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Hospital management and development

HOSPITAL MANAGEMENT
AND DEVELOPMENT
052 ADVANCING HEALTH CARE SYSTEM PERFORMANCE
WITH GEOINFORMATICS
SETH WIAFE

055 DESIGNING STRONG LINKS TO NATURE

TYE FARROW

058 SPONSORED FEATURE: THE 411 ON THE ROAD TO

HEALTH CARE
SHEILA MURRAY

059 PATIENT PRISONER SECURITY – A CALL TO ACTION

THOMAS A SMITH

062 HEALTHY CHOICES IN HOSPITAL VENDING MACHINES

AND CANTEENS?
CHRISTINE HANCOCK, KATY COOPER AND KAREN SIEGEL

International Hospital Federation Reference Book 2007/2008 049

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ESRI—The GIS Company™

On any given day, more than one million people around the
world use ESRI geographic information system (GIS) software
to improve the way their organizations conduct business. ESRI
GIS solutions are emerging as an integral component of health
organizations in addition to nearly every other type of business
and government service.

By adding a geographic component to data and analysis, ESRI

software promotes exploring, analyzing, and visualizing massive Headquarters: Redlands, California
amounts of information according to spatial relationships. Since Locations: 10 office locations (USA);
most health and human service problems facing the world 80 offices and affiliates (worldwide)
today exist in a location-based context, geography can play a
Employees: 4,000 worldwide
major role in helping health professionals understand health
dynamics and the spread of disease. Health surveillance systems Founded: 1969
are used to gather, integrate, and analyze health data; interpret
Founders: Jack and Laura Dangermond,
disease transmission and spread; and monitor the capabilities
who maintain private ownership and a
of health systems. GIS is the enabling technology to spatially
zero-debt company
relate much of this information, making it a very powerful tool
for identifying, tracking, and responding to disease patterns and Focus: GIS software development
health services needs.
Health Applications
ESRI is the world leader in GIS technology. Its innovative s $ISEASE3URVEILLANCE
software solutions and professional services help health
organizations use and compare disparate datasets—such as s 6ACCINE4RACKING(OSPITAL
emergency room, laboratory, pharmaceutical, and immunization s "ED#APACITY-ANAGEMENT
registries—to detect and manage disease outbreaks.
s !CCESSTO#ARE
Applications also permit control over data access and health
information privacy. s (EALTH3ERVICES2OUTING

ESRI software is extensively used by state and national public s %MERGENCY-ANAGEMENT

health organizations throughout the world, including the U.S. s #LAIMS!NALYSIS
Centers for Disease Control and Prevention and the World
s 3ITE,OCATIONAND!NALYSIS
Health Organization. In addition, more than 85 country-level
health ministries, thousands of scientists, and hundreds of s 3ERVICE!REA!NALYSIS
hospitals benefit using GIS tools from ESRI. ESRI offers its s $ATA7AREHOUSING
solutions through a global network of regional U.S. offices,
s $ATA)NTEGRATION
international distributors, and more than 2,000 authorized
business partners. s 3TRATEGIC0LANNING

Contact: Ann Bossard, Hospitals and Health Systems Specialist, s #OMPETITIVE!NALYSIS

ESRI Health and Human Services Solutions s &ACILITYAND!SSET-APPING
abossard@esri.com s )NVENTORY-ANAGEMENTAND4RACKING

Copyright © 2007 ESRI. All rights reserved. The ESRI globe logo, ESRI, ESRI—The GIS Company, and @esri.com are trademarks,
registered trademarks, or service marks of ESRI in the United States, the European Community, or certain other jurisdictions. Other
companies and products mentioned herein are trademarks or registered trademarks of their respective trademark owners.
52-54 Seth Wiafe 7/1/08 12:38 pm Page 52

Hospital management and development: GIS

ADVANCING HEALTH-CARE
SYSTEM PERFORMANCE WITH
GEOINFORMATICS
ARTICLE BY SETH WIAFE

Abstract

Health-care systems represent robust and demanding information environments that require comprehensive
infrastructure capable of addressing inadequacies in existing systems. Although several modern
geotechnologies have been available for over three decades, most healthcare systems and public heath
agencies have incorporated only a limited number of these innovative technologies into their routine
practices. Understanding geoinformatics capabilities in the health-care industry as a decision support system
in responding to health-care challenges associated with assessment, assurance, and policy development is
needed.

G
eography is important in
understanding the dynamics of
health causes and spread of
diseases1. Any attempt to advance quality
improvement in health care requires
geospatial consideration and
implementation of geoinformatic science
and technologies such as geographic
information systems (GIS), global
positioning systems (GPS), and remote
sensing applications. Recent progress in
geotechnologies has intensified the need
for evidence-based spatial decision
support systems (SDSS) in health-care
practices. A GIS integrates data from
multiple sources, providing the ability to
analyze and visualize how data relates
over space and time2. The use of a GIS
requires the creation of geospatial
databases, appropriate hardware and
software acquired, applications developed,
and all components installed, integrated
and tested before users can use it. This
usually occurs after a thorough needs
assessment and analysis of the benefits of
GIS for the organization. This paper
provides a snapshot of the benefits of GIS
and related technologies and how they are
being used in health-care systems.
Geoinformatics in health care
Health geoinformatics combines spatial
analysis and modeling, development of
geodatabases, information systems
design, human-computer interaction and
networking technologies to understand
the relationship between people,
environments, and health effects. GIS
provides the opportunity of linking
databases to maps, creating visual
representation of statistical data, and
analyzing how location influences
features and health events on the earth’s
surface.
Within the last decade, the world has
experienced some catastrophic events
that clearly provide evidence of the
importance of state-of-the-art health
information systems (HIS). The events of
11 September 2001, provided an
enormous evidence of the need for spatial
information in rescue missions and
emergency preparedness efforts. Since
“9/11”, several health agencies have
adopted GIS for immediate rescue,
response, and long-term recovery efforts.
Plans to process data and train personnel
to prepare them for emergencies before
they occur have been developed. The
Severe Acute Respiratory Syndrome
(SARS) outbreak took public health
experts by surprise while establishing an
insurgence of fear among communities
everywhere. SARS was present in 28
countries by affecting over 7000 possible
cases with over 600 deaths between
November 2002 and May 20033. The
success of containing SARS was
attributed greatly to the Global Outbreak
Alert and Response Network (GOARN),
an electronic network developed by
Health Canada, used extensively by World
Health Organization (WHO) since 1997
as an early warning system4. Mapping
technology was used to help victims
in December 2004 after a massive
earthquake struck Sumatra island and
triggered a tsunami that killed more than
230,000 people in a dozen countries,
including 160,000 in Indonesia’s province
of Aceh. As a collaborated effort, Mercy
Corps, working with the University of
Washington and the Pacific Disaster
Center5, used GIS mapping technology to
plot everything from village survival rates
to access to destroyed fish ponds6.
Compared with other public services as
natural resource, urban planning and
transportation, it is evident that the full
capacity of GIS in health-care
management has not been fully explored.
There is limited evidence that GIS are
being formally considered or regularly
used in strategic decision-making in any
major health-care planning system7.
Several initiatives that advocate the
inclusion of GIS operations at different
stages of health-care planning and
management have been noticed. In 2003,
GIS was recognized as an emerging
information technology that can be used
to enhance the ability to prepare for and

052 International Hospital Federation Reference Book 2007/2008

52-54 Seth Wiafe 7/1/08 12:38 pm Page 53
Making health data
timely, accessible, and
linking them to various
public and private data
systems will solve many
of the health
information challenges
facing health-care
systems
respond to public health emergencies8.
Several organizations including the WHO
are committed to support countries in the
adaptation and integration of GIS within
their respective health-care programmes.
In an address to his staff, the Director
General of WHO, Dr Lee acknowledged
that, “Health information is the glue that
holds a health system together.” WHO
plans to establish a health metric network
to fulfil the health information
inadequacies9.
Making health data timely, accessible,
and linking them to various public and
private data systems will solve many of the
health information challenges facing
health-care systems10. Successful adoption
of GIS by health-care managers and
policy-makers depends on understanding
the spatial behaviours of health-care
providers and consumers in the rapidly
changing health-care landscape and how
geographic information affects these
dynamic relationships.
Geoinformatics in emergency reponse
In most cases, linking emergency
resources with victims creates a
geologistical challenge. A big part is the
fragmentation of emergency services and
lack of a central communications clearing
house. To address this challenge, Loma
Linda University Medical Center (LLUMC)
has developed an integrated Advanced
Emergency Geographic Information
System (AEGIS) that can be accessed
anywhere. AEGIS allows all emergency
resources to be fully coordinated as a
web-based situational awareness system
for use in all emergency medical services.
AEGIS monitors and maps the location
and status of emergencies, locates victims
and emergency response personnel, and
tracks other factors such as prevailing
weather conditions that can impact
emergency response on a real-time basis.
Hospital management and development: GIS
AEGIS overlays traffic congestion and
accidents on freeways to plot the fastest
routes to area trauma centres. All
authorized emergency responders can
access AEGIS via the Web or by using a
basic cell phone or in-vehicle unit. AEGIS
has contributed in reduction of response
and transport time from a half-hour or
more to just minutes at a time when
minutes mean lives saved11.
GIS provides high quality patient care
management
Ensuring delivery of high quality care
requires care givers to have the necessary
accurate and timely information and the
ability to visualize them at their fingertips.
Hospitals that have developed patient/bed
management systems that operate during
non-surge periods are in a better position
to provide critical information to
local incident management during
unanticipated disaster surges12. Downey
Regional Medical Centre (DRMC) has
implemented a GIS-based patient care and
room management applications using
location as an integral data component13.
This system facilitates capturing of vast
array of information of patients’
admittance, switching rooms, discharge,
and moving from in-hospital to outpatient
care. With information centralized,
automated and networked, data accuracy
is vastly improved and retrieval speed
tremendously enhanced. On a broader
scale, linking hospitals in local, statewide
and multi-state systems will enable health-
care surge capacity the ability to
adequately prepare and respond to mass-
casualty events and other regional public
health emergencies.
GIS in disease outbreak and
surveillance
Global health experts believe that the
world is now closer to another influenza
pandemic than at any time since 1968,
when the last of the twentieth century’s
three pandemics occurred. WHO14 uses a
series of six “phases of pandemic alert” as
a system for informing the world of the
severity of the threat, and for the need to
launch intense preparedness activities. A
review of current disease surveillance
systems indicates a lack of consistency
across systems regarding data
integration, management, and adoption of
information technology. Incorporating
GIS in any disease surveillance system
International Hospital Federation Reference Book 2007/2008 053
enhances its ability to provide accurate
and timely information that is more
efficient and less cumbersome15.
Defining suitable locations for health-
care services
Access to health care is a significant
factor that contributes to a healthy
population. Accessibility and utilization of
health care depends largely on having the
appropriate health-care resources in the
right place at the right time. GIS has been
used in a number of situations to estimate
the optimal location for a new clinic or
hospital to minimize distances potential
patients need to travel taking into account
existing facilities, transport provision,
hourly variations in traffic volumes and
population density16. Through the USAID-
funded Partners for Health Reform plus
(PHRplus) Project, stand-alone GIS-
enabled HIS and mapping tools have been
developed to support the Yemen Ministry
of Health officials to understand health
issues visually, and make decisions more
easily. Four GIS applications have been
developed, the health facility viewer,
health facility targeting, health care
accessibility, and health risk index. These
applications demonstrate sophisticated
use of health information to enhance
facility utilization, improve distribution of
preventive and curative care, and provide
evidence-based rationale for targeted
assistance and service delivery17.
Resources required to implement
a GIS
Developing a GIS requires investment in
computer hardware, GIS software,
networking environment, data,
procedures, and trained staff. Staffing for
a GIS programme is critical as it is not
easily feasible to directly expand the local
health-care staff positions to fill the GIS
need. Areas where expertise is needed
include GIS project management, GIS
database skills, and application
development. Training of the health care
workforce in general computing, database
principles, and GIS are essential for
inreasing efficiency of use.
Conclusion
Several dimensions of health and human
services can benefit from the adoption of
geoinformatics as a way of improving
health and be in a better position to
prevent and respond to public health
52-54 Seth Wiafe 7/1/08 12:38 pm Page 54
Hospital management and development: GIS
emergencies. There is a need for health-
care systems to create new types of
information that are both clinically
relevant as well as place and time
sensitive in response to large scale
emergencies. When appropriately
implemented, GIS could potentially act as
a powerful evidence-based practice tool
for early problem detection and solving
while modifying clinically and cost-
effective actions in predicting outcomes,
and continually monitor and analyze
changes in health-care practices. J
Author
Seth Wiafe is an Assistant Professor and Interim
Chair of Environmental and Occupational Health
department and Academic Director of Health
Geoinformatics Program. He served as health
GIS marketing coordinator for ESRI’s Health and
Human Services Solutions group from 2002-
2005. Wiafe received his Bachelor of Science in
Public Health (BSPH) degree in Health
Geographics from Loma Linda University School
of Public Health in June 2002 and Master of
Public Health (MPH) degree in Environmental and
Occupational Health in 2004. Wiafe is also a
medical technologist and served as the Director
of Clinical Laboratory Sciences at Gimbie
Adventist Hospital, Ethiopia 1992 to 1999. He
served as listserv administrator of Pacific Public
Health Training Center (PPHTC) from 2002 –
2005. He is involved with both local and
international projects relating to Geographic
Information Systems (GIS) health applications,
including the partnership for quality medical
donations (PQMD) mapping project, LLU mobile
mapping project, African American Health
Initiative (AAHI) project of San Bernardino
county. He serves as co-investigator for the LLU
Center for Public Health Preparedness and the
Regional Academic Center of Excellence in
Environmental Health.
054 International Hospital Federation Reference Book 2007/2008
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