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Interoperable solutions to track disease outbreaks

Interoperable geospatial solutions could enable communication and decision making between agencies such as the World Health Organization, public health authorities, research institutes etc, to address inequities in access to health care. Interoperable geospatial solutions could also assist with rapid identification of urgent national risks, including international health emergencies like SARS or pandemic influenza, by seamlessly integrating surveillance data from the periphery to the central government for quick analysis and decision making. More recently, crowdsourcing and sensor Web enablement serve as location-based data to syndromic surveillance. In this way, interoperable solutions bring together epistemic communities, facilitates content gathering, and enables evidence-based decision making which could minimise duplication and conflicting actions by diverse agencies responding to a health emergency, environmental hazard, or pandemic.

Evidence-based decision making in public health and safety was one of the four priority themes at GeoConnections in constructing the Canadian Geospatial Data Infrastructure (GeoConnections, 2006), during that time over 25 health-related applications were developed within the CGDI. As the technology matures, the number of GIS Web-based systems will grow and the need to exchange geospatial data with a wider audience will increase. The advantage of CGDI for accessing spatial data and spatial analysis to the health community is for low cost, quick, and comprehensive models that help to address health problems. CGDI has adopted many specifications addressed by ISO/TC211, OGC, FGDC and W3C in describing, publishing, visualising, accessing and manipulating geospatial resources, such as Catalog services interface, Web Map Service (WMS), Styled Layer Descriptor (SLD), Web Feature Service (WFS), Web Processing Service and so on. These services can be chained together to implement complex tasks by the defining of the workflow process. Using a distributed network to facilitate the discovery, sharing and use of the spatial data and services, at low cost, is attractive to end-users.

Time-series maps

For example, the New Brunswick Lung Association created an application in the CGDI for a pandemic exercise, enabling users to visualise time-series thematic maps of an influenza pandemic data using OGC WMS, WFS, and WPS, along with Time Tag Specifications.  The time-series maps revealed corresponding trends and impacts to school absenteeism, hospital admissions, drug sales, fuel and food supply.  Interruptions to public transport, essential services, and critical infrastructure could be plotted on the map. This ‘Common Operating Picture’ enabled decision makers at local, provincial, state, and national levels to identify triggers for action (disease control), plan options for recovery, and ensure the continuity of critical infrastructure and essential services.  The maps and data could be queried, classified, overlaid, highlighted and shared by multiple concurrent users of Web and mobile applications.

Health information privacy and IT security are important considerations and can constrain the availability of data even in aggregate map form.  Privacy laws enable inter-jurisdiction data sharing, but are prohibitive to research related use of personally identifiable health information. Current Privacy Laws dictate that the security of health data should be maintained at all times.  The current standards and rules in dealing with spatially visualising confidential information are seriously limited (Leitner, 2006).  Since health data is confidential, the CGDI protects the security of the data through transactional web map services (which hide the original data used to generate thematic illustrations).  The New Brunswick Lung Association’s web mapping portal provided a statistical and geographical mask with data aggregations to certain levels to share disease information. The Association’s web mapping portal enabled temporal, spatial, and statistical computation on the fly of distributed data and data embedded in the system.  A similar example is provided by Raoul Kamadjeu and Herman Tolentino, who illustrate the configuration of a system capable of producing thematic map showing country immunization coverage at the district level, by country, for the specified antigen and period, without compromising individual patient’s identity and status.  The EO2HEAVEN project (www.eo2heaven.org) funded through the European Commission’s 7th Framework Program, also addressed privacy issues through aggregation of health data. Open standards (OGC) and interoperability were vital to the EO2HEAVEN project both in terms of cross-domain communication among partners in diverse fields and locations, and in order to facilitate the integration and analysis of spatial, temporal, and epidemiological data.  The project focused on monitoring health impacts from environmental changes, including air and water pollution, and climate change, including effects on allergies, cardiovascular and respiratory health, and for emergence of cholera outbreaks.

In the first decade of the twenty-first century epidemic as well as endemic disease is again an urgent contemporary challenge.  A highly pathogenic influenza pandemic could disrupt international trade and threaten continuity of government and society as we know it virtually at any time. Geospatial applications enable both information sharing and collaboration – both are fundamental to disease prevention, community health and global health policy alike. Applications that leverage interoperable geospatial services and spatial data infrastructure can facilitate novel research, rapidly identify ‘hot spots’ for prevention, provide practitioners, planners and managers with information to improve services / reduce population vulnerability, initiate and evaluate interventions to reduce exposures (at individual and population levels), and aid in the dissemination and education of policymakers and civil society alike. Geospatial applications can facilitate inter-disciplinary knowledge gathering and draw together epistemic communities (health, safety, environment) to help remove inequalities in basic health care and respond to environmental determinants of health. For example, research institutes and health organizations are examining population vulnerability to heat events and adopting spatially explicit approaches to heat response planning for various cities around the world.

The ultimate goal for global and national health policy is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The economy of scale is present when epidemiological research and health planning communities utilize interoperable geospatial solutions to manage health programs, address inequalities in health care provision, access, and promotion, improve understanding of the burden of disease, support mobile and eHealth applications, telemedicine etc. – that can be scaled up during novel disease outbreaks and pandemic response efforts.  Web-based GIS and interoperable geospatial standards offer a timely solution to a historic challenge – our understanding of disease ecology, human behaviour, the conditions that lead to disease outbreaks and population health vulnerabilities, and how public health systems and society may adapt in order to confront health issues in the 21st Century. 

Seeing the growing need for interoperability in Healthcare, Epidemiology, and other health fields, members of the OGC (www.opengeospatial.org) have co-initiated an OGC Health Domain Working Group.  This new Domain Working Group will look at how OGC standards can support applications that enable users to exchange, integrate, and visualize distributed health and environmental information. Applications include, for example, chronic illness, public health resources, critical infrastructure, pollution, meteorological information, and pandemic surveillance and control.