Incorporating geospatial capacity within clinical data systems to address social determinants of health

Indiana University-Purdue University Indianapolis, School of Liberal Arts, The Polis Center, Indianapolis, IN 46202, USA.
Public Health Reports (Impact Factor: 1.55). 01/2011; 126 Suppl 3:54-61. DOI: 10.2307/41639305
Source: PubMed


Linking electronic health record (EHR) systems with community information systems (CIS) holds great promise for addressing inequities in social determinants of health (SDH). While EHRs are rich in location-specific data that allow us to uncover geographic inequities in health outcomes, CIS are rich in data that allow us to describe community-level characteristics relating to health. When meaningfully integrated, these data systems enable clinicians, researchers, and public health professionals to actively address the social etiologies of health disparities.This article describes a process for exploring SDH by geocoding and integrating EHR data with a comprehensive CIS covering a large metropolitan area. Because the systems were initially designed for different purposes and had different teams of experts involved in their development, integrating them presents challenges that require multidisciplinary expertise in informatics, geography, public health, and medicine. We identify these challenges and the means of addressing them and discuss the significance of the project as a model for similar projects.

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    • "t al . 2013 ) . Useful intermediate goals , such as improving methods for handling confidential health and spatial data and devel - oping protocols for including or linking spatial data and Electronic Health Record ( EHR ) data , may help move the field toward a comprehensive and efficient system for collecting , sorting and sharing spatial data ( Comer et al . 2011 ; Simpson and Novak 2013 ) . There is considerable interest throughout the health sector in the potential for better environmental and spatial data to contribute to better health . A recent abstract illus - trates this interest and the need for more trained personnel to fulfil the promise of geospatial data in health . In the abstract ,"
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    ABSTRACT: In the past 15 years, a major research enterprise has emerged that is aimed at understanding associations between geographic and contextual features of the environment (especially the built environment) and elements of human energy balance, including diet, weight and physical activity. Here we highlight aspects of this research area with a particular focus on research and opportunities in the United States as an example. We address four main areas: (1) the importance of valid and comparable data concerning behaviour across geographies; (2) the ongoing need to identify and explore new environmental variables; (3) the challenge of identifying the causally relevant context; and (4) the pressing need for stronger study designs and analytical methods. Additionally, we discuss existing sources of geo-referenced health data which might be exploited by interdisciplinary research teams, personnel challenges and some aspects of funding for geospatial research by the US National Institutes of Health in the past decade, including funding for international collaboration and training opportunities.
    Annals of GIS 03/2015; online(2). DOI:10.1080/19475683.2015.1019925
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    • "Amid mounting interest not only in the health of health workers but more broadly in the significance of social determinants of health, systematic consideration of how data systems affect power relations is warranted. Innovations such as IS applications for conducting inspection activities [75] providing more comprehensive and timely information to health professionals and managers [76] or establishing more comprehensive general surveillance of affected communities [77] suggest ways that experts can extend their consideration of health-relevant information. Nonetheless, direct engagement of the people whose health is being monitored has remained neglected – leaving them de facto as little more than objects for observation. "
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    ABSTRACT: Background: Although information systems (IS) have been extensively applied in the health sector worldwide, few initiatives have addressed the health and safety of health workers, a group acknowledged to be at high risk of injury and illness, as well as in great shortage globally, particularly in low and middle-income countries. Methods: Adapting a context-mechanism-outcome case study design, we analyze our team's own experience over two decades to address this gap: in two different Canadian provinces; and two distinct South African settings. Applying a realist analysis within an adapted structuration theory framing sensitive to power relations, we explore contextual (socio-political and technological) characteristics and mechanisms affecting outcomes at micro, meso and macro levels. Results: Technological limitations hindered IS usefulness in the initial Canadian locale, while staffing inadequacies amid pronounced power imbalances affecting governance restricted IS usefulness in the subsequent Canadian application. Implementation in South Africa highlighted the special care needed to address power dynamics regarding both worker-employer relations (relevant to all occupational health settings) and North-south imbalances (common to all international interactions). Researchers, managers and front-line workers all view IS implementation differently; relationships amongst the workplace parties and between community and academic partners have been pivotal in determining outcome in all circumstances. Capacity building and applying creative commons and open source solutions are showing promise, as is international collaboration. Conclusions: There is worldwide consensus on the need for IS use to protect the health workforce. However, IS implementation is a resource-intensive undertaking; regardless of how carefully designed the software, contextual factors and the mechanisms adopted to address these are critical to mitigate threats and achieve outcomes of interest to all parties. Issues specific to IS development, including technological support and software licensing models, can also affect outcome and sustainability - especially in the North-south context. Careful attention must be given to power relations between the various stakeholders at macro, meso and micro levels when implementing IS. North-South-South collaborations should be encouraged. Governance as well as technological issues are crucial determinants of IS application, and ultimately whether the system is seen as a tool, weapon, or white elephant by the various involved parties."You may call me a fool, But was there a rule The weapon should be turned into a tool? And what do we see? The first tool I step on Turned into a weapon. - Robert Frost"White (albino) elephants were regarded as holy in ancient times in Thailand and other Asian countries. Keeping a white elephant was a very expensive undertaking, since the owner had to provide the elephant with special food and provide access for people who wanted to worship it. If a Thai King became dissatisfied with a subordinate, he would give him a white elephant. The gift would, in most cases, ruin the recipient. - The Phrase Finder"
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    Public Health Reports 01/2011; 126 Suppl 3:1-5. DOI:10.2307/41639296 · 1.55 Impact Factor
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