"Location, location, location" is a phrase long associated with real estate, but in recent years it's also played a role in attempts by healthcare professionals to track disease.
Now some health IT experts are adding location information – where patients have lived – into their EHRs.
"There's a huge body of health information that's been generated at high levels, particularly at the state and county levels, but it's had little effect in doctors' offices," said Bill Davenhall, marketing manager of health and human services solutions for ESRI, a California-based provider of geographic information systems (GIS) services to a variety of industries.
If Davenhall has anything to say about it, that's going to change soon. In his eyes, the healthcare sector has done well in incorporating genetics and lifestyle into the factors considered when patients are treated, but "the third leg of the stool should be locational history."
After all, he said, it's certainly worth knowing if a patient grew up near a metal manufacturing plant, for example, as chromium, which is used in metal manufacturing processes, is known to cause brain tumors.
Moreover, Davenhall said, while eating locally grown foods is a popular theme in health circles, it may not be such a wise idea if, say, the local soil has been contaminated by past industrial use or a specific toxic dumping incident.
While geomedicine – which Davenhall describes as a process of taking generalized environmental information "and pushing it into the interface between doctors and patients" – may not be a common practice now, he points to three potential uses:
Geo-coding. Most people think of an address as a street name or number of an apartment. But with GIS any address can be easily communicated in terms of longitude and latitude. According to Davenhall, a current ESRI project incorporates census bureau data into a reference database for use by healthcare providers. "Historically, an address has not been used as part of clinical information," he said. "It is, however, one of the largest contextual pieces of information" because it can be matched up with a range of public databases that include the location of toxic waste sites, past industrial sites and other potential "environmental burdens."
Curriculum development. Geomedicine may still have an exotic ring to most providers, but Davenhall said universities and research institutions have begun developing curricula and programs that look at the intersection between location identification and technology. "The next generation (of providers) will have the expectation that health information will be located geographically," he predicted.
Personal apps. Healthcare organizations may be just catching on to geomedicine, but patients need not wait. ESRI's "My Place History" iOS app can help users build a profile of their past living circumstances for comparison with, among other things, toxic location databases.
"I recently read that the average American moves 11.7 times in a lifetime," Davenhall said. From a healthcare perspective, that amounts to a tremendous range of potential encounters with environmental circumstances that could impact a person's health.
The data is available to enable providers to make addresses clinically relevant, Davenhall added, but healthcare stakeholders still "have to figure out how to operationalize it."
