Difficult to change commercial systems

Getting changes and corrections to commercial systems can be frustrating. When the system itself is a sunset product, it is impossible.  During the course of this issue we received conflicting response of the data source and its mutability. The following summarizes efforts to address immunization concerns in an EHR.


First reported to NOD March 17, 2015 “When our providers Add Immunization in the Patient module, they see a lot of extra non-useful items in the Immunization drop-down list. Can we have this list edited to remove the non-useful entries? ”

A parallel internal ticket is created June 2, 2017. “…the problem with the Immunization list (drop down list) in NOD – there are many selections available that are close, but do not actually represent (in most cases) what was given…the user is not always aware of the choices available and selects the first “close enough” vaccine, then manually types in the brand that was given.”

Since that time the issue was brought up repeatedly to the Vendor, to the AOHC Operations Committee and back to the vendor. We received different explanations about the editability of this list.

The most recent activity took place May 23, 2017 when the issue was discussed and demonstrated via a screen sharing conference between SHCHC and NOD/Telus. We were advised that the list can be altered with the provision of a valid reason and authoritative source.

Immunization List in NOD

The list of Immunizations visible to each provider comes from a built-in NOD Immunization list. Each provider can setup a default list of immunizations by selecting from this built-in list. In practice this is done by the DMC at account setup.

According to the vendor, the choices in this list come from the provincial MOHLTC and the Multum Lexicon.

Report to Ops Committee

The attached document Sandy Hill Immunizations List Case was presented to the AOHC Ops Committee without success beyond further discussion with the vendor.

Continuing Advocacy for Accuracy in Patient Data

Our shared objective is to have a list which is both accurate for Ontario and accurate for the person.

At our screen sharing conference we identified the following general issues with the Immunization list.

– It contains redundant entries which confuse the user and lead to poor choices
– It must have the historical immunizations which our diverse and global client base received elsewhere
– Built in lists require a clear process for sourcing and maintaining accuracy which is accessible to application clients.

Next Steps

– SHCHC to review work to date and present detailed recommendations to the Operations Committee and NOD/Telus for review and implementation.


About mielniczuk

Community, systems, design, collaboration, change, evidence, Intelligent Accountability(c)
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