Orchestrating the HIT-GIS

Three of my colleagues have tried to develop GIS like tools to document results, and present them to other authorities.

The first individual made full use of an ArcGIS, trying to get a big business to accept the value of the maps he was producing detailing the communications that went on via typical Verizon networks.  The reason to do this was primarily market related, pertaining the consumer population and how it performs at the regional level.

The second individual used Qlik to produce a visual that was certainly impressive to present, and had some value to it in that if one modified the resolution of the map (zoomed in or out), the data clustering analyses that was undertook adjusted to different areas.  This technician’s idea was that such a map could be used as an automated part of a regular business intelligence review, even to predict health related features of a population based upon regional comparisons.

The third individual had not produced a GIS, just the data for a GIS, and was concerned mostly for live presentation of medical information to whomever needed to use the data.  The idea was that on a regular basis, a physician could obtain access to this live or fairly up to date information and run a query to see how his office was performing relative to the others.  Or, if a patient recently came in with a rare disease, the physician should be able to access of the nearby physicians’ activities records to see if any other cases have presented.

Each of these people had a very different take on how GIS can be used by a healthcare industry.  Chances are, if you come into an an industry already trained in GIS, with a background in GIS applications, your impression of the role and purpose for a GIS will be very different than the impressions these three IT-experienced workers have about its use.  If you are a manager, or chief officer in charge of making serious corporate level decisions about how to advance your company, you may come up with yet another interpretation of the role of GIS in the workplace.

The fact is, GIS can be used for and with all systems that are already present within a given industry.  GIS can be used to manage business level or BI related decision making processes and activities.  GIS can be used to manage your sub-clientele, businesses, colleagues, and gatekeepers, using a GIS as a tool to keep track of your marketing and use of human and physical resources (products).    GIS can be used to manage the business of your industry, or the various smaller units that make up your business, like monitoring the activities related to the various lines of service and allied health services that serve as satellites to your programs.  GIS can be used to manage small businesses and individuals in these businesses, such as doctors and their clinics and their business and service related activities, their cost for the cost of care that they provide their patients.  GIS can also be used to evaluate patients and families, local populations and local events related to health, serving as a thermometer measuring the amount of activity that is going on in the region, serving to provide you with warnings when certain risks become evident, such as not refilling a prescription on time, failing to set up a timely follow up appointment, missing too many of your recommended regular behavioral health visits, not engaging in regular activities design to improve the health of your self or your baby.

To develop a Medical GIS as part of your HIT-GIS system, you have to assign priorities to your various projects.  You also have to evaluate and estimate the amount of work or work hours required for each project, to determine where to assign your priorities, where to put aside the goals of one project manager, in order to better meet the wants and needs of another.

GIS related projects can be assigned priorities in part based upon their predefined need, predefined or estimated time line for that need, and frequency at which this need must be met.  A monthly report requires more monitoring and active engagement than an annual summary report.  A research project designed to tackle a recent issue within the system may require monthly reporting and completion by the end of 6 or 9 months, just before the stockholder’s report is produced for example.  A research project designed to tackle a necessary, although not rushed, research proposal, may take fourth place to three other priorities in GIS known to be considered higher priority.

To orchestrate an HIT-GIS to be constantly productive and the produce more and more products over time, as per the protocols designed for standard PIP and QIA activities, a number of important descriptions or features about the HIT-GIS program have to be designed.  These written statements will then serve as a guide to developing the policy for an HIT-GIS.

The Policy/Statement has to consist of the following:

  • Overall Goal.
  • Objectives (several components of the goal)
  • Examples of statements that meet H0-H1 requirements for the overall program, to determine how they can be assess for completion of incompletion status.
  • A proposed chronology and order for developing the different components of an HIT-GIS.

The following levels of application for Medical GIS have to be evaluated and considered (and reporting procedures, frequency and/or requirements):

  1. Administrative — focused on financial aspects, policy and guidelines development, gatekeepers profiling, benefits cost analyses, foreign language needs requirements, descriptions of special teams, overall regional and business mapping, develop a business intelligence financial database (grants, donations, contributors, new investors), competitiveness, degrees of innovation with examples, unique HR contributions [Annual, some Quarterly]
  2. Services Facility or Equipment — focused on service units, facilities, equipment maintenance, rates of utilization, rates of upkeep and repair, quality assurance, data quality assurance/completeness, flow of money related to contracted services and product or utilization [Annual, Quarterly, Monthly]
  3. Clinical — focused on facility/provider metrics, including the basic measurements, like patients per doctor, patients per specialist, numbers of specialties and specialists, rates of service or performance, numbers of measurable treatment protocols (prescriptions written, EKGs given per year, patient no-shows, complaints, etc.)  [Quarterly, Ad Hoc]
  4. Population/Epidemiological — focused on population and subpopulation health scores and data.  Applies to surveillance and intervention studies.  Applied to investigatory population health programs development. May engage in regional health reporting. May overlap with Special Studies, Administrative, Clinical, and Patient group related activities. Not meant to overlap with public health requirements already in place (violence, infectious diseases); may serve to further research, present and/or map these findings. [Annual review; project reviews or completions; recurring monthly or quarterly reports; large scale reporting for special study topics; automated reporting as much as possible, in HEDIS style for defining administrative and clinical metrics to assess.]
  5. Patient — quality of care to patient; patient survey and survey cards, complaints line, utilization of on-line services and phone services (Hotlines), patient health rates and QOC rates regarding aspects for certain health needs. [Quarterly, Ad Hoc, rolled up to Annual Report]
  6. Special Studies –– listing of all studies (institutional, to private/provider office level), descriptions of most agile or recently completed studies, details on PR and publications policies and products related to studies, normal audiences targeted with studies, special audiences and patient populations or needs targeted with studies; targeted populations, number of people impacted by each study, number and percent of potential people or communities impacted.  [Irregular to Regular, office to institution, large grant to small grant; institutional, educational, descriptive, internal only.  All must have IRB confirmation, approval and remain compliant.]
  7. System — compliance, follow up to complaints rates, types of patient focus group related reviews provided, policy change or development, committees operating and organized.   [Irregular to Regular, weekly to monthly or quarterly, rolled up annually, with certain concepts primarily annual or just once (focus groups)].
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