Utilizing patient geographic information system data to plan telemedicine service locations.
OBJECTIVE
To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs).


METHODS
This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients' average travel distance (ATD) to the closest clinic site.


RESULTS
A total of 4027 visits by 2049 unique patients were analyzed. The best travel distances for site groupings of 3, 4, 5, or 6 site locations were ranked based on increasing ATD. Each one-site increase in the number of available telemedicine sites decreased minimum ATD by about 8%. For a given group size, the best groupings were very similar in minimum travel distance. There were significant differences in predicted patient load imbalance between otherwise similar groupings. A majority of the best site groupings used the same small number of sites, and urban sites were heavily used.


CONCLUSIONS
With EHR geospatial data at an individual patient level, we can model potential telemedicine sites for specialty access in a rural geographic area. Relatively few sites could serve most of the population. Direct access to patient GIS data from an EHR provides direct knowledge of the client base compared to methods that allocate aggregated data.


CONCLUSIONS
Geospatial data and methods can assist health care location planning, generating data about load, load balance, and spatial accessibility.
Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.
Neelkamal
N
Soares
Environmental Health Institute, Center for Health Research, Geisinger Health System, Danville, PA, USA.
Joseph
J
Dewalle
Department of Geography and Program in Environmental Studies, Bucknell University, Lewisburg, PA, USA.
Ben
B
Marsh
D003625:Data Collection / Q000379:methods; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D057286:Electronic Health Records; D040362:Geographic Information Systems; D006285:Health Planning / Q000379:methods*; D006297:Health Services Accessibility; D006801:Humans; D010414:Pennsylvania; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000458:organization & administration*
electronic health records; geographic information systems; service planning; telemedicine