Health Business

Geospatial technology is being used to cut the time it takes the ambulance to reach the patient, firstly by helping the crew take the fastest route and secondly by assisting the command and control in the positioning of waiting vehicles and the selection of vehicles for dispatch.
    
Geospatial information systems (GIS) encompass the collection, processing and display of data in a way that is linked to location and usually involves the use of a map. Real-time GIS help identify the location of the patient and the best route for the ambulance, whereas off-line systems, processing historical data, can help predict potential requirements and improve readiness.
    
The London Ambulance Service is confident that not only is their GIS helping crews get to incidents quicker but that they’ve generated a ten per cent improvement gain from technology over the last three years.

In the vehicle
Ambulances are fitted with a mobile data terminal that receives data from the command and control system. When a 999 call arrives at an ambulance service, a map reference is generated. This is sent to the data terminal and the integrated sat nav starts directing the crew where to go. This first map reference can, however, be quite coarse. Whilst the ambulance is moving towards the patient the command and control system can use additional data to refine the reference. Updated co-ordinates are sent to the terminal which refines the route and modifies instructions to the crew. This can be repeated as many times as necessary, if and when, new information comes along.         

An address gazetteer provided by the council, which includes information about all the new buildings, streets and developments in the area supplemented by data feeds from other sources, such as the Royal Mail, A to Z, etc, is often use to help refine the reference.
    
GIS like these are particularly important for helping crews navigate areas they do not know. Indeed it is reported that drivers are so confident in the system that they need regular reminders to carry traditional maps in their vehicles, in the unlikely incidence of a failure.  
    
The Scottish Ambulance Service has installed the Terrafix Automatic Vehicle Location system. While the front terminal facilitates the dispatch, satellite navigation and status functions for the ambulance, a rear terminal provides an electronic patient report form as well as clinical support data for the crews. Scotland is currently the only area with electronic patient records and the Scottish Ambulance Service and the patient benefit from this. This rear terminal allows two way communication with the command and control system. Once the patient is identified their records are sent to the vehicle giving the crew valuable access to medical history, in parallel, the condition of the patient and details of treatment received on board is received so that the A&E team is fully briefed when the patient arrives at the hospital.

Command and control
At the heart of the winter in December 2008, ambulance services were receiving unprecedented levels of calls. London ambulance reported that they were receiving nearly 4,000 calls every day of which over 1,000 were “life threatening” designated as category ‘A’ calls. National performance standards dictate that ambulance services must reach 75 per cent of such calls within eight minutes. Geospatial technology is being used by ambulance services to ensure that the right resources are in the right place at the right time.
    
Analysis shows that ambulance services find that the volume of category A calls are likely to vary throughout the day, with peaks and troughs depending on the nature of the locality and the time of the week. Those serving large city centres find that large number of calls may come on Friday or Saturday evenings from locally known hotspots. They may have anything from 100 to 200 and 50 vehicles attending such incidents including fire engines, fast response cars, motorbikes and even bicycles. Command and control centre suppliers such as Northgate analyse past data to determine the hotspots.
    
Through automating the process of managing demand, the services find that they are better able to adapt to changing conditions, such as road closures or newly emerging incident patterns.
    
Geospatial technology suggests which resources should be placed where, to achieve optimum coverage. Systems automatically calculate the expected demand pattern, based on historical incident data, and the best standby locations for available fleets. Whereas many of the variables that affect coverage change gradually, such as predicted demand and the availability of fixed locations during the day, some factors, such as the allocation of resources to incidents, can change from one minute to the next.
    
Geospatial systems provide a seven day, 24 hour service which would be impossible for human controller to undertake. They not only save resources, but more importantly save lives as performance improves.
    
Command and Control Systems like Alert C3 from MIS Emergency Systems Ltd also enable incident replay and investigation. The newly developed Mobile Data Analysis Tool maintains a record of every data transmission, the success or failure of the transmission, the location of the vehicle when it was transmitted, and so on. All of the data is then held within an analysis database. Uses include establishing any vehicle faults or geographical communications black-spots.

Maximising potential
Experts in the field such as Andy Gordon-Jones, Director of Health for Northgate Public Services, claim that there is much more that can be done with existing data collected by the health service, such as the Hospital Episode Statistics (HES) data which Northgate is responsible for collating. He also suggests that work with local commissioners of health services who support World Class Commissioning is under-developed. He believes that the market for geospatial technology will grow as resources become more constrained within the NHS, as the technology is increasingly integrated into information management more generally, and its benefits are wholly proven.
    
HealthMap is an example of an online global disease tracking and mapping tool, which trawls through information from disparate data sources such as news reports, official alerts, blogs and chat rooms. It is currently being used to track the outbreak of swine flu in real-time across the globe, with new developments being channelled though the likes of Twitter. The site can be used by anyone wanting to track and map infectious disease outbreaks. It averages around 50,000 visitors each month including regular users from the World Health Organization and the European Centre for Disease and Prevention and Control.  
    
NHS County Durham is using information to drive through innovation in World Class Commissioning (WCC). It is using geospatial technology as an integral part of its one stop information point – the ‘WCC Desktop portal’. This brings together the organisation’s full range of trusted information resources – datasets, documents, web sites and analytical tools in one single location. GIS is built into the WCC Desktop and data analysis is interactive. It supports national comparisons with users able to cross-reference external policy and guideline documents, and access thematic, map-based analyses of their own catchment populations.
    
According to Amanda Hume, Executive Director of Performance, Delivery and Contract Management for NHS County Durham, the WCC desktop is seen by it as a major advance in ensuring that commissioning decisions are based on health needs of the local population. She says, “Now we are commissioning for healthy outcomes through innovation and information. That’s what we are here for – to improve health and reduce inequalities. We are excited about seeing the changes happen that will benefit the people of Durham and Darlington.”
    
We have a wealth of information and sophisticated technology which can be used to provide further health and social care breakthroughs. The signs of innovation are there, we simply need to harness them for the health of our health system.

For more information
Web: www.intellectuk.org