The pervasiveness of the Internet and Intranets has expanded the availability of the type of decision support provided by command centers and HSRs. Utilizing ArcIMS as the platform for establishing a situational awareness portal can harness the disparate information required for both situational awareness and preparedness. Seamless integration of critical data from multiple sources provides a clear picture of a community's health status. ArcIMS facilitates information sharing between hospitals and other relevant response organizations such as public health departments, emergency medical services, and police and fire departments.
Portals also allow the hospital to tap into emergency planning, event impact, and response modeling technologies that help management explore complex "what if" scenarios using real data—demographic, socioeconomic, health services demand, and supply. Additional impact and response models will be developed for bed capacity and clinical response planning, disease spread mitigation, and hospital resource and pharmaceutical stockpile deployment.
Much of the external information required to support portals and HSRs is already in digital form thanks to collection efforts by public agencies at all levels of government. The types and amount of health-related data routinely collected are extensive.
Linking patient geography to health effects can yield significant insights and allow the detection of otherwise unknown relationships between health events. Adding spatially enabled layers containing relevant administrative, clinical information, and environmental data allows for visualization and interpretation of otherwise "unseen" data. Hospitals, working with in-house patient registration applications or admissions/discharge/transfer (ADT) application developers, can easily add GIS tools to existing information systems.
The data needed for geospatially enabling hospitals falls into the following categories:
Admission Data—The data collected when a patient is registered into an HIS, whether through the inpatient admitting department, the emergency room, or an off-site clinic, represents one of the most important sources of geospatial information. No matter how they arrive, patients have a street address or an originating location. Ensuring valid and accurate addresses are collected at the point of care is one of the most important steps in assuring high-quality spatial referencing and is one of the most important pieces of information needed for the detection and control of communicable and infectious diseases.
Clinical Data—While a single diagnosis may not warrant alarm, a number of similar cases originating from the same area might. Applying geospatial intelligence in conjunction with clinical observations and test results can bring potentially serious disease outbreaks to the attention of medical personnel and public health practitioners.
Care Environment Data—In any public health emergency, information about the hospital's physical capacities is extremely important. Management needs to know information such as the number of available beds, locations of fixed medical equipment, and the existence of special facilities (i.e., isolation units, decontamination rooms, emergency evacuation facilities). Information about the hospital's ventilation systems has significant implications in controlling the spread of disease within the hospital.
Community Environmental Data—Data about the quality of air, water, food, and shelter becomes significant in an emergency and includes local and regional weather conditions and forecasts.
Regional Infrastructure Data—The current status of the transportation network, water and sanitation systems, and energy and communications infrastructure is critical to the logistics of response and mitigation.
Critical Events Data—911 calls, fire and law enforcement responses, calls to mental health or poison control centers, and communication and electrical outage reports often provide early warning of an event. Hospitals can benefit from this information only if there is a systematic process that aggregates and evaluates the relative geospatial importance of seemingly unrelated events.
Geocoding address information by implementing an enterprise address management and geocoding system automatically identifies incorrect addresses, fixes them, and assigns a geographic code to the data record. Consequently, addresses entered into any master registration file database will be cleansed and made actionable. Core data that requires the appending of geocodes in accordance with privacy guidelines set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPPA) include
- Patient encounters (both inpatient and outpatient)
- Clinical, administrative, and ancillary employees
- Active and inactive medical staff
- Drugs, food, and essential product suppliers
- Essential technical service personnel
Linking digital facility engineering drawings to the HIS provides a powerful method for managing and deploying physical and human assets. Using ArcIMS and ArcSDE, hospitals can create a customized bed management system integrated with facility engineering plans that features immediate display and query capabilities for locating patients, fixed assets, and care resources. In the event of a large-scale catastrophe, management can query for bed resources. The entire admission, transfer, and discharge process can be visualized on one screen in real time. The complex and multilayered process of patient care and room assignments can be easily comprehended and the relationship of patient rooms to safe occupancy zones and contaminated areas perceived.
Hospitals need to leverage existing information in new ways so that they can respond to communitywide emergencies such as bioterrorism attacks or natural disease outbreaks. While most hospitals have had a planning and management process for a large-scale event that can be predicted, they lack an automated, low-cost system that works around the clock and utilizes the existing information flow to generate actionable information.
Making sure hospitals have the information needed to manage large threats or critical events will require the use of geospatial intelligence in all hospital transactions. Building greater geospatial capacity into the hospital IT infrastructure will allow hospitals to identify and respond intelligently and quickly and will certainly improve the flow and dissemination of critical information to those who need to act.
For more information, contact
William Davenhall, Manager
Health and Human Services Solutions Group
Esri
380 New York Street
Redlands, California 92373-8100
Tel.: 909-793-2853, ext. 1-1714
E-mail: bdavenhall@esri.com
