JUDGE’S CHOICE AWARD
By: Dr. C. R. Clarke MD, MBA, MSc (Comp Sci), BSc (Math)
Canada needs a web-based decision support system (DSS) to support its immunization and pandemic programs. New vaccines are developed ever year; immunization schedules are constantly changing, expanding, and becoming ever more complex. The ever-present threat of a pandemic requires a rapid response to urgently administer a new vaccine to millions of Canadians. The Canadian Immunization Guide is of questionable practicality to busy physicians and nurses.
Background – The Need for a DSS
The Canadian Immunization Guide (CIG) specifies the vaccines and schedules for immunizing against infectious diseases. A new edition is published every four years. The current CIG is the 2006 edition; it is 389 PDF pages. Attempts to order a hard copy via the Public Health Agency of Canada (PHAC) website result in a “404 not found” error. The PHAC website provides a link to the National Advisory Council on Immunizations (NACI). The NACI website lists over thirty “Recent Statements” on vaccine use (presumably released since the last edition of the CIG). There is a second link to over seventy “Recommendations, Statements, and Updates” dating back twelve years; it is unclear if some of these updates supersede others or have been incorporated in the latest edition of the CIG.
It is extremely doubtful that the physicians and nurses responsible for administering Canada’s immunization programs have received and read all these changes, and are incorporating them into daily decision making.
Administration of pediatric vaccines is complicated due to the interrelationships of time intervals required between different vaccines, and prohibitions on co-administration. For many health care providers, the CIG is too complex and fragmented to be complied with accurately. Compliance is further disrupted when patients do not conform to the recommended schedule and miss a shot or two. This probably occurs in about 50% of all patients; health care workers become frustrated and confused about what shot to give next, when, and in what combination.
When a patient changes physicians, moves city, or progresses from toddler to child to teen to adult, their immunization record (a yellow wallet-sized card in Ontario) invariably becomes incomplete or lost altogether. Additionally, many new Canadians arrive without ever having been immunized to Canadian standards.
Non-compliance with ever-changing immunization guidelines poses a real and present danger of pandemics and a resurgence of infectious diseases once considered eradicated. Canada is spending billions on pandemic planning and pediatric/young adult immunization programs, but has no Information Technology support to ensure a good bang for the buck.
A Decision Support System for Canada’s Immunization and Pandemic Programs
Canada needs a web-based Decision Support System (DSS) to schedule and record immunizations for each and every Canadian. This DSS would automate all the specifications and algorithms implicit in the CIG (and its associated Recommendations, Statements, and Updates). Each patient (or parent) would create “an account” just as they would create an account at a social media or on-line shopping website. Each newborn’s account would start with the recommended immunization schedule. Starting at two months of age, the DSS would record each immunization as it was given. Immunization data would be entered using any web-enabled PC, Laptop, iPad etc. located in any physician’s office, school, long term care / retirement home, or public health clinic. Immunization data would include the vaccine manufacturer and lot number to facilitate speedy analysis of any adverse reactions and recall of contaminated vaccine.
After each immunization, the DSS would reformulate the patient’s schedule for all future immunizations. If a patient missed an appointment, the DSS would immediately and automatically reformulate a complete, revised future immunization schedule for that patient, highlighting any necessary catch-ups and automatically adjusting for previous deviations from the schedule.
The DSS would automatically e-mail patients with reminders about impending or missed immunizations. At any time, a patient could sign-on to the website and look at their schedule for future immunizations. “Is my Tetanus up to date ?”. “Does Junior get a shot at 24 months of age ?”. The DSS would immediately provide the answer directly to the patient . . . on their own laptop . . . in their own home. Public service announcements in the media would remind patients to check their immunization status regularly.
Any new vaccines or other revisions to the CIG would be immediately incorporated into the DSS algorithms. Whether the change was a new meningitis vaccine for a two-year old, a booster for a teenager, or changes to the frequency for protecting the elderly in long term care, each patient’s personalized immunization schedule would be updated; each patient would be e-mailed with the change. Physicians and nurses would no longer suffer the uncertainty and anxiety of being out of date; the latest guidelines would always be incorporated in the DSS. In the event of an anticipated pandemic, the DSS would incorporate the new vaccine and patients would automatically be e-mailed with the details. Canadians would receive timely accurate information, well before being fed the usual hysteria by the media.
The DSS can be created using commonplace web programming technology; it would be accessed over the internet, from physician’s offices, public health offices, and patients’ own homes.
Canadians would have optimum protection against infectious disease. Canadians would receive the quickest possible protection when the next pandemic inevitably strikes. The Canadian health care system and the Canadian economy would avoid the tsunami-like impact a pandemic would cause. Canada would be assured that the money spent on its immunization programs is money well spent.