The problem
I live in the fashionable SoFo (south of Fortinos) neighborhood of Maple, Ontario, a suburb of Toronto.
Prominent in the local news is the Toronto School Board’s decision to suspend over 5,000 elementary students with incomplete immunization records. For as long as I have been a parent (13 years) the standard method for recording immunizations in Ontario has been a yellow card in which the doctor or assistant writes in each immunization as it is administered.
Of course if you forget to bring the card, remember to bring next time, and remember to ask that the last immunization be recorded. And don’t lose the card! You can imagine the failure rate of this system is pretty high. I submit that the vast majority of parents whose children had incomplete immunization records were not anti-vaxxers, but rather people with busy lives who may have lost or forgotten to have updated yellow cards.
The consequence for children and their parents is that there is an annual scramble to assemble the records and if they are not available (a pediatric office closes, for example, or the child is from another jurisdiction) then the child has to endure needless extra vaccination.
Inventive Principles 1 through 10
This is a real problem happening right now. I don’t have the right answer “here in the other oven” like on a cooking show. This seems a good opportunity to go through the exercise of trying all of the inventive principles to identify candidate solutions. In this first post on the subject, I will see what the first ten principles yield.
Remember the cardinal rule: there are no stupid ideas, only ideas that may serve to inspire the best idea. Ideally we’d be working on this together and riffing on each other’s ideas. I am deliberately not censoring my ideas or leaping to reasons why they won’t work.
Let’s see if we can give this process a shot in the arm.
Principle 1 – Segmentation
“What if we broke it up?”
Immunization is complicated. Not only are there several diseases to be guarded against, but some require boosters, all based on the child’s age.
School curriculum can be complicated, too, but if you have a university or college degree, chances are a prospective employer won’t be asking for your high school diploma. If you have the more advanced credential, it’s assumed you have the lesser.
Can we break up the child’s life into phases and just have the doctor issue a certificate saying you have all your toddler vaccines, all your pre-teen vaccines, all your adolescent vaccines? It’s a small improvement but a little more manageable than maintaining a record for a lifetime.
Principle 2 – Taking Out
“What if we removed parts of it?”
The yellow card gets filled out by the physician’s office and is in the care of the parent.
What if instead, if requested, the doctor could send an immunization confirmation to the parent by email, taking paper out of the equation?
What if we took the parents out of the equation altogether and allowed the school board to contact the physician directly?
Principle 3 – Local Quality
“What if we made part of it different?”
The yellow immunization record is just a series of rows upon which immunizations are written in sequential order along with the date. This makes reviewing it difficult, especially since the rows are very cramped and doctor’s handwriting is not renowned for legibility, and for laymen reviewing the card the immunization names are hard to decipher anyway.
What if the card was broken into pre-printed rows for each immunization and the doctor only had to date and sign in the right square? And each row could include the correct age for the shot. This would give a sense of progress to the card making it easier to interpret – like trying to earn a free sub!
Principle 4 – Asymmetry
“What if it wasn’t symmetrical?”
Right now the rhythm is “get a shot, get a notation”. What if instead the doctor was responsible for providing an immunization record to the parents every summer, in time for school registration?
Principle 5 – Merging
“What if we put it together with something else?”
What if vaccinations were done in school?
Principle 6 – Universality
“Can it accomplish multiple objectives?”
Parents have to bring the child’s health insurance card every time they see the doctor. What if at certain milestones (like discussed in Segmentation) we added a sticker to the card? It works for cars – we pay our road tax and get a sticker that goes on the license plate.
Principle 7 – Nested Doll
“What if we could fold it away?”
We could put a receipt in with each vial of immunization that includes a unique QR code. The parent could be given the receipt by the doctor as a record or use the QR code to trigger a unique emailed receipt that could be forwarded to the school. The same email could have useful information on potential side effects and their treatment.
Principle 8 – Anti-Weight
“Can we remove the effect of weight?”
Let’s interpret the bulk of the immunization record as the problem here. What if we simply made the record small enough to fit in a wallet alongside the health card? This might be made to work well with pre-printed format proposed in Local Quality above.
Principle 9 – Prior Counteraction
“What if it pushes back before it’s pushed?”
The immunization rules have been put in place by the Ontario government. Even if no improvements are made to the process of recording immunization, parents could at least be given a warning in advance with a media campaign advising that the consequence of incomplete records will be suspension, giving parents abundant time to act.
Principle 10 – Prior Action
“CAN SOMETHING BE DONE IN ADVANCE TO IMPROVE THE OUTCOME?”
It is common for a doctor’s office to call or email to remind a parent of a coming immunization appointment for a child. The reminder could be expanded to include advising the parent to bring the immunization record.
