Ontario is using the equivalent of an honour system to track student vaccinations after it spent hundreds of thousands of taxpayer dollars on a failed attempt to collect more reliable data.
The system, called ICON, is an online tool for parents to enter their kids’ vaccination details.
At a time of recent measles outbreaks in British Columbia and worldwide, top doctors say relying on parents to be honest is an unacceptable way to protect public health.
Numerous studies show self-reporting is prone to significant error. Ontario’s ICON system allows for both accidental and intentional misinformation.
Accurate vaccination data is essential to predicting a population’s vulnerability to outbreaks. Unreliable immunization information could lead to public health officials having “no ability to see danger coming,” said Dr. David Fisman, a professor of epidemiology and medicine at the University of Toronto’s Dalla Lana School of Public Health.
It wasn’t meant to be this way.
Ontario recently built a reporting program for health-care providers, called ICON-HCP, but then scrapped it at a cost of $660,000.
EHealth Ontario had developed the reporting site without consulting front-line workers to make sure it would be compatible with the 12 different electronic medical record systems that are used across the province.
Everyone was so confident the system would work that in 2017, the Liberal government moved to amend the Immunization of School Pupils Act, requiring health-care providers to report this critical data to public health officials.
After the system’s rollout, doctors flagged a problem: the names of the vaccines in the new system did not match the names as they appeared in doctors’ existing electronic records.
When Premier Doug Ford took office, he formally put the legislation on pause.
Ontario’s eHealth — which oversees the province’s electronic health record system — is now working on a new online tool that health-care providers will use to send immunization records to public health officials, several sources told the Star. It’s unclear how long it will take. One source estimated two to three years while another suggested a test phase could be rolled out within several months.
“Ideally, the vaccination information would come directly from the doctor/nurse each time a vaccine is given,” said Toronto Public Health spokesperson Dr. Vinita Dubey.
In February’s issue of the journal Vaccine, U.S. researchers surveyed parents and found 25 per cent gave incorrect answers about their child’s HPV vaccination status. The study analyzed the parents’ responses against verified medical data for nearly 20,000 adolescents.
EHealth is consulting doctors in its latest effort to build a new reporting tool for health-care professionals, said OntarioMD, a subsidiary of the Ontario Medical Association that helps doctors use digital health services.
Students who are not up to date with their immunizations, and who do not have a valid exemption for medical or religious reasons, may be suspended from school.
For years, schools relied on parents to bring paper proof of their children’s immunization history to kindergarten registration, by which point most children have received the majority of vaccines. These yellow cards were filled out by health-care providers. Then the schools would courier hundreds of thousands of copies of these records to public health units across the province, where staff manually entered the information into a database.
Now Ontario is promoting an electronic self-reporting system that requires no evidence of immunization at all.
The self-reporting system allows a parent to attach a copy of the immunization record. Dubey said it is not known how many families do this.
After a test run of the system, Toronto Public Health, the largest of 35 public health units in Ontario, expanded its reliance on the online tool in February to cover the vaccination details of prospective junior kindergarten students. This cohort includes about 25,000 children.
Toronto’s French and English school boards confirmed they have circulated this information to parents but will still accept paper immunization records if parents are unable to report online.
Public health officials insist all self-reported data is “verified” before staff forward it to a central database.
The online tool does not require parents to submit documentation showing a child’s vaccinations are complete and up to date. It does not even require parents to enter an accurate date for when vaccinations were administered.
Parents can select from a drop-down menu of immunizations that are grouped by age and simply check them off.
The “core basis for determining if a vaccine record appears accurate,” said Dubey, consists of a staffer checking the parent’s selections on one screen against another screen that shows the government’s list of required vaccines.
Toronto Public Health “does not cross-reference records with health-care providers,” Dubey said.
“I don’t know how long it will take vaccine-hesitant folks to realize that they can simply copy and paste the vaccine schedule in and have their kids stay in school,” Fisman said.
Accidental errors are a concern for Dr. Hirotaka Yamashiro, president of the Pediatricians Alliance of Ontario. He has seen the online self-reporting system and worries “it’s very hard for parents to understand what it is they’re inputting” because the vaccine options in the drop-down menu don’t always match the information on a patient’s yellow card. “That leads to a lot of unreliability in what’s reported.”
Diana Zlomislic is a Toronto-based investigative reporter. Follow her on Twitter: @dzlo