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Geomedicine: Mapping a new era for healthcare

From underpinning medical research to helping a state department of health keep diseases under control – GIS and mapping technology are introducing a new era of ‘geomedicine’ to the health sector.

Whether it is in areas of medical research and epidemiology, or service provision and policy making– health professionals world-wide are increasingly using Geographic Information System (GIS) technology to deliver greater insight into their data and analysis. The growing field of geomedicine uses GIS technology to examine the link between environmental factors and the geographical distribution of health issues. But while it is a fast growing area, geomedicine has actually held a very long and compelling history in the health sector.

“The value of a geographic perspective in health management can be traced back to around 400 BC,” said Dr Andrew Seit, the GIS in Health specialist for Esri Australia. “The first effective use of the principle is often believed to be Dr John Snow, who used a map to plot homes affected by cholera. By mapping where each of the affected patients resided, Dr Snow was able to identify two potential sources of the disease, namely, two public water pumps. Dr Snow’s map was the compelling evidence that officials needed to remove the pump handles off the suspected taps – and this action resulted in the outbreak being contained and an epidemic being avoided.”

Diverse applications
Since this early use of geography in epidemiology, the understanding of its value – and technology itself – has advanced considerably. Dr Seit says while epidemiology is often used as the poster child of GIS in the sector, the technology has applications across all parts of healthcare, from service provision and asset management, to policy making and research. “For example, some of Australia’s leading cardiologists have enlisted cutting-edge mapping technology in the war against Australia’s biggest killer – heart disease,” Dr. Seit said. “Using our GIS technology, a national team of researchers from the Queensland University of Technology (QUT) have just concluded a comprehensive seven-year study into access to cardiac services before and after cardiac events.”

QUT Associate Professor Robyn Clark, who headed up the study, said measuring access to cardiac care through a “geographic lens” helped identify a significant gap between regional and metropolitan access to cardiac care. “We looked at the distance to cardiac treatment centre locations in all of Australia’s 20,000 population centres,” Associate Professor Clark said. “By mapping the huge amounts of statistical data we collected with GIS technology, we were able to identify critical patterns and relationships that would not have been so apparent in table form. “More specifically, we were able to identify locations and groups of people with limited access to cardiac services.” “For example, we found that only 40 per cent of indigenous people reside within an hour of appropriate cardiac medical facilities and cardiac rehabilitation services, while 12 per cent of indigenous Australians live three or more hours from any kind of hospital.”

Dr Seit said the study had important implications for the use of GIS technology across the field of health care. “The model Cardiac ARIA has established can be applied to a whole range of other acute and chronic conditions in areas such as mental health, midwifery, cancer treatment or burns services,” Dr Seit said. “Medical information has limited use unless it is combined with knowledge of the environmental factors associated with patients, locations and conditions. A health system underpinned with GIS technology will ultimately see us all benefit from a more precise understanding of the links between our health and where we reside, work and play.”

The study’s results were also used to create a cardiac health index, which ranks geographic areas according to fatal heart attack risk. “The Cardiac Accessibility and Remoteness Index of Australia is a simple ranking system that helps governments and local communities prioritise locations in terms of risk,” Associate Professor Clark said. “Because the index is backed by reputable research, community members and medical bodies have greater leverage to lobby governments for improved cardiac care where it is needed most. It is also a valuable tool for governments when deciding how best to distribute health care infrastructure efficiently and cost-effectively.”

Beyond the work being conducted by QUT, GIS technology is also adding a valuable perspective to researchers dealing with a large range of other medical issues. For example, the Royal College of Surgeons has been working to significantly reduce the incidence of surgery-related mortality as part of a Victorian state-wide audit, which also leverages GIS.

The Victorian Audit of Surgical Mortality (VASM) involves the clinical review of all cases where patients have died in hospital while under the care of a surgeon. The audit used GIS technology to map and analyse complex patient health care data and deliver an insight into mortality rates. “During the audit, information – such as hospital locations, patient age and cause of death – is digitally layered on a map, enabling the identification of previously unseen correlations in the data,” Dr Seit said. “Emerging trends can then be analysed, including whether location-based demographic trends, such as population and gender mix, impact mortality. Alternatively, we can pinpoint whether clinical issues are key determinants.”

Containing epidemics
The VASM is funded by the Victorian Department of Health and managed by the Royal Australasian College of Surgeons. Beyond their work with VASM, the Victorian Department of Health also uses GIS technology in other areas, including policy development and to track epidemics, such as Legionnaires’ disease.

When Legionnaires’ disease hospitalised more than 100 Victorians in 2001, it was deemed one of the world’s worst outbreaks of the disease on record. Dr Seit said after investigations found the source of the outbreak was contaminated water cooling towers, the state’s Environmental Health Unit was restructured and the Department of Health was tasked with managing disease control and prevention. “The Department partnered with us to develop a GIS solution that would provide it with a complete and accurate view of Legionella risk,” he said. The Department’s Legionella Team Leader Stuart Adcock said the GIS layers showed patient and disease data over a map of information about the state’s water cooling towers, so staff can quickly assess the proximity of outbreaks to potential contamination risks. “Thanks to GIS, we have immediate access to information about water cooling towers, such as their location, when they were last inspected and audited, or if they have a history of contamination,” said Adcock. “If an outbreak occurs, we are able to reference that data with the location and spread of the disease as well as individual case information, via a user-friendly map interface. “This enables us to visualise patterns and relationships between seemingly unrelated factors, such as the proximity of an infected patient’s home to a contaminated water cooling tower,” Adcock added.

“For example, if a case is reported from someone who frequents a particular street, we can identify all the cooling towers within a 500 metre radius. We can then narrow down and investigate potential contamination risks in less than an hour and take steps to sample and disinfect cooling towers in that area.” Adcock said the department had previously relied on paper-based maps to perform the same tasks. “That could take up to a day and there was a much greater risk that key information could be missed,” said Adcock. “Also, if more than one person in an area was affected, it could be too late to draw the key geographical linkages now readily available through GIS. “Early detection and response is crucial when people are being exposed to potentially fatal infectious diseases, and Esri Australia’s GIS solution has enabled us to achieve in one hour what previously took a whole day.”

More than a decade since the 2001 crisis, Adcock said the Department is confident it is prepared if faced with another outbreak. “Our GIS continues to guide our policy makers’ decisions on how to manage the risk of future Legionnaires’ disease outbreaks,” Adcock said. “Given the 2001 outbreaks impact on Victorian families is still being felt, the value of the GIS to future prevention, detection and response cannot be overstated.”

Health service provision
Beyond dealing with medical conditions, geographic and map-based technologies are also lending value to other health sector priorities, such as health service provision.

For example, remote South Australians who must travel to receive medical treatment are now being more consistently reimbursed by the government, thanks to an interactive, online distance calculator. Asia Pacific digital mapping and location-based data specialists MapData Services developed a clever calculator for SA Health’s Patient Assistance Transport Scheme (PATS), which subsidises travel, escort and accommodation costs when patients travel more than 100 kilometres to see a health specialist.

PATS Manager Rae Winter said the calculator, which is embedded into SA Health’s PATS website, had contributed to making the scheme more efficient, with eligible patients across country South Australia now receiving their payments eight times faster.

“The calculator makes the system more effective by having one tool used by all patients, health services providers and SA Health staff to determine PATS payments,” Winter said. “With the user-friendly interface, users simply enter their start and end destinations in the calculator and click ‘Check Eligibility’. The calculator draws on cutting-edge mapping data and technology to immediately display the travel distance from patients’ homes to their health specialist, as well as whether they are eligible for PATS and their exact payment amount.” “It provides clear, unambiguous determinations for patients so they can make informed choices about their health needs,” said Winter. “And because our staff use the same calculator to assess each application, the potential for misunderstandings or inaccurate quotes and distance calculations is removed.”

MDS General Manager Cassandra Barker said the calculator leverages South Australia’s most accurate road network data to take the guesswork out of the reimbursement process. “When delivering an important community tool such as this, it’s crucial that the underlying data is of the highest quality,” said Barker.

“The PATS calculator is updated regularly with the most current and accurate road network data available – which is very important when ensuring users are being reimbursed the correct amount. “For example, in instances of recurring medical appointments, while a patient’s start and end address may not change, the distance travelled may be different each time. The calculator takes into consideration changes that may affect the route travelled – such as new bridges, closed streets or other adjustments to the road network – and provides an accurate and updated distance travelled each time,” Barker informed. “We also recently updated the system so that patients travelling to an appointment from Kangaroo Island don’t need to manually adjust their claim to exclude the time spent on a ferry – the app automatically calculates a total that doesn’t include mileage for that distance.”

Barker said SA Health’s distance calculator provided a glimpse into the future of the health industry, where clever mapping applications will play a crucial role in service delivery. “SA Health has delivered enormous benefits to the community by creatively using our mapping data and technology to ensure their services are more accessible and transparent,” Barker said. “They join a growing number of health departments, hospitals, universities, research institutes and pharmaceutical companies across Australia and New Zealand that are discovering the value of using online mapping apps to deliver information to their users quickly, directly and easily.”