While other industries have leveraged geospatial data, healthcare has yet to embrace the power of geospatial information systems (GIS) and analytics to improve outcomes, quality, access to care, and lower costs.

Participants at a two-day Geomedicine Summit that kicked off Oct. 13 in Durham, N.C., argue that the technology has reached a tipping point of interest, but major barriers remain. Hosted by the Duke Center for Health Informatics, a goal of the summit—attended by health system executives and researchers—was to inform healthcare leaders to recognize the potential of geospatially-aware health data and to influence electronic health record vendors to develop supporting functionality.

EHR systems are an enabling technology for geomedicine but they also serve as a technical barrier, argues Estella Geraghty, M.D., chief medical officer for Esri, a leading GIS software developer. “First of all, the electronic health record must be able to accommodate and geocode standardized addresses,” said Geraghty. “And, I would go a step further to say that ideally the medical record will start to have living and workplace histories with beginning and ending dates for each.”

Conference participants assert that geography plays a significant role in people’s health and geomedicine holds tremendous potential for healthcare in unlocking geographic trends by factoring in literally hundreds of thousands of geo data elements to support more effective delivery of care.  But, currently, health-related geographic information is scarcely used by clinicians during medical diagnostic encounters with patients and it is not typically part of a comprehensive medical record.

In that regard, Duke University has emerged as a leader in the field of geomedicine. Duke Medicine has developed a sophisticated enterprise data warehousing infrastructure that geocodes address data from its electronic health records system, called Maestro Care, an Epic EHR. And, a web-based query tool—the Duke Enterprise Data Unified Content Explorer—enables researchers and clinicians to access geocoded data and geospatial visualizations.

Richard Wait, M.D., chair of the department of surgery at Tufts University-Baystate Medical Center in Springfield, Mass., asked the question: can a large health system leverage GIS across the entire organization? “Looking at what’s happening at Duke and a number of other places now, the answer is probably. But, not without an awful lot of work on the part of an awful lot of people,” said Wait, who added that “the curse of GIS is that we have to clean data all the time.”

He concluded that the inaccuracy of the data won’t change “until we get the Cerners and Epics and all the others on the same page where we can have the patients go in and at the door, from day one, they are accurately geocoded.”

Geraghty agreed, saying that geocoding should happen immediately “during that first moment” when a patient gets put into the EHR system. She added that Cerner, an industry sponsor of the Geomedicine Summit, is “committed to standardizing addresses and they are excited about the potential of geocoding them in the electronic health record.”

Dora Barilla, associate director of the Institute for Community Partnerships at Loma Linda University Health, told the conference that their health system’s six hospitals use both Cerner and Epic EHRs. “We’ve been talking with both and looking at population health and all of the different modules, and they fall very short of what’s really needed to get into this world,” said Barilla. “No one has really captured what we need. Address is just the beginning.”  

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