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Susan Smith
Susan Smith
Susan Smith has worked as an editor and writer in the technology industry for over 16 years. As an editor she has been responsible for the launch of a number of technology trade publications, both in print and online. Currently, Susan is the Editor of GISCafe and AECCafe, as well as those sites’ … More »

Mapping Infectious Disease with Esri Workflows

June 21st, 2019 by Susan Smith

This week, GISCafe Voice spoke with Este Geraghty, MD, MS, MPH, GISP, Chief Medical Officer & Health Solutions Director, Esri. Formerly the Deputy Director of the Center for Health Statistics and Informatics with the California Department of Public Health, Dr. Geraghty led the state vital records and public health informatics programs. There she engaged in statewide initiatives in meaningful use, health information exchange, open data and interoperability.

These maps show areas of low vaccination rates (and increased risks of measles outbreaks).  Maps of the situation in both New York and Washington show the reality of outbreaks.

These maps show areas of low vaccination rates (and increased risks of measles outbreaks).  Maps of the situation in both New York and Washington show the reality of outbreaks.

As both a technologist and physician, Dr Geraghty is in a unique position to provide a perspective on how various groups are using GIS to support communities who are grappling with educational issues surrounding infectious diseases and vaccination. “I strongly believe GIS technology has the opportunity to create the biggest transformational impact in health that we’ve seen.”

“Historically the way the health departments and organizations have used GIS is to find out the state of affairs, i.e., where are cases, and then figure out what to do about that,” said Geraghty. “The mindset is changing, partly because technology is advancing, but in this decade I’ve been working with GIS technology, tremendous changes have happened.”

In the case of measles, not only is the the current state of affairs taken into account, but what is the entire workflow that needs to happen to understand what’s going on to prevent or intervene in ways that promote health?

“My first question is what are workflows involved, so of course there are surveillance and mapping cases, but when you enable time in your mapping platform, then you can see spread and time of diseases,” said Geraghty. “This is not even an analysis, this is a simple overview. Then you can get into the more predictive analysis. In the case of measles that’s a really broad spectrum. When you look across the U.S. and you start to pull in information such as what are the different states’ policies on vaccination – there are a handful of states that allow an exemption due to a medical issue. But other states will allow exemptions based on religious beliefs, and others will allow exemptions based on religious or personal beliefs exemptions. That of course plays into whether or not people are vaccinated. And you can look at other predictive factors to see if a certain area is at risk,  so you can look at school vaccination rates in addition to the policy levels, and you can look at levels of education. Some of the reasons people are not being vaccinated have to do with celebrities and the celebrities who are very vocal against vaccination who may have large followings.”

This level of surveillance helps our understanding of what’s going on. You can figure out where you have gaps. “Gaps can be in vaccination, but then you may have gaps in your vaccination resources. Have you analyzed the supply chain for where vaccine supplies go, to make sure you know the communities that have the most supplies available? You might look at the affordability of vaccinations and levels of insurance across different communities to make sure that people who want to be vaccinated can be. We can look at things like the anti-vaxx community and then target health care providers in areas that have low vaccination rates to provide materials specific to the anti-vaccination population.”

A very effective way to communicate complex information intuitively to people is Esri’s Story Maps.  Story Maps are part of the outreach and community education for the population to start asking and answering some of their questions.  There are also opportunities to use mobile or web based applications to show citizens where vaccination resources are located. Can they go to doctor, pharmacy, what does it cost?

“With Esri’s mobile suite of mobile applications we can put tools in the hands of users so they can be empowered to find vaccination resources on their own,” said Geraghty.

Public health goals, like the Healthy People 2020 goal, gives the recommendation of 95% population vaccination for MMR (Measles, Mumps Rubella) vaccine based on the measles illness. Measles is so infectious that it is necessary to have a  95% vaccination rate in order to protect the 5% who can’t be vaccinated for medical reasons. This is the idea of herd immunity.

By looking at different schools and school district vaccination rates it’s possible to find out what schools have higher or lower vaccination rates.

As a physician, Geraghty said that for those people concerned about vaccines, the additives in the vaccine may cause allergic reaction or reaction for people who have immune problems. There is also a “vaccine-hesitant” population who have heard negative things about vaccines but need valuable scientific information to make a decision. Measles and other diseases like polio were nearly eradicated in the U.S. and have unfortunately gained a comeback.

While most who get measles will recover, a percentage will die from it.

The CDC is equipped with GIS they can use themselves through business units within CDC and also have a department within in it called Geospatial Research, Analysis and Services Program (GRASP) that has over 100 or contractors doing larger GIS projects. Esri is frequently involved in supporting the CDC.

The World Health Organization (WHO) had to develop a strategy for dealing with polio in the Democratic Republic of the Congo (DRC). In the DRC, there is not a great population census so you don’t know where people live. Esri, WHO and the CDC looked at satellite imagery in one km square grids and did a mapathon where you place a dot on every building with the assumption that where there’s a building, there’s a population. They used that information to send out teams to ask if people have been vaccinated or to provide the polio vaccine. It’s a different level of using geography and different all over the world, depending on the problem to solve and level of technology.

“Esri’s platform is so enormous that it was hard to tell a story,” said Geraghty. “Today what we tend to do is talk about different solution needs. In Health and Human Services, talking to organizations about homelessness, opioid crisis, vector borne disease, public health preparedness, access to care, site selection for a clinic or hospital of WIC center for health departments. We try to apply a solution to whatever that organizations need are and show them the art of the possible.”

“I tell people to begin recognizing that whatever you’re trying to address has a workflow associated with it. With the ArcGIS platform, the first part of the workflow is collecting the data you need to solve the problem, so there are tools in the Esri platform for data collection and data management and the second part of your workflow might be visualization and understanding what you’re trying to get at. Mapping and other visualization tools are very useful there. Then you might see some patterns and go to the next step of your workflow which is analysis to understand root causes. We have over 1,000 analytical tools and if you know you need analysis in your workflow, then we can help you pick the right tool.  Then you might go to decision support where you can take all your analytical results and prioritize and use mobile tools to accomplish your intervention and maybe use dashboards to see if you achieved your outcome, or watch as you move the needle in your efforts. If you can understand the workflow you’re addressing, we can help you find the tools to help you address it.”

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Categories: 3D Cities, air pollution, analytics, ArcGIS, ArcGIS Earth, ArcGIS Online, geospatial, GIS, government, lidar, location based sensor fusion, location based services, location intelligence, mobile, mobile mapping, Open Source, public safety, remote sensing, satellite based tracking, satellite imagery, sensors

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