Geographic Information Systems

A six-year-old patient admitted to a hospital medicine service due to status asthmaticus is a common occurrence in pediatric hospitalists nationwide.

But what if the questions about why the patient was there weren’t just limited to their body? What if the question was: Where did the patient come from in the first place? What if the diagnostic process were a data-driven dive into that child’s state, town, neighborhood, or even block?

Welcome to the world of geographic information systems (GIS).

The technology is a computer system that analyzes and displays geographically referenced information. All geographic areas have longitudinal and latitudinal coordinates, so those physical bounds can be paired with any data set.

Whether it’s a doctor looking at health care outcomes in a given state, or a city comparing the location of grocery stores to where the most children live, it’s creating a new layer of analysis using spatial information.

And, in the apocryphal case of a six-year-old with breathing issues, it’s a way to analyze how where a child lives is impacting their overall health.

“If you can map and visualize health outcomes, it can really help and hone your ability to improve them,” said Jordan Tyris, MD, MSHS, one of two presenters, at Pediatric Hospital Medicine 2023, of “GIS and Beyond: A Tool to Integrate With Health Care.”

Dr. Gourishankar

GIS technology has been increasingly popular since the COVID-19 pandemic started, according to Dr. Tyris and lead session presenter Anand Gourishankar, MBBS, MRCP, MAS. Both work as pediatric hospitalists at Children’s National Hospital in Washington. In the fictitious presentation of a six-year-old with asthma, each agrees that delving into geographic-based information sets can help inform care decisions.

“In fact, given how early on the technology still remains in terms of its application in health care, there are still likely leaps in knowledge to be gained as the practice is adopted more widely,” said Dr. Gourishankar, an associate professor at the George Washington University’s School of Medical and Health Sciences in Washington, D.C.

The technology “touches all areas of medicine, in terms of research, advocacy, policy, administration, education,” he said. “When we start asking the question of why-what-how, but you (add in) asking the question from where, from a geographic standpoint—it gives the leverage of attaching all the questions or needs or implementation plans from a geography standpoint. It’s (another) angle for solving problems.”

Potential applications for solving problems with GIS are limited only by the data sets hospitalists can acquire. In slide after slide, the presenters showcased how data tied to mapping tells a story.

The number of dentists retiring across Alabama shown in the context of the number of children living in each of the state’s counties, all color-coded to show where the biggest risks are of children not being near a dentist over time. Asthma rates in Washington, D.C., juxtaposed with poverty tiers, highlighting the well-established connections between income levels and health outcomes. The location of pharmacies in the nation’s capital, using those same asthma rates—again color-coded, this time to highlight how the areas that have the most drugstores have the fewest number of kids.

Part of the reason interest in GIS has seen an uptick since the pandemic began is that the technology has been useful in comparing pre- and post-COVID-19 trend lines in areas that reacted differently to the coronavirus. Using the technology, different public health rules in different geographic areas can be compared to do analyses of health outcomes.

Said another way, Dr. Gourishankar sees combining data points as painting a fuller picture. If you overlay medical issues in a given area with, say, poverty indexes, income brackets, and educational attainment, every practitioner from public health officials to front-line hospitalists can learn how the social factors interplay.

Health care “should address all these determinants all at one time, not just focusing on one area,” he adds. “It doesn’t work (to look at just one). There are so many moving parts to take care of a patient…we need to be mindful of addressing all these geographic” factors.

Dr. Gourishankar understands that hospitalists unfamiliar with or untrained in GIS can quickly feel overwhelmed by data, mapping, or the complexities of pairing the two disciplines. He said that’s a natural reaction to a burgeoning field, but that like all knowledge, the power of the resulting information is worth the effort.

He compared it to a teenager getting behind the wheel for the first time.

“I’ll give you an analogy of driving a car,” he said. “You start the engine, you start driving. You don’t see what’s happening behind the scenes, what’s under the hood, what’s going on with that. As long as you have a general sense of how you use your knowledge and content expertise, and you ask good questions,” it works.

Then, “find the right people and right tools to use it,” Dr. Gourishankar said. “It doesn’t become a one-man show, (because) you’re also leveraging and using help from people who have wide expertise. We don’t exist without other people who are helping us. It’s a team science.”

Dr. Tyris, an assistant pediatrics professor at George Washington University, notes that hospitalists interested in working with GIS can either rely on those trained in it, learn the basics themselves, or try to pull off a hybrid. There are even open-source programs that hospitalists can practice on for free, providing low-risk, high-reward training opportunities.

“It’s very doable,” she said. “There are people throughout the hospital medicine community who are learning the skills to be able to do the work. So, it’s very feasible. You just need to know where to find the resources, which is the biggest barrier, not learning the resources.”

At its core, Drs. Gourishankar and Tyris agree GIS technology is like every other tool in a hospitalist’s toolbox: if used correctly, and in tandem with other more traditional and hands-on tools, it can help reduce lengths of stay or prevent future hospitalizations.

“I’m hoping that GIS will make you switch from reactive to proactive,” Dr. Gourishankar said.

Richard Quinn is a freelance writer in New Jersey.