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The great public health mashup
By David Raths
Every day, epidemiologists and researchers at South Carolina’s Department of Health and Environmental Control run dozens of specialized software programs and laboratory systems to detect the early warning signs of infectious disease outbreaks.
But their analyses might be more accurate if they could solve a problem common to distributed workgroups: an inability to get applications and reporting systems to share data. In the health care arena, a lack of standards can lead to higher costs, slower research and a greater risk of pandemics, public health officials say.
“We have so many systems in this agency, and they are not talking to each other,” said Jared Shoultz, director of the department’s Division of Public Health Informatics. “Public health is working toward data standards and unified data models, but we aren’t there yet.”
Lately, however, state and local officials are finding ways around the problem by using a variety of techniques that include geographic information systems and Web-based tools. Such technologies enable public health officials to bridge departmental divides and share datasets across jurisdictions.
“Geography is the one common factor all these databases have in common,” Shoultz said. “Where the fish kills are or cancer clusters, for instance. We have been using GIS as an integration tool to link datasets.”
Likewise, California’s Loma Linda University Medical Center is funding a project to improve patient transportation during emergencies. The Advanced Emergency GIS project uses mapping software to integrate data from hospitals, emergency dispatchers, first responders, traffic and weather feeds, and public health agencies.
For example, ambulance workers could see if a hospital is at capacity and divert patients to another facility. The tool improves situational awareness among emergency responders and fosters greater collaboration on other public health issues.
“Any other type of medium that included 15 to 20 data sources at once would be confusing to look at,” said Ed Carubis, former chief information officer at New York City’s Department of Health and Mental Hygiene and now a consultant to GIS developer ESRI.
In other jurisdictions, health datasets are being shared with the public via the Web. In those cases, nongovernment researchers are overlaying their data to offer unique views into public health issues.
As researchers are discovering nationwide, the greater the number of participants, the more unique and innovative the results.
Salmonella in S.C.
In South Carolina, public health officials are tracking Salmonella infections by using GIS to combine data from two sources. The state has a database of licensed food service facilities and a separate lab database of reported Salmonella cases. Connecting the dots between those two datasets had proved difficult.
“If we can map the overlay of those two, it gives us a place to start to look for a cause,” Shoultz said.
His office developed a set of Web services that automatically pulls data together so an epidemiologist with no GIS training can see the locations of Salmonella cases overlaid with licensed food service establishments, census data and street maps.
“The GIS is improving collaboration between systems that don’t talk to each other,” Shoultz said.
The Department of Health and Environmental Control has also created a Web-based mapping tool called the South Carolina Community Assessment Network, which Shoultz said is a simple way to put health data at users’ fingertips.
“If you were creating an operations plan for a health region, you might want to pare down stroke, heart disease or teen pregnancy data by region,” he said. The network “is an empowering tool to let you do that. We used to creat e maps in an annual publication and send them out to libraries and other groups. But by having a tool online that people can use themselves, we are getting much more use than we ever did before.”
He added that he found an unanticipated benefit: When people can answer their own questions, it frees his employees to work on more complicated analyses.
Atlanta aggregations
Although such technologies can sometimes bring researchers and public health officials together, the desire to collaborate often precedes the swapping of data.
In 2001 in Atlanta, people were calling public health agencies to report the locations of dead birds. Concern about the spread of West Nile virus in the metropolitan area spurred public health officials to form a regional working group called Metro Atlanta Public Health GIS (MAPH GIS).
The environmental health directors of the region’s five public health districts realized they needed a clearer understanding of the impact of the virus, said Juanette Willis, arbovirus coordinator at the DeKalb County Board of Health’s Division of Environmental Health.
Before the consortium was formed, the districts were gathering data individually and missing the bigger picture.
“When you map clusters of where those dead birds are found, you start getting a picture of what’s going on,” she said. “But until you pull all the regional maps together, you might not see a pattern. For instance, right on the border of a county, it may not look like much, but when you combine counties, you see it.”
By aggregating their mapping data, officials were able to forecast West Nile virus activity by dead bird clusters.
“Once we identified active areas, it allowed us to be more proactive in our efforts,” Willis said. “We actually went door to door in these areas and talked to people about potential mosquito breeding sites, such as planters and other man-made containers.”
Although MAPH GIS was created in direct response to the West Nile threat, it has since grown to address other public health concerns that affect the Atlanta metropolitan region. In 2005, the consortium produced maps of shelters and their capacity to accommodate Hurricane Katrina evacuees.
Sometimes such maps can have a political impact, officials say. Several years ago, because septic system permitting was on the state legislature’s agenda, the MAPH GIS group mapped all the on-site sewer systems in four counties.
“This map spoke reams,” Willis said. “It helped educate legislators and others in public policy on what the septic system looked like. People assume because we are in a metro area that we don’t have a lot of septic systems, but we do. But we have to make sure we permit and regulate them properly.”
The people involved in the Atlanta consortium are not GIS experts. They include restaurant inspectors, epidemiologists and environmental health coordinators who might have some knowledge of GIS. They share geographic information, computer resources and expertise.
“We do presentations about the types of maps we create, and that networking can spur others,” Willis said. “We share our work and get ideas.”
Hippocrates in New Jersey
As demonstrated in Atlanta, GIS collaborations often start with a public health or safety threat. What began as New Jersey’s response to the anthrax scare of 2001 has developed into Hippocrates, a Web-based situational awareness tool shared by the state’s public health community.
“When we started getting white-powder reports related to the anthrax scare, we realized we weren’t managing it well,” said David Gruber, senior assistant commissioner at the state’s Division of Health Infrastructure Preparedness and Emergency Re ponse. “We weren’t doing a good job of accumulating data and notifying people who needed information.”
In response, state officials started working on improving collaboration tools. But what they ended up with was much broader in scope than a mere notification system. Although Hippocrates includes features such as automated e-mail messaging, GIS is at its heart.
“Very early on we saw that an interactive mapping element was going to be a crucial element,” Gruber said.
Hippocrates fuses fixed geographic data elements with dynamic data that brings maps to life, he said. Health-specific layers include the locations of long-term care facilities and a module for mapping chemical facilities.
Users can also see real-time displays of weather and traffic and the movements of ambulances via Global Positioning System devices mounted on the vehicles.
Because Hippocrates is Web-based, Gruber said, it is easy to connect all components of the state’s health system and its partners in the state emergency operations center and at the federal level.
Hippocrates is designed to provide real-time situational awareness, so when there’s an event in one part of the state, health officials in other areas can receive information and respond appropriately. For instance, a wildfire outbreak in southern New Jersey in 2007 closed three long-term care facilities and one hospital.
“The mapping capability allowed us to see the appropriate shelters as well as the smoke plume from the fire,” Gruber said. “For the first time, we could share information about hospital diversion status and depict it in real time.”
As geospatial data technology permeates further into government agencies, experts predict richer datasets and more innovative uses of the technologies.
“Eight or 10 years ago, these departments might have had some desktop software that they used for specific projects,” said Chris Kinabrew, a public health specialist at ESRI. “Now it is being incorporated throughout health departments as more people figure out how to leverage it in many different ways.”
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