Geo-Medicine: Should EMRs Feature A Geographical History?

“Geography is destiny in medicine.” –Jack Lord, MD

In my undergrad English lit courses, I heard a lot about “character is destiny”. Which is a fancy way of blowing things out of proportion – e.g., Romeo and Juliet didn’t die via the quality of being “star-crossed”, but because they were super emo.

Well, this week, I watched a TED talk by Bill Davenhall (below) that claimed “geography is destiny”.

This idea is not so exaggerated. Just watch it (9 min.):

What it says: Where you’ve lived may determine how healthy you are.

There’s the classic equation:

health = genetics + lifestyle + environment

and of the three aspects, Davenhall argues that “environment” has been ignored for far too long by physicians.

He cites the fascinating example of his own heart attack. Having lived for a considerable period in each of Scranton, Pennsylvania; Louisville, Kentucky; and Los Angeles, California–all places with poor-quality air–he argues that he shouldn’t have been surprised to be at high risk for a health train wreck.

If only his health providers had had this information, they might have advised him to take preventative measures.

But they didn’t have it.

Geo-medicine and EMR?

Davenhall says it’s time for geo-medicine – the movement to incorporate place history into health care. And I believe this is a tremendous idea.

Think about it. At the doctor’s office, we fill out tons of forms about our genetics and our lifestyle, but we rarely get asked about our geographical or “place” history. This could be important!

For example, just a few days ago I realized that there was actually a thick (opaque!) layer of minerals at the bottom of my trusty hot water carafe—the result of dirty Toronto water… And I think it’s been building up there for more than a year. Toronto also can get so smoggy in the summer that you can barely see a large chunk of the CN Tower. It’s a big difference from my hometown on the East Coast, which has the most wonderful water and air I’ve ever experienced.

So let’s get this place history into our medical records.

We need a geo- layer in the EMRs of the future.

It doesn’t have to be very complicated. Consider a Google Map with balloons indicating places where you’ve lived and the length of stay. More sophisticated information could be favourite vacation spots and hobby information. In the TED talk, Davenhall gave the example of a colleague who frequented the major ski destinations in the US, a pattern that would show up in his EMR.

How about adding a social aspect?

You know me; I can’t let this go without talking about where social media might fit in. Here are some ideas:

Community-driven overlays: How do we combine your place history with risk factors?Where do we get the data? Well, governments actually collect a lot of data on environmental factors and summarize it in nice maps. Some governments are even allowing citizens to request data and visualizations! (For US, see Data.gov). For the ones the government doesn’t cover, maps could be pulled from scientific literature and even the news. This should become easier as Science 2.0 and open data projects gain momentum.
Automatic location detection and reporting: iPhone GPS apps are obvious. Location-sharing services like FourSquare could also be mashed up with Google Maps if the temporal and spatial resolution ever gets to that point

The second actually brings me another point…

Finally, what about privacy?

I pitched my geo-medicine ardor to a friend and he said it sounded like a privacy nightmare. He said that if it gets anywhere near tracking location in real-time, there is going to be information we want to keep to ourselves.

I agree—real-time is the tricky part. But health-relevant information should be retrievable from the “macro” level – i.e., only the places in which we’ve spent a considerable period of time. Most realistically, this data would be populated by self-report, and updated only when you move somewhere new.

I’m up for it – how about you?

For further reading, check out MobiHealthNews’s post.

Tags: EHR, electronic medical records, Electronic Medical Records, Foursquare, geo-medicine, Google, Google Maps, iPhone, open access, PHR, science 2.0, toronto

Paul Kishimoto

http://yro.slashdot.org/story/09/11/30/0359216/... and the linked article give a good example of the unexpected privacy problems that can be created by location-tracking.

From what I know, I can't see how short-period data from social applications will contribute any information relevant to individual health. In general, omniscient information-gathering based only on the expectation that some future use will be found for the data more often leads to private profit than public good.

Rather than do this, a case should be made for certain types of recording. The benefits of logging, say, residential postal codes are apparent from stories like Mr. Davenhall's; but more granular data can not be included until its utility is clearly explained.
Elizabeth Han

Thanks for the great article, Paul! That is scary. And with Twitter search getting more powerful and stuff like Twitterfall, Twitter Search on Bing Maps--it would be easy for distasteful searches to be conducted.

Much of the feedback I've been getting is concerned with this privacy issue. Probably the Foursquare/Gowalla-esque incarnations are too far-fetched. But an extra tab on the EMR for macro location history would still be useful.
vartabedian

I think there's something to this. I was poking around one of friend's Gowalla history and was shocked to find his restaurant geo history - daily fast food. While I musn't assume he was making poor choices at these locations, it's definitely telling. And reviewing my own history: probably too much coffee.

I need to think more about this.
Elizabeth Han

I see you've switched from Foursquare to Gowalla!

Actually, Brian from the MobiHealthNews post mentioned that after the Davenhall TED talk, the audience discussed how the super-granular info like you allude to (which restaurants, coffee shops...even what kind of house you lived in when you were kid/if there was toxic stuff in the walls, etc.) might be even more helpful than the macro info. But then you get into huge issues with privacy...

It does occur to me, however, that Foursquare and Gowalla give you the choice to 'check in', right? So you don't have to check in somewhere if you don't want anyone to know you were there? Still, pretty complicated.

hospitalSongs

Geo-Medicine: Should EMRs Feature A Geographical History?

“Geography is destiny in medicine.” –Jack Lord, MD

What it says: Where you’ve lived may determine how healthy you are.

health = genetics + lifestyle + environment

Geo-medicine and EMR?

We need a geo- layer in the EMRs of the future.

How about adding a social aspect?

Finally, what about privacy?

I’m up for it – how about you?

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