Ottawa Hospital Research Institute

Project Title: Development of a mobile enhanced immunization information system - CANImmunize
Funding Recipient: Ottawa Hospital Research Institute (OHRI)
Project Contact: Katherine Atkinson – Research Program Manager (katkinson@toh.ca)
Project Period: April 1st, 2016 – March 31st, 2019

About the Project

CANImmunize is a free digital tool for Canadians that empowers individuals to manage their own immunization information. Phase 1, completed in March 2016, “Building a Vaccine Tracking App for Canadians” developed a mobile immunization app for iOS and Android devices, called ImmunizeCA. Phase 2 aimed to further develop the app into a full platform and was rebranded as CANImmunize. The goal of Phase 2 was to address the needs identified during Phase 1, while working towards integration with Provincial and Territorial immunization information systems. The current project has developed a greater suite of functionalities, including an Account Based System and a web platform which allows users to access their records on all of their digital devices.

Objectives

The project began with 13 distinct objectives, which were revised throughout the project in consultation with stakeholders including PHAC. The most recent objectives which support a secure, state of the art Accounts Based System on mobile devices and the web, are as follows:

Synchronization of CANImmunize Records Between Devices and Family Members
Improve CANImmunize Scheduler to improve recommendations
Build CANImmunize.ca, a responsive website which allows Canadians to access CANImmunize on the web
Improved reminder experience that includes push notification and email reminders of upcoming vaccinations
Improved communication through tailored banners, notifications, and information based on subgroups as well as promotional content disseminated to target audiences
Information for Canadians on navigating Catch-up Schedules
A portal within CANImmunize tailored to offer useful information for newcomers to Canada
Portals for Users with Special Conditions that includes the development of content and a page on the CANImmunize website for parents of children with inflammatory bowel disease
The Canadian Vaccine Catalogue, fully functional, accessible terminology service that delivers up to date identification information on currently licensed vaccines in Canada
Reporting to Local Public Health through synchronization of information with the provincial registries
Development of Protocols & Procedures which Protect User Privacy
Development of a Rigorously Secure Application Environment

Outcomes

Short Term: CANImmunize will improve knowledge of immunization and contribute to more accurate record keeping
Medium Term: The platform’s ability to provide reminders directly to individuals about immunization appointments means that it can immediately start helping people immunize their children on time. CANImmunize can also help reduce barriers faced by families and individuals when it comes to understanding provincial immunization schedules and local vaccine programs
Long Term: This project will improve the quality of data in IISs and reduce vaccine preventable disease outbreaks. I has the potential to increase vaccination uptake across the country, and will also situate Canada as a leader in global immunization innovation.

The challenge that the project addresses

Despite the documented evidence for the benefits of immunization, there appears to be a resurgence of vaccine preventable diseases such as the measles. This is a consequence of two factors, increasing vaccine hesitancy and the lack of high quality data on immunization coverage. The CANImmunize platform will help address these two factors by improving immunization uptake in both paediatric and adult populations, and by improving the quality of the data residing in immunization information systems (IISs). Many of the Provinces and Territories use IISs to monitor and track the vaccination status of their constituents. CANImmunize can help augment the quality of the data contained within these systems by empowering parents and adults to record their own immunizations and those of their dependents, particularly as immunizations are being offered by a growing number of healthcare providers in Canada. The addition of the CANImmunize Accounts feature facilitates both management of records between devices and reporting to local public health units, including Ottawa Public Health. Through CANImmunize, constituents are able to report their immunization status as it is being updated, allowing public health officials to obtain the data in real-time, as opposed to relying on passive reporting mechanisms. Integration with these IISs will be essential in creating the CANImmunize ecosystem and will benefit both the public and public health authorities. Improving data residing in IISs is also important for federal public health officials as it assists in Pan-Canadian surveillance of vaccine safety, coverage and effectiveness.

Lessons learned

The team has faced numerous technical obstacles in the last years which have led to a delayed release of the CANImmunize Account system, a vital security feature allowing for the sharing of records, and an integral component to the development of CANImmunize Web. This delay caused an unprecedented ripple effect in our other deliverables, requiring constant re-evaluation of our priorities and our project objectives. As with any innovation project, CANImmunize Accounts required first that the technology be developed and tested on the mobile and server sides, and second that a comprehensive privacy and security program be developed, reviewed, approved and implemented according to the highest health information protection standards. Given the rapidly changing health information privacy and security landscape in Canada, the uncertainty about the rigorous governance of such data, and the intensive learning curve for the team, conducting this work took longer than anticipated. The Ottawa Hospital Research Institute and The Ottawa Hospital were required to agree on the legal liability and public branding of this system, as well as ensure that the necessary assessments and insurance be in place. Several third-party legal services also needed to be procured, as was recommended best practice in this new area. Procurement of these services in a public institution was proven to be a lengthy process but transparency and accountability of these processes is paramount. Despite these challenges, the project has successfully developed and deployed a secure, state of the art product for Canadians.

About the Ottawa Hospital Research Institute

The Ottawa Hospital Research Institute is an independent health research facility closely affiliated with The Ottawa Hospital and the University of Ottawa, committed to excellence in the creation of scientific knowledge that contributes to the prevention, diagnosis and treatment of human disease. Research at OHRI is focused on answering important health questions and translating new findings into benefits for patients and society. One of OHRIs strategic priorities is “Practice-Changing Research” which is designed to put knowledge to work. The CANImmunize platform represents an extension of this priority to the digital age. OHRI has also established a new mobile health research center, The Ottawa Hospital mHealth Lab, to support in-house development and evaluation of digital technologies that improve health. The mHealth Lab is collaborating with leading physicians and scientists in the areas of knowledge translation, clinical decision-making, acute stroke rehab, public health, infectious diseases and vaccinology.