Harnessing Geography Improves Outcomes
Implications for Health Care Information Systems
Health care information systems have been based on functions that health care providers must perform for clinical or administrative documentation. These functions usually create a record that will protect the institution and its participants from lawsuits, aid medical researchers, and/or provide a record of who did what to whom and for how much.
However, when care is rendered, very little of this information is used to protect the safety of a patienteither inside or outside hospital wallsdespite the existence of real-time laboratory, drug dosing, and administrative procedures that automatically report when "panic" values are reached and patients' lives are threatened.
Hospitals are notorious for underutilizing the entire medical history of a patient in treatment. This shortcoming is largely the result of an intense focus on the episode at hand. While other parts of the health care system are held accountable for providing a continuum of care, typically this continuum is poorly served by a health information system designed primarily for episodic care record keeping and legal documentation.
SARS: The Need for Better Time and Place Information
The near global epidemic of Sudden Acute Respiratory Syndrome (SARS) in 2003 made a convincing case for using exact place and time knowledge in understanding and controlling the spread of disease. In the absence of this knowledge, every country's health care system is seriously compromised.
Can current information systems in major hospitals protect patients, staff, and visitors from a spreading pathogen? What type of information would be needed to respond to a smallpox case in an emergency department? Could that hospital accurately locate every physician, patient, employee, and visitor to the facility within the previous 24 hours? The threat of SARS and other epidemics is creating a greater interest in a comprehensive and integrated personal health information system that considers the continuous, time, and spatially sensitive nature of health and disease.
Health Care Aggressively Adopts GIS
Health organizations are realizing the business value of geographic information, and hospitals and other stakeholders in health care are adopting GIS. Here are some ways that GIS is currently deployed in the health care system.
- Service delivery is being improved through location analysis. Providers benefit from enhanced planning and can make more effective choices for distribution and deployment of resources. They are improving service accessibility and collecting accurate spatial metrics for their distribution systems through defining service areas, analyzing response times, monitoring bed availability, and gauging surge capacities.
- Hospitals have built GIS into their admission, discharge, and transfer (ADT) systems. GIS improves the timeliness of the admitting process, deploys internal resources more efficiently, and provides for greater accountability. This same system can also monitor bed surge capacity in real time and provide hospital management with easily accessible command center information.
- Managed health care organizations use GIS to quantify geographic disparities in disease outcomes and disease management practices. Clinicians use GIS to better understand the demographic characteristics and services utilization of the population they serve.
- With the advent of the Internet, GIS can be more readily accessed by health and human service organizations. Case managers can help clients comply with service referrals and deliver on accountability promises.
- Medical researchers use GIS to aid in diagnosis and treatment through enhancing and measuring medical images and other spatialalthough not geographicfunctionality. Providing spatial "eyes" to surgeons and radiologists will represent significant advances in understanding the relevance of spatial location to human anatomy.
- Health ministries are using GIS to establish national command centers that track infectious disease and monitor events that could affect the capacity or readiness of the entire health care system. Using GIS, the movement of national drug stockpiles and deployment of scarce medical resources can be orchestrated during emergencies or when communities are threatened.
GIS offers a new approach for health care information professionals. A decade ago this author wrote that about 80 percent of all health care transactions had significant geographic relevancy. Today this figure is closer to 100 percent. In the very near future, information concerning time and place will play a crucial role in every major health care reform or initiative. GIS will certainly be an essential technology in the much-needed transformation of health care information.
About the Author
Born and educated in the United States, Bill Davenhall has worked in the health and human services field since 1974. He has directed many different initiatives involving the progressive use of information systems within hospitals and human service organizations. Davenhall is a frequent speaker and writer and is well known as one of the leading advocates for the use of GIS to help solve some of the greatest challenges in health. He earned a master's degree from the University of Kentucky in 1974. Davenhall is global manager of Esri's Health and Human Services Solutions Group in Redlands, California.