Blockchain and immunizations have no adverse effects
A national immunization registry for Canada is a natural for blockchain
Co-authored with Ian Fish, IBM Services Partner & Canadian Healthcare Services Leader and Scott Hayward, IBM Services Panorama Sustainment Business Architect. This material is our own and don’t necessarily represent IBM’s positions, strategies or opinions.
Cold chain breaks were the subject of an earlier blog post from the IBM Canada Health Care practice. Public Health Informatics has arrived at a seminal moment in Canada, owing to the combination of emerging technologies and our ability to leverage the Panorama Public Health Surveillance solution. We developed Panorama in the aftermath of the global SARS epidemic and have deployed it in most of Canada and several other countries.
But even closer to Panorama is the Immunization Registry, a use case it directly fulfills today on behalf of provinces that have deployed it. Blockchain would enable Panorama to extend its value to support a national immunization registry with relatively little additional effort.
The Canadian Medical Association Journal reported experts calling for a national immunization registry in February, 2011. Key benefits included data standardization, coordinated immunization schedules and the ability for Canadians’ to bring their data as they move between provinces.
Currently, provincial and territorial public health departments are individually responsible for administering and tracking immunizations for the bulk of the Canadian population. Federal bodies like the Department of National Defence and First Nations and Inuit Health Branch administer programs for specific populations.
Differences exist across provinces in childhood immunization schedules. Delivery mechanisms also vary, with public health administering most vaccines in some provinces while primary care physicians play a majority role in others. The resulting inconsistency in data standards, quality and completeness have inhibited development of a national view of immunization coverage.
This situation is changing. Provinces have already developed immunization registries, with many leveraging Panorama integration to receive scheduled immunizations from physician EMR systems. Others plan to pursue this goal, creating conditions for a comprehensive national immunization registry using blockchain.
A federal authority, potentially PHAC, could host the national registry. Identity-obfuscated immunization data would be categorized by location (eg. first three characters of the client’s postal code). Provinces and territories with Panorama would have an extended, real-time blockchain writing component. Other jurisdictions could add immunization records through other means.
A national immunization registry derives a number of unique benefits from a blockchain solution. As custodians of their citizens’ data, each province maintains exclusive write permissions to immunization data they report. This data could be shared in identity-obfuscated form in an immutable shared registry. Manufacturers could participate by publishing vaccine reference data and lot numbers to ensure data quality, without having access to any clinical data.
Federal authorities would be able to track immunization coverage at a national level from a single trusted source, critical information in the event of an outbreak. Researchers granted access to non-identifiable data could study vaccine efficacy and investigate clinical hypotheses across a national population, where stronger statistical inferences become achievable. These two new capabilities represent direct health benefits to Canadians.
A national registry would also help the federal government predict future vaccine needs, identify at-risk populations and make evidence-based policy decisions. Sharing data in a common registry would accelerate the adoption of national data standards and promote coordination of immunization schedules.
Blockchain also provides a mechanism to transfer messages securely across networks. This reduces the likelihood of data breaches when transferring clinical data in reports or spreadsheets.
Once a national immunization registry has been established, extensions naturally emerge that amplify the benefits. Provinces already report Adverse Events Following Immunizations (AEFIs) to PHAC. The registry could be extended to accept real-time reporting of AEFIs, linked to the associated immunization. This enables immediate identification of vaccine lots numbers that may be causing an elevated frequency of adverse events across the country. Such real-time information is currently not available.
Further, identity-obfuscation would give Canadians more control over their data. Using SecureKey technology, they could grant access to parts of their immunization record from the single trusted source. We envision new use cases where Canadian families share their immunization history when they move to a new province, and parents grant consent to share their children’s immunization history with schools.
In both cases, Canadians maintain complete control over their clinical data. Receiving organizations will have confidence that the data came from a trusted source.
Privacy legislation varies across the country. A next step would be to review data privacy and data sharing agreements for anonymized or identity-obfuscated data, to highlight any legislative limitations that may need to be addressed.
Panorama is well suited to be the base for this according to our assessment of success factors discussed in the public sector blockchain post one of the authors published recently.
This model avoids key blockers to successful deployment and expansion of the blockchain collaboration. Existing pan-Canadian governance, relationships and contracts could be minimized. Panorama procurement approaches could be leveraged. The Canadian eco-system provides substantial innovation and production resources.
A national immunization registry with blockchain breaks new ground and delivers substantial clinical value with a compelling business case.
