IMPLEMENTING GEOCODING OF A CLIENT BASE IN A MINNESOTA PUBLIC HEALTH AGENCY

Ruth Novack RN, MSN, CCRN, CPAN MDAKSPAN Fall Conference Fishing for Excellence September 30th, 2017

PRESENTATION OBJECTIVES

❑ At the end of the presentation the attendee will be able to define Geographical Information Systems (GIS) and identify one use in evaluating community health

❑At the end of the presentation the attendee will be able to list three geocoding spatial references utilized in identifying location

❑At the end of the presentation the attendee will be able to list three barriers to GIS

THANK YOU

Special thank you to Dr. Lynn Choromonaski PhD, Clinical Informaticist, MVNA Minneapolis, MN who so graciously precepted me and developed this project.

UNDERSTANDING GEOGRAPHICAL INFORMATION SYSTEMS (GIS)AND GEOCODING

Creating a visual display from data

WHAT IS GEOCODING AND GEOGRAPHICAL INFORMATION SYSTEMS (GIS)

American Heritage® Dictionary of the English Language, Fifth Edition. Copyright © 2016 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt

Geographical Information Systems (GIS) Software combining spatially referenced data to geographical location allowing large amounts of combined data to be view on a map and providing an avenue to generate knowledge.

❑Mapping for disease control can be seen as early as 1854 when Dr. John Snow studied the London Cholera outbreak and determined it to be from contaminated water verses air (Utzinger et al., 2011).

❑Today GIS has assisted in following the trail of the Zika virus and assists in preventative measures utilized for the 2016 summer Olympics games held in Rio, Brazil

Rio Olympics: South Korea unveils anti-Zika uniform - CNN.com. (n.d.). Retrieved June 17, 2016, from http://edition.cnn.com/2016/04/29/sport/rio-olympics-zika-south-korea/ Utzinger, J., Rinaldi, L., Malone, J. B., Krauth, S. J., Kristensen, T. K., Cringoli, G., & Bergquist, R. (2011). Geospatial health: the first five years. Geospatial Health, 6(1), 137–154

Geocoding — a subset of Geographic Information System (GIS) spatial analysis — has been a subject of interest since the early 1960s. 1970 to 80’s rise in commercial vendors of geocoding software. development These platforms merged the 1960s approach of separating spatial information with the approach of organizing this spatial information into database structures The end of the 20th century geocoding becoming more user-oriented, especially via open-source GIS software. 2000’s rise of software in GIS

Geocoding Timeline:

Geocoding - Wikipedia. (n.d.). Retrieved November 1, 2016, from https://en.wikipedia.org/wiki/Geocoding

❑ Census Tract ❑ Zipcode ❑ Block ❑ Neighborhoods ❑ Communities

Geocoding:

❑ Attributes reflects social context

❑ Spatial indicating location or addresses

❑ Temporal or time stamp

Public Health Data (3-dimension):

❑ Provides a common geographical framework combining people, their health, socio-economic characteristics and environment.

❑ GIS utilized in the collection of data surrounding children and blood lead levels recognizing environmental factors and community interventions strategies

Value of GIS and Population Health

Cockings, S., Dunn, C. E., Bhopal, R. S., & Walker, D. R. (2004). Users’ perspectives on epidemiological, GIS and point pattern approaches to analysing environment and health data. Health & Place, 10(2), 169–182. https://doi.org/10.1016/j.healthplace.2003.09.001

❑ HIPPA Compliance

❑ Inaccurate Addresses

❑ Expense (software and personnel)

❑ Requires GIS specialist and training

Barriers in GIS:

❑ Create a spatially referenced client database providing a system for maintaining confidentiality when geocoding to the city of Minneapolis, MN to neighborhoods.

❑ Develop and integrate a numerical coding into the electronic health record (EHR) for PHA clients within the neighborhoods of the city limits of Minneapolis, MN

❑ Determine client attributes social, demographic and health related to be included in the spatially referenced excel database for joining with GIS for graphical mapping

❑ Develop mapping process for transparent overlay of environmental characteristics and PHA client population.

Project Objectives:

❑ To spatially prepare clients data in a Minneapolis, MN PHA, while preserving client confidentiality, to achieve the greatest match when geocoded to a neighborhood.

❑ To develop a numerical coding of the 87 Minneapolis, MN neighborhoods

❑ To implement a system for data entry into PhDoc electronic health record (EHR)

Project Goals:

Project Rationale supported by:

Socio-Ecological Theory (SET)

PROJECT METHODOLOGY:MINNEAPOLIS, MN PHA ASTHMA

CLIENTS AGE 18 AND UNDER

0

1.3

2.5

3.8

5

Catego

ry 1

Catego

ry 2

Catego

ry 3

Catego

ry 4

Series 1Series 2Series 3

Asthma clients age 18 and under were geocoded to their respective neighborhoods for mapping.

Figure 1. Geocoding of Minneapolis, MN Public Health Agency asthma clients age 18 and under.

PGEOCODE_NEIGHBORHOOD PGEOCODE_CODEFOLWELL 1HAWTHORNE 2HAWTHORNE 2HAWTHORNE 2HOLLAND 3JORDAN 4LIND-BOHANON 5MCKINLEY 6EAST PHILLIPS 7EAST PHILLIPS 7MIDTOWN PHILLIPS 7PHILLIPS WEST 8STEVENS SQ/LORING HGTS 9VICTORY 10WHITTER 11

MAPPING MINNEAPOLIS, MN PHA ASTHMA CLIENTS

Maps: Molly McDonald, MGIS

Figure 1 Minneapolis neighborhood and asthma clients

Figure 2 enhanced area map

MINNEAPOLIS, MN PHA ASTHMA CLIENTS BY NEIGHBORHOOD:

Map: Molly McDonald, MGIS

PROJECT ACTIONS:

• Current client exported into excel and addresses reformatted for geocoding

• Large city map posted including streets, neighborhood boundaries

• Alphabetized listing of neighborhoods and geocode

• Coding and tagging updated into PhDoc for data entry

• Intake personnel trained on new coding entry

GEOCODE ADDRESS FORMATTING:

Wrong: 2010 W 31st Ave Corrected Address: 2010 31st Ave W Addresses reformatted with direction at the end.

GEOCODE UPDATE IN PHDOC:PhDoc is the electronic health record system for the PHA. Geographical coding was entered into the database

Present Code entry

CODE AND TAGS (CONTINUED)

Future numerical code, neighborhood name and tag note rank

CHANGE MANAGEMENT:Working with end-users to create system for data entry: • Large map Minneapolis city

street and neighborhood boundary map

• Alphabetized neighborhood listing and associated code

• 8x11 Minneapolis neighborhood with zipcode map

❑ A successful system was developed allowing the incorporation of geocodes into the PhDoc EHR with data extraction and mapping

Project Success:

Dots are geocoded asthma and lead PHA clients

Neighborhood Tier index:Top—GreenMiddle—YellowBottom—Brown

❑ Geocoding of current patient population to adjusted addresses demonstrated several clients to not be within city limits:

Incidental finding:

Dots are geocoded asthma and lead PHA clients

Neighborhood Tier index:Top—GreenMiddle—YellowBottom—Brown

Dots plotted outside city limits:

• Should not be with city program

• Misappropriation of city funding

• The implementation of geocode data entry into the PHA electronic system allows data extraction at a granular level assisting in explaining health care needs.

• Geospatial health assists in explaining health and illness based on geographical location.

• Continued discussion on privacy and granularity when creating the healthcare geocoding system.

• Futuristically develop open source link allowing PHA to create interactive maps from client data.

• Developing granular level of geocoding within healthcare to monitor population health

Conclusion and Recommendations:

Questions:

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REFERENCES• Alsher, P. (n.d.). Change Management Methodology: Behavioral

Objectives are Key. Retrieved January 30, 2016, from http://www.imaworldwide.com/blog/bid/194743/Change-Management-Methodology-Behavioral-Objectives-are-Key

• American Heritage® Dictionary of the English Language, Fifth Edition. Copyright © 2016 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt

• Cockings, S., Dunn, C. E., Bhopal, R. S., & Walker, D. R. (2004). Users’ perspectives on epidemiological, GIS and point pattern approaches to analysing environment and health data. Health & Place, 10(2), 169–182. https://doi.org/10.1016/j.healthplace.2003.09.001

• Environmental Justice Strategy. (n.d.). Retrieved October 23, 2016, from http://portal.hud.gov/hudportal/HUD?src=/program_offices/economic_resilience/Environmental_Justice_Strategy

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• Rio Olympics: South Korea unveils anti-Zika uniform - CNN.com. (n.d.). Retrieved June 17, 2016, from http://edition.cnn.com/2016/04/29/sport/rio-olympics-zika-south-korea/

• Stokols, D. (1996). Translating Social Ecological Theory into Guidelines for Community Health Promotion. American Journal of Health Promotion, 10(4), 282–298. https://doi.org/10.4278/0890-1171-10.4.282

• Utzinger, J., Rinaldi, L., Malone, J. B., Krauth, S. J., Kristensen, T. K., Cringoli, G., & Bergquist, R. (2011). Geospatial health: the first five years. Geospatial Health, 6(1), 137–154.

• Zhang, J., Shi, H., & Zhang, Y. (2009). Self-organizing map methodology and google maps services for geographical epidemiology mapping. In Digital Image Computing: Techniques and Applications, 2009. DICTA’09. (pp. 229–235). IEEE. Retrieved from http://ieeexplore.ieee.org/xpls/abs_all.jsp?arnumber=5384978