Ottawa Hospital Research Institute Puts Immunizations in the Cloud Using AWS

The Ottawa Hospital Research Institute is the research arm of The Ottawa Hospital, one of Canada’s largest learning and research hospitals with more than 1,100 beds, approximately 12,000 staff and annual budget of more than $1.2 billion. It ranks fourth out of more than 600 Canadian hospitals for competitive, peer-reviewed grants from the prestigious Canadian Institutes of Health Research.

Creating a National Digital Immunization Strategy

Immunization remains a critical defence against potentially dangerous diseases, yet the C.D. Howe Institute reports insufficient vaccination coverage in many Canadian communities. With recent outbreaks of infectious diseases such as measles, mumps, and whooping cough, a team of medical researchers at The Ottawa Hospital Research Institute turned to Amazon Web Services (AWS) for help delivering CANImmunize, a free, bilingual app designed to close the gaps in Canada’s immunization strategy and meet national targets for vaccinations.

“It’s difficult to account for these gaps because a variety of different healthcare providers carry out immunizations and every province does things differently,” says Cameron Bell, an electrical engineer and lead technical architect who designed the original version of CANImmunize in 2014 during a work placement with Dr. Kumanan Wilson, a physician and researcher in immunization at The Ottawa Hospital.

“Prior to CANImmunize, individuals tracked their own vaccinations by hand on paper cards that were easily misplaced,” explains Bell. “After hearing a neighbor express her frustration with this dated system, Dr. Wilson came up with the idea for an app that would simplify the record keeping around immunization and educate children and parents about the importance of vaccinations.”

Addressing Vaccine Hesitancy

Dr. Wilson tasked Bell and other researchers with finding a way to better address "vaccine hesitancy," a term used by The World Health Organization’s SAGE Working Group on Vaccine Safety to describe three major reasons for missing or refusing immunization: complacency resulting from a low expectation of contracting a disease, lack of confidence in vaccines, and difficulty accessing immunization services.

As part of an effort to encourage those who fail to vaccinate or fall behind in vaccinations, the CANImmunize app allows Canadian citizens to use smartphones and other electronic devices to store, update, and share immunization records. App users receive appointment reminders, expert-approved advice, province/territory-specific information about immunization, and alerts about vaccine-preventable disease outbreaks.

A Trusted and Secure Choice

The Ottawa Hospital Research Institute team’s familiarity with AWS made it the natural choice for the organization's cloud services. “AWS was already to go-to for personal projects for many of our developers,” says Bell. “We were all aware it offered the best developer experience and reserved-instance pricing was also a draw. Having the flexibility to control when money is spent is a necessity when working in a grant-funded environment.”

The developers of the CANImmunize app appreciated how easy it was to set up and administer relational databases in the cloud by using Amazon Relational Database Service (Amazon RDS). They also liked the mature support for Javascript technologies like Nodejs. Users benefit from a platform that offers on-demand access to scalable web and application servers, storage, databases, content delivery, cache, search, and root access to both Linux and Windows instances.

“This is the first time we have built a system of this magnitude,” says Bell. “With privacy a top priority, we worked with APN Partner iSecurity Consulting to configure the CANImmunize cloud environment with multiple layers of security.”

The location of data storage was also an easy fit from a security point of view.

“One of the attractions to AWS was access to a suite of infrastructure services within the new Canadian AWS region,” says Bell. “Working in healthcare, we’re responsible for protecting the personal health information of hundreds of thousands of Canadians. It was essential for us to keep our data physically located in Canada and it needed to be highly secure.”

Disease Fighters

Bell and his colleagues designed the CANImmunize app with children in mind. The educational component of the effort to address vaccine hesitancy through CANImmunize includes "Immunity Warriors: Invasion of the Alien Zombies," a digital comic that portrays the influenza virus as alien spaceships unleashing a zombie massacre.

Via the app, travellers can receive updates on diseases they may encounter in other countries, allowing them to be proactive in immunizing against such possible dangers as Yellow Fever, Cholera, Typhoid, Tuberculosis, Diphtheria, Rubella and Rabies. Users benefit from immunization reminders and information about outbreaks, and pregnant women receive timely advice.

“Immunization has saved more lives than any other public health intervention in the last century, yet too many individuals are being missed,” says Bell. “There is a small percentage of parents who choose not to immunize, but in most cases, the failure to vaccinate comes down to parents or individuals not knowing, forgetting, or finding it too inconvenient.”

With more than 200,000 people now using the app, and a new version of the app on the horizon, Bell is optimistic about an increase in immunizations during the next biannual national immunization coverage survey.