The following notes are made regarding the need to define a policy within the managed care setting, when the goal is to produce a spatial analysis or geographic information systems (GIS) tool for implementing full scare spatial monitoring of health at the institutional level.
What is the GIS to be used for?
What are examples of data analyses and institutional quality of care, quality improvement measures that can be applied to spatial analyses for the purpose of defining significant changes, and monitoring quality of care performance?
Based on experience in the managed care setting, and in a national healthdata warehouse setting where GIS was used extensively for a number of years, my analyses revealed the following discoveries about GIS implementation in managed care based population health monitoring programs, and the value of GIS in monitoring cost, quality of services, epidemiological data, surveillance related health concerns, and changes in population health due to system, institutional, population or epidemiological and environmental changes in a region’s areal health patterns.
- Design an institutional GIS-HIT Policy; establish a committee devoted to this topic
- Define metrics levels, internally and institutionally, and described briefly their potential uses
- Define stages and order of development of these different reporting processes and tools
- Define stages and levels of reporting the outcomes of any analyses performed using these processes
- Have a Report plan and format designed and developed
- Establish reporting rights for this data, including methods for:
- coverage of authorship and inventorship for the processes implemented,
- IRB related requirements for approvals of release of this information,
- compliance related details regarding reporting processes,
- rules for differentiating internal versus external, multiinstitutional versus single institutional reporting and sharing of data and results,
- administrative versus non-administrative sharing practices for research processes and results,
- reporting processes normally approved without need for IRB approval using the given data analysis processes,
- methods for release of information from these projects, methods for warehousing or storage of this data for long term use and reporting purposes,
- methods for designing the “Atlas” presentation processes for summarizing results,
- processes related to release of data or findings to outside sources, ranging from other research groups and institutions, to news reporters and press release individuals, to standard refereed medical journal publishers and repositories.
Process for implementing the HIT-GIS tool and program in managed care
- Development of a software plan for implement HIT-GIS in a stepwise fashion
Processes for engaging in population health research using this system:
- Types of processes involved include standard annual reporting, quarterly reporting, monthly reporting, research related reporting, ad hoc research or pre-research related reporting.
- All processes have to undergo internal IRB reviews and a similar review by the IRB sponsoring or supporting the original researcher.
- All processes need to have an abstract on the research process, and accompanying documents detailed the data requested and the research processes under consideration; a flowchart is preferred, although not required.
- A GANTT diagram or other similar chronological tool should be provided to clarify deadline related requirements.
- If available, information on known future users and publishers or the research must be identified.
- Sponsors and funding resources for this work must be defined. If a grant is serving as part of this funding or support, a copy of that grant and/or research proposal should be provided.
- A researcher’s bibliography of previously published materials related to this project must be included. This document must contain recent, up to date materials
- A basic information packet must be provided with each major submission of work, which includes:
- the title of this project,
- a short title if available for this project,
- the list of its researchers, including contact and address information and details about their position in the research team,
- a brief biography of those most involved in this program
- an abstract on the topic background and history, and the related research processes and methodologies
- a budget or estimated budgets/cost sheet for the work
- conflict of interest statement
[34 types, about 1000-2000 metrics, depending upon reports/subgroupings]
The following classes of metrics are defined. All have been developed and produced in the current managed care system and regional health care system that I am responsible for. An estimate of the numbers of metrics that are required appears in brackets.
- QA – missing data [unk, total ICD? Region, facility?]
- Standard metrics – population data on ICDs, plus demographics/area [2-16]
- Standard metrics – IH LOS, OP, LOS [7-10],
- Standard ICD QOC metrics – Ch Well Visits; CDM Yrly visits; 2MoFU for MH [10-15]
- Standard Rx Compliance Measures – Refill rates [2-3]
- Ethnicity measure for overall [2-16]
- Basic Foreign Language requirement, documentation metric; external use metric? [8,14]
- Specific Ethnic ICD/place measures (2 levels) – AfrAm or Hisp, other, Asian, AI/NA [5 each, incl W]
- ACOs, MU metrics [45-60]
- Other than ACO/QOC-S/MUs, simple basic QIA/PIP metrics (defined elsewhere) [15-20]
- HEDIS Admin metrics focused on facilities 
- Institutional 300+ Disease reporting tool (set for monthly or bimonthly use) [repeats above, 1 report, 300+ metrics]
- Ethnic-focused ICD reporting tool/report [40-100, x 4-5, x 8 or 11]
- SES-focused reporting tool, with special topics: poverty groups and areas [ditto]
- Age-subgroups tools: suicide, epilepsy SUNDS etc. [5-7]
- V-codes: ch/adult abuse, abandonment, refusal of care for religious reason, immunization refusal [socially meaningful, 12-15]
- ICD codes: suicide risk, special cultural/region risks, ID risks [age/gender related, 7 x 12 = 94]
- E Codes:
- 65+ yo ICDs report [dupl. above but with different ages, ca. 20-100]
- Congenital Diseases report [20-45]
- Genetic Diseases report [1-4, or up to 100+ ICDs]
- Pregnancy/Child-bearing report (Chlamydia and non-chlamydia, age) 
- Comprehensive Chronic Disease Mgmt report (2-4 levels) [n cd, 4 grps, 8 regions, 11 facilities, 4-5 ethn]
- Charlson Disease list and scores report (totals, levels 1, 4, 6+) [ditto]
- Prediction modeling formula/reports (regionally, institutionally, by boroughs; SES-PH, BCBS and OptumHealth “black box” tools) [2 formulas, x 8, 11]
- Newborn/Infant Care (3 or 4 years), risk levels (prediction tool) [25-40 icds, x 8,11]
- Young:Old Childcare (0-8, 9-17) (tic, beh h, ep, pulm, drug, smoking, alc ab, drug ab, suicide, fx, disl, tc.) (prediction tool) 25-40 icds, x 2 age groups, compared x 8, 11]
- Child Schooling (4-17), (Beh H, Nutr, CD, BMI, Injuries, Fx/Disl, ED use) [1 group, ditto]
- Mother:Child relationship (families, unmarr. vs married?; 10-45 yo) [1 group, ditto]
- Childhd:Adult [changing coverage] QOC conversion rates (asthma, CD, MH), 10-30, 12-26, 15-25/27) [25-40 icds, 8, 11]
- Pre-post 65+/- [changing coverage] QOC relationship (55-64, 65-74) [15-40 icds, 2 groups]
- SNGs reports: IDs, Autism, EP, MS, PTSD, Specific Drug Abuse hxs, Bullying, Ch Viol. Ch Sx Ab, Age-Fxs, Bioterrorism [15-25 icd small groups, 8, 11]
- Special reports, Risk Areas: Child Abuse indicators combination ICDs and V-codes, Suicide, Adult Abuse, Gender specifics; Infib, Violence indicators 6-12 icd subgroups]
- Special reports, cultural: culturally-bound indicators, culturally-linked indicators, cultural QOC comparisons (B vs W, H vs W, A vs W) [3 x 40 = 120, starting]
- Standardized Special reports: Diabetes, asthma, MS, epilepsy [3-7]