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Geo-Medicine New Frontier In Medical Informatics

Can it reveal hidden disease patterns?

 Health IT specialists will soon want to know more about a field called geo-medicine, which combines geographic information system (GIS) software with clinical databases to provide insights that might improve individual and population health. While most of the activity is still confined to academic research, GIS firms have begun to explore its commercial potential as well.

According to Esri, a Redlands, Calif.-based GIS vendor, "A geographic information system (GIS) integrates hardware, software, and data for capturing, managing, analyzing, and displaying all forms of geographically referenced information." A GIS application allows users to plug data into electronic maps to find out where particular things are, measure the quantity or density of those things in certain geographical areas, or find out what's inside a particular area or what's nearby.

By combining electronic health record data from primary care clinics with patient addresses and socioeconomic data for particular areas, the researchers found an association between socioeconomic status and levels of HbA1c--a measure of long term blood sugar control--but did not find one between socioeconomic status and LDL cholesterol control.In healthcare, researchers could use this approach to find correlations between health conditions and the geographical areas where patients live. In a 2010 study in the Journal of the American Board of Family Medicine, for example, investigators from the University of California Davis School of Medicine used GIS software to investigate outcome disparities in patients with type 2 diabetes and hyperlipidemia.

Loma Linda University Medical Center in southern California is also exploring the uses of geo-medicine, according to an article inThe Atlantic Cities. Dora Borilla, an assistant professor at Loma Linda's School of Public Health, said her team is geo-coding patient addresses for use with GIS software so that they can show how "where you work and play impacts your health." She views this as a step toward improving the health of the population that her hospital serves.

Bill Davenhall, a healthcare manager at Esri, told The Atlantic Cities that consumers can use GIS mapping to correlate their health conditions to environmental factors in the areas where they now live or where they grew up. His company offers a free iPhone app (soon to be available for Android phones) that enables individuals to link public health information to their environmental experience. Called My Place History, the app uses datasets from the Dartmouth Atlas of Health Care, the Environmental Protection Agency, and the National Library of Medicine.

Estella Geraghty, MD, lead author of the outcomes disparities article and an assistant professor of clinical internal medicine at UC Davis, told InformationWeek Healthcare that she sees growing interest in GIS in healthcare and attributes this change largely to the rise of mobile phone apps.

"Nearly everybody with a smartphone has some application that involves geography. So there's an increasing awareness of the importance of geography."

However Geraghty reserves the term "geo-medicine" for applications that clinicians can use at the point of care. "The patient is in the office, and the doctor is going to make a recommendation or provide resources based on where that patient lives."

Geo-medicine might even become part of the visit summary that many doctors with EHRs print out for patients before they leave the office. If a patient were obese, a medical practice could program its EHR to print out "resources for obesity" along with the summary. Among those resources, suggests Geraghty: "All the Jenny Craigs or Weight Watchers and Nutrisystems and safe places to walk in that person's community."

However, "we have to think carefully about the kinds of things we design that people can act upon. That's the biggest challenge--making it clearly relevant," Geraghty cautioned. For instance, she noted, it doesn't make sense to look at a patient's geographical exposures to substances that might cause lung cancer, because there are no screening tests for lung cancer.

Geraghty acknowledges that GIS is still more relevant to public health than to clinical practice. "It really has been useful in public health. It's a great tool for [disease] surveillance and for understanding the epidemiology of illness or environmental exposures. But the challenge is to use some of that data in the healthcare arena--and I think there are ways to do it."

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