Over the last several years, the growth in sophistication and ease of use of geographic information system (GIS) software has allowed some public health agencies and provider organizations to more clearly identify and start addressing health resource disparities.
The clinician who has received perhaps the most attention in this realm is Jeffrey Brenner, M.D., a Camden, N.J.-based physician who uses data gathered in a health information exchange to target high-cost individuals. The Camden Coalition of Healthcare Providers uses the HIE data to identify high-cost “hot spots” — high-rise buildings where a large number of hospital emergency room “super users” live. By identifying and working with these individuals on patient-centered care coordination issues, the coalition has been able to reduce emergency room use and in-patient stays.
Recently I had the chance to speak with Este Geraghty, M.D., M.S., M.P.H., the chief medical officer and health solutions director for ESRI, the world’s largest GIS software company. I asked her why GIS wasn’t more widely deployed in healthcare previously and why CIOs should start paying more attention to this field now.
She said that one reason it hadn’t caught on earlier is that in the not-too-distant past you had to have a fair amount of expertise to use the software. “That has all changed now, so the timing may be right to move this forward as a tool in the analytics suite that a hospital or health system might use,” she said.
Este Geraghty, M.D.
I asked Geraghty if the shift to value-based payment might increase the need for GIS. One of the most obvious use cases is accountable care, she said. “We have new regulations and reform efforts focusing on things like accountable care organizations and population and community health needs. It makes people focus geographically.”
Geraghty said Dr. Brenner’s work in Camden is an example she cites frequently. “By doing that intervention, they improved the quality of care for the residents of those buildings, because they could manage their chronic conditions better and attend to acute things like an earache or a cold that might have sent them to the emergency room in the past. They were getting higher quality care, with better continuity and significantly bending the healthcare cost curve for the local hospital.”
Another example involves the Children’s National Health System in Washington, D.C., which geocoded data on 344 children who had scalds or contact burns. Its researchers were able to create hot-spot representations of where these burns were occurring and develop a targeted public awareness campaign around lowering water temperatures, and the rates of burns dramatically decreased.
Geraghty cited another example: a physician at the University of Florida, Nancy Hardt, M.D., is looking at hotspots of issues related to teen pregnancies, low-birthweight babies, domestic violence, and child maltreatment. She worked with community groups and agencies to create a family resource center in a neighborhood of great need. They also developed a mobile clinic staffed by medical professionals and volunteers. “Because maps and hotspots are easy to read and understand, people are engaged,” Geraghty said. “It helped facilitate action. It is a great example of community engagement to change things.”
Geraghty said provider organizations now have a lot of incentive to think about healthcare costs and what kind of tools they have that will help them make a difference. She mentioned that Kaiser Permanente combines EHR data with public and commercial data sets to do different kinds of hot-spotting and analyses that are geospatial, such as working on required community health need assessments. Kaiser is trying to figure out where people with chronic conditions live and compare that data with other data about the communities and neighborhoods they live in because they know there are social determinants of health and economic factors that impact our health, she explained. Where they see patterns they can better target interventions or tailor educational materials for that group.
She said understanding social determinants of health is a challenging but exciting approach. “I can relate anything to health. If you want to talk about transportation, I will think about pollution or driving while fatigued or diabetics driving trucks,” she said. “I am really grateful that people are thinking in this broader way — about how we achieve wellness vs. the ill health we are dealing with as a nation right now. It is a big data issue and an integration issue, but that is the beauty of geography. It makes integration on the data level easier, because a place is a place. When you have latitude and longitude, you can pull together different types of data sets.”
Geraghty’s job includes being something of an evangelist about GIS to health systems. “The key we have to focus on is the return on investment and value statement. When you have a conversation with somebody, they might say, ‘That is interesting and nice.’ But what I want people to understand is that it is more than a map; it is an analysis, and it allows you to pull together lots of types of information.”