GIS in Healthcare
GIS in Healthcare
GIS in Healthcare
GIS in Health
29. GIS in Health and Human Services
Part C 29
erated rapidly after the 1970, when US Census data
29.4.1 Immunization............................ 920
became relatively freely available in digital form.
29.4.2 Disease Surveillance,
The importance of the legendary work of the Dart-
Outbreak Investigation,
mouth Health Care Atlas Project and its founder and Syndromic Surveillance......... 921
Jack Wennberg. In areas where high GIS adoption 29.4.3 Public Health Emergency
rates occurred, such as in public health, we feature Preparedness and Response ........ 922
key applications such as immunization manage- 29.4.4 Community Health Assessment,
ment, disease tracking, outbreak analysis, disease Planning, and Profiling............... 923
surveillance, syndromic surveillance, emergency 29.4.5 Environmental Health................. 924
preparedness and response, community health as- 29.4.6 Chronic Disease Prevention
sessment, environmental health, chronic disease and Control ............................... 925
prevention, and animal and veterinary health. 29.4.7 Infectious Diseases ..................... 927
The final Sect. 29.5 describes how GIS education 29.4.8 Animal and Veterinary Health ...... 929
has expanded across the academic fields of pub- 29.4.9 Human Services ......................... 929
lic health, healthcare administration, and social 29.4.10 Hospitals and Health Systems ...... 930
services. It is pointed out that the material pre-
29.5 GIS and HHS Education .......................... 930
sented in this chapter is not intended to be an
29.5.1 Biostatistics and GIS ................... 930
exhaustive examination of the history of GIS, but 29.5.2 Community Health and GIS .......... 930
rather, a brief introduction and overview which 29.5.3 Epidemiology and GIS ................. 930
will generate further interest and self-discovery. 29.5.4 Global Health and GIS................. 931
29.5.5 GIS and e-Health ....................... 931
The increasing utilization of Geographic Information researchers, and hospital and health system employ-
Systems (GIS) technology over the past several decades ees – as well as the public they serve. While maps
has transformed health and human services (HHS) and spatial analysis have a long history in the field
and given new eyes to public health professionals, of health and human services, the early 21st century
912 Part C Applications
is a time when health professionals and the public and human services challenges and how GIS bene-
have many powerful spatial analytic tools at their dis- fits them. The chapter includes a special focus on
posal. This chapter begins with definitions of health GIS for several specific disease programs. It concludes
and public health (Sect. 29.1), followed by a brief with a summary of GIS in HHS education. Overall,
history of geography and GIS in health and human it takes a selective approach due to space limita-
services. It provides numerous examples of health tions.
ernmental public health agencies at the national and organizations (NGOs – aka civil society), universities,
local levels, but also a broad array of non-governmental and other partners.
Part C 29.2
400 BC, Hippocrates said that one’s health depends the progression of a disease around the world. Some
on the air one breathes, the water one drinks, and the maps were showing risk for a particular disease based
environment in which one lives [29.9]. In this sense, ge- on known causes (e.g., malaria and mosquitoes), oth-
ography has always been a part of individual health – ers were showing the distribution of a particular disease
and public health. Maps and mapmaking have helped at a national level (e.g., cancer). It is very clear from
the medical and public health community understand Koch’s work that the history of medical mapping is tied
the role of geography in outbreaks and pandemics of not only to advancements in medical science and pub-
plague, cholera, typhoid, malaria, and numerous other lic health, but also to advancements in the technology
infectious diseases. The study and control of epidemic of mapping.
spread at a variety of appropriate scales is inherently Much attention in the history of medical geography
geographical [29.10]. Maps and mapmaking have also has been focused on John Snow, the father of epidemiol-
helped health officials and researchers analyze and un- ogy. Snow mapped the relative density of cholera deaths
derstand chronic diseases such as cancer and heart in relation to water sources, as part of a process iden-
disease, which represent a growing disease burden in tifying the infamous Broad Street pump (Fig. 29.2) as
developed nations as well as low-income countries. a likely source of contaminated water [29.13]. Koch re-
Whether one is looking at electronic web-based maps minds us that this work by Snow was part of a larger
and globes portraying the recent H1N1 pandemic . . . or movement for better statistical and graphic analysis –
a 1694 map of plague . . . one thing is clear. Depending which culminated in a series of extraordinary studies of
on the mapping and spatial analysis capabilities of the cholera outbreaks in the 1850s, including the work of
time and place, public health and medical professionals Snow (p. 38). While Koch focuses significant attention
have utilized geography in their work. More recently on John Snow, he also describes many other chapters
geography is becoming embedded in routine business in the history of medical geography, before and after
processes of health and human services organizations the 1850s, and beyond London. Reading this history, it
(e.g., route planning for a fleet of vehicles). becomes clear that over the last few centuries mapping
In Cartographies of Disease Koch describes many has helped physicians, sanitarians, boards of health, and
interesting chapters in history of medical geogra- high level health officials (such as the Surgeon General
phy, both before and after Finke’s Medical Geog- of the United States) contain disease outbreaks and un-
raphy [29.11, 12]. The formal discipline of medical derstand the worldwide spread of a disease. However,
geography started as early as 1792 . . . Koch suggests perhaps more provokingly, Koch makes the case that
that mapping and mapmaking let us study the inter- maps and spatial analysis were critical in establishing
pretations of selected aspects of spatially grounded, the notion that public health was in the public health
914 Part C Applications
Fig. 29.1 Timeline of medical geography: Highlights from Cartographies of Disease (after [29.11])
GIS in Health and Human Services 29.2 A Brief History of Geography and GIS in HHS 915
Part C 29.2
Fig. 29.2 John Snow mapped cholera deaths in proximity to the water pumps in London’s Soho district in 1854. His map
identified the likely source of the cholera outbreak as the Broad Street Pump. Upon the pump handle’s removal, cholera
cases tapered off substantially (after [29.14])
interest – hence the rise of public health and sanitary graphic purposes, the selection of random or systematic
science as a discipline. One notable event in this his- population samples, and to describe study areas [29.15].
tory is the International Sanitary Conference of 1874 He rightfully predicted that there would be future
in Vienna. During that conference, maps of the spread uses of remote sensing techniques within epidemiol-
of cholera were shared among attendees from many na- ogy. Aerial photography had been used in the past to
tions, well before the advent of the today’s International identify and map disease vector habitats (e.g., as early
Health Regulations and the regional and international as 1949 when Audy published a study on the distribu-
Health GIS conferences that take place routinely each tion of scrub typhus in parts of Southeast Asia [29.16]).
year. Much of this work was manual in nature and the advent
of GIS technology over the intervening decades facil-
29.2.1 The Early Years of GIS in Health itated many epidemiological investigations that would
and Human Services have not otherwise been possible.
The launch of ERTS-1 (Earth Resources Technol-
In 1970 Cline commented that aerial photography was ogy Satellite) in 1972 provided the first opportunity
already in use by some epidemiologists for demo- to acquire global remote sensing data on a regular ba-
916 Part C Applications
sis [29.17]. Through the 1970s and 1980s there were an room patients from St. Joseph’s Hospital in Lexing-
increasing number of research projects utilizing remote ton, Kentucky. Creating the map required the use of the
sensing and GIS to investigate the epidemiology of dis- DIME file, the Admatch program, and the master pa-
eases. In 1990 Louisiana State University (LSU) hosted tient history file from the hospital processed by an IBM
the first International Conference on Applications of 360 mainframe computer. Fortran was used by a pro-
Remote Sensing to Epidemiology and Parasitology. grammer for a six-month period to produce what was
LSU has become a collaborating center of the WHO in known as a dot density map in black and white depict-
this field. ing the dossier of patients in various small areas of the
One of the first uses of GIS in hospitals occurred Lexington metropolitan area. The current value of the
shortly after the release of the 1970 Census of Popula- project in today’s dollars would be about $ 250 000.
tion in the United States. The US Census raw data was The one map that was created from taping about 30
not available to the general public before 1970. How- 8 1/2 by 11 sheets of paper was used by the hospital
ever, in 1970, the US Census Bureau granted public management to make an important decision in that com-
use access to its raw data collection. This meant that munity concerning expansion of the emergency room.
for the first time, researchers and commercial entities In the course of the decade of the 1970s, great strides
could work with relational data for small geographic ar- were made in the use of demographic and geographic
eas such as ZIP Codes, census tracts, and block groups. data across a wide range of private and public inter-
By liberating the finely grained census data, health and ests, continuing to improve every aspect of GIS data
human services organizations were able to begin to use and software use in the health and human services sec-
the population data at the local levels. tor.
Part C 29.2
Around the same time, the US Census Bureau In the second half of the 1970s the US Depart-
released two important products that would forever ment of Health and Human Services (DHHS) sponsored
change the way GIS or computer mapping programs a major demonstration and research project in Jefferson
would be focused. The programs were called Admatch County, Kentucky, called Human Service Coordination
and DIME. Admatch was a computerized address man- Alliance (HSCA). The HSCA project had as its goal
agement program that would link a street address to service integration on a massive community scale –
a specific geography; DIME was a master reference across several geographically contiguous counties in
file called the Dual Independent Map Encoding. The Kentucky serving the Louisville metropolitan statisti-
combination of these two programs ushered in the first cal area (MSA) – a population of just over 1 000 000
industrial strength geocoding technology (as we call people. The project consumed large amounts of agency
it today), which is one of the central components of service data, including beneficiary demographics, ser-
a modern-day GIS. However, one must remember that vice delivery characteristics, and service performance
approximately 40 years later (i. e., in 2010) similar ad- measures. GIS (called computer mapping) was intro-
dress level geocoding is still not available in many duced into the project to illustrate the various market
countries of the world. segments being served, as well as to provide vi-
In early 1973, the Ford Foundation Fund granted sual communication of patterns and trends to health
a non-profit organization called DUALabs (a data-use services agency leadership. The project included ev-
access laboratory) the resources necessary to under- ery concurrent human service activity from nutrition
stand how the Census Bureau’s raw data tapes could service to family service to personal addiction ther-
be disseminated in a useful and efficient way. The DU- apy.
ALabs legacy was that it provided a business model
for most of the commercial demographic companies in More Affordable Software and Data
the USA and paved the way for mapping census data. Through the 1980s, there was an explosion of relatively
Clearly without the release of the public use files of the moderately priced software and data packages and ser-
US Census of 1970, the commercial mapping industry vices created by both public and private organizations
of the USA would have been significantly smaller and to exploit the extensive data offering of the US Cen-
would have taken much longer to become an established sus. These new tools and data services greatly expanded
way to analyze geographic and demographic data. the assessment (i. e., sensory) capacities of epidemiol-
In 1973 Davenhall et al. [29.18], using the software ogists, as well as public health planners, environmental
and data products available from the US Census Bureau, health professionals, monitoring and evaluation special-
created the first patient distribution map of emergency ists, hospital marketing departments, and many others.
GIS in Health and Human Services 29.2 A Brief History of Geography and GIS in HHS 917
Part C 29.2
lytical solution. Public health agencies, hospitals, and could be made regarding where resources needed to
social service agencies began to purchase these bundles be deployed. GIS also provided analytical tools for ex-
and incorporate geographic thinking into the oper- ploratory analysis of potential sources of outbreaks.
ational activities – largely at the desktop computer Static maps produced through GIS software showed
level. study areas for epidemiological research papers and pre-
The anthrax attacks and events of September 11, sentations. For most of these purposes, GIS has been
2001 in the United States accelerated the CDC’s viewed as an analytical tool that served a narrow slice
and HRSA’s nascent public health emergency pre- of the overall public health functions.
paredness programs as well as these agencies’ co- Biostatisticians working on large datasets (e.g., can-
operative agreements with state and local health cer registry) also appreciated the capabilities of GIS
departments across the USA. Given increased re- for data management, analytical functions, and visual
sources and responsibilities, health departments hired display/reporting. Biostatistics is a branch of applied
more epidemiologists and deployed robust informa- statistics and is concerned with developing and using
tion technology to support public health preparedness techniques to summarize and analyze medical and bi-
and response. Many health departments recognized ological data [29.20]. Biostatisticians are responsible
the capabilities of desktop GIS software for public for analyzing data and designing research studies. Early
health preparedness. This was also the time frame on, they used GIS to geocode data and then analyze
during which both robust internet mapping software large datasets – proactively looking for clusters or other
and mobile GIS software (e.g., ESRI’s ArcPad) were spatial (aberrations) and also responding to calls for in-
launched. Well before the advent of applications such vestigations. Biostatisticians have also used static maps
as GoogleEarth, federal health agencies such as CDC produced through GIS software to share visualizations
and HRSA, as well as numerous state and local of their work with colleagues and the public.
health departments, began publishing internal and pub- Environmental health professionals, responsible for
lic web-based data query systems (i. e., interactive inspections and data collection covering large geogra-
health atlases) and web-based services locators. These phies – such as those working in vector control – saw
agencies also enhanced electronic disease surveillance the applicability of not only desktop GIS, but also mo-
systems, immunization registries, and cancer registries bile GIS. Such programs (sometimes independent of
with mapping and spatial analysis capabilities. How- public health agencies) have workflows that are inher-
ever, it would take another decade for web-based ently geographical. Vector control staff were some of
situational awareness systems to emerge as standard the first to use mobile GIS on a routine basis. Environ-
practice. mental health professionals use desktop and mobile GIS
918 Part C Applications
to manage large inventories of facilities and sites under with them. As hospitals came under greater pressure to
regulation . . . and also to meet numerous regulations slow the cost increase largely through reduction in work
(i. e., an assurance function). force in non-essential departments, computer mapping
Individuals working in the marketing and planning and demographic analysis were outsourced to large con-
departments of hospitals also recognized how GIS could sulting firms. The deployment was almost exclusively
help them analyze service/catchment areas and locate desktop, and seldom was GIS part of an enterprise ap-
best sites for new services. In social services, informa- proach to IT.
tion technology staff had the vision that helping case It is worth noting the use of GIS by public health and
managers see the client in the context of their environ- hospitals has been inextricably related. The hospital is
ment would help them actualize the core functions of still a large data generator for public health, while public
social work. health is a hospital’s single most consumer of its com-
The vignettes mentioned before highlight some of plete data collection. Without each other’s contributions
the pioneers, but today the story is vastly different. Most of data and analysis, the adoption of modern GIS would
health departments in the USA and a growing number have been seriously compromised. While hospitals in
around the world, use GIS in their daily work – and it the USA are often not that close to the philosophical
is not just epidemiologists searching for clues to dif- underpinning of public health, outside the USA this ar-
ficult outbreaks or biostatisticians working on disease tificial separation is almost non-existent. In the decades
registries. Public health professionals use GIS to ana- ahead a greater synergistic relationship between those
lyze chronic disease trends (e.g., heart disease, diabetes, in acute care and those in prevention will drive greater
cancer), analyze access to public health services (e.g., utilization of GIS as resource allocation, community
Part C 29.3
vaccinations), analyze the built environment, respond accessibility, and government accountability increase.
to natural and man-made disasters, and design com- There are many good examples of this data and analytic
munity health communications programs. While there synergy, as highlighted in the following scenario.
is still a heavy desktop GIS presence in health depart- An emergency room physician is exasperated by
ments, increasingly it is also found residing within an the number of motorcycle and traffic-related injuries
organization’s IT department supporting web-based ap- coming through the hospital’s emergency room. This
plications (both internal and public-facing). The most physician, in collaboration with injury prevention staff
recent GIS servers allow GIS functionality to be de- at the health department, obtains traffic accident re-
ployed on mobile devices across the entire organization, ports from the department of transportation, geocodes
so it is expected that not only vector control but also all the locations of incidents and conducts several anal-
many other field-based programs will move in this di- yses (e.g., density analysis). Based on the results, the
rection. physician and public health department agree on several
possible interventions – such as traffic calming mea-
29.2.3 GIS Starting in Hospitals sures, other road safety improvements, and an education
campaign. In this scenario, GIS is a tool for the analysis,
In hospitals, GIS gained acceptance in the early 1990s and the maps that are the outputs of the analysis serve
as an essential analytical tool for strategic planning and as an advocacy support tool.
marketing, largely in the USA. Analytical studies of Perhaps the best example of the data and analytic
patient origins and resident destinations, health facility synergy GIS provides between hospitals and public
site locating, and market demographic analysis headed health can be seen in the seminal work of the Dartmouth
up the list of most useful applications. Also, many hos- Clinical Evaluation Research Center, in conjunction
pitals hired marketing and planning consultants who with the Dartmouth Medical School (covered in detail
could bring the mapping tools and demographic tools in the following section).
Part C 29.3
Mapping the human body [29.23, 24]
Animal/plant biology Remote sensing
Controlling vector-borne disease
Mapping food availability
Cultural Lifestyle Behavioral risk factor mapping
Targeting health promotion
Segmentation analysis
Place studies
Physical Environment Investigating toxic exposures
Controlling vector-borne disease
Analyzing the built environment
Analyzing the food environment
Health care organization Analyzing accessibility of health care services
Routing vehicles
Workforce studies
Hospital-acquired infections
Bed management
Laboratory services
29.3.1 Growth of GIS in Health in the USA have leveraged geographic information sys-
and Human Services tems to assess and protect the health of the populations
they serve. According to Miranda et al. [29.28]:
There are many drivers for the growth of GIS in health
and human services, as detailed earlier in this chapter. Many GIS-based projects have been successful in
Given the recent increased policy interest in the social supporting public and environmental health prac-
determinants of health, it is worth discussing how GIS tice, including those investigating toxic exposure,
aids in the analysis of the four determinants of health vector-borne disease, health information access,
referenced by LaLonde [29.4] several decades ago. Ta- and the built environment.
ble 29.1 describes this notion at a high level. It is not
meant to be a comprehensive catalog, but just to make WHO states that GIS [29.29]
the point that the major geographical features of the
earth’s surface (physical, biological, and cultural) mesh • Allows policy makers to easily visualize problems
well with the determinants of health (human biology, in relation to existing health and social services and
lifestyle, environment, and health care organization). the natural environment and so more effectively tar-
Over the past 15 years many leading health organi- get resources.
zations, including WHO, World Bank, US Agency for • Is highly suitable for analyzing epidemiological
International Development (USAID), and CDC have ac- data, revealing trends and interrelationships that
knowledged the utility of mapping and spatial analysis would be more difficult to discover in tabular for-
in tackling some of the world’s greatest health problems mat.
Part C 29.4
including the HIV/AIDS pandemic, malaria, tuberculo- • (Is an) ideal platform for the convergence of disease-
sis, maternal and child mortality, and other devastating specific information and their analyses in relation
diseases. The majority of ministries of health (MOH) to population settlements, surrounding social and
around the world, and all 50 state health departments health services and the natural environment.
agement of vaccine logistics, and the analysis and • Determine who needs to be treated (spatial join with
visualization of adverse events reporting. population information, calculate vaccination rates).
Leading public health organizations around the • Notify those who need to be treated (activate auto-
world have validated the utility of GIS for immuniza- mated telephone reminders in low vaccination rate
tion programs. Even in the most resource-constrained areas).
settings, WHO and UNICEF have encouraged hand-
drawn mapping as a way for health professionals 29.4.2 Disease Surveillance,
in local facilities and district health officers to un- Outbreak Investigation,
derstand unmet needs and monitor progress [29.30]. and Syndromic Surveillance
WHO’s Regional Office for the Eastern Mediterranean
(EMRO) has included GIS in guidance for overall pa- GIS has a long history of providing support to tra-
tient safety [29.31]. This Strategic Plan for Patient ditional disease surveillance. Most electronic disease
Safety from WHO EMRO suggests GIS can be use- surveillance systems now include a mapping module
ful in assessing the scope of patient harm. It suggests so that analysts and public health leaders can visualize
MOH develop a GIS system that can capture the geo- disease outbreaks on the map. When an outbreak is de-
graphical and frequency distribution of adverse events tected and public health personnel go into the field for
especially when the occurrence can be sporadic. It additional investigation, GIS strengthens local data col-
suggests the findings of the GIS may highlight the mag- lection, management, and analysis. From the beginning,
nitude of some adverse events at the national level. GIS provides a baseline for monitoring and evaluat-
An example from a specific country plan is also avail- ing outbreak investigation activities. Mobile GIS allows
Part C 29.4
able [29.32]. field personnel to leverage GPS
USAID has supported a number of GIS capacity devices to navigate more efficiently and quickly
building initiatives around the world that have enhanced to locations for data collection. This is critical when
vaccination efforts (e.g., Yemen [29.33]). Recently, the time is of the essence. Surveillance of case loca-
USAID-funded project DELIVER project has reviewed tions is maintained more effectively, so the geographic
ESRI’s network analyst for use in developing countries. progression of the disease is continually monitored.
Their positive review suggests that all countries may High-transmission areas (e.g., gathering places) or areas
consider using such solutions to improve delivery and with environmental conditions ideal for disease vectors
logistics [29.34] of numerous public health programs, (e.g., standing water) are more easily identified when
including immunization. GIS has also been helpful in field staff have maps, imagery, and descriptive metadata
analyses of immunization coverage in conflicts, includ- at their fingertips.
ing Afghanistan [29.35]. CDC has piloted a GIS tool for GIS also facilitates targeting of prevention and con-
increasing urban vaccination rates in India. That project trol measures based on priority locations. For example,
helped dramatically increase the number of vaccina- recent research has shown the effectiveness of im-
tion service centers, and GIS was crucial in managing plementing integrated vector control within a defined
logistics and personnel [29.36]. Domestically, CDC’s distance buffer of known dengue case locations [29.40].
immunization program has encouraged state health de- GIS has also proved to be a cost-effective tech-
partments to utilize GIS alongside of immunization nology for controlling animal outbreaks (e.g., avian
registries in order to analyze pockets of need (i. e., ar- influenza) [29.41]. In other outbreak situations, GIS
eas of under-immunization). CDC has also used GIS is a valuable tool for designing economically feasible
internally to detect spatio-temporal clusters of adverse population-based public health investigations (e.g., gen-
reactions to vaccinations [29.37]. erating a spatially random sample during rapid needs
Health departments have used GIS applications to assessments) [29.42, 43].
track stockpile shipments (including vaccines) in real Syndromic surveillance systems have been used
time [29.38]. GIS has also proved to be a useful analysis for early detection of outbreaks, to follow the size,
tool in the administration of mass vaccination in lo- spread, and tempo of outbreaks, to monitor disease
cal jurisdictions [29.39]. According to one presentation, trends, and to provide reassurance that an outbreak
GIS helped a local health department has not occurred [29.44]. GIS supports syndromic
surveillance not only as a visualization aid, but also
• Determine who was treated (geocode patient infor- in detecting abnormalities based on spatial queries.
mation). Examples include the use of dead bird reporting to pre-
922 Part C Applications
dict West Nile virus in humans, and analyzing chief For disaster planning [29.48]:
complaint data from hospital information systems to
The analysis revealed many opportunities for im-
determine spikes in gastrointestinal or respiratory com-
provement and as a result, GIS has now become
plaints.
a pivotal tool in the County’s planning process.
With accurate location information, GIS can provide
spatial visualization of complex relationships between Many public health authorities now have EOCs in or-
cases, contacts, and objects in the environment in both der to increase situational awareness, collaborate with
time and space. Spatial visualization helps in identi- other first responders, and mount a more effective re-
fying disease sources and the best implementation of sponse. Increasingly, public health is seen as a first
countermeasure and response strategies. responder like fire, police, and public safety. There
are many roles for GIS in health EOCs. The WHO
29.4.3 Public Health Emergency Regional Office for the Western Pacific states that in-
Preparedness and Response formation is the lifeblood of an EOC in [29.49]. The
guide suggests an action plan should include support-
GIS has been used for decades in response to nat-
ural disasters such as floods, earthquakes, wildfires, Table 29.2 Essential and static data layers for a health
and hurricanes. Following events such as 9/11, the EOC (Emergency Operations Center)
anthrax attacks, and hurricane Katrina, the debate
ensued regarding exactly what public health emer- Essential data layers
gency preparedness was and how it should be meas-
Part C 29.4
• Event locations
ured [29.45]. Regardless of one’s definition of public
health emergency preparedness, it is clear preparedness • Hospitals and health facilities
and response depend on location-based information, • Public health departments
such as the location of incidents, where responders • Shelters
are, and where emergency services and health facili- • Schools
ties are located. GIS supports emergency preparedness
through • Roads
• Public transportation
• Needs assessments and planning. • Restaurants and regulated facilities
• Evacuation route planning.
• Modeling chemical spills. • Major administrative boundaries
• Targeting emergency notifications. • Census data (especially demographic data,
• Determining sites for points of dispensing (PODS). languages spoken, poverty, elderly, etc.)
• Enhancing the utility of emergency operations cen- • Post offices
ter (EOC) software. • Municipalities
During a public health emergency, there will be dozens, • Counties
perhaps hundreds, of response efforts going on si- • Surrounding state counties
multaneously through both the public and the private
sectors. Besides helping all responders and those di- Static health layers
recting them attain situational awareness (by seeing • Advanced and basic life support
response activities on the map), flexibility is one of
• Acute and non-acute care hospitals
the most useful features of a GIS. By altering the
planning assumptions that are entered into the GIS, • Points of distribution
public health officials can conduct analyses quickly • Blood banks
and efficiently on any issue for which data are avail- • RSS medical stockpile locations
able [29.46]. • Health departments
Using GIS (including data analysis pre and post • Hospitals from surrounding states
mapping) helps to sensibly choose the best places • Long term care facilities
to locate our limited resources in order to improve • Command centers
service to the public that we serve [29.47].
GIS in Health and Human Services 29.4 GIS Relevance to Public Health 923
Table 29.2 (continued) Some data layers are event-specific, while others
tend to be important regardless of the scenario. Exam-
Real time feeds (dynamic layers) ples of data layers more specific to the type of event
• Incidents/events include first responder locations (e.g., real-time feeds re
• Weather/traffic ambulance or helicopter locations), hospital diversion
status, flood plain/zone boundaries, the extent of smoke
• Medical stockpile
plume (wildfires), electrical utility information, POD
• SitStat surveys locations, etc. Many health agencies have reinforced
• Hospital divert status how important it is to be able to determine neighbor-
• Ambulance locations hood level population estimates during emergencies. It
is worth noting that many of the essential data layers
GIS coordinators within EOCs perform essential should not need to be collected from scratch. . . , rather,
functions including the following many are available already within the health department
• Provide situational awareness to leadership and or from other governmental agencies. Some are likely to
partners already be geocoded.
• Map real-time spread of incidence / clustering 29.4.4 Community Health Assessment,
• Determine stockpile pod locations Planning, and Profiling
• Locate and identify vulnerable populations
• Provide real-time mapping and analysis of vaccine Many health departments have used GIS to visualize
Part C 29.4
inventory the results of community health assessment activities.
• Monitor bed capacity/surge capacity in hospitals Community health assessment is a required activity for
those local health departments seeking to be accred-
• Help infected people locate treatment ited in the USA. Moreover, hospitals are being asked to
• Facilitate mobile response and routing, especially do more with community health assessments under the
in rural areas current health reform initiatives in the USA. More re-
• Identify gathering areas in high cluster areas cently, health departments are recognizing the utility of
• Call up volunteers and staff by location GIS in many phases of the process. For example, a local
health department in Texas has commented, use of a GIS
• Map distribution of care providers
proved crucial in the planning, administration, and
analysis of the community needs assessment [29.52].
ing materials such as a map of the event area; and That same health department has suggested,
the checklist of recommended equipment and sup-
The utilization of a GIS in orchestrating the com-
plies also includes maps and aerial photos. In any
munity needs assessment efforts was essential in
emergency response, the EOC will ask many where
achieving the desired outcome of usable data.
questions.
Lifestyle was one of the four determinants of health
1. Where are the incidents? Where are they headed
referenced earlier in the Lalonde report – and is an im-
(e.g., wildfires, storms, chemical spills)?
portant component of community health. One of the
2. Where are the people at risk?
ways lifestyle is analyzed is through behavioral risk fac-
3. Where are the health assets (fixed, such as hospitals
tor surveillance surveys. The CDC’s Behavioral Risk
and clinics)?
Factor Surveillance System (BRFSS) was established in
4. Where should we send our employees (e.g., during
1984. It is the world’s largest continuously conducted
H1N1, the EOC at CDC in the USA coordinated the
telephone health surveillance system. BRFSS moni-
deployment of 1100 CDC employees [29.50])?
tors state-level prevalence of the major behavioral risks
5. Where are the mobile healthcare resources (e.g.,
among adults associated with premature morbidity and
ambulances) and other first responders?
mortality. By 1994, all states, the District of Columbia,
Health departments have begun leveraging GIS as and three territories were participating in the BRFSS.
part of their EOCs, some developing stand-alone ap- Many other countries have recognized the value of the
plications [29.51] and others using GIS in conjunction BRFSS and have asked CDC to help them establish and
with products such as WebEOC. evaluate similar surveillance systems [29.53, 54].
924 Part C Applications
#1: Monitor environmen- GIS is a tool for EH assessment, analyzing trends, and communicating EH problems and
tal and health status to risks to the public through static or interactive maps. GIS also has many functions helpful
identify and solve commu- for exposure assessment, data aggregation, data management, and other linkages
nity EH problems
#2: Diagnose and inves- GIS supports EH surveillance systems with more efficient data collection methodologies,
tigate EH problems and better understanding of disease transmission dynamics, and a framework for outbreak
health hazards in the com- investigation and response. There is universal consensus that a GIS can be a useful aid
munity at the beginning of an environmental epidemiology or risk assessment study [29.56].
#3: Inform, educate and GIS facilities targeting health communication geographically and demographically.
empower people about EH Desktop GIS and web-based portals such as ToxMAP (http://toxmap.nlm.nih.gov/
issues toxmap/main/index.jsp) and South Carolina community assessment network (SCAN –
http://scangis.dhec.sc.gov/scan/) educate and empower people to understand EH issues
#4: Mobilize community Maps are great tools for community engagement. Desktop GIS and web-based por-
partnerships and actions tals such as the ones listed above help mobilize community partnerships. Another
to identify and solve EH example is the rat information portal in New York City (http://www.nyc.gov/html/doh/
problems html/pest/rats.shtml). GIS provides a framework for analyzing and solving many other
EH problems (e.g., lead poisoning mitigation and prevention; integrated vector control to
prevent malaria, dengue, etc.)
#5: Develop policies and The quote Documenting need is not enough; documenting where there is need is critical to
plans that support individ- intervention strategies [29.57] holds true for EH practice. GIS has helped policymakers
ual and community EH understand the scope of environmental health emergencies, the built environment, and the
efforts zone of influence of mobile sources of air pollution. GIS also plays a central role in public
health impact assessments (see www.sfdph.org/phes)
#6: Enforce laws and regu- GIS-based methods help measure compliance with local laws (e.g., environmental setback
lations that protect EH and regulations in jurisdictions); compliance with spatial advertising restrictions in local and
ensure safety national laws (e.g., no tobacco advertising near schools). GIS-based methods are also uti-
lized to geocode facilities and sites under regulation, route inspectors who regulate them,
and track progress. GIS-based models allow planners to consider the safety of citizens
when planning routes and testing preparedness plans
GIS in Health and Human Services 29.4 GIS Relevance to Public Health 925
Part C 29.4
tions to EH problems cific baseline for implementing and evaluating EH interventions and programs. GIS helps
researchers aggregate data – and understand complex, multidimensional relationships
between pollution and disease
at all levels of government and the partners that support 3. Health effects potentially related to exposure to en-
them are increasingly using GIS technology to assess vironmental hazards [29.61].
and protect the health of the populations they serve,
understand the impacts of the environment on human Initiatives such as EPHT have resulted in not only
health, and to improve environmental health services national but also state level EPHT portals [29.62], as
delivery. Environmental health organizations are inter- well as the ongoing development of specific GIS ex-
ested in increasing their overall GIS capacity so they tensions such as rapid inquiry facility tool (RIF). RIF
may enhance environmental health practice both across is an automated tool that provides an extension to
programmatic areas (e.g., air pollution, water, toxics ESRI ArcGIS functions and uses both database and
and waste, built environment, etc.) and across common GIS technologies. Its purpose is to rapidly address
business functions such as assessment, policy develop- epidemiological and public health questions using rou-
ment, and assurance. tinely collected health and population data. RIF was
The National Environmental Public Health Per- developed by the Imperial College London in collab-
formance Standards [29.60] from the CDC are an oration with CDC [29.63]. More recently, there has
important benchmark for participating agencies to mea- been an emphasis on the built environment’s impact
sure the capacity of their local environmental public on human health, including obesity and chronic dis-
health system or program. Below is an overview of eases.
the relevance of GIS to Essential Environmental Public
Health Services. 29.4.6 Chronic Disease Prevention
Recently, a number of countries have initiated en- and Control
vironmental public health tracking initiatives. CDC
defines environmental public health tracking as the GIS also supports numerous other chronic disease pre-
ongoing collection, integration, analysis, and interpre- vention and control activities. As mentioned throughout
tation of data about the following factors. this chapter, GIS is utilized to support the work of can-
cer registries. GIS is also helping support heart disease
1. Environmental hazards programs, stroke registries, diabetes registries [29.64],
2. Exposure to environmental hazards and even the siting of defibrillators. There has been
926 Part C Applications
extensive research into the impact of the built envi- icy efforts and policy changes in schools [29.74]. More
ronment, including the food environment [29.65], on recently, New York City Health Department used GIS
risk factors and health outcomes. Recently, the CDC to monitor nicotine replacement therapy and found that
launched a chronic disease GIS exchange [29.66] that the GIS analyses provided a unique, near real-time vi-
may highlight many of these efforts. It is also antici- sual method of assessing participation patterns as well
pated that GIS will contribute to the emerging field of as the impact of media and outreach strategies [29.75].
exposomics [29.67].
Cancer Prevention
Tobacco Control and Prevention and Control/Cancer Registries
Tobacco control and prevention is a priority in many Cancer and mapping have a long history together. Hav-
public health agencies, and GIS supports this winnable iland’s map of the distribution of cancer in British
battle in numerous ways. GIS has been used to an- counties in 1892 reminds us that the cancer registries of
alyze tobacco advertising and compliance with the today continue long tradition in mapping cancer. Cancer
law [29.68–70], better understand level tobacco pre- registries were early adopters of GIS since the geocod-
vention efforts [29.71], prioritize communities for ing, data management, and spatial analysis capabilities
intervention [29.72], and model the impacts of tobacco of GIS benefit a wide range of cancer registry research
taxes [29.73]. GIS has also been used to visualize pol- questions and investigations.
Part C 29.4
Fig. 29.4 In 2003, WHO and the Hong Kong Department of Health launched an interactive web mapping application to
provide up-to-date, accurate information ont eh distribution of SARS in Hong Kong, China, and other parts of the world
GIS in Health and Human Services 29.4 GIS Relevance to Public Health 927
Part C 29.4
revise control measures [29.77].
Based on experiences with SARS and a recogni- HIV/AIDS
tion of the growing GIS capacities within governmental According to WHO and UNAIDS, over 33 million peo-
public health, many authors of national and subnational ple around the world are living with HIV. In addition to
No data < 0.1 % 0.1 % < 0.5 % 0.5 % < 1.0 % 1.0 % < 5.0 % 5.0 % < 15.0 % 15.0 % < 20.0 %
lives lost, there are many other substantial consequences lation – and populations at risk – so they may
of the HIV/AIDS epidemic including orphans and vul- target resources effectively. This helps ramp up ac-
nerable children needing care, stresses on the health cess to condoms, health communications, voluntary
Part C 29.4
system, and lost economic productivity, among others. counseling and testing services (VCT), prevention of
WHO suggests the HIV/AIDS epidemic still constitutes mother-to-child transmission (PMTCT) services, and
one of the greatest challenges to public health and inter- anti-retroviral therapy (ART), among other things.
national development [29.79].
According to [29.79], AIDS was the first major epi- Malaria and Dengue
demic in recent world history that scientists were unable Public health professionals are using GIS in a wide va-
to follow in the spatial domain due to confidentiality is- riety of ways to tackle mosquito-borne diseases such as
sues. However, there have been numerous maps of HIV malaria and dengue. GIS is an essential component of
diffusion and in the early 21st century, GIS is an essen- malaria prevention and control. According to Hay and
tial component of HIV/AIDS prevention and control. Snow, maps are essential for all aspects of the coordi-
At the global level, HIV prevalence maps (such as the nation of malaria control [29.80]. The Global Malaria
UNAIDS one) communicate the scope and distribution Action Plan recognizes the utility of mapping, espe-
of HIV/AIDS worldwide and at the country. Diffusion cially for monitoring and evaluation [29.81]. The WHO
mapping has not only been local; it is now well known regional dengue plan for 2008–2015 [29.82] includes
that major roadways played a role in disease diffusion a string of GIS-related items under Expected Result
throughout many African countries. 10. In the WHO dengue plan ministries of health are
The MEASURE (monitoring and evaluation to as- encouraged to conduct basic GIS workshops in 2009–
sess and use results) Evaluation project uses different 2010 and to include GIS as part of their integrated
strategies to collect and use data about health issues. For vector management.
example, a tool for assessing and modifying HIV/AIDS GIS enhances malaria and dengue surveillance and
prevention programs locally or nationally is called the control at the national level all the way to the commu-
priorities for local aids efforts (PLACE) method. The nity level [29.83]. GIS and GNSS help NMCPs, dengue
PLACE method can identify geographic areas that con- control programs, and NGOs understand subnational
tain key HIV transmission networks. distribution of population – and populations at risk – so
The HIVspatialdata.net website has a collection of they may target resources effectively. This helps ramp
demographic and health surveys for many countries. up access to insecticide-treated bednets (ITNs), indoor
GIS and GNSS help Ministries of Health, National residual spraying campaigns (IRS), rapid diagnostics
AIDS Commissions (NACs) and their partners docu- tests (RDTs) and artemisinin-based combination ther-
ment the accessibility of services through nationwide apy (ACT), among other things. GIS has also enhanced
health facility inventories. It also helps MOHs and ITN marketing and distribution efforts [29.84]. Recent
NGOs understand subnational distribution of popu- reports and articles provide strong evidence that GIS
GIS in Health and Human Services 29.4 GIS Relevance to Public Health 929
enhances decision-making for national malaria control The adoption of GIS in the human services sector is
programs (NMCPs, for an overview of such activities similar to that in hospitals and public health. Human ser-
in Zambias [29.85]) as well as national dengue control vices organizations used GIS to understand the extent
programs [29.86]. In some cases vector control re- and scope of their market, where their clients originated,
sources need to be targeted due to resource limitations. and where resources need to match service demand.
GIS helps here as well. Recent findings from Thai- There is a long history of the helping professions
land suggest that integrated vector control programs utilizing maps for assessment, planning and advocacy.
using GIS-based foci based (i. e., conducting commu- Reference [29.57] suggests GIS can benefit social work
nity intervention campaigns within a defined radius of by
sero-positive cases) are very effective [29.87]. Refer-
1. Continuing and strengthening the social survey tra-
ence [29.87] also suggests using a history of reporting
dition.
dengue cases may be a practical tool for producing
2. Providing a framework for understanding human
a GIS map of the risk areas, through which future vector
behavior.
control efforts could be targeted.
3. Identifying community needs and assets.
4. Improving the delivery of social services.
29.4.8 Animal and Veterinary Health
5. Empowering communities and traditionally disen-
franchised groups.
Cline notes [29.88]:
Hillier also argues [29.57]: documenting need is not
while most pathogens transmitted in a human-to-
enough; documenting where there is need is critical to
Part C 29.4
human cycle are not constrained geographically,
intervention strategies.
zoonotic and insect-transmitted diseases, in con-
If social work needs mapping, then human ser-
trast, tend to be focal in distribution, with their
vices agencies need GIS. In the late 1990s, Wong and
maintenance cycles dependent upon exacting eco-
Hillier [29.91] concluded there were outstanding po-
logical conditions.
tential rewards for human service agencies using GIS
This dependency makes zoonotic and insect-transmitted in terms of agency planning, data analysis, policy-
disease well suited to GIS analysis. Over the last making, fundraising, client information, outreach, and
decade, GIS has become central to the work of many other management and direct-practice functions. Over
agricultural and veterinary health agencies. Agencies the last decade GIS has emerged as a critical tool for
around the world have built GIS into applications planning and understanding community needs, empow-
supporting management of animal disease epidem- ering citizens to locate services, enhancing the ability
ics [29.89, 90]. Some organizations have also docu- of helping professionals to provide information and re-
mented cost savings as a result of using GIS. ferral; providing analytical capabilities to staff (e.g.,
policy questions, case management decisions, service
29.4.9 Human Services eligibility), helping manage large amounts of program
and administrative data, enabling logistics and pro-
Around the world, over half a million social workers gram support (e.g., routing efficiency), and enhancing
and human service professionals help vulnerable and fraud detection. Professionals working in human ser-
distressed people every day. Their clients include fos- vices agencies ask many where questions such as
ter children, the elderly, the mentally ill, the homeless,
1. Where are the people who need help – those at risk?
the disabled, and many others in need. Social workers
2. Where are our services located?
and human service professionals accomplish their work
3. Where should we send our employees today (e.g.,
through hundreds of different programs at governmen-
many state agencies have staffs numbering over
tal agencies, non-profit organizations, private practices,
1000)?
and other venues. These programs are in great demand
4. What are the most efficient routes?
due to the global economic crisis and numerous other
5. Where are the field staff located?
drivers including changing demographics. Increased de-
6. Where should we concentrate our limited fraud in-
mand for human services and social services brings
vestigation capabilities?
new attention to concerns regarding access to services,
efficiency (e.g., routing and logistics), and program in- One of the primary business functions of human
tegrity (e.g., fraud detection). service professionals is to provide case management
930 Part C Applications
for their clients whether in an agency office, at their 29.4.10 Hospitals and Health Systems
clients’ homes, or in other service delivery settings.
Professional social work case managers are guided by In recent years, GIS has expanded beyond the plan-
standards [29.92] and routinely use computerized case ning and marketing departments of hospitals to include
management information systems. Such systems help a number of other applications beyond the analysis of
track client history, progress toward meeting goals, and hospital service areas and market share. At a regional
report results, among other functions. Case manage- and national level, there has been more interest in us-
ment systems with GIS at their core help human service ing GIS for service locators (consumer oriented) and
professionals provide more effective and efficient case health facility assessments (policy oriented). A num-
management. GIS leverages the power of place in ber of organizations also partnered to come up with
establishing helping relationships, assessing complex a standardized approach for identifying a health facil-
problems, selecting problem-solving interventions, and ity [29.94]. It is also worth noting GIS can provide an
helping clients to function effectively – all stated goals inside view of the facility to determine when beds are
of case management. The SchoolMinder application in available for cleaning after a patient discharge, where
Illinois illustrates how adding server-based GIS tools maintenance is needed on equipment and the position-
to case management systems helps answer the where ing of assets throughout the hospital. All of this can be
questions relevant to their cases and workflows. Since managed and viewed through a web based GIS tool.
deploying the SchoolMinder application, the average GIS can also help administrators and infection control
distances for initial foster care placement in Cook professionals make better decisions about policies for
County dropped from 15.9 to 4.0 km (median numbers the containment and immediate outbreak management
Part C 29.5
dropped from 10.3 to 2.4 km) [29.93]. response to secondary infections [29.95, 96].
exploratory spatial data analysis. The enhanced time fective use of health information technology, defines
awareness of commercial GIS software will make the e-Health as [29.100]:
application of GIS in epidemiology grow even more.
To understand the role of GIS in epidemiology, it is The application of Internet and other related tech-
important to remember that epidemiology is largely nologies in the healthcare industry to improve the
quantitative but also observational. Epidemiologists access, efficiency, effectiveness, and quality of clin-
explore patterns of disease across populations. GIS ical and business processes utilized by healthcare
technologies are powerful and useful tools in observa- organizations, practitioners, patients, and con-
tional epidemiology (with its focus on person, place, sumers to improve the health status of patients.
and time) as well as analytical epidemiology (identi-
fying point sources, and controlling disease outbreaks, Since GIS is information technology (IT), it is covered
with its focus on location-based response activities). by the above-referenced definitions for e-Health. Below
Epidemiologists use the mapping and visualization are several examples of how GIS enhancing e-Health.
functions of GIS to define study areas. They use analytic The geographic information contained in electronic
functions such as geocoding, buffering, exploratory spa- health records and health information systems is one
tial data analysis, field data collection (navigating to of the critical components for detection of disease out-
locations as well as recording location), and outbreak breaks. More specific geographic information in health
investigation. Location is proxy for exposure in envi- records increases options for detecting outbreaks (i. e.,
ronmental epidemiology. one can always aggregate up, but not down). Specific
geographic information within health information sys-
Part C 29.5
29.5.4 Global Health and GIS tems also helps health officials determine the extent
of an outbreak. With such knowledge, health organi-
Global health priorities are largely focused on zations may use GIS to determine what resources are
HIV/AIDS, malaria, maternal and child health, and available in close proximity (e.g., facility diversion sta-
preventing leading killers like diarrhea in children. tus, stockpile locations, volunteers). Such analysis is
However, many of these initiatives in global health essential for the response and communication with the
have developed as vertical programs. Recently donors public. Surveillance is not just important for infec-
have been calling for integrated approaches to com- tious/communicable diseases: chronic disease registries
bating disease and strengthening health systems. GIS (cancer, stroke, etc.) also benefit from more specific
has special capacity to integrate and analyze data from geographic information. Specific and standardized loca-
a wide variety of programs that address malaria, tu- tion information embedded in electronic health records
berculosis, child and maternal health, clean water, food (and registries) facilitates more targeted spatial analyses
and nutrition, and education. GIS provides strategies for across health information exchanges [29.101, 102].
spatial data use for decision making that support and GIS helps deliver the e-Health promises of foster-
strengthen linkages across health interventions towards ing participation by consumers, as well as addressing
the aim of overall health system strengthening. MOHs disparities (e.g., in access to services and health out-
and the non-governmental organizations (NGOs) sup- comes). The strategic planning documents of numerous
porting them are using GIS in a broad range of programs e-Health initiatives suggest e-Health is going to foster
and functional areas. participation by consumers by allowing them to bet-
ter manage their own care and be more informed in
29.5.5 GIS and e-Health decision making. If this is going to be the case, then
consumers need to know where services are located.
There are a number of definitions for e-Health. The Also, health authorities and community-based organiza-
WHO defines e-Health as the use of information and tions need to understand where the consumers needing
communication technologies (ICT) for health [29.99]. various services are located – and what disparities cur-
HIMSS (Healthcare Information and Management Sys- rently exist in not only their access to services, but also
tems Society), a not-for-profit membership organization health outcomes and health risk factors. Such location
devoted to healthcare transformation through the ef- data is not just for research, it has extreme practical
932 Part C Applications
value. The geocoordinates of health facilities are nec- per processes to using PDAs and mobile phones for data
essary for analyzing access to services, but may also collection [29.104].
feed public-facing services locators. Moving forward, The WHO health metrics network has empha-
it is anticipated that more consumers will utilize such sized how important it is to map human resources,
services locators from smartphones and other mobile budgets, and expenditures at the national and dis-
devices. trict levels [29.105]. There are an increasing number
GIS helps us understand unwarranted geographic of ArcGIS server applications that are examples of
variation in health services delivery – supporting the e- providing this type of transparency. Moving forward,
Health goal of supporting providers in the delivery of it is anticipated that many MOHs, subnational health
safer, more effective, and more efficient healthcare. Nu- departments, and NGOs will map various health man-
merous researchers have documented the unwarranted agement information system (HMIS) data (whether it
geographic variation in health services delivery [29.22], be operations data or health outcomes).
which not only has an impact on costs to consumers The personalization of health is not new. Medicine
and governments but also on health outcomes. Many has always had a person at the center of its inquiry and
e-Health initiatives facilitate the increased availability practice. The Hippocratic oath has always had a single
of health services and health outcomes data. In helping person in mind with its policy of do no harm. However,
place such data on the map, GIS provides new eyes to studying one person at a time is labor intensive and does
researchers, clinicians, and practitioners to understand not produce the generalizability that is required to im-
and address unwarranted geographical variations. pact large groups of people. This, of course, is where
GIS helps deliver e-Health’s promises for more public health comes in by providing the broad brush ap-
Part C 29.6
transparency – i. e., timely, accurate, and comprehen- proach to health problems and then raising awareness
sive reporting on health system activities and outcomes. as to what requires our attention as a society. While the
MOHs, subnational health departments, and NGOs are public health disciplines have studied population health
on the front lines implementing health improvement at group levels, they seldom focus on individual levels.
initiatives around the world including chronic disease Geomedicine, on the other hand, provides a different
prevention and control; HIV/AIDS prevention, care and type of analysis – it attempts to link the highly gov-
treatment; malaria prevention and control; and maternal ernable health information to the unique context of the
and child health, among others. Elected representa- individual. It proposes that factors in our environment
tives, governing bodies, taxpayers, and external donors have a substantial impact on our own personal health.
want the health organizations they fund to design and Geomedicine attempts to harness the power of a GIS
implement successful programs. Health organizations to present environmental context in a scalable fash-
(both governmental and non-governmental) also have ion – where the knowledge of medicine can impact
increasing responsibilities to partner with other gov- how humans choose to engage with the underlying con-
ernment agencies and NGOs (e.g., joint proposals), text. To assure that both the information upon which
coordinate across vertical programs, and build local ca- geomedicine is used is useful, health data must be geo-
pacity. Therefore, they need tools that help them report graphically accurate, and accuracy is solely a function
on what they are doing [29.103] and collaborate with of how well computer systems registration software col-
others. Health organizations are also moving from pa- lects this data.
29.6 Summary
GIS continues to find its place in health and human ser- The future of increasing use of GIS in health and hu-
vices. Numerous research projects explore novel uses, man services is extremely bright. The increasing focus
while over time many GIS functions and operations on electronic health records, and the corresponding ge-
are becoming standard practice within health and hu- ographic information contained within them will open
man service organizations. The value of GIS in HHS up many new possibilities for population health analy-
continues to enlarge. As more countries face uncertain sis and planning. GIS has been found to be an essential
economic times, these founding market segments must technology in a wide variety of health and human ser-
get more out of the data as well as their analysis. vices agencies and activities. Over 1000 case studies
GIS in Health and Human Services References 933
have been identified by just one GIS company. These easy-to-use applications to serve specific needs while
case studies span the continuum of HHS organizations. maintaining a framework to seamlessly share relevant
The advent of cloud computing will increasingly information across the entire health and human services
make GIS more affordable for every MOH, while al- continuum. Location will be an integral part of every
lowing software developers to focus on creating custom, health and human service.
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934 Part C Applications
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936 Part C Applications
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