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21st century Epidemiological Surveillance. New maps, new formulas, new techniques.
Curated by Brian Altonen
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More Poor People Are Now Living in Suburbs Than Cities: Brookings Institution

More Poor People Are Now Living in Suburbs Than Cities: Brookings Institution | Episurveillance | Scoop.it
If you think of the typical American suburb as a refuge from the bustling city next door, you may want to think again.
Brian Altonens insight:

More details on this topic are provided by Elizabeth Kneebone at 






The Brookings Institute provides planners with plenty of opportunity to learn more about social inequality and healthcare at:



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SUDEP (Sudden Unexplained Death in Epilepsy) | epilepsy.com

SUDEP (Sudden Unexplained Death in Epilepsy)   |   epilepsy.com | Episurveillance | Scoop.it

"Most people with epilepsy live a full and healthy life. However, they should be aware that epilepsy can be fatal."


In terms of the attention we pay to people with epilepsy as part of a managed care program . . . in spite of the numbers of people experiencing seizures in life, and the high cost for managing these patients at the managed care level, ($17.6 B/year, direct and indirect costs according to the Epilepsy Foundation website), there is just one HEDIS/NCQA metric that evaluates the treatment of epilepsy, as part of several chronic disease populations.  This metric is:  Annual Monitoring for Patients on Persistent Medications.

Brian Altonens insight:

SUDEP or "Sudden Unexplained Death in Epilepsy" is, 

according to Virtual Medical Center --  "the most common single epilepsy related cause of death."(http://www.virtualmedicalcentre.com/diseases/sudden-unexpected-death-in-epilepsy-sudep/880).


1.  SUDEP is a more frequent cause of death than in lower risk groups, at a rate of  0-14% of deaths of children with epilepsy, based on autopsy and epilepsy registry information .

2.  For patients undergoing aggressive epilepsy treatment and drug trials, SUDEP explains about 29-75% of the deaths.

3.  In populations with epilepsy, SUDEP is estimated to afflict between 1:500 and 1:1000 patient years, meaning if 1000 people with epilepsy were monitored for one year, one would die of SUDEP.

4.  The highest rate of SUDEP reported is 2.2-10 deaths per 1000 patient years, found in candidates for epilepsy surgery, patients with severe refractory epilepsy, or receiving care from a specialist epilepsy referral center.

5.  The lowest rate is 0.35-2.5 deaths per 1000 patient years noted by some studies focused on just children.  


SUDEP is one of those reasons for more aggressively monitoring populations with epilepsy.  Since epilepsy is such a rare event, HIT and data sharing are essential to successfully managing and  improving the quality of life for this population.  


The rarity of epilepsy makes it imperative that we require the largest insurance companies with EHR/EMR to undergo this change in the near future.


Speculation about the causes for SUDEP have focused on cerebral, heart and pulmonary dysfunctions, and certain medication uses.   Like many underrepresented diagnoses, the lack of a valuable HIT hampers such research processes even more.     


Even with questionable documentation and reporting rates for seizure related events and diagnoses, epilepsy is a very common diagnosis that is underevaluated by epidemiological and community health programs.  This may in part be due to the social stigma attached to epilepsy and seizures, but is more likely a result of some attitudes and behaviors that persist about witnessing seizures and having seizures.    


Epilepsy is a unique major disability in that for the most part it is invisible, except when a seizure event happens (see http://www.epilepsyfoundation.org/livingwithepilepsy/parentsandcaregivers/parents/typesofseizures.cfm).  As a result of the behaviors that often accompany a seizure event, by victims and witnesses, epilepsy is one of the least understood, most opinion-generating disabilities now impacting our culture.    


With a well established HIT system, a more effective managed care program targeting people with epilepsy can be produced, resulting in a more thorough investigation of this underresearched population.  The same managed care process should also be implemented for other underrepresented chronic diseases, such multiple sclerosis, tourette's syndrome, fibromyalgia, migraines and cluster headaches, ALS, etc. etc. 


Several informative pages to review about epilepsy and SUDEP are:







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National Population Health Grid

National Population Health Grid | Episurveillance | Scoop.it

Promotion of a New Disease Mapping Technique -- Innovation at its Best."

Brian Altonens insight:

Central map is from CEO Alex Algard’s StopTheShootings.org, http://www.geekwire.com/2012/whitepage-ceo-develops-school-shootings/

The graph is from “Estimated child fatalities per day attributed to child maltreatment”, http://www.childhelp.org/pages/statistics/

The 8 surrounding 3D maps were produced as part of the NPHG project, demonstrated at http://nationalpopulationhealthgrid.wordpress.com/ ;


Entrepreneurship, Innovation at its Best: the Young Entrepreneurship Workbook" by Kevin O'Logan, is at  http://www.amazon.com/Entrepreneurship-Innovation-its-Best-Workbook/dp/0984269800


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Some West Nile Sites

Some West Nile Sites | Episurveillance | Scoop.it

An impressive 3 year study of the ecology of West Nile Ecology using GIS for Spatial Disease Research and Surveillance

Brian Altonens insight:

The various maps I produced for west nile research during its first 4 to 5 years of penetration into the U.S. are depicted by the following map'  The pins on this map serve as links to the images/maps provided about each of the points, areas or regions reviewed.




Aside from standard ArcView basemaps and TIGER files, these maps utilized remote sensing, landsat imagery, NLCD, NDVI, DEMs, seamless government base maps, raster imagery, aerial photography, field mapping  activities and surveillance, GPS and numerous ArcView Avenue extensions. 


Field sampling techniques of point, grid and transect nature were used, including elevation base transect work.  Grid analyses, density analyses, spatial analyses add-ons were employed.  Ecological and population density reviews were developed.  Host-vector spatial distributions/density were evaluated.  Temporal trapping histories were reviewed.  Species-vector relationships and trap types were documented, dead host birds positive and negative testing were evaluated.  


A very large vector swarm late in the year (October) was evaluated.


A handheld photosensor was used to evaluate the relation of sunlight penetration through tree canopy cover to ground surface, in order to realte this to overall species types and densities captured at these traps.


late in 2002, aerial photos were used to predict/define positive testing site features and the likelihood for return of a positive testing vector the following Spring (it returned, which proved that local species carriers could exist and survive the overwinter). 


Field analyses and GPSing were used to develop the site ecology, water, canopy and trap information for a positive testing human case of unknown origins.   A DEM analysis of a creek floodplain and ravines was used to document species in relation to elevation.


The two major GIS options were used to produce both the vector and raster products. 


This work later resulted in my receiving an award for this presentation of several of its components in 2006.

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Addiction: Twenty-first Century Style | National Defense Health Initiative

Addiction:  Twenty-first Century Style | National Defense Health Initiative | Episurveillance | Scoop.it

Technology is wonderful  . . . the distribution of smoking by gender in one year age increments, adjusted and evaluated for statistically significant differences between men and women in terms of rates filed by EMR claims for more than 15% of the U.S.. 

Brian Altonens insight:

The age differences between male and female smokers are displayed using the above pyramid technique for detailed analyses EMR claims for large populations.  This method, including the mapping technique, can be directly applied to managed care program development, without need for a GIS. 


The above pyramids tell us that intervention programs for the two genders have to be engaged in at different ages (upper right).  They also suggest that additional efforts have to be made to determine why female rates for claims ICDs for smoking continue to increase as women get older, until the age of 45-50.


The lower two maps detail 3D NPHG maps of this data, showing us where the peaks are for two V-code defined risks that are often linked to populations that smoke.


The National Defense Health Initiative web site (click on image for link) details the changes in these tobacco prevention programs underway. 

"Technology is wonderful . . . " it begins--due to the development of the e-cigarette.  The topic of discussion for this page:  Will the e-cigarette soon be regulated by the FDA?

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Part 1. What Can Wal-Mart Teach FEMA About Disaster Response?

Part 1.  What Can Wal-Mart Teach FEMA About Disaster Response? | Episurveillance | Scoop.it

Pictured above:  David Miller, Senior Director - Market Planning & Research at Walgreens.  He and his team of two GIS technicians led the way to making innovative use of business data in GIS to prepare and react to this natural disaster.


[Preface:  Part 2 of this 2-part series is under Global Health.  Unfortunately, American (U.S.) big business and international businesses are still years away from having impacts nationally, internationally or in major parts of the world with GIS and natural disaster management, until they develop a new GIS.]



Brian Altonens insight:

"In the hours after Hurricane Rita made landfall, one emergency operations center was tracking the damage, power outages, and flooding, while sending truckloads of supplies straight to the Gulf Coast."  [Wal-mart]


The giant retailer Wal-Mart was named after its founder, Sam Walton. The name of the drug store chain Walgreens came from its founder, Charles R. Walgreen.  These two different chains had quite a similar response to natural disasters when Hurrican Katrina struck the Gulf shores. 


The Walmart-Walgreens approach to natural disaster management during Hurricane Katrine will probably be a main example and topic of conversation for a few more years.  Even though a decade has passed, with several more FEMA events taking place, the primary advancements we see with GIS are defined well by ESRI's major contributions to these efforts and activities engaged in at the government level.


The following describe some of the impacts of these corporate events on the system in general.  It is important to note here that Walmart and Walgreens acted independent of each other throughout these events.


What Can Wal-Mart Teach FEMA About Disaster Response?

LAKE CHARLES, La., Sept. 29, 2005.  (the link attached to the above picture as well.)  http://abcnews.go.com/WNT/HurricaneRita/story?id=1171087&page=1. 


Wal-Mart CIO Linda Dillman, shares the experience of how the company's IT team reacted to the disaster and how its previous experiences in dealing with Hurricane Charlie helped shape its response to Hurricane Katrina.    http://www.ciol.com/ciol/news/70464/wal-mart-cio-hurricane-charlie-paved-katrina-response


Kelly A. Boyd and Jacqueline W. Mills.  GIS Applications during Response to Hurricane Katrina:  Small, Local Government and State Government Experiences.   Thursday, May 17th 2007.  http://www.directionsmag.com/articles/gis-applications-during-response-to-hurricane-katrina-small-local-governmen/122896


Michael Barbaro and Justin Gillis.  Washington Post Staff Writers

 Tuesday, September 6, 2005.  Wal-Mart at Forefront of Hurricane Relief.  http://www.washingtonpost.com/wp-dyn/content/article/2005/09/05/AR2005090501598.html


ESRI's Proceedings on this Disaster in 2006.  http://proceedings.esri.com/library/userconf/health06/docs/katrina.pdf


Policy Change in relation to this event, from Penn State University  https://www.e-education.psu.edu/geog497b/node/277




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Long Term Care Costs - Cost of Care Survey 2013 - Genworth

Long Term Care Costs - Cost of Care Survey 2013 - Genworth | Episurveillance | Scoop.it
Review the average long term care cost in your area using Genworth's Cost of Care Survey. Find out how much long term care costs in your state.
Brian Altonens insight:

Whenever we monitor disease, we have to monitor costs.  


One of the worst things about monitoring ICD-cost relationships is the variance in cost and standard deviation that appears in Big Data / Large Population research.


The cost for some of the most expensive drugs, like a treatment for unique form of hemophilia, can cost more than 6 million dollars per year.  "How can the patient afford this!?"  we must wonder.  


This is exactly what I wonder whenever I see such variance and max-min relationships within my cost-disease healthcare evaluations, with maps demonstrating exactly where those populations with the greatest cost reside.


There is a narrow cost range that fits nearly all processes engaged in as a part of the health care process.  Yet claims and billing records tell us the system (insurance agencies, allowed billing, and such) wants this to be otherwise.  


We can lower costs by narrowing this price range, not just reducing the availability of high cost medications through changes in the formulary and the promotion of mostly generics (as in current plans).  


The most cost effective way to manage finances in the long run is to narrow the range of prices possible.  For example, the hemophiliac who only pays $100,000 per year would certainly not want to be in the predicament that the $6 million/year patient could be in, nor does the RA victim wish to rely upon his or her high cost Mab for the rest of his/her productive life.  


Pricing is still not standardized.  The national map of colorectal exam prices I displayed (but did not generate) is proof of this ($9000 versus $2500, depending on what State you are in).


What doesn't make sense is the cost variation between countries, in which a 10 fold difference is sometimes found to be the case.  The Genworth Survey is a reminder that cost in the long run will be the determining factor in the survival of our care management, managed care or whatever later program is generated in the U.S., in comparison with those competitors outside the U.S.


You cannot effectively monitor and change anything in health care or population health in the U.S. until you map the outcomes of your studies.  Otherwise, whatever interventions you develop to lower healthcare costs may wind up being a waste of money.


For comparisons, last year's map is at: http://www.lifehappens.org/cost-of-care-map/



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NEJM — Global Health readings

NEJM — Global Health readings | Episurveillance | Scoop.it

The New England Journal of Medicine - dedicated to bringing physicians the best research and information

Brian Altonens insight:

A page devoted to free articles, full text, on the various global health issues published in NEJM. 

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Improving Quality of Care Through Disease Management

Improving Quality of Care Through Disease Management | Episurveillance | Scoop.it
Brian Altonens insight:

In a recent chapter in their book on the human or social ecology of disease, Bruce A. Wilcox, Duane J. Gubler, and H.F. Pizer demonstrated that urban centers demonstrate incredible growth in the lower and middle income classes relative to higher income classes over the past century (see figure).  The impacts this is now having on population health are several. 


The most important impact is an increase in the possibility of highly adaptive bacterial and viral diseases remerging as medication resistant strains.   Higher income classes are not necessarily immune to these diseases.


The second impact is financial and service related, with neither fully compatible enough to meet the demands of a health care system working to meet the needs of its population. 


Source:  Chapter 4 - Urbanization and the social ecology of emerging infectious diseases, pages 113-137.  In The Social Ecology of Infectious Diseases, Kenneth H. Mayer and H.F. Pizer (eds.). 2008 Elsevier Inc. ISBN: 978-0-12-370466-5. Accessed at http://www.hawaii.edu/publichealth/ecohealth/si/course-ecohealth/readings/Wilcox_etal-2007.pdf


Recently, a review of the success of disease management programs was published in Circulation (this link):  AHA Policy Recommendations.  Improving Quality of Care Through Disease Management.  Principles and Recommendations From the American Heart Association’s Expert Panel on Disease Management.  


Each one of the methods for improving care, as recommended by this article, will be more successful, more appropriately targeted, and possibly for a lesser cost by making two changes:  1)  develop culturally specific programs with an emphasis on socioculturalism and community health, and  2) utilize small area spatial analysis, with or without GIS, to document your results and report them in your annual reviews.


GIS and spatial modeling techniques enable us to more accurately monitor disease patterns and relate them to place and socioeconomic status.  The purpose here is to more accurately understand their causes and use this to more effectively intervene when there are potential outbreaks

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Pest Management in NYC, or R.I.P.

Pest Management in NYC, or R.I.P. | Episurveillance | Scoop.it
Brian Altonens insight:

If we put our mind to it, we can map anything we want.  After all, this is what innovation consists of.


A good example of innovation is demonstrated by New York City's venture into Medical GIS and epidemiological surveillance by the production of its interactive R.I.P. or Rat Information Portal at http://gis.nyc.gov/doitt/nycitymap/template?applicationName=DOH_RIP.


State, county, regional and city public health and environmental health programs have been utilizing GIS for years to keep track of everything needed to better manage the local environment, people, and the various public health responsibilities they are responsible for.  Most healthcare businesses have failed to fully embrace this new technology. 


The major reasons businesses have not or cannot venture into innovations and new technology, according to Harvard Business writer Regina E. Herzlinger in "Why Innovation in Health Care is So Hard" (http://hbr.org/web/extras/insight-center/health-care/why-innovation-in-health-care-is-so-hard), is that businesses are consumer focused, not health focused. 


Herzlinger identified six forces that influence businesses and help to explain their lack of innovation, and the matching barriers or obstacles.  Lack of accountability and lack of a "a robust IT infrastructure" are two of the major reasons businesses haven't advanced according to Herzlinger.  


Herzlinger recommends a "consumer" focused model for changing the primarily business focused model that already exists.  For health care businesses , this means a need to focus less on the short term 'consumer care model' centered on products development and cost, in exchange for a more aggressive long term plan model that is focus on the patient and long term financial savings. 


R.I.P. makes meaningful use of EMR, HIT and medical GIS to reach this goal.



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Rabie Cases Map: Mississippi Board of Animal Health :: Protecting the Health of Mississippi's Livestock and Poultry Today and Tomorrow

Rabie Cases Map: Mississippi Board of Animal Health :: Protecting the Health of Mississippi's Livestock and Poultry Today and Tomorrow | Episurveillance | Scoop.it
Brian Altonens insight:

Local or small area analysis of rabies represents an example of a disease ecology study.  The study of childhood asthma in relation to urban settings is an example of a environmental study.  A spatial analysis of child abuse in relation to poverty and income an example of a human behavior study.  Each of these are routinely engaged in by local Public Health departments, but can also be implemented as routine small area analyses by the right health care facilities, teaching hospitals, local insurance programs, and even non-profit groups. 


HIPAA and availability of EMR-PHI are the limiting variables for establishing these community-health oriented preventive health programs.  In contrast, zoonotic diseases studies like rabies and certain animal and livestock disease patterns are much more commonly reviewed due to recently re-emerged cases. 


Animal born diseases are largely responsible for the ongoing GIS based disease surveillance programs now in place due to homeland security concerns.  Such studies have also set the stage for the current Avian influenza surveillance programs.

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Obesity and Health Care Spending

Obesity and Health Care Spending | Episurveillance | Scoop.it
Side-by-side maps of obesity rates and Medicare reimbursement expenditures around the country.




"November 24, 2009, 12:32 pm
Obesity and Health Care Spending
 . . . *** . . . 
In the past we’ve talked about the connection between unhealthy lifestyles (in particular, obesity rates) and health care spending. Here are two maps that might further complicate that discussion a bit.

The Centers for Disease Control and Prevention last week released a report on obesity and diabetes. Here is a map taken from that report, showing obesity rates around the country [Obesity map] . . .

And below is a map of Medicare expenditures around the country, from the Dartmouth Atlas Project. State health care expenditures per capita for all age groups can also be found here.

How much overlap do you see?"



Brian Altonens insight:

The entire text of this item was included above for the sake of discussion.  


This is an example of how sometimes our perception of maps can result in misjudgment and errors.  Look-alikes don't count.  Making visual comparisons without a fine-tuned statistical overviews can result in mistaken judgments, missed opportunities and even false conclusions or judgments in health care. 


The claim here is that obesity is a primary cause for unhealthiness and therefore Medicare expense.  But the map demonstrates the opposite statistically.  At the large area level, it appears as though the southeast quadrant of the US in both maps displayed, and perhaps the California-Nevada sections between the two maps, each demonstrate correlations.  In actuality, there is very little direct spatial statistics correlation between the above two maps once you review them at the small area level.  Furthermore, if we take a look at the small areas over Nevada, Southern California, eastern Texas and western Lousiana, we find there is even an opposing relationship between high and low risk areas, and over Appalachia, there is only only a slight to moderate correlation seen AT THE SMALL AREA LEVEL.    


The Obesity map is 2007, the Medicare reimbursements map is 2006; each were developed by different research groups, and age distributions for the members of these two groups could be off. The methods, dates and equations used to produce each of these maps could also make a difference here.   So, this is more an example of hastily drawn conclusions based upon first impressions.  But, I have to admit, the other maps inferred in this article have not been fully reviewed.  


The point is that until our HIT/EMR community takes on statistics as a spatial pursuit, not just a generic modeling routine minus the appropriate methodology checks, this will lead to more errors, false leads and wrong conclusions, and unfortunately more wasted preventive health money.  

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Kentucky Health News: W. Va. plans private-public model to provide school breakfast, improve child health, fight obesity; could this approach help Ky.?

Kentucky Health News: W. Va. plans private-public model to provide school breakfast, improve child health, fight obesity; could this approach help Ky.? | Episurveillance | Scoop.it
Brian Altonens insight:

Until recently, Medical GIS consisted mostly of short lived retroactive studies funded primarily by grants, and presented at meetings, conferences, etc..  Continuous surveillance using live data provides additional paybacks in that it documents the long term changes being made and assigns responsibility for these changes, or lack thereof.   By delaying this progress with HIT and EMR availability, we also delay the implementation of better, more targeted, less expensive health care programs.

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Spatial Health

Spatial Health | Episurveillance | Scoop.it

July 1973. From page 72 of “The Future Society: Aspects of America in the years 2000″ American Academy of Political and Social Science annual meeting. “Health Challenges of the Future” lecture by George E. Ehrlich.

Brian Altonens insight:

A little more than 40 years ago, George E. Ehrlich gave a lecture at Temple University on July  of 1973 entitled “Health Challenges of the Future".   This lecture was part of the annual meeting of the American Academy of Political and Social Science devoted to "The Future Society: Aspects of America in the years 2000."

Then Professor of Medicine at the Temple University School of Medicine, Ehrlich predicted the depersonalization of medicine which the computer might result in. 


Also evident is the possibility that we are falling short of one of his visions about the direction in which the field of medicine was heading due to the invention of the computer.  


Ehrlich thought that by 2000 we would be fully engaged in making the best use of the computer and the storage of patient records, thereby create tremendous improvements in people and population health.  He speculated that with the computer, diagnoses could be made more rapidly, lab orders and clinical testing could be automated, with the results generated and then posted in a timely manner, and that we could therefore understand the best options for care we had available to us, all in very short time.  


Ehrlich's major concern with these technological advancements was the further reduction of the human contribution that could ensue--a reduction of interactions that normally occurred between patients and care givers.


Unfortunately, many of today's practitioners, allied healthcare givers, and patients agree with Ehrlich's last statement.


Even more unfortunate however, the failure of the system to more quickly and more effectively make the best use of its technology to provide patients with more health care value for their money.


This latter failure has nothing to do with the technology itself, only with those responsible for the best use of that technology--those responsible for employing it within the health care system with the best long term interests in mind.      


George Ehrlich could not foresee the increasing split that ihas occurred between the rich and poor since the 1970s.   But he would probably aggree and be incredibly surprised to see how that, in spite of technological achievements and advancements, the human side of providing care and making care accessible has not changed in more than forty years.  


The recent resistance to change and improvements in healthcare, are a repeat of these same events unforeseen by Ehrlich.  The ongoing resistance to change due to financial managers and CFOs of these systems offers little explanation for the tremendous acceptance these companies have for their lack of progress during the past 40 years.  


The failure of insurance companies to implement EFFECTIVE, cost savings population health analytics programs into their systems is an example of what Ehrlich refers to with his criticisms.  


Conformity is not always to our benefit when it comes to  healthcare.  The attached quality of life and financial benefits of receiving more effective care are opportunities missed due to poor management and the corporations' resitance to change.   


Ref:  George E. Ehrlich, (Publ. in The Annals of the American Academy of Political and Social Sciences, Vol. 408, July 1973, pp. 70-82.) 

Brian Altonen's curator insight, February 10, 2014 9:13 PM

eCloud, Big Data and EMR come to life!  More than 40 years ago a professor in New York predicted that computers would take the place of workers in many clinical settings, and standardize the way in which we manage tertiary and the most high specialized forms of quaternary care.  His primary concern was the depersonalization of medicine these changes would result in.  In many ways he was right.


The NPHG technique I developed  (http://nationalpopulationhealthgrid.wordpress.com/) provides a cost-effective means to make complete use of our eCloud, Big Cloud and EMR/EHR data.   It specializes in the analysis of Big Data at the small area spatial level. (No limits to unit area size.).  


The products of the NPHG mapping technique are highly effective outcomes that can be used to demonstrate the unique success of a program driven by community needs, instead of just system needs.   NPHG maps enable highly targeted intervention programs to be developed.  They provide a more effective demonstration of the failure or success of your program.  The enable you to identify the places where the best outcomes were generated, for more insights into how to improve the different parts of your program.    


This method of analysis and review is capable of producing hundreds of maps  per day, automatically, enabling detailed, comprehensive programs to be developed.  


Imagine, for example, being able to routinely analyze 150 to 200 diseases weekly, for a special topic like Hispanic, Asian or African American population health, infectious disease migration patterns, rare or genetic disease distributions, or culturally related ICDs.  In addition, cost and utilization patterns can be evaluated at the areal or neighborhood level.  For conditions ignored in most annual reporting processes like HEDIS ot the Annual QI (PIP) reviews, programs unique to your population profile can be developed for routine use.

In essence, there are no limits to the applications of this tool, at the R&D, Business, or Quality Improvement level.

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The spatial evaluation of EMR/EHR data as a primary means to document Meaningful Use

The spatial evaluation of EMR/EHR data as a primary means to document Meaningful Use | Episurveillance | Scoop.it
Brian Altonens insight:

Have you ever wondered if the health care facility or company you are working for, or the region you are working in, has particular diseases and conditions that the patients are most susceptible to?  


For example, does the diagnosis Boston Exanthem infect mostly people in Boston area, or is it simply a name for a fairly common condition?


If the facility that hired you had a GIS developed, with which it kept track of the local population health data, you could obtain an answer to this question almost instantaneously.   Even an effective SAS programmer could produce the same, without need for a GIS.


Systems that lack spatial tools or methods to analyze their data are simply not operating at their fullest potential.  This sets the stage for higher costs in the long run and forces us to rely upon less effective prevention programs.


The responsibility of local population health should be in the hands of local healthcare facilities and regional health insurance companies.  Their responsibility is to oversee the quality of care being provided locally and to modify it whenever neccessary in order to reduce long term costs.  


The responsibility of population health surveillance is not just that of a local county or regional public health department, or the state's environmental health and epidemiology offices and agencies.    


With a well designed spatial surveillance program, even the smallest providers down to the hospital level can maintain a trackable, manageable database system, providing them with daily or live updates in order to develop more effective intervention/prevention programs.   


This more aggressive use of our EMR/EHR data along with free or open source spatial analytic tools serves a purpose.   It ensures us a more effective surveillance program and allows us to demonstrate timeliness in terms of response rates and meaningful use in terms of cost, quality of care, and overall health of our patients.   


For examples of medical GIS at work during the past decade, see:







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StopTheShootings.org - maps of school shootings

StopTheShootings.org - maps of school shootings | Episurveillance | Scoop.it
387 school shootings in the U.S. since 1992. View interactive maps and stats for U.S. school shootings.
Brian Altonens insight:

Sometimes, non-profit organizations and publically minded CEOs are what we need to have an impact upon local public health. 


The StopTheShootings organization is an example of this. . .  


"Thanks to heavy media coverage, most people are familiar with mass school shootings at Columbine, Virginia Tech, and now, Newtown.


But there are many other tragic stories that often go unheard. To remedy this, WhitePages CEO Alex Algard created StopTheShootings.org in 2009.

In light of the recent Newtown tragedy, Algard re-launched the website to spread awareness about U.S. school shootings that have taken place since 1992. Previously, there was no authoritative information resource on the incidents and StopTheShootings hopes to fill that void as a useful resource to the public."

For examples of other less often thought of quality of care services and agencies, see:









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Longstanding Fears Help Explain the Latest Wave of Obamacare Outrage | TIME.com

Longstanding Fears Help Explain the Latest Wave of Obamacare Outrage | TIME.com | Episurveillance | Scoop.it
Losing health insurance has long been a terrifying possibility for Americans who buy coverage on the open market.
Brian Altonens insight:

By calling the new program "Obamacare", we are simplying trying to divert blame away from ourselves as "health insurance" companies.   


Once the phone numbers are working, and the people start enrolling, how will insurance companies manage the new rules? 


Can and, if so, how might they impact the health of people?


One Director/VP for a very large regional plan in the Mid-Atlantic region told me her [her company's] concern was that by allowing patients to switch programs a year into the new program, that this could enable the highest cost, highest risk patients to move to other companies, like her own.  In turn, these events would have a negative impact on the company's earnings, and so she felt it was time to hire someone who could carry out a risk assessment with hopes of preventing these new enrollments.  This company's goal, therefore, was to develop a way to identify new enrollees that might cost too much early on, and then stall their application and approval processes, with hopest that they'll go elsewhere.  Such a statement by one of the largest companies in the country suggests to me that even the biggest companies don't want to take on the responsibility of providing care to the poor. 


See also:


"Noonan: Obama Disaster Plan Recovery" at http://online.wsj.com/news/articles/SB10001424052702303789604579197883480604424


"This Obamacare Website is Crashing because it doesn't want you to know how costly its Plans are": http://www.forbes.com/sites/theapothecary/2013/10/14/obamacares-website-is-crashing-because-it-doesnt-want-you-to-know-health-plans-true-costs/


Jonathan Serrie's "ObamaCare reg on digital patient records raises security concerns" IT phobia is described at http://www.foxnews.com/politics/2013/10/02/obamacare-reg-on-digital-patient-records-raises-security-concerns/


The Hillsdale Collegian point of view: "Local Physicians Fear Obamacare" - http://www.hillsdalecollegian.com/2013/11/local-physicians-fear-obamacare/


"Special Investigation: How Insurers Are Hiding Obamacare Benefits From Customers" http://talkingpointsmemo.com/dc/insurance-companies-misleading-letters-obamacare



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A map of the U.S. depicting overall positive drug test rates

A map of the U.S. depicting overall positive drug test rates | Episurveillance | Scoop.it

Drug Testing Index -- maps of the U.S. depicting overall marijuana, cocaine, amphetamine and opiates positive rates.

Brian Altonens insight:

Evaluating patients with GIS is a major asset to the health care business industries, including some we rarely pay much attention to.


The urine drug testing business engaged in by Quest Diagnostics should be of interest to health and disease mappers due to its relationship to the drug abuse/misuse we often analyze. 


Quest Diagnostics performs many of the tests that potential employees must go through for future employment.  Like any industry interested in progress, Quest has produced national maps of its findings for the numerous labs across this country. 


By applying GIS and making it a normal routine for its business, Quest Diagnostics has taken on a fairly innovative way for managing its overall business in the country.  This mapping allows its managers, and us, to compare Quest Diagnositcs findings to the national disease maps.  The typical responsibilities for this work are very much in par with (if not greater than) those in other HIT/Quality Improvement programs. 


Quest Diagnostics Inc. engages in more than 150 million procedures per year.  These procedures impact about 30% of the U.S. adult population.  These activities earned the company more than $7.4B company in 2012, making it one of the Standard and Poors, Barron's and Fortune 500 companies during the most recent years. 







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Syria's refugees – satellite mapping the scale of the crisis. | martinplaut

Syria's refugees – satellite mapping the scale of the crisis. | martinplaut | Episurveillance | Scoop.it
The camps in Turkey, Iraq and Egypt have not yet been mapped by the UN's satellites – so even the maps by UNOSAT are just a drop in the ocean. The UNHCR says it needs $1.1 billion to cope with the crisis by December ...

Via ImaginationForPeople
Brian Altonens insight:

GIS is a mainstay in foreign countries.  It can exert more pressure politically and financially than any photograph or carefully planned news release.  Mapping the consequences of everyday changes with GIS or remote sensing can exert more pressure than even the best planned public relations campaigns.  By focusing too much on the minutia (people, cases and events), we often lose track of the bigger meaning (populations and their needs).


When we attach points to a map we are pointing to cause and effect, victims and events.  Maps assign more than just meaning to a situation, they link it to events and consequences people and places.  With regards to privacy and privacy concerns, there is no need to reveal a name or address on a map when it provides you with this much data.  We stop thinking about individuals and focus on what happened to a region due to this style of mapping.  We begin to think about culture and place, and the population as a whole.  


Concerns for particular individuals, people you may know by name or face, are minimized whenever events like these happen.  As individuals, only a few onlooker ever assign meaning to individuals they might know on such a map.  To total strangers, meaning is instead assigned to events and populations.  All of this is due to an aerial photo, a satellite image, or a highly detailed map about an event.

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e-Mapping The World’s Health - Better Health

e-Mapping The World’s Health - Better Health | Episurveillance | Scoop.it
Better Health is a network of healthcare professional blogs, offering commentary on news, research, health policy, healthcare reform, true stories, disease management and expert interviews.
Brian Altonens insight:

The 2 minute video at this site is recommended.


It is about some new technology being displayed at the TedMed 2010 conference. 


Inventors and marketers for this program state it is capable of mapping disease outbreak information that is automatically obtained and downloading by scanning the internet, at a rate of more than 50,000 sites per hour.  Data are gathered, evaluated, reassembled and then live projections are produced.  Such maps would be used for stopping outbreaks or preventing their spread.  The IT tools required for this are accessible via iPhone apps, by clinicians and other health professionals.

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In Syria outbreak, polio exploits conflict once more - Reuters India

In Syria outbreak, polio exploits conflict once more - Reuters India | Episurveillance | Scoop.it
In Syria outbreak, polio exploits conflict once more Reuters India Caused by a virus transmitted via contaminated food and water, it can spread rapidly among children, especially in the kind of unsanitary conditions endured by displaced people in...
Brian Altonens insight:

In 2006, the polio-endemic countries were down to Afghanistan, India, Nigeria, and Pakistan.  In the late 1990s major immunization programs provided more than 450 Million immunizations worldwide, 80 million in China, 147 million in India.  Today, Nigeria, Pakistan and perhaps Afghanistan remain as the most active ecological settings from where wild poliovirus could once again re-merge to produce new epidemics. 


If such a case migrated into this country, where would it most likely come in?


Through episurveillance mapping, US polio history and cases noted in medical records can be spatially evaluated.  Human migration is of course the major determinant for such a diffusion, but is not the only factor in need of review.  The disease migration, sequestering and re-eruption processes have different spatial rules and behaviors to adhere to.  The most viable regions for this disease to re-emerge, and the most susceptible populations, can be identified using GIS, and would be based upon human transportation/diffusion routes, U.S. case evidence and history, and regional, human and natural ecological patterns.

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Exploring the Role of GIS During Community Health Assessment Problem Solving: Experiences of Public Health Professionals (article)

Exploring the Role of GIS During Community Health Assessment Problem Solving: Experiences of Public Health Professionals (article) | Episurveillance | Scoop.it

Figure above:  Levels of Engagement in Medical GIS.

Brian Altonens insight:

Within the healthcare/managed care systems, where are we with  population health technology and medical GIS available to us today?


This article provides a summary of where the medical GIS field was in 2006, findings used to design a series of surveys devoted to medical GIS, and culminating in a fairly detailed survey through  Survey Monkey. 


The above figure informs us of where we are the medical GIS field.  In general, heathcare systems and population health industries tend to be behind most of the public health and epidemiology fields out there when it comes to HIT, data integration, and the production of reports that rely upon spatial epidemiology techniques for their surveillance. 


Like any research methodology in need of growth, it helps to understand the potentials of the field before defining any actions that need to be taken to improve a company's ranking in the technology.  The illustration above [linked to the Medical GIS Survey, not the article] depicts the different skill levels for each of the ranks defined for spatial epidemiology and HIT (with or without GIS).


For a direct link to this article, see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1578566/







Matthew Scotch, Bambang Parmanto, Cynthia S Gadd and Ravi K Sharma.  Int J Health Geogr. 2006 Sep 18;5:39. Exploring the role of GIS during community health assessment problem solving: experiences of public health professionals.




Brian Altonen's curator insight, October 25, 2013 7:16 AM

There are three major periods in the development of medical GIS applications: 1) informative, or information base, 2) analytical, or focused on statistical methodologies and developing results, and 3) preventive, in which these results are applied. 


The forms of GIS employed determine where a GIS team may be ranked in this specialty.  Managed care programs for example are usually between levels 4 and 6, on a scale of 1 to 10.   A robust plan utilizes spatial data and spatial algorithms to interpret findings, and applies these findings to developing effective cost savings and/or intervention programs. 


Most programs engaged in medical GIS are still in the informative period.  They employ GIS to illustrate findings, but rarely to evaluate the statistical significance of health, costs, services, or behavioral changes over time and space.  Programs in the experimental stage of GIS use (levels 5.5-6) apply spatial analytics to a few special studies, but not as the standard means for generating HEDIS style metrics, meaningful use outcomes, or reports on a variety of special studies and population health features.  The more advanced spatial analytic teams are those which automated their studies and can generate reports on numerous population health metrics, on a regular or ad hoc basis.


This article details the steps that need to be taken for meaningful use of GIS in a community health oriented managed care program.

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Managing and Mapping Disasters : FEMA.gov examples

Managing and Mapping Disasters :  FEMA.gov examples | Episurveillance | Scoop.it
Brian Altonens insight:

Disaster plans and mapping these disasters using GIS are now the standard.  In 2006, at a Medical GIS conference I attended, the bulk of the mapping projects displayed were produced using non-GIS products, typically CAD and Remote Sensing utilities.  Spatial displays of events were evident, but spatial analyses pretty much absent.  Seven years later, the ratio of displays of GIS to non-GIS are pretty much reversed.  The application of spatial statistics modeling techniques however is still in its early stages of implementation. 


Another way to interpret how we employ GIS is the assess how many times we utilize GIS to predict and plan our operations with, versus how often we apply it in retrospect of the disasters, tragedies and outbreaks that took place.  


We may not be able to predict the path of a tornado or hurricane, or the next site for an earthquake, or the impact site of a tsunami, or the palce where the next epidemic could erupt, but we can predict where the greatest loss of lives will probably occur, where the greatest numbers of patients in need of care are to be anticipated, or where the highest cost for recovery will need to be generated.  All of this can be determined within minutes to hours of when the disaster, tragedy or potential public health threat initiates.  


The Geoplatform generated by FEMA, viewable via this site, is an example of such endeavours.


See the interactive map insert on this page as well, developed with the support of ESRI.  The May 20, 2013 tornado in Oklahoma is reviewed.

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Utilizing GIS for Surveillance - Free Disease Outbreak Maps Provided as Examples

Utilizing GIS for Surveillance - Free Disease Outbreak Maps Provided as Examples | Episurveillance | Scoop.it
Download Disease Maps in high resolution formats.
Brian Altonens insight:

Dozens of companies are now well ahead of most businesses engaged in epidemiological surveillance or what I like to call episurveillance. 


The values of this important skill are not related just to  how it can be used to save lives or prevent large scale outbreaks.  It can also be used to reduce costs accrued due to delayed testing and interventions, failure to identify fraud during its earliest stages, and the inability of programs to develop more  effective interventions programs in order to improve their HEDIS, PIP and/or Meaningful Use scores.    


Companies that do not currently use GIS to evaluate their services are pretty much placing themselves behind the eight ball, and quite soon, will be behind in the competition as well.  Companies that are right now initiating a GIS are at least better prepared for the future changes expected with Managed Care. 

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HealthLandscape: GIS Tracks Emerging Statewide Patient Care Patterns

HealthLandscape: GIS Tracks Emerging Statewide Patient Care Patterns | Episurveillance | Scoop.it
Brian Altonens insight:

An example of effectively combining GIS and Managed Care in North Carolina.  More effective patient care means efficient cost saving programs.

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