally. Now it’s looking like you will be bringing the results from the Covid vaccine and other health information on your digital wallet.  It should not be a surprise then  that latest Apple operating system (i0S), is literally  programmed with a health app you cannot delete!

Alzheimers and Smartphones. Friends or Foe?

A black and white cartoon of an older woman holding a smartphone in one hand and a cane in the other.
Alzheimers and Smartphones. Friends or Foe?

Dear Ms. Smartphone: Would a smartphone help my Aunt who was recently diagnosed with Alzheimer’s disease? Right now she has a landline and a flip phone but I am considering giving her my old smartphone instead of trading it in. Then I can send her pictures and images, plus plug her into more social media. The rest of my family doesn’t see it this way. They think the smartphone will just make her feel worse. I am wondering what you would do and if Alzheimers and smartphones make sense together? Cecelia, Boston

Dear Cecilia: Thanks for the useful question. Many people are in your shoes wondering if digital tools can improve the care for older adults. I would begin with a face-value assessment to evaluate if your Aunt is smartphone ready. Does she have the mental faculties to follow digital commands? Does she have good-enough eyesight to see text on a small screen, and is she free from palsy or hand -shakes? As you seek out information, keep in mind that I am not a medical doctor and you should ask a gerontologist to weigh in. There’s actually an app, or a purported app, that can help doctor’s spot signs of Alzheimer’s.

Friendly Smartphone!

Assuming your Aunt passes your face-value test, try communicating with her on a regular basis, using the smartphone. Since social isolation and loneliness often accompany the decline in memory loss, keeping in regular touch might be a healthy intervention.  You might text her, send pictures, or try to engage her on Facebook. Here is an academic paper that prescribes both companionship and memory training over the smartphone to slow down the cognitive decline. Perhaps you can tap your personal knowledge of your Aunt’s social groups and family’s stories to help retain connections and memories.  

If your Aunt is at an early stage of dementia, you could also use the phone, or even better a smart watch, to map her spatial movements. This might help if she’s not supposed to drive a car or gets lost when she goes out. You can set up a “geo-fence” alert so that you don’t have to monitor her whereabouts all the time.

Over-Friendly Smartphone…

At a later stage of dementia, having a smartphone, actually any phone, could be worrisome. As the disease progresses, your Aunt might get lonely or paranoid, and hence more susceptible to soothing messages from an outside caller. There are evil telemarketers and the like who take advantage of people who are not in full command of their mental faculties. 

I often lecture on taking the keys away from older people when they are no longer capable drivers- and can happily point to rideshare as a substitute.  If you need to take away the phone and electronic devices, I imagine there will be tech-backups you want to explore, like a voice activated 911 device, blocking of online accounts and passwords, and ‘beeper reminders’ to take medications. I hope all goes well for you and your Aunt.