The thunder will not peace at my bidding
It is a little known fact that I promised at the beginning of writing these series of ‘The Thousand Miles Journey’ articles, to use 24 months to propose my ‘Yet another theory of everything’ interspersed with articles based on topical paediatric topics (my area of professional interest). It is of no surprise however, that my last post here was on the 28th of June 2016 when I lost all confidence following the murder of MP Jo Cox on the 16th of June 2016. An old adage attributed to a great hero of the current prime minister, albeit disputed, will be my marching motto as I restart these series of articles:
“If you are going through hell, keep going..”
As the thunder will not peace at my bidding (hommage to the Bard of Avon), and sensing the truism of Vivian Greene’s saying about life, then it is time to dust down my shoes and snake the venom.
“Life isn't about waiting for the storm to pass. It's about learning how to dance in the rain.” - Vivian Greene
In attempting to snake the venom, the tact here is to use the science of vaccination because we all know now (at least I do) that “There are times when killing a snake is the wrong thing to do”. I have a problem with the current system for recording childhood immunisation in the NHS. For what is an important area of clinical paediatric practice and in an era where giant strides have been made in digitising health records in the NHS; it is not beyond imagination that a digital solution can be devised within a year from posting this (here in is the challenge to all the relevant clinical directors). It is also possible that someone, somewhere is already working on this problem (In which case, I will be very happy indeed). In actual fact, I will not like to be classed as a member of some whining brigade by those who believe fervently in that old chestnut: ‘Don’t bring me problems, bring me solutions’. I will therefore be using this platform to describe a digital solution to this problem as I conceive it. However, before I flesh out my solution, let me attempt to quantify the problem.
The Problem:
Shortly before a child is born in the NHS, the parents are given a personal child health record (PCHR). This is a book with a red cover, otherwise known as the “red book” (1) - not to be confused with the other little red book. This is where the child’s weight and height, vaccinations and other important information are recorded. It is an important and simple innovation and parents are encouraged to take the child’s red book with them every time they visit the baby clinic or GP or during hospital admission. At the time when all the different NHS care providers (primary, secondary and tertiary) are not truly integrated, this was a novel solution. My belief is that the red book needs to evolve (a discussion for another day). There are specific problems with current uptake of childhood vaccination: some are more difficult to tackle than others. However, digitisation of the vaccination record (and a well implemented one at that), will shed light on some low hanging fruits which are barriers to the uptake of childhood vaccination.
Let us take a scenario, not so hypothetical, where a child has received a set of vaccination in one care setting and end up receiving the same set of vaccination again in another setting because the mother forgot to take the red book with her. It creates unnecessary worry for the parents and the child receives extra vaccinations which are not necessary! Might the parents decide not to vaccinate again? There are forces out there who are campaigning against the well established benefits of vaccination. This is not an ammunition we should be giving these forces.
A centrally digitised vaccination record can now become a very useful tool for alerting parents of missed vaccination appointments, a repository for all NHS care providers to access vaccination records. Finally, it will provide an opportunity for targeted information campaigns to increase the uptake of vaccination.
The Platform: Don’t reinvent the wheel.
The wheel is a remarkable invention and trying to re-engineer it is like carrying coals to Newcastle. The wheel, in this case, is the NHS Spine Portal (see below). This is the platform on which my proposed digital vaccination records is based. If you are already a fan of using the spine to access a few services including Summary Care Records (SCR), then please indulge me. Let me preach to the choir.
This is clearly a secure platform and robust enough to make sure data stored here are resilient. So all I ask for is an extra link on the above portal which says “Launch routine Immunisation record”.
Access levels
All that is needed here are 3 access levels to the records (1. Admin; 2. Write access; 3. View Access). The admin can allocate access levels centrally whilst clinician who administer routine immunisations (GPs/Hospital Doctors/AHP) can have write access and the wider NHS professional network can have view access. An API can be developed to provide access to specific immunisation data in an app or website format for parents and legal carers of the child.
Architecture
The system’s architecture is a template-based smart system. When a child is born, the demographic data is populated from the spine and the prevailing immunisation template is automatically picked based on the most up to date advice from Public Health England. The database will be able to have the batch number and expiry date of vaccination administered (including screenshot of the batch number, if you want to go fancy). I will leave the details of how it looks and works to the imagination of the systems developers. The template cannot be too rigid, so it should allow for comments on deviations from norm (in the form of that well and tested ‘free text box’). Just remember, the best solutions are simple, adaptable and user friendly. It doesn’t need to be complicated. The benefits are in the intelligence from such a database to the NHS health economics in this area, and may prove significant in improving immunisation rate.
And you know what? It can be implemented within a year from today.
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