Aging in Place with Grace

Geomedicine: Mapping My Health!

 As far back as most of us can remember, even before the U.S. Environmental Protection Agency was formed, it was recognized that our surroundings could affect our health, even in minute ways.  But this concept has taken a leap of several magnitudes in the creation of an emerging field called geomedicine.

The whole idea behind geomedicine is to use geographic information system (GIS) software with scientific and medical databases to provide clues or correlations of climate and environment that could improve the health of both individuals and entire populations.  This is a model that links our own health status to specific geographic locations where we have lived and worked. 

Smokestak photopin 3.2013 small_6702244011Toxic substances abound in our world and have only continued to become more and more influential in our health and the environment in which we live.  The fact that the very air we breathe could cause a particular and specific predisposition to or actual cause for certain diseases would help both the consumer and the health care realm in managing the disease and possibly improving the outcome.

In a 2010 study published in the Journal of the American Board of Family Medicine, researchers used GIS software that combined data from electronic health records with patient addresses and socioeconomic status to study why there were such differences in the outcomes of two separate groups of patients: one group with type 2 diabetes and another with high blood cholesterol (LDL) levels.  What they uncovered was a relationship between the income, education and occupation in the control of blood sugar levels, but no relationship whatsoever between those same factors and high blood cholesterol.

Another example:  

  • An inhaler complete with a GPS sensor created by David Van Sickle, an epidemiologist at the University of Wisconsin-Madison, is designed to pinpoint the location of a person’s asthma attack with the intent of tracking and, optimistically, eliminating recurring asthma attacks. 
  • Each time the person puffs on the inhaler, the location is mapped.  This will isolate the places and times a person is seriously affected by the environment around him.

The geomedicine model is never more evident than in a downloadable app released in June, 2012 called “My Place History” from a company called ESRI.  The idea is to enter addresses of places you have lived or worked into the app which then uses the Toxics Release Inventory (TRI) database from the US EPA, as well as the National Institute of Health’s ” known chemical” database,” to create a report for the user that allows them to see the possible environmental hazards or exposures for those locations.  ESRI’s global manager, Bill Davenhall, has said: 

“This application is useful in helping people understand the potential link between public health data stored in one data base [toxic releases] and their individual places of residence or employment.”  He goes on to say, “There is a great deal of data collected to benefit public health.  Unfortunately, this information seldom gets into the hands of the health-seeking consumers presenting symptoms to their physicians.”

He has also commented that such data should become part of a person’s electronic medical record and that “where you live matters to your health.”

Another similar app for the iPad developed by Critigen is one called Health Indicators.  This app combines a lot of very complex governCell phone GPS 123rd 3.2013ment health data (translation: Big Data) and put it into a mobile GIS, allowing the user to do comparisons of counties, states and census regions. So, for example, a category titled “Managing Disease” provides verifiable data on how well the chosen location manages potentially fatal conditions.

Geomedicine has been called the “new frontier in medical informatics” in some realms.  The fact that a physician or health care provider could utilize this type of information to give specific advice or recommend appropriate resources should be another welcome “tool” in the medical community’s toolbox.

In a commentary about aging in place (AIP) data, my colleague Louis Tenenbaum, in a post dated March 11,2013 notes that  ”a recent McKinsey report suggests it [aging in place] is not catching on because the data is not actionable, does not provide value.”  Note that:  

  • Right now, the state of aging in place is action/reaction, not problem/solution-based.
  • Moving AIP-related facts and figures into the “Big Data” (or extremely large quantities of data) dominion would foster a way for the AIP field to move out of the current action/reaction mode.  
  • Electronic health record- keeping (EHR) is fractionated across vendors, health systems and providers, so a “level playing field” must be achieved in order for such data to be used in a form and function as it should.

 But this is exactly where geomedicine could step in to actually provide usable, correlatable data to a treating health care provider in diagnosis and disease management on a “Big Data” basis.  With “My Place History,” for example, one could look at a person’s past exposure and actually postulate a future health care issue.

However, there is a recognized caveat.  InformationWeek Healthcare cites a statement from Estella Geraghty, MD, of UC Davis.  “We have to think carefully about the kinds of things we design that people can act upon.  That’s the biggest challenge – making it clearly relevant.  It doesn’t make sense to look at a patient’s geographical exposures to substances that might cause lung cancer, because there are no screening tests for lung cancer.” 

Geomedicine has huge potentials for not only health care, but for those seeking age at home as it could provide them with a geographical location that is best suited to their present or possibly even their future medical conditions and care., Ken Terry, March 1, 2013: Geo-Medicine New Frontier in Medical Informatics

Geraghty, Estalla M. et al. “Using Geographic Information Systems (GIS) to Assess Outcome Disparities in Patients with Type 2 Diabetes and Hyperlimipemia.” J Am Board Fam Med January-February 2010 23:88-96. Print, Jamie Epstein, February 28, 2013: Healthcare Physicians Turn to Technology to Save Lives, Lyke Maduako, February 8, 2013: Geomedicine: Rescue inhaler topped with a GPS Sensor: Creating a New Paradigm for Doctors and Patients″>, Kenny Ratliff, February 1, 2013: Making Sense of Health Data, Louis Tenenbaum, March 12, 2013: Big Data & Aging In Place, Caitlin Rosenthal, March, 2013: Big Data in the Age of the Telegraph, Bill Davenhall, May 29, 2012: Making Health Data Do Something

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