Geographic information systems (GIS) is a powerful communication tool and the medical community is just now starting to harness its full potential.
There is a wide range of mapping technologies out there, with varying levels of expertise required. One of the reasons the medical community has been slow to adapt mapping technology to parasitic disease is precisely because there is a strict learning curve associated with sophisticated mapping technologies. Doctors, nurses, and infectious disease specialists are not trained in how to use graphic information systems technology. The slow uptake can be partly attributed to this learning curve barrier.
Programs like Google Maps benefit from a simple, straightforward user interface that allows most anyone to run their own mashup, but, as Product Manager Jessica Lee told us, they are limited in how complex their mapping technology can be by the web browser. Programs that rely on a third party interface are inherently limited. But, on the other extreme, programs like ArcGIS take months or even years to learn. “I’ve taken a whole class devoted specifically to learning ArcGIS,” said Stanford junior Hari Mix, “and I’m still only grasping the tip of the iceberg.” It takes forty to sixty hours to get through the introductory tutorial to ArcGIS. The suite-style platform program is not designed for the everyday person to make a map.
Cost of Equipment
The financial implications of hardware and software remain a key obstacle to the slow uptake of GIS technology in the medical community. Cost has become less of an issue in the past decade, with relatively cheaper hardware and software. In addition, most GIS software works adequately on a standard desktop computer. Instead, there is a more recent problem that most GIS software does not adequately handle spatial statistics. Thus there is a lack of software to perform spatial analysis. Experts say that the discipline of spatial statistics is in the early development stage and not well understood yet by most users.
In addition to cost barriers, availability can also be a barrier. In the past five years, however, availability and access to technology has increased dramatically. In Berkeley Professor Seto’s research on schistosomiasis in China, he found that some tools are now much more widely available: many Chinese provinces and counties now use or have access to GPS systems to start much more efficient targeting of extreme disease hotspots. Coupled with changes in computing power and an increase in Internet availability, spatial data information is much more widely available.
The advent of GIS in health care raises important privacy concerns given the sensitive nature of patient data and the implications of data sharing that may include location and patient data grouped together. While privacy concerns do not impact data usage for public health departments, it does influence sharing data sets or published work among researchers and the public. A study by Brownstein, et al (2006) found that in a simulated low-resolution GIS patient map, twenty-six percent of patient addresses could be precisely inferred from the map output. A higher resolution GIS that is publication quality allowed for precise re-identification of seventy-nine percent of patient addresses. The availability of GIS information is crucial to the growth of GIS in medicine, but revealing even a portion of patient data compromises fundamental standards of patient privacy. In the future, GIS work will likely require anonymizing techniques or other methods of delivering necessary information without revealing patient information. GIS will also likely drive a revision of HIPAA, the Health Insurance Portability and Accountability Act of 1996 that established national standards in patient information privacy. According to John Brownstein, an Instructor at Harvard Medical School and faculty at Children’s Hospital Boston, GIS is introducing new technologies and information sets never considered when HIPAA was created and will likely need to be revised to reflect modern data usage.
GIS has important policy implications that will continue to play a pivotal role in the future of mapping and parasitic disease. As the medical community continues to absorb and take advantage of GIS technology in the coming years, the policy implications will grow, as well. Some key policy implications are that GIS makes it much easier to target available resources, to garner political support if one is able to show tangible areas for improvement.
According to Berkeley Professor Edmund Seto, GIS reveals the need for integrated public health initiatives. Specifically related to his work with schistosomiasis in China, he sees a need for not only using drugs, but also for changing the structure of ditches, introducing sanitation measures to allow stool to ferment longer and higher temperatures. GIS also demands more interdisciplinary collaboration. The medical community needs more input from computing industry to make better use of the technology available in a way that is useable to someone from a biology or chemistry background.
Brownstein, John, Christopher Cassa, Isaac Kohane, and Kenneth Mandl. “An Unsupervised Classification Method for Inferring Original Case Locations from Low-Resolution Disease Maps.” Int J Health Geogr 5 (2006): 56.