GIS Jump Start for Health Professionals

By Kristen S. Kurland

Now, more than ever, professionals can benefit from the power of location data, maps, and analytics in healthcare.  

Health professionals see the importance of the who, what, when, and where of data analytics. The “where” adds a crucial element because good healthcare begins locally and understanding the impacts of place leads to better health. Health professionals recognize the insights gained from visualizing and analyzing location data. Maps, dashboards, apps, and charts can serve as location analytic tools to quantify problems, make predictions, improve operations, assess infrastructure, and make better decisions overall.

GIS Jump Start for Health Professionals is a concise workbook that introduces location analytics available in geographic information systems (GIS) to health professionals, medical students, residents, fellows, nursing students, medical researchers, and others interested in health IT and informatics, health-care administration, and health policy. GIS Jump Start for Health Professionals provides hands-on tutorials that introduce the ArcGIS tools and shows how to use web-based data, storytelling apps, and much more. The book includes concepts and short video lectures to improve learning outcomes. Focused lessons get health professionals up and running quickly and experiencing first hand the value of location data, maps, and analytics.

Written by Kristen S. Kurland, an award-winning professor at Carnegie Mellon University and co-creator of the GIS Tutorial series, this book can be used as a short course or incorporated into another course. It is also valuable to self-learners who want location technology experience. 

• Language: English
• Publisher: Esri Press
• Release date: Sep 14, 2021
• ISBN: 9781589486546

Kristen S. Kurland

Kristen S. Kurland is a Teaching Professor of Architecture, Information Systems, and Public Policy at the H. John Heinz III College and School of Architecture, Carnegie Mellon University, where she teaches GIS, building information modeling, computer-aided design, 3D visualization, infrastructure management, and enterprise data analytics. 

Book preview

Chapter 1

Introducing GIS for health

Objectives

Examine a GIS definition.

Explore GIS for health applications.

Discover unique capabilities of GIS.

Learn about map layers.

Understand GIS through a case study.

Introduction

If you have ever used maps to find places, you know that they often work well. The actual streets are shown, and they lead you to the retail store, lake, or whatever you are seeking. Similarly, sailors use nautical charts to avoid hitting reefs, and travelers use maps to find points of interest in unfamiliar lands. Maps are also used to understand important health-related themes, such as the prevalence of diabetes across different parts of a country or the locations of underserved populations. Often such needs are served by using a geographic information system (GIS), as well as computer-based, dynamic mapping, and spatial analysis systems. You will explore a more thorough definition of GIS in the next section.

Place-to-place directions are an example of reference mapping. The real power of a GIS, however, is its analytical mapping capabilities. Analytical mapping involves collecting digital data; creating map compositions; interacting with and understanding spatial data; and finally sharing maps and analysis results with others via reports, posters, or web applications such as ArcGIS® StoryMapsSM stories and using ArcGIS Dashboards. Modern GIS applications integrate and interoperate with other products, such as machine learning tools, medical records, or advanced statistical applications.

A GIS is no longer a tool used only by specialists but by many users in an organization. GIS skill-set needs range from online maps that are easy to create and use to complex analyses and enterprise deployments and administration. Organizations are using maps to tell stories and reveal patterns, trends, and relationships about many things related to location. Real-time visualization and analytics make sense of data through location intelligence. Field collection and dashboard tools allow you to not only view but also dynamically interact with the data. Data from disease registries, data warehouses, and electronic health and medical records is visualized and analyzed in 2D, 3D, and 4D. 3D GIS adds a new element to visualizing, analyzing, and communicating health data. Integration with tools such as building information modeling (BIM) allows for better infrastructure management of clinics and hospital buildings. 4D GIS is used in health care to monitor and visualize spatial data over time. Data and events such as disasters, disease, weather, and so on, along with statistical and machine learning tools, enable real-time integration of spatial and temporal data to capture and describe dynamic processes.1 And on a practical level, operations management with GIS is used by cities and health-care organizations to manage day-to-day location-based tasks, such as scheduling operating room times or home-care delivery services.

Modern capabilities, such as smart mapping, bring professional-grade cartographic skills to every user, making it easy and quick to create beautiful and informative maps using GIS. But to use it well, you must learn certain principles and concepts that will be covered in this book. In later chapters, you will gain hands-on GIS experience using a web viewer, ArcGIS StoryMaps stories, websites for downloading data, and dashboards. The power of modern GIS is in web-based applications that integrate effectively but have some limitations in spatial data processing and analysis. For those who want to exercise deeper analytics skills, consider learning desktop GIS, such as ArcGIS Pro, which includes advanced GIS tools.

Definition of GIS

What exactly is a GIS? Clarke (2003) contends that there is no single good definition of GIS; there are many.2 Various industries might be influenced by existing definitions, but below is a brief one proposed for those who are interested in applying GIS to health projects:

GIS is a computer-based, dynamic mapping system with spatial data processing, querying, and sharing capabilities.

We will analyze each part of this definition.

Computer-based: Clearly, GIS is a computer technology. You will be using web technologies on your computer to learn GIS. Desktop and enterprise GIS applications are used for advanced functions.

Dynamic mapping system: A GIS is not a static map or picture, but a changeable system that you control. With a GIS, you can compose, view, and share your own maps. You change colors as you desire, zoom to get details, turn parts of the map on and off, get recorded data by clicking mapped features, and so forth.

Spatial data processing: You can create points on a map, such as a patient address or a clinic location. You can symbolize map features automatically using their accompanying data values. (You will learn more about map design in chapter 2.) Map layers and geospatial data can be manipulated for advanced analysis.

Data and spatial queries: You can also perform data queries. For example, you might find and highlight patients with a particular disease. In addition, you can perform spatial queries such as the number of patients within a given proximity to a health center.

Sharing capabilities: Modern GIS applications allow you to not only create your own GIS maps but also share your maps with other colleagues, teams, or the public. You can also share your maps for use in other GIS applications, including stories, dashboards, or web applications. Further, data from a GIS can be shared in other statistical and analytical applications.

This dynamic mapping system integrates many types of physical, biological, cultural, demographic, economic, and other information to reveal spatial relationships and patterns. Using map layers and advanced analytical tools, a GIS delivers deeper insight into data, information, and root causes that leads to smarter decision-making.

GIS for health applications

Although the roots of GIS in health can be seen in the writings of Hippocrates (fifth century BC), plague maps in Europe (1694), and cholera mapping by London’s Dr. John Snow in 1854, GIS as we know it today began in the 1960s and was used primarily in the government sector. Early computerized mapping systems for governments included land use, cadastral data such as parcels and property records, and managing assets such as utility lines.

Much has changed since the early years, and with the modernization of mapping applications, GIS is expanding to many industries, including health and human services. A movement to web and cloud computing, integration of real-time information, the Internet of Things (IoT), mobile computing apps, machine learning, automated workflows, and much more have enabled organizations to unleash the power of GIS as a platform relevant to understanding and communicating many of the health issues our world faces today.

Why are so many in health-related fields now seeing the benefits of managing their organizations using GIS? The answer is quite simple: GIS is a powerful tool to enhance the way health agencies do business since consumer access to health care is in part controlled by geographic location. In fact, research indicates that, in the case of some health issues, your postal code is just as important as your genetic code.3 Health policy, public health, research, planning, and management are increasingly important in the role of health informatics. Health information systems are being automated and geospatial information is becoming commonplace, sometimes at a large cost but with even larger benefits.

What does this mean for health GIS applications? One consequence is that there will be even more data available for possible input to GIS—additional data about patients, facilities, programs, and events that include disease incidence, medical diagnostics, and treatments. Much of the additional data will include street addresses, postal codes, or other location elements that will make it applicable to GIS processing.

Public health agencies use GIS to map health status, identify disease clusters, investigate environmental health problems, and understand the spread of communicable and infectious disease. Best practices such as the 10 essential public health services use GIS to access and monitor population health and community needs, inform people about health issues, enable equitable access to health services, and much more.4 Human services and health-care policy agencies use smart mapping and analysis to see where programs can address the aging population, food insecurity, homelessness, poverty, and other issues facing our world today.

GIS is used by hospitals and private health organizations to manage costs, provide better access to health care, and improve patient outcomes. GIS is not only an application for large geographic areas; it can also be used for smaller areas and indoors. For example, hospitals and clinics can determine areas of infection, improve the physical conditions of health-care spaces, and optimize patient flow and navigation in a hospital.

You will look at a few GIS examples for health industries.

Health-care delivery: The business of GIS

Managing health-care costs by efficiently meeting population health and patient needs with available resources is central to every health-care organization. GIS provides an effective way to visualize, organize, and manage a wide variety of information, including administrative and medical data, social services, and patient information. Being able to quickly analyze existing health-care markets and to ascertain the likely demand for services requires flexible yet powerful analytical tools, such as those within a GIS.

Spatial data processing tools enable health-care service providers to identify new markets and align their current service mix by analyzing current or projected patient population locations and needs. Synthesis of geospatial data can be used to identify new site locations or areas for community intervention. GIS offers a provider the ability to study the location and demographics of patients and competing services to improve strategic planning and productivity.

As an example, market studies documenting community health-care needs related to preventive care and access to health services can be produced in a GIS. Health-care provider information, such as hospital and clinic locations, can be mapped and compared with patient locations or their medical conditions to determine service and referral areas.

Social determinants of health are important to the study of health-related conditions, and these vary from place to place. By highlighting and mapping economic and demographic data such as income, age and sex, race and ethnicity, education, and employment alongside health outcomes, an overall picture of health and disparities emerges in a community. Businesses related to health-care delivery, such as clinics, pharmacies, or healthy food sources, can be mapped to determine whether populations in need have adequate access to such resources.

Based on a drive toward continuous quality improvement (QI) and accountability, hospitals and private health-care practices aim to evaluate and enhance key quality, patient satisfaction, and performance metrics. Because of its ability to inform where targeted patient interventions should take place, GIS is often a central component of population health, quality improvement, and safety projects. For example, there is a growing focus on reducing hospital readmissions, improving patient satisfaction, and lowering health-care costs. By extracting data from a hospital’s electronic health record, location-based analysis of patients with high readmission rates may show patterns of overutilization or inadequate primary care access. Defining geographic areas for intervention opportunities could improve both health outcomes and health system costs.

A recent project for a pediatric hospital studied patients with limited English proficiency (termed English learners) and found that their readmission rates were three times higher than English-proficient patients. Using GIS and data from the hospital’s emergency department, along with US Census data of English-learning households identified by neighborhoods (as seen in figure 1-1), target areas were identified for language-appropriate education and outreach. Thus, GIS supports strategic plans such as promoting a hospital’s language access services to impacted English-learning communities, connecting local social services to families, and identifying potential partnerships between community organizations, schools, and this patient population.

Map of Pittsburgh, Pennsylvania, with neighborhoods symbolized by the percent of English-learning households in four colors that represent 0 to 2 percent, 2 to 4 percent, 4 to 8 percent, and 8 to 12 percent. Neighborhoods with the highest values are labeled.

Figure 1-1. Map showing English-learning households across Pittsburgh, Pennsylvania, labeled with the top 10 neighborhoods targeted for outreach.

GIS can also be used for marketing and promotion within health-care organizations. Getting the right message to the right market requires a high degree of precision. Patient data that has been mapped can be used to profile responses to various advertising programs and help refocus messages to targeted market segments. Health-care service providers can also use interactive maps on tablets or smartphones to provide accurate and timely information about various service locations and navigation instructions for patient use.

These are just a few examples of how geospatial and location data are used for business and patient care decisions related to health and medical services.

GIS for health insurance agencies

Health insurance organizations are seeing the benefits of GIS to help tackle medical conditions that contribute to rising health-care costs. An example of using GIS to address the increasing prevalence of obesity (and associated problems such as type 2 diabetes) involves not only mapping the condition but also using multiple layers of information to address the problem. Environmental and other factors might contribute to the development of obesity, and a cross-disciplinary approach is needed.

In a recent project, a health insurance organization, partnering with a county medical society, examined the staggering costs of obesity in terms of economic, health, and social impact. They concluded that collaborating with multiple disciplines was the only way to find sustainable solutions. A task force of architects, city officials, school superintendents, medical directors, physicians, nurses, and other health-care providers reviewed how obesity was addressed comprehensively at federal, state, and local levels. GIS was a key instrument used by this group, facilitating their ability to work together to find solutions.5

A GIS committee mapped built environment features such as sidewalks, access to parks, recreation, and healthy food resources. Using these maps in a clinical setting, health-care providers helped patients see where they could be more physically active and pursue a more balanced, healthier diet. Added layers of street lighting and crime data helped architects, city planners, and government officials improve neighborhood safety.

One member of the task force, the director of physical education for Pittsburgh public schools, used GIS to determine how much green space was within a 10-minute walk from elementary schools. Figure 1-2 shows two map examples plus survey results of potential physical activity spaces for each school. Finding nearby green space was necessary because many building conditions and lack of playgrounds and fields made physical activity at some schools difficult. Using the maps and surveys, school and city officials determined which schools were a top priority for improving access to green spaces.

Map of Morningside Elementary School showing its close proximity to green spaces, and map of Minadeo Elementary School showing no green spaces in close proximity. Each image contains a table with attribute fields for gym size and type, playground size, field size, sidewalk, and other related attributes.

Figure 1-2. Maps comparing two schools, one with good access to green spaces and one with a lack of access.

Based on research by the task force and others, it was shown that access to green space improves mood and mental health, especially for low-income populations. Today, many cities are investing to achieve a 10-minute walk to green space for all residents.6 Mapping existing green space (or locations of potential green space, such as vacant lots) along