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Vol 19, No. 10, October 2015   |   Issue PDF view/purchase
Amplifying Spatial Awareness via GIS
Tech which brings Healthcare Management, Preventative & Predictive Measures under the same Cloud

Esri is the world leader in geographic information system (GIS) technology. GIS is a powerful spatial analytic tool for hospitals and health systems in areas such as infection control, bed management, service area analysis, and data integration. Esri software is extensively used by health organizations throughout the world including 127 national health ministries, the World Health Organization (WHO), US Centres for Disease Control and Prevention (CDC), all 50 U.S. state public health departments, and over 400 hospitals.

About the interviewee

Dr. Este Geraghty is Esri's Chief Medical Officer and Health Solutions Director where she leads the health and human services sector team, focusing on the improvement of health through strategic use of geographic information systems. Formerly the Deputy Director of the Centre for Health Statistics and Informatics with the California Department of Public Health, Dr. Geraghty led the state vital records and public health informatics programs.

There she engaged in state-wide initiatives in meaningful use, health information exchange, open data and interoperability. Dr. Geraghty maintains her academic appointment as an Associate Professor of Clinical Internal Medicine at the University of California at Davis. Her research focuses on using geographic information systems to influence health policy and advanced community development programs. In addition to her degrees in Medical Informatics and Public Health, Dr. Geraghty is also a board certified internist and public health professional as well as a Geographic Information Systems Professional.

Lin: What brought you to join Esri as a Chief Medical Officer?

Estella (Este): While I was studying for my medical degree, I was already interested in computers and technology and my interest was adequate enough for me to pursue an additional degree in Health Informatics. During my residency in a hospital, my advisor thought I was very suitable to remain in the academic field and have a career in research and publishing. He was accurate enough that I received an award to pursue a postgraduate degree in Public Health that ultimately emphasized Spatial Epidemiology with the coursework including Geographic Information System (GIS). It was the best combination of my interests: medicine, public health and computer science.

I have worked as a lecturer in Healthcare GIS and worked on some Spatial Epidemiological research at University of California Davis (UC Davis). Prior to joining Esri as Chief Medical Officer, I established the California open data portal at the State Health Department; a data library which allows researchers and anyone with a topic of interest in population and space to work with or download data and create visualizations, including maps. Some of the ideas and innovations were far beyond of what I have imagined when I initiated the data portal.

Esri opened up a new opportunity. Here, I am able to use my expertise by applying GIS in global healthcare.

Lin: From your experiences, what makes a good data?

Este: At Esri, we have packaged tools to review the quality of the dataset, e.g. the limits, outliers and confounders. Though there are automated tools, it is important for the user to be equipped with the statistical knowledge for inference purposes. We also have a data team who cleans the datasets as necessary. An example of a frequently used dataset is the US Census data, which requires some efforts to prepare the data in the correct format for further analytical work.

Lin: Is Esri’s software ‘R’ friendly? (R-software is an open source statistical programming language, one of the preferred languages among statisticians and epidemiologists)

Este: Yes, in fact, Esri’s software is integrated with R-software and Python. It is completely configurable, and users are able to customize the tools. Esri’s software offers transparency to the users.

Lin: Data is everywhere, and including Cloud services, if data were to remain in the storage area and not analysed, there is no good reasoning for continuous data collection. What are the different approaches we could employ to utilize and translate data analytical work to healthcare?

Este: We could begin by using tools that allow for simple data integration. Esri software allows this by standardizing or linking that data based on its geographic variables, e.g. exact location of where you are, to the postcodes, the regions, or the prefectures. In the context of healthcare, patients are then followed-up, and information can be collected for meaningful analytical research work and to assess clinical outcomes. For instance, we can evaluate the performance of a treatment in a hospital or identify the need for more resources in a type-specific disease.

Esri makes climate data such as air quality and pollution available. Researchers and clinicians could use such information to assess the frequency of asthma attacks among children residing in different regions or postcodes. Health outcomes can be easily analysed and visualized, resulting in powerful decision-making tools for better health care and treatment options in the clinical environments.

Lin: How would Esri be helpful for a residential area where huge income inequality gap exists?

Este: Esri helps analysts understand income and other types of disparities through its analytical and visualization tools, and for many countries, data resources. All of these resources can provide insights that can improve the health in underserved neighbourhoods such as where there is a need for a language translator for better health awareness and available health supports like vaccination programmes, health checks, and the like. Understanding the neighbourhood characteristics might inspire appropriate programs such as diabetic education or senior centres where they are truly needed. Better resources allocation and decisions-making results when you are able to visualize patterns of need geographically.

Lin: A number of developing countries are able to access the Internet for free; source via Mark Zuckerberg and Facebook. Most of the infectious diseases spread very rapidly in developing countries, how would access to GIS tools reduce disease transmission rate and may be a predictive tool for the next disease outbreak?

Este: The Ebola outbreak is a prime example of the value of GIS tools for better disease control. For example, Esri assisted the Centre for Disease Control and Prevention (CDC) and the World Health Organization (WHO) in their efforts to control and manage Ebola in West Africa. Throughout the crisis, Esri’s ArcGIS software was used to evaluate disease spread, site treatment units and speciality labs, understand cultural practices around burials, languages spoken, transportation routes and more. With such information, health authorities were able to allocate resources and facilities for diagnosis, treatment and care of infected patients.

With GIS mapping, important epidemiologic tasks such as contract tracing (a method to identify and diagnose any persons who may have come into contact with an infected person) can be performed in the field. In the case of Ebola, many people came into contact with the virus through the burial process. In West Africa, the traditional burial process often involves cleansing the body of the deceased by hand. Unfortunately, the Ebola virus can be transmitted from a deceased individual after death and thus this burial process became an important risk factor for contracting Ebola. Maps helped to direct dignified burial teams to the villages where they were needed. They also helped those teams identify appropriate religious leaders to assist bereaved families in safer dignified ways to bury loved ones.

The mapping procedure for Ebola was not a straightforward process. It turned out that the locations and populations of villages in West Africa was not well described or mapped. As experts sought to create foundational maps, they discovered things like the name of a town or a village would appear multiple times in a single prefecture. This could be problematic, for example, when an individual with Ebola disease symptoms steps into the clinic and states only their village’s name. If the correct village is not identified in a timely manner, it’s possible that delays in contact tracing could lead to increased disease spread. Accurate mapping enhances the ability of our public health officials to monitor diseases and predict future outbreaks.

Esri’s ArcGIS platform is also applicable to vaccination programmes wherefore better cost effectiveness can be achieved.

Lin: How does existing data help to forecast and prevent future catastrophic events?

Este: I’m a big believer in the One Health Initiative. This initiative broadens our perspective so that we are not restricting our analysis to humans alone. We should also consider animals and the environment. For example, in the case of Ebola, some researchers/responders focused on the likely transmission-vector, fruit bats. They reviewed preferred habitats, such as palm trees, and mapped the Palm trees density in different regions to provide clues for surveillance teams.

Lin: What are the goals that Esri would like to achieve in the next five years?

Este: Traditionally spatial analysis and visualization have been performed with single desktop software licenses. While this method has produced value in countless examples, more modern approaches to using Esri’s software, as a platform and across an organization, are far more powerful. A platform approach enhances collaboration, sharing, and the opportunity to leverage geographic information for decision-makers everywhere within the organization. I would love to see health and human services organizations adopt the ArcGIS platform approach in ways that will improve population health outcomes, create efficiencies that reduce costs, and increase patient satisfaction with the services they receive.

One way that we plan to make platform adoption easier for organizations is to create solutions for the different industries we serve that will provide them with a number of information products that can be used immediately. Early successes will inspire more broad spatial thinking and benefit.

Lin: And what about educating students on GIS or other coding courses?

Este: Esri has been operating for 46 years and we have over a million users around the world. With such a large customer base we recognize the importance of continuing spatial education and have a team fully dedicated to that mission. Esri also has numerous training materials available from free courses online or in-person trainings to tutorial books and conference to detailed documentation of our tools. Learners have many opportunities to increase their knowledge of GIS and how to place matters in health. We even have paid summer internships that offer students practical experience in applied geography at Esri.

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