The problem
As I described in an earlier post, some elementary students in Ontario were suspended for incomplete immunization records. This series of posts is an effort to come up with ideas using each of the 40 Principles.
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 21 – Rushing Through
“If it won’t work slowly, could it work quickly?”
I can imagine setting an occasion when paediatricians would rush through immunizing large number of children, i.e. no checkup or other issues, just a shot. This could also be done by a wider variety of health professionals.
I don’t see how this addresses the record keeping issues raised by the problem, however. Drawing a blank again.
Principle 22 – Blessing in Disguise
“What if we turn the negative into a positive?”
My assumption is that the problem here is record keeping issues, not parents deciding not to vaccinate their children. The only positive I can think of is that this prompts dramatic improvements to record keeping. That’s not a solution per se, rather it calls for a solution. Drawing a blank again.
Principle 23 – Feedback
“What if it could monitor itself?”
Absent a wholesale change to where records are kept, the onus will be on the parents. Feedback could be reminders at each registration of a child. If they register with their school, the parent is reminded to immunize the child (well ahead of the documentation deadline). The same trigger could take place when parents make an appointment with a paediatrician.
Principle 24 – Intermediary
“If it won’t work directly, can something go in between?”
A centralized database of immunizations could be an intermediary where immunizations are recorded and parents, doctors and schools could refer to a common data set. The challenges include equipping those who need to access it and write to it and ensuring reasonable privacy. As much as this strikes me as a natural solution (I make my living in IT, after all), Ontario’s experience with building medical databases is troubling.
Nevertheless efforts are under way to create centralized databases. Ontario has a new system called ICON which claims to allow parents to review past and upcoming immunizations, “Like your Yellow Card, only better.” I almost added an exclamation point!
Of course even a perfect IT solution hosted by Ontario could not address faulty records of new residents in the province. For that, the federal government is developing CANImmunize, which bills itself as a “digital immunization record for Canadians”.
Tracking immunizations seems like a relatively straightforward goal compared to a system intended to track all medical issues citizens face. I wish those implementing ICON and CANImmunize success, after all…
“A complex system that works is invariably found to have evolved from a simple system that worked. A complex system designed from scratch never works and cannot be patched up to make it work. You have to start over with a working simple system.”
John Gall
Of course, the intermediary could be someone other than the provincial or federal government. One could imagine an app which records immunizations as they occur on a phone, storing alongside all other personal data a parent has on the cloud.
The other possibility is that the participants agree on using some blockchain to record immunizations. The advantage here is that the records are distributed and immutable unlike centralized systems where participants rely on the good will and competency of the record keeper.
Principle 25 – Self-Service
“Can it service itself?”
This Principle seeks to make a system service itself as part of its normal operation. Can we make updating records be a natural by-product of immunization?
To ensure the record is not filled out prematurely the shot needs to be given and then the record made. I return to the idea earlier that the doctor can be made record the immunization as a trigger for getting paid for the patient visit. This requires some central record keeping.
Principle 26 – Copying
“Can a facsimile be used instead?”
This is a relatively simple fix. If the yellow card is kept at the doctor’s office and a copy made for the parent at each visit, we avoid the problem of the card not coming with the parent for each immunization. That same copy can be given to the school.
Principle 27 – Cheap Short-Living Objects
“What if we made it so cheap we could throw it away?”
In my mind this yields the same answer as 26.
Principle 28 – Substituting of Mechanical Systems with Electromagnetic Systems
“Can we eliminate moving parts with electronics?”
I’m not seeing anything here, either.
Principle 29 – Pneumatics and Hydraulics
“Can we position it with a fluid?”
Nope.
Principle 30 – Flexible Membranes/Thin Films
“Can we replace a heavy structure with a thin film?”
Again, not that I can see.
Just ten more Principles to go. Then I’ll wrap up, see if there are common themes and comment on how this process went.
