To GIS students: Invest in Medical GIS

The Trump Healthcare plan will no doubt provide opportunities for growth and change.  But the same opportunities could be argued for any new healthcare plan that is proposed over the next 18 months.

We fall for the same tricks every time the healthcare systems appears to be a failure.  One of these tricks is condemning the recent past, while making promises for the weeks and months ahead.

Does anyone remember when Clinton and Gore were running for president?  What was it that the two of them offered to the American people?  What they offered was not any different from what we are still trying to establish today.  Since that run for presidency, there have been no successes made in the attempted improvement of healthcare insurance programs available.

The common cause for all of these failed presidencies and laws passed regarding health care (the HITECH Act for example)  are the same–the insurance companies.  You cannot reform health care without reforming the insurance company, the role of the insurance company, how it should managed healthcare insurance, and how it needs to either bow out of the health insurance industry (hard for some, since that is all they do), or come up with a plan that they are willing to take responsibility for, and follow.

The common thread to the slowly maturing failures of health maintenance organizations since Nixon signed them into existence, is equivalent to that of Presidents Ford, Carter, Reagan, Bushes 1 and 2, etc. etc, etc.  The common thread is the health insurance industry, an industry with too little competitions, too much merging allowed, too much regional pseudomonopoly-like settings.

Trump’s idea of allowing citizens to produce and managed their own medical savings accounts in theory makes sense, that is assuming we did not treat them like we treat the family’s educational account established for kids.  That money must not be allowed to be pulled for anything but for what it was originally intended, and that money should be treated like money put away for retirement–it must never be taxed.

The way disease and health mapping come into play here is at the clinical and, believe it or not, the insurance industry level, maps can be used to reduce the cost of anything and everything pertaining to the rising cost of care.  Yet, why don’t these industries use maps to surveil their patients or members–the source of their revenue?

The health insurance industry and many health administration people haven’t an inkling of an idea on how to read a medical topology map.  They don’t know how to interpret statistics (not simple reported information in the form numbers, actual p values and Chi-squares used to determine statistical significance).   These businesses do have statisticians capable of understanding the basic non-spatial ways of developing statistical insights.  But these same businesses do not know or understand the steps required to develop spatial statistical information.

This means that in order to be ahead in the healthcare profession, you have to learn spatial statistics, not simple t-Test, ANOVAs, Chi Squared methods or even survival plotting.  You have to know and work with theoretically, and with the ability to develop new protocols in health statistics methods, using spatial data.  GIS is the main way to convert any non-quantifiable measure into a quantifiable measure, by relating the measure events or things to each other over time and space.  If children in one zip code use a specific swear word with sexual innuendos, and that term they use is very different from the terms used by another place, because another culture is there, you can document the publishing of the swear words as graffiti, and analyze their relationships to each other, and to the types of churches that exist in the same neighborhood, not to mention measures of race, ethnicity, average age, average history of income, or citizenship.

Does the current plan for improving our healthcare system make it possible for more attention to be paid to previously ignored social and cultural events with meaning?  Is healthcare more than just the patient-doctor-billing agent (collectors) relationship?  Is it possible to make sense of each and every event that happens, good or bad, moral or immoral, culturally correct versus politically correct?  GIS tells use the answers to these questions.  It takes second to apply GIS to billing data, to determine where physicians are prescribing more drugs than expected, or being paid much more than would be predicted for a given area with specific population derived predicted healthcare needs.

Obamacare was developed to improve upon the HIT system that exists, encourage or force programs to commit to developing an HIT.  The Obamaplan also had the idea of monitoring performance of healthcare systems and businesses.

The Obamacare system has lost its race because the wrong directions were taken by the entire system and its administration.  No attempts are made to make the insurance companies more liable for their laziness, malfeasance and malpractice.  And if there is an insurance company you have that your are wondering about, if that insurance is a large scale company with other affiliates in the country, then that company is probably one of the dozens I analyzed to see how inefficient the companies can be, how skill-less they are becoming, and how incapable they are of seeing into the future of the healthcare industry.  They are still living as reactionary businesses, not proactive preventive healthcare focused businesses.

So, to make GIS work for your job as a technician looking for work in the healthcare insurance industry, the best thing to do is to look into how this is being done, in managed care.  This site I am putting together on Managed Care Innovations, will allow those who are “literate in healthcare statistics” to do just that, not the insurance companies (stuck in their way), but the newcomers to this field.  A lot of my methods are there–but you have to be able to interpret programming language to determine how it can be done quite effectively.

There are a series of requirements for establishing an HIT system so that it is capable of developing into an HIT-GIS workstation.  There are a series of large scale metrics that have to be accomplishable in a system.  Since 2006 I have worked with agencies that report on thousands of metrics in some way shape or form, not just the 40 to 60 required for meaningful use.  Systems and technology savvy IT managers, directors and statistical experts can produce two or three thousand metrics per years–they can analyze all of the patients for unhealthy lifestyle, poor genetic history, multiple chronic disease mortality and morbidity indices.  They can analyze the congenital conditions, and relate culture and place to costs and losses in revenue.  They can evaluate the culture of their patient load, and know where people are most likely to engage in spouse abuse, illegal surgical practices entered into EMRs in the form of specific ICDs, places where exposure to the environment might be causing learning disorders in children, or hampering the performance of patients in terms of engaging in preventive health activities.