News Feature | December 2, 2014

The Role Of 'Place' In Patient Care

EHRs With Clinical Decision Support Provide Better Care

Healthcare relies on GIS (geographic information system) data less than many other markets. That’s about to change.

Ed Hess, Health IT Outcomes

While most healthcare providers are wrestling EHR implementations to the ground and consumed with fulfilling Meaningful Use requirements, a few providers are demonstrating how this newly digitized patient data can actually be used to improve patient care and drive population health management initiatives. For providers in the former camp, imagine not just easy access to this digital health data but visual access as well. This is possible when patient geography is made part of a population health management strategy or initiative. It’s not just the ability to better understand clinical data, but to actually provide a deeper context to that clinical data.

If you’re trying to reduce asthma-related readmissions, for instance, imagine how your patient assessment and treatment plans might be impacted by fully understanding pollution levels or pollen counts where your patients reside. If you’re developing an intervention strategy for childhood obesity in your region, imagine the power of knowing the types of restaurants and playgrounds available relative to the residences of a given population. The health of a population is inextricably linked to the geography of that population and the characteristics that define this location.

On top of clinical and basic geographic information, there are several other layers of data that might be relevant to your population health management efforts. Ethnicity is a prime example. How about socioeconomic data and census data? Absolutely. Combine this type of GIS data with clinical data, and you are now looking at a complete picture – a map, actually – of your patient population.

Leveraging GIS technology in the healthcare space is a relatively new phenomenon, riding the coattails of the also relatively recent move to digital health records. There are mobile apps, such as Sickweather, that combine mapping and clinical data. The results are interesting but rudimentary. In other industries, however, GIS is a fixture. Retailers plan store expansion with GIS. Local, state, and federal governments plan public works projects with GIS. Utilities anticipate needs and plan for growth with GIS. Every industry combines its proprietary customer data with market-specific geographic data in order to best serve the population of a given area. The healthcare industry will be no different.

In fact, healthcare system planners are already leveraging GIS technology for some efforts. There’s a reason why healthcare facilities are built in specific locations and marketing efforts target specific groups. But this is just nibbling around the edges. The biggest breakthroughs will come as clinical data is combined with GIS to create actionable methods that improve patient care, treatments, and interventions. “Typically, EHRs are used when patients are in front of healthcare providers,” says Mark Zirkelbach, CIO at Loma Linda University Medical Center (LLUMC). “We need to more effectively use that EHR data to better serve patients both before they arrive at a facility and after they leave.”

For its part, LLUMC has integrated patient geography with its current EHR from Epic Systems. Working within the EHR, doctors can locate a patient’s home address on a map. Additionally, icons on the map indicate where and when follow-up treatments are scheduled for the patient. This gives doctors an opportunity to discuss the likelihood patients will keep these appointments. (The distance to the follow-up location and access to transportation – private or public – both affect a patient’s ability to keep scheduled appointments. This impacts patient care and, ultimately, hospital readmission rates.) Doctors can make sure patients know the location and distance to follow-up appointments. The map is visual and easy for patients (and doctors) to grasp. Recommending a daily walking regimen to a patient living near busy streets might not make sense, for example. Combining clinical and geographic data brings about a new dialog between doctor and patient.

In addition to placing patient appointments on a map, LLUMC is also working toward incorporating other data to promote wellness. In the future, for example, patients should be able to view the location of healthy eating restaurant options, fitness centers, community parks, and farmers markets. Integrating this data is another step toward Zirkelbach’s goal of using the EHR outside of what has typically been limited to a doctor-patient appointment.

This type of initiative, of course, places a high value on geography. So high, in fact, that you’d consider it right alongside clinical data when caring for a patient. Maybe you’re not there yet. Your EHR is not fully implemented. But, how are you going to leverage that EHR to data improve patient care? What role will it play in your population health management strategy? When you finally get around to addressing those questions, it seems hard to believe the answer won’t contain at least some element of geography.

Click here to learn more about GIS, including how the technology helped one organization cut healthcare costs 50%.