Breezing through Nashville

As promised, I had the opportunity to present my poster “Visualizing Spatio-Temporal Patterns of Emergency Department Utilization during a Polar Vortex” at the 2014 CSTE Annual Conference in Nashville, TN. Thanks to everyone who stopped by; I think it was generally well received. As an experiment in visualization, it was a moderate success. Most folks could understand the graphics once they were explained, but the patterns were not as immediately apparent as one might want. By virtue of sharing the visualization in this forum, I was able to get helpful feedback that should improve future attempts to present information in this format.

My poster

Hourly time series (black lines) were smoothed using the hourly average over the past 24 hours. Individual time series shading indicates whether the series is trending up (green) or down (red). Blue shading indicates the minimum temperature during the event, from coldest (blue) to warmest (white).

Elsewhere at the conference, the evolving regulatory landscape for healthcare was in the subtext, if not the text, of many sessions. Meaningful use continues to require dedicated sessions to facilitate public health coordination in response to vendor issues and requirement questions, particularly for electronic laboratory reporting. The delayed ICD-9 / ICD-10 transition also got its own session; there is some indication that facilities which had already been planning to switch in 2014 will proceed as planned, potentially creating a greater period of transition and overlap between the standards. And the Affordable Care Act has introduced requirements for hospitals and other healthcare providers that are relevant to public health activities like community health assessments, as covered by the workshop I attended on Sunday.

On the surveillance side, focused surveillance for specific, time-limited scenarios is getting more attention. This includes preparation for known, planned gatherings bringing people together from across the nation or the globe, and also unscheduled events like hurricanes and earthquakes which can potentially add burden to and reduce the capacity of the healthcare infrastructure at the same time. At a roundtable meeting on this topic, I had the opportunity to share HMS’ experiences in tailoring surveillance for these events, and to learn from the experiences of other health departments. The discussion also highlighted upcoming events in our coverage areas for which we may be able to provide surveillance support to the relevant public health agencies.

I also had the opportunity to attend several talks around the challenges and opportunities of spatial data analysis. While state and county-level statistics are reported regularly, it is fairly well understood that most counties are not homogenous populations. Instead, they have distinct subpopulations with unique health needs and health contexts. This has important policy implications, as healthcare providers and public health departments seek to address the ongoing regulatory changes. The processes for improving care at Divers County Hospital A may have little impact at Divers County Hospital B because they serve different populations.

Increasingly it is becoming possible to collect data at the necessary spatial resolution to appreciate these differences. And the tools to work with data at that resolution are being more widely adopted. We aren’t there yet, but I imagine a day in the near future where accounting for these spatial differences, or perhaps more accurately for the underlying factors that lead to differences across space, will be as commonplace as adjusting for the age structure of the population has become.