Publication Date: 2020-04-27

Approval Date: 2019-11-22

Posted Date: 2019-09-09

Reference number of this document: OGC 19-049

Reference URL for this document: http://www.opengis.net/doc/IP/userguide/19-049

Category: User Guide

Editor: Ajay K Gupta, CISSP, MBA, Ram Peruvemba, MD, Paul Churchyard, Robert Thomas, Terry Idol

Title: OGC Disasters Resilience Pilot User Guide: HSR Health SDI - Facilitating Public Health During a Disaster


COPYRIGHT

Copyright © 2020 Open Geospatial Consortium. To obtain additional rights of use, visit http://www.opengeospatial.org/

Important

Attention is drawn to the possibility that some of the elements of this document may be the subject of patent rights. The Open Geospatial Consortium shall not be held responsible for identifying any or all such patent rights. Recipients of this document are requested to submit, with their comments, notification of any relevant patent claims or other intellectual property rights of which they may be aware that might be infringed by any implementation of the standard set forth in this document, and to provide supporting documentation.

Note

This document is a user guide created as a deliverable in an OGC Interoperability Initiative as a user guide to the work of that initiative and is not an official position of the OGC membership. There may be additional valid approaches beyond what is described in this user guide.


POINTS OF CONTACT

Name

Organization

Ajay K Gupta, CISSP, MBA

Health Solutions Research

Ram Peruvemba, MD

Health Solutions Research


1. Introduction

Health Solutions Research (HSR) is a GeoHealth company that merges, publishes, and analyzes data on social determinants of health with health outcomes & costs, ultimately providing point-of-care decision support at multiple geographic levels.

HSR staff and management include clinicians, public health analysts, data analysts, as well as geospatial analysts.

For the Open Geospatial Consortium (OGC) Disaster Resilience Pilot, HSR’s philosophy of providing health-related insights at the point-of-care is being leveraged to design and deliver solutions to bring health data into the emergency or disaster response planning effort.

1.1. Disaster Response Planning

According to the United Nations (UN) Office for Disaster Risk Reduction, financial damages and the cost in human lives due to natural disasters are tremendous:

United Nations Statistics on Disasters, 2005-2014

$1.4 Trillion

1.7 Billion

0.7 Million

Damages

People Impacted

Lives Lost


The statistics pre-date the 2017 Atlantic Hurricane Season which was one of the most active in history with 17 named Hurricanes [Federal Emergency Management Agency 2018] and with just three storms - Hurricanes Harvey, Irma, and Maria - causing $265 billion in damages. Hurricane Maria, which made landfall in Puerto Rico on September 20, 2017 as a Category 4 hurricane caused $90 billion in damages, crippled the power grid for months, impacted 100% of the island’s 3.8 million population and caused 2,975 deaths [Milken Institute School of Public Health 2018].

In the Response to Hurricane Maria, there is anecdotal evidence that the lack of medical personnel early on in the response contributed heavily to storm-related fatalities. These are lives that could have been saved if medical personnel were dispatched to the disaster impacted area sooner.

The scope of the geospatial need for medical personnel wasn’t known by Emergency Operations Managers until the response was underway. HSR’s system provides the foresight to ensure the medical and health needs of the impacted population are known to both Emergency Operations Managers and Emergency Medical Responders in advance and can be addressed.

1.2. Use Case:

To provide this foresight, HSR is creating a revolutionary Health Geo Platform – a Health-focused Spatial Data Infrastructure (SDI), as a National Health SDI, with an initial application to allow for the inclusion of health information in emergency or disaster response planning and execution processes. This application is named a Health Risk Index and merges data on social determinants of health as well as health data to identify an impacted population’s risk – health risk – from a natural disaster. This information can be utilized by Emergency Operations Managers and the boots-on-the-ground Emergency Medical Responders to ensure their efforts address the unique health challenges caused by experiencing a natural disaster.

Currently, emergency response operations conducted by the Federal Emergency Management Agency (FEMA) and their peers at State and Local levels have limited visibility into the health needs of the disaster-impacted populations they serve. Therefore, emergency operations managers and emergency medical responders may develop response & evacuation plans, or may enter disaster struck areas unaware of the overall health and medical needs among civilians.

The Health SDI and its Health Risk Index application will provide the necessary, geocoded public health information that may prove vital to the success of emergency response efforts and will align smoothly with the global emergency response systems. The Health SDI and the Health Risk Index are revolutionary decision support tools that hold unlimited capabilities.

1.3. User Guide Organization:

Chapter 2 provides a high-level description of the architecture of the Health SDI and the data sources behind the Health Risk Index.

Chapter 3 provides additional details on the symbology and specific data sets used and published in this effort.

Chapter 4 provides discussion on key special topics that may be relevant and related to this effort going forward.

Chapter 5 details how the SDI works describing how actionable information is put into the hands of the two primary end users (emergency operations managers and emergency medical response personnel) in a way that they can use during disaster response scenarios.

Chapter 6 will present a Conclusion of this specific effort - which is Phase 1 of a longer effort to ensure emergency response personnel have the health and medical information they need, when they need it, and within their existing workflow to best serve the impacted population.

This chapter will also discuss viable future applications of the Health SDI. The utility of a SDI progresses is limited only by imagination. For example, the SDI can provide focus on the greatest health needs in the world and streamline medical and pharmaceutical research to address those needs.

2. Simple Architecture

The current data workflow for the Health SDI supporting generation of the Health Risk Index is shown in Figure 1. This will continue to be refined throughout all phases of this effort.

Health SDI Process Flow

Health SDI Process Flow
Figure 1. Health SDI Process Flow

The first step is to identify and retrieve relevant health and social data. Following data retrieval, the data is geocoded and prepared for analysis. The analysis of the data includes calculating the Health Risk Index as well as displaying the health needs information of relevance to the end users and data consumers, discussed in Section 2.3 below.

Symbology is addressed following the National Alliance for Public Safety GIS Foundation guidelines, and the shapefile is published to the Health SDI, is available as a direct download, and exposed through Open Standards.

2.1. Data Providers

The Health Risk Index leverages both data on social determinants of health as well as health outcomes and costs from a broad variety of sources. These include global non-governmental organizations, such as the UN and World Health Organization, national government organizations, such as the Centers for Disease Control and Prevention (CDC) and the Homeland Infrastructrue Foundation-Level Data (HIFLD) produced by the Department of Homeland Security (DHS) within the U.S., as well as U.S. State, and Local government agencies. Health Registries, disease-specific healthcare organizations, university and non-profit research organizations and other sources of data are also considered.

HSR continues to seek data from new sources, including US-sources at the National, State, and Local levels, non-governmental organizations, educational organizations, as well as international sources that make health and health-related data available for public consumption.

2.2. Catalog Providers

HSR is working towards building an SDI that can serve as a National SDI as well as an international SDI for health issues and therefore are working to integrate and collaborate with existing SDIs and catalog providers, including GeoPlatform.gov, AmeriGEOSS, and NextGEOSS.

2.3. Data Consumers

As the near-term output of the Health Risk Index relates to disaster response efforts, the primary data consumers, or end users, include:

  • Emergency Operations Managers, and

  • Emergency Medical Responders.

Emergency Operations Managers are those individuals who plan and oversee the overall disaster response effort. Emergency Medical Responders are the “boots-on-the-ground” who go into disaster-impacted areas and provide disaster relief services including needed medical care. The needs of these users are certainly related and both users can have visibility into the data provided to each other.

2.3.1. Data Consumers' Questions

The questions these consumers ask that the Health Risk Index provides include:

  1. What are the high-risk areas for medical evacuation?

Emergency Operations Managers develop evacuation plans responsive to specific nuances of each disaster event. The Health Risk Index provides information on the risk of adverse health impact due to the disaster. Emergency Operations Managers can use this information to design evacuation plans that best meet the impacted populations' health needs and limit the likelihood of adverse and life-threatening health events, including fatalities.

2a. What healthcare assistance is needed, where, and for whom?

To identify this information the Health Risk Index includes data on pre-existing conditions; health conditions that may be worsened by or flair up during disasters such as allergies, asthma, heart disease; and health conditions that are caused by the disaster such as illnesses or trauma.

In addition to Emergency Operations Managers and Emergency Medical Responders, this information is relevant to hospitals, healthcare providers, as well as pharmacy distribution personnel serving the disaster impacted area. The CDC may also be interested in this information for the purposes of disease outbreak monitoring and containment.

2b. What health conditions are patients likely to present with?

Related to 2a, this will identify the medical equipment, medical supplies, and pharmaceutical medication first responders should bring to a disaster-impacted area.

In addition to Emergency Operations Managers and Emergency Medical Responders, this information is relevant to hospitals, healthcare providers, as well as pharmacy distribution personnel serving the disaster impacted area.

All information will be provided in seamlessly and within the first responders current workflow.

2.3.2. Secondary Consumers

Secondary consumers of the Health Risk Index include partners to whom the Index is exported and include:

  • Esri

  • Compusult

These partners receive an export of the Health Risk Index following OGC standards for display in their platforms. In the interest of public health, HSR is open to working with other interested partners as well.

In the long-term, the Health Risk Index can be used to track post-disaster recovery as well, and additional consumers can include providers (e.g., hospitals and health systems), as well as departments and ministries of health at the national and local levels who are charged with ensuring the long-term health of populations.

3. General Use Cases by User Activity

This section will provide details on the use case and data consumers, or end users, of the Health Risk Index and health needs data.

3.1. Publication of data

The Health Risk Index is published to the Health SDI. Effort to publish the Health Risk Index to GeoPlatform.Gov are underway.

3.2. Registration of data

At present, the Health Risk Index uses the most currently available data for the identified datasets that are in the public domain. Later phases of this effort will include discussion of licensing these data sets from providers to have access to either (or both where available) more regularly updated data and current data as well as access to data at the Census tract level. These discussions will involve addressing and documenting policy and procedure issues, security and privacy issues, as well as the republication of data.

3.3. Discovering of data

To produce the Health Risk Index, HSR sought health and social data that, when considered together, stratify the health risks facing an impacted population due to a natural disaster.

Additionally, boundary layers were discovered through searching the U.S. Census Bureau (Census), guidance on symbology was taken from the National Alliance for Public Safety GIS Foundation, and address data was discovered from the U.S. Department of Transportation’s National Address Database (NAD).

3.4. Downloading of data

The following data tables are used in the construction of the Health Risk Index:

Table 1. Resource Table

Data Provider

Data Catalogue

Name

Use

Retrieval Method

Homeland Infrastructure Foundation-Level Data

GeoPlatform

Health / Emergency Response Facilities

Geographic Layers

Direct Download (GeoPlatform 2017)

National Alliance for Public Safety GIS

Symbol Library

Symbology Guidelines

Symbology

Reference (NAPSG Foundation 2019)

National Oceanic and Atmospheric Administration

National Hurricane Center Data Archive

Storm Paths

Geographic Layers

Direct Download (NOAA 2019)

U.S. Census Bureau

American Fact Finder

American Community Survey 5 year Data Tables

Social Determinants

Python Census API (Python Software Foundations 2019) (U.S. Census Bureau 2019)

U.S. Census Bureau

U.S. Census Bureau

TIGER Line U.S. Boundary Layer

Geographic Boundaries

Direct Download (U.S. Census Bureau 2019)

U.S. Centers for Disease Control

Agency for Toxic Substances and Disease Registry

Social Vulnerability Index

Social Determinants

Direct Download (ATSDR 2018)

U.S. Centers for Medicare and Medicaid Services

AmeriGEOSS

Chronic Conditions

Health Dataset

Direct Download (CMS.gov 2019)

U.S. Department of Health and Human Services

GeoPlatform

Empower Map

Health Dataset

Direct Download/API (HHS.gov 2019)

U.S. Department of Housing and Urban Development

HUD User Portal

HUD USPS ZIP Code Crosswalk Files

Geographic Scale Mobility

Direct Download (HUD User 2019)

U.S. Department of Transportation

U.S. Department of Transportation

National Address Database

Address Data and Attributes

Direct Download (Transportation.gov 2019)

The Dartmouth Institute for Health Policy and Clinical Practice

Dartmouth Atlas Data

Our Parents, Ourselves: Health Care for an Aging Population Appendix Table 4

Health Dataset

Direct Download (Dartmouth Data Atlas 2012)

3.5. Data Integration

The health and social data inputs are joined to crosswalk files which allows for the information to be displayed at multiple geographic levels. Data from the health and social datasets are then used to calculate the Health Risk Index at each geographic level. Additionally, the health needs information relevant to the on-the-ground Emergency Medical Responders is displayed and exported. After the Health Risk Index is calculated for each geographic level the table is joined to the geographic boundary files from the Census, where symbology is then established and the layer is published to the Health SDI. The layers available on the Health SDI can be retrieved using OGC standards. This allows our partners, such as Esri and Compusult to import and utilize the data in their platforms, allowing for wide use of the information by the First Responder community overall.

Data Integration Workflow
Figure 2. Data Integration Workflow

Finally, predicted storm paths from the U.S. National Oceanic and Atmospheric Administration (NOAA) or other sources of disaster impact information can be overlaid onto the Health Risk Index to retrieve the index at all geographic levels as shown in Figure 2 for the National Level.