CANADI AN GEOSPATI AL

DATA I NFRASTRUCTURE
GAPS AND OPPORTUNITIES IN PUBLIC HEALTH
Prepared by: New Brunswick Lung Association
Website: www.nb.lung.ca
Phone: 506!55"#6$
%ate: &arch '$( )006
*unded by: +eo,onnections( Natural -esources ,anada
.ABL/ 0* ,0N./N.1
.able o2 ,ontents...................................................................................................................)
/3ecuti4e 1u55ary...............................................................................................................6
Preamble.....................................................................................................................................................7
Who is This For?........................................................................................................................................7
Report Layout.............................................................................................................................................8
Literature -e4iew................................................................................................................$$
Introduction..............................................................................................................................................11
GI !pplication Potential........................................................................................................................1"
#iscussion $ Recommendations................................................................................................................1%
Needs and +aps in Public 7ealth.......................................................................................$6
In&rastructure............................................................................................................................................1'
Trainin( and )ducation...........................................................................................................................17
Research....................................................................................................................................................18
#iscussion $ Recommendations*.............................................................................................................."+
8ser Needs Assess5ent........................................................................................................))
,ser Types.................................................................................................................................................""
,ser -eeds................................................................................................................................................""
,se .ase cenarios..................................................................................................................................."/
#iscussion $ Recommendations*.............................................................................................................."'
,ase 1cenarios......................................................................................................................)6
.hronic Respiratory ymptoms................................................................................................................"7
!ir Pollution 0orbidity10ortality Trends..............................................................................................."8
#rin2in( Water 3uality............................................................................................................................"4
Road Transport Plannin(........................................................................................................................./1
5ospital !ccessibility Patterns................................................................................................................./"
#isease .lusters........................................................................................................................................//
5ealthcare Plannin(................................................................................................................................/6
7o8ine pon(i&orm )ncephalopathy......................................................................................................./%
Identi&yin( .ontaminated 7lood Products............................................................................................../'
%isease 1ur4eillance .ools and +91...................................................................................'#
98er8ie:..................................................................................................................................................../4
7ioterrorism #etection cenarios............................................................................................................/4
.ommunicable #isease #etection cenarios........................................................................................../4
;ector17orne #isease #etection cenarios.............................................................................................6+
!ssessment Re<uirements........................................................................................................................61
#etection Per&ormance.............................................................................................................................61
#ata .ollection.........................................................................................................................................61
-eed to Install .omputers in 5ealth ystems.........................................................................................61
#ata tora(e Re<uirements......................................................................................................................6"
#ata !nalysis Re<uirements....................................................................................................................6"
,ni8ariate !l(orithms..............................................................................................................................6"
patial cannin( o&t:are.......................................................................................................................66
0ulti8ariate !l(orithms...........................................................................................................................66
Response #ecision10a2in( Re<uirements..............................................................................................6%
2
Personnel Re<uirements...........................................................................................................................6%
ystem 0odel............................................................................................................................................6%
#etectability !nalysis...............................................................................................................................6'
#iscussion $ Recommendations................................................................................................................6'
7ealth %ata : .ypes( 1ources( %atabases..........................................................................!#
Introduction..............................................................................................................................................64
tandard health data................................................................................................................................64
Ris2 Factors &or #isease...........................................................................................................................%+
.linical tudies.........................................................................................................................................%+
5ealth er8ices )8aluation......................................................................................................................%+
Policy Impact )8aluation.........................................................................................................................%+
5ealth #atabases......................................................................................................................................%1
Clinical Administrative Dataases!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"#
Healt$ H%man Res&%rces Dataases!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"#
Healt$ S'endin( Dataases!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"#
Healt$ Services Dataases!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"#
Canadian Instit%tes &) Healt$ Researc$!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"2
7ealth %ata 9ntegration.......................................................................................................5'
Introduction..............................................................................................................................................%/
5ealth #ata .hallen(es...........................................................................................................................%/
Data Fra(mentati&n!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"*
Data De)icienc+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!",
Data Anal+sis!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!",
Data Disseminati&n!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!",
5ealth #ata olutions..............................................................................................................................%%
-etalin(%istic Standards!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!""
-edical .&ca%laries!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"/
Uni)ied -edical Lan(%a(e S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"0
-etat$esa%r%s!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"0
Semantic Net1&r2!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"3
Le4ical Pr&(rams!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"3
-edical Rec&rds!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"5
-edical In)&rmatics!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!/6
C&nce't%al Healt$ Data -&del!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!/#
#iscussion $ Recommendations................................................................................................................'1
Pri4acy 9ssues.......................................................................................................................6)
Introduction..............................................................................................................................................'"
#ata Pri8acy Issues..................................................................................................................................'"
Research not !&&ectin( Patient Identi&ication.........................................................................................'/
Research !&&ectin( Patient Identi&ication...............................................................................................'6
Research in8ol8in( .ommunity Inter8ention..........................................................................................'6
3uestions .oncernin( the Pri8acy !ct....................................................................................................'%
.onclusion................................................................................................................................................'7
#iscussion $ Recommendations................................................................................................................'8
+91 %ata 1ets........................................................................................................................60
Introduction..............................................................................................................................................7+
7ase 0ap #ata..........................................................................................................................................7+
Ge&Base Canada!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!06
Landsat70 ET-8 -rSID -&saics!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0#
*
Di(ital C$arts &) t$e 9&rld!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0#
.limate .han(e and 5ealth.....................................................................................................................71
9ORLDCLI-!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0#
-ete&r&l&(ical Services Canada!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0#
Nati&nal Center )&r Atm&s'$eric Researc$!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02
Nati&nal Climate Data Center!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02
Pale&climat&l&(+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02
ORNL DAAC Climate C&llecti&n!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02
GEO Data P&rtal!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02
ea Le8el Rise...........................................................................................................................................7/
GSHHS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0,
NOAA:s -edi%m Res&l%ti&n Di(ital .ect&r S$&reline!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0,
Envir&nment Canada Sea7Level Rise Pr&;ect!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0,
GRID7E%r&'e!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0"
#isease ;ectors.........................................................................................................................................7%
9est Nile .ir%s -a's!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0"
#iscussion $ Recommendations*..............................................................................................................7%
1tatistical &odules...............................................................................................................66
Introduction..............................................................................................................................................7'
Time1eries 0odel....................................................................................................................................7'
Poisson 0odel...........................................................................................................................................77
7ayesian 0odel.........................................................................................................................................77
7ootstrap 0odel........................................................................................................................................78
7ernoulli 0odel........................................................................................................................................78
pace1Time Permutation 0odel..............................................................................................................74
9rdinal 0odel...........................................................................................................................................8+
)=ponential 0odel...................................................................................................................................8+
Probability 0odel .omparison................................................................................................................81
Fe: .ases .ompared to .ontrols............................................................................................................81
7ernoulli 8ersus 9rdinal 0odel...............................................................................................................81
Temporal #ata..........................................................................................................................................81
#iscussion $ Recommendations................................................................................................................8"
;isuali<ation .echni=ues....................................................................................................."'
.is%ali<ati&n -et$&d!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!3*
.is%al .ariales!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!3,
-a''in( Pr&cess!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!3"
,+%9Nested > 0+,,o5pliant Public 7ealth Architecture.........................................""
In&ormation >0ap? #eli8ery.....................................................................................................................88
5ealth In&ormation er8ice !rchitecture................................................................................................84
#atabase 0ana(ement ystems...............................................................................................................41
ecurity and !uthentication.....................................................................................................................4/
#atabase Pro8iders...................................................................................................................................4/
W0 and WF.........................................................................................................................................46
.G#I1)ndorsed tandards......................................................................................................................47
Recommendations.....................................................................................................................................47
,o5pli5entary .echnologies.............................................................................................##
Introduction..............................................................................................................................................44
tatic 0appin(..........................................................................................................................................44
Interacti8e 0appin(...............................................................................................................................1+1
,
Pro(rammable 0appin(.........................................................................................................................1+"
Public 5ealth !(ency o& .anada...........................................................................................................1+/
-atural Resources .anada....................................................................................................................1+6
,. Geolo(ical ur8ey............................................................................................................................1+6
9pen ource o&t:are............................................................................................................................1+%
=%ant%m GIS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#6/
SAGA GIS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#63
Ge&(ra'$ic Res&%rces Anal+sis S%''&rt S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#65
O'en In)rastr%ct%re )&r O%tc&mes S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##6
SaTScan!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!###
Remote and 0obile !pplications...........................................................................................................111
Proprietary GI* o&t:are ;endors.......................................................................................................11/
CARIS >111!caris!c&m? >Canada?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##*
PCI Ge&matics >111!'ci(e&matics!c&m? >Canada?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##*
ESRI >111!esri!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##*
Inter(ra'$ >111!inter(ra'$!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##*
-a'In)& >111!ma'in)&!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##,
Bentle+ S+stems >111!entle+!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##,
A%t&Des2 >111!a%t&des2!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##,
Sa)e S&)t1are >111!sa)e!c&m? >Canada?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##,
#iscussion $ Recommendations..............................................................................................................11%
1u55ary o2 -eco55endations........................................................................................$$6
,onclusion...........................................................................................................................$))
Appendi3 $: 7ealth %atabases..........................................................................................$)'
.linical !dministrati8e #atabases.........................................................................................................1"/
Disc$ar(e Astract Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2*
H&s'ital -&ridit+ Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2*
Nati&nal Am%lat&r+ Care Re'&rtin( S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2*
5ealth 5uman Resources #atabases....................................................................................................1"6
Re(istered N%rses Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2,
Licensed Practical N%rses Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2,
Re(istered Ps+c$iatric N%rses Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2,
5ealth pendin( #atabases...................................................................................................................1"6
Nati&nal Healt$ E4'endit%re Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2,
OECD Healt$ Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2"
Canadian -IS Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2"
Nati&nal P$+sician Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2"
Nati&nal Prescri'ti&n Dr%( Utili<ati&n In)&rmati&n S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2/
Nati&nal Healt$ E4'endit%re Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2/
5ealth er8ices #atabases.....................................................................................................................1"'
Canadian @&int Re'lacement Re(istr+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2/
Canadian -edicati&n Incident Re'&rtin( and Preventi&n S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#20
Canadian Or(an Re'lacement Re(ister!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#20
C&ntin%in( Care Re'&rtin( S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#20
H&me Care Re'&rtin( S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#23
H&s'ital -ental Healt$ Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#23
Nati&nal Re$ailitati&n Re'&rtin( S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#23
Nati&nal Tra%ma Re(istr+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#23
T$era'e%tic A&rti&ns Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#25
Healt$ Indicat&rs!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#25
"
Res'irat&r+ Disease in Canada!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**
Canadian Cancer Re(istr+AB!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**
Canadian Patient Data Re(istr+AB!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**
Canadian T&acc& Use -&nit&rin( S%rve+AB!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**
Canadian T%erc%l&sis Re'&rtin( S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**
-&rtalit+ Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,
Nati&nal Air P&ll%ti&n S%rveillance S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,
Nati&nal L&n(it%dinal S%rve+ &) C$ildren and C&%t$!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,
Nati&nal Perinatal S%rveillance S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,
Nati&nal P&'%lati&n Healt$ S%rve+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,
N&ti)iale Disease Re'&rtin( S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*"
Nati&nal P&'%lati&n Healt$ S%rve+D Ast$ma S%''lement!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*"
.anadian Institutes o& 5ealth Research................................................................................................1/%
Bibliography.......................................................................................................................$'6
/
/?/,8.9;/ 18&&A-@
P-/A&BL/
T$e e4'ansi&n &) t$e Canadian Ge&s'atial Data In)rastr%ct%re int& t$e '%lic $ealt$ disci'ine is deemed
critical )&r addressin( s$&rtc&min(s in '&'%lati&n $ealt$ m&nit&rin(E devel&'in( e))ective interventi&n
strate(ies )&r c$r&nic and in)ecti&%s diseaseE im'r&vin( $ealt$ care servicesE and res'&ndin( t& $ealt$ and
sa)et+ emer(encies!
T$e Ne1 Br%ns1ic2 L%n( Ass&ciati&n is 'leased t& 'resent t$is re'&rt assessin( (aps and opportunities
&or de8elopment o& .G#I1nested public health in&rastructure and applications! T$e re'&rt is divided int&
si4 Secti&ns! Eac$ secti&n c&ntains &%r researc$ and c&ncl%des 1it$ rec&mmendati&ns! T$is re'&rt 1ill
assist Ge&C&nnecti&ns and P%lic Healt$ A%t$&rities acr&ss Canada )&r t$e im'r&ved a''licati&n &)
ma''in( tec$n&l&(+ in s%''&rt &) '%lic $ealt$ decisi&n7ma2in(!
T$e )&ll&1in( F%esti&ns 'r&vide t$e necessar+ &ocus )&r t$is st%d+D
9$at (a's e4ist )&r 1e7ased ma''in( )&r '%lic $ealt$G
H&1 can 1e7ased ma''in( $el' t& %ild t$e ca'acit+ &) '%lic $ealt$ 'r&)essi&nals H c&mm%nities t&
%nderstand t$reats t& $%man $ealt$E sa)et+E and t$e envir&nmentG
9$at GIS t&&ls and data are needed )&r e'idemi&l&(ical m&delin( and res'&ndin( t& in)ecti&%s diseaseG
H&1 can t$e CGDI s%''&rt a )%ll+7&'erati&nal '%lic $ealt$ 9-S H 9FS in)rastr%ct%re I incl%din(
'%lic access and disease7c&ntr&l a''licati&nsE 1$ile ens%rin( data 'rivac+G
H&1 '%lic $ealt$ %ser reF%irements e met t$r&%($ ad&'ti&n &) 9-S tec$n&l&(+E c&m'limentar+
tec$n&l&(ies H statistical t&&lsE and data standardsG
H&1 can a distri%ted access net1&r2E nested in t$e CGDIE e estalis$ed am&n( $ealt$ a%t$&rities )&r
envir&nmental7$ealt$ ma''in(G
W70 91 .791 *0-A
9$ile n&t limited t& t$e )&ll&1in(E 1e $ave identi)ied )&%r 2e+ a%diences )&r t$is re'&rt! T$e
researc$ and rec&mmendati&ns are 'artic%larl+ relevant t&D
#! +eo,onnections: F&r t$e c&nvenience &) &%r )%nderE Ge&C&nnecti&nsE 1e 'r&vide a F%ic2 &vervie1
&) t$e c&ntents &) t$is re'&rt ;%st el&1E incl%din( 2e+ rec&mmendati&ns! T$is re'&rt 1ill e &)
interest t& c&r'&rate devel&'ment strate(+E tec$nical and '&lic+ 'ers&nnelE and $ealt$ 'r&;ect
advis&rs! F%rt$erm&reE 1e $ave determined t$at )%rt$er researc$ and sta2e$&lder en(a(ement is
needed t& address t$e iss%es identi)ied in t$is re'&rt!
2! 7ealth Authorities: T$e researc$ and rec&mmendati&ns in t$is re'&rt c&ncentrate &n '%lic $ealt$
a''licati&nsE (a's H needsE disease s%rveillance and ma''in( tec$n&l&(iesE met$&d&l&(iesE data
standardsE 'rivac+ '&lic+E 'ers&nnel and trainin( reF%irementsE and m&re!
0
*! -esearch +roups: T$is re'&rt &%tlines t$e c$allen(es t& medical researc$ (r&%'s 1$en accessin(
'%lic $ealt$ dataE %t als& 'r&vides s%stantial insi($t &n t$e tec$n&l&(iesE met$&d&l&(iesE and
standards t$at can )acilitate access t& data )&r medical researc$ and m&delin( '%r'&ses! T$e re'&rt
als& identi)ies 'ri&rities )&r researc$ and GIS ma''in(E ased &n a t$&r&%($ literat%re revie1 and
%ser c&ns%ltati&n!
,! +eo5atics 9ndustry: GIS is emer(in( as a critical t&&l )&r s'atial e'idemi&l&(ical anal+sis &)
c$r&nic and in)ecti&%s diseases! Ge&matics Ind%str+ interested in rea2in( int& t$e '%lic $ealt$
mar2et m%st )irst %nderstand '%lic $ealt$ %ser reF%irements! T$is re'&rt 'r&vides a s&lid
)&%ndati&nE incl%din( s%((ested minim%m standards )&r 9-SH9FS a''licati&nsE t& meet '%lic
$ealt$ needs!
-/P0-. LA@08.
9e $ave divided t$e re'&rt int& si4 secti&ns! ! summary o& recommendations can be &ound on Pa(e 11'.
Here is an &%tline &) t$e re'&rtE incl%din( (&als )&r eac$ secti&n!
1ection 0ne:
+oal: T& 'r&vide a rie) intr&d%cti&n t& t$e (r&1in( need )&r e7$ealt$E disease s%rveillanceE and
1e7ma''in( a''licati&nsE in s%''&rt &) '%lic $ealt$ decisi&n7ma2in(! T$is secti&n als& identi)ies
(a's 1it$in '%lic $ealt$ and t$e CGDIE )&r devel&'ment &) 1e7ma''in( a''licati&ns H
in)rastr%ct%reE trainin(E and researc$!
,hapter $: Literat%re Revie1
,hapter ): Needs and Ga's in P%lic Healt$
1ection .wo:
+oal: c&ntains a $i($7level disc%ssi&n &) GIS a''licati&ns in '%lic $ealt$E incl%din( case scenari&s!
,hapter ': User Needs Assessment
,hapter !: Case7Scenari&s
1ection .hree:
+oal: (iven (r&1in( c&ncerns &ver 'andemics and in)ecti&%s disease 1&rld1ideE t$is secti&n
disc%sses t$e reF%irements )&r disease s%rveillance met$&d&l&(ies and tec$n&l&(iesE incl%din(
disease detecti&nE data c&llecti&nE st&ra(eE and anal+sisE in)rastr%ct%re and s&)t1areE and m&re!
,hapter 5: Disease S%rveillance T&&ls and GIS
1ection *our:
+oal: t$e )&%ndati&n )&r t$e e4'ansi&n &) CGDI int& '%lic $ealt$ incl%des 'a+in( cl&se attenti&n t&
$ealt$ data inte(rati&n and standardsE 'rivac+ iss%esE data setsHs&%rcesE statistical m&delin(E and
vis%ali<ati&n tec$niF%es! T$ese t&'ics are disc%ssed in t$is Secti&n!
,hapter 6: Healt$ Data T+'esE S&%rcesE and Dataases
,hapter 6: Healt$ Data Inte(rati&n and Standards
,hapter ": Privac+ Iss%es
,hapter #: GIS Data Sets
,hapter $0: Statistical -&d%les
,hapter $$: .is%ali<ati&n Tec$niF%es
3
1ection *i4e:
+oal: in c&nsiderati&n &) t$e )irst )&%r secti&nsE 1e $ave devel&'ed an &vervie1 &) CGDI7nested
OGC7c&m'liant '%lic $ealt$ arc$itect%reE incl%din( rec&mmendati&ns )&r a''licati&nsE dataasesE
deliver+ c$annelsE net1&r2 sec%rit+E minim%m standardsE and m&re!
,hapter $): CGDI7Nested H OGC7C&m'liant P%lic Healt$ Arc$itect%re
,hapter $': C&m'limentar+ Tec$n&l&(ies
1ection 1i3D
+oal: t& 'r&vide a )%ll s%mmar+ &) rec&mmendati&ns c&ntained 1it$in t$is re'&rt! Cl&sin( t$&%($ts
and directi&n is 'r&vided in t$e c&ncl%si&n!
,hapter $!: S%mmar+ &) Rec&mmendati&ns
,hapter $5: C&ncl%si&n
At t$e end &) t$is re'&rt +&% 1ill )ind A''endi4 # and Bili&(ra'$+! T$e Ne1 Br%ns1ic2 L%n( Ass&ciati&n
'r&'&ses t$at $ealt$ a%t$&rities acr&ss Canada c&nsider t$e rec&mmendati&ns in t$is re'&rtE as 'art &)
devel&'in( e7$ealt$ s+stems and t&1ard ad&'ti&n &) CGDI7nested GIS a''licati&nsE dataE and services!
It is essential t$at m&re researc$ and devel&'ment e c&nd%cted in &rder t& address t$e (a's and
&''&rt%nities identi)ied in t$is re'&rt! T& t$at endE 1e rec&mmend t& Ge&C&nnecti&ns t& s%''&rt $ealt$
researc$ (r&%'s t& enale t$e e4'ansi&n &) t$e CGDI int& '%lic $ealt$!
T$is 'r&;ect 1as c&nd%cted in -arc$ 266/E and 1as 're'ared + sta)) &) t$e Ne1 Br%ns1ic2 L%n(
Ass&ciati&nE incl%din( -a%rice Lantei(neE Jia&l%n CiE and Eddie Old)ield! Dr! Bar -acKinn&n and
m+sel) 'r&vided &versi($t (%idance in t$e devel&'ment &) t$is re'&rt! S$&%ld +&% e interested in
c&ntactin( %s re(ardin( t$is re'&rtE &r a&%t an+ &) t$e t&'ics addressed $ereinE 'lease d& n&t $esitate t&
c&ntact me! And rememerD
BWhen @ou ,anCt Breathe( Nothing /lse &attersD
Kennet$ -a+ee
President and CEO
Ne1 Br%ns1ic2 L%n( Ass&ciati&n
P$&neD >"6/? ,""735/# e4t #62
EmailD 2en!ma+eeLn!l%n(!ca
5
SECTI ON ONE
CHAPTER #D Literat%re Revie1
CHAPTER 2D Needs and Ga's in P%lic Healt$
#6
L9./-A.8-/ -/;9/W
9N.-0%8,.90N
Res'irat&r+ disease e4erts a ma;&r im'act &n t$e Canadian $ealt$care s+stemE acc&%ntin( )&r m&re t$an M,
illi&n d&llars &) direct e4'endit%re 'er ann%m! Indirect c&sts related t& disailit+ and m&rtalit+ is estimated
t& e4ceed direct $ealt$ c&sts + t1&7)&ld! T$e Centre )&r C$r&nic Disease Preventi&n and C&ntr&l identi)ies
res'irat&r+ disease as t$e m&st 'revalent c$r&nic c&nditi&n in c$ildren
A#B
! It a))ects nearl+ 2!" milli&n
CanadiansE 3N &) ad%lts and #2N &) c$ildren! Res'irat&r+ disease in Canada res%lts in #"6E666 emer(enc+
de'artment visitsE "6E666 $&s'itali<ati&ns and #5E266 deat$s 'er ann%m!
9$ile researc$ers identi)+ t$e ca%ses &) res'irat&r+ disease in CanadaE t$ere e4ists a si(ni)icant (a' in t$e
medical sciences t&1ard t$e a''licati&n &) GIS ma''in( tec$n&l&(+ in )&rm%latin( $ealt$ '&lic+ initiatives!
T$e recent SARS &%trea2 &) 266276* dem&nstrated t$e need )&r (e&(ra'$ic a''licati&ns in medicine
A2B
!
D%rin( t$e &%trea2E t$e 9&rld Healt$ Or(ani<ati&nE Centers )&r Disease C&ntr&lE and Healt$ Canada 1ere
'r&activel+ en(a(ed in ma''in( t$e viral 'andemicE and a''l+in( GIS m&dels t& (l&al and nati&nal $ealt$
'&lic+! GIS tec$n&l&(+ 'r&ved inval%ale t&1ard its e'idemi&l&(ical m&delin( and event%al c&ntr&l! 9$ile
'%lic attenti&n is c%rrentl+ )&c%sed &n t$e '&ssiilit+ )&r an Avian Fl% 'andemicE res'irat&r+ disease
c&ntin%es t& e4$iit a (reater m&ridit+7m&rtalit+ trend t$an all deat$s + in;%r+E + a )act&r &) t$ree7)&ldE
re'resentin( m&re t$an 5N &) all m&rtalit+ ca%ses in Canada
A*B
! T$is dem&(ra'$ic )act %ndersc&res t$e
reF%irement t& s'atiall+ m&del t$e a((ravatin( a(ents &) res'irat&r+ diseaseE air '&ll%ti&n and climatic
e4tremesE and t$eir '&tential im'act %'&n t$e $ealt$care s+stem!
T$e SARS &%trea2 als& alerted Canadian '&lic+ decisi&n7ma2ers &n t$e need )&r c&&'erative mec$anisms
)&r im'r&vin( Canada:s '%lic $ealt$ s+stem! Healt$ &))icials reali<e t$at it is necessar+ t& c&mm%nicate in a
c&lla&rative )as$i&n i) $ealt$care '&lic+ decisi&ns are t& e made in an e))ective and timel+ manner! T$e
c&nseF%ences &) )ail%re 1ere n&ted + H&n&%rale -r! @%stice Arc$ie Cam'ell d%rin( $earin(s &) t$e
Inde'endent SARS C&mmissi&nD
OThe constant and overwhelming request for information led to chaos, confusion, frustration and
defeat for those who had to respond to these requests There was no order or logic in the frenzied,
disorganized, overlapping, repetitious, multiple demands for information from hospitals and local
public health units
A,B
!P
T$e ens%in( 'andem&ni%m nat%rall+ devel&'ed a c&n)r&ntati&nal and inF%isiti&nal )ear am&n( )r&nt7line
$ealt$ service 'r&viders! As a res%ltE t$e Nati&nal Advis&r+ C&mmittee &n SARS and P%lic Healt$
rec&mmends t$at Canada devel&' a distri%ti&n res&%rce net1&r2 )&r 2n&1led(e7s$arin( and evidence7
ased decisi&n7ma2in(!
A"B
CanadaQs Healt$ In)&1a+ n&1 serves t$e mandate &) devel&'in( CanadaQs e7
$ealt$E IT and 1e7arc$itect%reE )&r disease s%rveillance and m&re >111!in)&1a+7in)&r&%te!ca?! It 'r&m&tes
inter&'erailit+ and standards am&n( $ealt$ in)&rmati&n s+stemsE and incl%des a standards revie1 'r&cess
1it$in 1$ic$ t$e OGC H CGDI standards ma+ e c&nsidered! T$e Canada Healt$ In)&1a+ 1&r2s in
'artners$i' 1it$ t$e Pr&vinces and 'rivate sect&rE t& devel&' t$e necessar+ in)rastr%ct%re )&r e7$ealt$!
Nearl+ a decade $as 'assed since t$e )irst call t& inte(rate GIS tec$n&l&(+ int& t$e Canadian $ealt$7care
'lannin( 'r&cess
A/B
! Since t$at timeE &nl+ t$ree researc$ (r&%'s in Canada $ave )&ll&1ed %' &n t$e initial
'r&'&sal
A0E 3E 5B
! C&nversel+E GIS a''licati&ns $ave ec&me a sta'le in E%r&'ean $ealt$ '&lic+ eval%ati&n t&&ls
7 devel&'in( $ealt$ data mana(ement t&&ls in Ital+
A#6B
E a nati&nal '%lic $ealt$ atlas in T$e Net$erlands
A##B
E
##
$ealt$care 'lannin( t&&ls in S1it<erland
A#2B
E and m&d%lar GIS a''licati&ns in t$e United Kin(d&m
A#*B
! 9$ile
(l&al st%dies $ave advanced t$e a''licati&n &) GIS tec$n&l&(+ in medical researc$E Canadian researc$ers
$ave la((ed e$ind! T$is is d%e in 'art t& t$e lac2 &) trainin( in (e&(ra'$ic e'idemi&l&(+ in (eneralE and
accessiilit+ t& critical res&%rces in GIS tec$n&l&(+ in 'artic%lar!
T$e e4'ansi&n &) t$e CANADIAN GEOSPATIAL DATA INFRASTRUCTURE int& t$e '%lic $ealt$ disci'line is
deemed critical )&r addressin( s$&rtc&min(s in '&'%lati&n $ealt$ m&nit&rin(E devel&'in( e))ective
interventi&n strate(ies )&r c$r&nic and in)ecti&%s diseaseE im'r&vin( $ealt$care servicesE and res'&ndin( t&
$ealt$ and sa)et+ emer(encies!
In additi&nE ased &n an e4tensive eval%ati&n &) t$e literat%reE 1e c&ncl%de t$at GIS ma''in( t&&ls can
enale '%lic $ealt$ &))icials t&D
anal+<e '&'%lati&n $ealt$ 'arameters
access disease in)&rmati&n in a timel+ manner
devel&' $ealt$care '&lic+ initiatives
c&&rdinate medical res'&nse meas%res
m&nit&r envir&nmental determinants &) $ealt$
+91 APPL9,A.90N P0./N.9AL
D%rin( t$e 'ast decadeE GIS a''licati&ns $ave tended t& )&c%s %'&n ei($t ma;&r m&delsD a(ric%lt%ral
A#,B
E
climate im'act
A#"E #/B
R medicalE 'arasit&l&(+
A#0E #3E #5B
E 'esticide
A26E 2#B
E '&ll%ti&n
A22E 2*E 2,E 2"E 2/E 20E 23E 25E *6B
E 1aste
mana(ement
A*#E *2E **B
and 1ildli)e mana(ement
A*,B
! -edical t&'ics addressed in a GIS )&rmat incl%dedD
c&mm%ter sa)et+
A*"B
E envir&nmental $ealt$ decisi&ns
A*/B
E $ealt$ data ma's
A*0B
E ma''in( &) $ealt$ service
'r&viders
A*3B
E '&'%lati&n (r&1t$
A*5B
E disease cl%ster identi)icati&n
A,6B
E (e&(ra'$ic access t& $ealt$care
A,#B
E and
(e&(ra'$ic e'idemi&l&(+
A,2B
!9$ile GIS st%dies in medicine $ave een varied and inn&vativeE t$e+ $ave als&
tended t& e inc&nsistentE es'eciall+ in t$eir a''licati&n t& and maintenance &) re(i&nal needs in $ealt$7care
'lannin(! A c&m're$ensive literat%re revie1 $as identi)ied an e4tensive ass&rtment &) '&tential GIS $ealt$7
related a''licati&nsD
Asth5a
e4'&s%re ris2 anal+sis &) ast$ma t& tra))ic7related air '&ll%ti&n
A,*B
R
ass&ciati&n et1een tra))ic e4'&s%re levels and t$e dia(n&sis &) ast$ma in c$ildren
A,,E ,"E ,/B
R
(eneral envir&nmental ris2 )act&rs )&r ast$ma emer(enc+ care
A,0B
R
dedicated envir&nmental mana(ement s+stem dataase c&%'led 1it$ an am%lat&r+ s'ir&metric
m&nit&rin( 'r&(ram )&r ast$ma
A,3B
R
relati&ns$i' et1een c$ild$&&d ast$ma s+m't&msE $&s'ital admissi&nsE and l&n(7term e4'&s%re
t& amient 'artic%late matter in an ind%striali<ed %ran center
A,5B
R
(e&(ra'$ic ma''in( &) ast$matic e'idemi&l&(ical data in an %ran center
A"6B
!
(e&(ra'$ic cl%ster anal+sis &) c$r&nic in)lammat&r+ diseases
A"#B
R
(e&(ra'$ic cl%ster anal+sis &) c$ild$&&d and ad%lt ast$ma $&s'itali<ati&n 'atterns relative t&
'r&4imit+ t& amient '&ll%ti&n s&%rces
A"2E "*B
R
anal+sis &) l%n( $ealt$ s%rve+ dataases
A",E ""B
R
(e&(ra'$ic variailit+ in t$e 'revalence &) r&nc$ial res'&nsiveness
A"/B
R
c&mm%nit+ '$armac+ ast$ma st%d+
A"0B
R
cl%ster im'act anal+sis &) m&t&r ve$icle emissi&ns &n res'irat&r+ $ealt$
A"3B
R
(e&(ra'$ic variati&ns in t$e 'revalence &) ast$ma
A"5B
!
#2
,hronic 0bstructi4e Pul5onary %isease
relati&ns$i' et1een m&t&r ve$icle emissi&ns and res'irat&r+ $ealt$ %sin( a (e&(ra'$ic
in)&rmati&n s+stem t& estimate t$e avera(e dail+ e4'&s%re t& P->2!"?
A/6B
!
'&'%lati&n ris2 assessment &) s$&rt7term e4'&s%re t& l&1 levels &) (ase&%s '&ll%tants in an %ran
envir&nment
A/#B
R
cr&ss7secti&nal im'act anal+sis &) n%rsin( c$aracteristics &n m&rtalit+ trends in ac%te care
$&s'itals )&r 'atients 1it$ c$r&nic &str%ctive '%lm&nar+ disease
A/2B
R
s'ir&metric anal+sis &) im'aired l%n( )%ncti&n am&n( First Nati&ns c$ildren
A/*B
R
time7series anal+sis &) elderl+ 'e&'le $&s'itali<ed )&r c$r&nic &str%ctive '%lm&nar+ disease
ass&ciated 1it$ incremental e4'&s%re t& 'artic%late air '&ll%ti&n
A/,B
R
e))ects &) c$r&nic e4'&s%re t& $i($ levels &) 'artic%late air '&ll%ti&n &n '%lm&nar+ )%ncti&n
A/"B
R
ass&ciati&n &) dail+ m&ridit+7m&rtalit+ trends in %ran '&'%lati&ns t& 'artic%late matter
c&m'&nents
A//B
R
time series anal+sis &) emer(enc+ de'artment re)errals )&r cardi&res'irat&r+ 'r&lems c&rrelated
1it$ aer&aller(en and air '&ll%ti&n levels
A/0E /3B
!
&yocardial 9n2arction
ris27assessment m&dels t& estimate &%t7&)7$&s'ital m+&cardial in)arcti&n deat$s d%e t& 'atients
1it$ '&&r (e&(ra'$ic access t& $&s'ital emer(enc+ )acilities
A/5E 06B
!
seas&nal 'attern anal+sis &) ac%te m+&cardial in)arcti&n $&s'ital admissi&ns
A0#E 02E 0*E 0,E 0"B
R
im'act &) $&s'ital n%rsin( c$aracteristics &n m&rtalit+ trends )&r m+&cardial in)arcti&n
A0/B
R
c$r&nic e4'&s%re t& 1&r2'lace n&ise levels ass&ciated 1it$ e4cess ris2 )&r m&rtalit+ )r&m ac%te
m+&cardial in)arcti&n
A00B
!
Bronchitis
(e&(ra'$ic cl%ster anal+sis &) c$r&nic in)lammat&r+ diseases ass&ciated 1it$ in)lammat&r+
&1el disease
A03B
R
di))erences in 'atient satis)acti&n and F%alit+ &) care )&r c&mm&n ac%te c&nditi&ns in 1al27in
clinicsE )amil+ 'ractices and emer(enc+ de'artments
A05B
R
cl%ster im'act anal+sis &) m&t&r ve$icle emissi&ns &n res'irat&r+ $ealt$
A36B
R
(e&(ra'$ic c&rrelati&nal anal+sis &) res'irat&r+ $ealt$ indicat&rs >ac%te and c$r&nic r&nc$itisR
'%lm&nar+ )%ncti&n? and acc%lt%rati&n indices )&r Native American '&'%lati&n sam'les
A3#B
!
an eval%ati&n &) $ealt$care data 'r&)iles t& identi)+ 1$ee<in( s+ndr&mes in c$ildren
A32B
R
an anal+sis &) s&cial and $ealt$ s%rve+s t& identi)+ t$e relati&ns$i' et1een c$r&nic res'irat&r+
diseases and '&tential determinants
A3*B
R
cr&ss7secti&nal s%rve+s &) r%ral $&%se$&lds &n t$e e))ects &) envir&nmental 'esticide e4'&s%re &n
res'irat&r+ $ealt$
A3,B
R
$ealt$ e))ects &) (r&%nd7level &<&neE acid aer&s&ls and 'artic%late matter
A3"B
R
s%rve+s identi)+in( res'irat&r+ s+m't&ms ass&ciated 1it$ a(ric%lt%ral st%le %rnin(
A3/B
R
res'irat&r+ s+m't&ms am&n( c$ildren e4'&sed t& acid aer&s&ls
A30B
R
res'irat&r+ $ealt$ stat%s &) 'read&lescent sc$&&lc$ildren in r%ral c&mm%nities
A33B
!
Pneu5onia
c$ild$&&d c&mm%nit+7acF%ired 'ne%m&nia 'atterns detected t$r&%($ 'r&s'ective s%rveillance
A35B
R
l&n(7term air '&ll%ti&n e4'&s%re e))ects &n 'ediatric res'irat&r+ s+m't&ms and $&s'itali<ati&n
'atterns
A56B
!
'ert%ssis m&rtalit+ trends matc$ed 1it$ n&n7)atal cases + a(eE dateE and (e&(ra'$+
A5#B
R
cl%ster im'act anal+sis &) m&t&r ve$icle emissi&ns &n res'irat&r+ $ealt$
A52B
R
(e&(ra'$ic s%rve+ &) Sta'$+l&c&cc%s &cc%rrence and antimicr&ial s%sce'tiilit+
A5*B
R
#*
(e&(ra'$ic s%rve+ &n t$e %se &) 'r&'$+la4is a(ainst Pne%m&c+stis carinii 'ne%m&nia
A5,B
R
'ediatric m&ridit+ trend anal+sis t& identi)+ 'ne%m&nia7ind%ced res'irat&r+ tract in)ecti&ns
am&n( First Nati&ns c$ildren
A5"B
!
9n2luen<a
m&rtalit+ trend anal+sis &) in)l%en<a 'andemic
A5/B
!
eval%ati&n &) GIS ma''in( '&tential )&r in)l%en<a s%rveillance data
A50B
R
eval%ati&n &) GIS statistical tec$niF%es t& devel&' c&m're$ensive '&'%lati&n sam'lin( strate(ies
in t$e s%rveillance &) in)ecti&%s diseasesE m&st n&tal+ in)l%en<a
A53B
R
s'atial anal+sis and mana(ement &) an Avian in)l%en<a e'idemics em'l&+in( a GIS t&&l&4
>.etGIS?
A55B
!
m%ltinati&nal im'act assessment &) in)l%en<a 'andemics
A#66B
R
real7time emer(enc+ de'artment s%rveillance s+stem t& detect i&terr&rist events and emer(in(
in)ecti&ns
A#6#B
R
$ist&rical (e&(ra'$ic m&delin( &n s'read &) t$e #5#37#5 in)l%en<a e'idemic in CanadaE 1it$
'artic%lar re)erence t& t$e '&tential e))ectiveness &) $%man F%arantine
A#62B
R
$ist&rical (e&(ra'$ic m&delin( &n t$e in)l%ence &) Native American m&ilit+ 'atterns &n t$e
s'read &) t$e #5#37#5 in)l%en<a e'idemic
A#6*B
!
1e4ere Acute -espiratory 1yndro5e
'&tential )&r GIS tec$n&l&(+ in 'redictin( (l&al distri%ti&n &) in)ecti&%s diseases
A#6,E #6"B
a s'atial anal+sis &) t$e SARS &%trea2
A#6/B
!
7anta4irus
s'atial distri%ti&n anal+sis &) $em&rr$a(e )ever
A#60B
!
A4ian *lu
inte(rati&n &) GIS tec$n&l&(+ 1it$in c&ntin(enc+ 'lans )&r a '&tential avian in)l%en<a 'andemic!
Bioterroris5
inte(rati&n &) GIS tec$n&l&(+ int& t$e dail+ r&%tine &) l&cal $ealt$ de'artments
A#63E #65E ##6B
R
a''licati&n &) GIS tec$n&l&(+ in t$e investi(ati&n &) '&tential e4'&s%re t& ant$ra4
A###B
!
Air Pollution
(e&s'atial anal+sis &) amient nitr&(en di&4ide c&ncentrati&nsE t& assess e'idemi&l&(ical
e4'&s%re ris2s )r&m tra))ic7related air '&ll%ti&n
A##2B
R
(e&(ra'$ic variati&ns in 'ediatric ast$ma $&s'itali<ati&n 'atterns and 'r&4imit+ t& amient
'&ll%ti&n s&%rces
A##*B
R
seas&nal variati&n anal+sis &) residential rad&n c&ncentrati&ns
A##,B
R
eval%ati&n &) air&rne )%n(al c&ncentrati&ns in '%lic sc$&&ls
A##"B
R
(e&s'atial anal+sis &) ad%lt ast$ma $&s'itali<ati&n and residential e4'&s%re t& '&ll%ti&n
A##/B
R
(e&(ra'$ic and tem'&ral distri%ti&n &) '&l+c+clic ar&matic $+dr&car&ns
A##0B
R
s&)t1&&d d%st e4'&s%re in l%mer mills
A##3B
R
e4'&s%re is&'let$s &) s%l)%r di&4ide c&ncentrati&n )r&m 'etr&le%m 'r&cessin( 'lants
A##5B
R
res'irat&r+ $ealt$ e))ect &) m&t&r ve$icle emissi&ns
A#26B
R
'artic%late and i&aer&s&l emissi&ns )r&m sa1mills
A#2#B
R
t$e e))ectiveness &) t$e Canadian Sm&( Advis&r+ Pr&(ram
A#22B
!
,li5ate ,hange
variati&n in t$e 'revalence &) ast$ma s+m't&msE ast$ma attac2s and %se &) ast$ma medicati&n
et1een Canadian and internati&nal sites d%e t& envir&nmental in)l%ences
A#2*B
R
in vitr& aer&s&l c$aracteristicsE in viv& de'&siti&n and clinical data )&r $+dr&)l%&r&al2ane
'ress%re7metered d&se in$alers
A#2,B
#,
emer(ence &) t$e 9est Nile .ir%s in Canada res%ltin( )r&m c$an(in( ec&s+stem 'r&cesses and
its '&tential im'act &n '&'%lati&n $ealt$ interventi&n strate(ies
A#2"B
!
s'atial m&delin( &) landsca'e sensitivit+ t& climate c$an(e
A#2/B
!
0ther
-ana(in( S%r(e Demand >e!(! res%ltin( )r&m Nat%ral Disasters H Pandemics?
C&&rdinatin( Healt$ and Sa)et+ a%t$&rities >D&mestic H Emer(enc+ Res'&nse?
%91,81190N > -/,0&&/N%A.90N1
It is clear t$at man+ '&tential a''licati&ns e4ist )&r GIS in '%lic $ealt$E in Canada! In &rder t& de'l&+ t$ese
a''licati&ns in a c&nsistent and e))ective manner acr&ss t$e CGDIE Ge&C&nnecti&ns needs t& 'r&vide '%lic
$ealt$ &r(ani<ati&ns 1it$ access t& additi&nal res&%rces &n t$e CGDI 1e7secti&n &n '%lic $ealt$D
$tt'DHH111!(e&c&nnecti&ns!&r(HCGDI!c)mH)%seacti&nH$ealt$!1elc&meH(cs!c)m! T$is c&%ld incl%de case
st%diesE statistical m&d%lesE lin2s t& '%lic $ealt$ GIS s'ecialistsE trainin( &''&rt%nitiesE 1e7'a(es &)
'%lic $ealt$ a%t$&rities and CanadaQs Healt$ In)&1a+E and &t$er res&%rcesE as identi)ied in t$is re'&rt!
F%rt$erm&reE Ge&C&nnecti&ns can )acilitate t$e ad&'ti&n &) GIS a''licati&ns am&n( '%lic $ealt$
a%t$&ritiesE + iss%in( calls &or proposals 1$ic$ )&c%s &n devel&'in( CGDIQs '%lic $ealt$ in)rastr%ct%reE
data and services! -an+ rec&mmendati&ns )&r data 'rivac+E in)rastr%ct%reE and a''licati&ns are c&ntained in
t$is re'&rt! L&calE re(i&nalE and nati&nal st%dies 1$ic$ incl%de t$e devel&'ment and %tili<ati&n &) 1e7
ased GIS a''licati&ns and s'atiall+7re)erenced $ealt$ dataE 1ill $el' t$e CGDI t& e4'and in t$e '%lic
$ealt$ d&main!
A s+stematic a''r&ac$ is rec&mmended )&r e4'andin( t$e CGDI in t$e '%lic $ealt$ d&main!
Ge&C&nnecti&ns needs t& ens%reE in 'artners$i' 1it$ nati&nal $ealt$ a(enciesE t$at a''licati&nsE data and
services 1it$in t$e CGDI remain c&nsistentE n&n7d%'licative H c&n)lictin(E and inter&'erale! 9$ile t$ese
'rinci'les a''l+ t& an+ CGDI related devel&'mentE t$e+ are 'artic%larl+ im'&rtant in '%lic $ealt$E 1it$ t$e
additi&nal c$allen(es t$at '%lic $ealt$ 'resentsE as &%tlined in t$is re'&rt!
#"
N//%1 AN% +AP1 9N P8BL9, 7/AL.7
T$e Ne1 Br%ns1ic2 L%n( Ass&ciati&n $eld a 1&r2s$&' &n N&vemer 22E 266"E entitledD OP%lic Healt$
and 9e7ased -a''in(!P T$is 1&r2s$&' aimed t& rin( t&(et$er 'r&)essi&nals acr&ss '%lic $ealt$E '%lic
sa)et+ and envir&nment disci'linesE t& e4'l&re c$allen(es and &''&rt%nities )&r en$ancin( evidence7ased
decisi&n7ma2in( t$r&%($ 1e7ased ma''in( tec$n&l&(+! Over 06 'r&)essi&nals attendedE re'resentin( a
relativel+ even distri%ti&n &) t$e a&ve * disci'lines! T$ere 1ere als& re'resentatives )r&m * levels &)
(&vernmentE ind%str+E academiaE and n&n7(&vernment &r(ani<ati&ns! T$e t1&7'art 1&r2s$&' c&nsisted &)
)&%r 'anel 'resentati&ns )&ll&1ed + F%esti&n 'eri&dsE and )&%r rea27a1a+ (r&%'sE tas2ed 1it$ addressin(
2e+ iss%es related t& ma''in( )&r '%lic $ealt$!
T$e 1&r2s$&' enaled t$e L%n( Ass&ciati&n t& (at$er 'artici'ant )eedac2 &n reF%irements >dataE
tec$n&l&(+E standards etc?! A 1esite c&ntainin( all t$e 'resentati&ns madeE t$e )inal re'&rtE and lin2s t&
relevant sitesE is availaleD HREFST$tt'DHH111!n!l%n(!caHma''in(T -ACROBUTTON HtmlResAnc$&r
111!n!l%n(!caHma''in(! T$e 1&r2s$&' 1as )%nded + Ge&C&nnecti&nsE Nat%ral Res&%rces Canada!
A)ter a revie1 &) 'artici'ant )eedac2 at &%r recent 1&r2s$&'E 1e $ave devel&'ed a disc%ssi&n &) 2e+ needs
and (a's in '%lic $ealt$ 1it$ res'ect t& ad&'ti&n &) 1e7ased GIS tec$n&l&(+! T$e disc%ssi&n is
&r(ani<ed int& t$ree main cate(&riesD In)rastr%ct%reE Trainin(E and Researc$! T& meet t$e (a's t$at are
identi)ied el&1E 1e $ave e4'l&red n%mer&%s tec$n&l&(iesE standardsE and met$&d&l&(iesE 1$ic$ are
descried in t$e s%seF%ent c$a'ters &) t$is re'&rt!
9N*-A1.-8,.8-/
Healt$ a%t$&rities can ad&'t 1e7ased ma''in( tec$n&l&(ies t& s%''&rt $ealt$ ased researc$ and
'lannin(E rec&(ni<in( t$e l&n(7term $ealt$ ene)its &) investin( in GIS tec$n&l&(+E incl%din( im'r&ved
e'idemi&l&(ical anal+sisE disease 'reventi&nE and $ealt$ 'r&m&ti&n! Investments in OGC7c&m'liant 1e
ased GIS can als& $el' $ealt$ a%t$&rities t& inte(rate m%lti'le data s&%rces &ver t$e Internet! 9e7ased
GIS a''licati&ns s$&%ld ec&me 'art &) CanadaQs Healt$ In)&1a+ and Pr&vincial H Territ&rial e7$ealt$
s+stems! T$e CGDI 'r&vides access t& a''licati&nsE services and dataE t& s%''&rt s&%nd decisi&n7ma2in(!
P%lic $ealt$ ma''in( a''licati&ns s$&%ld e nested 1it$in t$e CGDIE 1$ile still ens%rin( 'rivac+ &) data
and sec%re access!
All a(encies m%st ma2e an e))&rt t& c&ns&lidate and ad$ere t& standards )&r data c&llecti&nE s'atial
m&delin(E s&)t1are inter&'erailit+E etc! Data 'rivac+ and sec%rit+ iss%es are ein( dealt 1it$ at a nati&nal
level + Ge&C&nnecti&ns in 'artners$i' 1it$ t$e Canadian P%lic Healt$ Ass&ciati&nE t$e O))ice &) P%lic
Healt$ PracticeE Privac+ C&mmissi&nerE and &t$ers! T$ere is alread+ a )ederalH'r&vincial a(reement t& s$are
in)&rmati&n at t$e time &) emer(encies! CanadaQs Nati&nal Sec%rit+ P&lic+ 'r&vides additi&nal (%idance )&r
t$e devel&'ment &) nati&nal $ealt$ in)&rmati&n s+stems!
T$e medical c&mm%nit+ is &nl+ n&1 ec&min( a1are &) t$e tec$n&l&(+Qs '&tential 7 man+ tec$nical and
n&n7tec$nical arriers remain )&r ad&'ti&n! F&r e4am'leE t$ere is c%rrentl+ ins%))icient )%ndin( and
res&%rces >incl%din( s2illed GIS sta))? ein( assi(ned t& devel&' GIS in)&rmati&n services and
in)rastr%ct%re in s%''&rt &) '%lic $ealt$ decisi&n7ma2in(! T$ere remain en&rm&%s (a's in %ildin( a
distri%ted access net1&r2 )&r '%lic $ealt$E $&1ever man+ &) t$ese (a's are e(innin( t& e addressed +
CanadaQs Healt$ In)&1a+!
#/
Healt$ a(encies and '%lic sa)et+ a%t$&rities s$are c&mm&n res'&nsiilities 1it$ res'ect t& c&mm%nit+
interventi&n and illnessHin;%r+ 'reventi&n! Healt$ and sa)et+ a%t$&rities s$&%ld 1&r2 in c&lla&rati&n t&
devel&' t$e GIS t&&ls and in)rastr%ct%re t& s%''&rt c&mm&n (&als >e!(! res'&ndin( t& $ealt$ emer(encies?!
Terms &) re)erence s$&%ld e devel&'ed + a''r&'riate a%t$&rities )&r dealin( 1it$ $ealt$ emer(enciesE
incl%din( inte(rati&n &) 1e7ma''in( t&&lsE s$arin( &) s'atial dataE and ali(nment &) strate(ic 'ri&rities in
'%lic $ealt$ and sa)et+!
T$e P%lic Healt$ A(enc+ &) Canada identi)ied " 2e+ reF%irements )&r t$e ad&'ti&n &) GIS + '%lic $ealt$
'r&)essi&nalsD
N&7c&st access t& data
Int%itive and eas+7t&7%se t&&ls
S%''&rt and Trainin(
-&re researc$ and a''lied met$&d&l&(ies
Cr&ss7sect&ral a''r&ac$
CGDI '%lic $ealt$ in)rastr%ct%re m%st e %ilt in c&nsiderati&n &) t$ese " reF%irementsE in &rder t& 'r&vide
e))ective s%''&rt t& '%lic $ealt$ decisi&n7ma2ers! F%rt$erm&reE ased &n 'artici'ant7)eedac2E a''licati&ns
nested 1it$in t$e CGDI s$&%ld c&nsider t$e )&ll&1in( %ser reF%irementsD
Have a %ser )riendl+E int%itive inter)ace
Pr&vide access t& metadata catal&(%e services
Pr&vide m%lti'le levels &) access >'ermissi&ns?
O))er t&&ls H )%ncti&nalit+ ased &n %ser 'r&)iles H 'ermissi&ns
Enale m%ltimedia e4tensi&ns
All&1 %sers t& lin2 H vis%ali<e t$eir &1n data
All&1 %sers t& c&nd%ct s'atial F%er+in(
Pr&vide s%''&rt t& m%lti'le end7%ser devicesD m&ile '$&nesE PDAsE etc
Res'ectHEm'l&+ cart&(ra'$ic re'resentati&n and vis%ali<ati&n standards
Have a sin(le entr+ '&int )&r m%lti'le a''licati&ns
Finall+E 'r&'&nents &) 1e7ma''in( s$&%ld c&mm%nicate t$e ene)its &) t$is tec$n&l&(+ t& decisi&n7ma2ers
acr&ss de'artments >l&calE 'r&vincialE and )ederal? in &rder t& (arner t$e necessar+ s%''&rt )&r investin( in
t$is t+'e &) in)rastr%ct%re! In &rder t& im'lement 1e7ma''in( in)rastr%ct%re )&r '%lic $ealt$E
'r&vincialHterrit&rial de'artments &) $ealt$ m%st $ave a c$am'i&nE t&'7level c&mmitmentE and a %siness
case t$at rec&(ni<es t$e c%m%lative $ealt$ and ec&n&mic ene)its >&r intan(iles?! T& )&ster (reater ad&'ti&n
&) GIS tec$n&l&(+ in '%lic $ealt$E Ge&C&nnecti&ns m%st 1&r2 1it$ '%lic $ealt$ a%t$&rities t& ens%re
sec%rit+ &) t$eir dataases and &'erati&ns 1ill n&t e c&m'r&mised + t$e im'lementati&n &) 1e ma''in(
tec$n&l&(ies and t$e s$arin( &) data!
.-A9N9N+ AN% /%8,A.90N
T$ere are *E"66 '%lic $ealt$ 'r&)essi&nals in Ne1 Br%ns1ic2 t$at reF%ire trainin( &n e7$ealt$ t&&ls and
tec$n&l&(ies! Acr&ss CanadaE t$e n%mer &) $ealt$ 'r&)essi&nals reF%irin( trainin( in e7$ealt$ 'resents a
da%ntin( c$allen(e! In &rder )&r 1e7ma''in( tec$n&l&(ies t& e e))ectiveE '%lic $ealt$ 'r&)essi&nals m%st
e trained t& %se t$e tec$n&l&(+ in dail+ 'ractice! Healt$ a%t$&rities s$&%ld 'r&vide &''&rt%nities t& d&ct&rsE
n%rsesE and '%lic $ealt$ &))icials )&r in7service learnin( &n GISH-a''in( )&r disease 'reventi&n and $ealt$
'r&m&ti&n! Universities can e en(a(ed t& intr&d%ce GIS H -a''in( 1it$in t$e N%rsin( Fac%lt+E S&cial
SciencesE and &t$er disci'lines as a''r&'riate I ta2in( it e+&nd t$e traditi&nal realm &) s&)t1are
#0
en(ineerin(! Private Sect&r can &))er &''&rt%nities and s'&ns&rs$i's )&r 'r&)essi&nal devel&'ment %sin(
GIS H -a''in(E in 'artic%lar )&r a''licati&ns in '%lic $ealt$!
Ge&C&nnecti&nsE in c&lla&rati&n 1it$ 'artnersE s$&%ld &r(ani<e train7t$e7trainer 1&r2s$&'s )&r '%lic
$ealt$ &))icials and $ealt$ care 'lannersE incl%din( trainin( 1it$ res&%rces devel&'ed + t$e P%lic Healt$
A(enc+ &) Canada! Trainin( can e c&nd%cted virt%all+E as 1ell as t$r&%($ 1&r2s$&'sE and in 'artners$i'
1it$ &t$er $ealt$ and sa)et+ (r&%'s! S2ills en$ancement in GIS7ma''in( )&r '%lic $ealt$ 'r&)essi&nals
s$&%ld e a 'rimar+ &%tc&me &) t$is trainin(!
Ed%cati&n &) decisi&n7ma2ers and seni&r $ealt$ &r (&vernment &))icials &n t$e a''licati&n and ene)its &)
GIS tec$n&l&(iesE is reF%ired )&r 1ider ad&'ti&n! S&me 2e+ ene)its t$at 1ere identi)iedD
GIS in)&rmati&n ene)its t$e '%lic + increasin( a1areness &) t$e s'read &) c&mm%nicale diseaseE
)&r e4am'le avian in)l%en<a &r treatment resistant t%erc%l&sis!
Disease s%rveillanceE %sin( GISE can $el' $ealt$ &))icials t& 'lan imm%ni<ati&n strate(ies
-a''in( can s$&1 disease 'revalence acr&ss (e&(ra'$ic areasE enalin( l&+ists t& see2 )%nds H
res&%rces )&r im'r&ved $ealt$ care and t& mana(e s%r(e in demand
Im'lementin( GIS in $ealt$ instit%ti&ns is c&st7e))ectiveE )r&m a disease 'reventi&n and $ealt$
'r&m&ti&n '&int &) vie1
Healt$ a(encies s$&%ld e4'l&re t$e %se &) e7tec$niF%es )&r m&nit&rin( and c&ntr&llin( t$e s'read &)
in)ecti&%s diseases >s%c$ as Avian Fl%?E as 1ell as c&nd%ctin( e'idemi&l&(ical s'atial anal+sis! T& enale
$ealt$ 'r&)essi&nals t& %tili<e GIS tec$n&l&(+ )&r e'idemi&l&(ical anal+sisE GIS s$&%ld ec&me a credit
c&%rse in $ealt$ ed%cati&n! Relevant c%rric%la 1&%ld $ave t& e devel&'ed t$r&%($ a nati&nal &versi($t
c&mmittee! Healt$ care 'r&)essi&nals need t& devel&' a v&ca%lar+ t& e4'ress t$eir needs t& GIS
'r&)essi&nals I and vice versa! Seminars and in7service ed%cati&n )&r 1&r2in( 'r&)essi&nals 1&%ld $el'
increase a1areness t$e '&tential )&r GIS t& $el' identi)+ disease cl%sters and disease 'revalence! Trainin(
s$&%ld em'$asi<e t$e im'&rtance &) data ca't%re )&r GIS ma''in(!
P&tential '%lic $ealt$ %sers &) GIS tec$n&l&(+ 1ere identi)iedE incl%din(D D&ct&rsE N%rsesE -edical
O))icersE Researc$ (r&%'sE H&s'ital -ana(ersE Pr&vincial E'idemi&l&(istsE Healt$ Emer(enc+
C&&rdinat&rsE Am%lat&r+ ServicesE and m&re!
-/1/A-,7
-a''in( can $el' t& s&lve &t$ '&lic+ and researc$ needs I it can als& $el' $ealt$ care t& (& t$r&%($ a
paradi(m shi&t* t& )&c%s m&re &n $ealt$ 'r&m&ti&n and illness 'reventi&n! T$is can e ac$ieved t$r&%($
etter mana(ementE earl+ identi)icati&nE and '%lic alertin( as t& envir&nmental ris2s >determinants &)
$ealt$? and '&'%lati&n v%lnerailities! E'idemi&l&(ists s$&%ld 'la+ a (reater r&le in decidin( reF%irements
)&r vis%ali<ati&n &) '%lic $ealt$ data! T$e science and met$&d&l&(ies 1it$in e'idemi&l&(+ and s'atial
anal+sis are s+ner(istic!
CanadaQs Nati&nal Sec%rit+ P&lic+ identi)ied a 2e+ c$allen(e t& '%lic $ealt$ is Ot$e %neven ca'acit+ and
c&&rdinati&n 1it$in and et1een ;%risdicti&nsE 'artic%larl+ in relati&n t& researc$ and devel&'mentE
s%rveillanceE and emer(enc+ res'&nse!P T$e G&vernment &) CanadaE al&n( 1it$ Pr&vinces and Territ&riesE
can %se GIS tec$n&l&(+ 1it$ a vie1 &) mana(in( t$reats I 'andemic diseaseE i&7terr&rismE envir&nmental
$ealt$E and m&re! Alt$&%($ data relevant t& $ealt$ researc$ $as man+ di))erent s&%rcesE $&s'ital dataases
are n&t al1a+s inter7&'erale! E))&rts need t& e made t& render '%lic $ealt$ data m&re availale et1een
$ealt$ a%t$&rities I t$is 1ill reF%ire researc$ int& data standardsE dataase s&l%ti&nsE %siness in)&rmati&n
s+stems H 'r&cessesE data c&llecti&n 'r&ced%resE data licensin( etc! Standards t$at need t& e c&nsidered
#3
incl%de $ealt$ data standards >e!(! Healt$ Level 0 H HL0?E OGC inter&'erailit+ standardsE ISO s&)t1are
standardsE -etadata standardsE IT standards >)&r net1&r2 sec%rit+?E and m&re!
A n%mer &) arriers remain t& enale GIS7ased researc$ in t$e '%lic $ealt$ c&mm%nit+! T$ese can e
s%mmari<ed as )&ll&1sD
i! s%rveillance data ca't%re is c%rrentl+ inc&nsistent and 1idel+ %navailale
ii! c&st &) data is 'r&$iitive t& smaller researc$ (r&%'s
iii! data c&llecti&n 'ractices are n&t c&nsistent
iv! disease 'revalence data is di))ic%lt t& l&cate
v! real time data is n&t readil+ availale I %t is reF%ired )&r disease s%rveillance
vi! 'redictive in)&rmati&n )&r '&lic+ reF%ires m&delin( met$&d&l&(ies t& e devel&'ed
Academic instit%ti&ns and n&n7(&vernmental &r(ani<ati&ns in 'artners$i' 1it$ vari&%s '%lic $ealt$
a(enciesE s$&%ld devel&' a researc$ a(enda t& stim%late t$e %se &) GIS H 1e ma''in( tec$n&l&(+ )&r '%lic
$ealt$! T$is c&%ld incl%de l&calE 'r&vincialE and cr&ss7&rder initiatives t$at address envir&nmental7$ealt$
c&ncerns %sin( GIS H -a''in( tec$n&l&(+! F&r e4am'leE a ;&int researc$ a(enda c&%ld e devel&'ed
et1een t$e Ne1 En(land States and Eastern Canadian Pr&vinces t&D
st%d+ t$e res'irat&r+ c&nseF%ences &) air F%alit+ and climate c$an(e
stim%late t$e %se &) GIS H 1e ma''in( tec$n&l&(+ in determinin( ris2s and $ealt$ c&nseF%ences &)
c&mm&n envir&nmental and sa)et+ c&ncerns
determine s'atial trends in disease e'idemi&l&(+ and '&'%lati&n $ealt$
Increase t$e s$arin( &) (e&s'atial data sets et1een $ealt$ a%t$&rities in t$e N&rt$7East t& )%rt$er
enale decisi&n7ma2in( &n envir&nmental $ealt$ iss%es
User7(enerated )eedac2 als& 'r&vided %s t$is list &) '%lic $ealt$ 'ri&rities )&r GIS ma''in(D
-&nit&r e'idemic &%trea2s >in)l%en<a?E c&mm%nicale disease cl%stersE and disease vect&rs >e!(!
mi(rat&r+ ird r&%tesE <&&n&tic vect&rs?
S+ndr&micHs%rveillanceH&%trea2Hadverse event detecti&n
A&ri(inal $ealt$ stat%s >T%erc%l&sisE Diaetes etc?
-&nit&r c$r&nic diseases >incl%din( &esit+?
-&nit&r 1ater >incl%din( 1ell71ater? and )&&d F%alit+
Cr&ss7disci'linar+ researc$ >s%c$ as lin2in( air F%alit+E climate c$an(e and $%man $ealt$?
P&'%lati&n dem&(ra'$ics >)&r assessin( '&'%lati&n v%lnerailities?
@&int $ealt$ and sa)et+ emer(enc+ mana(ement
Hi($1a+ sa)et+ H 9eat$er7related incidents
P%lic Healt$ In)rastr%ct%re H )acilities
Am%lance ve$icle r&%tin(
All res'irat&r+ diseases
Gl&al 9armin( I $ealt$ im'acts m&delin( >'astE c%rrentE )%t%re scenari&s?
Fl&&d <&nes and Sea7Level Rise H C&astal Er&si&n
Emer(enc+ eF%i'ment l&cati&ns
En$ance %'&n $ealt$ data standards
B%ild &n7line $ealt$ re'&sit&ries >)&r '%lic ed%cati&n?
#5
%91,81190N > -/,0&&/N%A.90N1:
In additi&n t& t$e rec&mmendati&ns a&ve >s%mmari<ed )r&m 'artici'ant )eedac2 at &%r N&vemer 22
nd
1&r2s$&'?E $ere are a )e1 '&inters! F&r t$e CGDI t& s%ccess)%ll+ e4'and int& t$e '%lic $ealt$ disci'lineE a
n%mer &) (a's need t& e addressed! T$ese (a's can e s%mmari<ed asD
lac2 &) in)rastr%ct%re
c&ncerns &ver data 'rivac+
lac2 &) 2n&1led(e H trainin(
inc&nsistent a''r&ac$ t& devel&'ment &) a''licati&ns
lac2 &) Canadian met$&d&l&(ies H researc$
inadeF%ate 'r&m&ti&n &) ene)its t& decisi&n7ma2ers
%neven ca'acit+ am&n( $ealt$ a%t$&rities
lac2 &) en(a(ement &) e'idemi&l&(ists
'&&r access t& data
arriers t& inte(rati&n &) $ealt$ data 1it$in CGDI >e!(! $ealt$ data standards H inc&nsistencies?
inadeF%ate researc$ a(enda
Ge&C&nnecti&ns needs t& devel&' a strate(+ t& address t$ese (a'sE )&r e4'andin( t$e CGDI in '%lic $ealt$!
Rec&mmendati&ns in t$is re'&rt 'r&vide a startin(7'&int )&r Ge&C&nnecti&ns in devel&'in( s%c$ a strate(+!
-&re c&&rdinati&n is needed et1een Ge&C&nnecti&ns and CanadaQs Healt$ In)&1a+ &ver t$e ne4t " +earsE
as 'art &) %ildin( CanadaQs in)rastr%ct%re and e7$ealt$ servicesE t& address (a's identi)ied a&ve and t&
enale '%lic $ealt$ a%t$&rities t& levera(e GIS a''licati&ns!
26
SECTI ON T9O
CHAPTER *D User Needs Assessment
CHAPTER ,D Case Scenari&s
2#
81/- N//%1 A11/11&/N.
81/- .@P/1
Users can e classi)ied r&adl+ int& t$ree levels &) access! Users are de)ined + t$eir decisi&n7ma2in(
reF%irementsE t$eir reF%ired s'eci)icit+ &) data >i!e! 'atient identi)iersE $ealt$ &%tc&mesE etc?E data 'rivac+
limitati&nsE and %ser stat%s! T$ese %ser t+'es are re)erred t& in s%seF%ent c$a'ters!
*irst Le4elD D&ct&rsE N%rsesE -edical O))icersE H&s'ital -ana(ersE Pr&vincial E'idemi&l&(istsE
Healt$ Emer(enc+ C&&rdinat&rsE Am%lat&r+ ServicesE and m&re!
1econd Le4elD Researc$ Gr&%'sE Healt$ A%t$&rities in &t$er ;%risdicti&ns
.hird Le4elD General P%lic
T$e 1&r2s$&' $eld &n N&vemer 22
nd
E 266"E 'r&vided t$e Ne1 Br%ns1ic2 L%n( Ass&ciati&n 1it$ a variet+
&) 'artici'ant7in'%tsE c&llected )r&m rea27a1a+ 1&r2in( (r&%'s and individ%al eval%ati&n )&rms! In &rder
t& de)ine s'eci)ic %ser reF%irements in a 'r&;ectE health authorities are encouraged t& %se a n%mer &)
met$&dsE 1$ic$ s$&%ld e 'r&m&ted + Ge&C&nnecti&ns 1it$in ne1 calls )&r 'r&'&sals!
T$e )&ll&1in( met$&ds can e %sed t& determine %ser needsD
Surveys: t& &tain a statistical sam'le &) %ser needs )r&m acr&ss '%lic $ealt$ de'artments!
Focus Groups: t& &tain s'eci)ic )eedac2 and rec&mmendati&ns )r&m '%lic $ealt$ 'r&)essi&nals &n
'r&'&sed s+stemsE a''licati&nsE met$&d&l&(ies etc!
eb!"am: t& rec&rd %ser interacti&n 1it$ a''licati&ns >in eta7testin( '$ase?
"lient Forums: Ge&matics Ind%str+ s$&%ld en(a(e '%lic $ealt$ 'r&)essi&nals t& determine s'eci)ic
%ser needsE in terms &) )%ncti&nalit+E a''licati&n inter)ace H deliver+ c$annelsE 9-SH9FS standardsE
and additi&nal 1eHdata services!
#dentify $merging %athogens: 1$ic$ diseases s$&%ld a GIS s+stem e ca'ale &) m&delin(E t&
im'r&ve decisi&n ma2in( >es'eciall+ 1$ere t$ere is c&ncern &ver $%man e4'&s%re t& envir&nmental
determinants H ris2 )act&rs? I t$is c&%ld $ave l&calE re(i&nalE &r nati&nal )&c%s!
#dentify %riority &usiness 'eeds: 1$ic$ needsH(a's in $ealt$ care c&%ld e addressed 1it$ GIS
ma''in( >e!(! l&cati&n selecti&n )&r clinics?
()* (se "ase )odeling: Once s'eci)ic a''licati&ns are identi)iedE U-L Use Case -&delin( can
e %sed t& de)ine t$e tas2sH'r&ced%res &) a $ealt$ 'r&)essi&nalE t$eir interacti&ns 1it$ t$e GIS s+stem
H dataaseE and t$e desired &%tc&mes >incl%din( an+ de'endencies in t$e 1&r2)l&1?!
81/- N//%1
As s%mmari<ed in t$e secti&n a&veE UNeeds and Ga's in P%lic Healt$QE 'r&)essi&nal $ealt$ %sers reF%ire
access t& a de'endale 1e7ma''in( s+stemE inte(rated 1it$in an e7$ealt$ services envir&nmentE 1it$ an
int%itive inter)ace! -an+ 'r&)essi&nal $ealt$ %sers ma+ n&t $ave GIS ac2(r&%nd and 1&%ld reF%ire t$e
22
s%''&rt &) GISHIT 'r&)essi&nals I &r t$e services c&%ld e a%t&mated &r &%ts&%rced! Trainin( and ed%cati&n
are seen as essential c&m'&nents t& t$e s%ccess)%l intr&d%cti&n &) GIS in an+ '%lic $ealt$ ;%risdicti&n! Data
m%st e acc%rateE relevantE and timel+ I an+ 1e7ma''in( s+stem s$&%ld e acc&m'anied + a dataase
%sin( a''r&'riate $ealt$ data standardsE 1it$ s'atial and tem'&ral stam's &n $ealt$ dataE )%rt$er descried in
t$e )&ll&1in( Secti&ns!
All '%lic $ealt$ reF%irements c&%ld e streamlined in a 1&r2)l&1 mana(ement 'lan I 1$ere t$e deliver+ &)
s'eci)ic end7%ser 'r&d%cts H ma's H data 1&%ld meet reF%irements in terms &) level &) detailE timelinessE
)&rmatE and a''licailit+! T& desi(n 1&r2)l&1s )&r t$e %se &) GIS in '%lic $ealt$E a U-L s+stem ma+ e
%sed >Uni)ied -&delin( Lan(%a(e?! U-L Use Case H Be$avi&r Dia(rams and Interacti&n Dia(rams 1&%ld
e m&st %se)%l! T$ese dia(rams can $el' '%lic $ealt$ a%t$&rities t& m&del t$e 1&r2)l&1 &) individ%al
$ealt$ 'r&)essi&nals and de'artmentsE t$eir in)&rmati&n needsE access '&intsH)reF%enc+E interacti&n 1it$ data
and eac$ &t$erE and decisi&n7ma2in( reF%irements and de'endencies! U-L can als& e %sed t& desi(n
a''licati&n )eat%res H )%ncti&nalit+E in res'ect t& %ser reF%irements
T$e (eneral '%lic interested in '%lic $ealt$ in)&rmati&n 1&%ld reF%ire access t& a((re(ate dataE
distri%ted &n &'en 1e )&rmats H $tmlE and s$&%ld e (iven t&'ical in)&rmati&n and disclaimers a&%t t$e
%se &) dataHma's! In t$e Secti&n entitledD OCGDI7nested OGC7c&m'liant P%lic Healt$ Arc$itect%rePE 1e
$ave 'r&vided a detailed descri'ti&n &) t$e t+'e &) in)rastr%ct%re reF%ired t& meet t$e needs &) %sers in all
t$ree levels!
81/ ,A1/ 1,/NA-901
Since relativel+ little GIS7ased researc$ in '%lic $ealt$ $as een d&ne in CanadaE little is 2n&1n a&%t
s'eci)ic %se cases &r c&nventi&nal met$&d&l&(ies! H&1everE %se7cases can e devel&'ed 2n&1in( t$e
c$r&nic and c&mm%nicale diseases are a 'ri&rit+ )&r Canadian $ealt$ 'r&)essi&nalsE and 1$at
met$&d&l&(ies $ave een em'l&+ed in s'eci)ic cases )r&m ar&%nd t$e 1&rld! T$ere)&re a n%mer &) %se
cases $ave een )&rm%lated t& eval%ate t$e a''licati&n '&tential &) GIS t& '%lic $ealt$E its e))ectiveness )&r
en$ancin( $ealt$care decisi&n7ma2in( via (e&s'atial anal+sisE and t$e res%ltin( medicalE s&cialE ec&n&micE
and envir&nmental ene)its! S%mmari<ed $ereE t$ese cases ill%strate t$e advanta(es &) GIS tec$n&l&(+ )&r a
C&mm%nit+7&)7Practice in res'&nse t& t$e (r&1in( demand )&r (e&s'atial in)&rmati&n deemed essential t&
t$e $ealt$care decisi&n7ma2in( 'r&cess in Canada!
"hronic +espiratory SymptomsD Determine t$e ass&ciati&n et1een c$r&nic res'irat&r+ s+m't&ms and l&n(7
term amient c&ncentrati&ns &) )ine 'artic%lates >P-2!"?E t&tal s%s'ended 'artic%latesE &<&neE and s%l)%r
di&4ide am&n( l&n(7term n&n7sm&2in( residents residin( in t$e vicinit+ &) air'&rtsE c&al7)ired electrical
(eneratin( stati&nsE smeltersE '%l' mills and &t$er air '&ll%ti&n emittin( ind%strial c&m'le4es! Res%lts ma+
e disc%ssed 1it$in t$e c&nte4t &) 'r&vincial and )ederal standards in e4cess &) s%((ested levels! In additi&nE
s$&%ld 'r&vinces 1is$ t& devel&' a c$r&nic disease strate(+E t$is data 1&%ld e &) tremend&%s val%e in
determinin( t$e im'acts &) s%c$ a strate(+E incl%din( 1$ic$ '&'%lati&ns are m&st a))ected!
,ir %ollution )orbidity!)ortality TrendsD Assess t$e relati&ns$i' et1een air '&ll%ti&nE mete&r&l&(ical
variales and dail+ m&rtalit+ trends ased &n $&s'ital and emer(enc+ r&&m admissi&ns )&r res'irat&r+
c&nditi&ns! GIS m&dels 1&%ld identi)+ 'atient e4'&s%re levels )r&m amient air&rne emissi&nR c&nstr%ct an
atm&s'$eric dis'ersi&n m&delR lin2 'atient:s residential address via a GIS dataaseR )it a c&nditi&nal l&(istic
re(ressi&n m&delR incl%de a(eE inc&me (r&%'E e4'&s%re levels as cate(&rical variales! T$e st%d+ c&%ld
identi)+ t$e 'r&ailit+ &) c&m'licati&ns )r&m res'irat&r+ distressE and t$e r&le &) air '&ll%tants c&m'&siti&n
and c&ncentrati&nE mete&r&l&(ical variales >tem'erat%re and relative $%midit+?E and relative distance )r&m
emissi&n s&%rces and $&s'ital access!
2*
-rin.ing ater /ualityD Eval%ate t$e im'act a(ric%lt%ralE c&mmercial and residential devel&'ment activities
&n t$e F%alit+ &) 1ater disc$ar(ed int& streamsE la2es and 1etlands andE %ltimatel+E rec+cled )&r '&tale %se
t$r&%($ aF%i)er 1ells! Res%lts ma+ (%ide researc$ers and '&lic+ma2ers in t$e devel&'ment &) tar(eted
sensin( and m&nit&rin( tec$n&l&(iesR tail&r c&ntr&l meas%res )&r ris2 miti(ati&n &) '&tale 1ater )r&m
micr&ial and c$emical envir&nmental c&ntaminati&n! Devel&'ment &) accessile dataases t& identi)+
)act&rs t$at increase t$e 'r&ailit+ &) (r&%nd1ater '&ll%ti&n 1&%ld lead t& m&re e))ective 'r&(rams )&r
l&catin( residential 1ells s%sce'tile t& c&ntaminati&n! Active m&nit&rin( &) residential 1ells is essential t&
red%ce '&tential $%man e4'&s%re t& c&ntaminated drin2in( 1ater!
+oad Transport %lanningD Eval%ate envir&nmental c&nseF%ences &) r&ad tra))ic in %ran areas d%rin( t$e
trans'&rt 'lannin( sta(e &) r&ad net1&r2 c&nstr%cti&n! Uran 'lanners 1&%ld e ale t& inte(rate GIS7
m&dels 1it$in traditi&nal travel demand m&dels )&r r&ad net1&r2 'lannin(! Inte(rati&n 1&%ld all&1 land
%seE trans'&rt and envir&nmental 'lanners t& m&del t$e envir&nmental e))ects &) vari&%s r&ad net1&r2
scenari&sR aid in t$e selecti&n &) envir&nmentall+ 're)erred r&ad net1&r2sR $i($li($t '&ll%ti&n level
mana(ement reF%irements )&r )%t%re r&ad net1&r2sR enc&m'ass air '&ll%ti&n and )%el c&ns%m'ti&n m&d%les
1it$in t$e s+stemR and ill%strate t$e s+stem:s %tilit+ t$r&%($ case st%dies at trans7&%ndar+E metr&'&litan and
l&cal7area scales! F%rt$erm&reE researc$ (r&%'s and )leet mana(ers interested in &t$ red%cin( air '&ll%ti&n
and im'r&vin( )%el e))icienc+ &) )leetsE can c&mine GIS 1it$ GPS H A%t&matic .e$icle L&cat&r
tec$n&l&(+E as 'r&vided + c&m'anies li2e Netisti4 >111!netisti4!c&m?!
0ospital ,ccessibility %atternsD Identi)+ '&'%lati&n se(ments v%lnerale t& di))erential (e&(ra'$ic access t&
critical medical treatment )&r a variet+ &) medical c&nditi&nsE incl%din( str&2eE m+&cardial in)arcti&n and
res'irat&r+ distress! A GIS m&del c&%ld identi)+ t$e 'r&ailit+ &) c&m'licati&ns )r&m medical c&nditi&nE
t$e r&le &) trans'&rtati&n m&de and relative distance t& $&s'ital accessR identi)+ t$e '&'%lati&n se(ments
1it$ limited (e&(ra'$ic access t& a $&s'ital ca'ale &) 'er)&rmin( medical 'r&ced%resR identi)+ dela+s in
&tainin( medical treatmentD 1aitin( timesE trans'&rt timesE medical sta))in(R identi)+ '&'%lati&n se(ments
e4cl%ded )r&m 'ri&rit+ access + a(eE inc&meE distanceE medical c&nditi&nE trans'&rt m&deE etc! O%tc&mes
c&%ld e disc%ssed 1it$in t$e c&nte4t &) c&mm%nit+ $ealt$ care H clinicsE vers%s traditi&nal centrali<ed
$&s'ital careE in red%cin( &r e4aceratin( '&'%lati&n dis'arit+ 'atterns!
-isease "lustersD Identi)+ t$e (e&(ra'$ical distri%ti&n and variati&n in diseaseR c&rrelate s'atial and
tem'&ral trends in disease vect&rsR ma' '&'%lati&ns at ris2R assess res&%rce all&cati&nsR m&nit&r interventi&n
strate(ies! GIS a''licati&nsE 1$en c&mined 1it$ s'atial anal+tical cl%ster met$&dsE ma+ e em'l&+ed t&
devel&' e'idemi&l&(+ m&dels &) diseaseE im'r&ve disease 'reventi&n and c&ntr&l! Envir&nmentall+
im'acted disease transmissi&n m&desE and ca%sative a(entsE m&st &)ten e4$iit n&nrand&m 'atterns!
Ge&(ra'$ic e'idemi&l&(+ is )ast ec&min( an e))ective t&&l in t$e descri'ti&n and anal+sis &) disease
cl%sterin( c&rrelated 1it$ dem&(ra'$icE envir&nmentalE e$avi&ralE s&ci&ec&n&micE (eneticE and in)ecti&%s
ris2 )act&rs! Disease ma''in(E $&1everE reF%ires $i($7res&l%ti&nE (e&(ra'$icall+ re)erenced $ealt$ and
envir&nmental data! See Statistical )odules section1
0ealthcare %lanningD Assess t$e a''licailit+ and '&tential &) GIS tec$n&l&(+ t& mana(e $ealt$care
'lannin(! 9$en c&%'led 1it$ a''r&'riate s'atial anal+tical met$&dsE GIS a''licati&ns can ill%strate t$e
s'atial7tem'&ral &r(ani<ati&n &) $ealt$careE e4amine its relati&ns$i' t& $ealt$ access and &%tc&mesE and
identi)+ &''&rt%nities )&r im'r&vin( $ealt$care deliver+ services! T$e ad&'ti&n &) GIS a''licati&ns +
$ealt$care researc$ers and '&lic+7ma2ers reF%ires access t& an inte(rated s'atial data &n $ealt$ service
%tili<ati&n 'atternsE &%tc&mes and &t$er data )r&m diverse $%man services de'artments! F%rt$erm&reE
researc$ ma+ l&&2 at t$e im'acts &) 'r&'&sed $&s'ital cl&s%resE red%cti&n H increase &) edsE and l&cati&n
selecti&n )&r ne1 clinics!
2,
&ovine Spongiform $ncephalopathyD C&nd%ct a tem'&ral7s'atial anal+sis &) '&tential &vine s'&n(i)&rm
ence'$al&'at$+ am&n( cattle $erds 'ri&r t& t$e intr&d%cti&n &) active s%rveillance meas%res! Tem'&ral
m&del c&%ld identi)+ '&'%lati&n ris2 cl%sters 'ri&r t& t$e intr&d%cti&n &) e))ective c&%nter7meas%resE as a
c&nc%rrent time7la( vect&r e4ists )&r all ris27)act&r vis%ali<ati&n 'r&cesses! Strate(+ ma+ als& e a''lied t&
&t$er e'idemi&l&(ical 'r&)iles in veterinar+ medicineE incl%din(D &vine t%erc%l&sisE s1ine )l%E ird )l%E E7
c&liE &r an+ &t$er c&mm%nicale diseases trans)erale t& $%mans!
"ontaminated &lood %roductsD C&nd%ct a tem'&ral7s'atial anal+sis '&tential )&r c&ntaminated l&ts &) l&&d
'r&d%ct res%ltin( )r&m $e'atitis7CE HI. &r &t$er l&&d7'r&d%ct ass&ciated7c&mm%nicale disease! Devel&'
an anti&d+ testin( met$&d t& estimate t$e ris2 &) in)ecti&n at eac$ e4'&s%re time )r&m m%lti'le e4'&s%re
data! -et$&d ma+ als& e em'l&+ed t& estimate transmissi&n rates and ris2s ass&ciated 1it$ di))erent
s&%rces &) in)ecti&n )r&m a ran(e &) in)ecti&%s disease a''licati&ns! P%r'&se &) tem'&ral7s'atial m&del is t&
identi)+ '&'%lati&n ris2 cl%sters 'ri&r t& t$e intr&d%cti&n &) e))ective c&%nter7meas%resE as a c&nc%rrent
time7la( vect&r e4ists )&r all ris27)act&r vis%ali<ati&n 'r&cesses! Strate(+ ma+ als& e a''lied t& an+ n%mer
&) e'idemi&l&(ical 'r&)iles res%ltin( )r&m c&ntaminated l&&d 'r&d%ctsE &r(an d&nati&nsE 'erc%tane&%s
e4'&s%re in $ealt$care 1&r2ersE intraven&%s dr%( %sersE tatt&& 'arl&rsE etc!
"limate "hange #mpacts: Climat&l&(ists ac2n&1led(e t$at e4treme climatic e'is&des 1ill devel&' in
)reF%enc+ and severit+ as (l&al 1armin( trends mani)est
A#20
E
#23B
! One &) t$e derivatives &) (l&al 1armin(
is t$e ass&ciated increase in air '&ll%ti&n t$at $as ma;&r c&nseF%ences )&r $%man $ealt$! Several Canadian
st%dies $ave recentl+ c&rrelated m&rtalit+ ris2 1it$ $eat and air '&ll%ti&n
A#25E #*6E #*#E #*2E #**B
! F&r t$e 'r&vince &)
Ne1 Br%ns1ic2E m&rtalit+ trends estimate an avera(e &) *2 e4cess deat$s 'er ann%m res%ltin( )r&m e4treme
1eat$erE and ##3 e4cess deat$s 'er ann%m res%ltin( )r&m air '&ll%ti&n e4'&s%re
A#*,B
! Dail+ mean elevated
m&rtalit+ ass&ciated 1it$ e4treme $&t 1eat$er and air '&ll%ti&n is estimated t& e 6!65 deat$s 'er da+!
Predictive m&dels dem&nstrate an increased trend )&r t$e immediate )%t%re
A#*"B
E 1it$ a tri'lin( &) $eat7related
e4cess deat$s + t$e +ear 2636! T$is 1&%ld res%lt in 50 $eat7related deat$s and #", air '&ll%ti&n7related
deat$s 'er ann%m! Findin(s indicate t$at air '&ll%ti&n m&rtalit+ e4ceeds $eat m&rtalit+ + )&%r7)&ldR and t$at
m&ridit+ trends 1ill mirr&r m&rtalit+ trends + "!" )&ld! T$is trend 1ill si(ni)icantl+ a))ect emer(enc+ and
$&s'itali<ati&n services! T$e case m&del dem&nstrates t$at t$e Ne1 Br%ns1ic2 $ealt$ s+stem is
inadeF%atel+ 're'ared t& c&'e 1it$ t$e accelerated )reF%enc+ &) e4treme climatic events
A#*/B
! Pr&vincial
$ealt$care '&licies need t& ada't t& intensi)+in( demands eca%se &) climate c$an(eE increased air '&ll%ti&n
and t$e ass&ciated s$&rt7term s%r(es in 'atient admissi&ns
A#*0B
! P&lic+ initiatives need t& e m&re e))icientE
c&m're$ensive and (e&(ra'$icall+ relevant! A 'reliminar+ eval%ati&n &) t$is case m&del c&ncl%des t$at GIS
ma''in( t&&ls are deemed essential t&D anal+<e '%lic $ealt$care 'arametersR 'r&vide critical in)&rmati&n in
a timel+ mannerR devel&' $ealt$care '&lic+ initiativesR m&nit&r climatic events in real timeR c&&rdinate
medical res'&nse meas%resR and ed%cate decisi&n7ma2ers and t$e (eneral '%lic!
2"
%91,81190N > -/,0&&/N%A.90N1:
T$e case scenari&s descried a&ve are disc%ssed in m&re detail in t$e ne4t c$a'ter! T$e+ d& n&t re'resent
an e4$a%stive list &) case scenari&sE %t d& 'r&vide a r&ad ran(e &) '&tential GIS a''licati&ns t$at 1&%ld
(reatl+ ene)it t$e Canadian '%lic $ealt$ care s+stem! D%e t& t$e lac2 &) c&nsistent GIS7ased researc$ in
CanadaE e'idemi&l&(ists 1ill $ave a di))ic%lt time l&catin( in)&rmati&n &n disease7s'eci)ic a''licati&ns &)
GISE and ma+ e deterred + t$is )act! T$ere)&reE it is im'&rtant )&r Ge&C&nnecti&ns t& )&ster ne1 researc$
and a''licati&ns t$at can $el' t& 'r&d%ce case7st%diesE 1$ic$ can e trans)erred t& $ealt$ re(i&ns acr&ss
Canada!
In additi&n t& t$e '&int a&veE Ge&C&nnecti&ns s$&%ld enc&%ra(e t$e devel&'ment &) case7st%dies in &rder
t& 'r&vide Canadian $ealt$ a%t$&rities 1it$ dem&nstrale ene)its &) GIS a''licati&ns and in)rastr%ct%re )&r
'%lic $ealt$!
It is critical t$at '%lic $ealt$ a''licati&ns 1it$in t$e CGDI c&nsider t$e di))erent reF%irements &) %sers!
P%lic $ealt$ a%t$&rities reF%ire access t& s'eci)ic dataE m&delin( met$&d&l&(iesE s'atial anal+sis t&&ls etc!
T$e (eneral '%lic reF%ires access t& a((re(ate level dataE 1it$&%t access t& ac2(r&%nd m&delin(
met$&d&l&(ies &r s'atial anal+sis t&&ls! T$e Ne1 Br%ns1ic2 L%n( Ass&ciati&n rec&mmends t$at
a''licati&ns $ave t$ree access m&d%lesD &ne )&r '%lic accessE &ne )&r '%lic $ealt$ a%t$&ritiesE and &ne )&r
GIS 'ers&nnel >i!e! administrat&rs?!
In &rder t& ta2e )%ll advanta(e &) GIS tec$n&l&(iesE t$e CGDI m%st 1&r2 1it$ $ealt$ a%t$&rities t& render
'%lic $ealt$ data availale >1$ile ens%rin( 'rivac+ sa)e(%ards? &n a near real7time asis! In additi&nE data
m%st c&n)&rm t& ri(&r&%s standardsE incl%din( $ealt$ c&des >e!(! HL0?E timeHs'atial stam's etc! -&re
rec&mmendati&ns &n data standards are c&ntained in Secti&n ,! H&1everE it is clear t$at '%lic $ealt$
a%t$&ritiesE researc$ (r&%'sE and t$e '%lic reF%ire access t& near real7time data &n '&'%lati&n $ealt$E
disease distri%ti&nE $ealt$ careE and m&re!
In &rder t& desi(n e))ective ma''in( a''licati&ns 1it$in t$e CGDIE '%lic $ealt$ a%t$&rities are enc&%ra(ed
t& %se U-L t& identi)+ %se casesE 1&r2)l&1 de'endenciesE and decisi&n7ma2in( reF%irements >dataE GIS
t&&lsE s'atial anal+sis?! S%c$ U-L dia(rams can e %se)%l t& a''licati&n devel&'ersE t$e CGDIE data and
service 'r&vidersE and end7%sers!
As %ser needs are identi)iedE t$e CGDI s$&%ld c&m'ile a list &) %se7casesE met$&d&l&(iesE and U-L
dia(ramsE t$at can assist ne1 a''licati&n devel&'ers in t$eir desi(n I ma2in( t$e devel&'ment 'r&cess )&r
ne1 a''licati&nsE servicesE and data m&re e))icientE and less c&stl+ t& t$e devel&'er!
2/
,A1/ 1,/NA-901
T$ese case scenari&s ill%strate t$e advanta(es &) GIS tec$n&l&(+ )&r res'&ndin( t& t$e (r&1in( demand )&r
(e&s'atial in)&rmati&n deemed essential t& t$e $ealt$care decisi&n7ma2in( 'r&cess acr&ss a m%ltit%de &)
s%7sect&rs!
,7-0N9, -/1P9-A.0-@ 1@&P.0&1
7ypothesisD Determine t$e ass&ciati&n et1een c$r&nic res'irat&r+ s+m't&ms and l&n(7term
amient c&ncentrati&ns &) )ine 'artic%lates >P-2!"?E t&tal s%s'ended 'artic%latesE &<&neE and s%l)%r
di&4ide am&n( l&n(7term n&n7sm&2in( residents residin( in t$e vicinit+ &) air'&rtsE c&al7)ired
electrical (eneratin( stati&nsE smeltersE '%l' mills and &t$er air7'&ll%ti&n emittin( ind%strial
c&m'le4es!
1a5ple &ethodD Standardi<ed res'irat&r+ s+m't&ms F%esti&nnaire!
1a5ple 1i<eD >nS#E"668?
Pollution %ataD C%m%lative amient c&ncentrati&ns &tained )r&m 'r&vincial air7m&nit&rin( and
1eat$er stati&nsR t$e Canadian GHG Re(istr+ and CEPA Envir&nmental Re(istr+! T$e latter ma+ e
%tili<ed t& identi)+ 'l%me s&%rce emissi&nsE emissi&n levelsE and emissi&n events!
+91 &odelD Eval%ate c$r&nic res'irat&r+ s+m't&ms ased &n residential and 1&r2'lace related <i'
c&des! C&nstr%ct t$ree7dimensi&nal is&'let$s &) '&ll%ti&n 'l%mes! Incl%de 'l%me elevati&nE
c&ncentrati&n levelsE c&m'&siti&nE and 'revailin( 1inds d%rin( &servati&n 'eri&d! C&nstr%ct
amient c&ncentrati&n levels >micr&(rams 'er c%ic meter >micr&(ramsHm*?? at #7#6 2ms radi%s &)
'l%me e'icenter! -eas%re in terms &) n%mers &) $&%rs in e4cess &) several t$res$&ld levels
c&rres'&ndin( t& 'r&vincial and nati&nal standards as 1ell as mean c&ncentrati&n l&n(7term amient
im'act levels!
AnalysisD Identi)+ l&n(7term amient levels ass&ciated 1it$ devel&'ment &) de)initeE and increasin(
severit+ &)E res'irat&r+ s+m't&ms related t& (eneral air1a+ &str%ctive diseaseE c$r&nic r&nc$itisE
and ast$ma!
1tatistical &ethodsD -%ltivariate anal+ses reF%ired t& ad;%st )&r 'ast and 'assive sm&2in(E and
&cc%'ati&nal e4'&s%re!
%iscussionD Res%lts disc%ssed 1it$in t$e c&nte4t &) 'r&vincial and )ederal standards )&r P->2!"?E
P->#6?E t&tal s%s'ended 'artic%lates >TSP?E &<&neE s%l)%r di&4ide >SO2?E etc!E in e4cess &) s%((ested
levels!
1elected -e2erencesD
Ae+E D!E!R B!E! Ostr&E F! Petersen and R!@! B%rc$ette #55" C$r&nic res'irat&r+ s+m't&ms ass&ciated 1it$ estimated
l&n(7term amient c&ncentrati&ns &) )ine 'artic%lates less t$an 2!" micr&ns in aer&d+namic diameter >P-2!"? and
&t$er air '&ll%tants! @ournal o& )=posure !nalysis and )n8ironmental )pidemiolo(y ">2?D#*07#"5!
Ae+E D!E!R F! PetersenE P!K! -ills and 9!L! Bees&n #55* L&n(7term amient c&ncentrati&ns &) t&tal s%s'ended
'artic%latesE &<&neE and s%l)%r di&4ide and res'irat&r+ s+m't&ms in a n&nsm&2in( '&'%lati&n! !rchi8es o&
)n8ironmental 5ealth ,3>#?D**7,/!
Ae+E D!E!R P!K! -illsE F!F! Petersen and 9!L! Bees&n #55# L&n(7term amient c&ncentrati&ns &) t&tal s%s'ended
'artic%lates and &4idants as related t& incidence &) c$r&nic disease in Cali)&rnia Sevent$7Da+ Adventists!
)n8ironmental 5ealth Perspecti8es 5,>A%(?D,*7"6!
Gars$ic2E EricR F! LadenE @!E! Hart and A! Car&n 266* Residence near a ma;&r r&ad and res'irat&r+ s+m't&ms in U!S!
.eterans! )pidemiolo(y #,>/?D02370*/!
20
Gilm&%rE -!I! #55" Interacti&n &) air '&ll%tants and '%lm&nar+ aller(ic res'&nses in e4'erimental animals! To=icolo(y
#6">27*?D**"7*,2!
Hr%aE F!R E! Faian&vaE K! K&''&va and @!@! .andener( 266# C$ild$&&d res'irat&r+ s+m't&msE $&s'ital admissi&nsE
and l&n(7term e4'&s%re t& air&rne 'artic%late matter! @ournal o& )=posure !nalysis and )n8ironmental
)pidemiolo(y ##>#?D**7,6!
Nic&laiE T! #555 Air '&ll%ti&n and res'irat&r+ disease in c$ildrenD 1$at is t$e clinicall+ relevant im'actG Pediatric
Pulmonolo(y upplement #3D57#*!
Nic&laiE T! #555 Envir&nmental air '&ll%ti&n and l%n( disease in c$ildren! 0onaldi !rchi8es &or .hest #isease
",>/?D,0"7,03!
Ostr&E B!D! #55* E4aminin( ac%te $ealt$ &%tc&mes d%e t& &<&ne e4'&s%re and t$eir s%seF%ent relati&ns$i' t& c$r&nic
disease &%tc&mes! )n8ironmental 5ealth Perspecti8es #6#>S%''l ,?D2#*72#/!
Sc$1art<E @!R D! SlaterE T!.! Lars&nE 9!E! Piers&n and @!=! K&eni( #55* Partic%late air '&ll%ti&n and $&s'ital emer(enc+
r&&m visits )&r ast$ma in Seattle! !merican Re8ie: o& Respiratory #isease #,0>,?D32/73*#!
Sc$1elaE D! 2666 Air '&ll%ti&n and $ealt$ in %ran areas! Re8ie:s on )n8ironmental 5ealth #">#72?D#*7,2!
van BreeE L!R -! -arraE H!@! van Sc$eindelenE P!H! Fisc$erE S! de L&&sE E! B%rin($ and P!@! R&m&%t #55" D&se7e))ect
m&dels )&r &<&ne e4'&s%reD t&&l )&r F%antitative ris2 estimati&n! To=icolo(y Letters 32H3*>Dec?D*#07*2#!
9ed<ic$aE @!A!R and G!C! D&nalds&n 266* E4acerati&ns &) c$r&nic &str%ctive '%lm&nar+ disease! Respiratory .are
,3>#2?D#26,7#2#"!
A9- P0LL8.90N &0-B9%9.@&0-.AL9.@ .-/N%1
7ypothesisD Assessed t$e relati&ns$i' et1een air '&ll%ti&nE mete&r&l&(ical variales and dail+
m&rtalit+ trends!
%ata 1ourceD H&s'ital and emer(enc+ r&&m admissi&ns )&r res'irat&r+ c&nditi&ns!
+91 &odelD Identi)+ 'atient e4'&s%re levels )r&m amient air&rne emissi&n! C&nstr%ct an
atm&s'$eric dis'ersi&n m&del! Lin2 'atient:s residential address via a GIS dataase! Fit a c&nditi&nal
l&(istic re(ressi&n m&delR incl%de a(eE inc&me (r&%'E e4'&s%re levels as cate(&rical variales!
1tatistical &ethodsD Estimate relati&ns$i' %sin( l&(istic re(ressi&n m&dels! Identi)+ resid%als! I)
c&variates n&t time de'endentE a''l+ a (enerali<ed linear mi4ed m&dels! I) c&variates var+E a''l+ t$e
(enerali<ed estimatin( eF%ati&ns met$&d! Per)&rm time7series anal+sisE 1it$ B&47@en2ins m&delin(!
C&nstr%ct a m%ltivariate m&delE inc&r'&rate admissi&n c&des and envir&nmental variales!
%iscussionD Identi)+ t$e 'r&ailit+ &) c&m'licati&ns )r&m res'irat&r+ distressE and t$e r&le &) air
'&ll%tants c&m'&siti&n and c&ncentrati&nE mete&r&l&(ical variales >tem'erat%re and relative
$%midit+?E and relative distance )r&m emissi&n s&%rces and $&s'ital access!
1elected -e2erencesD
Anders&nE H!R!R C! S'i4E S! -edinaE @!P! Sc$&%tenE @! Castellsa(%eE G! R&ssiE D! Vmir&%E G! T&%l&%miE B! 9&;t+nia2E A!
P&n2aE L! Bac$ar&vaE @! Sc$1art< and K! Kats&%+anni #550 Air '&ll%ti&n and dail+ admissi&ns )&r c$r&nic
&str%ctive '%lm&nar+ disease in / E%r&'ean citiesD res%lts )r&m t$e APHEA 'r&;ect! The )uropean Respiratory
@ournal* 9&&icial @ournal o& the )uropean ociety &or .linical Respiratory Physiolo(y #6>"?D#6/,7#60#
At2ins&nE R!9!R H!R! Anders&nE @! S%n+erE @! A+resE -! BacciniE @!-! .&n2E A! B&%m($arE F! F&rastiereE B! F&rser(E
G! T&%l&%miE @! Sc$1art< and K! Kats&%+anni 266# Ac%te e))ects &) 'artic%late air '&ll%ti&n &n res'irat&r+
admissi&nsD res%lts )r&m APHEA 2 'r&;ect! !merican @ournal o& Respiratory and .ritical .are 0edicine #/,>#6 Pt
#?D#3/67#3//!
BallesterE F!R @!-! Tenias and S! Pere<7H&+&s 266# Air '&ll%ti&n and emer(enc+ $&s'ital admissi&ns )&r cardi&vasc%lar
diseases in .alenciaE S'ain! @ournal o& )pidemiolo(y and .ommunity 5ealth "">#?D"07/"!
Bra+E D&minicR P! -&nner+ and A!G! T&ma 266, Air&rne envir&nmental '&ll%tant c&ncentrati&n and $&s'ital e'ista4is
'resentati&nD a "7+ear revie1! .linical 9tolaryn(olo(y and !llied ciences 25>/?D/""7/"3!
Ca2ma2E S!R R! B%rnett and D! Kre1s2i #553 Ad;%stin( )&r tem'&ral variati&n in t$e anal+sis &) 'arallel time series &)
$ealt$ and envir&nmental variales! @ournal o& )=posure !nalysis and )n8ironmental )pidemiolo(y 3>2?D#257#,,!
Dia<E @%li&R @!C! AlerdiE -!S! Pa;aresE C! L&'e<E R! L&'e<E -!B! La(e and A! Oter& 266# A m&del )&r )&recastin(
emer(enc+ $&s'ital admissi&nsD e))ect &) envir&nmental variales! @ournal o& )n8ironmental 5ealth /,>*?D57#"!
ErasE B!R A!-! Kell+E B! P$+sic2E C! C&de and -! Ed1ards 266" Air '&ll%ti&n and c$ild$&&d ast$ma emer(enc+
$&s'ital admissi&nsD estimatin( intra7cit+ re(i&nal variati&ns! International @ournal o& )n8ironmental 5ealth
Research #">#?D##726!
23
F%sc&E D!R F! F&rastiereE P! -ic$el&<<iE T! S'adeaE B! Ostr&E -! Arca and C!A! Per%cci 266# Air '&ll%ti&n and $&s'ital
admissi&ns )&r res'irat&r+ c&nditi&ns in R&meE Ital+! The )uropean Respiratory @ournal* 9&&icial @ournal o& the
)uropean ociety &or .linical Respiratory Physiolo(y #0>/?D##,*7##"6!
G1+nnE R!C!R R!T! B%rnett and G!D! T$%rst&n 2666 A time7series anal+sis &) acidic 'artic%late matter and dail+
m&rtalit+ and m&ridit+ in t$e B%))al&E Ne1 C&r2E re(i&n! )n8ironmental 5ealth Perspecti8es #63>2?D#2"7#**!
I$ri(E -!-!R S!L! S$alat and C! Ba+nes #553 A $&s'ital7ased case7c&ntr&l st%d+ &) stillirt$s and envir&nmental
e4'&s%re t& arsenic %sin( an atm&s'$eric dis'ersi&n m&del lin2ed t& a (e&(ra'$ical in)&rmati&n s+stem!
)pidemiolo(y 5>*?D256725,!
LeeE @!T!R H! KimE C!S! C$&E C!C! H&n(E E!H! Ha and H! Par2 266* Air '&ll%ti&n and $&s'ital admissi&ns )&r isc$emic
$eart diseases am&n( individ%als /,8 +ears &) a(e residin( in Se&%lE K&rea! !rchi8es o& )n8ironmental 5ealth
"3>#6?D/#07/2*!
LinnE 9!S!R C! S<lac$cicE H! G&n( @r!E P!L! Kinne+ and K!T! Ber$ane 2666 Air '&ll%ti&n and dail+ $&s'ital admissi&ns in
metr&'&litan L&s An(eles! )n8ironmental 5ealth Perspecti8es #63>"?D,207,*,!
-annE @!K!R I!B! Ta(erE F! L%rmannE -! Se(alE C!P! =%esenerr+ @r!E -!-! L%((E @! S$an and S!K! .an den Eeden 2662
Air '&ll%ti&n and $&s'ital admissi&ns )&r isc$emic $eart disease in 'ers&ns 1it$ c&n(estive $eart )ail%re &r
arr$+t$mia! )n8ironmental 5ealth Perspecti8es ##6>#2?D#2,07#2"2!
-ic$el&<<iE P!R F! F&rastiereE C!A! Per%cciE D! F%sc&E A! Barca and T! S'adea 2666 Ac%te e))ects &) air '&ll%ti&n in
R&me Ain ItalianB! !nnali dellAIstituto uperiore di anita */>*?D2507*6,!
-&&l(av2arE S!H! 2666 Air '&ll%ti&n and $&s'ital admissi&ns )&r c$r&nic &str%ctive '%lm&nar+ disease in t$ree
metr&'&litan areas in t$e United States! Inhalation To=icolo(y #2>S%''l ,?D0"756!
R&sales7Castill&E @!A!R .!-! T&rres7-e<aE G! Olai<7Fernande< and .!H! B&r;a7A%rt& 266# Ac%te e))ects &) air
'&ll%ti&n &n $ealt$D evidence )r&m e'idemi&l&(ical st%dies Ain S'anis$B! alud Publica de 0e=ico ,*>/?D",,7"""
Sae<E -!R A! T&iasE P! -%n&< and -!@! Cam'ell #555 A GEE m&vin( avera(e anal+sis &) t$e relati&ns$i' et1een air
'&ll%ti&n and m&rtalit+ )&r ast$ma in Barcel&naE S'ain! tatistics in 0edicine #3>#/?D26007263/!
Tana2aE H!R S! H&nmaE -! Nis$iE T! I(aras$iE S! Teram&t&E F! Nis$i& and S! Ae #553 Acid )&( and $&s'ital visits )&r
ast$maD an e'idemi&l&(ical st%d+! The )uropean Respiratory @ournal* 9&&icial @ournal o& the )uropean ociety
&or .linical Respiratory Physiolo(y ##>/?D#*6#7#*6/!
T$&m's&nE A!@!R -!D! S$ields and C!C! Patters&n 266# Ac%te ast$ma e4acerati&ns and air '&ll%tants in c$ildren livin(
in Bel)astE N&rt$ern Ireland! !rchi8es o& )n8ironmental 5ealth "/>*?D2*,72,#!
T$%rst&nE G!D!R K! It&E P!L! Kinne+ and -! Li''mann #552 A m%lti7+ear st%d+ &) air '&ll%ti&n and res'irat&r+ $&s'ital
admissi&ns in t$ree Ne1 C&r2 State metr&'&litan areasD res%lts )&r #533 and #535 s%mmers! @ournal o& )=posure
!nalysis and )n8ironmental )pidemiolo(y 2>,?D,257,"6!
9&n(E C!-!R R!9! At2ins&nE H!R! Anders&nE A!@! Hedle+E S! -aE P!C! C$a% and T!H! Lam 2662 A tale &) t1& citiesD
e))ects &) air '&ll%ti&n &n $&s'ital admissi&ns in H&n( K&n( and L&nd&n c&m'ared! )n8ironmental 5ealth
Perspecti8es ##6>#?D/0700!
%-9NE9N+ WA./- F8AL9.@
7ypothesisD T& eval%ate t$e im'act a(ric%lt%ralE c&mmercial and residential devel&'ment activities
$ave &n t$e F%alit+ &) 1ater disc$ar(in( int& streamsE la2es and 1etlands andE %ltimatel+E rec+cled
)&r '&tale %se t$r&%($ aF%i)er 1ells!
-e=uire5ents: ,n interactive framewor. for quantitative analysis between human and natural
systems1
%ata 1ources: G#S!based remote sensing imagery analysis, groundwater!surface water hydrologic
flu2es and water quality data to assess the vulnerability of potable water supplies1
&ethod: Spatially referenced data derived from dynamic models can be used to ran. watershed!
specific stressors and receptors3 volatile organic compounds and nitrate!nitrogen analyzed using
gas chromatography4mass spectrometry and the cadmium reduction method, respectively1
;ariables: Soil permeability, depth to water, aquifer hydraulic conductivity, and topography1
,ssign numerical weightings according to variable5s importance in regional groundwater quality1
6ariable weights comprise a G#S map layer1 These map layers may be combined to formulate a
groundwater pollution potential map1
25
+91 &odel: G#S techniques to quantify e2planatory variables that affect well susceptibility to
nitrate: population density, land cover, local relief 7percent slope8, and soil te2ture1
1tatistical &ethods: *ogistic regression may identify forest 4 grassland 4 cultivated land cover
variables that significantly impact probability of '9
:
!' contamination1 )atlab may be employed as
a scientific programming tool for numerical analysis, coupled with a -ynamic -ata $2change
solution in order to develop a water quality model from within the G#S application1
%iscussion: +esults may guide researchers and policyma.ers in the development of targeted sensing
and monitoring technologies3 tailor control measures for ris. mitigation of potable water from
microbial and chemical environmental contamination1 -evelopment of accessible databases to
identify factors that increase the probability of groundwater pollution would lead to more effective
programs for locating residential wells susceptible to contamination1 ,ctive monitoring of
residential wells is essential to reduce potential human e2posure to contaminated drin.ing water1
.echnologies enabled:
i! distributed sensing approaches for microbial and chemical contamination 7eg! 'at$&(ensE end&crine
disr%'t&rs?R
ii! distri%ted a''licati&n7s'eci)icE and in)rastr%ct%re7ada'tive 1ater treatment s+stemsR
iii! (e&statistical inte(rati&n &) m&nit&rin( data and GIS la+ersR
iv! s+stems anal+sis &) micr&ial and c$emical 'r&li)erati&n in distri%ti&n s+stems!
0utco5es:
i! technology implementation needed to ma2imize economic and public health benefits3
ii! information technology!based monitoring infrastructure development3
iii! integration of processes and spatial analysis3
iv! educational and training platforms for students, practitioners and regulators3
v! technology diffusion potential to rural ; remote regions in "anada with limited financial
resources 7including First 'ations8
,onclusion: #ntegration of spatial data, G#S, water modeling ma.es it possible to organize and
analyze data spatially, and view results on interactive maps as well as tables and distribution charts1
The integration allows scientists and managers in different locations to coordinate and share their
estimations for environmental e2posure and ris. assessments1 )odel can subsequently be applied to
other pollutant source sectors1
1elected -e2erences:
AdriaensE P!R P! G&&vaertsE S! S2erl&sE E! Ed1ards and T! E(li 266* Intelli(ent in)rastr%ct%re )&r s%stainale '&tale
1aterD a r&%ndtale )&r emer(in( transnati&nal researc$ and tec$n&l&(+ devel&'ment needs! Bi&tec$n&l&(+ Advances
22>#72?D##57#*,!
Aeli&nE C!-!R and B!C! C&nte 266, S%sce'tiilit+ &) residential 1ells t& .OC and nitrate c&ntaminati&n! Envir&nmental
Science W Tec$n&l&(+ *3>/?D#/,37#/"*!
B$ad%riE B!R @! Har&rE B! En(el and -! Gr&ve 2666 Assessin( 1aters$ed7scaleE l&n(7term $+dr&l&(ic im'acts &) land7
%se c$an(e %sin( a GIS7NPS m&del! Envir&nmental -ana(ement 2/>/?D/,*7/"3!
C$&E @!H!R K! Se&2 S%n( and S! R+&n( Ha 266, A river 1ater F%alit+ mana(ement m&del )&r &'timisin( re(i&nal
1aste1ater treatment %sin( a (enetic al(&rit$m! @&%rnal &) Envir&nmental -ana(ement 0*>*?D22572,2!
Fritc$E T!G!R C!L! -cKni($tE @!C! Celderman @r! and @!G! Arn&ld 2666 An aF%i)er v%lnerailit+ assessment &) t$e Pal%4+
aF%i)erE central Te4asE USAE %sin( GIS and a m&di)ied DRASTIC a''r&ac$! Envir&nmental -ana(ement 2">*?D**07
*,"!
HarmanE 9!A!R C!@! Allan and R!D! F&rs+t$e 266# Assessment &) '&tential (r&%nd1ater c&ntaminati&n s&%rces in a
1ell$ead 'r&tecti&n area! @&%rnal &) Envir&nmental -ana(ement /2>*?D20#7232!
LiE C!R!R G!H! H%an(E C!F! LiE @! Str%(er and @!D! Fisc$er 266* A 'esticide r%n&)) m&del )&r sim%latin( r%n&)) l&sses &)
'esticides )r&m a(ric%lt%ral lands! 9ater Science and Tec$n&l&(+ D @&%rnal &) t$e Internati&nal Ass&ciati&n &n 9ater
P&ll%ti&n Researc$ ,0>#?D**7,6!
-an&sE B!R T! B&%rnarisE N! Sille&sE .! Ant&n&'&%l&s and @! Pa'at$anasi&% 266, A decisi&n s%''&rt s+stem a''r&ac$ )&r
rivers m&nit&rin( and s%stainale mana(ement! Envir&nmental -&nit&rin( and Assessment 5/>#7*?D3"753!
*6
-arsili7LielliE S!R E! Ca'&raliE S! Arri($i and C! Becattelli 266# A (e&re)erenced river F%alit+ m&del! 9ater Science
and Tec$n&l&(+ D @&%rnal &) t$e Internati&nal Ass&ciati&n &n 9ater P&ll%ti&n Researc$ ,*>0?D22*72*6!
-illerE C!R P! C$%de2 and S! Bac&c2 266* A c&m'aris&n &) 1ell$ead 'r&tecti&n area delineati&n met$&ds )&r '%lic
drin2in( 1ater s+stems in 9$atc&m C&%nt+E 9as$in(t&n! @&%rnal &) Envir&nmental Healt$ //>2?D#072/E ,,!
Pa+ra%dea%E S!R -!G! T&%rn&%dE F! Cerness&n and B! Pic&t 266# Ann%al n%trients e4'&rt m&dellin( + anal+sis &)
land%se and t&'&(ra'$ic in)&rmati&nD case &) a small -editerranean catc$ment! 9ater Science and Tec$n&l&(+D
@&%rnal &) t$e Internati&nal Ass&ciati&n &n 9ater P&ll%ti&n Researc$ ,,>27*?D*2#7*20!
Sanc$e<7-art&sE F!R P!A! A(%ileraE A! Garrid&7Frenic$E @!A! T&rres and A! P%lid&7B&sc$ 2662 Assessment &)
(r&%nd1ater F%alit+ + means &) sel)7&r(ani<in( ma'sD a''licati&n in a semiarid area! Envir&nmental -ana(ement
*6>"?D0#/702/!
SlivaE L!R and D!D! 9illiams 266# B%))er <&ne vers%s 1$&le catc$ment a''r&ac$es t& st%d+in( land %se im'act &n river
1ater F%alit+! 9ater Researc$ *">#,?D*,/27*,02!
S&(aeE H!R T! Ta2e<a1aE C! S$imi<% and S! -atm%i 266# A GIS met$&d&l&(+ )&r t$e real7time assessment &) micr&7
'&ll%tant c&ncentrati&n in riverD a''licati&n t& t$e La2e Bi1a asin in @a'an! Envir&nmental Tec$n&l&(+
22>#6?D###57##2,!
.intenE A!@!R and S!-! D%nn 266# Assessin( t$e e))ects &) land %se &n tem'&ral c$an(e in 1ell 1ater F%alit+ in a
desi(nated nitrate v%lnerale <&ne! T$e Science &) t$e T&tal Envir&nment 2/">#7*?D2"*72/3!
9an(E Jin$a&R -! H&merE S!D! D+erE C! 9$ite7H%ll and C! D% 266" A river 1ater F%alit+ m&del inte(rated 1it$ a 1e7
ased (e&(ra'$ic in)&rmati&n s+stem! @&%rnal &) Envir&nmental -ana(ement 0">*?D2#57223!
-0A% .-AN1P0-. PLANN9N+
7ypothesisD GIS7ased m&delin( t& eval%ate envir&nmental c&nseF%ences &) r&ad tra))ic in %ran
areas d%rin( t$e trans'&rt 'lannin( sta(e &) r&ad net1&r2 c&nstr%cti&nE %ran desi(n and 'lannin(!
Bene2itsD Ale t& inte(rate m&del 1it$in traditi&nal travel demand m&dels )&r r&ad net1&r2
'lannin(! Inte(rati&n all&1s land %seE trans'&rt and envir&nmental 'lanners t& m&del t$e
envir&nmental e))ects &) vari&%s r&ad net1&r2 scenari&sR aid in t$e selecti&n &) envir&nmentall+
're)erred r&ad net1&r2sR $i($li($t '&ll%ti&n level mana(ement reF%irements )&r )%t%re r&ad
net1&r2sR enc&m'ass air '&ll%ti&n and )%el c&ns%m'ti&n m&d%les 1it$in t$e s+stemR and ill%strate
t$e s+stem:s %tilit+ t$r&%($ case st%dies at trans7&%ndar+E metr&'&litan and l&cal7area scales!
1elected -e2erencesD
A))%mE @!K!R A!L! Br&1n and C!C! C$an 266* Inte(ratin( air '&ll%ti&n m&dellin( 1it$ scenari& testin( in r&ad trans'&rt
'lannin(D t$e TRAE-S a''r&ac$! The cience o& the Total )n8ironment *#2>#7*?D#7#,!
AndreE -ic$elR and A! .illan&va 266, C$aracterisati&n &) an %ran %s net1&r2 )&r envir&nmental '%r'&ses! The
cience o& the Total )n8ironment **,H**">Dec #?D3"755!
Bra%erE -!R G! H&e2E P! van .lietE K! -elie)steE P! Fisc$erE U! Ge$rin(E @! Heinric$E @! C+r+sE T! BellanderE -! Le1ne
and B! Br%ne2ree) 266* Estimatin( l&n(7term avera(e 'artic%late air '&ll%ti&n c&ncentrati&nsD a''licati&n &) tra))ic
indicat&rs and (e&(ra'$ic in)&rmati&n s+stems! )pidemiolo(y #,>2?D22372*5!
Bri((sE D!@!R C! de H&&($E @! G%lliverE @! 9illsE P! Elli&ttE S! Kin($am and K! Small&ne 2666 A re(ressi&n7ased
met$&d )&r ma''in( tra))ic7related air '&ll%ti&nD a''licati&n and testin( in )&%r c&ntrastin( %ran envir&nments! The
cience o& the Total )n8ironment 2"*>#7*?D#"#7#/0!
Bri((sE D!@!R C! de H&&($E @! G%lliverE @! 9illsE P! Elli&ttE S! Kin($am and K! Small&ne 2666 A re(ressi&n7ased
met$&d )&r ma''in( tra))ic7related air '&ll%ti&nD a''licati&n and testin( in )&%r c&ntrastin( %ran envir&nments! The
cience o& the Total )n8ironment 2"*>#7*?D#"#7#/0!
En(lis$E P!R R! Ne%traE R! Scal)E -! S%llivanE L! 9aller and L! V$% #555 E4aminin( ass&ciati&ns et1een c$ild$&&d
ast$ma and tra))ic )l&1 %sin( a (e&(ra'$ic in)&rmati&n s+stem! )n8ironmental 5ealth Perspecti8es #60>5?D0/#70/0!
Giann&%liE -!R V! SamarasE -! KellerE P! De$aanE -! Kalliv&daE S! S&rens&n and A! Ge&r(a2a2i 266" Devel&'ment &) a
dataase s+stem )&r t$e calc%lati&n &) indicat&rs &) envir&nmental 'ress%re ca%sed + trans'&rt! The cience o& the
Total )n8ironment >@%n 2#R E'% a$ead &) 'rint?!
Girvet<E E!R and F! S$illin( 266* Decisi&n s%''&rt )&r r&ad s+stem anal+sis and m&di)icati&n &n t$e Ta$&e Nati&nal
F&rest! )n8ironmental 0ana(ement *2>2?D2#372**!
G&rdianE -!E!R S! Hane%se and @! 9a2e)ield 266" An investi(ati&n &) t$e ass&ciati&n et1een tra))ic e4'&s%re and t$e
dia(n&sis &) ast$ma in c$ildren! @ournal o& )=posure !nalysis and )n8ironmental )pidemiolo(y >@%n 25R E'%
a$ead &) 'rint?
GreenE R!S!R S! Sm&r&dins2+E @!@! KimE R! -cLa%($lin and B! Ostr& 266, Pr&4imit+ &) Cali)&rnia '%lic sc$&&ls t& %s+
r&ads! )n8ironmental 5ealth Perspecti8es ##2>#?D/#7//!
*#
G%nierE R!B!R A! Hert<E @! v&n Be$ren and P! Re+n&lds 266* Tra))ic densit+ in Cali)&rniaD s&ci&ec&n&mic and et$nic
di))erences am&n( '&tentiall+ e4'&sed c$ildren! @ournal o& )=posure !nalysis and )n8ironmental )pidemiolo(y
#*>*?D2,672,/!
L&vettE A!A!R @!P! Par)itt and @!S! Brainard #550 Usin( GIS in ris2 anal+sisD a case st%d+ &) $a<ard&%s 1aste trans'&rt!
Ris2 !nalysis * !n 9&&icial Publication o& the ociety &or Ris2 !nalysis #0>"?D/2"7/**!
-avr&%lid&%E -!R S!@! H%($es and E!E! Hella1ell 266, A F%alitative t&&l c&minin( an interacti&n matri4 and a GIS t&
ma' v%lnerailit+ t& tra))ic ind%ced air '&ll%ti&n! @ournal o& )n8ironmental 0ana(ement 06>,?D23*7235!
Re%n(&atE P!R -! C$ir&n and I! -&mas 266, Assessment &) e4'&s%re t& tra))ic '&ll%ti&n in e'idemi&l&(ical st%diesD a
revie1 Ain Frenc$B! Re8ue dA)pidemiolo(ie et de ante Publi<ue "2>*?D20#725/!
Re+n&ldsE P!R E! El2inE R! Scal)E @! v&n Be$ren and R!R! Ne%tra 266# A case7c&ntr&l 'il&t st%d+ &) tra))ic e4'&s%res and
earl+ c$ild$&&d le%2emia %sin( a (e&(ra'$ic in)&rmati&n s+stem! 7ioelectroma(netics >S%''l "?D"37/3!
701P9.AL A,,/119B9L9.@ PA../-N1
7ypothesisD Identi)+ '&'%lati&n se(ments v%lnerale t& di))erential (e&(ra'$ic access t& critical
medical treatment )&r a variet+ &) medical c&nditi&nsE incl%din( str&2eE m+&cardial in)arcti&n and
res'irat&r+ distress!
%ata 1ourceD H&s'ital and emer(enc+ r&&m admissi&nsR am%lance dataases anal+<ed )&r trans'&rt
distance and timesR 'atients: l&cati&n at time &) incidents!
+91 &odelD Rec&nstr%ct am%lance r&%tes and 'atients: residence &verlaid &n t$ematic ma's &)
'r&vincial $&s'itals Fit a c&nditi&nal l&(istic re(ressi&n m&delR incl%de a(eE (enderE inc&me (r&%'E
trans'&rtati&n m&deE medical c&nditi&nE and disc$ar(e val%es as cate(&rical variales!
AnalysisD Identi)+ t$e 'r&ailit+ &) c&m'licati&ns )r&m medical c&nditi&nE t$e r&le &) trans'&rtati&n
m&de and relative distance t& $&s'ital access! Identi)+ t$e '&'%lati&n se(ments 1it$ limited
(e&(ra'$ic access t& a $&s'ital ca'ale &) 'er)&rmin( medical 'r&ced%res! Identi)+ dela+s in
&tainin( medical treatmentD 1aitin( timesE trans'&rt timesE medical sta))in(! Identi)+ '&'%lati&n
se(ments e4cl%ded )r&m 'ri&rit+ access + a(eE inc&meE distanceE medical c&nditi&nE trans'&rt m&deE
etc!
%iscussionD 9$at r&le 1&%ld a T1&7Tier s+stem 'la+ in red%cin( &r e4aceratin( '&'%lati&n
dis'arit+ 'atternsG
1elected -e2erencesD
AllacciE -!S! 266" Identi)+in( envir&nmental ris2 )act&rs )&r ast$ma emer(enc+ careD a m%ltilevel a''r&ac$ )&r
ec&l&(ical st%d+! @ournal o& !mbulatory .are 0ana(ement 23>#?D27#"!
Avr%s2inE G!A!R G!-! @acF%e<E @!R! -eli2erE -!@! Sl&tnic2E A!-! Ka%)mann and @!O! Nria(% 266, .is%ali<ati&n and
e4'l&rat&r+ anal+sis &) e'idemi&l&(ic data %sin( a n&vel s'ace time in)&rmati&n s+stem! International @ournal o&
5ealth Geo(raphics *>#?D2/!
Ga&E @!R S! Tan(E R! T&l$%rst and K! Ra& 266# C$an(in( access t& $ealt$ services in %ran C$inaD im'licati&ns )&r
eF%it+! 5ealth Policy Plan #/>*?D*627*#2!
G%a(liard&E -ar2 F! 266, S'atial accessiilit+ &) 'rimar+ careD c&nce'tsE met$&ds and c$allen(es! International
@ournal o& 5ealth Geo(raphics *>#?D*!
L&veE D!R and P! LindF%ist #55" T$e (e&(ra'$ical accessiilit+ &) $&s'itals t& t$e a(edD a (e&(ra'$ic in)&rmati&n
s+stems anal+sis 1it$in Illin&is! 5ealth er8ices Research 25>/?D/257/"#!
Na%ener(E E!R and K! Bas% #555 E))ect &) ins%rance c&vera(e &n t$e relati&ns$i' et1een ast$ma $&s'itali<ati&ns and
e4'&s%re t& air '&ll%ti&n! Public 5ealth Reports ##,>2?D#*"7#,3!
O:NeillE L! 266* Estimatin( &%t7&)7$&s'ital m&rtalit+ d%e t& m+&cardial in)arcti&n! 5ealth .are 0ana(ement cience
/>*?D#,07#",!
R&ser&7Bi4+E L! 266, S'atial access t& $ealt$ care in C&sta Rica and its eF%it+D a GIS7ased st%d+! ocial cience B
0edicine "3>0?D#20#7#23,!
Sc&ttE P$illi' A!R C!@! Tem&vs2+E K! La1renceE E! G%daitis and -!@! L&1ell #553 Anal+sis &) Canadian '&'%lati&n 1it$
'&tential (e&(ra'$ic access t& intraven&%s t$r&m&l+sis )&r ac%te isc$emic str&2e! tro2e 25>##?D2*6,72*#6!
TanserE F!R and D! 9il2ins&n #555 S'atial im'licati&ns &) t$e t%erc%l&sis DOTS strate(+ in r%ral S&%t$ A)ricaD a n&vel
a''licati&n &) (e&(ra'$ical in)&rmati&n s+stem and (l&al '&siti&nin( s+stem tec$n&l&(ies! Tropical 0edicine B
International 5ealth ,>#6?D/*,7/*3!
*2
V1arensteinE -!R D! Kri(e and B! 9&l)) #55# T$e %se &) a (e&(ra'$ical in)&rmati&n s+stem )&r $&s'ital catc$ment area
researc$ in NatalHK1aV%l%! outh !&rican 0edical @ournal 36>#6?D,507"66!
%91/A1/ ,L81./-1
7ypothesisD Identi)+ t$e (e&(ra'$ical distri%ti&n and variati&n in diseaseR c&rrelate s'atial and
tem'&ral trends in disease vect&rsR ma' '&'%lati&ns at ris2R assess res&%rce all&cati&nsR m&nit&r
interventi&n strate(ies!
&ethodsD Devel&' test statistics t& detect tem'&ral7s'atial cl%sterin( 'atterns )&r in)ecti&%s and n&n7
in)ecti&%s disease! Derive c&nditi&nal 'r&ailities )&r P&iss&n distri%ted rand&m variales! A''l+
Ba+esian statistics t& sm&&t$ disease ris2 estimates! C&mine s'atial and tem'&ral vect&rs t&
c&nstr%ct a t$ree7dimensi&nal (rid! C&ntr&l c&m'&nents + 1ei($tin( meas%res t& identi)+ disease
tem'&ral7s'atial cl%ster tendencies! Sim%late di))erent distri%ti&n 'atterns )&r t$e '&'%lati&n! A''l+
test t& s'eci)ic disease vect&rsE l&cali<ed acc&rdin( t& ma' c&&rdinates >addressesE '&stal c&des?!
A''l+ GIS tec$n&l&(+ t& c&m'%te 'air1ise distancesR m%ltidimensi&nal scalin( t& meas%re s&cial
distance!
+91 &odelD Em'l&+ e'idemi&l&(ical cl%ster anal+sis s&)t1are t& anal+<e m&ridit+7m&rtalit+ rates
+ l&n(it%de7latit%de and tem'&ral vect&rs!
%iscussionD GIS a''licati&nsE 1$en c&mined 1it$ s'atial anal+tical cl%ster met$&dsE ma+ e
e))ectivel+ em'l&+ed t& devel&' e'idemi&l&(+ m&dels &) diseaseE im'r&ve disease 'reventi&n and
c&ntr&l! Envir&nmentall+ im'acted disease transmissi&n m&desE and ca%sative a(entsE m&st &)ten
e4$iit n&nrand&m 'atterns! Ge&(ra'$ic e'idemi&l&(+ is )ast ec&min( an e))ective t&&l in t$e
descri'ti&n and anal+sis &) disease cl%sterin( c&rrelated 1it$ dem&(ra'$icE envir&nmentalE
e$avi&ralE s&ci&ec&n&micE (eneticE and in)ecti&%s ris2 )act&rs! Disease ma''in(E $&1everE reF%ires
$i($7res&l%ti&nE (e&(ra'$icall+ re)erenced $ealt$ and envir&nmental data!
1elected -e2erencesD
Br&1nsteinE @!S!R H! R&senE D! P%rd+E @!R! -illerE -! -erlin&E F! -&stas$ari and D! Fis$ 2662 S'atial anal+sis &) 9est
Nile vir%sD ra'id ris2 assessment &) an intr&d%ced vect&r7&rne <&&n&sis! ;ector 7orne and Coonotic #iseases
>Larc$m&ntE NC?! 2>*?D#"07#/,!
C$a'%tE E!K!R @!I! -ee2 and R! Heimer 2662 S'atial anal+sis &) $%man (ran%l&c+tic e$rlic$i&sis near L+meE C&nnectic%t!
)mer(in( In&ectious #iseases 3>5?D5,*75,3!
Elli&ttE P!R and D! 9artener( 266, S'atial e'idemi&l&(+D c%rrent a''r&ac$es and )%t%re c$allen(es! )n8ironmental
5ealth Perspecti8es ##2>5?D5537#66/!
GeslerE 9! #53/ T$e %ses &) s'atial anal+sis in medical (e&(ra'$+D a revie1! ocial cience B 0edicine 2*>#6?D5/*7
50*!
HallE H!I!R C!.! Lee and 9!E! Ka+e #55/ Cl%sterD a s&)t1are s+stem )&r e'idemi&l&(ic cl%ster anal+sis! tatistics in
0edicine #">075?D5,*75"6!
HassanE A!N!R S! Dister and L! Bec2 #553 S'atial anal+sis &) l+m'$atic )ilariasis distri%ti&n in t$e Nile Delta in relati&n
t& s&me envir&nmental variales %sin( (e&(ra'$ic in)&rmati&n s+stem tec$n&l&(+! @ournal o& the )(yptian ociety
o& Parasitolo(y 23>#?D##57#*#!
H;almarsE U!R -! K%lld&r))E G! G%sta)ss&n and N! Na(ar1alla #55/ C$ild$&&d le%2aemia in S1edenD %sin( GIS and a
s'atial scan statistic )&r cl%ster detecti&n! tatistics in 0edicine #">075?D06070#"!
@&nE Vdene2 266# -et$&ds &) m&rtalit+ >incidence? rates inter'retati&n assessment in small '&'%lati&ns! .entral
)uropean @ournal o& Public 5ealth 5>#?D#,72#!
N&rstr&mE -! 266# Ge&(ra'$ical In)&rmati&n S+stem >GIS? as a t&&l in s%rveillance and m&nit&rin( &) animal diseases!
!cta ;eterinaria candina8ica* upplementum 5,D0573"!
Pere<E A!-!R -!P! 9ardE P! T&rres and .! Ritacc& 2662 Use &) s'atial statistics and m&nit&rin( data t& identi)+
cl%sterin( &) &vine t%erc%l&sis in Ar(entina! Pre8enti8e ;eterinary 0edicine "/>#?D/*70,!
RantaE @!R @! Pit2aniemiE -! Karv&nenE E! .irtalaE @! R%sanenE A! C&l'aertE A! Na%22arinen and @! T%&mile$t& #55/
Detecti&n &) &verall s'ace7time cl%sterin( in a n&n7%ni)&rml+ distri%ted '&'%lati&n! tatistics in 0edicine
#">2*?D2"/#72"02!
Ric$ards&nE -!R S!9! van LillE G!D! van der S'%+E V! -%nc$E C!N! B&&+senE N! Be+ersE P!D! van Helden and R!-!
9arren 2662 Hist&ric and recent events c&ntri%te t& t$e disease d+namics &) Bei;in(7li2e -+c&acteri%m
**
t%erc%l&sis is&lates in a $i($ incidence re(i&n! International @ournal o& Tuberculosis and Lun( #isease
/>##?D#66#7#6##!
9arin(E Ste'$en C!R A! Va2&s7FeliertiE R! 9&&dE -! St&neE P! Pad(ett and R! Ara)at 266" T$e %tilit+ &) (e&(ra'$ic
in)&rmati&n s+stems >GIS? in ra'id e'idemi&l&(ical assessments )&ll&1in( 1eat$er7related disastersD met$&d&l&(ical
iss%es ased &n t$e Tr&'ical St&rm Allis&n e4'erience! International @ournal o& 5y(iene and )n8ironmental
5ealth 263>#72?D#657##/!
Cianna2&%liasE N!R B!H! R&1eE L!9! Svens&nE D!P! Sc$&')l&c$erE K! Kell+ and D!C! .&a2lander 266* V&nes &)
'reventi&nD t$e (e&(ra'$+ &) )all in;%ries in t$e elderl+! ocial cience B 0edicine "0>##?D26/"7260*!
7/AL.7,A-/ PLANN9N+
7ypothesisD Assess t$e a''licailit+ &) GIS tec$n&l&(+ in $ealt$care 'lannin(! E4amine t$e
'&tential &) GIS a''licati&ns t& mana(e $ealt$care 'lannin(!
&ethodsD =%esti&nnaire and intervie1 a''r&ac$R $&s'ital admissi&n and sta))in( data!
+91 &odelD Anal+<e $ealt$care needsE accessE and %tili<ati&n 'atternsR eval%ate $ealt$care l&cati&ns!
Inte(rate s'atial data &n $ealt$ services %tili<ati&n and &%tc&mes! Devel&' a GIS s'atial dataase &)
availale servicesE dem&(ra'$ic and ec&n&mic vect&rs! Em'l&+ anal+tical met$&ds t& descrie t$e
ev&lvin( s'atial7tem'&ral &r(ani<ati&n &) $ealt$care! E4amine relati&ns$i' &) $ealt$ access t& $ealt$
&%tc&mes! C&nd%ct sim%lati&n anal+sis &n $&1 t& im'r&ve $ealt$care deliver+ services!
%iscussionD 9$en c&%'led 1it$ a''r&'riate s'atial anal+tical met$&dsE GIS a''licati&ns can
ill%strate t$e s'atial7tem'&ral &r(ani<ati&n &) $ealt$careE e4amine its relati&ns$i' t& $ealt$ access
and &%tc&mesE and identi)+ &''&rt%nities )&r im'r&vin( $ealt$care deliver+ services! T$e ad&'ti&n &)
GIS a''licati&ns + $ealt$care researc$ers and '&lic+7ma2ers reF%ires access t& an inte(rated s'atial
data &n $ealt$ service %tili<ati&n 'atternsE &%tc&mes and &t$er data )r&m diverse $%man services
de'artments!
1elected -e2erencesD
Bam)&rdE E!@!R L! D%nneE D!S! Ta+l&rE B!G! S+m&nE G!@! H%(& and D! 9il2ins&n #555 Accessiilit+ t& (eneral
'ractiti&ners in r%ral S&%t$ A%stralia! 0edical @ournal o& !ustralia #0#>##7#2?D/#,7/#/!
Bra<ilE K!R and -! Anders&n #55/ Assessin( $ealt$ service needsD t&&ls )&r $ealt$ 'lannin(! 5ealthcare 0ana(ement
Forum* .anadian .olle(e o& 5ealth er8ice )=ecuti8es 5>#?D22720!
B%llenE N!R G! -&&n and K! @&nes #55/ De)inin( l&calities )&r $ealt$ 'lannin(D a GIS a''r&ac$! ocial cience B
0edicine ,2>/?D36#73#/!
F&le+E R! 2662 Assessin( t$e a''licailit+ &) GIS in a $ealt$ and s&cial care settin(D 'lannin( services )&r in)&rmal carers
in East S%sse4E En(land! ocial cience B 0edicine "">#?D0575/!
Hi((sE G!R and -! G&%ld 266# Is t$ere a r&le )&r GIS in t$e :ne1 NHS:G 5ealth Place 0>*?D2,072"5!
@%are<E P!D!R P!L! R&ins&n and P! -att$e1s7@%are< 2662 #66N accessE <er& $ealt$ dis'aritiesE and GISD an im'r&ved
met$&d&l&(+ )&r desi(natin( $ealt$ 'r&)essi&ns s$&rta(e areas! @ournal o& 5ealth B ocial Policy #/>#72?D#""7#/0!
Kamel B&%l&sE -! Nai$R A!.! R&%dsari and E!R! Cars&n 266# Healt$ (e&maticsD an enalin( s%ite &) tec$n&l&(ies in
$ealt$ and $ealt$care! @ournal o& 7iomedical In&ormatics *,>*?D#5"72#5!
Karsent+E E!R and A! Levent$al 2662 Healt$ (e&(ra'$ic in)&rmati&n s+stem >HGIS?D a t&&l )&r $ealt$ 'lannin( and
e'idemi&l&(+ Ain Here1B! 5are&uah #,#>#2?D#6067#60"E #635!
Kla%ssE G%nnarR L! Sta%E -! 9idmer and A! B%sat& 266" H&s'ital service areasD a ne1 t&&l )&r $ealt$ care 'lannin( in
S1it<erland! 70. 5ealth er8ices Research ">#?D**!
L&vettE A!R R! Ha+nesE G! S%nnener( and S! Gale 2662 Car travel time and accessiilit+ + %s t& (eneral 'ractiti&ner
servicesD a st%d+ %sin( 'atient re(isters and GIS! ocial cience B 0edicine "">#?D507###!
-cLa))ert+E S!L! 266* GIS and $ealt$ care! !nnual Re8ie: o& Public 5ealth 2,D2"7,2!
-%radE A!A! 266, Creatin( a GIS a''licati&n )&r l&cal $ealt$ care 'lannin( in Sa%di Araia! International @ournal o&
)n8ironmental 5ealth Research #,>*?D#3"7#55!
N&&rE A!-!R D! V%r&vacE S!I! Ha+E S!A! Oc$&la and R!9! Sn&1 266* De)inin( eF%it+ in '$+sical access t& clinical
services %sin( (e&(ra'$ical in)&rmati&n s+stems as 'art &) malaria 'lannin( and m&nit&rin( in Ken+a! Tropical
0edicine B International 5ealth 3>#6?D5#0752/
N&&rE A!-!R P!9! Gi2andiE S!I! Ha+E R!O! -%(a and R!9! Sn&1 266, Creatin( s'atiall+ de)ined dataases )&r eF%itale
$ealt$ service 'lannin( in l&17inc&me c&%ntriesD t$e e4am'le &) Ken+a! !cta Tropica 5#>*?D2*572"#!
*,
PetersE @erem+R and G!B! Hall #555 Assessment &) am%lance res'&nse 'er)&rmance %sin( a (e&(ra'$ic in)&rmati&n
s+stem! ocial cience B 0edicine ,5>##?D#""#7#"//!
Sie(elE C!R A! Davids&nE K! Ka)adarE @!-! N&rrisE @! T&dd and @! Steiner #550 Ge&(ra'$ic anal+sis &) 'ert%ssis in)ecti&n
in an %ran areaD a t&&l )&r $ealt$ services 'lannin(! !merican @ournal o& Public 5ealth 30>#2?D26227262/!
B0;9N/ 1P0N+9*0-& /N,/P7AL0PA.7@
7ypothesisD C&nd%ct a tem'&ral7s'atial anal+sis &) '&tential &vine s'&n(i)&rm ence'$al&'at$+
am&n( cattle $erds 'ri&r t& t$e intr&d%cti&n &) active s%rveillance meas%res!
&ethodsD Generate ma' inde4 )&r $erdsE $erd densit+E and standardi<ed m&ridit+ rati&s >la+ered +
dia(n&sis?E + eF%al (e&(ra'$ic (ridsE t& vis%ali<e areas &) '&tential cl%sterin( &) BSE >and &t$er
disease vect&rs?!
+91 &odelD Test $+'&t$esis &) s'atial cl%sterin( %sin( a s'atial scan statistic a''lied t& t$e l&cati&n
&) t$e $erd 1$ere e4'&s%re li2el+ &cc%rred! C&nc%rrent '&sitive eval%ati&ns 1it$ &t$ Bern&%lli and
P&iss&n s'atial m&dels ma+ indicate mar2ed cl%sterin( &) BSE $erdsE 1it$ sec&ndar+ cl%sters
detected + eit$er Bern&%lli &r P&iss&n m&dels! Eval%ate case )reF%enc+ t$r&%($ timeR dem&nstrate
tem'&ral7s'atial cl%ster c&nsistenc+! F&c%s s'atial scan anal+ses %'&n '&tential s&%rces &) BSE
cl%sterin(E ass&ciated 1it$ )eed s&%rce &r &t$er '&tential c&ntaminatin( 'arameters!
%iscussionD P%r'&se &) tem'&ral m&del is t& identi)+ '&'%lati&n ris2 cl%sters 'ri&r t& t$e
intr&d%cti&n &) e))ective c&%nter7meas%resE as a c&nc%rrent time7la( vect&r e4ists )&r all ris27)act&r
vis%ali<ati&n 'r&cesses! Strate(+ ma+ als& e a''lied t& &t$er e'idemi&l&(ical 'r&)iles in veterinar+
scenari&sE incl%din(D &vine t%erc%l&sisE s1ine )l%E ird )l%E E7c&liE &r an+ &t$er <&&n&tic &r
c&mm%nicale diseases trans)erale t& $%mans!
1elected -e2erencesD
ArialE D!R D! CalavasE N! @arri(e and C! D%cr&t 266, S'atial $eter&(eneit+ &) t$e ris2 &) BSE in France )&ll&1in( t$e
an &) meat and &ne meal in cattle )eed! Pre8enti8e ;eterinary 0edicine /0>#?D/5732!
ArialE D!R D! CalavasE N! @arri(e and C! D%cr&t 266" P&%ltr+E 'i( and t$e ris2 &) BSE )&ll&1in( t$e )eed an in FranceD
a s'atial anal+sis! ;eterinary Research */>,?D/#"7/23!
Ber2eE O! 266" E4'l&rat&r+ s'atial relative ris2 ma''in(! Pre8enti8e ;eterinary 0edicine 0#>*7,?D#0*7#32!
Bradle+E R!R and P!P! Liers2i 266, B&vine s'&n(i)&rm ence'$al&'at$+ >BSE?D t$e end &) t$e e(innin( &r t$e e(innin(
&) t$e endG Folia -europatholo(ica ,2>S%''l A?D""7/3!
CassaE C!A!R S!@! GrannisE @!-! Over$a(e and K!D! -andl 266" A N&velE C&nte4t7Sensitive A''r&ac$ t& An&n+mi<in(
S'atial S%rveillance DataD Im'act &n O%trea2 Detecti&n! @ournal o& the !merican 0edical In&ormatics
!ssociation >Dec #"R E'% a$ead &) 'rint?!
D&nnanE P!T!R @!D! ParrattE S!.! 9ils&nE R!B! F&resE @!I! O:Ri&rdan and R!@! S1in(ler 266" -%lti'le scler&sis in
Ta+sideE Sc&tlandD detecti&n &) cl%sters %sin( a s'atial scan statistic! 0ultiple clerosis ##>,?D,6*7,63!
D%cr&tE C!R D! ArialE D! Calavas and T! Car'enter 266" A s'ati&7tem'&ral anal+sis &) BSE cases &rn e)&re and a)ter
t$e rein)&rced )eed an in France! ;eterinary Research */>"7/?D3*573"*!
EvansE B!R and F! -%nr&e 266, T$e r&le &) t$e veterinar+ c&mm%nit+ in t$e &vine s'&n(i)&rm ence'$al&'at$+ rec&ver+
'$ase in Canada! .anadian ;eterinary @ournal ,">*?D2##72#0!
Graven&rE -!B!R and R!R! Ka& 266* Ris2 assessments &n BSE! ;eterinary Record #"2>2/?D3#/!
GreenE L!E!R and S!@! C&rnell 266" Investi(ati&ns &) cattle $erd rea2d&1ns 1it$ &vine t%erc%l&sis in )&%r c&%nties &)
En(land and 9ales %sin( .ETNET data! Pre8enti8e ;eterinary 0edicine 06>*7,?D25*7*##!
-acNaE C!C! 266* Hierarc$ical Ba+esian s'atial m&dellin( &) small7area rates &) n&n7rare disease! tatistics in
0edicine 22>#6?D#0/#7#00*!
-&&reE G!E!R -!P! 9ardE -! K%lld&r))E R!@! Caldanar&E L!F! G%'tillE H!B! Le1is and L!T! Glic2man 266" A s'ace7time
cl%ster &) adverse events ass&ciated 1it$ canine raies vaccine! ;accine 2*>,37,5?D"""07""/2!
-&rle+E R!S!R S! C$en and N! R$ea%lt 266* Assessment &) t$e ris2 )act&rs related t& &vine s'&n(i)&rm ence'$al&'at$+!
Re8ue cienti&i<ue et Techni<ueE Internati&nal O))ice &) E'i<&&tics! 22>#?D#"07#03!
Od&iE A!R S!9! -artinE P! -ic$elE D! -iddlet&nE @! H&lt and @! 9ils&n 266, Investi(ati&n &) cl%sters &) (iardiasis %sin(
GIS and a s'atial scan statistic! International @ournal o& 5ealth Geo(raphics *>#?D##!
Od&iE A!R S!9! -artinE P! -ic$elE @! H&ltE D! -iddlet&n and @! 9ils&n 266* Ge&(ra'$ical and tem'&ral distri%ti&n &)
$%man (iardiasis in Ontari&E Canada! International @ournal o& 5ealth Geo(raphics 2>#?D"!
*"
Ols&nE K!L!R -! B&nettiE -! Pa(an& and K!D! -andl 266" Real time s'atial cl%ster detecti&n %sin( inter'&int distances
am&n( 'recise 'atient l&cati&ns! 70. 0edical In&ormatics and #ecision 0a2in(">@%n 2#?D#5!
Pere<E A!-!R -!P! 9ardE P! T&rres and .! Ritacc& 2662 Use &) s'atial statistics and m&nit&rin( data t& identi)+
cl%sterin( &) &vine t%erc%l&sis in Ar(entina! Pre8enti8e ;eterinary 0edicine "/>#?D/*70,!
Pri&laE S!A!R and I! .&rer( 266, -&lec%lar as'ects &) disease 'at$&(enesis in t$e transmissile s'&n(i)&rm
ence'$al&'at$ies! 0ethods in 0olecular 7iolo(y >Cli)t&nE N@?! 2/3D"#07",6
Ric2ettsE -!N! 266, P%lic $ealt$ and t$e BSE e'idemic! .urrent Topics in 0icrobiolo(y and Immunolo(y 23,D557
##5!
Sc$%delE A!A!R B!@! Carrill&E E!@! Gimen&E E!L! 9eerE @! Blanc& .ieraE C! van GelderenE E! Ull&aE A! Nader and B!G!
Cane #55, B&vine s'&n(i)&rm ence'$al&'at$+ s%rveillance in Ar(entina! Re8ue cienti&i<ue et Techni<ueE
Internati&nal O))ice &) E'i<&&tics! #*>*?D36#73*/!
S$eridanE H!A!R G! -cGrat$E P! 9$iteE R! Fall&nE -!-! S$&%2ri and S!9! -artin 2666 A tem'&ral7s'atial anal+sis &)
&vine s'&n(i)&rm ence'$al&'at$+ in Iris$ cattle $erdsE )r&m #55/ t& 2666! .anadian @ournal o& ;eterinary
Research /5>#?D#572"!
Tan(&E T!R and K! Ta2a$as$i 266" A )le4il+ s$a'ed s'atial scan statistic )&r detectin( cl%sters! International @ournal o&
5ealth Geo(raphics ,>-a+ #3?D##!
.i(reE H!R P! Bae2&E S!E! @&rsalE .! Bille7HansenE A!G! Hassin(E C! En&e and A! B&tner 266" S'atial and tem'&ral
'atterns &) 'i( $erds dia(n&sed 1it$ P&st1eanin( -%ltis+stemic 9astin( S+ndr&me >P-9S? d%rin( t$e )irst t1&
+ears &) its &cc%rrence in Denmar2! ;eterinary 0icrobiolo(y ##6>#72?D#072/!
9%/N.9*@9N+ ,0N.A&9NA./% BL00% P-0%8,.1
7ypothesisD C&nd%ct a tem'&ral7s'atial anal+sis '&tential )&r c&ntaminated l&ts &) l&&d 'r&d%ct
res%ltin( )r&m $e'atitis7CE HI. &r &t$er l&&d7'r&d%ct ass&ciated7c&mm%nicale disease in t$e
'r&vince &) Ne1 Br%ns1ic2!
&ethodsD Devel&' an anti&d+ testin( met$&d t& estimate t$e ris2 &) in)ecti&n at eac$ e4'&s%re time
)r&m m%lti'le e4'&s%re data! -et$&d ma+ als& e em'l&+ed t& estimate transmissi&n rates and ris2s
ass&ciated 1it$ di))erent s&%rces &) in)ecti&n )r&m a ran(e &) in)ecti&%s disease a''licati&ns
+91 &odelD An+ e4'&s%re t& c&ntaminated l&&d 'r&d%cts 'r&vides an &''&rt%nit+ )&r in)ecti&nE %t
t$e in)ecti&n stat%s at eac$ e4'&s%re time is n&t &served! InsteadE t$e availale data )r&m anti&d+
testin( &nl+ indicate 1$et$er at least &ne &) t$e e4'&s%res res%lted in in)ecti&n! Usin( a sim'le
Bern&%lli m&del t& descrie t$e ris2 &) in)ecti&n in eac$ +earE t$e asence &) in)&rmati&n re(ardin(
1$ic$ e4'&s%re led t& in)ecti&n ma+ e )itted int& a )rame1&r2 &) inc&m'lete data inter'&lati&n! T$e
e4'ectati&n7ma4imi<ati&n al(&rit$m ma+ 'r&vide estimates &) in)ecti&%s '&tential )&r eac$ disease
vect&r &ver an e4tended 'eri&d >267*6 +ears?!
%iscussionD P%r'&se &) tem'&ral7s'atial m&del is t& identi)+ '&'%lati&n ris2 cl%sters 'ri&r t& t$e
intr&d%cti&n &) e))ective c&%nter7meas%resE as a c&nc%rrent time7la( vect&r e4ists )&r all ris27)act&r
vis%ali<ati&n 'r&cesses! Strate(+ ma+ als& e a''lied t& an+ n%mer &) e'idemi&l&(ical 'r&)iles
res%ltin( )r&m c&ntaminated l&&d 'r&d%ctsE &r(an d&nati&nsE 'erc%tane&%s e4'&s%re in $ealt$care
1&r2ersE intraven&%s dr%( %sersE tatt&& 'arl&rsE etc!
1elected -e2erencesD
C$iavettaE @!A!R -! Esc&arE A! Ne1manE C! HeE P! Drie<enE S! Dee2sE D!E! H&neE S!F! O:Brien and G! S$er 266*
Incidence and estimated rates &) resid%al ris2 )&r HI.E $e'atitis CE $e'atitis B and $%man T7cell l+m'$&tr&'ic vir%ses
in l&&d d&n&rs in CanadaE #55672666! .0!@* .anadian 0edical !ssociation @ournal #/5>3?D0/0700*!
C$&%E R!R E!C! Clar2E -! Hel)and 266, Screenin( )&r $e'atitis C vir%s in)ecti&nD a revie1 &) t$e evidence )&r t$e U!S!
Preventive Services Tas2 F&rce! !nnals o& Internal 0edicine #,6>/?D,/"7,05!
DattaE S!D!R G!L! Armstr&n(E A!@! R&&me and -!@! Alter 266* Bl&&d e4'&s%res and $e'atitis C vir%s in)ecti&ns am&n(
emer(enc+ res'&nders! !rchi8es o& Internal 0edicine #/*>2#?D2/6"72/#6!
de CarliE G!R .! P%r& and G! I''&lit& 266* Ris2 &) $e'atitis C vir%s transmissi&n )&ll&1in( 'erc%tane&%s e4'&s%re in
$ealt$care 1&r2ers! In&ection *#>DecD S%''l 2?D22720!
el7Sada1+E -!R H! Ra(aE H! el7T&%2$+E L! el7-&r AelE A!-! -an(&%dE -!H! EissaE A!F! A)e)+E E! el7S$&ra(+E I!A!
Ira$emE S! -a$r&%sE A! Adel7-&nemE E!I! Saee and A! IsmailE T!A! -&rs+E S! Ete1aE E! N&r EdinE C! -&sta)aE
C! A&%el7-a(dE -!I! HassanE K! La2&%<E K! Adel7A<i<E G! el7Had+ and -! Saer 266, He'atitis C vir%s in)ecti&n
*/
at S$ar2ia G&vern&rateE E(+'tD ser&'revalence and ass&ciated ris2 )act&rs! @ournal o& the )(yptian ociety o&
Parasitolo(y *,># S%''l?D*/07*3,!
Fan(E C!T!R S!P! FieldE -!P! B%sc$ and P! He+ns Ad% 266* H%man imm%n&de)icienc+ vir%s7# and $e'atitis C vir%s RNA
am&n( S&%t$ A)rican l&&d d&n&rsD estimati&n &) resid%al trans)%si&n ris2 and +ield &) n%cleic acid testin(! ;o=
an(uinis 3">#?D57#5!
Gi&rdan&E H!-!R A!.! FrancaE L! -eirellesE C!A! Escan$&elaE N!F! Nis$im%raE R!L! Sant&sE K!R! =%adr&sE -! -a<<aliE
G! Alves7Fil$& and E!C! S&ares 266* C$r&nic liver disease in 2idne+ reci'ients 1it$ $e'atitis C vir%s in)ecti&n!
.linical Transplantation #0>*?D#5"7#55!
Hale+E R!9!R and R!P! Fisc$er 266* T$e tatt&&in( 'arad&4D are st%dies &) ac%te $e'atitis adeF%ate t& identi)+ r&%tes &)
transmissi&n &) s%clinical $e'atitis C in)ecti&nG !rchi8es o& Internal 0edicine #/*>5?D#65"7#653!
L%2sami;ar%l2%lE P!R N! T$ammataE D! S%;irarat and -! Til&2l%rs 266, He'atitis C vir%s in)ecti&n am&n( T$ai l&&d
d&n&rsD anti&d+ 'revalenceE ris2 )act&rs and devel&'ment &) ris2 screenin( )&rm! outheast !sian @ournal o&
Tropical 0edicine and Public 5ealth *">#?D#,07#",!
Ort&nE S!L!R S!L! StramerE R!C! D&dd and -!@! Alter 266, Ris2 )act&rs )&r HC. in)ecti&n am&n( l&&d d&n&rs
c&n)irmed t& e '&sitive )&r t$e 'resence &) HC. RNA and n&t reactive )&r t$e 'resence &) anti7HC.! Trans&usion
,,>2?D20"723#!
Reill+E -!R A! SalimE E! La1l&rE O! Smit$E I! Tem'erle+ and C! Pa1itan 266, -&dellin( in)ecti&%s disease transmissi&n
1it$ c&m'le4 e4'&s%re 'attern and s'arse &%tc&me data! tatistics in 0edicine 2*>#5?D*6#*7*6*2!
Reill+E -!R and E! La1l&r #555 A li2eli$&&d7ased met$&d &) identi)+in( c&ntaminated l&ts &) l&&d 'r&d%ct!
International @ournal o& )pidemiolo(y 23>,?D0307052!
R&+E K!-!R D! G&lder(E A! Ta+l&r and P! -ills 266* Investi(atin( t$e s&%rce &) $e'atitis C vir%s in)ecti&n am&n(
individ%als 1$&se r&%te &) in)ecti&n is %nde)inedD a st%d+ &) ten cases! candina8ian @ournal o& In&ectious #iseases
*">"?D*2/7*23!
.&(tE -!R F! -%$la%erE S!L! Bra%nE T! Lan(E R! B%sc$E R! Lan(eE G! Fr&sner and @! Hess 266, Prevalence and ris2
)act&rs &) $e'atitis C in)ecti&n a)ter cardiac s%r(er+ in c$ild$&&d e)&re and a)ter l&&d d&n&r screenin(! In&ection
*2>*?D#*,7#*0!
CinE N!R S! -eiE L! LiE F!L! 9eiE L!=! V$an( and C!V! Ca& 266* St%d+ &n t$e e'idemi&l&(+ and distri%ti&n &) $%man
imm%n&de)icienc+ vir%s7# and $e'atitis C vir%s in)ecti&n am&n( intraven&%s dr%( %sers and ille(al l&&d d&n&rs in
C$ina Ain C$ineseB! Chon(hua Liu Din( 7in( Due Ca Chi 2,>##?D5/275/"!
*0
SECTI ON THREE
CHAPTER "D Disease S%rveillance T&&ls and GIS
*3
%91/A1/ 18-;/9LLAN,/ .00L1 AN% +91
0;/-;9/W
Earl+ detecti&n &) c&$&rt e4'&s%re d%e t& an &%trea2 &) c&mm%nicale disease is essential )&r avertin(
catastr&'$ic &%tc&mes!
A#*3E #*5B
T$e 'rimar+ c$aracteristic &) an+ emer(enc+ 'lannin( t&&l is its ailit+ t&
ens%re earl+ detecti&n and s%seF%entl+ en(a(e a''r&'riate res'&nse meas%res! Real time s%rveillance data
is an essential in(redient!
A#,6B
Data s&%rces s$&%ld incl%de a m%ltit%de &) disease activit+ indicat&rs and
i&sens&rsD sc$&&l &r 1&r2 asenteeism ratesR 'atient re)erralsE 1al27in clinicsE emer(enc+ de'artments and
d&ct&rQs &))icesR m&nit&rin( &ver7t$e7c&%nter sales &) medicati&nR and mete&r&l&(ical data! Anal+sis &)
t$ese data s&%rces m%st als& &cc%r in real time! Emer(enc+ res'&nse meas%res m%st e 'rec&m'iledE trained
and tested s& t$at emer(enc+ res'&nse 1ill &cc%r 1it$&%t dela+ irres'ective &) an+ ass&ciated 1eat$er &r
l&(istic c&nditi&ns!
A#,#E #,2B
B90./--0-91& %/./,.90N 1,/NA-901
9$ile m&st acterial &r(anisms c&ntaminatin( airE )&&dE &r 1ater are nat%ral &cc%rrences and ver+ s'eci)ic
in t$eir transmissi&n7m&deE man+ t&4ins can e 1ea'&ni<ed int& i&terr&rism a(ents and intr&d%ced int& airE
)&&d &r 1ater s+stems via c&m'act aer&s&lE va'&%r &r mist 'ac2a(es T$ese incl%deD &acillus anthracis
>ant$ra4?E
A#,*E #,,E #,"B
&rucellaeE
A#,/B
&ur.holderia mallei s'! and &ur.holderia pseudomallei s'!E
A#,0E #,3B
"lostridia perfringensE
A#,5E #"6B
"lostridium botulinum >&t%lism?E
A#"#B
"occidiomycosisE
A#"2B
"o2iella burnetti
s'! >= Fever?E
A#"*E #",B
Francisella tularensis >T%laremia 7 rait )ever?E
A#""B
Hem&rr$a(ic )everE
A#"/B
)ycoto2in
>T2?E
A#"0B
+icinus communis >Ricin?E
A#"3E #"5E #/6B
Staph enteroto2in BE
A#/#B
6ariola virus >small'&4?E
A#/2B
and
<ersinia pestis >'la(%e?!
A#/*B
9$ile &r(anisms var+ in inc%ati&n '$ases and e'idemi&l&(ical im'actE
'lannin( and assessment 'r&t&c&ls s$&%ld 'r&ceed + 1a+ &) 1&rse7case scenari&s! &acillus anthracis
in)ecti&n is a viale Class A t$reat m&del )&r devel&'in( critical 'lannin( and assessment t&&ls! It entails a
narr&1 res'&nse &''&rt%nit+
A#/,B
and '&ses e4treme demands &n an+ detecti&n s+stem!
A#/"B
9$ile i&sens&r
tec$n&l&(ies are c%rrentl+ availaleE e4'&s%re treatment re(imens are di))ic%lt!
A#//B
T$e e'idemi&l&(ical case
distri%ti&n c%rve res%ltin( )r&m an ant$ra4 &%trea2 is s%ddenE stee'E and e4tremel+ let$al! T$e s'atial
distri%ti&n &) aer&s&li<ed cases is in)l%enced + mete&r&l&(ical c&nditi&nsR )&&d &r 1ater7related cases is
in)l%enced + 'r&d%cti&n and distri%ti&n net1&r2s! -eter&l&(ical dataE as 1ell as m%nici'al and c&r'&rate
'r&d%cti&n and distri%ti&n net1&r2sE m%st e anal+<ed via GIS ma''in( tec$n&l&(ies t& im'r&ve &%trea2
detecti&n and c$aracteri<ati&n! Earl+ detecti&n 1ill minimi<e t$e si<e &) t$e &%trea2E &t$ in areal c&vera(e
and case t&tals! T$e m&st im'&rtant (&al &) an+ c&nta(i&%s disease detecti&n s+stem is earl+ dia(n&sisE even
i) t$e earl+ cases are '&st7m&rtem!
,0&&8N9,ABL/ %91/A1/ %/./,.90N 1,/NA-901
F&r m&re traditi&nal c&mm%nicale disease detecti&n scenari&sE s%c$ as in)l%en<aE t$e m&st %se)%l data
s&%rces are alm&st entirel+ clinicalE
A#/0B
1it$ smaller r&les )&r i&sens&rs and n&n7clinical indicat&rs &)
disease activit+ s%c$ as asenteeism! 9$ile t$e detecti&n &) a sin(le case is &'timalE s%c$ sensitivit+ is
e+&nd t$e sc&'e &) an+ detecti&n s+stem c%rrentl+ in e4istence! Bein( ale t& acc%ratel+ distin(%is$ sin(le
cases )r&m ac2(r&%nd disease vect&rs reF%ires e4treme s'eci)icit+! -&st s+stems &) re'&rtale disease
n&ti)icati&n $ave $i($ s'eci)icit+ %t m&derate sensitivit+!
T$e ailit+ t& m&nit&r )&r ne1 c&mm%nicale diseases 1it$ %n2n&1n eti&l&(+E s%c$ as SARSE is an
essential 'rereF%isite &) an+ c&nta(i&%s disease detecti&n s+stem! C%rrent s+stems &) re'&rtale disease
*5
n&ti)icati&n $ave e4tremel+ l&1 sensitivit+ )&r ne1 s+ndr&mes %ntil several +ears a)ter t$e e4istence &) t$e
s+ndr&me is identi)ied! P%lic $ealt$ de'artments s$&%ld devel&' and disseminate s+ndr&me de)initi&ns! T&
date $&1everE t$e re'&rtin( sensitivit+ and s'eci)icit+ &) ne1 s+ndr&mes remains m&derate at est! Data
anal+sisE 1$et$er man%al &r a%t&maticE d&es n&t %s%all+ &cc%r in real time! C%rrent '%lic $ealt$ decisi&n7
ma2in( and res'&nse strate(ies ma+ e inadeF%ate >as stated in t$e Learnin( )r&m SARS re'&rt?E $&1ever
t$e stat%s F%& is &)ten c&nsidered acce'tale! Eval%ati&n &) t$ese strate(ies are c&nsidered t& e c&nc%rrent
1it$ t$e devel&'ment &) an+ c&nta(i&%s disease detecti&n and s%rveillance s+stem!
T$e e'idemi&l&(ical c%rve &) a c&nta(i&%s 'ers&n7t&7'ers&n &%trea2 &) man+ c&mm%nicale diseases is
%s%all+ c$aracteri<ed + a (rad%al &nsetE )&ll&1ed + an e4'&nential increase re)lectin( s%seF%ent case
(enerati&ns! Use)%l 'r&t&t+'e diseases 1$ic$ c$aracteri<e t$is t$reat cate(&r+ incl%deD Di'$t$eria
>"orynebacterium diphtheriae s'!?E
A#/3E #/5B
German measles >+ubella virus s'!?E
A#06B
Le'r&s+ >)ycobacterium
leprae s'!?E
A#0#E #02B
-easles >)orbillivirus (en!R )easles virus s'!R r%e&la?E
A#0*B
-enin(&c&cc%s >'eisseria
meningitidis s'!?E
A#0,E #0"E #0/B
-%m's >+ubulavirus (en!R )umps virus s'!?E
A#00E #03B E
P)ei))er:s acill%s
>0aemophilus influenzae s'!?E
A#05E #36B
R$e%matic )everE
A#3#B
Severe Ac%te Res'irat&r+ S+ndr&me >SARS?E
A#32E
#3*B
Small'&4 >6ariola virus s'!?E
A#3,B
Stre't&c&cc%s A >Streptococcus pyogenes s'!?E
A#3"E #3/B
and T%erc%l&sis
>)ycobacterium (enR )ycobacterium tuberculosis s'!?!
A#30E #33B
;/,.0-B0-N/ %91/A1/ %/./,.90N 1,/NA-901
.ect&r7 and $&st7&rne disease detecti&n scenari&s incl%de &%trea2s inv&lvin( t$e transmissi&n &) an a(ent
via an insect vect&r &r animal $&st t& $%mans! T$e e'idemic 'attern &) &%trea2 diseases c$aracteristic )&r
t$is cate(&r+ is m&deled in Fi(%re #!
*igure $: ;ector and 7ostBorne /pide5iological .rans5ission Patterns
As t$e m&del im'liesE disc&ver+ &) &%trea2s in t$is cate(&r+ reF%ires t$at detecti&n s+stems m&nit&r n&t
&nl+ $%man disease mani)estati&nsE %t als& c&ntri%tin( vect&rs and $&sts &) t$e i&l&(ical a(ents! S%c$
s+stems need t& inc&r'&rate data )r&m veterinar+ s&%rces! Beca%se &) t$eir recent &cc%rrence and ra'id
s'readE 9est Nile ence'$alitisE SARS and t$e H"N# Bird Fl% vir%ses are si(ni)icant re'resentative t$reats in
t$is cate(&r+! 9$ile &t$er diseases in t$is cate(&r+ ma+ reveal mar2ed vect&r $eter&(eneit+E an+ anal+sis &)
(eneral ca'acit+ 1&%ld need t& em'l&+ ad;%nct (e&(ra'$ic vect&r c$ec2lists )&r 'arasitesE insectsE 1ild and
d&mestic animals! T$e ailit+ t& 'r&cess envir&nmental data re'resents an additi&nal reF%irement )&r vect&r7
&rne disease detecti&n s+stemsE s%c$ as rem&te sens&r+ satellite ima(er+ anal+sis em'l&+ed as an earl+
1arnin( t&&l )&r Ri)t .alle+ Fever!
A#35B
T$e ailit+ t& m&nit&r )&r ne1 vect&r7&rne diseases >i1e1E H"N#? is a
reF%irement! 9e n&te t$at t$e c%rrent s+stem &) re'&rtale disease n&ti)icati&n $as e4tremel+ l&1 sensitivit+
)&r ne1 s+ndr&mes %ntil t$e e4istence &) t$e 'r&lem ec&mes 2n&1n!
Ani5a
l7ost
9nsect
;ector
7u5a
n%isea
se
Biological
Agents
,6
A11/11&/N. -/F89-/&/N.1
S%rveillance data reF%irements incl%de clinical data 1it$ s'atial and tem'&ral in)&rmati&n! Al(&rit$m
reF%irements incl%de ailit+ t& anal+<e s'atialE dem&(ra'$icE and tem'&ral data! Data lin2a(e is im'&rtant in
t$is cate(&r+ t& ac$ieve s'eci)icit+ in case detecti&n! I) t$e disease is re'&rtaleE im'r&vement in detecti&n
sensitivit+ and data anal+sis can res%lt )r&m c&m'lete and timel+ re'&rtin(E eit$er via Electr&nic La&rat&r+
Re'&rtin( &r 1e7ased met$&ds! I) t$e disease is n&t re'&rtaleE &%trea2s are &nl+ detected + clinicians
1$& n&tice (e&(ra'$ical c&incidences in case 'atterns! Be)&re &ne can n&tice a 'atternE $&1everE an
acc%m%lati&n &) cases need t& devel&'! T$is level &) detecti&n 'er)&rmance can e im'r&ved + r&%tine
anal+sis &) clinical data c&llected + $&s'itals!
%/./,.90N P/-*0-&AN,/
TimelinessD Planners need t& determine t$e t&lerance level )&r &'timal )irst7case detecti&n 'er)&rmance in
&rder t& 'revent s%seF%ent in)ecti&n 1aves!
SpecificityD Planners need t& determine t$e t&lerance level )&r )alse alarm rates! Precise &'timal s'eci)icit+
levels ma+ e determined + )alse alarm c&st anal+ses 'er Healt$ Re(i&n!
ToleranceD Planners need t& determine t$e t&lerance level )&r minimal &%trea2 si<e detecti&n )&r s'eci)ic
disease cate(&ries! Acce'tale t&lerance levels ma+ e determined + eval%atin( t$e sensitivit+
levels &) e4istin( detecti&n met$&ds t$r&%($ sim%lati&n anal+ses!
%A.A ,0LL/,.90N
9$ile Sentinel In)&rmati&n s+stems e4ist in Canada >in ta%lar and (ra'$ )&rm?E data c&llecti&n s$&%ld
trans'ire in real time in &rder t& minimi<e earl+7&nset im'act &) sec&ndar+ 1ave &%trea2s! In &rder t&
c&nd%ct s'atial and tem'&ral vect&r anal+sisE all data m%st e time7stam'ed and ass&ciated 1it$ s'atial
indicat&rsE t$e s'eci)icit+ &) 1$ic$ 1ill determine anal+tical t&lerance levels! Data s$&%ld e c&llected 1it$
t$e intent &) acc%rate sam'lin( &) '&'%lati&n standard deviati&ns in &rder t& minimi<e T+'es I W II err&rs!
Data s$&%ld e inter7lin2edR )&r e4am'leE )erile res'irat&r+ illness identi)icati&n reF%ires t$at tem'erat%re
and c$ie) c&m'laint variales e rec&rded! A 'r&t&t+'e S%rveillance Data Tem'late is attac$ed el&1! Data
t+'es 1ere derived )r&m t$e De)ense Advanced Researc$ Pr&;ects A(enc+ Bi&Alert 'r&(ram >9a(ner et al
266,aE 266,?! T$e tem'late is intended )&r s%rveillance m&nit&rin( + eac$ ;%risdicti&nal a%t$&rit+! T$e
detectailit+ anal+sis ma+ devel&' Receiver O'eratin( C$aracteristic >ROC?
A#56B
c%rves and Activit+
-&nit&rin( O'eratin( C$aracteristic >A-OC? c%rves
A#5#E #52B
)&r eac$ detecti&n s+stem + in;ectin( data )r&m
2n&1n &%trea2s int& sam'les &) s%rveillance data c&llected d%rin( n&n7&%trea2 'eri&ds )r&m eac$
;%risdicti&n! 9e7ased s+stems ma+ ec&me a )easile &'ti&n )&r $&s'ital %se i) t$e c%rrent man%all+
entered data &n re'&rtale diseases is a%t&mated!
N//% .0 9N1.ALL ,0&P8./-1 9N 7/AL.7 1@1./&1
S%rveillance )&r c&mm%nicale diseases is $i($l+ de'endent &n micr&i&l&(+ c%lt%res and )&r t$is reas&n
electr&nic la&rat&r+ re'&rtin( s$&%ld e a 'rimar+ (&al &) man+ $ealt$ de'artments! Im'lementati&n &)
electr&nic la&rat&r+ re'&rtin( ma+ reF%ire t$at t$e $&s'ital install a server 1it$in t$eir )ire1all t& 'r&cess
t$eir &1n &%t&%nd )eed )r&m t$e micr&i&l&(+ s+stem! T$is $ealt$ s+stem resident c&m'&nent &) a '%lic
$ealt$ s%rveillance s+stemE i) installed in $&s'itals and &%t'atient settin(sE ma+ e ale t& a%t&maticall+
m&nit&r emer(in( diseases! T& detect an emer(in( 'ne%m&nic disease s%c$ as le(i&nnairesE &r SARSE t$e
ailit+ t& a%t&maticall+ detect 'atients 1it$ )ever and c$est radi&(ra'$s c&nsistent 1it$ 'ne%m&nia 1&%ld e
e4tremel+ desirale! H&1everE t$is t+'e &) detecti&n reF%ires t$at m%lti'le data streams 1it$in $ealt$
s+stems e inter7lin2ed 1it$ 'atient identi)iers!
,#
Surveillance Data Template
Data Coverage Region
Real Time or Time
Lag
Stamping -
Temporal / Spatial
Detectability
Analysis
Patient Temperatures
Chief Complaints
Lab Test Orere
Lab Test Results
!icrobiology
"ram Stains
Cultures
#irological Testing
Chest Raiographs
Clinician Reports
#ector !onitoring
Transit $tili%ation
Preclinical ata
%A.A 1.0-A+/ -/F89-/&/N.1
T$is critical dataase s$&%ld e str%ct%red t& st&re individ%al rec&rds in &t$ an&n+mi<ed and identi)iale
)&rmats s%itale )&r emer(in( s+ndr&me m&nit&rin( s%c$ as 'ne%m&nic illnesses! T$e dataase s$&%ld e
ca'ale &) 'r&d%cin( )&r anal+sis dail+ and 1ee2l+ c&%nts + <i' c&desE and &t$er s&ci&dem&(ra'$ic
variales I i!e! data m%st e time stam'ed and l&cati&n stam'ed! Ot$er data s%c$ as air tem'erat%re ma+
als& e %sed + detecti&n al(&rit$ms t& (enerate alternative m&dels %nder n&rmal c&nditi&ns! It is essential
t$at an+ data st&ra(e s+stem $as t$e )le4iilit+ t& e4tend t$e dataase t& s%''&rt ne1 m&dels as t$e+ ec&me
availale!
%A.A ANAL@191 -/F89-/&/N.1
F&r detecti&n &) individ%al casesE data anal+sis is F%ite sim'leE 'r&vided t$at t$e s%rveillance data 'r&vides
t$e acc%rate dia(n&sis and t$e disease in F%esti&n d&es n&t $ave a ac2(r&%nd level in t$e c&mm%nit+ t$at
d&es n&t re'resent &%trea2s! T$e data anal+sis m%st e ale t& 'r&cess On&is+P data! I) t$e disease in
F%esti&n is a s+ndr&me >n&t dia(n&sed + a de)initive test?E t$en t$e anal+sis m%st c&m'%te t$e 'r&ailit+
t$at eac$ 'atient ein( 'r&cessed $as t$e disease! Fr&m t$ese determinati&ns a&%t eac$ 'ers&n in t$e
c&mm%nit+E al(&rit$ms t$en l&&2 )&r an&mal&%s n%mers &) cases in recent times in di))erent dem&(ra'$ic
and (e&(ra'$ic strata &) t$e '&'%lati&n! T& detect c&mm%nicale diseases in t$e sec&nd &r t$ird (enerati&n
&) c&mm%nicale (r&1t$E at least &ne &) t$e %nivariate al(&rit$ms s$&%ld e 'r&cessed at t$e re(i&nal and
<i' c&de level )&r res'irat&r+ and c&nstit%ti&nal s+ndr&mesE and )&r &ver7t$e7c&%nter medicati&ns )&r
res'irat&r+ and )ever s+m't&ms!
A#5*B
! T$ese al(&rit$ms s$&%ld r%n dail+ in &rder t& identi)+ (rad%al increases
in illness e$avi&rE and trans)er t& r%nnin( m%ltivariate and s'atial scannin( al(&rit$ms )&r e4tended time
'eri&ds!
8N9;A-9A./ AL+0-9.7&1
Univariate detecti&n al(&rit$ms ma+ e %tili<ed )&r s%rveillance data &r(ani<ed as dail+ &r 1ee2l+ c&%nts!
E4am'les &) %nivariate detecti&n al(&rit$ms incl%deD ,utoregressive #ntegrated )oving ,verage m&del
,2
>ARI-A?E
A#5,E #5"E #5/B
"hange!%oint #dentifierE
A#50E #53B
"ontingency Table anal+sis >Fis$erQs E4act Test?E
A#55E 266E
26#E 262B
"umulative Sums m&del >C%S%m?E
A26*E 26,B
$2ponentially!eighted )oving ,verages m&del >E9-A?E
A26"B
False -iscovery +ate anal+sisE
A26/E 260E 263E 265E 2#6B
=alman Filter
A2##E 2#2E 2#*B
E 'eural 'etwor. m&delE
A2#,E 2#"B
+andomization testsE
A2#/E 2#0E 2#3B
+ecursive *east Squares m&del >RLS?E
A2#5B
+egression m&delsE Scalar 9utlier
-etection >Statistical =%alit+ C&ntr&l?E
A226B
Seasonal ,uto!+egressive #ntegrated )oving ,verage m&del
>SARI-A?E
A22#E 222E 22*B
Serfling m&delE
A22,E 22"E 22/B
Support 6ector )achine m&delE
A220B
Time!eighted
,veraging m&delE
A223B
(nivariate 0idden )ar.ov m&delE
A225B
and avelet anal+sis!
A2*6E 2*#B
An advanta(e &) %nivariate anal+sis is t$at m&st 'r&ced%res are )amiliar t& $ealt$ de'artment
e'idemi&l&(ists! A limitati&n is t$at t$e+ cann&t ta2e advanta(e &) all t$e s%rveillance data received! S'atial
anal+sis is '&ssileE %t it inv&lves r%nnin( %nivariate anal+ses &n eac$ (e&(ra'$ical area inde'endentl+E
1$ic$ res%lts in t$e m%lti'le $+'&t$esis testin( 'r&lem! F&r t$is cate(&r+ &) (rad%all+ e4'andin(
&%trea2sE %nivariate detecti&n al(&rit$ms s$&%ld e c&n)i(%red t& rec&(ni<e (rad%al increases in
s%rveillance data! C%S%m and 9avelets can d& t$is nativel+! Ot$er met$&ds reF%ire t$at t$e s%rveillance
c&%nts e cl%stered int& 1ee2l+ &r m&nt$l+ c&%nts! F&r ma4im%m timeliness &) detecti&nE it is
rec&mmended t$at t$e c&%nts n&t e cl%stered int& 1ee2s e(innin( &n S%nda+sE %t rat$er + 1ee2
se(ments (&in( ac2 )r&m t$e c%rrent date!
$nivariate Detection Algorithms
!etho
!etho
$tili%e
Data
$tili%e
Aggregate
!etho
!oeling
!etho
&alse Alarm
Rate
Autoregressive 'ntegrate !oving
Average

Change-Point 'entifier
Contingency Table Analysis
Cumulative Sums !oel
()ponentially-*eighte !oving Averages
&alse Discovery Rate Analysis
+alman &ilter
,eural ,et-or. !oel
Ranomi%ation Tests
Recursive Least S/uares !oel
Regression Analysis
Scalar Outlier Detection
Seasonal Auto-Regressive 'ntegrate
!oving Average

Serfling !oel
Support #ector !achine
Time-*eighte Averaging !oel
$nivariate 0ien !ar.ov !oel
*avelet Analysis
,*
1PA.9AL 1,ANN9N+ 10*.WA-/
1at1can 1o2tware
T$e SatScan s&)t1are 1as devel&'ed + -artin K%lld&r)) t&(et$er 1it$ In)&rmati&n -ana(ement Services
Inc!
A2*2B
It anal+<es s'atialE tem'&ral and s'ace7time data %sin( t$e s'atialE tem'&ralE &r s'ace7time scan
statistics! It 1as desi(ned t& 'er)&rm (e&(ra'$ical s%rveillance &) diseaseE detect s'atial &r s'ace7time
disease cl%stersR test 1$et$er a disease is rand&ml+ distri%ted &ver s'aceE &ver time &r &ver s'ace and timeR
eval%ate t$e statistical si(ni)icance &) disease cl%ster alarmsR and 'er)&rm re'eated time7'eri&dic disease
s%rveillance )&r earl+ detecti&n &) disease &%trea2s! SatScan %ses eit$er a P&iss&n7ased m&delE 1$ere t$e
n%mer &) events in an area is P&iss&n7distri%tedE acc&rdin( t& a 2n&1n %nderl+in( '&'%lati&n at ris2R a
Bern&%lli m&delE 1it$ 6H# event data s%c$ as cases and c&ntr&lsR a S'ace7Time Perm%tati&n m&delE %sin(
&nl+ case dataR an Ordinal m&delE )&r cate(&rical dataR &r an E4'&nential m&del )&r s%rvival time data 1it$
&r 1it$&%t cens&red variales! T$e data ma+ e eit$er a((re(ated at t$e cens%s tractE <i' c&deE c&%nt+ &r
&t$er (e&(ra'$ical levelE &r t$ere ma+ e %niF%e c&&rdinates )&r eac$ &servati&n! SatScan ad;%sts )&r t$e
%nderl+in( $&m&(eneit+ &) a ac2(r&%nd '&'%lati&n! It can als& ad;%st )&r an+ n%mer &) cate(&rical
c&variates 'r&vided + t$e %serE as 1ell as )&r tem'&ral trendsE 2n&1n s'ace7time cl%sters and missin( data!
It is '&ssile t& scan m%lti'le data sets sim%ltane&%sl+ t& l&&2 )&r cl%sters t$at &cc%r in &ne &r m&re &) t$em!
1can 1tatistics
Availale )r&m A%t&nlaE
A2**E 2*,B
t$e m&d%le 'r&vides a )ast im'lementati&n &) scan statistic searc$ )&r
s'atial &verdensities! T$e (&al is t& )ind rectan(%lar re(i&ns 1$ere t$e disease case c&%nt is $i($er t$an
e4'ectedE (iven t$e %nderl+in( '&'%lati&n distri%ti&n! T$e m&d%le 'r&ceeds )r&m t$e ass%m'ti&n t$at t$e
data (rid c&ntains t$e l&cati&nE '&'%lati&n si<e and disease c&%nt data! T$e l&cati&n data can e addressed
eit$er + <i'c&deE &r 47+ c&&rdinate )&rmat! T$e searc$ is 'er)&rmed + iterativel+ )indin( t$e m&st
si(ni)icant re(i&n and rem&vin( t$is re(i&n )r&m t$e (rid >i!e! settin( c&%nt S '&'%lati&n S 6 )&r all cells in
t$at re(i&n?! T$e searc$ 1ill st&' 1$en eit$er t$e m&st si(ni)icant re(i&n is n&t si(ni)icant >'7val%e X !6"? &r
t$e n%mer &) re(i&ns )&%nd is eF%al t& ma4Yre(i&ns! T$e si(ni)icance >p? val%e &) re(i&ns is )&%nd +
rand&mi<ati&n testin(D c&m'arin( t$e sc&re &) t$e re(i&n t& t$e ma4im%m re(i&n sc&res &) a lar(e n%mer &)
rand&ml+ (enerated (rids! T$e si(ni)icance >p? val%e is eF%al t& t$e n%mer &) re'licas e4ceedin( t$e sc&re
&) t$e re(i&nE divided + t$e t&tal n%mer &) re'licas! Usin( m&re re'licas (ives m&re acc%rate si(ni)icance
>p? val%esE 1it$ t$e r%n time &) t$e 'r&(ram scales a''r&4imatel+ linearl+ 1it$ t$e n%mer &) re'licas
reF%ested!
&8L.9;A-9A./ AL+0-9.7&1
S%rveillance data is in$erentl+ m%ltivariate! F&r e4am'leE )&r eac$ case t$ere ma+ e a dateE l&cati&nE and
s+m't&m! 9$en +&% $ave m%lti'le t+'es &) s%rveillance dataE m%ltivariate anal+sis is essential )&r
e4tractin( ma4im%m in)&rmati&n )r&m t$&se si(nals! T$e 9SARE
A2*"E 2*/E 2*0E 2*3E 2*5E 2,6B
s&)t1are 'r&(ram ta2es
as in'%t a date7inde4ed i&s%rveillance data stream s%c$ as Emer(enc+ De'artment data! It t$en eval%ates a
ran(e &) dates in 1$ic$ )&r eac$ da+E it c&m'ares events )r&m t$at date 1it$ events )r&m a aseline
distri%ti&n &tained )r&m 'ast data! T$is aseline al(&rit$m ma+ e devel&'ed )r&m sim%lated dataE real
data )r&m act%al &%trea2s &r real data )r&m n&n7&%trea2 'eri&dsE 1it$ t$e %ser c&ntr&llin( $&1 t$e
aseline is rec&nstr%cted )&r eac$ m&del tested!
Earl+ disease &%trea2 detecti&n s+stems t+'icall+ m&nit&r $ealt$ care data )&r irre(%larities + c&m'arin(
t$e distri%ti&n &) recent data a(ainst t$is aseline distri%ti&n! Determinin( t$e aseline is di))ic%lt d%e t&
t$e 'resence &) di))erent trends in $ealt$ care dataE s%c$ as trends ca%sed + t$e da+ &) t$e 1ee2 and +
seas&nal variati&ns in tem'erat%re and 1eat$er! Creatin( t$e aseline distri%ti&n 1it$&%t ta2in( t$ese
trends int& acc&%nt can lead t& $i($ )alse '&sitive c&%nts and sl&1 detecti&n times! T$is 9SARE s&)t1are
re'laces t$e traditi&nal aseline met$&d 1it$ a Ba+esian net1&r2 1$ic$ re'r&d%ces t$e aseline distri%ti&n
,,
+ ta2in( t$e ;&int distri%ti&n &) t$e data and c&nditi&nin( attri%tes t$at are res'&nsile )&r t$e trends!
Sim%lated anal+sis dem&nstrates t$at t$is al(&rit$m is etter ale t& detect &%trea2s in act%al Emer(enc+
De'artment data 1it$ t$e earliest '&ssile detecti&n time 1$ile maintainin( a l&1 )alse '&sitive c&%nt!
-/1P0N1/ %/,9190N&AE9N+ -/F89-/&/N.1
T$e decisi&ns a&%t $&1 t& res'&nd t& an&malies in t$e detecti&n data $ave a level &) %r(enc+ t$at is n&t as
e4treme as in lar(e7scale c&$&rt e4'&s%res! Res'&nse decisi&n ma2in( d&es n&t $ave t& &cc%r in $&%rs as in
t$e case &) man+ &t$er t$reatsE alt$&%($ timel+ res'&nse is im'&rtant eca%se s'read &) c&mm%nicale
disease is a )%ncti&n &) time! T$ere)&re t$e level &) certaint+ at 1$ic$ acti&ns 1ill &cc%r ma+ e $i($er! T$e
res'&nse decisi&n ma2in( s$&%ld $ave t$e )&ll&1in( c$aracteristicsD
Policy: A 1ritten &'erati&nal '&lic+ s$&%ld e4ist t$at &n7call sta)) can e4ec%te! F&r c&mm%nicale diseaseE it
s$&%ld addressD
9$& is res'&nsile )&r receivin( alerts
At 1$at deviati&n )r&m e4'ected s$&%ld $&s'itals e called )&r m&re in)&rmati&n )&r eac$ data
stream
9$at si<e deviati&n and 1$at 'atterns s$&%ld t$e &n7call sta)) start t& m&ili<e res'&nse res&%rces
9$at level &) evidence is reF%ired e)&re c&ntact tracin( and F%arantine is im'lementedG
Trainin(: It m%st e dem&nstrated t$at t$e &n7call sta)) are c&m'etent in t$e e4ec%ti&n &) t$e '&lic+!
0ediums: De)inin( m%lti'le &verla''in( decisi&n '&ints is essential )&r res'&nsive decisi&n ma2in(!
Table1Top )=ercises: In &rder t& test t$e e))ectiveness &) '&lic+E trainin(E and in)&rmati&n7e4c$an(e
'r&t&c&ls et1een decisi&n7ma2ers I tale7t&' e4ercises H sim%lati&ns s$&%ld e c&nd%cted!
P/-10NN/L -/F89-/&/N.1
In&ormation Technolo(y Personnel* I) t$e detecti&n s+stem is r%nnin( l&call+ in a $ealt$ de'artmentE *7,
in)&rmati&n tec$n&l&(+ s'ecialists 1&%ld e reF%ired t& sta)) a )a%lt7t&lerant server )acilit+! I) t$e
detecti&n s+stem is ein( r%n as a service + a c&mmercial &r &t$er entit+E n& in)&rmati&n
tec$n&l&(+ 'ers&nnel 1&%ld e reF%ired!
)pidemiolo(y Personnel: E'idemi&l&(ists 1&%ld e reF%ired t& e4amine t$e &%t'%t &) t$e detecti&n s+stem
>2, $&%rs a da+E 0 da+s a 1ee2?! T$ese 'ers&nnel 1&%ld reF%ire trainin( t& %nderstand t$e 'r&'erties
&) a statistical &%trea2 detecti&n s+stemD )alse alarm ratesE sensitivit+E timeliness! T$e n%mer &)
'ers&n7$&%rs 'er +ear 1&%ld de'end &n 1$et$er t$e data anal+sis is a%t&mated t& t$e '&int t$at
e'idemi&l&(ists &nl+ need t& l&&2 at t$e data 1$en an alarm is s&%nded &r 1$et$er screens m%st e
e4amined m&re )reF%entl+!
1@1./& &0%/L
A m&del e4am'le 1&%ld resemle a SARS )ever clinicE 1$ic$ c&llects variales a&%t ever+ 'atient seen in
eac$ clinic in t$e 'r&vince! T$e variales ma+ incl%deD &cc%'ati&nE '&stal c&deE (enderE a(eE c&ntacts! Data
1&%ld e anal+<ed &nce a da+ at a centrali<ed l&cati&n! T$e SARS )ever clinic m&del 1&%ld n&t e an ideal
e4am'le i) t$e data 1ere c&llected &n 'a'er and t+'ed int& a 1e inter)ace &nce a da+ + )ever clinic
'ers&nnel! Ideall+E t$e data entered 1&%ld a%t&maticall+ e directed t& a centrali<ed 1e7ased s+stem at t$e
time &) service! T$e s+stem 1&%ld need t& em'l&+ m%ltivariate data anal+sisE 1$ic$ 1&%ld all&1 t$e
,"
identi)icati&n &) small cl%sters &) cases + &cc%'ati&n >e!(!E $ealt$care 1&r2er? and 'lace &) em'l&+ment
>e!(!E $&s'ital site?!
An+ in)l%en<a s%rveillance 'r&;ect reF%ires a c&lla&rative e))&rt et1een ;%risdicti&ns &) $ealt$ services
and disease c&ntr&l centers at t$e 'r&vincialE nati&nal and internati&nal levels! S%c$ a 'r&;ect m%st &tain
and anal+<e $&s'italE '$armac+ and la&rat&r+ data in an e))&rt t& determine t$e timin( and im'act &)
in)l%en<a activit+ and t& determine $&1 1ell circ%latin( strains &) t$e vir%s matc$ t$&se %sed in t$e c%rrent
in)l%en<a vaccines!
Active s%rveillance d%rin( t$e in)l%en<a seas&n s$&%ld incl%de data &n in'atient admissi&n dia(n&sisE
&%t'atient '$armac+ 'rescri'ti&ns )&r antiviral medicati&nE &%t'atient in)l%en<a7li2e illnesses )r&m sentinel
'$+siciansE and res'irat&r+ vir%s is&lati&ns and detecti&ns! An+ in)l%en<a s%rveillance net1&r2 m%st als&
serve as an e))ective alert mec$anism )&r t$e emer(ence &) in)l%en<a vir%ses 1it$ 'andemic '&tential!
%/./,.AB9L9.@ ANAL@191
Detectailit+ is a term 1$ic$ re)ers t& t$e t+'es and si<es &) &%trea2s t$at a detecti&n s+stem is ca'ailit+
&) identi)+in(! Detectailit+ de'ends &n t$e F%alit+ &) s%rveillance data ein( c&llectedE 1$ic$ ma+ di))er
)r&m re(i&n t& re(i&n in terms &) c&m'leteness and acc%rac+! It ma+ als& c&ntain di))erent da+s &) t$e 1ee2
and seas&nal e))ectsE de'endin( &n climate and l&cal c%st&ms and events! A detectailit+ anal+sis s$&%ld
'r&d%ce Receiver O'eratin( C$aracteristic >ROC? and Activit+ -&nit&rin( O'eratin( C$aracteristic
>A-OC? c%rves )&r eac$ detecti&n s+stem >re(i&nal data and al(&rit$ms? + in;ectin( data )r&m 2n&1n
&%trea2s int& sam'les &) re(i&nal s%rveillance data c&llected d%rin( n&n7&%trea2 'eri&ds!
%91,81190N > -/,0&&/N%A.90N1
T$e dramatic increase in ne1 diseases s%c$ as SARS and t$e t$reat &) &t$er diseases s%c$ as dr%( resistant
T%erc%l&sisE c&mined 1it$ increased internati&nal trade and travelE 'r&vide man+ &''&rt%nities )&r
diseases t& s'read acr&ss internati&nal &rders at alarmin( s'eed! GIS is emer(in( as a '&1er)%l tec$n&l&(+
)&r earl+ detecti&nE and a''r&'riate timel+ res'&nses t& disease &%trea2s! GIS tec$n&l&(+ can als& in)&rm
$ealt$ &))icials and t$e '%lic a&%t emer(in( $ealt$ t$reatsE and en$ance decisi&n ma2in( at all levels!
Since detecti&n at earl+ sta(es is im'&rtant )&r $ealt$ &))icials t& ta2e e))ective c&%nter7meas%res t& c&ntr&l
t$e s'read &) diseaseE 1e7ased GIS tec$n&l&(+ can 'r&vide F%ic2 access t& distri%ted data )&r anal+sisE
vis%ali<ati&nE and 'lannin( H m&delin(! F%rt$erm&reE 1e7ased GIS can enale m%lti7disease s%rveillance I
instead &) sin(le stand7al&ne a''licati&ns! An+ GIS s+stemE $&1everE relies &n ri(&r&%s data standards!
Standardi<ed (e&re)erencin( &) e'idemi&l&(ical data can enale &))icials t& vis%ali<e $ealt$ in)&rmati&n in
relati&n t& dem&(ra'$icsE mete&r&l&(ical c&nditi&nsE administrative &%ndariesE distance )r&m 'atient t&
$&s'ital H clinicE disease vect&rsE <&&n&tic diseasesE and m%c$ m&re! T$is can reveal trendsE de'endenciesE
and relati&ns$i's et1een variales t$at ma+ n&t $ave een 'revi&%sl+ c&nsidered! GIS can ill%strate $ealt$
data at m%lti'le scales I )r&m a ver+ l&cal scale t& 'r&vincialE nati&nalE and internati&nal scales! Finall+E a
GIS s+stem can $el' $ealt$ a%t$&rities t& m&nit&r t$e e))ectiveness &) disease c&ntr&l meas%res!
A reliale GIS s+stem reF%ires inte(rati&n 1it$ $&s'ital H $ealt$ dataasesE 1it$ near real7time access t&
data ased &n %ser reF%ests! T& enale access t& de7identi)ied data >i!e! 1it$&%t 'atient identi)iers?E $ealt$
a(encies m%st )irst $ave a sec%re net1&r2 and dataase mana(ement s+stemE 1$erein 'ermissi&ns can e
set! An internal GIS s+stem can 'r&vide $ealt$ 'r&)essi&nals 1it$ a sec%re 1a+ t& access data and vis%ali<e
disease e'idemi&l&(+ &n a (e&(ra'$ic asis! Sec&ndl+E t& )acilitate in)&rmati&n s$arin( et1een a(enciesE
'ermissi&ns and sec%re data transmissi&n met$&ds m%st e %sed t& trans)er data >1it$ 'atient identi)iers?!
CanadaQs Healt$ In)&1a+ is 1&r2in( 1it$ t$e Pr&vinces and 'rivate sect&r t& enale t$is e4c$an(e &) $ealt$
data et1een a(encies! T$irdl+E in &rder t& enale '%lic alertin(E $ealt$ a(encies m%st e ale t& e4'&rt
,/
t$eir data and ma's t& a '%lic7access 1e '&rtal! S%c$ data and ma's 1&%ld n&t c&ntain 'atient identi)iersE
and 1&%ld need t& e a((re(ated &r tr%ncated in &rder t& 'r&tect 'rivac+ &) 'atient data! Similarl+E a s+stem
c&%ld e estalis$ed )&r 'r&vidin( researc$ &r(ani<ati&n &r $ealt$ NGOs 1it$ access t& de7identi)ied data
t$r&%($ a 9-S H 9FS service I ideall+ nested 1it$in t$e CGDI!
An+ c&mm%nicale disease s%rveillance 'r&;ect reF%ires a c&lla&rative e))&rt et1een t$e de'artments &)
$ealt$ services and disease c&ntr&l centers at t$e 'r&vincialE nati&nal and internati&nal levels! T$e CGDI
c&%ld enale t$is c&lla&rative e))&rt + 'r&vidin( access t& a''licati&nsE dataE and services I let al&ne an
inter&'erale net1&r2 &) a''licati&n $&sts and %sers! I) t$e CGDI 1ere t& enale disease s%rveillanceE it
m%st ma2e $&s'italE '$armac+ and la&rat&r+ data availale s& t$at $ealt$ a%t$&rities c&%ld determine t$e
timin( and im'act &) disease activit+ and $&1 1ell circ%latin( strains &) t$e vir%s matc$ t$&se %sed in
c%rrent vaccines! Active s%rveillance d%rin( t$e 'rinci'al seas&ns s$&%ld incl%de data &n in'atient
admissi&n dia(n&sisE &%t'atient '$armac+ 'rescri'ti&ns )&r antiviral medicati&nE &%t'atient illnesses )r&m
sentinel '$+siciansE and vir%s is&lati&ns and detecti&ns! A disease s%rveillance net1&r2 m%st als& serve as
an e))ective alert mec$anism )&r t$e emer(ence &) vir%ses 1it$ 'andemic '&tential I in &t$er 1&rdsE it
1&%ld need t& e a push system rat$er t$an a pull system! A '%s$ s+stem 1&%ld c&ntain t$e necessar+
a%t&mati&n and al(&rit$ms H statistical t&&ls t& identi)+ disease &%trea2sE and t$en n&ti)+ a''r&'riate $ealt$
a%t$&rities! Similarl+E $ealt$ a%t$&rities c&%ld iss%e alerts c&mined 1it$ dataHma's t& t$e '%licE via t$e
CGDIE i) desi(nated reci'ients 1ere in 'lace >e!(! 1esites )&r mediaE sc$&&lsE m%nici'al (&vernmentsE
$&s'itals etc?! T$is is m&re acc%ratel+ descried as an $tml7ased 1e serviceE 1$ic$ d&1nl&ads ma's H
data )r&m 9-S services 1it$in t$e CGDIE t$at c&ntain a((re(ate disease in)&rmati&n at l&calE re(i&nalE and
nati&nal scales! %ervasive networ.ing can )%rt$er enale '%lic $ealt$ &))icials t& iss%e alerts and U'%s$Q
in)&rmati&n t& )r&nt line $ealt$ 1&r2ers I t$e Universit+ &) Ne1 Br%ns1ic2Qs C&m'%ter Science Fac%lt+ is
c&nd%ctin( inn&vative researc$ in t$is area!
C&lla&rati&n et1een Ge&C&nnecti&ns and '%lic $ealt$ a%t$&rities 1&%ld enale an e))icient m%lti7
;%risdicti&nal earl+ 1arnin( s%rveillance s+stem t$at can F%ic2l+ and e))icientl+ trac2 emer(in( in)ecti&%s
disease 'at$&(ens acr&ss l&calE stateE 'r&vincial and internati&nal &rders! It 1&%ld %ild &n relati&ns$i's
alread+ estalis$ed and enc&%ra(e eac$ level &) (&vernment t& c&ntin%e in t$eir e))&rts t& 're'are )&r a
c&&rdinated res'&nse t& disease s%rveillance in traditi&nal diseasesE emer(in( 'at$&(ens and i&terr&rism! I)
t$e CGDI enaled t$is c&lla&rati&n in t$e tec$n&l&(ical senseE it c&%ld lead t& a seamless m%lti7
;%risdicti&nal n&ti)icati&n and res'&nse s+stem 1$ere a standardi<ed n&ti)icati&n 'r&cess leads t& a
'redictale t$reat7ased res'&nse! It 1&%ld %ild and stren(t$en 'r&)essi&nal relati&ns$i's acr&ss CanadaR
'r&vide a )rame1&r2 )&r )&rmal a(reements 1$ic$ de)ine ma;&r '&lic+ iss%esR and enale $ealt$ a%t$&rities
t& meet t$e c$allen(es in$erent in disease s%rveillance!
,0
SECTI ON FOUR
CHAPTER /D Healt$ Data T+'esE S&%rcesE Dataases
CHAPTER 0D Healt$ Data Inte(rati&n
CHAPTER 3D Privac+ Iss%es
CHAPTER 5D GIS Data Sets
CHAPTER #6D Statistical -&d%les
CHAPTER ##D .is%ali<ati&n Tec$niF%es
,3
7/AL.7 %A.A : .@P/1( 108-,/1( %A.ABA1/1
9N.-0%8,.90N
CanadaQs Healt$ In)&1a+E mandated t& administer t$e devel&'ment and maintenance &) a c&m're$ensive
and inte(rated $ealt$ in)&rmati&n s+stem )&r Canada needs t& e ale t& 'r&vide and c&&rdinate t$e
'r&visi&n &) acc%rate and timel+ in)&rmati&n necessar+ t& estalis$ s&%nd $ealt$ '&liciesE mana(e t$e $ealt$
care s+stem e))ectivel+E and (enerate '%lic a1areness &) )act&rs a))ectin( (&&d $ealt$! At t$e c&re &) t$is
s+stem is accessiilit+ t& m%lti'le dataasesE re'&sit&ries &) clinicalE dem&(ra'$ic and administrative data
c&llected + $&s'itals and $ealt$ care )acilities d%rin( t$e n&rmal c&%rse &) 'atient care and administrati&n!
A n%mer &) nati&nal $ealt$ dataases c%rrentl+ e4istE administered + t$e Canadian Instit%te )&r Healt$
In)&rmati&nE an inde'endent n&n7'r&)it &r(ani<ati&n! T$is Instit%te serves as a )&cal '&int )&r c&lla&rati&n
am&n( ma;&r $ealt$ 'la+ersD 'r&vincial and )ederal (&vernmentsE re(i&nal $ealt$ a%t$&rities and $&s'italsE
researc$ers and ass&ciati&ns re'resentin( $ealt$ care 'r&)essi&nals! It 'r&vides essential statistics and
anal+sis &n '%lic $ealt$ and t$e 'er)&rmance &) t$e Canadian $ealt$ care s+stem! It identi)ies nati&nal
$ealt$ indicat&rsR c&&rdinates t$e devel&'ment and maintenance &) nati&nal $ealt$ in)&rmati&n standardsR
mana(es dataases and re(istriesD $ealt$ care servicesE $ealt$ $%man res&%rcesE and $ealt$ s'endin(R
e4amines 1$at )act&rs determine (&&d $ealt$R c&nd%cts anal+sis and s'ecial st%diesE and 'artici'ates in
researc$R '%lis$es re'&rts and disseminates $ealt$ in)&rmati&nR and c&&rdinates and c&nd%cts ed%cati&n
sessi&ns and c&n)erences! In additi&nE t$e P%lic Healt$ A(enc+ &) CanadaE la%nc$ed a -a' and Data
E4c$an(eE t$r&%($ 1$ic$ t$e+ 'r&vide '%lic $ealt$ &r(ani<ati&ns acr&ss Canada 1it$ access t& $ealt$7
related and dem&(ra'$ic dataE as 1ell as an interactive ma''in( a''licati&n!
Ge&C&nnecti&ns s$&%ld 1&r2 in c&lla&rati&n 1it$ t$e Canadian Instit%te )&r Healt$ In)&rmati&nE P%lic
Healt$ A(enc+ &) CanadaE and CanadaQs Healt$ In)&1a+E t& )acilitate t$e inte(rati&n &) $ealt$ dataases
1it$in and acr&ss $ealt$ ;%risdicti&ns! In &rder t& seamlessl+ inte(rate $ealt$ dataE a steerin( c&mmittee
c&%ld 'r&vide (%idance &n t$e &n(&in( en$ancement and maintenance &) s%c$ dataases! It c&%ld ma2e
rec&mmendati&ns &n &'erati&nal &r strate(ic iss%es related t& t$e dataases! Healt$ a%t$&rities H re(i&ns
1&%ld t& e re'resented &n t$e c&mmitteeE 1it$ t$e reF%irement t$at memers '&ssess decisi&n7ma2in(
a%t$&rit+ &n matters related t& t$e dataases in t$eir res'ective re(i&ns! In t$is 1a+E Ge&C&nnecti&ns c&%ld
ed%cate $ealt$ a%t$&rities &n t$e need )&r data standards t$at 1&%ld enale '%lic $ealt$ data t& e
inte(rated 1it$ (e&s'atial a''licati&ns >e!(! time H s'atial stam's?! T$e )&ll&1in( is a list &) t$e t+'es &) data
t$at c&%ld e 'art &) a distri%ted '%lic $ealt$ GIS net1&r2D
1.AN%A-% 7/AL.7 %A.A
data c&llected )&r s%rveillance >e(! disease re(istriesE '&'%lati&n $ealt$ s%rve+s?
data c&llected )&r t$e administrati&n &) $ealt$care s+stems >e(! $&s'ital disc$ar(e dataE medical and
'$armace%tical services reim%rsement data?
data c&llected as 'art &) clinical care deliver+ >e(! la&rat&r+ W 'at$&l&(+ re'&rtsE medical rec&rdsE
dia(n&stic ima(in(?
data c&llected )&r administrati&n &) '%lic and 'rivate sect&r services >e(! cens%s dataE elect&ral
rec&rdsE em'l&+ment rec&rdsE m&t&r ve$icle license and accident rec&rdsE sc$&&l enr&llment lists?
'rimar+ care net1&r2s >e(! 'atient r&sters?
e4istin(E estalis$ed researc$ c&$&rts
,5
F%esti&nnaires >s%rve+s?
$ealt$ 'r&)essi&nal data
-91E *A,.0-1 *0- %91/A1/
m&ridit+ and m&rtalit+ trends res%ltin( )r&m envir&nmental e4'&s%re >e(! air '&ll%ti&nE 1ater
'&ll%ti&nE (l&al 1armin(E climate c$an(eE e4treme 1eat$er eventsE $eat and c&ld e4'&s%re?
m&ridit+ and m&rtalit+ trends res%ltin( )r&m c$r&nic disease >e(! cancerE res'irat&r+ diseaseE
m+&cardial in)arcti&nE str&2e?
in;%r+ ris2s ass&ciated 1it$ s&cialE ec&n&mic and c%lt%ral li)est+les
&cc%'ati&nal e4'&s%re ris2s >e(! asest&sE 1&&d d%stE en<eneE t&l%eneE radiati&nE rad&nE 1&r2'lace
stress?
&cc%'ati&nal m&ridit+ and m&rtalit+ trends )&r vari&%s disease >e(! cancerE res'irat&r+E
cardi&vasc%larE adverse 're(nanc+ &%tc&mes?
,L9N9,AL 1.8%9/1
'revalence and incidence &) disease >e(! m&ridit+ and m&rtalit+ trends?
disease %rden and treatment &%tc&mes >e(! str&2eE cancerE ast$maE diaetesE renal )ail%re?
'redict&rs &) 'r&(n&sis and clinical c&%rse
eval%ati&n &) screenin( and dia(n&stic t&&ls
&%tc&mes and ris2s related t& adverse dr%( e))ects
&%tc&mes and ris2s related t& medical devices >e(! im'lants?
c&st7e))ectiveness st%dies
c&st7ene)it st%dies
(enetic ris2 )act&rs )&r devel&'ment &) disease
s%r(ical and medical interventi&n trials
's+c$&7e$avi&ral and ed%cati&nal interventi&ns
c&mm%nit+ and '&lic+ interventi&ns
7/AL.7 1/-;9,/1 /;AL8A.90N
(eneral '&'%lati&n %tili<ati&n 'atterns &) $ealt$care services
'redict&rs &) s'eci)ic $ealt$care service %tili<ati&n 'atterns
c&sts and &%tc&mes ass&ciated 1it$ interventi&n strate(iesE clinical 'r&(ramsE $&s'ital medical
'r&ced%res
satis)acti&n &) li)e st%dies
F%alit+ &) li)e st%dies
P0L9,@ 9&PA,. /;AL8A.90N
c&m'arative eval%ati&n &) re(i&nal $ealt$care '&licies
$&s'ital cl&s%res and s'atial distri%ti&n
sta))in( m&di)icati&ns in medical 'ers&nnel
'&'%lati&n screenin( 'r&(rams )&r disease >e(! TB clinics?
'&'%lati&n interventi&n 'r&(rams )&r disease >e(! Fl% vaccinati&ns?
"6
c&st s$arin( et1een 'rivate W '%lic ins%rance 'r&(rams >e(! T1&7Tier s+stems?
$ealt$ service %tili<ati&n &%tc&mes
disease &cc%rrence &%tc&mes
c&m'arative eval%ati&n &) re(i&nal S&cial Assistance 'r&(rams
7/AL.7 %A.ABA1/1
%lease see ,ppendi2 > for a full description of the following health databases1
.LI-I.!L !#0I-ITR!TI;) #!T!7!)
Disc$ar(e Astract Dataase
H&s'ital -&ridit+ Dataase
Nati&nal Am%lat&r+ Care Re'&rtin( S+stem
5)!LT5 5,0!- R)9,R.) #!T!7!)
Re(istered N%rses Dataase
Licensed Practical N%rses Dataase
Re(istered Ps+c$iatric N%rses Dataase
5)!LT5 P)-#I-G #!T!7!)
Nati&nal Healt$ E4'endit%re Dataase
OECD Healt$ Dataase
Canadian -IS Dataase
Nati&nal P$+sician Dataase
Nati&nal Prescri'ti&n Dr%( Utili<ati&n In)&rmati&n S+stem
Nati&nal Healt$ E4'endit%re Dataase
5)!LT5 )R;I.) #!T!7!)
Canadian @&int Re'lacement Re(istr+
Canadian -edicati&n Incident Re'&rtin( and Preventi&n S+stem
Canadian Or(an Re'lacement Re(ister
C&ntin%in( Care Re'&rtin( S+stem
H&me Care Re'&rtin( S+stem
H&s'ital -ental Healt$ Dataase
Nati&nal Re$ailitati&n Re'&rtin( S+stem
Nati&nal Tra%ma Re(istr+
T$era'e%tic A&rti&ns Dataase
Healt$ Indicat&rs
Res'irat&r+ Disease in Canada
Canadian Cancer Re(istr+
Canadian Patient Data Re(istr+
Canadian T&acc& Use -&nit&rin( S%rve+
Canadian T%erc%l&sis Re'&rtin( S+stem
-&rtalit+ Dataase
"#
Nati&nal Air P&ll%ti&n S%rveillance S+stem
Nati&nal L&n(it%dinal S%rve+ &) C$ildren and C&%t$
Nati&nal Perinatal S%rveillance S+stem
Nati&nal P&'%lati&n Healt$ S%rve+
N&ti)iale Disease Re'&rtin( S+stem
Nati&nal P&'%lati&n Healt$ S%rve+D Ast$ma S%''lement
.!-!#I!- I-TIT,T) 9F 5)!LT5 R))!R.5
-emer instit%tes incl%deD
#nstitute of ,boriginal %eoples5 0ealth
#nstitute of ,ging
#nstitute of "ancer +esearch
#nstitute of "irculatory and +espiratory 0ealth
#nstitute of Gender and 0ealth
#nstitute of Genetics
#nstitute of 0ealth Services and %olicy +esearch
#nstitute of 0uman -evelopment, "hild and <outh 0ealth
#nstitute of #nfection and #mmunity
#nstitute of )usculos.eletal 0ealth and ,rthritis
#nstitute of 'eurosciences, )ental 0ealth and ,ddiction
#nstitute of 'utrition, )etabolism and -iabetes
#nstitute of %opulation and %ublic 0ealth
"2
7/AL.7 %A.A 9N./+-A.90N
9N.-0%8,.90N
E))&rts t& devel&' re(i&nal $ealt$ in)&rmati&n net1&r2s t$at cr&ss traditi&nal (e&7'&litical &%ndaries
reF%ire (reater c&nsiderati&n &) $&1 $ealt$ and '&'%lati&n data a((re(ati&n m&dels ma+ im'in(e %'&n t$e
anal+sis and inter'retati&n &) e'idemi&l&(ical 'atternsE and ass&ciated disease s%rveillance met$&ds!
C%rrentl+E t$ere are )e1 &''&rt%nities t& eval%ate t$e c&nseF%ences &) st%d+ area si<e selecti&n! S$arin(
$ealt$7related data acr&ss $ealt$ re(i&nsE 'r&vinces &r nati&ns is rareE &)ten restricted in t$e interest &)
'r&tectin( individ%al 'rivac+E in)&rmati&n c&n)identialit+E 'r&'rietar+ ;%risdicti&nal interests and data
&1ners$i' asserti&ns! Inc&nsistencies acr&ss $ealt$ re(i&ns and 'r&vincial &%ndaries re(ardin( t$e
em'l&+ment &) (e&c&din( re)erencesE statistical and ma''in( s&)t1are )%rt$er c&nstrain t$e ailit+ t&
amal(amate data )&r m%lti7re(i&nal st%dies! As s%c$E researc$ers and '&lic+ anal+sts $ave limited )&resi($t
as t& $&1 >and t& 1$at e4tent? )indin(s ma+ c$an(e + st%d+ area m&di)icati&ns!
A2,#B
T$e (e&(ra'$ic st%d+ &) e'idemi&l&(ical 'atterns is an im'&rtant t&&l in %nderstandin( disease eti&l&(+E
c&ntr&l and 'reventi&nE as 1ell as a val%ale res&%rce )&r eval%atin( 'atterns in envir&nmental $ealt$
'at$&(enesis! InadeF%ate 'ractical (%idance is availale )&r selectin( a''r&'riate (e&(ra'$ic res&l%ti&ns )&r
e'idemi&l&(ical m&delin( &r disease s%rveillance!
A2,2B
Ge&c&din( $ealt$ events 1it$in acce'tale err&r
sam'lin( strate(ies is 'r&lematic at estD small areal %nits +ield less reliale rates d%e t& )e1er at7ris2
'atientsR 1$ile lar(er areal %nits dist&rt nat%rall+ &cc%rrin( variati&n! T$e res%ltin( &%tc&mes c&m'licate t$e
ailit+ t& distin(%is$ et1een %nderl+in( $ealt$ ris2s and met$&d&l&(ical sam'lin( strate(ies! B&t$ t$e
e'idemi&l&(ical anal+sis &) s%s'ected disease hot!spots and '%lic $ealt$ eval%ati&n &) res&%rce all&cati&ns
are &)ten c&nstrained + &vert c&ncerns t& 'r&tect c&n)identialit+ &) (e&(ra'$icall+ re)erenced $ealt$ data
e))ectivel+ eliminatin( man+ anal+tical &'ti&ns!
A2,*B
An+ e))&rt t& devel&' a '%lic $ealt$ in)&rmati&n and
disease s%rveillance net1&r2 1ill enc&%nter several asic 'r&lemsE all &) 1$ic$ c&m'&%nd t$e a''licati&n
&) data standards!
7/AL.7 %A.A ,7ALL/N+/1
#!T! FR!G0)-T!TI9-
P%lic $ealt$ data tends t& e divided int& sil&sD $&s'italsE '$+siciansE )inancial mana(ementE etc! T$e
&ri(inati&n &) data )ra(mentati&n stems )r&m Federal %d(ets t$at all&cate se'arate )%ndin( l&c2s )&r
di))erent 'r&viders and services! 9$ile 'r&vinces n&1 %tili<e an inte(rated $ealt$ care deliver+ m&delE
t$e &r(ani<ati&n &) '%lic $ealt$ data remains )ra(mented!
A2,,B
F&r '%lic $ealt$ 'lanners t$is
)ra(mentati&n c&nstrains an+ e))ective eval%ati&n &) re(i&nal res&%rce all&cati&ns! F&r e'idemi&l&(istsE
'%lic $ealt$ determinants and $ealt$ stat%s remain disc&nnected )r&m t$e deliver+ &) $ealt$ care
services! F&r '%lic $ealt$ in)&rmati&n net1&r2sE eac$ m%lti7)%ncti&nal level is $am'ered + 'rivac+
c&ncernsE 'r&'rietar+ in)&rmati&n and data tec$n&l&(ies!
CanadaQs Healt$ In)&1a+ and Pr&vincial e7$ealt$ initiatives aim t& address data )ra(mentati&n! T$e
CGDI s$&%ld c&nsider t$e additi&nal inter&'erailit+ c$allen(es and data iss%es in$erent in e4istin(
Healt$ dataases!
"*
#!T! #)FI.I)-.E
Data 'rimaril+ e4ists )r&m $&s'itali<ati&n services >e1g1 d&c%mentati&n &n c%rrent 'atient and client
$ealt$ rec&rds?E %t is asent )r&m man+ &t$er areas &) '%lic $ealt$D
preventive services
service resources 7e1g1 health professionals, technology8
intervention strategies and patient outcomes
private health care providers 7e1g1 homecare8
impact of health care policies or services
policy development and health program evaluation
C&m'&%ndin( data de)icienc+ is t$e inailit+ &) t$e '%lic $ealt$ s+stem t& )acilitate data s$arin(E
even 1it$ an&n+mi<ed statistical data!
AIid!B
#!T! !-!LEI
A n%mer &) critical iss%es $ave een identi)ied 1$ic$ create %niF%e c$allen(es )&r t$e c&llecti&n and
mana(ement &) data in '%lic $ealt$D
the traditional use of summary tables to depict disarticulated data is an inherently deficient
analytical substitute
epidemiological analysis is an ongoing process: continuous access to original data is essential
statistical models and queries do not e2ist in a vacuum: theorems evolve alongside data in a
symbiotic relationship within scientific envelopes
data from non!medical determinants of health are rarely available in a standardized format
full data potential is only revealed through e2tensive analysis of population health status trends
and variations
data is useful to health care planners only when analysed from a broad range of theorem!based
statistical strategies
data analysis needs to be integrated with policies or programs in order to initiate improvements
to the health care system1
data analysis should be used to evaluate, never promulgate, health care policy
#!T! #I)0I-!TI9-
9$ile t$e demand )&r $ealt$ in)&rmati&n is (reater t$an everE researc$ res%lts are rarel+ accessile &r
e4tremel+ di))ic%lt t& access! A c&&rdinated a''r&ac$ t& 'r&vidin( c&m're$ensive '%lic $ealt$
in)&rmati&n t& diver(ent researc$ (r&%'s is essential i) 1e are t& im'r&ve '%lic $ealt$ and t$e $ealt$
care s+stem! 9$ile tec$n&l&(ical advances $ave enaled t$e creati&n and maintenance &) s&'$isticated
$ealt$ in)&rmati&n s+stems )inanciall+ and l&(isticall+ vialeE c&&rdinated acti&n 'lans are reF%ired
since n& sin(le s&l%ti&n can res&lve t$e iss%es &) '%lic $ealt$ in)&rmati&n access! B%ildin( a GIS7
enaled nati&nal $ealt$ in)&rmati&n s+stem reF%ires additi&nal ste's t& rem&ve data access de)iciencies
and enale in)&rmati&n access s&l%ti&nsE 1it$in t$e c&nte4t &) strin(ent 'rivac+ sa)e(%ardsE
c&n)identialit+ reF%irements and data sec%rit+ arran(ements!
F&r t$e a''r&'riate disseminati&n &) '%lic $ealt$ dataE t$e )&ll&1in( (a's need t& e addressedD
-ata #ntegration: T$e 'resent )ra(mented a''r&ac$ t& '%lic $ealt$ data necessitates t$e
devel&'ment &) c&mm&n data standards )&r '%lic $ealt$ in)&rmati&n s+stems >See Tale #?!
",
-ata *in.age: 9$ile e4istin( '%lic $ealt$ rec&rds ma+ all&1 t$e st%d+ &) $ealt$ interventi&nsE
t$ese re'resent &nl+ s&me &) t$e determinants &) $ealt$ stat%s >e1g! li)est+leE &cc%'ati&nE
envir&nmental )act&rsE etc!?! C&nseF%entl+E 'resent data s+stems d& n&t 'ermit assessin( t$e
e))ect &) interventi&ns &n l&n(7term $ealt$ &%tc&mesE 'artic%larl+ in a re(i&nal c&nte4t!
-ata +elevance: De'endenc+ &n inc&m'lete data necessitates t$e devel&'ment &n an &n(&in( asis
ne1 &r e4'anded data s+stems in $ealt$ servicesE as 1ell asE t$e inte(rati&n &) s%rve+ data &n
&%tc&mes 1it$ s%rve+ data &n interventi&nsE $ealt$ determinants and $ealt$ stat%s!
*igure $: *rag5entation o2 Public 7ealth 9n2or5ation 1yste5s in British ,olu5bia
A2,"B
-ata Sharing: Unnecessar+ arriers t& data s$arin( need t& e eliminatedR in)&rmati&n e4c$an(e
'r&t&c&ls need t& e devel&'ed t& all&1 data s$arin( via a''r&'riate sec%rit+ c&nditi&ns!
-ata ,ccessibility: Traditi&nal data anal+sis and disseminati&n 'r&t&c&ls need t& e re7eval%ated i)
t$e $ealt$ stat%s am&n( CanadaQs diverse '&'%lati&ns is t& im'r&veR &t$ medical and n&n7
medical 'ers'ectives in descriin( $ealt$ determinants need t& c&7e4istR $ealt$ s+stem
'er)&rmance and re'&rt cards need t& e m&re accessile!
7/AL.7 %A.A 10L8.90N1
0)T!LI-G,ITI. T!-#!R#
Ac$ievin( t$e visi&n &) a GIS7enaled nati&nal $ealt$ in)&rmati&n in)rastr%ct%re reF%ires t$e ailit+ t&
lin2 dis'arate in)&rmati&n tec$n&l&(ies! 9$ile (e&(ra'$ic standards are c&nsistentl+ c&%c$ed in
tec$nical 'recisi&nE t$e %n'redictale m%lti7lin(%istic val%es &) $ealt$ care in)&rmati&n necessitates a
reliance %'&n (enerali<ed inter&'erailit+ 'rinci'les rat$er t$an 'r&scried d&ctrine! In &rder t& all&1 )&r
a r&ad c&nce't%al ev&l%ti&n in scienti)icE tec$nical and %siness envir&nmentsE a GIS7enaled $ealt$
data in)rastr%ct%re needs t& devel&' la+ered trans)&rmative ca'acit+ c$aracteristic &) m%lti7ada'tive
inter)aces %tili<in( medical lan(%a(eE electr&nic rec&rd mana(ementE and in)&rmati&n e4c$an(e
net1&r2in( strate(ies >See Fi(%re 2?!
""
*igure )
0ealth Data System
!essaging
Application
0ealth
'nformation
System
0ospital
Databases
Legacy
Application
Le)ical
Transformation
Database
C"D'
"ate-ay
0)#I.!L ;9.!7,L!RI)
A GIS7enaled $ealt$ in)&rmati&n in)rastr%ct%re als& reF%ires access t& standardi<ed medical v&ca%lar+
datasets devel&'ed 1it$ t$e intent &) 'arsin( variale clinical lan(%a(e elements &) $ealt$ care
in)&rmati&n! S+stemati<ed n&menclat%re licensin( a(reements are rec&mmendedE as %'(rades )&r t$e
metalin(%istic 'arsin( le4is are &)ten ass%med + t$e dataset 'r&vider! F&r e4am'leD t$e S+stemati<ed
N&menclat%re &) -edicine Clinical Terms >SNO-ED CT?E devel&'ed + t$e C&lle(e &) American
Pat$&l&(istsE 'r&vides c&re termin&l&(+ data trans)er standards )&r t$e electr&nic $ealt$ rec&rdE 1it$ a
medical v&ca%lar+ &) m&re t$an *//E666 $ealt$ care c&nce'tsE 55*E666 c&nce't descri'ti&nsE and #!,/
milli&n semantic relati&ns$i's!
A2,/B
Availale in &t$ En(lis$ and S'anis$E SNO-ED CT $as a''licati&ns )&r electr&nic medical rec&rdsE
intensive care %nit m&nit&rin(E clinical decisi&n s%''&rtE medical researc$ st%diesE clinical trialsE
c&m'%teri<ed '$+sician &rder entr+E disease s%rveillanceE ima(e inde4in( and c&ns%mer $ealt$
in)&rmati&n services!

9$ile t$e 'r&d%ctQs license is &nl+ availale in t$e United StatesE e))&rts are
c%rrentl+ %nder1a+ t& estalis$ SNO-ED CT as a (l&al clinical termin&l&(+ dataset! S%c$ a m&ve 1ill
)acilitate nati&nal $ealt$care s+stems t& etter %tili<ed in)&rmati&n tec$n&l&(+ as a )&%ndati&n )&r t$e
electr&nic medical $ealt$ rec&rd! In 266,E a "7+ear M*2!" milli&n license 1as (ranted t& t$e United States
Nati&nal Lirar+ &) -edicineQs Uni)ied -edical Lan(%a(e S+stem.
T$e Canadian C&din( Standards )&r ICD7#6 CAE is an&t$er versi&n &) clinical lan(%a(e elements in
$ealt$ care in)&rmati&nE a c&m'ilati&n &) internati&nal r%les &) c&din( estalis$ed + t$e 9&rld Healt$
Or(ani<ati&n and t$e Dia(n&sis T+'in( Standard devel&'ed t& den&te case c&m'le4it+ )&r a''licati&n in
Canadian )acilities! T$e .anadian .odin( tandards &or I.#11+1.! and ..I >266/? are a''licale t&
disc$ar(es and am%lat&r+ care visits e(innin( A'ril #E 266/! Statistics Canada is res'&nsile )&r t$e
m&rtalit+ a''licati&ns &) ICD7#6 as 'r&d%ced + t$e 9&rld Healt$ Or(ani<ati&n! ICD7#67CA )&r c&din(
'r&ced%res re'laces ICD75 and ICD757C- in Canada! Unli2e ICD75E ICD7#67CA a''lies e+&nd ac%te
$&s'ital care t& incl%de c&nditi&ns and sit%ati&ns t$at are n&t diseases %t re'resent ris2 )act&rs t& $ealt$E
s%c$ as &cc%'ati&nal and envir&nmental )act&rsE li)est+le and 's+c$&7s&cial circ%mstances!
"/
,-IFI)# 0)#I.!L L!-G,!G) ET)0
T$e Uni)ied -edical Lan(%a(e S+stem
A2,0B
is c&nsidered t& e t$e 'remier medical re)erence s&%rce!
Pr&d%ced and distri%ted + t$e United States Nati&nal Lirar+ &) -edicineE t$e U-LS dataases are
ass&ciated 1it$ le4ical s&)t1are t&&ls )&r %se + s+stem devel&'ers in %ildin( electr&nic in)&rmati&n
s+stems t$at createE 'r&cessE retrieveE inte(rateE &r a((re(ate $ealt$ data! Desi(ned t& e m%lti7'%r'&seE
t$e datasets are n&t restricted t& 'artic%lar a''licati&nsE %t can e a''lied in s+stems t$at 'er)&rm a
ran(e &) )%ncti&ns inv&lvin( &ne &r m&re t+'es &) in)&rmati&n >e1g1E 'atient rec&rdsE scienti)ic literat%reE
(%idelinesE '%lic $ealt$ dataE etc!?! 9$ile t$e ass&ciated le4ical s&)t1are t&&ls can assist s+stem
devel&'ers in c%st&mi<in( t$e Uni)ied -edical Lan(%a(e S+stemE t$e+ can als& )%ncti&n inde'endentl+!
*igure ': 1N0&/% .er5inology Architecture within the 8&L1 &etathesaurus
0)T!T5)!,R,
Central t& t$e Uni)ied -edical Lan(%a(e S+stem is t$e -etat$esa%r%sE
A2,3B
a lar(eE m%lti7'%r'&seE and
m%lti7lin(%al v&ca%lar+ dataase re)erencin( i&medical and $ealt$ related c&nce'tsE namesE and
relati&ns$i's! T$e -etat$esa%r%s is ased &n electr&nic versi&ns &) nearl+ #"6 di))erent t$esa%riE
classi)icati&nsE c&de setsE and termin&l&(ies >e1g1E SNO-ED CT? em'l&+ed in 'atient careE $ealt$
services illin(E '%lic $ealt$ statisticsE inde4in( and catal&(in( i&medical literat%reE and asicE
clinicalE and $ealt$ services researc$! T$ese s&%rce v&ca%laries are availale in t$e -etat$esa%r%s as a
sin(leE )%ll+7s'eci)ied dataase )&rmat >See Fi(%re *?!
"0
)0!-TI. -)TW9RF
Beca%se &) t$e c&m'le4it+ &) t$e s&%rce v&ca%lariesE a semantic net1&r2
A2,5B
is reF%ired t& maintain
c&nsistent cate(&ri<ati&n &) all c&nce'ts re'resented in t$e -etat$esa%r%s and t& de)ine net1&r2
relati&ns$i's et1een c&nce'ts! 9$ile in)&rmati&n a&%t s'eci)ic c&nce'ts resides in t$e -etat$esa%r%sE
t$e semantic net1&r2 estalis$es t$e c&nce't%al t+'&l&(+ and t$eir inter7relati&ns$i's as te4t%al
descri't&rs and $ierarc$ical str%ct%reE via net1&r2 n&des and net1&r2 lin2sE t$ere+ all&1in( )&r t$e
cate(&ri<ati&n &) a diverse termin&l&(+ residin( &ver m%lti'le d&mains >See Fi(%re ,?! T$e U-LS
Semantic Net1&r2 is availale in %nit rec&rd and relati&nal )&rmat and is distri%ted s%;ect t& s'eci)ic
license terms and c&nditi&ns!
*igure !
L)DI.!L PR9GR!0
T$e S'ecialist Le4ic&n $as een devel&'ed t& 'r&vide t$e le4ical in)&rmati&n needed )&r t$e S'ecialist
Nat%ral Lan(%a(e Pr&cessin( S+stem! It is intended t& e a (eneral En(lis$ le4ic&n t$at incl%des &t$
c&mm&nl+ &cc%rrin( En(lis$ and i&medical v&ca%lar+! T$e le4ic&n entr+ )&r eac$ 1&rd &r term
rec&rds t$e s+ntacticE m&r'$&l&(icalE and &rt$&(ra'$ic in)&rmati&n needed + t$e S'ecialist Nat%ral
Lan(%a(e Pr&cessin( S+stem! T$e le4ical 'r&(rams and t&&ls 1ere desi(ned t& address t$e nat%ral
variailit+ in 1&rds and terms! 9&rds &)ten $ave several in)lecti&nal variants 1$ic$ c&%ld 'r&'erl+ e
c&nsidered instances &) t$e same 1&rdD e!(!E sin(%lar 'resentE 'ast and 'ast 'artici'le )&rm! -%lti71&rd
"3
terms ma+ als& $ave 1&rd &rder variants in additi&n t& in)lecti&nal and al'$aetic case variants! T$e
le4ical t&&ls all&1 t$e %ser t& astract and s&rts &%t t$ese variati&ns!
T$e le4ical t&&ls 1ere devel&'ed + t$e Le4ical S+stems Gr&%' &) t$e Lister Hill Nati&nal Center )&r
Bi&medical C&mm%nicati&ns!
A2"6B
T$e t&&ls )acilitate nat%ral lan(%a(e 'r&cessin( + $el'in( a''licati&n
devel&'ers 1it$ le4ical variati&n and te4t anal+sis tas2s in t$e i&medical d&main! T$e t&&ls are O'en
S&%rce res&%rce distri%ti&ns s%;ect t& s'eci)ic terms and c&nditi&ns! T$e t&&ls incl%deD
a large syntactic le2icon of biomedical and general $nglish3
a set of ?,6, programs designed to help users manage le2ical variation, inde2ing, and
normalization, etc1 in biomedical te2t3
a nested set of ?,6, ob@ects designed to help users analyze free te2t documents into words,
terms, phrases, sentences and sections3 and
two spelling resource programs: a spelling suggestion tool and a phrase retrieval tool1
0)#I.!L R).9R#
Healt$ Level SevenE Inc!
A2"#B
E an American Nati&nal Standards Instit%te7accredited standards
devel&'ment &r(ani<ati&nE $as 'r&d%ced s'eci)icati&ns )&r t$e e4c$an(eE mana(ement and inte(rati&n &)
clinical and administrative data t& s%''&rt inter&'erailit+ acr&ss $ealt$care in)&rmati&n s+stems >See
Fi(%re "?!
*igure 5
It $as estalis$ed a r&%st s%ite &) $ealt$ data standards t$at de)ines t$e )%ncti&ns needed in enc&din(
and transmittin( electr&nic medical rec&rds! C&llectivel+ called .ersi&n * N&rmative Editi&n 266"E t$e
standards $ave )&c%sed &n semantic inter&'erailit+ and %niversal a''licati&n 1$ile still acc&mm&datin(
re(i&nal variati&ns in electr&nic medical rec&rd 2ee'in(! T$e HL0 standards s%ite incl%desD c&nce't%al
standards >HL0 Re)erence In)&rmati&n -&del?E d&c%ment standards >HL0 CDA?E a''licati&n standards
>HL0 C&m'&nents )&r C&nte4t -ana(ement? and messa(in( standards >HL0 v2!4 and v*!6?! -essa(in(
standards are 'artic%larl+ im'&rtant eca%se t$e+ de)ine $&1 in)&rmati&n is 'ac2a(ed and
c&mm%nicated et1een '&rtals! S%c$ standards set t$e lan(%a(eE str%ct%re and data t+'es reF%ired )&r
"5
seamless inte(rati&n et1een data s+stems! C%rrentl+E t$e HL0 messa(in( standard is s%''&rted +
ever+ ma;&r medical in)&rmati&n s+stems vend&r in t$e United States!
T$e si(ni)icance &) t$e standards s%ite is its ailit+ t& inte(rate $ealt$ care in)&rmati&n 1$ile s%''&rtin(
m%lti'le data7access &;ectives >e1g1E 'atient careE clinical researc$E '%lic $ealt$?! T$e s%ite
inc&r'&rates a ne1 a''r&ac$ t& clinical in)&rmati&n e4c$an(eE c&nstr%cted ar&%nd a sin(le &;ect m&del
>HL0 Re)erence In)&rmati&n -&del? 1$ic$ %tili<es met$&d&l&(+ t$at inte(rates $ealt$ care in)&rmati&n
>messa(esE data t+'esE datasetsE data e4c$an(e and termin&l&(ies? via J-L s+nta4! T$e %se &) J-L
tec$n&l&(+ all&1s )&r t$e c&7e4istence &) $%man7readale and mac$ine7'r&cessale )&rmsE a critical
attri%te essential )&r e))ective data e4c$an(e acr&ss m%lti'le medi%msE 'lat)&rms and $ealt$ care
;%risdicti&ns!
2"2
T$e HL0 &r(ani<ati&n $as (r&1n )r&m #, memers in #530E t& &ver 2E266 memersE "66 c&r'&rate
memersE and internati&nal a))iliates in ** c&%ntries >incl%din( Canada
A2"*B
?! HL0 Canada is t$e )&r%m
)&r Canadian $ealt$ in)&rmati&n sta2e$&lders t& decide $&1 HL0 is ad&'ted and ada'ted )&r %se in
CanadaE and is res'&nsile )&r distri%tin( and re(%latin( HL0 c&'+ri($ted material in Canada! HL0
Canada is a rec&(ni<ed internati&nal a))iliate and a v&tin( memer &) t$e HL0 internati&nal C&mmittee!
Usin( a 1ell7de)ined set &) &'eratin( 'r&ced%resE HL0Qs memers $ave (enerated in)&rmati&n
tec$n&l&(+ e4'ertise in all se(ments &) t$e $ealt$care ind%str+! Pr&vidin( a c&m're$ensive )rame1&r2
>and related standards? )&r t$e e4c$an(eE inte(rati&nE s$arin( and retrieval &) electr&nic $ealt$
in)&rmati&nE HL0 standards are t$e m&st c&mm&nl+ %sed in t$e 1&rld! Pri&r t& t$e devel&'ment &) HL0E
$ealt$ care instit%ti&ns $ad t& devel&' c%st&m7%ilt inter)aces c&stin( as m%c$ as M2"6E666! In 2666 t$e
e4'ense &) an HL0 inter)ace 1it$ similar )%ncti&nalit+ c&st less t$an M#6E666! Savin(s in time and e))&rt
t& install HL0 inter)aces 1ere als& advanced! An inter)ace anal+st can n&1 c&m'lete HL0 inter)ace
c&nnecti&ns in a matter &) $&%rs
A2",B
! Previ&%s versi&ns &) t$e HL0 .2!4 standards are availale )ree &)
c$ar(e 1$ile c%rrent standards ma+ e '%rc$ased at a m&dest )ee!
0)#I.!L I-F9R0!TI.
In t$e +ears since its )&%ndin(E HL0 $as e4'anded its in)l%ence 1ell e+&nd traditi&nal messa(in(
'r&t&c&ls! T&da+ HL0 standards devel&'ment initiatives incl%deD
standardization of .nowledge representation
specification of components for conte2t management
support for healthcare data interchange using ob@ect request bro.ers
standardization of A)* document structures
specification of robust vocabulary definitions for use in clinical messages and documents
functional specifications for an electronic health record
wor. in the area of security, privacy, confidentiality, and accountability1
S%c$ inn&vati&ns $ave all&1ed )&r ever+t$in( )r&m t$e availailit+ &) a 'atient:s &nline medical rec&rd
t& a '$armac+:s )&rm%lar+ t& e re'resented and e4c$an(ed in an HL0 J-L d&c%ment! In )actE t$e
HL0:s Patient Rec&rd Arc$itect%re in versi&n *!6 all&1s )&r a c&mm&n )&rmat )&r e4c$an(in( a 'atient:s
medical rec&rd et1een di))erent $&s'ital s+stems &r even di))erent $&s'itals! T$is HL0 standard $as
t$%s c&me t& serve as a )&%ndati&n )&r t$e %niversal electr&nic medical rec&rd! T$e sc&'e &) HL0Qs
'r&(ressive activities is n&t limited t& t$e electr&nic medical rec&rdE $&1ever! IndeedE recent activities
and standards &) HL0 $ave incl%ded m&delin( and met$&d&l&(+E v&ca%lar+E clinical decisi&n s%''&rtE
)inancial mana(ementE administrati&nE re(%lated clinical researc$ and in)&rmati&n mana(ementE
/6
sc$ed%lin( and l&(isticsE clinical (%idelinesE c&mm%nit+7ased $ealt$E (&vernment 'r&;ectsE medicati&nE
sec%rit+ and acc&%ntailit+E tem'latesE J-LE and '%lic $ealt$ and emer(enc+ res'&nse!
.9-.)PT,!L 5)!LT5 #!T! 09#)L
T$e C&nce't%al Healt$ Data -&del >CHD-? is a re)erence t&&l )&r &r(ani<in(E vie1in( and de)inin( $i($7
level $ealt$ in)&rmati&n! CHD- 1as devel&'ed + t$e Partners$i' )&r Healt$ In)&rmati&n Standards!
A2""B
It
started 1it$ t$e Healt$ Level Seven >HL0? Re)erence In)&rmati&n -&del >RI-? and e4amined its sc&'e &)
c&vera(e a(ainst t$e Canadian Healt$ In)&rmati&n Frame1&r2 t& determine 1$et$er t$e m&del adeF%atel+
met Canadian in)&rmati&n reF%irements! T$e CHD- can s%''&rt data c&llecti&n 'lans )&r creatin( and
ali(nin( etter in)&rmati&n )r&m m%lti'le s&%rces t& s%''&rt '&lic+ ma2in( and &t$er decisi&ns t$at reF%ire
t$e inte(rati&n &) data &) man+ t+'esE )r&m m%lti'le s&%rces!
%91,81190N > -/,0&&/N%A.90N1
CanadaQs Healt$ In)&1a+ and Pr&vincial e7$ealt$ initiatives aim t& address data )ra(mentati&n and
de)icienc+E t& im'r&ve %'&n anal+sis and disseminati&n &) data t& '%lic $ealt$ decisi&n7ma2ers! T$e CGDI
s$&%ld c&nsider t$e additi&nal inter&'erailit+ c$allen(es and data iss%es in$erent 1it$ inte(rati&n &)
e4istin( $ealt$ dataases!
In &rder t& ac$ieve a nati&nal GIS7enaled $ealt$ in)&rmati&n in)rastr%ct%reE 1e c&ncl%de t$at $ealt$ data
standards are a critical )act&r t& e c&nsidered! 9eQve identi)ied t$e need )&r lin2a(e &) dis'arate $ealt$ data
and in)&rmati&n tec$n&l&(iesE s'eci)icall+ in t$e areas &)D
metalinguistic standards
standardized medical vocabulary datasets
a semantic networ. establishing a conceptual typology to categorize diverse terminologies residing
over multiple domains
le2ical software programs and tools designed to address the natural variability in words and terms
industry standard specifications for the e2change, management and integration of clinical and
administrative data to support interoperability across healthcare information systems
T$e CGDI m%st c&nsider 1$et$er it is advanta(e&%s &r n&t t& inc&r'&rate t$ese t&&ls H s+stems t& enale t$e
inte(rati&n &) dis'arate data! Alternativel+E s%c$ s+stems s$&%ld e 'art &) CanadaQs Healt$ In)&1a+E and
data '%lis$ed t& t$e CGDI c&%ld t$en alread+ e U$arm&ni<edQ t& t$e e4tent '&ssile!
9$ile t$is c$a'ter &nl+ disc%ssed t$e $arm&ni<ati&n &r inte(rati&n &) CGDI 1it$ $ealt$ standards and
dataase rec&rds mana(ement s+stemsE a m&re detailed descri'ti&n &) CGDIHOGC Arc$itect%re can e
)&%nd in Secti&n "!
/#
P-9;A,@ 9118/1
9N.-0%8,.90N
Privac+ ri($ts in $ealt$ researc$ is a sensitive t&'ic rarel+ addressed at t$e researc$ level! T$e c&m'le4it+ &)
t$e iss%e is accent%ated + t$e )ail%re &) Federal and Pr&vincial le(islat&rs t& devel&' a $arm&ni<ed
)rame1&r2 &) '&lic+ and le(islati&n (&vernin( t$e 'r&tecti&n &) 'ers&nal $ealt$ in)&rmati&n acr&ss CanadaE
1$ile at t$e same time a))&rdin( accessiilit+ + medical researc$ers! P&lic+ deates m&re &)ten c&nsider
t$e ri($ts &) 'rivac+ in d&ct&r7'atient relati&ns$i's and 'ers&nal $ealt$ in)&rmati&n )r&m t$e 'ers'ective &)
'%lic accessE rarel+ )r&m t$e stand'&int &) disease s%rveillanceE e'idemi&l&(+ and '&'%lati&n $ealt$! T$e
rare e4ce'ti&ns in 1$ic$ t$e e'idemi&l&(ical vie1'&int is seri&%sl+ c&nsidered &cc%r &nl+ d%rin( s$&rt7
lived intensel+ scr%tini<ed media eventsE s%c$ as Avian )l% &r SARS 'andemics! T$is des'ite t$e )act t$at
ann%al m&ridit+ trends res%ltin( )r&m c$r&nic res'irat&r+ disease (reatl+ e4ceed t$ese O'andemicsP!
N&t1it$standin(E t$ere d&es e4ist a r&adE internati&nal 'ers'ective &n t$e %nderl+in( 'rinci'lesE trends and
initiatives (&vernin( t$e 'r&tecti&n &) 'ers&nal $ealt$ in)&rmati&n in t$e area &) medical researc$! Canadian
le(islat&rs and '&lic+ advisers are ;%st n&1 e(innin( t& address emer(in( medic&7le(al iss%es in
(e&(ra'$ic e'idemi&l&(+ and '%lic $ealt$ researc$! T$e c$allen(e &) s%c$ disc%ssi&ns arises )r&m t$e
c&nversi&n &) le(al c&nce'ts int& 'ractical a''licati&n! Princi'al am&n( t$ese is t$e )ail%re &) (&vernment
'&lic+ t& distin(%is$ et1een researc$ st%dies t$at reF%ire 'rimar+ &r sec&ndar+ &servati&nal data t$at
ma+E &r ma+ n&tE reF%ire 'atient identi)icati&n &r c&ntact!
T$e Ne1 Br%ns1ic2 L%n( Ass&ciati&n $as incl%ded t$is secti&n &n data 'rivac+E rec&(ni<in( man+ &) t$e
iss%es descried are nati&nal in sc&'eE and reF%ire t$e a''r&'riate a%t$&rities t& address t$em! S&me
rec&mmendati&ns are incl%ded at t$e end &) t$is c$a'ter )&r Ge&C&nnecti&nsQ c&nsiderati&n! Healt$
a%t$&rities s$&%ld e a1are &) 'rivac+ la1sE limitati&nsE and c$allen(es I 1e rec&mmend t$at $ealt$
a%t$&rities 'r&ceed ca%ti&%sl+ 1it$ ad&'ti&n &) GIS a''licati&nsE %t s$&%ld n&t 1ait )&r 'rivac+ iss%es t&
e )%ll+ res&lved e)&re 'r&ceedin(E as t$ere is an %r(ent reF%irement )&r disease s%rveillance a''licati&ns!
%A.A P-9;A,@ 9118/1
9$at is identi)iale dataG de7identi)ied dataG n&n7identi)iale dataG
H&1 s$&%ld data 'r&tecti&n '&lic+ est de)ineE distin(%is$ and deal 1it$ s%c$ dataG
Under 1$at c&nditi&ns can sec&ndar+ %se &) 'ers&nal $ealt$ in)&rmati&n e all&1ed )&r $ealt$ researc$G
H&1 are emer(in( r%les res'ectin( data lin2a(e )arin( in 'racticeG
9$at sa)e(%ardin( iss%es s'eci)ic t& $ealt$ researc$ need t& e addressedG
H&1 1&%ld $arm&ni<ed standards and '&licies )&r accessin( data and c&ntactin( 'atients acr&ss
di))erent c%st&diansE sect&rs and ;%risdicti&nsE im'act $ealt$ researc$ acr&ss CanadaG
H&1 1&r2ale is t$e reF%irement )&r 'reliminar+ c&ntact + $ealt$ in)&rmati&n c%st&dian 'ri&r t&
c&ntact + researc$erG
9$at are t$e (%idin( 'rinci'les )&r c&llectin(E %sin( and discl&sin( 'ers&nal >$ealt$? in)&rmati&nG
9$ere in)&rmed c&nsent is reF%iredE $&1 s$&%ld t$e )&rm &) c&nsent m&st a''r&'riate in t$e
circ%mstances e determinedG
H&1 s$&%ld $ealt$ 'ractiti&ner data e treated %nder t$e '&lic+G
9$at are s&me in)&rmati&nal ris2s t& c&mm%nities 'artici'atin( in $ealt$ researc$G H&1 can t$ese e
/2
dealt 1it$G 9$at are t$e retenti&n and destr%cti&n reF%irements s'eci)ic t& $ealt$ researc$G
-/1/A-,7 N0. A**/,.9N+ PA.9/N. 9%/N.9*9,A.90N
-esearch Areas:
i! Ris2 )act&rs )&r disease
morbidity and mortality trends resulting from environmental e2posure 7eg1 air pollution,
water pollution, global warming, climate change, e2treme weather events, heat and cold
e2posure8
morbidity and mortality trends resulting from chronic disease 7eg1 cancer, respiratory
disease, myocardial infarction, stro.e8
in@ury ris.s associated with social, economic and cultural lifestyles
occupational e2posure ris.s 7eg1 asbestos, wood dust, benzene, toluene, radiation, radon,
wor.place stress8
occupational morbidity and mortality trends for various disease 7eg1 cancer, respiratory,
cardiovascular, adverse pregnancy outcomes8
ii! Clinical st%dies
prevalence and incidence of disease 7eg1 morbidity and mortality trends8
disease burden and treatment outcomes 7eg1 stro.e, cancer, asthma, diabetes, renal failure8
predictors of prognosis and clinical course
evaluation of screening and diagnostic tools
outcomes and ris.s related to adverse drug effects
outcomes and ris.s related to medical devices 7eg1 implants8
iii! Healt$ services eval%ati&n
general population utilization patterns of healthcare services
predictors of specific healthcare service utilization patterns
costs and outcomes associated with intervention strategies, clinical programs, hospital
medical procedures
iv! P&lic+ im'act eval%ati&n
comparative evaluation of regional healthcare policies
hospital closures and spatial distribution
staffing modifications in medical personnel
population screening programs for disease 7eg1 T& clinics8
population intervention programs for disease 7eg1 Flu vaccinations8
cost sharing between private ; public insurance programs 7eg1 Two!Tier systems8
health service utilization outcomes
disease occurrence outcomes
comparative evaluation of regional Social ,ssistance programs
%ata 1ourcesD
.ital statistics
data collected for surveillance 7eg1 disease registries, population health surveys8
data collected for the administration of healthcare systems 7eg1 hospital discharge data,
medical and pharmaceutical services reimbursement data8
data collected as part of clinical care delivery 7eg1 laboratory ; pathology reports, medical
records, diagnostic imaging8
data collected for administration of public and private sector services 7eg1 census data,
electoral records, employment records, motor vehicle license and accident records, school
/*
enrollment lists8
-/1/A-,7 A**/,.9N+ PA.9/N. 9%/N.9*9,A.90N
Researc$ met$&d&l&(+ ased %'&n t$e sec&ndar+ %se &) data t& de)ine sam'le )rames and assemle st%d+
'&'%lati&ns )&r &servati&nal st%dies s&metimes reF%ire 'atient c&ntact! Under s%c$ circ%mstancesE 'atient
identi)icati&n is a))ected!
-esearch Areas:
i! Ris2 )act&rs )&r disease
morbidity and mortality trends resulting from environmental e2posure
morbidity and mortality trends resulting from chronic disease
in@ury ris.s associated with social, economic and cultural lifestyles
occupational e2posure ris.s
occupational morbidity and mortality trends for various disease
ii! Clinical st%dies
prevalence and incidence of disease
disease burden and treatment outcomes
predictors of prognosis and clinical course
evaluation of screening and diagnostic tools
outcomes and ris.s related to adverse drug effects
outcomes and ris.s related to medical devices
cost!effectiveness studies
cost!benefit studies
iii! Healt$ services eval%ati&n
satisfaction of life studies
quality of life studies
iv! Genetic researc$
ris. factors for development of disease
%ata 1ourcesD
i! Disease re(istries
data collected for the administration of healthcare systems 7eg1 hospital discharge data8
data collected as part of clinical care delivery 7eg1 laboratory ; pathology reports, medical
records, diagnostic imaging8
data collected for administration of public and private sector services 7eg1 electoral records,
school enrollment lists8
primary care networ.s 7eg1 patient rosters8
e2isting, established research cohorts
-/1/A-,7 9N;0L;9N+ ,0&&8N9.@ 9N./-;/N.90N
-esearch Areas:
i1 "linical trials of surgical and medical interventions
ii1 %sycho!behavioral and educational interventions
iii1 "ommunity and policy interventions
iv1 +esponding to Threats, for e2ample: &io!terrorism, to2ic spills, natural disasters
/,
v1 -ealing with contaminated water wells 4 vector!borne diseases 7rodents, birds, etc8
%ata 1ources Gnone3hausti4eHD
i1 0uman tissue
ii1 /uestionnaires
iii1 )edical records
iv1 %rescription data
v1 0ealth professional data
vi1 Framewor.4&ase!)ap -ata
vii1 #nfrastructure and )unicipal -ata
viii1 +egistered Farm ,nimals and 9perations
F8/1.90N1 ,0N,/-N9N+ .7/ P-9;A,@ A,.
Devel&'in( a '%lic $ealt$ s%rveillance s+stem nat%rall+ entails t$e c&llecti&n &) vast am&%nts &) 'ers&nal
$ealt$ in)&rmati&n! An+ attem't t& estalis$ s%c$ a s+stemE even &n a re(i&nal level 1&%ld tri((er Federal
'rivac+ le(islati&n (&vernin( &t$ t$e 'rivate and '%lic sect&rs! On @an%ar+ #E 266#E t$e Pers&nal
In)&rmati&n Privac+ and Electr&nic D&c%ments Act e(an re(%latin( t$e c&llecti&nE %se and discl&s%re &)
'ers&nal in)&rmati&n + a 1ide7ran(e &) n&n7(&vernmental entitiesE incl%din( c&r'&rati&nsE ass&ciati&nsE
'artners$i'sE trade %ni&nsE and 'rivate individ%als! Initiall+ a''licale &nl+ t& )ederall+7re(%lated 'rivate
sect&rs and inter'r&vincial H internati&nal in)&rmati&n trans)ersE as &) @an%ar+ #E 266, it n&1 enc&m'asses
all entities 1it$in its sc&'e! T& t$e e4tent t$at t$e Pri4acy Act incl%des $ealt$ care 'r&vidersE 'r&visi&ns in
t$e la1 a''ear desi(ned t& sa)e(%ard re'&rtin( &li(ati&ns estalis$ed %nder )ederal and 'r&vincial la1!
H&1everE eca%se &) its restricti&ns &n n&n7c&nsens%al in)&rmati&n c&llecti&nE t$e Pri4acy Act ma+
seri&%sl+ im'ede '%lic $ealt$ s%rveillance and in)&rmati&n data mana(ement s+stems!
T$e asic tenet &) t$e Pri4acy Act is t$e reF%irement t$at all individ%als m%st e4'licitl+ c&nsent t& t$e
c&llecti&nE %seE and discl&s%re &) t$eir 'ers&nal in)&rmati&n! Primaril+ intended )&r 'rivate enter'riseE t$e
Pri4acy Act $as (enerated c&ntr&vers+ in t$e '%lic $ealt$ sect&r eca%se &) its ver+ s'eci)ic de)initi&n &)
Opersonal health informationDP
2"/
i1 information concerning the physical or mental health of the individual3
ii1 information concerning any health service provided to the individual3
iii1 information concerning the donation by the individual of any body part or any bodily substance of
the individual or information derived from the testing or e2amination of a body part or bodily
substance of the individual3
iv1 information that is collected in the course of providing health services to the individual3 or
v1 information that is collected incidentally to the provision of health services to the individual1
T$is e4tremel+ r&ad de)initi&n c&vers all $ealt$ in)&rmati&n a&%t an individ%al $&1ever t$at data is
acF%iredE incl%din( incidentall+7acF%ired in)&rmati&n d%rin( t$e 'r&visi&n &) $ealt$ services! Since t$e
Pri4acy Act als& a''lies t& t$e n&n7'r&)it $ealt$ sect&rE it '&tentiall+ 'laces int& F%esti&n t$e le(alit+ &) a
variet+ &) e4istin( &r '&tential in)&rmati&n7s$arin( 'racticesD
i1 The ,ct would ma.e difficult the measuring of health outcomes and quality of care
BCDEF
ii1 The ,ct would impede providers from submitting insurance claims on behalf of patients
BCDGF
iii! The ,ct would obstruct communication between members of a health care team treating a patient
CDH
or among different providers
BCIJF
iv1 The ,ct would impose a heavy burden on public health care researchers
CI>
/"
v1 The ,ct would deter any electronic data system utilized for the surveillance of infectious disease and
public health trends
T$ese c&ncerns indicate t$at t$e Pri4acy Act 1as n&t dra)ted 1it$ s%))icient attenti&n t& t$e 'artic%lar
iss%es )acin( t$e $ealt$ sect&r! -a;&r sta2e$&lders $ave called )&r t$e devel&'ment &) se'arate re(%lati&ns
1it$in t$e Pri4acy Act t$at 1&%ld s'eci)icall+ a''l+ t& t$e '%lic $ealt$ sect&r!
Several additi&nal F%esti&ns need t& e clari)ied %nder t$e Pri4acy ActD
i1 ,re non!profit health care providers insulated by the fact that the Pri8acy !ct focuses on
commercial activity, and the information at issue must be collected, used, or disclosed Kin the course
ofK such activityL
ii1 #f such is the case, would the Pri8acy !ct be triggered if non!profit providers enter into contractual
obligations involving the data transfer or management of personal health information1
iii1 -oes the form of consent required under the Pri8acy !ct vary, with varying degrees according to
the sensitivity nature of the information requiring e2press consentL
iv1 -oes the Pri8acy !ct allow for non!consensual disclosure if the disclosure is requested Kfor the
purposes of enforcing any law of "anada, a province or a foreign @urisdictionK or Kfor the purpose
of administering any law of "anada or a province1K
v1 -o these e2ceptions e2tend to reporting requirements under provincial or federal public health
legislation provided those laws impose a reporting obligation1
vi1 #s non!consensual disclosure permitted if an emergency threatens the life, health or security of an
individual, or group of individuals 7e1g1 community81
vii1 ould this only apply to reporting during an infectious disease outbrea., but not ordinary disease
surveillance1
It is clear t$at t$e Pri4acy Act raises si(ni)icant di))ic%lties )&r t$e c&llecti&n and mana(ement &) disease
s%rveillance dataE since t$e Pri4acy Act 1&%ld 'revail &ver 'r&vincial '%lic $ealt$ stat%tes! Clearl+E a
c&m're$ensive set &) 'r&'&rti&nalit+ 'rinci'les need t& e estalis$ed t& (&vern t$e c&llecti&n and %se &)
'%lic $ealt$ in)&rmati&nE incl%din( t$e )&ll&1in( 'r&vis&sD
i1 non!consensual data use is necessary in order to promote a legitimate public health ob@ective
ii1 this ob@ective cannot be achieved with non!identifiable personal health information
iii1 the public interest in public health outweighs any harm to the particular individual7s8 concerned
T$ese 'r&'&rti&nalit+ 'rinci'les need t& devel&' additi&nal dimensi&nsD
i1 collect or disclose as little identifying information as required in order to achieve the stated public
health ob@ective3
ii1 convert to non!identifiable data during initial stages of data collection, thereby limiting access to
identifiable personal health information3
iii1 prohibit the use of identifiable personal health information to ma.e decisions about an individual7s8
in other conte2ts 7e1g1, with respect to disability benefits, income ta2 credits, etc183 and
iv1 ta.e data security precautions to prevent improper use or further disclosure for unauthorized
purposes1
It is c&ncl%ded t$at t$e Pri4acy Act is t&& s1ee'in( and restrictiveE and m%st e amended t& 'r&'erl+
acc&mm&date in)ecti&%s disease s%rveillance and '%lic $ealt$ data mana(ement s+stems! It is n&t clear i)
t$e Pri4acy Act a''lies t& $ealt$ care 'r&viders! T& t$e e4tent t$at it d&esE its ti($t restricti&ns &n t$e n&n7
c&nsens%al c&llecti&n &) in)&rmati&n t$reatens t& %ndermine '%lic $ealt$ re'&rtin( &li(ati&ns %nder
)ederal and 'r&vincial la1! T$e im'ediments '&sed + t$e Pri4acy Act t& '%lic $ealt$ mana(ement
s+stems c&%ld e addressed t$r&%($ a''r&'riate stat%t&r+ amendments! H&1everE t$e Pri4acy Act ma+ still
'revail &ver 'r&vincial '%lic $ealt$ stat%tes since an+ c&ntestin( &) t$e Pri4acy Act 1&%ld a%t&maticall+
//
inv&2e t$e ,anadian ,harter o2 -ights and *reedo5sE necessitatin( t$e inv&cati&n &) t$e Not
Withstanding ,lause! 9$ile )e1 1&%ld c&ntest t$at $ealt$ researc$ is deemed t& e &) (reat s&cial
im'&rtanceE t$ere is an intrinsic ri($t &) all Canadians t& 'rivac+ and c&n)identialit+! T$is ri($t is
c&nstit%ti&nall+ ens$rined in &t$ t$e ,anadian ,harter o2 -ights and *reedo5s
A2/2B
and t$e Fuebec
,harter o2 7u5an -ights and *reedo5s!
A2/*B
T$e '&tential di))ic%lties '&sed + t$e Pri4acy Act t& '%lic $ealt$ and disease s%rveillance are 'art &) a
lar(er set &) c&ncerns re(ardin( its a''licati&n t& t$e $ealt$ sect&r!
A2/,B
As 1e attem't t& im'lement a
str&n(er nati&nal s+stem &) disease s%rveillanceE )ederal le(islati&n dealin( 1it$ $ealt$ in)&rmati&n 'rivac+
m%st e revie1ed and eit$er amended &r its a''licailit+ clari)ied!
Privac+ le(islati&n and c&des are desi(ned t& 'r&vide individ%als 1it$ t$e means t& 'revent e4'l&itati&n &)
t$eir 'ers&nal in)&rmati&n &r its %se in 1a+s &ver 1$ic$ t$e+ $ave n& c&ntr&l! Ultimatel+E 'rivac+ le(islati&n
ac2n&1led(es individ%al c&ntr&l &ver %se &) 'ers&nal in)&rmati&nE t$at isE &ver t$e c&llecti&nE %seE
discl&s%reE retenti&n and dis'&sal &) t$eir in)&rmati&n + c&llectin( &r(ani<ati&ns! In t$is c&nte4tE 'rivac+
reF%irements t$at are de)ined + t$e ten standard 'rivac+ 'rinci'les &%tlined in 1chedule $ &) t$e Pri4acy
Act 'resent a ma;&r c$allen(e t& t$e $ealt$ care sect&r! T$e 'rinci'les 'r&vide n& (%idance in terms &)
standards! T$e+ d& 'r&videE $&1everE s&me (%idance re(ardin( %siness r%les! A n%mer &) reF%irements in
t$e ten 'rinci'les remain di))ic%lt t& reali<e in t$e $ealt$ sect&rE 'artic%larl+ &1ners$i' &) in)&rmati&n as
&''&sed t& rec&rds t$at c&ntain 'ers&nal in)&rmati&nE and t$e reF%irement t& n&ti)+ re(ardin( '%r'&ses &)
c&llecti&nE &tainin( 'atient c&nsentE and n&ti)icati&n re(ardin( c$an(es t& %ses and s$arin( 1it$ t$ird
'arties! An+ attem't t& devel&' 'rivac+ tec$n&l&(+ in '%lic $ealt$ dataase mana(ement s+stems m%st
c&nsider t$ese asic 'rinci'les and ass&ciated %siness r%les! T$e 'rivac+ criteria devel&'ed + Healt$
CanadaQs O))ice &) Healt$ and t$e In)&rmati&n Hi($1a+ ma+ serve as an a''r&'riate m&del!
2/"
T$is m&del
s%mmari<es t$e ten 'rivac+ 'rinci'les &) t$e Pri4acy Act (&verned + a set &) %siness r%les in s%''&rt &)
critical im'lementati&n reF%irements in an in)&rmati&n tec$n&l&(+ envir&nment! T$e+ are ased &n t$e
Canadian Standards Ass&ciati&n:s &odel ,ode 2or the Protection o2 Personal 9n2or5ationE t$at $as een
inc&r'&rated int& Sc$ed%le # &) t$e Pri4acy Act! 9$ile t$is ,ode 1as n&t desi(ned s'eci)icall+ )&r $ealt$
researc$E it can 'r&vide (%idance t& '%lic $ealt$ data mana(ement!
,0N,L8190N
An+ instit%ti&n mandated t& c&&rdinate t$e devel&'ment and maintenance &) a c&m're$ensive and
inte(rated $ealt$ in)&rmati&n s+stem ass%mes res'&nsiilit+ )&r 'r&vidin( and c&&rdinatin( t$e 'r&visi&n &)
acc%rate and timel+ in)&rmati&n necessar+ t& estalis$ s&%nd $ealt$ '&liciesE mana(e t$e $ealt$ care s+stem
e))ectivel+E and (enerate '%lic a1areness &) )act&rs a))ectin( (&&d $ealt$! Since res'ectin( 'ers&nal
'rivac+E sa)e(%ardin( t$e c&n)identialit+ &) individ%al rec&rdsE and s+stem sec%rit+ are critical t&
s%ccess)%ll+ meetin( t$is mandateE $ealt$ a%t$&rities s$&%ld desi(nate Privac+ O))icer and remain
c&mmitted t& ens%rin( data 'rivac+! One s%c$ met$&d is t& c&nd%ct a 'rivac+ im'act assessment &r a%dit &n
eac$ &) its data $&ldin(s &n an ann%al asis! T$is a''r&ac$ is essential t& assessin( t$e '&ssile 'rivac+7
related c&nseF%ences &) s+stems and 'ractices )&r t$e c&llecti&nE %seE and discl&s%re &) 'ers&nal
in)&rmati&n!
9$ile dataases c&%ld e desi(ned n&t t& c&llect &r maintain in)&rmati&n t$at directl+ identi)ies individ%als
>e1g! nameE addressE and tele'$&ne n%mer?E it is inevitale t$at all dataases d& c&llect s&me data elements
t$at c&%ldE in c&minati&n 1it$ &t$er in)&rmati&nE lead t& 'ers&nal identi)icati&n iss%es >e1g! $ealt$ care
n%merE '&stal c&deE and )acilit+ assi(ned n%mersE etc!?! As s%c$E t$e instit%ti&n m%st a''l+ discl&s%re
av&idance 'ractices >e1g! mas2sE a((re(ati&nsE and tr%ncati&ns?E as 1ell as reF%ire em'l&+ee and %ser
c&n)identialit+ a(reementsE t& minimi<e re7identi)icati&n '&tential! Dataases 1$ic$ c&llect 'ers&nal $ealt$
in)&rmati&n related t& dia(n&ses and 'r&ced%res 'er)&rmed in t$e $ealt$ care )acilit+ is essential )&r t$e
/0
classi)icati&n and anal+sis &) m&ridit+ and m&rtalit+ in)&rmati&n )&r statistical '%r'&sesE )&r t$e inde4in(
&) $&s'ital rec&rds + disease and &'erati&nsE and )&r t$e a''r&'riate st&ra(e and retrieval &) data! 9$ile
t$is data is c&llected in c&ded )&rm and ma+ reF%ire c&de 2e+s as 1ell as s'ecial trainin( t& render t$em
meanin()%lE t$e '&tential )&r identi)+in( 'ers&nal in)&rmati&n still remains! As s%c$E additi&nal sets &)
'rivac+ tec$n&l&(ies s$&%ld e a''lied t& s%c$ data access s+stemsE incl%din(D
anonymizing technology
platform for privacy preferences
A2//B
infomediaries and identity management systems
A2/0B
trust management systems
A2/3B
smart cards and personal computer cards
A2/5B
biometrics and biometric encryption
A206E20#B
public .ey infrastructure and public .ey certificates
A202B
Since (&vernments and NGOQs rel+ $eavil+ &n c&m'%teri<ed 'r&cesses and electr&nic net1&r2s )&r dail+
activitiesE c&mm%nicatin( and s$arin( critical in)&rmati&n reF%ires an essential element &) tr%st and
c&n)idence in t$&se 'artici'atin( in t$e electr&nic transacti&ns! A )rame1&r2 &) '&liciesE servicesE and
encr+'ti&n s&)t1are is n&1 deemed essential t& ens%re t$e sec%re transmissi&n &) sensitive in)&rmati&n &ver
internal and e4ternal net1&r2s! Feat%res s$&%ld incl%de 'rivac+ ass%ranceE access c&ntr&lE inte(rit+E
a%t$enticati&n and n&n7re'%diati&n t& (%arantee t$e sec%rit+ &) electr&nic transacti&ns and c&mm%nicati&ns!
T$e c&mm%nicati&n envir&nment m%st ma2e certain t$at sensitive electr&nic c&mm%nicati&ns remain
'rivate and tam'er7'r&&)! It m%st 'r&vide ass%rances t$at 'artici'ant identities in transacti&ns are valid!
P%lic 2e+ in)rastr%ct%re and certi)icates are t$e ind%str+ standards n&1 acce'ted + t$e Federal
G&vernment &) Canada!
A20*B
B+ %sin( di(ital si(nat%resE encr+'ti&n tec$n&l&(ies and a c&m're$ensive
)rame1&r2 &) '&licies and 'r&ced%resE t$e '%lic 2e+ in)rastr%ct%re can ens%re %ser c&n)identialit+ and
a%t$enticati&nE data inte(rit+ and transacti&n n&n7re'%diati&n! A '%lic $ealt$ GIS s+stem 1&%ld reF%ire
similar sec%rit+ meas%resE as man+ $ealt$ de'artmentsQ servers are 1it$in G&vernment 1ide area net1&r2s!
%91,81190N > -/,0&&/N%A.90N1
T$e 'rivac+ iss%es t$at c%rrentl+ c&nstrain t$e e))icient e4c$an(e &) '%lic $ealt$ dataE 1$et$er t$r&%($
CanadaQs Healt$ In)&1a+ &r t$e CGDIE reF%ire t$e c&lla&rati&n &) CanadaQs Privac+ C&mmissi&nerE t$e
@%stice De'artmentE Healt$ CanadaE t$e Pr&vincial and Territ&rial Privac+ C&mmissi&ners! Healt$
a%t$&rities 1ill %nd&%tedl+ e inv&lved in de)inin( t$eir %siness 'ractices and needsE s& t$at an+
amendments H clari)icati&ns t& t$e Privac+ Act 1&%ld enale n&rmal $ealt$ care services and disease
s%rveillance! Ge&C&nnecti&ns s$&%ld c&lla&rate 1it$ s%c$ a%t$&rities in revie1in( 'rivac+ la1s in t$e
c&nte4t &) e4'andin( t$e CGDI int& t$e '%lic $ealt$ d&main!
T$e Privac+ Act la+s &%t t$e c&nditi&ns )&r c&m'liance 1it$ 'rivac+ re(%lati&ns! Eac$ Pr&vince and
Territ&r+ $ave additi&nal '&ints %nder t$eir Privac+ Acts! It is clear t$at s&me )&rm &) $arm&ni<ati&n is
needed acr&ss ;%risdicti&ns i) data is t& e e4c$an(eale am&n( $ealt$ a%t$&ritiesE researc$ (r&%'sE and t& a
limited e4tentE t$e (eneral '%lic! Ge&C&nnecti&ns s$&%ld 'artici'ate in t$is $arm&ni<ati&n 'r&cessE +
'r&vidin( detailed s'eci)icati&n &n t$e ailit+ &) CGDI7enaled in)rastr%ct%re t& mana(e %ser 'ermissi&nsE
di(ital ri($ts H '%lic 2e+ accessE and ens%re data 'rivac+!
Ge&C&nnecti&ns s$&%ld devel&' a (%idance d&c%ment )&r CGDI7nested a''licati&n $&sts H devel&'ersE
1$ic$ &%tlines 'rivac+ iss%esE de)ines t$e minim%m reF%irements )&r ens%rin( data 'rivac+ >e!(! sam'le
disclaimersE 'rivac+ statementsE licenses?E &%tlines data sec%rit+ tec$n&l&(ies >e!(! '%lic 2e+
a%t$enticati&n H di(ital ri($ts mana(ement?E and 'r&vides c&ntact in)&rmati&n t& 'rivac+7related a%t$&rities!
Ge&C&nnecti&ns ma+ als& c&nsider settin( %' an et$ics revie1 c&%ncil &r &ardE t$at 1&%ld deal s'eci)icall+
/3
1it$ $ealt$ a''licati&n devel&'ersE t& ens%re t$at 'rivac+ sa)e(%ards are in 'lace I t$ere+ ens%rin( t$e
inte(rit+ &) t$e CGDI as a 1$&le!
/5
+91 %A.A 1/.1
9N.-0%8,.90N
At t$e $eart &) an+ GIS a''licati&n la+s data 1are$&%ses! 9it$&%t access t& eF%itale data res&%rcesE GIS
a''licati&ns 1&%ld $ave little val%e )&r devel&'in( sim%lati&n m&dels in climate c$an(e &r medical
e'idemi&l&(+! Bel&1 is a selected list &) Internet lin2s &))erin( '%lic d&main (e&s'atial and envir&nmental
dataE s&me 1it$ redistri%ti&n restricti&ns! T$e cate(&ries areD Base -a' DataE Climate DataE Sea7Level
Rise DataE and Disease .ect&rs Data!
As 1it$in t$e $ealt$ sect&rE GIS H Cadastral data can e inc&nsistentE i) ri(&r&%s standards are n&t em'l&+ed!
Sec&ndl+E data can e di))ic%lt t& &tain 1$en (&vernments H 'rivate data &ri(inat&rs ma2e t$eir data c&st7
'r&$iitive! Ge&Base and t$e CGDI $ave made si(ni)icant 'r&(ress in (ettin( Canadian Pr&vinces and
Territ&ries t& 'artici'ate in t$e nati&nal s'atial data in)rastr%ct%re + s$arin( )rame1&r2 data at n& c&st!
-&re e))&rt needs t& e made in &rder t& %nl&c2 t$ematic data sets >s%c$ as $ealt$E envir&nment H air F%alit+E
ener(+E trans'&rtati&n H r&ad t&'&l&(+E and in)rastr%ct%re?! In t$is res'ectE t$e Ne1 Br%ns1ic2 Ge&matics
Revie1 is assessin( 'r&vincial reF%irements )&r access t& dataE 1e7ma' a''licati&nsE and services! N&va
Sc&tiaQs Ge&7N&va is t$e m&del )&r distri%ted access and 1e7ma' services in Canada I 'artners$i'
et1een FederalE Pr&vincialE and -%nici'al (&vernments $as dem&nstrated t$e vertical inte(rati&n t$at is
needed acr&ss Canada )&r $arm&ni<ati&n &) )rame1&r2 data sets! Ne4tE t$e CGDI needs t& c&nsider
$&ri<&ntal inte(rati&n &) data acr&ss sect&rs >$ealt$E envir&nmentE sa)et+E c&mm%nities? in &rder t& 'r&vide
val%e7added services t& Canadians and t& (reatl+ im'r&ve decisi&n ma2in(! .ertical and H&ri<&ntal
inte(rati&n &) data are c&nsidered essential )&r CanadaQs (e&s'atial assets t& tr%l+ ene)it t$e Canadian
ec&n&m+E enc&%ra(e s&cial 'r&(ressE and 'r&tect t$e $ealt$ &) Canadians and &%r nat%ral res&%rces!
BA1/ &AP %A.A
G)97!) .!-!#!
Ge&Base Canada
20,
is a )ederalE 'r&vincial and territ&rial (&vernment initiative &verseen + t$e
Canadian C&%ncil &n Ge&matics!
06
It is %nderta2en t& ens%re t$e 'r&visi&n &)E and access t&E a c&mm&nE %'7t&7date and maintained ase
&) F%alit+ (e&s'atial data )&r all &) Canada! T$r&%($ t$e Ge&Base '&rtalE %sers 1it$ an interest in t$e
)ield &) (e&matics $ave access t& F%alit+ (e&s'atial in)&rmati&n at n& c&st and 1it$ %nrestricted %se!
User re(istrati&n is mandat&r+ )&r d&1nl&adin( Ge&Base data! T$e additi&n &) a 9e -a''in(
Service all&1s )&r data vis%ali<ati&n via a T.ie1 DataT )%ncti&nalit+ )&r eac$ Ge&Base t$emeE )&r
e4am'le )&r Di(ital Elevati&n DataE )&ll&1in( O'en Ge&S'atial C&ns&rti%m standards! -&st &)
Ge&ase data is 'r&d%ced %nder 'artners$i' 1it$ )ederalE 'r&vincial and territ&rial a(encies! Ge&ase
'artners are inv&lved in di))erent levels &) t$e data 'r&d%cti&n 'r&cess s%c$ as 'r&;ect )%ndin(E
s$arin( &) s&%rce data &r + 1&r2in( &n data c&llecti&n and data 'r&cessin(!
L!-#!T17 )T0G 0RI# 09!I.
T$e Ge&C&ver Landsat m&saics are delivered in a Universal Transverse -ercat&r H 9&rld Ge&detic
S+stem 'r&;ecti&n
20"
! T$e m&saics e4tends N&rt$7S&%t$ &ver " de(rees &) latit%deE and s'an East7
9est )&r t$e )%ll 1idt$ &) t$e Universal Transverse -ercat&r <&ne! Ima(es c&ntained in t$e datasets
1ere &tained )r&m Landsat70 carr+in( an En$anced T$ematic -a''er! Landsat70E is %t &ne &) a
series &) NASA satellites la%nc$ed d%rin( t$e 'ast t$irt+ +ears t& st%d+ t$e Eart$:s envir&nmentE
res&%rcesE and nat%ral and s+nt$etic c$an(es &n t$e Eart$:s s%r)ace! Landsat is t$e &nl+ satellite
s+stem &) its t+'e 1it$ t$e missi&n t& c&llectE arc$iveE and distri%te data &) all t$e Eart$:s land
s%r)ace!
#IGIT!L .5!RT 9F T5) W9RL#
T$e Di(ital C$art &) t$e 9&rld 1e site is mana(ed + t$e Penns+lvania State Universit+ -a's
Lirar+! It all&1s t$e %ser t& d&1nl&ad &%ndar+ and la+er )iles )&r di))erent c&%ntriesE in ArcHINFO
e4'&rt )&rmat! A ma''in( )%ncti&n all&1s )&r 'revie1 &) t$e data 'ri&r t& d&1nl&ad! T$e entire data
set is als& availaleE &n CD7RO-
20/
!
,L9&A./ ,7AN+/ AN% 7/AL.7
-ete&r&l&(ical c&nditi&ns and climatic eventsE li2e $%rricanes and $eat 1avesE a))ect $%man $ealt$ and
c&ntri%te t& t$e s'read &) disease + creatin( &'timal inc%ati&n envir&nments! F&r t$is reas&nE 1e are
incl%din( t$e )&ll&1in( GIS data s&%rces!
W9RL#.LI0
9ORLDCLI- is a set &) (l&al climate la+ers &n a sF%are 2il&meter (rid! T$e data la+ers are
(enerated t$r&%($ inter'&lati&n &) avera(e m&nt$l+ climate data )r&m 1eat$er stati&ns &n a *6 arc7
sec&nd res&l%ti&n (rid >&)ten re)erred t& as T# 2m2T res&l%ti&n?! .ariales incl%deD m&nt$l+ t&tal
'reci'itati&nR m&nt$l+ meanE minim%m and ma4im%m tem'erat%reR and #5 derived i&climatic
variales! Additi&nal variales are added &n an ann%al asis! Data sets are $%(e >meas%red in
Gi(aits?
200
!
0)T)9R9L9GI.!L )R;I.) .!-!#!
T$e C-C In)&rmatics Branc$ 'r&vides centrali<ed c&m'%tin( and telec&mm%nicati&ns services t&
meet t$e Atm&s'$eric Envir&nment Pr&(rams: &;ectivesE s%''&rt &t$er de'artmental &'erati&nsE
and assist &t$er a''r&ved %sers! It &'erates and maintains t$e s%'erc&m'%ter )acilit+ in D&rval and
vari&%s telec&mm%nicati&ns net1&r2s! C-C O'erati&ns Branc$ is res'&nsile )&r t$e
mete&r&l&(ical &'erati&ns &) n%mer&%s 'r&d%cti&n s+stems )&r 1eat$erE climateE air F%alit+E and
envir&nmental 'r&(rams at t$e Canadian -ete&r&l&(ical Centre! In additi&nE t$e Branc$ 'r&vides
$i($l+ s'eciali<ed s%''&rt t& envir&nmental emer(encies! Its &%t'%ts c&ntri%te and satis)+ nati&nal
and internati&nal -ete&r&l&(ical Service &) Canada:s &'erati&nal and related c&mmitments!
0#
-!TI9-!L .)-T)R F9R !T09P5)RI. R))!R.5
NCAR:s C&mm%nit+ Data P&rtal >CDP? is a c&llecti&n &) eart$ science datasets )r&m NCARE UCARE
UOPE and 'artici'atin( &r(ani<ati&ns in t$e )&ll&1in( researc$ areasD &ceanicE atm&s'$ericE s'ace
1eat$er and t%r%lence! T$r&%($ a''licati&n &) t$e climate m&delin( s+stem in CGDE NCAR is a
ma;&r c&ntri%t&r t& t$e assessments &) t$e Inter(&vernmental Panel &n Climate C$an(e! C%rrentl+
em'$asis is &n t$e detailed anal+sis &) t$e CCS- sim%lati&ns 'r&d%ced )&r t$e IPCC F&%rt$
Assessment Re'&rt >FAR? )&r a 1ide ran(e &) st%dies &) climate variailit+ and climate c$an(e! GIS
data sets are availale )r&m t$eir 1esite I )&r 'redictive climate m&delin(E 1$ic$ can enale
m&delin( &) $ealt$ ris2 )act&rs in )%t%re climate scenari&s!
-!TI9-!L .LI0!T) #!T! .)-T)R
Nati&nal Climate Data Center
203
E &verseen + t$e U!S! De'artment &) C&mmerceE is t$e 1&rld:s
lar(est arc$ive &) climate data! T$e center 'r&d%ces n%mer&%s climate '%licati&ns and res'&nds t&
data reF%ests )r&m all &ver t$e 1&rld! It &'erates t$e 9&rld Data Center )&r -ete&r&l&(+ l&cated in
As$evilleE N&rt$ Car&linaE and t$e 9&rld Data Center )&r Pale&climat&l&(+ l&cated in B&%lderE
C&l&rad&! It s%''&rts a t$ree tier nati&nal climate services s%''&rt 'r&(ram t$at incl%de re(i&nal
climate centers and state climat&l&(ists! It &))ers a 1ide ass&rtment &) data servicesE s&me )reeE %t
m&stl+ t$r&%($ s%scri'ti&n services!
P!L)9.LI0!T9L9GE
Pale&climat&l&(+ Branc$ &) t$e Nati&nal Climate Data Center
205
$&%ses st%dies &n 'ast climateE 'ri&r
t& instr%mental 1eat$er meas%rements! Pale&climat&l&(ists %se cl%es )r&m nat%ral T'r&4+T s&%rces
s%c$ as tree rin(sE ice c&resE c&ralsE and &cean and la2e sediments t& %nderstand nat%ral climate
variailit+! NOAA Pale&climat&l&(+ &'erates t$e 9&rld Data Center )&r Pale&climat&l&(+ and t$e
A''lied Researc$ Center )&r Pale&climat&l&(+E 1it$ t$e (&al t& 'r&vide data and in)&rmati&n
scientists need t& %nderstand nat%ral climate variailit+ as 1ell as )%t%re climate c$an(e!
Internati&nal 'artners incl%de t$e Past Gl&al C$an(es Pr&(ram &) t$e Internati&nal Ge&s'$ere
Bi&s'$ere Pr&(rammeE and t$e 9&rld Data Center s+stem &) t$e Internati&nal C&%ncil &) Scienti)ic
Uni&ns!
9R-L #!!. .LI0!T) .9LL).TI9-
T$e Oa2 Rid(e Nati&nal La&rat&r+:s Distri%ted Active Arc$ive Center >ORNL DAAC? c&m'ilesE
arc$ivesE and distri%tes several (l&al climate data sets
236
! Climate data incl%de meas%red and
m&deled val%es )&r variales s%c$ as tem'erat%reE 'reci'itati&nE $%midit+E radiati&nE 1ind vel&cit+E
and cl&%d c&ver! Climate $&ldin(s incl%de stati&n data c&llected )r&m t$e Gl&al Hist&rical
Climat&l&(+ Net1&r2E 1$ic$ c&m'rises t$&%sands &) stati&ns 1&rld1ide and incl%des rec&rded data
val%es s'annin( )r&m #0"* t& t$e #556s! -&deled (ridded climate data is als& availale re'resentin(
m&nt$l+ mean val%es )&r variales s%c$ as mean tem'erat%reE di%rnal tem'erat%re ran(eE
'reci'itati&nE rain da+sE s%ns$ine $&%rsE 1et da+ )reF%enc+E va'&r 'ress%reE cl&%d c&verE and (r&%nd7
)r&st )reF%enc+ inter'&lated )r&m climate stati&n data %sin( var+in( al(&rit$ms and tec$niF%es t&
'r&vide (l&al data c&vera(e )&r t$e land s%r)aces &) t$e eart$!
G)9 #!T! P9RT!L
T$e GEO Data P&rtal is t$e a%t$&ritative s&%rce )&r data sets %sed + t$e United Nati&ns
Envir&nment Pr&(ramme and its 'artners in t$e Gl&al Envir&nment O%tl&&2 Re'&rt and &t$er
inte(rated envir&nmental assessment 'r&;ects! T$e GEO Data P&rtal:s &nline dataase $&lds m&re
t$an #E,66 data sets c&m'risin( m&re t$an ,"6 di))erent varialesE as nati&nalE s%re(i&nalE re(i&nal
and (l&al statistics &r as (e&s'atial data sets >ma's?E c&verin( t$emes li2e )res$1aterE '&'%lati&nE
)&restsE GHG emissi&nsE climateE disastersE $ealt$ and GDP! A %ser ma+ dis'la+ t$e data as ma'sE
(ra'$sE data tales &r d&1nl&ad t$e data in di))erent )&rmats
23#
!
02
Ne1 data sets are added alm&st dail+E and incl%de m&re t$an #30 data sets &n (reen$&%se (as
emissi&nsD
carbon dio2ide emissions: cement production, gas flaring, gas fuel, liquid fuel, solid fuel,
fossil fuels3
'9C, S9C, suspended particulates3
ozone!depleting substances: chlorofluorocarbons 7"F"s8, hydrochlorofluorocarbons
70"F"s8, methyl bromide3
"0M emissions: agriculture, animal breeding, enteric fermentation, energy, fugitive fuel
emissions, waste management, land!use and forestry, transportation, and other
anthropogenic sources1
1/A L/;/L -91/
C&astal st&rm s%r(es and sea level rise $ave ma;&r $ealt$ im'licati&nsE incl%din(D s%r(e in demand )&r
d&ct&rsH'$+sicians and medical s%''liesE evac%ati&n &) l&17l+in( areas >incl%din( clinics H sc$&&ls?E and
l&n( term relie) and re$ailitati&n reF%irements! T$ere)&reE 1e $ave incl%ded t$e )&ll&1in( list &) GIS data
s&%rcesD
0*
G55
GSHHS >Gl&al Sel)7c&nsistentE Hierarc$icalE Hi($7res&l%ti&n S$&reline Dataase? is a $i($7
res&l%ti&n s$&reline data set amal(amated )r&m t1& data ases in t$e '%lic d&main
232
! T$e data $ave
%nder(&ne e4tensive 'r&cessin( and are )ree &) internal inc&nsistencies s%c$ as erratic '&ints and
cr&ssin( se(ments! T$e s$&relines are c&nstr%cted entirel+ )r&m $ierarc$icall+ arran(ed cl&sed
'&l+(&ns! T$e data can e %sed t& sim'li)+ data searc$es and data selecti&nsE st%d+ t$e statistical
c$aracteristics &) s$&relines and land7massesE &r devel&' sea7level )&recast m&dels res%ltin( )r&m
climate c$an(e! It c&mes 1it$ access s&)t1are and r&%tines t& )acilitate decimati&n ased &n a
standard line7red%cti&n al(&rit$m! T$e dataase is maintained + NOAA:s Nati&nal Ge&'$+sical
Data Center!
-9!!A 0)#I,0 R)9L,TI9- #IGIT!L ;).T9R 59R)LI-)
NOAA:s -edi%m Res&l%ti&n Di(ital .ect&r S$&reline is a $i($7F%alit+E GIS7read+E (eneral7%se
di(ital vect&r data set &ri(inall+ created + t$e Strate(ic Envir&nmental Assessments divisi&n &)
NOAA:s O))ice &) Ocean Res&%rces C&nservati&n and Assessment! T$e -edi%m Res&l%ti&n Di(ital
.ect&r S$&reline is n&1 mana(ed + t$e NOS S'ecial Pr&;ects O))ice! C&m'iled )r&m $%ndreds &)
NOAA c&astal c$artsE t$is 'r&d%ct c&m'rises &ver 0"E666 na%tical miles &) c&astline >nearl+ 2!"
milli&n vertices?E re'resentin( t$e entire c&ntermin&%s United States &) America! Alas2aE t$e
Ha1aiian IslandsE P%ert& Ric&E and all &t$er interests and territ&ries &) t$e United States are n&t
incl%ded in t$e c&llecti&n! T$ese di(ital (e&(ra'$ic &%ndar+ )iles are availale )&r d&1nl&ad )r&m
NOS SPO &r ma+ e &rdered directl+ )r&m SPO as an entire s%ite &n CD7RO- )r&m t$e
NOAAHS'ecial Pr&;ects O))ice FTP Server
23*
!
)-;IR9-0)-T .!-!#! )!1L);)L RI) PR9@).T
OIm'acts &) Sea7Level Rise and Climate C$an(e &n t$e C&astal V&ne &) S&%t$eastern Ne1
Br%ns1ic2P is a t$ree7+earE M2!" milli&n st%d+ mana(ed + Envir&nment Canada and carried &%t +
scientists and researc$ers )r&m &ver a d&<en (&vernment and academic (r&%'s! In carr+in( &%t t$e
'r&;ectE researc$ers are st%d+in( $&1 t$e c&astal area $as een c$an(in( in 'ast +ears and ma2in(
'redicti&ns &n $&1 it 1ill c$an(e &ver t$e ne4t #66 +ears! Usin( ver+ 'recise s%rve+in( met$&dsE
incl%din( LIDARE di(ital elevati&n ma's are ein( created t& s$&1 1$ic$ areas 1&%ld e a))ected
>&r )l&&ded? + $i($er sea7levelsE es'eciall+ 1$en c&mined 1it$ $i($ tides &r st&rm s%r(e!
0,
GRI#1),R9P)
GRID7E%r&'e
23,
data sets are maintained + t$e United Nati&ns Envir&nment Pr&(rammeE )&r t$e
'%r'&se &) assistin( t$e internati&nal c&mm%nit+ and individ%al nati&ns in ma2in( s&%nd decisi&ns
related t& res&%rce mana(ement and envir&nmental 'lannin(E and 1$ere a''licale 'r&vidin( data
)&r scienti)ic st%dies! 9it$in t$e &verall GRID7net1&r2E GRID7E%r&'e )&c%ses &n t$e creati&nE
acF%isiti&nE d&c%mentati&nE arc$ive and disseminati&n &) Gl&al and E%r&'ean di(ital (e&re)erenced
envir&nmental data! T$ese data sets are $eld and distri%ted in t$e )&rm &) c&m'%terised ma's!
T$ese data sets are s'atiall+ re)erencedR 1$ic$ enales (e&(ra'$ic in)&rmati&n t& e %sed in t$e
anal+ses &) &t$ $%man and '$+sical envir&nmentsE t+'icall+ via GIS and Ima(e Pr&cessin(
s&)t1are! GRID7E%r&'e als& $&lds a si(ni)icant n%mer &) statistical and ta%lar dataases
c&ncernin(E in 'artic%larE t$e $%man envir&nment! Cate(&ries incl%de atm&s'$ericE i&s'$ericE
$+dr&s'$ericE lit$&s'$eric and ant$r&'&(enic! T$ematic la+ers incl%deD climateE s&ilsE ve(etati&n and
1ater7related data setsE as 1ell as in)rastr%ct%ral and s&ci&7ec&n&mic data sets &n $%man '&'%lati&nE
&%ndariesE r&ads and rail1a+s! T$ese data sets are )%ll+ d&c%mented in an electr&nic meta7dataase
catal&(%e!
%91/A1/ ;/,.0-1
C&ncerns &ver Avian Fl% and &t$er <&&n&tic disease >i!e! transmissile et1een animals and t& $%mans?E
increase t$e need )&r t$e '%lic $ealt$ c&mm%nit+ t& access 9-SH9FS services 1$ic$ 'r&vide data a&%t
<&&n&tic diseases >i!e! s%s'ected casesE mi(rat&r+ ird 'atterns etc?! T$e )&ll&1in( are s&me e4am'les &)
t$ese t+'es &) GIS data s&%rcesD
W)T -IL) ;IR, 0!P
Disease ris2 )act&rs incl%de climate H mete&r&l&(ical c&nditi&nsE 1$ic$ can e4acerate disease
vect&rsE s%c$ as mi(rat&r+ irdsE m&sF%it&esE etc! Here is an e4am'le &) a ma'7ased sentinel
in)&rmati&n s+stem )&r s%s'ected H c&n)irmed cases &) 9est Nile in irds in t$e USA! Similarl+E
'%lic $ealt$ a%t$&rities in Canada s$&%ld c&nsider &tainin( access t& all data availale )&r '&tential
disease vect&rs I all <&&n&tic diseases! >$tt'DHH1estnilema's!%s(s!(&vH%sYird!$tml?
%91,81190N > -/,0&&/N%A.90N1:
T$e CGDI enales '%lic $ealt$ data 'r&viders t& s$are data 1$ile maintainin( c%st&dians$i' &) data! In
&t$er 1&rdsE '%lic $ealt$ a%t$&rities can maintain c&ntr&l &ver t$eir dataasesE 2ee'in( t$em %' t& date and
sec%re >i!e! mana(e 'ermissi&ns?E 1$ile t$e CGDI enales %sers t& access m%lti'le data H services availale
&ver t$e distri%ted net1&r2! T$e CGDI c&%ld )acilitate a '%lic72e+ certi)icati&n H a%t$enticati&n 'r&cess
)&r '%lic $ealt$ %sers &) t$e net1&r2! StillE ase ma' and envir&nmental data is (enerall+ )reel+ availale!
T$e CGDI s$&%ld )%rt$er 'r&m&te initiatives t& render data availale at n& c&st I since c&st is t$e 'rinci'al
arrier )&r $ealt$ researc$ in Canada!
Finall+E t$e CGDI m%st 1&r2 1it$ 'artners t& $&ri<&ntall+ inte(rate dataE )r&m acr&ss sect&rs >$ealt$E
envir&nmentE sa)et+? I since '%lic $ealt$ is de'endent %'&n s& man+ envir&nmentalHe4ternal )act&rs!
C%rrentl+E '%lic $ealt$ &))icials &)ten lac2 access t& s%c$ data >envir&nmental determinants &) $ealt$?!
0"
1.A.91.9,AL &0%8L/1
9N.-0%8,.90N
A c&m'arative eval%ati&n &) Canadian researc$ strate(ies 1as c&nd%cted 1it$in (l&al 'arameters! Ninet+7
)ive e'idemi&l&(+ 'a'ers 1ere identi)ied! All st%dies em'l&+ed statistical met$&ds t$at c&m'ensated )&r
small c$an(es in e4'&s%re ris2 1it$in lar(e '&'%lati&n sam'les! T$e P&iss&n distri%ti&n mi4ed7e))ects
m&del 1as t$e 're)erred tec$niF%eE (enerall+ a''lied 1it$in a Time7Series anal+sis! One ma+ em'l&+ t$e
'r&ced%re t& m&del t$e relati&ns$i' et1een air '&ll%ti&nE e4treme climatic events and res'irat&r+ $ealt$ in
an %ran settin(E %tili<in( di))erentials in $&s'ital admissi&n dia(n&stics as a meas%re &) e4'&s%re t&
'artic%late matter &ver e4tended 'eri&ds
A23"B
!
Statistical anal+tical tec$niF%es are diverse as t$e+ are c&m'le4! T$e c&minati&n &) (e&s'atial and
statistical anal+tical c&m'&nents int& an+ GIS 9e -a' Server A''licati&n needs t& c&nsider )le4ile
ada'tive reF%irements! User e4'ertiseE anal+tical re(imensE data acF%isiti&n met$&ds and c$aracterE and
m&delin( t$e&rems all serve t& c&nstrain inter)ace c$aracteristics I t$ese 're7reF%isites t& acc%rate m&delin(
&) $ealt$ data create si(ni)icant c$allen(es t& t$e desi(n &) an int%itiveE )le4ileE and eas+7t&7%se ma'
inter)ace! -aintainin( a vis%all+ int%itive 'lat)&rm 1$ile all&1in( )&r t$ree7dimensi&nal ela&rati&n in
statistical m&delin( is essential )&r ens%rin( e))ective decisi&n7ma2in(!
Detectin( c$r&nic disease mani)estati&ns and in)ecti&%s &%trea2s earl+ 1&%ld enale '%lic $ealt$ &))icials
t& etter c&ntain t$e im'act &) '&tential e'idemics &r envir&nmental c&ntaminati&n! Electr&nic 'atient
rec&rds anal+<ed 1it$ (e&s'atial met$&ds c&%ld assist $ealt$ s%rveillance and enale detecti&n 'ri&r t& m&re
traditi&nal medical alarm s+stems! P%lic $ealt$ researc$ers need t& desi(n real7time $ealt$ s%rveillance
s+stems emedded 1it$ c&st7e))ective (e&s'atial met$&ds t$at can disc&ver disease events 1it$&%t rec&%rse
t& m&re e4'ensive '&'%lati&n s%rveillance met$&ds! T$ese s+stems 1&%ld reF%ire t$e ailit+ t& %tili<e
'arallel met$&ds t& c&m'ensate )&r de)iciencies in$erent 1it$ all statistical m&dels! As ill%strated el&1E
s&me met$&ds are %nale t& deal 1it$ inc&m'lete dataR &t$er met$&ds are est s%ited )&r l&cal
mani)estati&ns %t n&t events t$at &cc%r sim%ltane&%sl+ acr&ss a r&ad s%rveillance area! -an+ met$&ds 1ill
n&t detect &%trea2s 1it$ ver+ )e1 casesE s%c$ as several cases &) small '&4 &r measlesR &t$er met$&ds &nl+
1&r2 )&r diseases 1it$ earl+ s+m't&ms severe en&%($ t$at 'e&'le (& t& t$e emer(enc+ r&&m! E))icient
disease s%rveillance reF%ires 'arallel 'r&cessin(E s+stems emedded 1it$ di))erent met$&ds ca'ale &)
anal+<in( )r&m alternate 'ers'ectives 'atient rec&rds )r&m emer(enc+ r&&msE $&s'itals and 1al27in clinics
t$r&%($&%t t$e c&%ntr+!
.9&/1/-9/1 &0%/L
Recent reacti&n a(ainst t$e %se &) Time7Series anal+sis $as een 'redicated %'&n a 2n&1n7)la1E its
v%lnerailit+ t& si(ni)icance tests related t& n&n7ca%sal event 'arameters! Pr&'&nents $ave adv&cated Case7
Cr&ss&ver anal+sis as an alternative
A23/E 230B
! T$is als& $as een c$allen(ed eca%se its ris2 estimates 1ere less
'recise t$an t$e Time7Series 'r&ced%re
A233E 235E 256E 25#E 252B
! All criticisms miss t$e %nderl+in( an&mal+ in$erent
in t$e data la+ersD $%man e$avi&%r e4erts a P&iss&n distri%ti&n 'atternE 1$ereas envir&nmental events
e4ert an e4'&nential distri%ti&n c%rve! An+ mi4t%re &) t$e t1& '$en&mena 1ill nat%rall+ en(ender
statistical iasE re(ardless &) t$e met$&ds em'l&+ed!
Time7Series anal+sis is 'artic%larl+ v%lnerale t& statistical ias d%rin( re(ressi&n anal+sisE es'eciall+ i) &ne
set &) variales &verl&ad t$e eF%ati&nE as &cc%r 1$en a''lied t& medical7envir&nmental 'arameters! F&r
0/
e4am'leE t$ere are nine 'artic%late matter variales >T&tal S%s'ended Partic%latesE SO
2
E CO
2
E NO
#
E NO
2
E O
*
E
P-
#6
>SSI?E P-
#6
E P-
2!"
?E and )ive mete&r&l&(ical variales >tem'erat%reE 'reci'itati&nE $%midit+E 1ind
s'eed and 1ind directi&n? emedded 1it$in a t+'ical anal+sis meas%rin( t$e relati&ns$i' et1een emissi&ns
and res'irat&r+ $ealt$! T$e a''licati&n &) m%lti'le envir&nmental variales t& a sin(le medical event
m%lti'lies t$e iasE even 1$en )iltered t$r&%($ a Ste'79ise re(ressi&n 'r&ced%re! T$e latter is s'eci)icall+
desi(ned t& see2 a est7)it eF%ati&n irres'ective &) T+'es I W II err&rs! T& red%ce )alse re;ecti&n events &)
t$e N%ll H+'&t$esisE researc$ers m%st )irst trans)&rm m%lti'le envir&nmental variales int& a sin(le
c&e))icientE and t$en a''l+ t$at variale t& t$e medical7envir&nmental re(ressi&n eF%ati&n
A25*B
! Ste'71ise
ANO.A &) t$e c&e))icient 1ill identi)+ t$e c&ntri%ti&n val%e &) t$e 'rimar+ in'%t variales 1it$&%t
c&n)&%ndin( t$e Time7Series re(ressi&n eF%ati&n!
P09110N &0%/L
T$e 'rimar+ ene)it &) t$e P&iss&n re(ressi&n m&del is t$at t$e statistical 'r&ced%re 1as e4'ressl+ desi(ned
t& e4amine t$e e))ects &) discrete &servati&ns &ver an interval &) timeE 1it$in a s'eci)ied (e&(ra'$ic <&ne!
T$e m&del is &nl+ a''licale i) t$e &served events &cc%r 1it$ a 2n&1n avera(e rateE inde'endent &)
'revi&%s and s%seF%ent &cc%rrences! T$e m&del ass%mes t$at an+ c$an(es in t$e 2n&1n rateE s%c$ as
$&s'ital admissi&nsE ma+ e meas%red eca%se &) s&me e4ternal )&rceE s%c$ as amient air F%alit+E actin(
%'&n eac$ s%seF%ent event!
T$e 'r&ced%re is val%ale in several 1a+sD its ailit+ t& meas%re small di))erences in lar(e '&'%lati&n
sam'lesR its ailit+ t& trans)&rm discrete &servati&ns >NSc&%nts? int& c&ntin%&%s variales >l&(arit$m
c&e))icients?R and t$e c&e))icient lends itsel) t& a re(ressi&n anal+sis 1it$ &t$er c&ntin%&%s varialesE s%c$ as
amient air F%alit+!
P&iss&n distri%ti&ns $ave t$ree s'ecial c&nditi&ns t$at ma2e traditi&nal re(ressi&n 'r&lematicD
i1 The %oisson distribution is s.ewed ! regression assumes symmetric distribution of errors3
ii1 The %oisson distribution is non!negative ! regression predicts values that are sometimes negative3
iii1 The %oisson distribution variance increases as the mean increases ! regression assumes a constant
variance1
N&t1it$standin(E t$e a&ve c&nditi&ns d& n&t im'act t$e P&iss&n re(ressi&n m&del! In 'artic%larE P&iss&n
re(ressi&n:s nat%ral l&( trans)&rmati&n ad;%sts )&r s2e1ness and 'revents t$e m&del )r&m 'r&d%cin(
ne(ative 'redicted val%es! It als& m&dels t$e variance as a )%ncti&n &) t$e mean!
BA@/19AN &0%/L
An electr&nic lirar+ searc$ identi)ied m&re t$an 3E666 statistical te4t&&2s e4'ressl+ dev&ted t& Ba+esian
m&dels! A similar -edline searc$ identi)ied m&re t$an "E666 st%dies re)erencin( its a''licati&n in medical
researc$E 1it$ m&re t$an #E666 'a'ers e4'ressl+ dev&ted t& its met$&d&l&(+! H&1everE &nl+ si4 'a'ers
eval%ated t$e 'r&ced%re 1it$in an amient air '&ll%ti&n e'idemi&l&(ical7(e&(ra'$ic c&nte4t
A25,E 25"E 25/E 250E 253E
255B
! T$is is s&me1$at s%r'risin( (iven t$at t$e tec$niF%e $as een c&nsidered a sta'le t&&l in t$e medical
researc$ c&mm%nit+ since t$e earl+ #556:s!
Ba+esian m&dels are 'artic%larl+ 1ell s%ited )&r identi)+in( relati&nalE ca%sal and t$res$&ld 'arameters in
m&ridit+ and m&rtalit+ trend anal+ses
A*66B
! Given t$e c&m'le4it+ &) ca%sal relati&ns$i's et1een amient
airE climatic e4tremesE and m&ridit+ trendsE it is 'er'le4in( t$at researc$ers $ave n&t attem'ted t&
c&m'ensate )&r t$e in$erent de)iciencies in Times SeriesE Cr&ss7Over and P&iss&n m&dels
A*6#B
! Ba+esian
avera(in( can acc&%nt )&r %ncertaint+ in$erent in est7)it m&del selecti&n 'r&cessesE s&met$in( t$at
00
traditi&nal statistical anal+ses &)ten ne(lect! B+ avera(in( several c&m'etin( m&delsE t$e tec$niF%e
inc&r'&rates %ncertaint+ 'rinci'les int& m&del 'arameter 'redicti&ns
A*62B
! T$e tec$niF%e ma+ e a''lied t&
man+ statistical 'r&ced%res incl%din( re(ressi&n and discrete (ra'$ical m&dels! T$e Ba+esian $ierarc$ical
a''r&ac$ can 'r&vide a l&(ical and F%anti)iale )rame1&r2 )&r investi(ative medical researc$! Its iterative
'r&cess &) inte(ratin( in)&rmati&n )r&m diverse and acc%m%lative 2n&1led(e s+stems 1&%ld enale
scienti)ic and '&lic+ anal+sts t& devel&' c&m're$ensive and en(a(in( decisi&n7ma2in( m&dels!
B00.1.-AP &0%/L
9$ile t$ere are &ver ##E666 statistical te4t&&2s e4'ressl+ dev&ted t& t$e B&&tstra' met$&dE a -edline
searc$ identi)ied &nl+ 2E6," st%dies re)erencin( B&&tstra' a''licati&ns in medical researc$E 1it$ ##3 'a'ers
e4'ressl+ dev&ted t& met$&d&l&(+! Onl+ t$ree 'a'ersE $&1everE eval%ated t$e 'r&ced%re in amient air
'&ll%ti&n anal+ses
A*6*E *6,E *6"B
! Given t$e c&m'le4it+ &) ca%sal relati&ns$i's et1een amient airE climatic
e4tremesE and m&ridit+ trendsE it is m+sti)+in( 1$+ m&re researc$ers $ave n&t attem'ted t& c&m'ensate )&r
t$e in$erent de)iciencies in Times SeriesE Cr&ss7Over and Ba+esian m&dels! 9$ile t$e &&tstra' sam'lin(
tec$niF%e 1ill n&t eliminate t$e %ncertaint+ 'rinci'le ass&ciated 1it$ 'r&ailistic eF%ati&n matricesE it 1ill
'r&vide a aseline re)erence '&int )&r t$res$&ld eval%ati&n!
All amient air '&ll%ti&n st%dies ass%me a minim%m ris2 e))ect %'&n m&ridit+Hm&rtalit+ trendsE +et c&nd%ct
t$eir anal+ses 1it$&%t d%e re(ard t& m%ltidirecti&nal variance t+'icall+ re)lected in e4tensive l&n(it%dinal
data! A re'etitive &&tstra' sam'lin( strate(+E s%c$ as t$e -&nte Carl& met$&dE is deemed an essential
c&rrective meas%re i) t$e e'idemi&l&(ical val%e &) s%c$ st%dies are t& c&ntri%te '&sitivel+ t& $ealt$ '&lic+
m&delin( initiatives!
B/-N08LL9 &0%/L
Based &n statistical 'r&ailit+ t$e&r+E t$e Bern&%lli -&del %s%all+ c&nsists &) a series &) e4'erimental trials
1$&se events are deemed rand&m 1it$ &nl+ t1& '&ssile &%tc&mesD s%ccess &r )ail%re ># &r 6?!
-at$ematicall+E s%c$ a m&del is 2n&1n as a discrete distri%ti&n 1it$ t$e 'r&ailit+ >'? ein( a rati& &)
&%tc&me events )&r variale >J?E
1$ere &t$ t$e variance &) J
and its standard deviati&n
'la+ a r&le in t$e si(ni)icance eval%ati&n &) '&ssile &%tc&mes
A*6/B
!
9$ile strictl+ desi(ned )&r '&sitive7ne(ative test eval%ati&nsE &%tc&mes 1it$in t$e Bern&%lli -&del ma+
als& re'resent 'e&'le 1it$ &r 1it$&%t a diseaseE &r 1it$ di))erent sta(es &) disease >earl+7lateE eni(n7
mali(nantE etc!?! T$e+ ma+ re)lect cases and c&ntr&ls )r&m a sam'le '&'%lati&nE &r c&nstit%te t$e '&'%lati&n
as a 1$&le! Bern&%lli data ma+ e anal+<ed tem'&rall+E s'atiall+E &r 1it$in a s'ace7time c&nstr%ct! T$e
Bern&%lli m&del reF%ires in)&rmati&n a&%t t$e l&cati&n &) eac$ set &) cases and c&ntr&ls! Se'arate l&cati&ns
ma+ e s'eci)ied )&r eac$ case and eac$ c&ntr&lE &r t$e data ma+ e a((re(ated )&r 'r&vincesE c&%ntiesE
'aris$esE cens%s tractsE '&stal c&de areasE sc$&&l districtsE $&%se$&ldsE etc!E 1it$ m%lti'le cases and c&ntr&ls
at eac$ data l&cati&n!
03
A n%mer &) )act&rs c&nstrain t$e 'r&ced%reD
there can be only two possible outcomes 7i1e1 &oolean83
there must be a fi2ed number of observations3
each observation must be independent 7i1e1 not covariate83
the probability for all outcomes must be equal 7i1e1 random83
repeated random sample trials must be conducted under identical conditions1
9$ile m&re t$an ""6 medical st%dies 1ere identi)ied %tili<in( s&me )&rm &) t$e Bern&%lli -&delE m&st 1ere
c&n)ined t& e4'erimental trials! Fe1 attem'ted t& %tili<e t$e Bern&%lli distri%ti&n eF%ati&n 1it$in t$e
c&nte4t &) s'atial7tem'&ral cl%sterin(R )&r e4am'leD
temporal!spatial analysis of bovine spongiform encephalopathy
A*60B
and bovine tuberculosis
A*63B
in
cattle herds3
cluster identification of blood donations contaminated with hepatitis!"
A*65B
3
geographic clustering of lower!bac. in@uries among medical personnel employed in nursing
homes
A*#6B
1
Several reas&ns ma+ attend t& t$is rel%ctance t& %tili<e t$e Bern&%lli -&del! Princi'all+E t$e Bern&%lli
distri%ti&n is deemed eF%ivalent t& t$e m&re '&'%lar Bin&mial distri%ti&nR as s%c$E it is &)ten dis(%ised as
a Bin&mial distri%ti&n test emedded 1it$in &t$er statistical )%ncti&ns! Sec&ndl+E in &rder )&r a Bin&mial
distri%ti&n )%ncti&n t& a''r&4imate a n&rmal distri%ti&n c%rveE identical Bern&%lli trials m%st e
c&nd%cted &n lar(e sam'le si<es in &rder t& red%ce t$e '&'%lati&n standard deviati&n and all&1 )&r m&re
'recise estimate &) t$e %n2n&1n 'r&ailit+ 'arameter! H&1everE as ' a''r&ac$es infinity >Z? and p
a''r&ac$es JE t$e Bin&mial distri%ti&n 1ill a''r&ac$ a P&iss&n distri%ti&n 1it$ e4'ected val%e [! As s%c$E
t$e P&iss&n distri%ti&n is &)ten deemed a m&re acc%rate a''r&4imati&n &) trial &%tc&mes!
1PA,/.9&/ P/-&8.A.90N &0%/L
Devel&'ed + t$e Harvard Universit+ -edical Sc$&&lE t$e S'ace7Time Perm%tati&n -&del reF%ires &nl+
case dataE 1it$ in)&rmati&n a&%t t$e s'atial l&cati&n and t$e time )&r eac$ case! T$e n%mer &) &served
cases in a cl%ster is c&m'ared t& 1$at 1&%ld $ave een e4'ected i) t$e s'atial and tem'&ral l&cati&ns &) all
cases 1ere inde'endent &) eac$ &t$er s& t$at t$ere is n& s'ace7time interacti&n! T$ere)&reE a cl%ster &cc%rs
in a (e&(ra'$ical area i)E d%rin( a s'eci)ic time 'eri&dE t$at area $as a $i($ 'r&'&rti&n &) e4cess cases &r a
smaller de)icienc+ &) cases t$an s%rr&%ndin( areas! T$is means t$at i)E d%rin( a s'eci)ic 1ee2E all
(e&(ra'$ical areas $ave t1ice t$e n%mer &) cases t$an n&rmalE t$en n&ne &) t$ese areas c&nstit%te a cl%ster!
On t$e &t$er $andE i) &ne (e&(ra'$ical area $as t1ice t$e n%mer &) cases 1$ile &t$er areas $ave a n&rmal
am&%nt &) casesE t$en t$ere 1ill e a cl%ster in t$at )irst area! T$e S'ace7Time Perm%tati&n -&del
a%t&maticall+ ad;%sts )&r &t$ '%rel+ s'atial and '%rel+ tem'&ral cl%sters!
$2ampleD A recent st%d+ em'l&+ed e'idemi&l&(ical and '%lsed7)ield (el electr&'$&resis data t&
determine t$e validit+ &) re'&rted cases &) $scherichia coli O#"0 in Alerta 7 1$et$er s'ace7time
cl%stersE identi)ied %sin( s'atial scan statisticsE are eF%ivalent t& &%trea2 scenari&s
A*##B
! T$e s'atial
and tem'&ral l&cati&ns &) re'&rted cases 1ere identi)iedE as 1ell as &nset dates &) clinical si(ns!
S'ace7time cl%sters 1ere identi)ied %sin( a 'erm%tati&n m&del! A%t$&rs c&ncl%ded t$at t$e S'ace7
Time Perm%tati&n -&del ma+ e an a''r&'riate t&&l )&r en$anced &%trea2 detecti&nE %t t$e %se &)
-&nte Carl& sim%lati&ns 1as deemed essential )&r determinin( t$e statistical validit+ &) t$ese
cl%sters!
A critical ias is ass&ciated 1it$ t$e S'ace7Time Perm%tati&n -&delD cl%sters ma+ e d%e eit$er t& an
increased ris2 &) diseaseE &r t& di))erent (e&(ra'$ical '&'%lati&n distri%ti&ns at di))erent timesE 1$ere )&r
e4am'le t$e '&'%lati&n in s&me areas (r&1s )aster t$an in &t$ers! I) t$e ac2(r&%nd '&'%lati&n increases &r
05
decreases )aster in s&me areas t$an in &t$ersE t$e -&del )ails t& identi)+ t$e ens%in( '&'%lati&n s$i)t
'r&d%cin( a iased p7val%es )&r disease ris2 &ver time! C&rrective meas%res need t& e a''lied t& c&ntr&l )&r
t$is ias
A*#2B
!
0-%9NAL &0%/L
9it$ t$e Ordinal -&delE eac$ &servati&n is a caseE and eac$ case el&n(s t& &ne &) several &rdinal
cate(&ries! I) t$ere are &nl+ t1& cate(&riesE t$e Ordinal -&del is identical t& t$e Bern&%lli -&delE 1$ere
&ne cate(&r+ re'resents t$e cases and t$e &t$er cate(&r+ re'resents t$e c&ntr&ls in t$e Bern&%lli -&del! T$e
cases in t$e Ordinal -&del ma+ e a sam'le )r&m a lar(er '&'%lati&n &r t$e+ ma+ c&nstit%te a c&m'lete set
&) &servati&ns! Ordinal data can e anal+<ed 1it$ t$e '%rel+ tem'&ralE t$e '%rel+ s'atial &r t$e S'ace7Time
Scan statistics!
$2ampleD F&r t$e Ordinal -&delE t$e data ma+ c&nsist &) ever+&ne dia(n&sed 1it$ reast cancer
d%rin( a ten7+ear 'eri&dE 1it$ t$ree di))erent cate(&ries re'resentin( earl+E medi%m and late sta(e
cancer at t$e time &) dia(n&sis!
T$e Ordinal -&del reF%ires in)&rmati&n a&%t t$e l&cati&n &) eac$ case in eac$ cate(&r+! Se'arate l&cati&ns
ma+ e s'eci)ied )&r eac$ caseE &r t$e data ma+ e a((re(ated )&r statesE 'r&vincesE c&%ntiesE 'aris$esE
cens%s tractsE '&stal c&de areasE sc$&&l districtsE $&%se$&ldsE etcE 1it$ m%lti'le cases in t$e same &r di))erent
cate(&ries at eac$ data l&cati&n! T& d& a tem'&ral &r s'ace7time anal+sisE it is necessar+ t& $ave a time )&r
eac$ case as 1ell!
9it$ t$e Ordinal -&delE it is '&ssile t& searc$ )&r $i($ cl%stersE 1it$ an e4cess &) cases in t$e $i($7val%ed
cate(&riesE )&r l&1 cl%sters 1it$ an e4cess &) cases in t$e l&17val%ed cate(&riesE &r sim%ltane&%sl+ )&r &t$
t+'es &) cl%sters! Reversin( t$e &rder &) t$e cate(&ries $as t$e same e))ect as c$an(in( t$e anal+sis )r&m
$i($ t& l&1 and vice versa!
/?P0N/N.9AL &0%/L
T$e E4'&nential -&del is desi(ned )&r s%rvival time dataE alt$&%($ it c&%ld e %sed )&r &t$er c&ntin%&%s
t+'e data as 1ell! Eac$ &servati&n is a caseE and eac$ case $as &ne c&ntin%&%s variale attri%te as 1ell as a
6H# cens&rin( desi(nati&n! F&r s%rvival dataE t$e c&ntin%&%s variale is t$e time et1een dia(n&sis and
deat$ &r de'endin( &n t$e a''licati&nE et1een t1& &t$er t+'es &) events! I) s&me &) t$e data is cens&redE
d%e t& l&ss &) )&ll&17%'E t$e c&ntin%&%s variale is t$en instead t$e time et1een dia(n&sis and time &)
cens&rin(! T$e 6H# cens&rin( variale is %sed t& distin(%is$ et1een cens&red and n&n7cens&red
&servati&ns!
$2ampleD F&r t$e E4'&nential -&delE t$e data ma+ c&nsist &) ever+&ne dia(n&sed 1it$ 'r&state
cancer d%rin( a ten7+ear 'eri&dE 1it$ in)&rmati&n a&%t eit$er t$e len(t$ &) time )r&m dia(n&sis %ntil
deat$ &r )r&m dia(n&sis %ntil a time &) cens&rin( a)ter 1$ic$ s%rvival is %n2n&1n!
9$en %sin( t$e tem'&ral &r s'ace7time E4'&nential -&del )&r s%rvival timesE it is im'&rtant t& reali<e t$at
t$ere are t1& ver+ di))erent time variales inv&lved! T$e )irst is t$e time t$e case 1as dia(n&sedE and t$at is
t$e time t$at t$e tem'&ral and s'ace7time scannin( 1ind&1 is scannin( &ver! T$e sec&nd is t$e s%rvival
timeE t$at isE time et1een dia(n&sis and deat$ &r )&r cens&red data t$e time et1een dia(n&sis and
cens&rin(! T$is is an attri%te &) eac$ caseE and t$ere is n& scannin( d&ne &ver t$is variale! Rat$erE 1e are
interested in 1$et$er t$e scannin( 1ind&1 incl%des e4ce'ti&nall+ man+ cases 1it$ a small &r lar(e val%e &)
t$is attri%te!
36
It is im'&rtant t& n&teE t$at 1$ile t$e E4'&nential -&del %ses a li2eli$&&d )%ncti&n ased &n t$e e4'&nential
distri%ti&nE t$e tr%e s%rvival time distri%ti&n m%st n&t e e4'&nential and t$e statistical in)erence >'7val%e?
is valid )&r &t$er s%rvival time distri%ti&ns as 1ell! T$e reas&n )&r t$is is t$at t$e rand&mi<ati&n is n&t d&ne
+ (eneratin( &servati&ns )r&m t$e e4'&nential distri%ti&nE %t rat$erE + 'erm%tin( t$e s'ace7time
l&cati&ns and t$e s%rvival timeHcens&rin( attri%tes &) t$e &servati&ns!
P-0BAB9L9.@ &0%/L ,0&PA-910N
T$e P&iss&n -&del is %s%all+ t$e )astest t& r%n! t$e Ordinal -&del is t+'icall+ t$e sl&1est!
9it$ t$e P&iss&n and s'ace7time 'erm%tati&n m&delsE an %nlimited n%mer &) c&variates can e ad;%sted
)&rE + incl%din( t$em in t$e case and '&'%lati&n )iles! 9it$ t$e Bern&%lli m&delE c&variates are ad;%sted )&r
+ %sin( m%lti'le data setsE 1$ic$ limits t$e n%mer &) c&variates cate(&ries t$at can e de)ined!
All 'r&ailit+ m&dels can e %sed )&r eit$er individ%al l&cati&ns &r a((re(ated data!
9it$ t$e P&iss&n -&delE '&'%lati&n data is &nl+ needed at selected time '&ints and t$e n%mers are
inter'&lated in et1een! A '&'%lati&n time m%st e s'eci)ied even )&r '%rel+ s'atial anal+ses! Re(ardless &)
m&del %sedE t$e time &) a case &r c&ntr&l need &nl+ e s'eci)ied )&r '%rel+ tem'&ral and s'ace7time
anal+ses!
T$e s'ace7time Perm%tati&n -&del a%t&maticall+ ad;%sts )&r '%rel+ s'atial and '%rel+ tem'&ral cl%sters! F&r
t$e P&iss&n -&delE '%rel+ tem'&ral and '%rel+ s'atial cl%sters can e ad;%sted )&r in a n%mer &) di))erent
1a+s! F&r t$e Bern&%lliE Ordinal and E4'&nential m&delsE s'atial and tem'&ral ad;%stments can e d&ne
%sin( m%lti'le data setsE %t it is limited + t$e n%mer &) di))erent data sets all&1edE and it is als& m%c$
m&re c&m'%ter intensive!
*/W ,A1/1 ,0&PA-/% .0 ,0N.-0L1
In a '%rel+ s'atial anal+sis 1$ere t$ere are )e1 cases c&m'ared t& c&ntr&lsE sa+ less t$an #6 'ercentE t$e
P&iss&n -&del is a ver+ (&&d a''r&4imati&n t& t$e Bern&%lli -&del! T$e )&rmer can t$en e %sed als& )&r
6H# Bern&%lli t+'e dataE and ma+ e 're)erale eca%se &) t$e ailit+ t& ad;%st )&r m&re c&variates &r
eca%se &) c&m'%tati&nal s'eed 1$en ad;%stin( )&r &nl+ a )e1 c&variates! As an a''r&4imati&n )&r
Bern&%lli t+'e dataE t$e P&iss&n -&del 'r&d%ces sli($tl+ c&nservative '7val%es!
B/-N08LL9 ;/-181 0-%9NAL &0%/L
T$e Bern&%lli -&del is mat$ematicall+ a s'ecial case &) t$e Ordinal -&delE 1$en t$ere are &nl+ t1&
cate(&ries! T$e Bern&%lli -&del r%ns )asterE ma2in( it t$e 're)erred m&del t& %se 1$en t$ere are &nl+ t1&
cate(&ries
./&P0-AL %A.A
F&r tem'&ral and s'ace7time dataE t$ere is an additi&nal di))erence am&n( t$e 'r&ailit+ m&delsE in t$e 1a+
t$at t$e tem'&ral data is $andled! 9it$ t$e P&iss&n -&delE '&'%lati&n data ma+ e s'eci)ied at &ne &r
several time '&intsE s%c$ as cens%s +ears! T$e '&'%lati&n is t$en ass%med t& e4ist et1een s%c$ time '&ints
as 1ellE estimated t$r&%($ linear inter'&lati&n et1een cens%s +ears! 9it$ t$e Bern&%lliE s'ace7time
'erm%tati&nE &rdinalE and e4'&nential m&delsE a time needs t& e s'eci)ied )&r eac$ case and )&r t$e
Bern&%lli -&delE )&r eac$ c&ntr&l as 1ell!
3#
%91,81190N > -/,0&&/N%A.90N1
As n&ted 'revi&%sl+E t& acc%ratel+ ma' in)ecti&%s disease incidents )&r earl+ 1arnin( H detecti&nE a n%mer
&) statistical m&d%les m%st e em'l&+ed! In additi&nE $ealt$ a%t$&rities s$&%ld r%n statistical m&d%les &n
$ist&rical H arc$ive data in &rder t& determine aseline c$aracteristicsE t+'ical '&'%lati&n v%lnerailities >e!(!
a(e?E and seas&nal )l%ct%ati&ns! Once t$e aseline c$aracteristics are estalis$edE a s+stem can e
im'lemented t& )la( an&malies in real7time H dail+ data )r&m $&s'ital admissi&ns H lasE indicatin( a
'&tential &%trea2! S%c$ statistical m&d%les and t$e res%ltin( aselines s$&%ld e '%lis$ed 1it$in t$e
CGDIE as 'art &) t$e -etadata C&ntentE in &rder t& in)&rm data %sers &) t$e s'eci)ic l&calHre(i&nal
'arameters &) '&'%lati&n $ealt$ and disease 'revalence! T$e CGDI s$&%ld 'r&vide $ealt$ a%t$&ritiesE as 'art
&) its Disc&ver+ ServiceE a set &) statistical m&d%les and met$&d&l&(iesE s& t$at aselines can e estalis$ed
acr&ss Canada!
CanadaQs Healt$ In)&1a+ and 'r&vincial $ealt$ a%t$&rities ear t$e res'&nsiilit+ )&r inte(ratin( $ealt$ data
%sin( c&mm&n standards! T$e CGDI s$&%ld inte(rate 1it$ CanadaQs Healt$ In)&1a+ t& s%''l+ its >t$e
CGDIQs? %sers 1it$ access t& '%lic $ealt$ dataE reF%ired )&r researc$ and decisi&n7ma2in(! T$e CGDI can
'r&vide CanadaQs Healt$ In)&1a+ 1it$ a ac2&ne )&r '%lic $ealt$ ma''in( a''licati&nsE servicesE and
standards! In additi&nE t$e CGDI m%st ens%re t$at a''licati&n $&sts are n&t leadin( %sers t& )alse
c&ncl%si&nsE + n&t 'r&'erl+ m&delin( data t$r&%($ ri(&r&%s statistical anal+sis 'ri&r t& '%lis$in( ma's!
StillE &ri(inal data is reF%ired in &rder t& all&1 statistical anal+sis and F%er+in( t& e 'er)&rmed acr&ss
;%risdicti&ns! In &rder )&r statistical anal+sis t& e 'er)&rmedE t$e &ri(inal data m%st incl%de s'atial and time
stam's! In additi&nE disease t+'e stam's are necessar+ )&r F%er+in( a(ainst disease t+'es I t$e Healt$ Level
Seven standard is a le4ical H semantic standard )&r $ealt$ rec&rds H disease t+'e c&din( &r v&ca%lar+! ItQs
'%r'&se is t& rin( t&(et$er diver(in( sets &) $ealt$ dataE and is t$e m&st 'r&minentl+ %sed $ealt$ data
standard in Canada! T$e CGDIE in c&ntradistincti&nE can 'r&vide cart&(ra'$ic standards )&r vis%ali<ati&n &)
$ealt$ dataE as 1ell as minim%m reF%irements )&r '%lic $ealt$ data sets >in &rder )&r data t& e ma''ed?!
Healt$ a%t$&rities s$&%ld 1&r2 t&1ard a%t&matin( real7time disease detecti&n al(&rit$msE 1$ic$ can
identi)+ disease &%trea2s )&r sentinel in)&rmati&n s+stemsE CGDI ma' disseminati&nE and '%lic alertin(!
P%lic $ealt$ a%t$&rities 1&%ld ene)it )r&m a 1e7ma''in( serviceE c&mined 1it$ standard ta%lar )&rmat
dataE )&r anal+<in( disease 'revalence and '&'%lati&n $ealt$! 9$ile (e&matics e4'ertise can e )&%nd 1it$in
t$e CGDI net1&r2E e'idemi&l&(ical e4'ertise is )&%nd 1it$in t$e '%lic $ealt$ sect&r I since t$eir (&als are
s+ner(isticE 1e rec&mmend str&n( c&lla&rati&n and c&ll&F%i%ms t& rin( t$ese t1& )ields &) e4'ertise
t&(et$er t& devel&' CanadaQs P%lic Healt$ GIS a''licati&ns and in)rastr%ct%re!
32
;918AL9IA.90N ./,7N9F8/1
T& dateE vis%ali<ati&n met$&ds )&r '%lic $ealt$ data in Canada $ave een 'er)&rmed &n a case7+7case
asis! T$ere is n& c&nventi&nal met$&d&l&(+ &r re'&sit&r+ &) '%lic $ealt$ ma's t& dem&nstrate t$e vari&%s
t+'es &) vis%ali<ati&n t$at ma+ e em'l&+ed! Alt$&%($ 1e rec&mmend t$at c&nsistent H c&nventi&nal
vis%ali<ati&n tec$niF%es e devel&'edE 1e are 'r&vidin( t$is r&ad &vervie1 &) '&ssile vis%ali<ati&n
tec$niF%es 1$ic$ can e a''lied t& '%lic $ealt$ data!
Ge&(ra'$ical entities and '$en&mena can e re'resented as (e&7re)erenced (e&metries >(e&metric
re'resentati&n? in a dataase and can e dis'la+ed &n screen &r 'rinted &n 'a'er >cart&(ra'$ic
re'resentati&n?! Generall+E (e&metric re'resentati&ns areD '&intE lineE area >'&l+(&n? &r s&me c&m'&site &)
all t$ree! Cart&(ra'$ic re'resentati&ns are (e&metric re'resentati&ns de)ined + a series &) r%les &r
s'eci)icati&ns descriin( c&l&rE s+m&l&(+E 'atterns and 'lacement &) a )eat%re!
F&r vis%ali<ati&n >cart&(ra'$+?E t$e m&st e))icient met$&d &) descriin( &served c$aracteristics and
s'eci)+in( cate(&ries 1it$ a set &) variales is &ne t$at inv&lves )&%r levels &) meas%rementsD N&minal
scalesE Ordinal ScalesE Interval Scales and Rati& Scales! F&%r meas%rement levels are nested in &ne
directi&n! In &t$er 1&rdsE data availale at $i($er level can e red%ced &r (enerali<ed t& l&1 levelsE %t t$e
reverse is n&t '&ssile!
;I,!LIC!TI9- 0)T59#
a! N&minal Scales &) -eas%rementD
9e %se n&minal scales 1$en 1e distin(%is$ am&n( )eat%res &nl+ ased &n F%alitative c&nsiderati&ns
>t+'eH2ind?! F&r e4am'le 1e distin(%is$ J disease >e!(! Ast$ma? )r&m C disease >e!(! COPD?!
! Ordinal Scales &) -eas%rementD
It inv&lves di))erentiati&n + class >n&minal scale?E %t als& + di))erences in ran2 1it$in a class &)
)eat%res acc&rdin( t& s&me F%antitative meas%re! F&r e4am'le 1e can di))erentiate $i($ '&ll%ti&n
and l&1er '&ll%ti&n!
c! Interval Scales &) -eas%rementD
Interval scales add in)&rmati&n a&%t t$e di))erence et1een ran2s t& t$e descri'ti&n &) 2ind and
ran2! Interval scales %se s&me 2ind &) standard %nit 1$ic$ ma+ e aritrar+! F&r e4am'leE $ealt$
indicat&rs are re'resented + t$e n%mer &) in)l%en<a cases 'er #66 Km
2
in di))erent re(i&ns &) t$e
c&%ntr+!
d! Rati& Scales &) -eas%rementD
A rati& scale is a )%rt$er re)inement &) an interval scale! It 'r&vides ma(nit%des t$at are intrinsicall+
meanin()%l! It %ses a scale 1$ic$ e(ins at a n&n7 aritrar+ '&int! F&r e4am'le t$e n%mer &)
in)l%en<a cases in di))erent areas! Fr&m t$e '&int &) vis%ali<ati&nE t$ere is n& di))erence et1een
interval and rati& scale
Fi(%re # s$&1s t$e e4am'le &) eac$ met$&d in di))erent (e&metries
Point Line Area
3*
N
o
5
i
n
a
l
0
r
d
i
n
a
l
9
n
t
e
r
4
a
l
>
-
a
t
i
o
;I,!L ;!RI!7L)
a? S$a'eD t$e (ra'$ic c$aracteristic 'r&vided + t$e )&rm &) a (ra'$ic mar2
? Si<eD mar2s var+ in si<e 1$en t$e+ $ave di))erent a''arent (e&metric dimensi&ns
c? Orientati&nD Lines and el&n(ated s$a'es e4$iit t$e vis%al variale! A directi&nal )rame &) re)erence
is needed t& de)ine t$e &rientati&n &) (ra'$ic mar2!
d? H%e >C&l&r?D t$e c&mm&n %se &) t$e term Oc&l&rP reall+ re)ers t& $%e!
e? .al%e >c&l&r?D re)ers t& t$e relative li($tness &r dar2ness &) a mar2
)? C$r&ma >c&l&r?D re)ers t& t$e de(ree t& 1$ic$ a $%e de'arts in Oc&l&%r)%lnessP )r&m a (re+ t&ne &)
t$e same val%e
(? PatternD Re'etiti&n &) asic (ra'$ic elements re'resentin( vari&%s c&minati&ns &) t$ese 'rimar+
variales
Arran(ement >Pattern?
Te4t%re >'attern?
3,
*igure $: ;isuali<ation ,ategories
Orientati&n >'attern?
Fi(%re 2 s$&1 di))erent vis%al variales a''earance!
$? Trans'arenc+D in di(ital ma'sE a semi7trans'arent )eat%re all&1s seein( t$e )eat%re a''earin(
%nder it!
0!PPI-G PR9.)
T& meet t$e needs &) s&'$isticated ma' %sersE it is necessar+ t& mani'%late ra1 data 'ri&r t& ma''in(!
A*#*B
Statistical tec$niF%es can e %sed )&r t$is '%r'&se! T$e 'revi&%s secti&n descried s&me &) t$ese statistical
met$&ds!
T$e ma''in( 'r&cess is rie)l+ descried as el&1D
a! Selecti&n &) )eat%res and t$eir attri%tes )&r ma''in( >data c&llecti&n?!
! EF%atin( t$em s& t$at t$e data re'resent c&m'arale val%es >n&rmali<ati&n?
c! Selectin( statistical t&&ls t& c&nvert t$em t& acc%rate ma''ale data
d! Select vis%al variales
e! -a' t$em >'ie c$arts H (ra'$s?
Here are t1& e4am'les &) $&1 t$e a&ve vis%ali<ati&n tec$niF%es can e a''lied )&r ma''in( $ealt$7related
data >in t$is caseE disease 8ectors?D
3"
Example of a thematic map showing the different insecticide treatments and the localization of bird reports and
mosquito pools, in 2003. This thematic map shows the different insecticide treatments (shaded areas) and the localization
of bird reports (colored dots) and mosquito pools (colored triangles) along with their status, in 2003.
Example of a thematic map showing the status of reported dead Corvidae around the Montreal Island, in 2005. This
thematic map shows the status (represented by different colors) of reported dead Corvidae for different territorial
subdiisions around the !ontreal "sland, in 200#.
$3%&'
3/
SECTI ON FI .E
CHAPTER #2D CGDI7Nested OGC7C&m'liant P%lic
Healt$ Arc$itect%re
CHAPTER #*D C&m'limentar+ Tec$n&l&(ies
30
,+%9N/1./% > 0+,,0&PL9AN. P8BL9,
7/AL.7 A-,79./,.8-/
T$e '%r'&se &) t$is secti&n is t& 'r&vide t$e reader 1it$ a c&nce't%al &%tline &) CGDI7nested OGC7
c&m'liant '%lic $ealt$ arc$itect%reD incl%din( a''licati&ns )&r c&ntent deliver+ >dataHma's?E dataase
mana(ement s+stemsE sec%rit+ H a%t$enticati&nE and 9-S H 9FS minim%m standards!
9N*0-&A.90N G&APH %/L9;/-@
%eli4ery ,hannels:
T$ere are a diversit+ &) 1a+s t& distri%te in)&rmati&n t& '%lic $ealt$ 'r&)essi&nalsE researc$ (r&%'sE and
t$e (eneral '%lic! F&r '%lic alertin( '%r'&sesE ma'sHdata made availale t$r&%($ t$e CGDIE can e '&sted
&n n&tice &ards in c&mm%nal areasE in ne1s re'&rtsE ne1sletters and ma(a<inesE televisi&n etc! F&r '%lic
ed%cati&n >i!e! n& immediate t$reat?E $ealt$ a%t$&rities c&%ld %tili<e t$e CGDI t& (enerate ma'sHmaterials t&
e distri%ted + '&st mailE emailE and &nline >via $tml?! F&r t$e a%t$enticated H s2illed %sersE a 1e7ased
ma''in( '&rtal >e!(! $tt'DHH#"/!*,!#"6!##"Hnla? can 'r&vide advanced )eat%res and )%ncti&nalit+ t& interact
1it$ data and ma's!
/nd8ser %e4ices:
End7%ser devices can incl%deD C&m'%ter terminalsE 1ireless and rem&te devices >PDAsE cell'$&nesE 'a(ers?
%eli4ery &edia:
T$e Fi(%re el&1 s$&1s t$e ev&l%ti&n &) (e&(ra'$ic 'r&d%ct deliver+D
Pre-
Generated
User
Generated
,
o
n
t
e
n
t
Pa'er CDHD.DHTa'e Email FTP HTTP
&edia
One Source
-%lti S&%rce
%ata 1ource
(ser -emand
)apping
[Off-line | on-line]
33
a? From off!line to online: Traditi&nall+E ma's 1ere 2e't &n 'a'er )ile! Di(ital ma's can e st&red in
medias s%c$ as CDHD.D )&r deliver+! Internet tec$n&l&(+ ma2es t$e in)&rmati&n deliver+ '&ssile
%sin( emailE FTP and HTTP 1e 'a(esE and t$r&%($ &nline 1e ma''in( >e!(! @ava?!
? From pre!generated to user!generated: ma's can e 're7(enerated t$en '%lis$ed t$r&%($ t$e
a&ve7menti&ned mediasR &nline 1e ma''in( ma2es %ser7(enerated ma's '&ssile I i!e! &n7
demand ma''in(!
c? From one source to multiple source >i!e! distri%ted data access?! T$r&%($ CGDIHOGC standardsE
data inter&'erailit+ is enaled! Di))erent s&%rces &) data can e inte(rated! H&1everE di))erent data
s&%rces &)ten %se di))erent (enerali<ati&n m&dels t& descrie &;ectsE and inc&nsistenc+ ma+ &cc%r
1$en inte(ratin(! T$is %ndersc&res t$e im'&rtance &) nati&nal data standards!
d? From pull to push mode: 1e7ma''in( a''licati&ns are t+'icall+ desi(ned t& 1ait )&r a %ser t&
access Hvisit I '%ll in)&rmati&n! F&r '%lic $ealt$ and '%lic sa)et+E t$e t+'ical met$&d &)
in)&rmati&n deliver+ is n&t adeF%ate! 9$en a disease &%trea2 &cc%rsE t$e a''licati&n s$&%ld O'%s$P
t$e in)&rmati&n t& a''r&'riate 'e&'le t$r&%($ active c$annels s%c$ as tele'$&neE 'a(ersE '&'7%'E
emailE alarm and s& &n!
7/AL.7 9N*0-&A.90N 1/-;9,/ A-,79./,.8-/
P%lic $ealt$ data need t& e strate(icall+ de)ined in terms &) data c&llecti&nE st&ra(eE %sa(eE
standards and distri%ti&n in t$e CGDI )rame1&r2! Healt$ a%t$&rities c&nsiderin( t$e ad&'ti&n &)
GIS tec$n&l&(+ m%st )irst c&nsiderD
a1 -ata dictionary 7metadata creation 4 A)*8
b1 -ata standards 7collection 4 medical vocabulary8
c1 -ata storage, safety and redundancy
d1 -ata distribution 7information system requirements8
e1 -ata sharing 7digital rights management 4 public .ey certification8
f1 -atabase design 7for data retrieval and modeling8
g1 -ata %rivacy 7patient identifiers 4 de!identified data8
As 1e7ased ma''in( )&r '%lic $ealt$ data is relativel+ ne1E standards )&r $ealt$ ma''in( need t&
e )%rt$er investi(ated!
a1 %ublic health indicators 7$1g1 disease baseline 4 tolerance levels, e2ceedances 4 anomalies8
b1 Statistics model 7single or multi variant analysis model8
c1 Spatial 4 temporal analysis model 7G#S )odel8
d1 6isualization algorithm and symbology
e1 *ocation resolution 4 scales
f1 +esolution of data to be available
Access t& s'atial data as a re)erence &r ac2(r&%nd )&r ma'sE is m&st accessile t$r&%($ CGDI
9-Ss s%c$ as Canadian AtlasE Ne1 Br%ns1ic2 L%n( Ass&ciati&nE TICSE etc! H&1everE a''r&'riate
data selecti&n and )%si&n >&n7t$e7)l+? need t& e )%rt$er investi(ated! T$is c&%ld e acc&m'lis$ed
t$r&%($ U-L desi(n and data 1&r2)l&1 mana(ement! -an+ 'artners 1ill need t& e inv&lved in
desi(nin( t$e m%lti'le 'at$1a+s t& )rame1&r2E t$ematicE and '%lic $ealt$ data 1it$in t$e CGDI!
Architecture
A CGDI7nested '%lic $ealt$ arc$itect%re m%st als& incl%deD
35
availailit+ &) $ealt$ data 1it$ s'atial and tem'&ral in)&rmati&n stam'sR
a''licati&ns 1it$ t$e ailit+ t& anal+<e s'atialE dem&(ra'$ic and tem'&ral dataR
a''licati&ns and dataases 1it$ t$e ailit+ t& dem&nstrate indicat&rs &) '%lic $ealt$ and disease
&%trea2 1it$in a level &) t&leranceE ailit+ t& alertE 1arn and act &n &%trea2 >P%s$ m&de?
*igure $ s$&1s t$e arc$itect%re &) $ealt$ in)&rmati&n services!
An+ $ealt$ ma''in( '&rtal t$at is %ilt %'&n CGDI 1ill %tili<e all t$e services &) CGDI >s%c$ as 9-SsE
9FSs and Ga<etteers? and t$en 'r&vide services >J-L Gate1a+ s%c$ as 9FSE 9-SE O9S? t& t$e
'%lic and s'eciali<ed %sers >1$& are 'art &) t$e CGDI?! *igure ) 'resents t$is in detailD
Healt$ -a''in(
P&rtal
-a''in(
J-L
Gate1a+
DB-S
CGDI
internet
A''licati&n
Dataases S'atial
Re)erence data
-a'
Statistics m&del
GIS m&del
And S+m&l&(+
-a''in(
Service
J-L Gate1a+ -a''in( P&rtal
9e
Services
Data
Service
s
56
Fi(ure 1: Healt$ 9e -a''in(
%A.ABA1/ &ANA+/&/N. 1@1./&1
A dataase mana(ement s+stem st&res all $ealt$ dataE as 1ell as %ser in)&rmati&n )&r assi(nin( 'ermissi&ns
t& data access and ma''in(! In sim'listic termsE a dataase mana(ement s+stem can e in a central
re'&sit&r+ &r distri%ted dataases!
%istributed %atabases data ma+ e st&red in m%lti'le c&m'%ters l&cated in t$e same '$+sical l&cati&nE &r
ma+ e dis'ersed &ver a net1&r2 &) interc&nnected c&m'%ters! A distri%ted dataase is distri%ted int&
se'arate 'artiti&nsH)ra(ments! Eac$ 'artiti&nH)ra(ment &) a distri%ted dataase ma+ e re'licated >ie!
red%ndant )ail7&versE RAID li2e?! Besides distri%ted dataase re'licati&n and )ra(mentati&nE t$ere are man+
&t$er distri%ted dataase desi(n tec$n&l&(ies! F&r e4am'leE l&cal a%t&n&m+E s+nc$r&n&%s and
as+nc$r&n&%s distri%ted dataase tec$n&l&(ies! T$ese tec$n&l&(ies: im'lementati&n can and d&es de)initel+
de'end &n t$e needs &) t$e %siness and t$e sensitivit+Hc&n)identialit+ &) t$e data t& e st&red in t$e
dataase! T$e level &) c&mmitment t$e %siness is 1illin( t& ma2e &n ens%rin( data sec%rit+E c&nsistenc+
and inte(rit+ I ma+ als& e sensitive t& c&st!
C&llecti&n &) data >e(! in a dataase? can e distri%ted acr&ss m%lti'le '$+sical l&cati&ns >e!(! $&s'itals H
de'artments H las H clinics?!
!d8anta(es o& #istributed #atabases
Re)lects &r(ani<ati&nal str%ct%re \ dataase )ra(ments are l&cated in t$e de'artments t$e+ relate t&!
L&cal a%t&n&m+ \ a de'artment can c&ntr&l t$e data a&%t t$em >as t$e+ are t$e &nes )amiliar 1it$ it?
Im'r&ved availailit+ \ a )a%lt in &ne dataase s+stem 1ill &nl+ a))ect &ne )ra(mentE instead &) t$e
entire dataase!
Im'r&ved 'er)&rmance \ data is l&cated near t$e site &) (reatest demandE and t$e dataase s+stems
t$emselves are 'arallelli<edE all&1in( l&ad &n t$e dataases t& e alanced am&n( servers! >A $i($ l&ad
&n &ne m&d%le &) t$e dataase 1&n:t a))ect &t$er m&d%les &) t$e dataase in a distri%ted dataase!?
Ec&n&mics \ it c&sts less t& create a net1&r2 &) smaller c&m'%ters 1it$ t$e '&1er &) a sin(le lar(e
c&m'%ter!
-&d%larit+ \ s+stems can e m&di)iedE added and rem&ved )r&m t$e distri%ted dataase 1it$&%t
a))ectin( &t$er m&d%les >s+stems?!
#isad8anta(es o& #istributed #atabases
C&m'le4it+ \ e4tra 1&r2 m%st e d&ne + t$e dataase administrat&rs t& ens%re t$at t$e distri%ted
nat%re &) t$e s+stem is trans'arent! E4tra 1&r2 m%st als& e d&ne t& maintain m%lti'le dis'arate s+stemsE
instead &) &ne i( &ne! E4tra dataase desi(n 1&r2 m%st als& e d&ne t& acc&%nt )&r t$e disc&nnected
5#
Fi(ure "* Healt$ 9e -a''in( Service Arc$itect%re
nat%re &) t$e dataase \ )&r e4am'leE ;&ins ec&me 'r&$iitivel+ e4'ensive 1$en 'er)&rmed acr&ss
m%lti'le s+stems!
Ec&n&mics \ increased c&m'le4it+ and a m&re e4tensive in)rastr%ct%re means e4tra la&%r c&sts!
Sec%rit+ \ rem&te dataase )ra(ments m%st e sec%redE and t$e+ are n&t centrali<ed s& t$e rem&te sites
m%st e sec%red as 1ell! T$e in)rastr%ct%re m%st als& e sec%red >e(D + encr+'tin( t$e net1&r2 lin2s
et1een rem&te sites?!
Di))ic%lt t& maintain inte(rit+ \ in a distri%ted dataase en)&rcin( inte(rit+ &ver a net1&r2 ma+
reF%ire t&& m%c$ net1&r2in( res&%rces t& e )easile!
Ine4'erience \ distri%ted dataases are di))ic%lt t& 1&r2 1it$E and as a +&%n( )ield t$ere is n&t m%c$
readil+ availale e4'erience &n 'r&'er 'ractice
#ata er8ice 7ro2ers
Federal and Pr&vincial (&vernments are c&ncerned 1it$ net1&r2 sec%rit+E %t m%st still 'r&vide access t&
t$e '%lic )&r services and in)&rmati&n! T$is 'resents a %niF%e c$allen(e t& 1e7ma''in( s+stemsE 1$ic$
de'end &n a distri%ted net1&r2 &) data 'r&vidersE 1e servicesE and a''licati&n tec$n&l&(+!
Here are t$ree '&ssile arc$itect%res )&r Federal and Pr&vincial (&vernments t& 'r&vide data >incl%din(
'%lic $ealt$ data? t& end7%sersD
FirstD t$r&%($ a''r&'riate data licensesE (&vernment can 'r&vide data t& researc$ &r(ani<ati&ns H et1een
$ealt$ a%t$&rities! T$e trans)er &) data &cc%rs in a '$+sical )&rmat >i!e! n&t electr&nic? I data can e
disseminated via CDHD.DE emailE &r FTP! In t$is )irst e4am'leE n& 1e7service is ein( 'r&vided! 9$ile
t$is met$&d is relativel+ sec%reE it is im'&ssile t& &tain timel+ H real7time data in t$e event &) a
'andemic H nat%ral disaster!
Sec&ndE G&vernment can enale %sers t& c&nnect 1it$ a dataase s+stem H 1e ma''in( serviceE t&
e4tract dataHma's &n7demand! 9it$ t$e 'r&'er a%t$enticati&n and sec%rit+ 'r&t&c&lsE t$e (&vernment
net1&r2 can remain sec%re >%t n&t air7ti($t? and %sers can d&1nl&ad availale data H ma's! 9$ile t$is
enales real7time access t& data >n&t necessaril+ real7time data?E it als& '&tentiall+ c&m'r&mises net1&r2
sec%rit+!
T$e t$ird &'ti&n is t& create a r&2erE 1$ic$ is ca'ale &) 'r&vidin( %sers 1it$ real7time access t& 1e7
services and dataE 1it$&%t c&m'r&misin( net1&r2 sec%rit+! S%c$ a r&2er 1&%ld need t& maintain %' t&
date dataases t$r&%($ data s$arin( a(reements acr&ss (&vernment and $ealt$ a(encies! S%c$ a s+stem
1&%ld ideall+ e c&nnected 1it$ CanadaQs Healt$ In)&1a+ and nested 1it$in t$e CGDI! >See Fi(%re *?!
52
G&vernment
Data H '%lic
$ealt$ data
G&vernment
Net )ire1all
Broker > ,+%9
Dataase -a''in(
-a''in(
Service
Data
Service
s
>#?
>2?
Fi(ure /* Data Service Br&2er
End7User H
Client
>*?
Sec%re Gate1a+ H
1/,8-9.@ AN% A8.7/N.9,A.90N
Arc$itects devel&'in( a(ainst a services la+er %sin( J-LE rat$er t$an directl+ a(ainst t$e B%siness La+erE
)ace t$ree sec%rit+ c$allen(esD #? a 'ersistent t$reat )r&m t$e end %ser &r client t& t$e %siness s+stemsR 2?
ens%rin( t$at an %na%t$&ri<ed %ser sendin( malici&%s J-L is l&c2ed )r&m t$e 9e serviceR and *?
l&c2in( r&(%e J-L messa(es t$at +'ass t$e J-L (ate1a+ AOQNeillE 266,B!
Several met$&ds e4ist t& &verc&me t$is sec%rit+ t$reatD
A%t$enticatin( %sers %sin( direct&r+ &r SSO >Sin(le ISi(n On? I a t+'e &) Di(ital Ri($ts -ana(ement!
T$e G&vernment &) Canada can 'r&vide a sin(le '&int &) access )&r c&$erent (&vernment in)&rmati&n
and services ACGDIE 266"BE and insert sec%rit+ t&2ensR >clientH%ser la+er?!
A%t$enticatin( client %sin( SSLE HTTP a%t$enticati&nE &r 9S7Sec%rit+E t& validate J-L c&ntent a(ainst
sc$emaR insert sec%rit+ t&2enE si(ns messa(eR >Access la+er?
A(ent )ilter tra))icE a%t$&ri<in( ased &n sec%rit+ t&2ens inside J-L messa(esR C&&rdinated J-L
sec%rit+ '&licies and en)&rcement >Services la+er?
User identit+ H P%lic Ke+ Certi)icati&n >%ser acc&%nt 'ermissi&nE IP acc&%nt 'ermissi&n? in t$e %siness
la+er
%A.ABA1/ P-0;9%/-1
An+ Healt$ A%t$&rit+ c&nsiderin( 1e7ma''in( tec$n&l&(+E s$&%ld ens%re a r&%st dataase mana(ement
s+stem is in 'lace! Sec&ndl+E a $ealt$ a%t$&rit+ s$&%ld ens%re c&m'liance 1it$ ind%str+ standards I i!e!
1$ic$ dataases are m&st c&mm&nl+ %sed in t$e '%lic $ealt$ d&mainE in &rder t& ens%re inter&'erailit+!
F&r s'atial ill%strati&n &) '%lic $ealt$ dataE 'r&minent dataase s+stems t$at can e c&nsidered incl%de
'r&'rietar+ )&rmatsD
ORACLE 7 111!&racle!c&m
IB- DB2 7 1117*6/!im!c&mHs&)t1areHdataHd2H
-icr&s&)t S=L Server 7 111!micr&s&)t!c&mHsFlHde)a%lt!ms'4
-+S=L S'atial >&'en s&%rce?!
P%lic
User
Internal
User
J-L
(ate1a+
Intranet
E4tranet
P&rtal
User Access Services B%siness
La+er la+er la+er la+er
A''licati&n
Server
J-L
Sec%rit+
Server
Dataase
Server
5*
Fi(ure 6* User Access 9e Services >Based &n AOQNeilE 266,B?
W&1 AN% W*1
Web &ap 1er4ice
T$e 9-S s'eci)icati&n standardi<es t$e 1a+ in 1$ic$ clients reF%est ma's! Clients reF%est ma's )r&m a
9-S instance in terms &) named la+ers and 'r&vide 'arameters s%c$ as t$e si<e &) t$e ret%rned ma' as 1ell
as t$e s'atial re)erence s+stem t& e %sed in dra1in( t$e ma'! T$is s'eci)icati&n de)ines t$ree 9-S
&'erati&nsD GetCa'ailities ret%rns service7level metadataE 1$ic$ is a descri'ti&n &) t$e service:s
in)&rmati&n c&ntent and acce'tale reF%est 'arametersR Get-a' ret%rns a ma' ima(e 1$&se (e&s'atial and
dimensi&nal 'arameters are 1ell7de)inedR GetFeat%reIn)& >&'ti&nal? ret%rns in)&rmati&n a&%t 'artic%lar
)eat%res s$&1n &n a ma'! Tales el&1 listed all 9-S mandat&r+ and &'ti&nal 'arameters! Since t$e
&'ti&nal 'arameters are n&t mandated t& c&m'l+ 1it$ 9-S reF%irementsE vend&rs ma+ n&t im'lement t$ese
&'ti&nal 'arameters! D%rin( t$e )irst '$ase &) Ne1 Br%ns1ic2 L%n( Ass&ciati&nQ ma''in( 'r&;ectE s&me
&'ti&nal 'arameters 1ere im'lemented >see last c&l%mn &) tales el&1E O+esP s$&1s im'lementedE On&P
s$&1s n&t +et!
Get .apabilities*
-e=uest Para5eter &andatory
>0ptional
%escription Implementation
.ERSION Sversi&n O
ReF%est versi&n
<$S
SER.ICE S 9-S -
Service t+'e
<$S
RE=UESTSGetCa'ailities -
ReF%est name
<$S
FOR-ATS-I-EYt+'e O
O%t'%t )&rmat &)
service metadata
'9
UPDATESE=UENCESstrin
(
O
SeF%ence n%mer &r
strin( )&r cac$e c&ntr&l
'9
GetFeatureIn&o >optional?
-e=uest Para5eter &andatory>
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%escription 95ple5entation
.ERSIONSversi&nY
N&
-
ReF%est versi&n
<$S
RE=UESTSGetFeat%reIn)
&r
-
ReF%est name
<$S
ma' reF%est 'art -
Partial c&'+ &) t$e -a' reF%est 'arameters t$at
(enerated t$e ma' )&r 1$ic$ in)&rmati&n is
desired!
<$S
=UERCYLACERSS
la+erYlist
-
C&mma7se'arated list &) &ne &r m&re la+ers t&
e F%eried
<$S
INFOYFOR-ATS
&%tY)&rmat
-
Ret%rn )&rmat &) )eat%re in)&rmati&n >-I-E
t+'e?
<$S
FEATUREYCOUNTSn%m
er
O
N%mer &) )eat%res a&%t 1$ic$ t& ret%rn
in)&rmati&n >de)a%lt S#?
'9
IS'i4elYc&l%mn -
i c&&rdinate in 'i4els &) )eat%re in -a' CS
<$S
@S'i4elYr&1 -
; c&&rdinate in 'i4els &) )eat%re in -a' CS
<$S
EJCEPTIONSS
e4ce'ti&nY)&rmat
O
T$e )&rmat in 1$ic$ e4ce'ti&ns are t& e
re'&rted + t$e 9-S >de)a%ltSJ-L?
<$S
5,
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>0ptional
%escription 95ple5entation
.ERSIONS versi&n N&! -
ReF%est versi&n
<$S
RE=UEST SGet-a' -
ReF%est name
<$S
LACERSSla+erYlist -
C&mma7se'arated list &) &ne &r m&re ma' la+ers
<$S
STCLESSst+leYlist -
C&mma7 se'arated list &) &ne renderin( st+le 'er
reF%ested la+er
<$S
CRSSnames'ace identi)ier -
C&&rdinate re)erence s+stem
<$S
BBOJSmin4!min+!ma44!
ma4+
-
B&%ndin( &4 c&rners >l&1er le)tE %''er ri($t? in
CRS %nits
<$S
9IDTHS&%tY1idt$ -
9idt$ in 'i4els &) ma' 'ict%re
<$S
HEIGHTS&%tY$ei($t -
Hei($t in 'i4els &) ma' 'ict%re
<$S
FOR-ATS&%t'%tY)&rmat -
O%t'%t )&rmat &) ma'
<$S
TRANSPARENT
STRUEHFALSE
O
Bac2(r&%nd trans'arenc+ &) ma' >de)a%lt S
FALSE?
<$S
BGCOLORSc&rl&rYval%e O
He4adecimal red7(reen7l%e c&l&r val%e )&r
ac2(r&%nd c&l&r >de)a%ltS 64FFFFFF?
<$S
EJEPTIONSSe4ce'ti&n
Y)&rmat
O
T$e )&rmat in 1$ic$ e4ce'ti&ns are t& e
re'&rted + t$e 9-S >de)a%ltSJ-L?
<$S
TI-EStime O
Time val%e &) la+er desired
'9
ELE.ATIONSelevati&n O
Elevati&n &) la+er desired
'9
Ot$er sam'le
dimensi&n>s?
O
.al%e &) &t$er dimensi&ns as a''r&'riate
'9
Envir&nmental $ealt$ in)&rmati&n is est anal+<ed + a )act&r &) time! Data is availale at m%lti'le time
scales >$&%rl+E dail+E m&nt$l+E ann%all+?! It is ver+ im'&rtant t& inc&r'&rate tem'&ral dimensi&n 1it$in
a''licati&ns and 9-S! At same time and same l&cati&nE t+'es &) t$e disease distri%ti&n and '&ll%ti&n
distri%ti&n ma+ di))er! Addin( disease t+'e and '&ll%ti&n t+'e dimensi&ns t& 9-SE it 1ill enale %ser t&
easil+ c&m'are and anal+<e envir&nmental $ealt$ data!
9e 'r&'&se t$at )&r envir&nmental $ealt$ 1e ma''in( 1it$in CGDIHOGC )rame1&r2E m%lti'le dimensi&ns
ta(s s$&%ld e im'lementedD
>1 time tag 7already in 9G" specification1 'ew &runswic. *ung ,ssociation will implement the first
time tag in their cross!border initiative, for )arch CJJE8
C1 disease type ta( 7not in 9G" specification yet8
*! pollution type ta( 7not in 9G" specification yet8
F%rt$erm&reE it is necessar+ )&r dataases t& incl%de time stam's >t& s%''&rt t$e time ta(?! It is $i($l+
'&ssile t$at m&re dimensi&n time ta(s c&%ld e devel&'edE in c&ns%ltati&n 1it$ e4'erts in s'atial disease
e'idemi&l&(+E mete&r&l&(+ H climat&l&(+E and &t$er end %sers!
Web *eature 1er4ice
5"
Basicall+E 9-S 'r&vides inter&'erailit+ )&r di))erent ma' s&%rces t& inte(rate t&(et$er as a ma' ima(e! In
additi&n t& 9-SE t$e OGC als& 'r&vides &t$er standards s%c$ as 9FS >9e Feat%re Service?!
9FS s%''&rts INSERTE UPDATEE DELETEE =UERC and DISCO.ERC &) (e&(ra'$ic )eat%res! 9FS
delivers G-L re'resentati&ns &) sim'le (e&s'atial )eat%res in res'&nse t& F%eries )r&m HTTP clients!
Clients access (e&(ra'$ic )eat%re data t$r&%($ 9FS + s%mittin( a reF%est )&r ;%st t$&se )eat%res t$at are
needed )&r an a''licati&n! A 9FS can eit$er e a asic 9FS >a READ7ONLC 9FS?E 1$ic$ im'lements t$e
GetCa'ailitiesE DescrieFeat%reT+'e and GetFeat%re inter)acesE &r a transacti&n 9FSE 1$ic$E in additi&n
t& s%''&rtin( all t$e inter)aces &) a asic 9FSE im'lements t$e Transacti&n inter)ace >and &'ti&nall+ t$e
L&c2Feat%re inter)ace?! Ultimatel+E 9FS enales a %ser t& interact 1it$ s'atial dataE n&t &nl+ t$e )eat%re
attri%tes!
In t$is 1a+E F%eries 1&%ld enale $ealt$ 'r&)essi&nals t& vie1 s%s'ected cases &) a disease in relati&n t&
$ealt$ )acilitiesE and determine relative distance H accessE es'eciall+ 1$en $ealt$ data and )acilities data are
distri%ted acr&ss m%lti'le servers!
F&r )%t%re $ealt$ ma''in( a''licati&nsE in &rder t& 'er)&rm m&re s'atial anal+sis &n distri%ted H rem&te
dataasesE 1e rec&mmend t$e im'lementati&n &) 9FS s'eci)icati&ns! Healt$ a%t$&rities in t$e 'r&cess &)E &r
c&nsiderin( ad&'ti&n &) 9-S tec$n&l&(+E m%st ens%re GIS vend&rs 'r&vide 9-S and 9FS ca'ailit+!
F%rt$erm&reE 9FS ca'ailit+ s$&%ld e 'resent &n t$e client and 1e7services sides!
Re)erenceD
OQNeillE -ar2 266, 0appin( ecurity to a er8ices 9riented !rchitecture! A6n7lineB
$tt'DHH111!)t'&nline!c&mHeaHma(a<ineHs'rin(Hde'artmentsH1$ite&ardHDe)a%lt!as'4
5/
%isplay
-ender
%isplay
/le5ent
+enerator
1elect %ata
#!T!
9,R.)
Device
Characteristics
Image
Constraints
St+le
=%er+
C&nstraints
95age
%isplay
/le5ent
*eature
Styled Layer
Descriptor
Geography
Markup
Language
Filter Encoding
W*1
W&1
Ge&C&nnecti&ns 266" The .anadian Geospatial #ata In&rastructure1 !rchitecture #escription! .ersi&n
2!6!
,+%9/N%0-1/% 1.AN%A-%1
CGDI7end&rsed standards )all int& t$e )&ll&1in( cate(&ries >actual specification names in
italics?D
%ata 4isuali<ation: T$e eb )ap Server 7)S8 inter)ace s'eci)icati&n de)ines services t& create and
dis'la+ s%'erim'&sed ma' la+ers &) (e&(ra'$ic data )r&m m%lti'le s&%rces!
%ata presentation: T$e Styled *ayer -escriptor 7S*-8 s'eci)icati&n is a c&m'ani&n s'eci)icati&n t& t$e
9-S inter)ace s'eci)icati&n! It 'r&vides s&me c&ntr&l &ver $&1 (e&(ra'$ic )eat%res are t& e '&rtra+edE &r
s+m&li<ed!
%ata storage: T$e eb )ap "onte2t 7)"8 d&c%ment s'eci)icati&n all&1s )&r t$e creati&n and st&ra(e &)
in)&rmati&n >metadata? a&%t ma's )&r re7%se! It is als& a c&m'ani&n s'eci)icati&n t& t$e 9-S inter)ace
s'eci)icati&n!
%ata 5anipulation: T$e eb Feature Service 7FS8 s'eci)icati&n de)ines data mani'%lati&n &'erati&ns &n
(e&(ra'$ic )eat%res s%c$ as 1ater &diesE in)rastr%ct%resE etc!
%ata encoding: Geography )ar.up *anguage 7G)*8 is an J-L c&din( )&r t$e trans'&rt and st&ra(e &)
(e&(ra'$ic in)&rmati&nE incl%din( &t$ t$e (e&metr+ and 'r&'erties &) (e&(ra'$ic )eat%res!
%ata =uery: T$e Filter $ncoding s'eci)icati&n 'r&vides a standard J-L7ased means &) restrictin( t$e
rec&rds t$at are ret%rned )r&m a F%er+! Filter enc&din( can $andle &t$ s'atial and n&n7s'atial as'ects &) a
F%er+!
%ata access: T$e Geo-ata -iscovery Service searc$es (e&s'atial data res&%rce re(istriesE and retrieves
metadata a&%t (e&s'atial data! Ga<etteers l&&2 %' (e&(ra'$ic re(i&ns ased &n sec&ndar+ re)erence
s+stems s%c$ as '&stal c&des and 'lace names >e!(!E Canadian Ge&(ra'$ic Name Service &r t$e Nati&nal
T&'&(ra'$ic Name Service?!
%ata description: T$e )etadata for Geodata s'eci)icati&n 'r&vides a standard 1a+ &) descriin(
(e&s'atial data!
C&m'liance 1it$ t$e CGDI im'lies t$at an a''licati&n &r service m%st %se &r s%''&rt t$e relevant CGDI
end&rsed7standards!
-/,0&&/N%A.90N1
Here is a F%ic2 s%mmar+ &) rec&mmendati&nsE ased &n t$e disc%ssi&n a&veD
T$e CGDI s$&%ld enale '%lic $ealt$ a%t$&rities and t$e (eneral '%lic t& 'er)&rm &n7demand
ma''in(E &nlineE 1it$ %ser7(enerated 'arametersE %sin( data )r&m m%lti'le s&%rces!
T$e CGDI s$&%ld enale a '%s$7s+stem I t& '%s$ ma's t& a net1&r2 &) '%lic $ealt$ a%t$&rities and
'%lic 1e sites >still ens%rin( data 'rivac+?E )&r earl+ 1arnin( H '%lic alertin(!
50
A CGDI7nested '%lic $ealt$ arc$itect%re 1ill de'end 'rimaril+ &n t$e availailit+ &) standardi<ed
'%lic $ealt$ data!
P%lic $ealt$ data m%st incl%de s'atial re)erences >'er rec&rdHDB? %t als& time stam'sE disease t+'e
stam'sE and '&tentiall+ &t$ers!
T$e e'idemi&l&(ical and GIS c&mm%nities c&%ld devel&' )%rt$er U&'ti&nalQ dimensi&n ta(s )&r
im'lementati&n
A''licati&ns m%st e ale t& 'r&vide anal+tical )%ncti&ns t& %sersE t& anal+<e s'atialE dem&(ra'$icE
and tem'&ral data! In additi&nE a''licati&ns m%st 'r&vide access t& statistical t&&ls H m&d%lesE and
m%st a''r&'riatel+ mana(e %ser 'ermissi&ns )&r access t& data I i!e! a''licati&ns m%st e ale t&
a((re(ate data t& decrease s'eci)icit+ H maintain 'rivac+!
CanadaQs Healt$ In)&1a+E 'r&vincial $ealt$ a%t$&ritiesE and t$e CGDIE s$&%ld c&nsider t$e
advanta(es and disadvanta(es &) %ildin( distri%ted dataase mana(ement s+stems as &%tlined
a&ve!
T$e CGDI c&%ld act as a data service r&2er )&r )ederal and 'r&vincial $ealt$ a%t$&rities! T$e reas&n
)&r t$is is t& ens%re sec%rit+ &) net1&r2sE data 'rivac+E %ser mana(ement H access restricti&nsE and
timeliness &) data H service )&r end7%sers! T$e data service r&2er 1&%ld 'r&vide a''licati&n $&sts
1it$ 9-SH9FS services )&r '%lic $ealt$ dataE 1$ile maintainin( data license a(reements 1it$
&ri(inal c%st&dians &) t$e data >'%lic $ealt$ a%t$&rities?!
T$e CGDI H Ge&C&nnecti&ns s$&%ld e4'l&re t$e %se &) '%lic 2e+ certi)icati&n &r similar %ser
mana(ement s+stem t& ens%re data 'rivac+ and net1&r2 sec%rit+E as &%tlined a&ve I t$is 1&%ld
reF%ire '%lic $ealt$ a%t$&rities t& re(ister IP addresses and individ%al %sers 1it$ t$e CGDI!
Ge&C&nnecti&ns s$&%ld $el' '%lic $ealt$ a%t$&rities t& im'lement dataase s&l%ti&ns t$at can
serve7%' '%lic $ealt$ data )&r 9-SH9FS services!
P%lic $ealt$ a''licati&n devel&'ers s$&%ld c&nsider &t$ t$e 9-S &'ti&nal standards and 9FS
standard >client side and server side? as a''r&'riate minim%m reF%irements )&r '%lic $ealt$
a''licati&ns! Ot$er CGDI7end&rsed standardsE as descried a&veE s$&%ld als& e c&nsidered!
T$e 9e -a' C&nte4t Standard s$&%ld e im'lementedE $&1ever ca%ti&n s$&%ld e ta2en )&r
enalin( %sers t& '%lis$ ma's t& t$e CGDI t$at ma+ c&ntain sensitive in)&rmati&n >i!e! im'in(e &n
'atient c&n)identialit+?!
53
,0&PL9&/N.A-@ ./,7N0L0+9/1
9N.-0%8,.90N
GIS ma''in( tec$n&l&(ies c&me in a variet+ &) s$a'es and si<esE de'endin( &n t$e r&%stness &) t$e
s&)t1are and t$e a''licati&n 'lat)&rmsE i1e1E des2t&'E 1e 'a(eE 1e server! T$ere are t$ree t+'es &)
ma''in( s&)t1are tec$n&l&(ies c%rrentl+ availale )&r $ealt$ care 'lannin(D
i1 static mapping 7allows data to be modeled, but only in a passive conte2t8
ii1 interactive mapping 7allows data to be modeled in real!time via standardized queries8
iii1 programmable mapping 7allows data to be altered in real!time via improvised queries8
1.A.9, &APP9N+
Static ma''in( is a 'assive %ser7inter)ace a''licati&n est de)ined 1it$in t$e c&nte4t &) a Read Onl+
-em&r+ tec$niF%e >RO-?! An e4am'le &) t$is 'assive ma''in( tec$niF%eE t$e 9&rld Healt$ Or(ani<ati&n:s
Gl&al Healt$ Atlas 'lat)&rm maintains an electr&nic lirar+ 1$ic$ 'r&vides ma''in( services &n '%lic
$ealt$ in t$e )&rm &) '%licati&nsE statistics and static ma's cate(&ri<ed and retrieved + (e&(ra'$ic area
and t&'ic
A*#"B
!
T$is ma''in( inter)ace all&1s %sers t& create 'ers&nali<ed ma's &) disease 'r&)ilesE selectin( (e&(ra'$ic
interestE l&cati&n &) $ealt$ )acilitiesE sc$&&lsE r&ads and &t$er (e&(ra'$ic )eat%resE etc! It enales a
c&m'arative anal+sis &) standardi<ed data and statistics )&r in)ecti&%s diseases at c&%ntr+E re(i&nalE and
(l&al levels! T$e anal+sis and inter'retati&n &) t$is data is c&m'lemented t$r&%($ in)&rmati&n &n
dem&(ra'$+E s&ci&ec&n&mic c&nditi&nsE and envir&nmental )act&rs! In s& d&in(E t$e Atlas s'eci)icall+
ac2n&1led(es t$e r&ad ran(e &) determinants t$at in)l%ence 'atterns &) in)ecti&%s disease transmissi&n!
55
T$is data 1are$&%se s+stem 'r&vides a )&cal access t& statistical dataE re'&rts and d&c%ments &n t$e ma;&r
diseases &) '&vert+ >malariaE HI.HAIDSE t%erc%l&sis?E t$e diseases &n t$eir 1a+ t&1ards eradicati&n and
eliminati&n >(%inea 1&rmE le'r&s+E l+m'$atic )ilariasis? and e'idemic 'r&ne and emer(in( in)ecti&ns
>menin(itisE c$&leraE +ell&1 )ever and anti7in)ective dr%( resistance?! T$e dataase is %'dated &n an &n(&in(
asis! In additi&n t& e'idemi&l&(ical dataE t$e s+stem 'r&vides in)&rmati&n &n essential s%''&rt servicesE
s%c$ asD a net1&r2 &) c&mm%nicale diseases c&lla&ratin( centresE t$e activities &) t$e Gl&al O%trea2
Alert and Res'&nse Net1&r2E am&n( &t$ers!
T$e Gl&al Healt$ Atlas c&m'rises t$ree c&m'&nentsD
i1 -ata /uery ! allows users to browse, view, query, search the contents of the 09Ns "ommunicable
-isease global database and output data in reports, charts and maps1
ii1 #nteractive )apping ! provides a user!friendly mapping interface for selecting geographic areas of
interest and create maps of diseases, the location of health facilities, schools, roads, geographic
features1
iii1 )aps and +esources ! provides access to static maps and related documents, publications and
statistics on infectious diseases1
#66
9N./-A,.9;/ &APP9N+
Interactive ma''in( is als& a 'assive %ser7inter)ace a''licati&nE %t est de)ined 1it$in t$e c&nte4t &) a
9rite Once Read -an+ tec$niF%e >9OR-?! An e4am'le &) an interactive ma''in( tec$niF%eE SIGE'i is a
statisticalE anal+tical and (e&(ra'$ic in)&rmati&n s+stems s&)t1are 'ac2a(e devel&'ed + t$e Pan American
Healt$ Or(ani<ati&nE a re(i&nal &))ice &) t$e 9&rld Healt$ Or(ani<ati&n
A*#/B
! T$e SIGE'i s&)t1are 'r&(ram
is a c&&'erative 'r&;ect t$at incl%des tec$nical s%''&rt in t$e devel&'ment &) GIS a''licati&nsE anal+tical
met$&ds and trainin( materials in medical e'idemi&l&(+ and '%lic $ealt$!
Cart&(ra'$ic data )&rmats )&r di(ital ma's can e $andled in vari&%s )&rmatsD ESRI S$a'e)ileE ArcIn)&
C&vera(eE GRIDE .-PE E'i-a'E and a r&ad set &) )&rmats )&r aerial and satellite '$&t&(ra'$s and ima(es!
It is '&ssile t& inc&r'&rate anal+sis 1it$ SIGE'i tales in dBaseE F&4Pr&E EJCEL and &t$ers )&rmats
created + r&%tine in)&rmati&n s+stems! E'iIn)& data )iles created )r&m an E'iIn)& F%esti&nnaire can e
directl+ im'&rted t& t$e SIGE'i dataase! Once a tale is im'&rted t& t$e dataaseE it can e lin2ed t&
cart&(ra'$ic la+ers and dis'la+ed &n a ma'! SiGE'i $as t$e ailit+ t& read &%ndar+ )iles in E'i-a'
versi&ns # and 2 )&rmats! In t$e case &) E'iIn)&HE'i-a' 2666D it can directl+ &'en t$e cart&(ra'$ic
dataases!
9$ile SIGE'i d&es n&t 'r&vide t$e cart&(ra'$ic 1are$&%se dataases needed )&r a''l+in( GIS $ealt$care
m&delsE '%licl+ distri%ted data sets ma+ e &tained )r&m vari&%s Internet s&%rces and inc&r'&rated int&
t$e SIGE'i 'r&(ram!
/3a5ple: 9ncidencia de 19%A
SiGE'i s%''&rts a c&m're$ensive ass&rtment &) anal+tical t&&lsD
i1 the creation of thematic maps utilizing measures and health indicators3
ii1 response to questions on the impact of spatial and geographical variables on health problems3
iii1 calculation, standardization, and spatial smoothing of rates and proportions3
iv1 descriptive statistics, correlation, and linear regression3
v1 identification of critical or priority areas and populations3
vi1 construction of a composite inde2 7eg1 inde2 of unmet basic needs in health, poverty inde2, etc183
vii1 identification and detection of both spatial and time!space clusters3
viii1 measurement of the association of environmental!ecological e2posure factors and health events in
epidemiological studies of case!control and cohorts3
i21 assessment of accessibility to health services1
#6#
/3a5ple: %istances 2ro5 7ealth ,enters in 1an Juan( Puerto -ico
P-0+-A&&ABL/ &APP9N+
Pr&(rammale ma''in( is a 'r&active %ser7inter)ace a''licati&nE est de)ined 1it$in t$e c&nte4t &) a 9rite
Read Active -an+ tec$niF%e >9RA-?! An e4am'le &) an interactive 'r&(rammale ma''in( tec$niF%eE
t$e G&&(le -a's A''licati&ns Pr&(ram Inter)ace all&1s devel&'ers t& emed ma's directl+ int& t$eir &1n
1e 'a(es 1it$ @avaScri't! One can add ma' &verla+s >incl%din( mar2ers and '&l+lines? and dis'la+ c%rs&r7
activated s$ad&1 1ind&1s $i($li($tin( '&ints7&)7interest in)&rmati&n! T$e -a's API is a )ree eta serviceE
availale )&r %se + an+ n&n7'r&)it 1e site )reel+ accessile + t$e '%lic! H&1everE G&&(le retains t$e
ri($t t& 'lace advertisin( &n t$e ma'! T$e G&&(le -a's API enales a %ser t& c%st&mi<e t$e ma''in(
inter)aceE t& create c%st&m ann&tated ma'sE and t& '%lis$ t$ese ma's &nline 1$ere %sers can activel+
inter)ace 1it$ t$e ma's + selectin( la+ered variales!
T$e G&&(le Eart$ API is a m&re r&%st versi&n &) t$e G&&(le -a's APIE 1$ic$ enales a t$ree7dimensi&nal
&verla+ &) t&'&(ra'$ic )eat%res! T$e API %tili<es a Ke+$&le -ar2%' Lan(%a(e and )ile )&rmat )&r m&delin(
and st&rin( (e&(ra'$ic )eat%res s%c$ as '&intsE linesE ima(es and '&l+(&ns )&r dis'la+ in t$e client inter)ace!
T$e G&&(le Eart$ s&)t1are c&m'rises )&%r versi&nsD
i1 Google $arth ! free version enables the user access to static maps on planetary imagery and
geographic information3
ii1 Google $arth %lus ! enables the user to plug in a G%S device, import spreadsheets on geospatial
zones, draw :- ob@ects, and print geographic location imagery3
iii1 Google $arth %ro ! intended for research, presentation, and collaboration tool for geospatial
location information3
iv1 Google $arth $nterprise Solutions ! comprises three components for on!site deployment: Google
$arth Fusion integrates custom data points, vectors, terrain, raster imagery and G#S data in most
ma@or formats3 Google $arth Server streams data to client software3 and Google $arth $nterprise
"lient enables viewing, printing, authoring and sharing of interactive maps1
#62
/3a5ple: /nglandKs 1trategic 7ealth Authorities 9n2or5ation &ap
T$e G&&(le Eart$ s&)t1are reF%ires e4tensive GIS s&)t1are 'r&(rammin( e4'ertiseE as 1ell as c&m'atile
$ard1areE es'eciall+ in t$e )&rm &) *7D vide& cards! An e4am'le &) G&&(le Eart$:s $ealt$care a''licati&n
'&tential can e )&%nd at En(land:s Strate(ic Healt$ A%t$&rities In)&rmati&n -a' t$at 'r&vides m%lti'le
la+ers &n '%lic $ealt$ in)&rmati&n in a (e&s'atial )&rmat
A*#0B
!
P8BL9, 7/AL.7 A+/N,@ 0* ,ANA%A
Canada is n&t remiss in e4'l&rin( &''&rt%nities in GIS tec$n&l&(+ in t$e )ield &) medicine! T$e P%lic
Healt$ A(enc+ &) Canada $as recentl+ devel&'ed a GIS in)rastr%ct%re 1it$in t$e A(enc+:s O))ice &) P%lic
Healt$ Practice t$at 'r&vides GIS services s'eci)icall+ desi(ned )&r medical researc$ and '%lic $ealt$
'r&)essi&nals! T$e Centre )&r S%rveillance C&&rdinati&n 'r&vides access t& a s'atial data 1are$&%se &n
cens%s &%ndariesE $ealt$ re(i&nsE medical )acilitiesE '&stal c&desE r&ad net1&r2sR as 1ell as dem&(ra'$ic
anal+tical c&m'&nents
A*#3B
!
T$e A(enc+:s P%lic Healt$ -a' Generat&r enales t$e %ser t& lin2 medical data in dBase )&rmat )r&m t$e
%ser:s 'ers&nal c&m'%terE via 9eE t& t$e Centre:s s'atial data 1are$&%se! T$e res%ltin( ma's ma+ t$en e
d&1nl&aded in a variet+ &) )ile )&rmatsE via 9eE ac2 t& t$e %ser:s 'ers&nal c&m'%ter $ard7drive! T$e
ene)it &) t$e s+stem is t$at t$e %ser d&es n&t reF%ire an+ GIS s&)t1areE 'r&(rammin( e4'ertiseE n&r
e4tensive $ard1are! Its ma;&r de)icit is t$e asence &) an interactive a''licati&n inter)aceE as t$at envisa(ed
+ c&mmercial versi&ns &))ered + G&&(le and -icr&s&)tE 1$ic$ t$e %ser ma+ t$en ma2e availale &n a
1e7server accessile + t$e '%lic at lar(e!
#6*
S'eci)icall+ desi(ned 1it$ 'r&)essi&nal medical researc$ers in mindE its (reatest '&tential ma+ rel+ n&t s&
m%c$ %'&n its GIS tec$n&l&(+ 'er seE %t %'&n t$e c&ntin%al %'(rade &) its s'atial data 1are$&%se and
s'atial metadata re'&sit&r+ t$at 'r&vide access t& a variet+ &) dem&(ra'$icE t&'&(ra'$ic and (e&s'atial
&%ndar+ datasets devel&'ed + Statistics CanadaE Nat%ral Res&%rces Canada and &t$er t$ird7'art+ s&%rces!
NA.8-AL -/108-,/1 ,ANA%A
Nat%ral Res&%rces Canada als& &))ers ma''in( ca'ailities )&r $ealt$ careE %t m&re )r&m t$e 'ers'ective &)
)%l)illin( (eneral c&ns%mer interests rat$er t$an enalin( s'eci)ic $ealt$ researc$ &;ectives!
A*#5B
T$e site
&))ers static ma's &n $ealt$ e$avi&%rsE n&n7medical determinants &) $ealt$E $ealt$ res&%rcesE r%ral $ealt$
iss%esE $ealt$ services %tili<ati&nE and $ealt$ stat%s!
/3a5ple: A4erage %istance to the Nearest *a5ily Physician( $##" Gkilo5etresH
8.1 +/0L0+9,AL 18-;/@
T$e U!S Ge&l&(ical S%rve+ maintains a lar(e n%mer &) ma''in( 1esitesE 1it$ &ne site s'eci)icall+
dedicated t& t$e 9est Nile vir%s ]$tt'DHH1estnilema's!%s(s!(&vH$ist&rical!$tml^! T$ese ma's re)lect
in)&rmati&n )&r ann%al re'&rtin( seas&ns )r&m 266676, t$at $ave een s%mitted and veri)ied + t$e Centers
&) Disease and C&ntr&l )&r irdsE $%mansE m&sF%it&E sentinel and veterinar+ datasets!
#6,
,on2ir5ed ,ases o2 West Nile ;irus in Birds 2or )00!
0P/N 108-,/ 10*.WA-/
A n%mer &) O'en S&%rce ma''in( and anal+tical s&)t1are 'ac2a(es are c%rrentl+ ein( devel&'ed and
tendered as Release Candidates )&r eta7testin( and eval%ati&n! S&me are F%ite 'r&misin(E and c&m'arale
t& t$e m&re O'r&)essi&nalPE $ence e4'ensiveE versi&ns c%rrentl+ &n t$e mar2et! 9$at is e4citin( a&%t t$ese
'r&;ects is t$atE 1$ile all t$e inte(rated %(s 1&%ld (enerall+ e ann&+in( t& man+ end7%sersE t$e s&%rce
c&de is &'enl+ availale )&r min&r t1ee2in( &r ma;&r m&di)icati&n as t$e end7%ser sees )it! An e4tensive
v&l%ntar+ s%''&rt net1&r2 &) &t$er end7%serH'r&(rammers als& acc&m'anies t$e m&st 'r&misin( 'r&;ectsR
1$ic$ in t%rn (enerates a lar(e v&l%me &) )%ndin( )r&m internati&nal c&r'&rate s&%rces! A )e1 &) t$ese
'r&;ects are rie)l+ descried!
It s$&%ld e n&ted t$at a st%d+ in t$e UK %tili<ed t$e Ne1 Br%ns1ic2 L%n( Ass&ciati&nQs 1e ma''in(
service H 9-S t& dem&nstrate inter&'erailit+ 1it$ O'en S&%rce s&)t1are! T$e article entitledD O9e GIS
in PracticeD P%lis$in( C&%r Healt$ -a's and C&nnectin( t& Rem&te 9-S S&%rces Usin( t$e O'en S&%rce
U-N -a'Server and D- S&l%ti&ns -a'LaPE is availale $ereD
$tt'DHH111!medsca'e!c&mHvie1articleH"2,52,!
#6"
3,!-T,0 GI
=%ant%m GIS >=GIS? is a %ser )riendl+ O'en S&%rce Ge&(ra'$ic In)&rmati&n S+stem >GIS?
ma''in( 'ac2a(e t$at r%ns &n Lin%4E Uni4E -ac OSJE and 9ind&1s! =GIS s%''&rts c&mm&n
vect&r rasterE and dataase )&rmatsE incl%din( S$a'e)ilesE P&stGISE GRASSE Ge&Ti))E TIFFE @PG
>etc!?! =GIS is licensed %nder t$e GNU P%lic License
A*26B
!
S&me &) its ma;&r )eat%res incl%deD
S%''&rt )&r s'atiall+ enaled P&stGIS tales
S%''&rt )&r s$a'e)ilesE ArcIn)& c&vera(eE -a'in)&E and &t$er )&rmats s%''&rted + OGR
Raster s%''&rt )&r a lar(e n%mer &) )&rmats
Identi)+ )eat%res
Dis'la+ attri%te tales
Select )eat%res
GRASS di(iti<in(
Feat%re laelin(
#6/
/3a5ple: -aster layer with Post+91 4ector o4erlay
Plugin &anager
Li2e man+ O'en S&%rce 'r&;ectsE t$e s&)t1are 'ac2a(e all&1s )&r t$e devel&'ment &) 'l%(insD
O'en -&deller D a i&climatic envel&'e m&delin( t&&l2it lirar+ t$at enales envir&nmental
nic$e m&delin( al(&rit$ms! A 1i<ard7ased cr&ss7'lat)&rm (ra'$ical %ser inter)ace 'r&vides
)acilities t& c&nstr%ct m&dels &n 'resent da+ climatic data and 'r&;ect 'ast and )%t%re climate
scenari&s! 9$en em'l&+ed as a =GIS 'l%(inE m&del 'r&;ecti&ns are a%t&maticall+ inserted
int& t$e ma' canvas availale )&r 'ansE <&&ms and &t$er standard GIS t$ematic ma''in(
&'erati&ns! T$e 'l%(in is als& availale as a standal&ne 'ac2a(e
A*2#B
!
O'en -&deller ]$tt'DHH&'enm&deller!s&%rce)&r(e!netH^
+aster GeoreferencerD 'l%(in t$at (enerates 1&rld )iles )&r raster )iles! 9&rld )iles are small
te4t )iles t$at c&ntain t$e 1&rld c&&rdinates )&r t$e %''er le)t c&rner &) t$e rasterE and t$e si<e
in 1&rld c&&rdinate %nits &) ever+ raster 'i4el! T$e 'l%(in can add 1&rld )iles t& scanned
'a'er ma'sE 1$ic$ are t$en em'l&+ed in 'r&;ects 1it$ &t$er datasets c&verin( t$e same area!
#60
!G! GI
SAGA GIS >S+stem )&r A%t&mated Ge&scienti)ic Anal+ses?E is a $+rid GIS ma''in( s&)t1are
'ac2a(e 1it$ a s'ecial A''licati&n Pr&(rammin( Inter)ace )&r (e&(ra'$ic data 'r&cessin(
A*22B
! T$e
'rimar+ &;ective &) t$e SAGA 'r&;ect 1as t& 'r&vide (e&scientists 1it$ an e))ective %t learnale
'lat)&rm )&r t$e im'lementati&n &) (e&scienti)ic met$&dsE 1it$in a %niF%e A''licati&n Pr&(rammin(
Inter)ace! T$e sec&nd &;ective 1as t& enale %ser7)riendl+ accessiilit+ t& t$ese met$&ds via a
r&%st Gra'$ical User Inter)ace! T&(et$er t$ese t1& &;ects %ndersc&re t$e im'lementati&n &) a
(r&1in( set &) (e&scienti)ic met$&dsE %ndled in e4c$an(eale m&d%lar liraries! 9ritten in t$e C88
'r&(rammin( lan(%a(eE it )&ll&1s an &;ect7&riented a''r&ac$! -&re&verE it relies &n t$e GNU
P%lic LicenseE 1$ic$ means t$at it remains an O'en S&%rce 'r&;ect!
1A+AKs 1yste5 Architecture
1tandard &odules
C%rrentl+ t$ere are a&%t #26 m&d%les availale in SAGA:s standard editi&n! Im'lemented met$&ds
incl%deD
File accessD (ra'$ical inter)ace t& vari&%s taleE vect&rE ima(e and (rid )ile )&rmats >etc!?R
Grid filtersD Ga%ssianE La'lacianE m%lti7directi&n Lee )ilter >etc!?R
GriddingD inter'&lati&n )r&m vect&r data %sin( trian(%lati&nE nearest nei($&%rE inverse
distance >etc!?R
GeostatisticsD sin(le and m%lti'le re(ressi&n anal+sisE variance anal+sisE resid%al anal+sisE
&rdinar+ and %niversal 2ri(in( >etc!?R
Grid calculatorD c&mine (rids t$r&%($ %ser7de)ined )%ncti&ns >etc!?R
Grid discretisationD s2elet&nisati&nE se(mentati&n >etc!?R
Grid toolsD mer(in(E resam'lin(E (a's )illin( >etc!?R
#mage classificationD cl%ster anal+sisE &4 classi)icati&nE ma4im%m li2eli$&&dE 'attern
rec&(niti&nE re(i&n (r&1in( >etc!?R
%ro@ectionsD vari&%s c&&rdinate trans)&rmati&ns )&r vect&r and (rid data >%sin( Pr&;, and
Ge&Trans liraries?E (e&re)erencin( &) (rids >etc!?R
-ynamic process simulationD TOP-ODELE nitr&(en distri%ti&nE er&si&nE landsca'e
devel&'ment >etc!?R
Terrain analysisD sl&'eE as'ectE c%rvat%resE c%rvat%re classi)icati&nE anal+tical $ills$adin(E
sin2 eliminati&nE )l&1 'at$ anal+sisE catc$ment delineati&nE s&lar radiati&nE c$annel linesE
relative altit%des >etc!?R
6ector toolsD '&l+(&n intersecti&nE c&nt&%r lines )r&m (rid >etc!?!
#63
+raphical 8ser 9nter2ace
+raphical 8ser 9nter2ace
T$e (ra'$ical %ser inter)ace all&1s t$e %ser c&ntr&l &ver t$e 'r&(ram via men% c&mmands and
t&&lars! It als& all&1s )&r data vis%ali<ati&n and mani'%lati&n via editin( and di(itisin(! -a's are
standard )&r (e&(ra'$ic data vis%ali<ati&nE %t &t$er vis%alisati&ns are als& &))ered in t$e )&rm &)
$ist&(ramsE scatter'l&tsE *d7vie1sE tales and dia(rams! All ma+ e 'rinted %sin( t$e la+&%t vie1!
Application Progra55ing 9nter2ace
At t$e $eart &) SAGA GIS is its A''licati&n Pr&(rammin( Inter)aceR a 'rec&m'iled s$ared C88
lirar+ t$at 'r&vides t$e m&d%le 'r&(rammer 1it$ a c&m're$ensive set &) )%ncti&ns and &;ect
classesE incl%din(D
(e&metrical '&intsE intersecti&ns >etc1?R
n%merical matri4 &'erati&ns >etc!?R
mem&r+E strin(s >etc!?!
data &;ect classes )&r talesE vect&r and (ridded data >mem&r+ $andlin(E data accessE data
t+'e s'eci)ic met$&dsE etc!?
GUI7li2e 'r&(ress ar n&ti)icati&n and &t$er messa(e $andlin(
m&d%le7related de)initi&ns >classes )&r 'arameter listsE asic )%ncti&nalit+ )&r all derived
m&d%le classes and t$e SAGA m&d%le lirar+ inter)ace de)initi&n?!
G)9GR!P5I. R)9,R.) !-!LEI ,PP9RT ET)0
Ge&(ra'$ic Res&%rces Anal+sis S%''&rt S+stemE c&mm&nl+ re)erred t& as GRASSE is an &'en
s&%rce GIS s&)t1are 'ac2a(eE released %nder t$e GNU P%lic License!
A*2*B
It is 'rimaril+ em'l&+ed
)&r (e&s'atial data mana(ement and anal+sisE ima(e 'r&cessin(E (ra'$icsHma's 'r&d%cti&nE s'atial
m&delin(E and vis%ali<ati&n! GRASS is c%rrentl+ %sed in academic and c&mmercial settin(s ar&%nd
t$e 1&rldE as 1ell as + man+ (&vernmental a(encies and envir&nmental c&ns%ltin( c&m'anies!
#65
9P)- I-FR!TR,.T,R) F9R 9,T.90) ET)0
O'en In)rastr%ct%re )&r O%tc&mes S+stem
A*2,B
enales cliniciansE researc$ersE and &t$er n&n7
'r&(rammers t& create and maintain )le4ile and '&rtale 'atientHresearc$ rec&rds! T$e ma;&r
c&m'&nents &) t$e s+stem are a 1e7accessile Server and Lirar+! T$e server is a $i($l+ )le4ile
1e7ased data mana(ement s+stem t$at mana(es %sersE 'atientsE and in)&rmati&n a&%t 'atients!
T$e lirar+ is a re'&sit&r+ t$at )acilitates t$e s$arin( &) metadata >'l%(7and7'la+ 1e7)&rmsE 'r&;ect
descri'ti&nsE etc!? et1een %sers and servers! T$e lirar+ als& $&sts a '%lic c&ntent dataase &)
O'en S&%rce medical s&)t1are 'r&;ects and related d&c%ments! Users &) t$e s+stem can em'l&+ t$eir
1e7r&1sers t& create and edit )&rms t$at are immediatel+ ca'ale &) c&llectin( data via 1e7
r&1sers! T$ese 1e7)&rms c&ntain =%esti&n items t$at c&nstrain t$e in)&rmati&n t$at can (& &n t$e
)&rm! =%esti&n items can e Tlan2TE T'ic2&neTE T'ic2man+TE Tte4t areaTE Tima(eTE Tvis%al anal&(
scaleTE etc! .alidati&n r%les de)ined + re(%lar e4'ressi&n strin(s can e %sed t& c&nstrain te4t in'%t
>acti&nSTtem'lateT?! Interactive elements s%c$ as vis%al anal&( scales >im'lemented in @ava A''let
andH&r @avascri't? are availale )&r inserti&n int& )&rms 1it$&%t 'r&(rammin(! Once a )&rm is
de)inedE it can e %sed t& c&llect data! F&rms can e e4'&rted as J-LE %'l&aded t& a metadata
re'&sit&r+E and re7im'&rted int& an&t$er server )&r re7%se! 9&r2)l&1s can e de)ined t& a%t&mate t$e
activati&n &) )&rms! Branc$Y&nYc&nditi&nE sendYemailE and &t$er 1&r2)l&1Yacti&ns 'r&vide $i($7
level t&&ls )&r ra'id m&delin( &) medical and clinical researc$ 1e7a''licati&n devel&'ment!
TSc$ed%lesT %se Tsc$ed%ledY1&r2)l&1T res'&nse acti&ns t& s%''&rt %ser7de)inale event t+'es! CearE
-&nt$E 9ee2E and da+ vie1s are availale! Once data $ave een c&llectedE &nline TRe'&rtsT can e
(enerated! T$is inv&lves t$e creati&n &) datasets t$at can c&mine data )r&m aritrar+ )&rms! Once a
dataset is createdE it can e F%eried &nline via l&(ical &'erati&ns >andE &rE and n&t?! TLive Re'&rtsT
t$at &r(ani<e data int& s'reads$eet7li2e tales )&r statistical anal+sis and e4'&rt are als& availale!
Datasets can als& e e4'&rted as c&mma delimited &r J-L )ile )&r &))7line anal+sis in -icr&s&)t
E4celE SPSSE SASE &r &t$er statistical s&)t1are!
##6
!T.!-
T$e SaTScan s&)t1are 1as devel&'ed + -artin K%lld&r)) t&(et$er 1it$ In)&rmati&n -ana(ement
Services Inc! It anal+<es s'atialE tem'&ral and s'ace7time data %sin( t$e s'atialE tem'&ralE &r s'ace7
time scan statistics! It 1as desi(ned t& 'er)&rm (e&(ra'$ical s%rveillance &) diseaseE detect s'atial &r
s'ace7time disease cl%stersR test 1$et$er a disease is rand&ml+ distri%ted &ver s'aceE &ver time &r
&ver s'ace and timeR eval%ate t$e statistical si(ni)icance &) disease cl%ster alarmsR and 'er)&rm
re'eated time7'eri&dic disease s%rveillance )&r earl+ detecti&n &) disease &%trea2s!
SaTScan %ses eit$er a P&iss&n7ased m&delE 1$ere t$e n%mer &) events in an area is P&iss&n7
distri%tedE acc&rdin( t& a 2n&1n %nderl+in( '&'%lati&n at ris2R a Bern&%lli m&delE 1it$ 6H# event
data s%c$ as cases and c&ntr&lsR a S'ace7Time Perm%tati&n m&delE %sin( &nl+ case dataR an Ordinal
m&delE )&r cate(&rical dataR &r an E4'&nential m&del )&r s%rvival time data 1it$ &r 1it$&%t cens&red
variales! T$e data ma+ e eit$er a((re(ated at t$e cens%s tractE <i' c&deE c&%nt+ &r &t$er
(e&(ra'$ical levelE &r t$ere ma+ e %niF%e c&&rdinates )&r eac$ &servati&n! SaTScan ad;%sts )&r t$e
%nderl+in( $&m&(eneit+ &) a ac2(r&%nd '&'%lati&n! It can als& ad;%st )&r an+ n%mer &) cate(&rical
c&variates 'r&vided + t$e %serE as 1ell as )&r tem'&ral trendsE 2n&1n s'ace7time cl%sters and
missin( data! It is '&ssile t& scan m%lti'le data sets sim%ltane&%sl+ t& l&&2 )&r cl%sters t$at &cc%r in
&ne &r m&re &) t$em!
-/&0./ AN% &0B9L/ APPL9,A.90N1
T$e ailit+ )&r 1ireless and rem&te end7%ser devices t& s%''l+ decisi&n7ma2ers 1it$ in)&rmati&n is
im'r&vin(! 9$ile c&nstrained + data st&ra(e ca'acit+E c&st &) net1&r2 c&nnectivit+ >e!(! satellite?E
and si<e &) screen )&r vis%ali<ati&n '%r'&sesE 1ireless and rem&te devices &))er an im'&rtant 1a+ )&r
'%lic $ealt$ 'r&)essi&nals t& access data and ma'sE and t& in'%t s%s'ected cases &) a disease in real7
time! Alt$&%($ man+ c&m'anies c%rrentl+ &))er 1irelessHm&ile end7%ser devicesE )e1 $ave
devel&'ed a''licati&ns t& meet t$e needs &) '%lic $ealt$ 'r&)essi&nals! T&1ard t$at endE t$e
Universit+ &) Ne1 Br%ns1ic2Qs C&m'%ter Science Fac%lt+ $ave devel&'ed 'r&t&t+'e a''licati&ns
)&r t$e '%lic $ealt$ d&main! Bel&1 is a recent '&ster 'resentati&n descriin( t$is tec$n&l&(+!
###
##2
P-0P-9/.A-@ +91: 10*.WA-/ ;/N%0-1
.!RI >WWW..!RI..90 ? >.!-!#!?
CARIS devel&'s and s%''&rts ri(&r&%sE tec$n&l&(icall+ advanced (e&matics s&)t1are! T$eir s+stems
(ive val%e t& s'atial data and em'&1er c%st&mers 1it$ in)&rmati&n t$at is meanin()%l! Inte(rit+ in
%sinessE rec&(niti&n as e4'ertsE F%alit+ c&ntr&lE and d+namic c%st&mer relati&ns are t$e distin(%is$in(
variales 1$ic$ ens%re t$eir &n(&in( s%ccess and t$at &) t$eir c%st&mers! CARIS 1as at t$e )&re)r&nt &)
t$e m&vement t&1ard c&m'%ter7aided cart&(ra'$+ and ma''in( in #505 and is s%r(in( (e&matics
tec$n&l&(+ )%rt$er 1it$ its &'enE )le4ile Internet and dataase7driven tec$n&l&(ies! T&da+E CARIS
&))ers a r&%st line &) s'atial in)&rmati&n mana(ement s&)t1are )&r c%st&mers acr&ss landE marine and
s&)t1are devel&'ment a''licati&ns! -&st recentl+E CARIS $as la%nc$ed S'atial F%si&n Enter'riseE a
9-S 1e7ma''in( a''licati&n! CARIS is %ser driven I and $eld , client )&r%ms in 266" t&1ard a
'r&d%ct devel&'ment t$at c&nsiders needs acr&ss '%lic $ealt$E sa)et+ and t$e envir&nment!
P.I G)90!TI. >WWW.P.IG)90!TI...90? >.!-!#!?
PCI Ge&matics is a 1&rld leadin( devel&'er &) Ge&matics s&)t1are >(e&(ra'$ic m&delin(E
meas%rementE anal+sisE and &%t'%t? and s&l%ti&ns ased &n its rem&te sensin(E di(ital '$&t&(rammetr+E
s'atial anal+sisE and cart&(ra'$ic editin( 'r&(rams! T$e c&m'an+ is a 'rivatel+ $eld Canadian
C&r'&rati&n $eadF%artered in t$e T&r&nt& area 1it$ an&t$er lar(e )acilit+ in t$e Nati&nal Ca'ital Re(i&n!
Its s&)t1are 'r&d%cts and s&l%ti&ns are distri%ted t$r&%($ a direct sales )&rceE internati&nal resellersE
and t$ird 'art+ devel&'ers! F&%nded in #532E PCI Ge&matics e(an %ildin( and s$i''in( (e&matics
s&)t1are t& clients ar&%nd t$e 1&rld 1$en t$e ind%str+ 1as still +&%n( and t$e '&tential &) (e&s'atial
in)&rmati&n 1as ;%st e(innin( t& e reali<ed! Since t$enE t$e c&m'an+ and re'%tati&n $ave c&ntin%ed t&
(r&1 as a res%lt &) inn&vative leaders$i'E active (e&matics c&mm%nit+ inv&lvementE and a str&n(
dedicati&n t& earn t$e tr%st &) c%st&mers %sin( PCI Ge&matics tec$n&l&(+! T&da+E 1it$ Ge&matica #6E
PCI Ge&matics 'r&vides all t$e ima(er+7centric (e&matics s&l%ti&ns necessar+ t& meet t$e e4'ectati&ns
&) a lar(e and e4'andin( ind%str+! PCI Ge&matics is c&ntin%&%sl+ driven t& ma2e ne1 and etter
a''licati&ns )&r t$e (e&matics 1&rld!
)RI >WWW.)RI..90 ?
9$en ESRI e(%n in #5/5E t$ere 1as an alm&st limitless ent$%siasm )&r t$e '&ssiilities &) GIS! ESRIE
elieved t$at t$is ne1 (e&(ra'$ic in)&rmati&n s+stem tec$n&l&(+ c&%ld rin( a&%t a etter )%t%re! GIS
and Ge&(ra'$+ )%ndamentall+ in)l%ences and c&nnects &%r man+ c%lt%resE s&cietiesE and 1a+s &) li)e! On
ESRIQs 1esite +&% can )ind a%ndant evidence &) t$e im'&rtant c&ntri%ti&ns t$at GIS tec$n&l&(+ can
ma2e in im'r&vin( F%alit+ &) li)e and s%''&rtin( m&re anal+tical decisi&n ma2in(! ESRIQs tec$n&l&(+
$el's )i($t )&rest )iresE determine ne1 nati&nal &%ndaries d%rin( 'eace ne(&tiati&nsE )ind 'r&misin(
sites )&r )ast7(r&1in( c&m'aniesE re%ild cities ar&%nd t$e 1&rldE s%''&rt &'timal land %se 'lannin(E
r&%te emer(enc+ ve$iclesE m&nit&r rain )&rest de'leti&nE c&ntain &il s'illsE and 'er)&rm c&%ntless &t$er
vital tas2s ever+ da+! GIS tec$n&l&(+ m%st c&nstantl+ ev&lve t& meet t$e c$an(in( needs &) %sinessE
ind%str+E (&vernmentE and ed%cati&n! T&da+E ESRI $as m&re t$an 2E566 s2illed em'l&+ees 1&rld1ide
1$& 1&r2 1it$ $%ndreds &) %siness 'artners and tens &) t$&%sands &) %sers! Eac$ &ne ma2es a %niF%e
c&ntri%ti&n t& t$is remar2ale tec$n&l&(+!
I-T)RGR!P5 >WWW.I-T)RGR!P5..90 ?
Inter(ra'$ is t$e 1&rld leader in deliverin( s&)t1are and services )&r t$e mana(ement and vis%al
re'resentati&n &) c&m'le4 in)&rmati&n! G&vernments and %sinesses in &ver /6 c&%ntries ar&%nd t$e
1&rld rel+ &n Inte(ra'$Qs tec$n&l&(+ and services t& s%''&rt etter and )aster &'erati&nal decisi&ns!
Inte(ra'$ tec$n&l&(+ is %sed in c&mm%nities ar&%nd t$e 1&rld t& ma2e it a sa)er and m&re 'r&s'er&%s
##*
'lace! Inte(ra'$ $as $el'ed clients t& devel&' '&1erE %tilitiesE and c&mm%nicati&ns net1&r2s! Inte(ra'$
$as een %sed t& 'r&tect t$e envir&nmentE desi(n and maintain t$e m&st envir&nmentall+ c&nsci&%s and
e))icient 'lantsE c&nstr%cti&n 'r&;ectsE s$i'sE and &))s$&re 'r&d%cti&n )acilities! Inte(ra'$Qs tec$n&l&(+
ens%res t$e sa)et+ &) s+stems t$at mana(e and de'l&+ sec%rit+E emer(enc+E and militar+ 'ers&nnel!
0!PI-F9 >WWW.0!PI-F9..90 ?
-a'In)& is t$e leadin( 'r&vider &) l&cati&n intelli(ence s&l%ti&nsE inte(ratin( s&)t1areE data and services
t& 'r&vide (reater val%e )r&m l&cati&n7ased in)&rmati&n and drive m&re insi($t)%l decisi&ns )&r
%sinesses and (&vernment &r(ani<ati&ns ar&%nd t$e 1&rld! -a'In)&:s inn&vative s&l%ti&ns $el'
c%st&mers %se l&cati&n intelli(ence t& en$ance t$eir 'er)&rmance and decisi&ns in man+ 1a+s +
meetin( a diverse set &) needs 7 )r&m asset mana(ement and net1&r2 'lannin(E t& site selecti&nE ris2
mana(ement and T1$at:s near meT m&ile a''licati&ns! C%st&mers: st&ries s$&1 +&% $&1 t& %se l&cati&n
intelli(ence t& im'r&ve 'er)&rmance! -&re t$an 0E666 &r(ani<ati&ns in nearl+ ever+ ind%str+ sect&r
ar&%nd t$e 1&rld rel+ &n -a'In)& tec$n&l&(+ and e4'ertise -a'In)& l&cati&n intelli(ence s&l%ti&ns are
'artic%larl+ advanced and '&1er)%l )&r t$ese vertical mar2etsD retailE )inancial servicesE
telec&mm%nicati&ns and '%lic sect&r! 9it$ services t$at ran(e )r&m anal+tical c&ns%ltin( t&
c&m're$ensive 'r&;ect im'lementati&nE t$eir ind%str+ s'ecialists %nderstand +&%r %siness and 1ill $el'
+&% inc&r'&rate L&cati&n Intelli(ence F%ic2l+ and e))ectivel+!
7)-TL)E ET)0 >WWW.7)-TL)E..90 ?
Bentle+ S+stemsE Inc&r'&rated 'r&vides s&)t1are )&r t$e li)ec+cle &) t$e 1&rldQs in)rastr%ct%re! T$e
c&m'an+Qs c&m're$ensive '&rt)&li& )&r t$e %ildin(E 'lantE civilE and (e&s'atial verticals s'ans
arc$itect%reE en(ineerin(E c&nstr%cti&n >AEC? and &'erati&ns! 9it$ 266, reven%es e4ceedin( M*66
milli&nE Bentle+ is t$e leadin( 'r&vider &) AEC s&)t1are t& t$e En(ineerin( Ne1s7Rec&rd Desi(n "66
and ma;&r &1ner7&'erat&rs!
!,T9#)F >WWW.!,T9#)F..90?
A%t&des2 )irst rev&l%ti&ni<ed t$e s&)t1are ind%str+ 1it$ t$e A%t&CAD_ 'r&d%ctE 1$ic$ intr&d%ced
dra)tin( &n a PC! T$e 1ides'read '&'%larit+ &) A%t&CAD s&)t1are )&r(ed &%r c&m'an+Qs li)etime
c&mmitment t& 'ractical inn&vati&n t$at drives 'r&d%ctivit+ and 'r&)itailit+! A%t&CAD als& 'aved t$e
1a+ )&r A%t&des2 tec$n&l&(+ leaders$i' in vari&%s ind%stries!
!F) 9FTW!R) >WWW.!F)..90 ? >.!-!#!?
Sa)e S&)t1are Inc! s'eciali<es in S'atial ETL >E4tractE Trans)&rm and L&ad? tec$n&l&(ies! F&%nded in
#55*E t$e c&m'an+ $as since ec&me t$e ind%str+ leader in s'atial data inter&'erailit+! Sa)e S&)t1areQs
)&c%s is &n 'r&vidin( s&)t1are s&l%ti&ns and 'r&)essi&nal services t$at deliver seamless data access and
)&rmat translati&n! T$e c&m'an+Qs (&al is t& ens%re t$at s&l%ti&ns and services meet c%st&mersQ needs
and 'r&vide t$e (reatest val%e t& t$e 1idest '&ssile set &) %sers! Clients )r&m a 1ide ran(e &)
&r(ani<ati&ns in di))erent ind%stries %se Sa)e S&)t1areQs standal&neE 9e7ased and emeddale
s&)t1are 'r&d%cts 1&rld1ide! C%st&mers can '%rc$ase &%r s&)t1are 'r&d%cts directl+ )r&m %s &r t$r&%($
a (l&al net1&r2 &) val%e7added Resellers!
##,
%91,81190N > -/,0&&/N%A.90N1
Healt$ a%t$&rities a&%t t& ad&'t GIS tec$n&l&(+E m%st c&nsider a n%mer &) )act&rs 1$en c$&&sin( t$e
ri($t tec$n&l&(+Hvend&rsD
C&st &) s&)t1areE $ard1are
A''licati&n Feat%res
OGC7c&m'liance
Net1&r2 Sec%rit+
Dataase L&cati&n
IT H Administrative S%''&rt
GIS7S2illed Sta))
F%rt$erm&reE de'endin( &n t$e end7%seE and 1$et$er t$ere is a reF%irement t& &tain m%lti'le data s&%rces
&r n&tE $ealt$ a%t$&rities ma+ c&nsiderD
Standal&ne A''licati&ns
9e7ased A''licati&ns >L&calH9ide Area Net1&r2 OR 9&rld 9ide 9e?
Finall+E de'endin( &n t$e level &) s'atial and statistical anal+sis t& e 'er)&rmedE $ealt$ a%t$&rities ma+
c&nsiderD
Pr&(rammale -a''in( >$i($ level &) anal+tical ca'ailities?
Interactive -a''in( >medi%m level &) anal+tical ca'ailities?
Static -a''in( >m&stl+ )&r servin( 're7(enerated ma's t& clientsE i!e! l&1 level &) anal+sis
ca'ailities?
T$e P%lic Healt$ A(enc+ &) Canada $as alread+ devel&'ed a (ate1a+ )&r $ealt$ a%t$&rities t& e4c$an(e
data and t& access a 1e7ased ma''in( a''licati&n! T$e a''licati&n is n&t a 9-SH9FS service at 'resentE
and data sets d& n&t c&m'rise man+ &) t$e '&tential data sets identi)ied in earlier Secti&ns >e!(! <&&n&tic
diseasesE disease vect&rsE mete&r&l&(ical H climat&l&(ical data?! Nevert$elessE it is desi(ned 1it$ t$e
'r&)essi&nal medical researc$ in mindE and is envisa(ed t& c&ntin%e t& e4'and its s'atial data 1are$&%se and
metadata re'&sit&r+! As a )irst ste' in c&nsiderin( ma''in( tec$n&l&(+E '%lic $ealt$ a%t$&rities s$&%ld
visit t$e -a' and Data E4c$an(eE t& determine 1$et$er t$e t&&ls and data 'r&vided are s%))icient )&r t$eir
'%r'&ses! I) t$e need )&r GIS s%''&rt is an &n(&in( reF%irementE it is rec&mmended t$at t$e $ealt$ a%t$&rit+
)%rt$er investi(ate availale tec$n&l&(ies!
O'en S&%rce S&)t1areE 1$ile $avin( t$e advanta(e &) ein( c$ea'E c%st&mi<ale and s%''&rted t$r&%($ a
distri%ted net1&r2 &) end7%sersE d&es $ave its disadvanta(es! Firstl+E &'en7s&%rce 'r&(rams can e m&re
%nrelialeE and d& n&t $ave (%aranteed s%''&rt I i!e! +&% need t& $ave +&%r &1n in7$&%se e4'ertise! F&r an
e4am'le &) $&1 t& %se O'en S&%rce s&)t1areE visitD $tt'DHH111!medsca'e!c&mHvie1articleH"2,52,! O%r
rec&mmendati&n t& $ealt$ a%t$&rities is t& invest in 'r&'rietar+ GIS )&rmatsE selectin( t$e est s&)t1are
ased &n s'eci)ic end7%ser reF%irements and level &) OGC7c&m'liance!
Rem&te and 1ireless a''licati&ns can 'r&vide )r&nt line $ealt$ 1&r2ers 1it$ t$e ailit+ t& 'r&vide sentinel
in)&rmati&n &n s%s'ected cases &) in)ecti&%s diseaseE t& 'r&vide an+ $ealt$ serviceH'$+sician data &n a real7
time asisE t& retrieve sentinel in)&rmati&n )r&m a GIS ma''in( serverE &r c&mm%nicate 1it$ &t$er $ealt$
care 'r&viders! Ge&C&nnecti&ns s$&%ld 'r&m&te t$e devel&'ment &) 1irelessHrem&teHm&ile a''licati&ns
)&r '%lic $ealt$ 'r&)essi&nalsE and c&%ld iss%e calls )&r 'r&'&sals t& t$is end!
##"
SECTI ON SI J
CHAPTER #,D S%mmar+ &) Rec&mmendati&ns
CHAPTER #"D C&ncl%si&n
##/
18&&A-@ 0* -/,0&&/N%A.90N1
Rec&mmendati&ns are &r(ani<ed in acc&rdance 1it$ t$e initial (%idin( F%esti&ns )&r t$is re'&rt!
1. What (aps e=ist &or :eb1based mappin( &or public health?
Secti&n &ne identi)ied man+ (a'sE )&r 1$ic$ t$e )&ll&1in( rec&mmendati&ns are madeD
Ge&C&nnecti&ns s$&%ld devel&' a s+stematic a''r&ac$ )&r e4'andin( t$e CGDI int& '%lic $ealt$
Ge&C&nnecti&ns s$&%ld 1&r2 in 'artners$i' 1it$ nati&nal $ealt$ a(encies H a%t$&rities t& devel&' a "7
+ear strate(+ 1it$ milest&nes
Ge&C&nnecti&ns H $ealt$ a%t$&rities s$&%ld ens%re a''licati&ns are )le4ile and inter&'erale H OGC7
c&m'liant
Ge&C&nnecti&ns s$&%ld im'r&ve %'&n in)rastr%ct%re >a''licati&nsE real7time dataE services?
Ge&C&nnecti&ns s$&%ld 'r&vide trainin( &''&rt%nitiesE and 1&r2 1it$ $ealt$ a%t$&rities t& devel&'
)&rmal and n&n7)&rmal ed%cati&n )&r P%lic Healt$ Pr&)essi&nalsE &n GIS
Ge&C&nnecti&ns s$&%ld s%''&rt additi&nal researc$ in GISHP%lic Healt$ I )&r l&calE re(i&nalE and
nati&nal st%dies
Ge&C&nnecti&ns H $ealt$ a%t$&rities s$&%ld add '%lic $ealt$ res&%rces t& t$e CGDIE incl%din( case
st%diesE met$&d&l&(iesE lin2s etc
". 5o: can :eb1based mappin( help to build the capacity o& public health
pro&essionals $ communities to understand threats to human healthH sa&etyH and the
en8ironment?
Ge&C&nnecti&ns s$&%ld 1&r2 1it$ $ealt$ a%t$&rities t& devel&' '%lic $ealt$ in)rastr%ct%re t$at %tili<es
t$e CGDI
Ge&C&nnecti&ns s$&%ld 1&r2 in 'artners$i' 1it$ nati&nal $ealt$ a%t$&rities t& devel&' a c&m're$ensive
researc$ a(enda >see case scenari&s in Secti&n 2?
Ge&C&nnecti&ns H Healt$ a%t$&rities s$&%ld ens%re standardi<ed (e&re)erencin( &) e'idemi&l&(ical data
Ge&C&nnecti&ns s$&%ld devel&' emer(enc+ 'r&t&c&ls in 'artners$i' 1it$ $ealt$ a%t$&ritiesE )&r t$e
'r&visi&n &) a''licati&nsE servicesE and dataE d%rin( 'andemics H crisis sit%ati&ns
##0
Ge&C&nnecti&ns and l&cal $ealt$ a%t$&rities s$&%ld 1&r2 1it$ nati&nal $ealt$ a%t$&rities t& address data
)ra(mentati&n H de)iciencies
Ge&C&nnecti&ns and nati&nal $ealt$ a%t$&rities need t& )%rt$er investi(ate t$e c$allen(es in$erent 1it$
inte(rati&n &) e4istin( $ealt$ dataases
Ge&C&nnecti&ns s$&%ld 'r&m&te initiatives t& render GIS data sets availale at n& c&st I since c&st is t$e
'rinci'al arrier )&r $ealt$ researc$ in Canada!
Ge&C&nnecti&ns s$&%ld 1&r2 t&1ard $&ri<&ntal inte(rati&n &) data I acr&ss sect&rsD $ealt$E
envir&nmentE sa)et+E etc!
T$e CGDI s$&%ld enale '%lic $ealt$ a%t$&rities and t$e (eneral '%lic t& 'er)&rm &n7demand
ma''in(E &nlineE 1it$ %ser7(enerated 'arametersE %sin( data )r&m m%lti'le s&%rces!
/. What GI tools and data are needed &or epidemiolo(ical modelin( and respondin(
to in&ectious disease?
Ge&C&nnecti&ns s$&%ld en(a(e e'idemi&l&(ists t& devel&' m&delin( H met$&d&l&(ies and revie1
'r&;ects
Ge&C&nnecti&ns s$&%ld 1&r2 1it$ $ealt$ a%t$&ritiesE e'idemi&l&(istsE and statisticiansE t& devel&' earl+
detecti&n met$&d&l&(ies >incl%din( a%t&mated statistical m&d%les t$at can r%n a(ainst CGDI7nested
9-SH9FS a''licati&ns and data?!
Ge&C&nnecti&ns s$&%ld ens%re t$at '%lic $ealt$ a''licati&n devel&'ers are em'l&+in( t$e 'r&'er
statistical met$&d&l&(ies e)&re '%lis$in( data H ma's
Ge&C&nnecti&ns s$&%ld c&nsider reF%irin( '%lic $ealt$ data 'r&viders t& '%lis$ statistical
met$&d&l&(ies and res%ltin( aselines H indicat&rs as 'art &) t$eir -etadata C&ntentE 1it$in t$e CGDI
T$e CGDI s$&%ld 'r&vide $ealt$ a%t$&ritiesE 1it$ a set &) statistical m&d%les H sam'le met$&d&l&(iesE s&
t$at ne1 '%lic $ealt$ a''licati&n devel&'ers can c&nd%ct 'reliminar+ anal+sis &) t$eir data t& estalis$
aselines and identi)+ disease 'revalence H '&'%lati&n ris2s!
P%lic $ealt$ data m%st incl%de s'atial re)erences >'er rec&rdHDB? %t als& time stam'sE disease t+'e
stam'sE and '&tentiall+ &t$ers!
T$e e'idemi&l&(ical and GIS c&mm%nities c&%ld devel&' )%rt$er U&'ti&nalQ dimensi&n ta(s )&r
im'lementati&n
A''licati&ns m%st e ale t& 'r&vide anal+tical )%ncti&ns t& %sersE t& anal+<e s'atialE dem&(ra'$icE and
tem'&ral data! In additi&nE a''licati&ns m%st 'r&vide access t& statistical t&&ls H m&d%lesE and m%st
a''r&'riatel+ mana(e %ser 'ermissi&ns )&r access t& data I i!e! a''licati&ns m%st e ale t& a((re(ate
data t& decrease s'eci)icit+ H maintain 'rivac+!
##3
6. 5o: can the .G#I support a &ully1operational public health W0 $ WF
in&rastructure I includin( public access and disease1control applicationsH :hile
ensurin( data pri8acy?
.he 5ost urgent reco55endations that re=uire i55ediate attention relate to pri4acy issues. A three
pronged approach is reco55ended:
ImmediateD Pr&vide a''licati&n devel&'ers 1it$ initial (%idelines t$at t$e Federal G&vernment is c%rrentl+
%sin( 1it$in t$e Canadian P%lic Healt$ Ass&ciati&n H Healt$ Canada as an initial U'l%(7inQ m&d%le!
S$&rt TermD Devel&' a m&re detailed U'l%(7inQ m&d%le ased &n )%rt$er researc$ addressin( t$e 'rivac+
iss%es identi)ied in t$is re'&rt!
L&n( TermD 9&r2 t&1ard a $arm&ni<ed 'l%(7in m&d%le t$at is ne(&tiated 1it$ nati&nal $ealt$ a(encies and
t$e 'r&vinces H territ&ries!
Ge&C&nnecti&ns s$&%ld 1&r2 in 'artners$i' 1it$ t$e @%stice De'artmentE CanadaQs Privac+
C&mmissi&nerE Healt$ CanadaE Pr&vincial and Territ&rial Privac+ C&mmissi&ners and Healt$
A%t$&ritiesE t& deal 1it$ 'rivac+ iss%es t$at c%rrentl+ c&nstrain t$e e))icientHe))ective e4c$an(e &) '%lic
$ealt$ data!
Ge&C&nnecti&ns H Healt$ a%t$&rities s$&%ld aim t& 'r&vide near real7time access t& dataE 1$ile
maintainin( data 'rivac+ >de7identi)ied data?
Ge&C&nnecti&ns s$&%ld devel&' a strate(+ H '&lic+ t& assist a''r&'riate a%t$&rities d%rin( a 'andemic
Ge&C&nnecti&ns s$&%ld 'r&vide $ealt$ a%t$&rities 1it$ details &n t$e ailit+ &) CGDI7enaled
in)rastr%ct%re t& mana(e %ser 'ermissi&nsE di(ital ri($ts H '%lic 2e+ accessE and ens%re data 'rivac+!
C&nsider t$at a''licati&nsE dataE and services m%st e made availale t& * t+'es &) %sersD '%lic $ealt$
'r&)essi&nalsE &t$er $ealt$ ;%risdicti&ns H researc$ (r&%'sE and t$e (eneral '%lic!
Ge&C&nnecti&ns s$&%ld devel&' a (%idance d&c%ment 'r&vidin( a''licati&n devel&'ers 1it$ t$e t&&ls H
2n&1led(e t& ens%re data 'rivac+ and ad$erence t& a''licale la1s!
Ge&C&nnecti&ns s$&%ld c&nsider estalis$in( an et$ics revie1 c&%ncilE t& deal 1it$ '%lic $ealt$
a''licati&n devel&'ersE t& ens%re 'rivac+ sa)e(%ards are in 'lace I t$ere+ ens%rin( t$e inte(rit+ &) t$e
CGDI as a 1$&le!
T$e CGDI s$&%ld incl%de a push7s+stem I t& '%s$ ma's t& a net1&r2 &) '%lic $ealt$ a%t$&rities and
'%lic 1e sites >still ens%rin( data 'rivac+?E )&r earl+ 1arnin( H '%lic alertin(!
T$e CGDI H Ge&C&nnecti&ns s$&%ld e4'l&re t$e %se &) '%lic 2e+ certi)icati&n &r similar %ser
mana(ement s+stem t& ens%re data 'rivac+ and net1&r2 sec%rit+E as &%tlined a&ve I t$is 1&%ld reF%ire
'%lic $ealt$ a%t$&rities t& re(ister IP addresses and individ%al %sers 1it$ t$e CGDI!
##5
%. 5o: public health user re<uirements be met throu(h adoption o& W0 technolo(yH
complimentary technolo(ies $ statistical toolsH and data standards?
Ge&C&nnecti&ns s$&%ld c&nd%ct researc$ int& Healt$ Data Standards I i!e! $&1 t& inte(rate $ealt$ data
int& t$e CGDI
Ge&C&nnecti&ns can 'r&vide U-L Activit+ H Use Case Dia(ram t&&ls )&r '%lic $ealt$ a%t$&rities
Healt$ A%t$&rities s$&%ld ens%re t$at * levels &) end7%sers are c&nsidered in devel&'ment &) ne1
a''licati&ns
Ge&C&nnecti&ns H Healt$ a%t$&rities s$&%ld ens%re standardi<ed (e&re)erencin( &) e'idemi&l&(ical data
Ge&C&nnecti&ns s$&%ld devel&' a '%s$7s+stem H 'ervasive net1&r2E t& enale '%lic alertin(
Healt$ a%t$&rities need t& devel&' an indicat&r s+stem t& )la( $ealt$ t$reats 1it$in a distri%ted net1&r2
&) 9-SH9FS a''licati&ns!
T$e CGDI s$&%ld 'r&vide t$e cart&(ra'$ic standards )&r vis%ali<ati&n &) $ealt$ data
T$e CGDI s$&%ld 'r&vide (%idance &n dataase reF%irements t& s%''&rt '%lic $ealt$ ma''in(
Ge&C&nnecti&ns s$&%ld $el' '%lic $ealt$ a%t$&rities t& im'lement dataase s&l%ti&ns t$at can serve7%'
'%lic $ealt$ data )&r 9-SH9FS services!
P%lic $ealt$ a''licati&n devel&'ers s$&%ld c&nsider &t$ t$e 9-S mandat&r+ and &'ti&nal standards
and 9FS standard >client side and server side? as a''r&'riate minim%m reF%irements )&r '%lic $ealt$
a''licati&ns! Ot$er CGDI7end&rsed standardsE as descried a&veE s$&%ld als& e c&nsidered!
T$e 9e -a' C&nte4t Standard s$&%ld e im'lementedE $&1ever ca%ti&n s$&%ld e ta2en )&r enalin(
%sers t& '%lis$ ma's t& t$e CGDI t$at ma+ c&ntain sensitive in)&rmati&n >i!e! im'in(e &n 'atient
c&n)identialit+?!
Healt$ A%t$&rities need t& c&nsider a n%mer &) )act&rs 1$en im'lementin( GIS s&)t1areHa''licati&nsE
incl%din( c&stE )eat%resE OGC7c&m'lianceE net1&r2 sec%rit+E dataase reF%irementsE s%''&rt sta))!
T$e P%lic Healt$ A(enc+ &) CanadaQs -a' and Data E4c$an(e s$&%ld serve as a startin( '&int )&r
$ealt$ a%t$&rities c&nsiderin( t$e %se &) GIS tec$n&l&(+! I) t$e reF%irement )&r GIS s%''&rt (&es
e+&nd a sin(le7a''licati&n H &ne7time7%seE $ealt$ a%t$&rities s$&%ld seri&%sl+ c&nsider im'lementin(
t$eir &1n s+stems I t$ese s$&%ld e inte(rated 1it$ e7$ealt$ services str%ct%re!
It is rec&mmended t$at $ealt$ a%t$&rities select 'r&'rietar+ GIS )&rmatsE as &''&sed t& &'en s&%rceE in
&rder t& ens%re reliailit+ and s%''&rt!
Rem&te and 1ireless a''licati&ns can e devel&'ed t& )%rt$er s%''&rt '%lic $ealt$ 'r&)essi&nals!
#26
'. 5o: can a distributed access net:or2H nested in the .G#IH be established amon(
health authorities &or en8ironmental1health mappin(?
Ge&C&nnecti&ns can $el' t& 'r&m&te ene)its t& decisi&n7ma2ers >case st%dies are inval%ale )&r t$is?
Ge&C&nnecti&ns s$&%ld 1&r2 t&1ard inte(rati&n &) t$e CGDI 1it$ e7$ealt$E CanadaQs Healt$ In)&1a+E
and $&s'ital dataases
Ge&C&nnecti&ns s$&%ld enc&%ra(e $ealt$ a%t$&rities t& de'l&+ internal LANH9AN a''licati&nsE %t
als& ma2e services availale via t$e CGDI s& t$at in)&rmati&n can e s$ared et1een ;%risdicti&ns!
Ge&C&nnecti&ns c&%ld %ild a seamless m%lti7;%risdicti&nal n&ti)icati&n and res'&nse s+stemE 1$ic$ can
e %sed t& send n&ti)icati&n t& a''r&'riate $ealt$ a%t$&rities t& enale t$reat7ased res'&nse! T$is
s+stem 1&%ld de'end %'&n &t$ a%t&mated H man%al disease s%rveillance H detecti&n s+stems!
Ge&C&nnecti&ns s$&%ld e4'l&re 1$et$er $ealt$ data s$&%ld e U$arm&ni<edQ 1it$in t$e CGDIE &r e)&re
it is '%lis$ed t& t$e CGDI >i!e! 1it$in e4istin( e7$ealt$ s+stems H CanadaQs Healt$ In)&1a+?
Ge&C&nnecti&ns s$&%ld ed%cate $ealt$ a%t$&rities &n $&1 t$e CGDI can enale access t& m%lti'le
s&%rces &) data H servicesE +et all&1 $ealt$ data 'r&viders t& remain t$e c%st&dians &) t$eir data and
mana(e %ser 'ermissi&ns!
Ge&C&nnecti&ns s$&%ld &r(ani<e c&ll&F%i%ms H 1&r2s$&'s t& rin( t&(et$er GIS and E'idemi&l&(ical
e4'ertsE t&1ard %ildin( CanadaQs P%lic Healt$ GIS In)rastr%ct%re H e4'andin( t$e CGDI in '%lic
$ealt$!
A CGDI7nested '%lic $ealt$ arc$itect%re 1ill de'end 'rimaril+ &n t$e availailit+ &) standardi<ed
'%lic $ealt$ data!
CanadaQs Healt$ In)&1a+E 'r&vincial $ealt$ a%t$&ritiesE and t$e CGDIE s$&%ld c&nsider t$e advanta(es
and disadvanta(es &) %ildin( distri%ted dataase mana(ement s+stems
T$e CGDI c&%ld act as a data service r&2er )&r )ederal and 'r&vincial $ealt$ a%t$&rities! T$e reas&n )&r
t$is is t& ens%re sec%rit+ &) net1&r2sE data 'rivac+E %ser mana(ement H access restricti&nsE and timeliness
&) data H service )&r end7%sers! T$e data service r&2er 1&%ld 'r&vide a''licati&n $&sts 1it$ 9-SH9FS
services )&r '%lic $ealt$ dataE 1$ile maintainin( data license a(reements 1it$ &ri(inal c%st&dians &) t$e
data >'%lic $ealt$ a%t$&rities?!
#2#
,0N,L8190N
The Paraigm ShiftD In &rder t& c&m'ete e))ectivel+ in t$e 2#
st
cent%r+ I t$at isE c&m'ete 1it$
emer(in( t$reats s%c$ as 'andemics and nat%ral disasters I Canada m%st envisa(e a 'aradi(m s$i)t! T$e
)%t%re $ealt$ and 'r&s'erit+ &) Canadians de'ends %'&n $ealt$ 'r&m&ti&n and illness 'reventi&n! S%c$ a
strate(+ 1&%ld reF%ire 2n&1led(e a&%t at7ris2 '&'%lati&nsE s&cial e$avi&rE s'atial disease e'idemi&l&(+E
access t& $ealt$ careE mete&r&l&(ical c&nditi&nsE disease vect&rsE and m&re! T$ere is n& &t$er tec$n&l&(+
t$at can mer(e t$e necessar+ data sets int& a meanin()%l re'resentati&n >e4'&sin( relati&ns$i'sE
de'endencies etc? t$an 1e7ased GIS! It is clear t$at t& res'&nd t& emer(in( t$reats in t$e 2#
st
cent%r+E
Canada needs a distri%ted '%lic $ealt$ in)rastr%ct%re nested in t$e CGDI and CanadaQs Healt$ In)&1a+!
As '%lic $ealt$ 'r&)essi&nals aim )&r t$is 'aradi(m s$i)tE s& s$&%ld t$e CGDI and 'rivate sect&r en(a(ed in
devel&'in( CanadaQs (e&matics tec$n&l&(ies and 1e services! T$ese (&als are s+ner(istic 1it$ $ealt$ as
t$e drivin( )act&rE ens%rin( CanadianQs c&ntin%ed s%''&rt &) s%c$ in)rastr%ct%reE tec$n&l&(iesE and services!
9e7ased GIS tec$n&l&(+ can $el' Canada n&t &nl+ t& res'&nd t& t$e t$reat &) 'andemics and nat%ral
disastersE %t als& (reatl+ enale '%lic $ealt$ a%t$&rities t& c&nd%ct r&%tine e'idemi&l&(ical anal+sis &)
c$r&nic and in)ecti&%s disease! In &rder t& )&ster (reater ad&'ti&n &) GIS tec$n&l&(iesE (e&matics
tec$nicians and e'idemi&l&(ists need t& devel&' a''r&'riate m&delin( met$&d&l&(iesE in &rder t& 'r&vide
acc%rate in)&rmati&n t& decisi&n7ma2ers and t$e '%lic! F%rt$erm&reE 1e7ased GISE + virt%e &) its ailit+
t& inte(rate m%lti'le data s&%rcesE can enale cr&ss7disci'linar+ researc$E )&r e4am'leD lin2in( air F%alit+E
climate c$an(eE and $%man $ealt$!
T$e G&vernment &) CanadaE al&n( 1it$ man+ Pr&vincial G&vernmentsE are c&mmitted t& clean air! In &rder
t& determine t$e e))ects air F%alit+ $as &n CanadiansE and 1$ere '&lic+ c$an(es are needed t& ens%re clean
air and illness 'reventi&nE t$e CGDI can 'r&vide '%lic $ealt$ &))icials 1it$ access t& t$e necessar+ data
setsE a''licati&nsE and services! In t$is e4am'leE and man+ &t$ersE t$e CGDI can $el' t$e (&vernment t&
ec&me m&re acc&%ntale t& t$e '%lic 1it$ re(ards t& envir&nmental $ealt$ (&als!
A s%ccess)%l GIS s+stem reF%ires e4tensive dataase desi(n! Healt$ a%t$&rities s$&%ldnQt %nderestimate t$e
am&%nt &) la&r and c&sts inv&lved in streamlinin( dataasesE ITE and ad&'tin( ne1 GIS s+stems!
Nevert$elessE e))iciencies are created 1$en dataase mana(ementE IT s%''&rtE and GIS maintenance are
distri%ted! In &rder t& acc&mm&date t$ese tec$n&l&(ies in t$e 1&r2'laceE '%lic $ealt$ a%t$&rities m%st
en(a(e in trainin( and ed%cati&n I incl%din( 'r&(rams aimed at eF%i''in( sta)) 1it$ GIS s2illsE s'atial
e'idemi&l&(ical 2n&1led(eE and statistical met$&ds!
A CGDI7nested '%lic $ealt$ in)rastr%ct%re H a''licati&ns can 'r&vide services t& $ealt$ 'r&)essi&nalsE
(&vernmentsE c&mm%nitiesE mediaE and t$e '%lic! In t$is 1a+E t$e in)rastr%ct%re serves man+ CanadiansE
and n&t ;%st &ne s%7secti&n &) t$e '&'%lati&n! As Healt$ In)&1a+ mat%resE t$e CGDI s$&%ld 'la+ an
increasin( r&le in devel&'ment &) t$e necessar+ in)rastr%ct%re and a''licati&nsE ta2in( int& c&nsiderati&n
data 'rivac+ iss%esE a''r&'riate tec$n&l&(ies and deliver+ c$annelsE data reF%irementsE etc!
As an earl+ inn&vat&rE t$e Ne1 Br%ns1ic2 L%n( Ass&ciati&n 1ill c&ntin%e t& 1&r2 1it$ $ealt$ a%t$&rities
and Ge&C&nnecti&nsE t& advance t$e a''licati&n &) GIS in '%lic $ealt$E incl%din( t$e ad&'ti&n &) &'ti&nal
9-SH9FS standardsE advanced dataase desi(nE arc$itect%re c&nce't%ali<ati&nE researc$ and trainin(! 9e
)irml+ elieve t$at t$e CGDI 1ill e in 26#6E 1$at t$e Internet ecame )&r %siness in t$e 56s I t$e
&'tim%m ve$icle )&r e4c$an(eE anal+sisE and disseminati&n &) geospatial dataE in s%''&rt &) decisi&n7
ma2in(E enric$in( CanadianQs livesE and 'r&tectin( $%man $ealt$ and t$e envir&nment!
#22
APP/N%9? $: 7/AL.7 %A.ABA1/1
,L9N9,AL A%&9N91.-A.9;/ %A.ABA1/1
%ischarge Abstract %atabase
T$e %ischarge Abstract %atabase
A*2"B
c&ntains dem&(ra'$icE administrative and clinical data )&r $&s'ital
disc$ar(es >in'atient ac%teE c$r&nicE re$ailitati&n? and da+ s%r(eries in Canada! T$is data is received
directl+ )r&m 'artici'atin( $&s'itals in ever+ 'r&vinceE e4ce't =%eec! T$e '%r'&se &) t$e dataase is t&
c&llectE 'r&cess and anal+se s%mmaries &) $&s'ital disc$ar(es and da+ s%r(eriesR s%''&rt mana(ement
decisi&n ma2in( at t$e $&s'italE re(i&nal and 'r&vincial levelsR )acilitate 'r&vincial and nati&nal
c&m'arative re'&rtin(R s%''&rt t$e devel&'ment and %se &) anal+tical t&&lsE s%c$ as case (r&%'in(
met$&dsE len(t$ &) sta+ anal+sis and res&%rce %tili<ati&n anal+sisR and s%''&rt related a''r&ved anal+sis
and researc$ + &t$er researc$ (r&%'s!
7ospital &orbidity %atabase
T$e 7ospital &orbidity %atabase
A*2/B
is a nati&nal data $&ldin( t$at ca't%res administrativeE clinical and
dem&(ra'$ic in)&rmati&n &n $&s'ital in'atient events! It 'r&vides nati&nal disc$ar(e statistics )r&m
Canadian $ealt$ care )acilities + dia(n&ses and 'r&ced%res! Disc$ar(e data are received )r&m ac%te care
)acilities and select c$r&nic care and re$ailitati&n )acilities acr&ss Canada! Disc$ar(e data )r&m
's+c$iatric )acilitiesE as 1ell as da+ 'r&ced%res >e1g1E da+ s%r(eries? and Emer(enc+ De'artment visits are
n&t ca't%red! T$e '%r'&se &) t$e dataase is t& c&llectE 'r&cessE and anal+se dia(n&ses and 'r&ced%res )&r
all $&s'ital se'arati&ns >disc$ar(es and deat$s?R )acilitate $&s'italE re(i&nalE 'r&vincial and nati&nal
c&m'arative re'&rtin(R s%''&rt mana(ement decisi&n ma2in( at t$e $&s'italE re(i&nalE and 'r&vincial
levelsR 'r&vide data t& )ederal de'artments s%c$ as Statistics CanadaR s%''&rt related a''r&ved anal+sis
and researc$! Data elements incl%de administrative data elements >e1g!E admissi&n and disc$ar(e data?E
clinical data elements >e1g1E dia(n&stic and 'r&ced%ral c&des?E and dem&(ra'$ic data elements >e1g1E
'atient a(e?! T$e H&s'ital -&ridit+ Dataase is '&'%lated + s%set data )r&m t$e Disc$ar(e Astract
Dataase )&r t$&se 'r&vinces t$at s%mit disc$ar(e statistics t& t$e DAD! T$e H&s'ital -&ridit+
Dataase als& a''ends data )r&m n&n7DAD ;%risdicti&ns ens%rin( nati&nal c&vera(e!
National A5bulatory ,are -eporting 1yste5
T$e National A5bulatory ,are -eporting 1yste5
A*20B
$as t$e '&tential t& incl%de data )&r all $&s'ital7
ased and c&mm%nit+7ased am%lat&r+ careD da+ s%r(er+E &%t'atient clinics and emer(enc+
de'artments! Am%lat&r+ care $as (r&1n si(ni)icantl+ in recent +ears t& ec&me t$e lar(est v&l%me &)
'atient activit+ in Canadian $ealt$care! Client visit data are c&llected at time &) service in 'artici'atin(
)acilities! Data c&llecti&n met$&ds ma+ var+ + )acilit+! T$e dataase incl%des dem&(ra'$icE clinicalE
administrativeE )inancial and service7s'eci)ic data elements )&r da+ s%r(er+ and emer(enc+! T$e '%r'&se
&) t$e Nati&nal Am%lat&r+ Care Re'&rtin( S+stem is t& c&llectE 'r&cess and anal+se s%mmar+ data &n
$&s'ital am%lat&r+ careR s%''&rt mana(ement decisi&n ma2in( at t$e $&s'italE re(i&nal and 'r&vincial
levelsR )acilitate 'r&vincial and nati&nal c&m'arative re'&rtin(R s%''&rt related a''r&ved anal+sis and
researc$R and s%''&rt t$e devel&'ment and %se &) case7mi4 and res&%rce %tili<ati&n (r&%'in(
met$&d&l&(ies!
#2*
7/AL.7 78&AN -/108-,/1 %A.ABA1/1
-egistered Nurses %atabase
T$e -egistered Nurses %atabase
A*23B
c&ntains dem&(ra'$ic >e1g! a(e (r&%'E (ender?E ed%cati&n and
em'l&+ment in)&rmati&n &n re(istered n%rses in Canada! T$e data c&llected is in acc&rdance 1it$ a Data
A(reement si(ned + 'r&vincial re(%latin( a%t$&rities res'&nsile )&r t$e RN licens%reE t$e Canadian
Instit%te )&r Healt$ In)&rmati&n and t$e Canadian N%rses Ass&ciati&n! Eac$ +earE 'r&vincial re(%lat&r+
a%t$&ritiesE CIHI and t$e Canadian N%rses Ass&ciati&n revie1 t$e c&re set &) elements eac$ 'r&vince
incl%des &n t$e re(istrati&n )&rms! Under t$e c%rrent a(reementE eac$ re(%lat&r+ a%t$&rit+ s%mits 26
data elements c&llected )r&m eac$ re(istered n%rse! C&llectin( data )r&m individ%al RNs is t$e
res'&nsiilit+ &) t$e re(%lat&r+ a%t$&rit+! T$e data are man%all+ enteredE and a 'r&vincial )ile is
s%mitted t& CIHI in a standardi<ed )&rmat! N&t all data elements c&llected )r&m t$e re(istrati&n )&rms
are sent t& CIHIR eac$ re(%lat&r+ a%t$&rit+ c&llects additi&nal in)&rmati&n )&r its &1n administrative
andH&r researc$ '%r'&sesE a'art )r&m t$e elements &%tlined in t$e Data A(reement! Pr&vincial re(%lat&r+
a%t$&rities are res'&nsile )&r data c&llecti&nE 1$ic$ &cc%rs d%rin( t$e ann%al re(istrati&n 'r&cess! T$e
data are ca't%red )r&m mandat&r+ licensin( )&rmsE and t$e re(%lat&r+ a%t$&rit+ c&m'letes an+
mani'%lati&n &) t$e ;%risdicti&nal data necessar+ t& meet nati&nal standards e)&re s%mittin( t$e data
)iles t& CIHI!
Licensed Practical Nurses %atabase
T$e Licensed Practical Nurses %atabase c&ntains dem&(ra'$icE ed%cati&n and em'l&+ment
in)&rmati&n &n licensed 'ractical n%rses in Canada! T$e data c&llected is in acc&rdance 1it$ an
a(reement et1een t$e 'r&vincial re(%lat&r+ a%t$&rities res'&nsile )&r t$e LPN licens%re and t$e
Canadian Instit%te )&r Healt$ In)&rmati&n! Eac$ +earE LPNs c&m'lete a mandat&r+ re(istrati&n )&rm )&r
&tainin( a license )&r 'ractice! A s%set &) t$is data is 'r&vided t& CIHI + t$e 'r&vincial n%rsin(
ass&ciati&ns res'&nsile )&r LPN licens%re! Pr&vincial re(%lat&r+ a%t$&rities are res'&nsile )&r data
c&llecti&nE 1$ic$ &cc%rs d%rin( t$e ann%al re(istrati&n 'r&cess! T$e data are ca't%red )r&m mandat&r+
licensin( )&rmsE and t$e re(%lat&r+ a%t$&rit+ c&m'letes an+ mani'%lati&n &) t$e ;%risdicti&nal data
necessar+ t& meet nati&nal standards e)&re s%mittin( t$e data )iles t& CIHI!
-egistered Psychiatric Nurses %atabase
Re(istered 's+c$iatric n%rses are ed%cated and re(%lated as a se'arate n%rsin( 'r&)essi&n in -anit&aE
Sas2atc$e1anE AlertaE and Britis$ C&l%mia! T$e -egistered Psychiatric Nurses %atabase c&ntains
s%''l+ and distri%ti&n in)&rmati&n )&r re(istered 's+c$iatric n%rses in t$ese 'r&vinces! Eac$ +earE RPNs
c&m'lete a mandat&r+ re(istrati&n )&rm )&r &tainin( a license )&r 'ractice! A s%set &) t$ese data is
'r&vided t& Canadian Instit%te )&r Healt$ In)&rmati&n + t$e )&%r 'r&vincial n%rsin( ass&ciati&ns
res'&nsile )&r RPN licens%re in t$e 1estern Canada! Pr&vincial re(%lat&r+ a%t$&rities are res'&nsile )&r
data c&llecti&nE 1$ic$ &cc%rs d%rin( t$e ann%al re(istrati&n 'r&cess! T$e data are ca't%red )r&m
mandat&r+ licensin( )&rmsE and t$e re(%lat&r+ a%t$&rit+ c&m'letes an+ mani'%lati&n &) t$e ;%risdicti&nal
data necessar+ t& meet nati&nal standards e)&re s%mittin( t$e data )iles t& CIHI!
7/AL.7 1P/N%9N+ %A.ABA1/1
National 7ealth /3penditure %atabase
T$e National 7ealth /3penditure %atabase
A*25B
'r&vides an &vervie1 &) all $ealt$ s'endin( in CanadaE
+ s'endin( cate(&r+ and s&%rce &) )%ndin(! Data are e4tracted man%all+ )r&m diverse '%lic d&c%mentsE
incl%din( nati&nal and 'r&vincial '%lic acc&%nts and &t$er )inancial re'&rts! Ot$er s&%rces incl%de
#2,
'rivate ins%rance c&m'aniesE AC Nielsen Canada and Statistics Canada! T$e dataase c&ntains
e4'endit%re data &n &ver ,6 cate(&riesR )ive s&%rces &) )inance >)ederalE 'r&vincialE territ&rial and
m%nici'al (&vernmentsE 1&r2ers: c&m'ensati&n &ards and &t$er s&cial sec%rit+ )%nds and t$e 'rivate
sect&r?! T$e '%r'&se &) t$e dataase is t& c&llectE 'r&cess and anal+se s%mmar+ data &n all $ealt$
e4'endit%res in CanadaR 'r&vide a macr& 'ers'ective &n $ealt$ s'endin( in CanadaR )acilitate 'r&vincialE
nati&nal and internati&nal c&m'arative re'&rtin(R s%''&rt '&lic+ 'lannin( and decisi&n ma2in( at t$e
'r&vincial and nati&nal levelsR s%''&rt related anal+sis and researc$ + &t$ers!
0/,% 7ealth %atabase
T$e 0/,% 7ealth %atabase
A**6B
c&ntains in)&rmati&n &n $ealt$ care s'endin(E $ealt$ care services and
$ealt$ stat%s am&n( memer c&%ntries &) t$e Or(ani<ati&n )&r Ec&n&mic C&7O'erati&n and
Devel&'ment! T$e Canadian Instit%te )&r Healt$ In)&rmati&n and Statistics Canada maintain t$e
Canadian se(ment &) t$e OECD Healt$ Dataase! -&st Canadian data &ri(inate )r&m dataases
maintained + CIHI and Statistics CanadaE s%c$ as t$e $ealt$ e4'endit%resE $ealt$ servicesE and $ealt$
'r&)essi&nals dataases at CIHI and t$e dem&(ra'$ic and vital statistics dataases at Statistics Canada!
T$e OECD $ealt$ dataase is divided int& ten 'artsD $ealt$ stat%sE $ealt$ care res&%rcesE $ealt$ care
%tili<ati&nE e4'endit%re &n $ealt$E )inancin( and rem%nerati&nE s&cial 'r&tecti&nE '$armace%tical mar2etE
n&n7medical determinants &) $ealt$E dem&(ra'$ic re)erences and ec&n&mic re)erences! T$e '%r'&se &)
t$e OECD Healt$ Dataase is t& c&llect and 'r&cess c&nsistent series &) internati&nall+ c&m'arale data
)&r m&st &) t$e #E266 variales c&ntained in t$e OECD $ealt$ dataaseR )acilitate internati&nal
c&m'arative re'&rtin(R s%''&rt '&lic+ 'lannin( and decisi&n7ma2in( at t$e 'r&vincial and nati&nal levelsR
and s%''&rt related anal+sis and researc$ + &t$ers!
,anadian &91 %atabase
T$e ,anadian &91 %atabase
A**#B
is t$e nati&nal data s&%rce )&r )inancial and statistical in)&rmati&n
a&%t $&s'itals and $ealt$ re(i&ns! T$e data are c&llected acc&rdin( t& a standardi<ed )rame1&r2 )&r
c&llectin( and re'&rtin( )inancial and statistical data &n t$e da+7t&7da+ &'erati&ns &) $ealt$ service
&r(ani<ati&ns! T$e )rame1&r2 is 2n&1n as t$e G%idelines )&r -ana(ement In)&rmati&n S+stems in
Canadian Healt$ Service Or(ani<ati&ns! H&s'itals and $ealt$ re(i&ns are e4'ected t& s%mit -IS
G%idelines7c&m'liant )inancial and statistical data relatin( t& $&s'ital services t& t$e dataase! Healt$
re(i&ns als& s%mit &t$er $ealt$ service activities! -&st 'r&vinces and territ&ries s%mit $&s'ital data
t$r&%($ t$eir res'ective ministries &) $ealt$! T$e variales and c&nce'ts %sed t& ca't%re in)&rmati&n in
t$e dataase are ased &n t$e -IS G%idelinesE a c&m're$ensive set &) standards %sed t& re'&rt
mana(ement in)&rmati&n t$at is %ltimatel+ s%mitted t& t$e C-DB and is related t& sta))in(E c&stsE
1&r2l&ad and 'r&visi&n &) services! T$e -IS G%idelines are desi(ned t& a''l+ acr&ss t$e c&ntin%%m &)
servicesE ran(in( )r&m $&s'itals t& c&mm%nit+7ased $ealt$ service &r(ani<ati&nsE 'r&vidin( a
)rame1&r2 t& (enerateE maintain and anal+<e in)&rmati&n reF%ired )&r e))ective decisi&n7ma2in(E and
acc&%ntailit+! T$e C-DB rec&rds )inancial and statistical in)&rmati&n ased &n a standardi<ed c$art &)
acc&%ntsE a''l+in( (eneral acc&%ntin( '&licies and 'r&ced%resE 1&r2l&ad meas%rement s+stemsE service
activit+ statistics and indicat&rs t$at s%''&rt mana(ement decisi&n7ma2in( in $ealt$ service
&r(ani<ati&ns! T$e in)&rmati&n in t$e C-DB can '&tentiall+ e %sed t& c&st t$e activities &) $ealt$
service &r(ani<ati&ns and )&rms t$e asis &) mana(ement re'&rtin( incl%din( ann%al (eneral7'%r'&se
)inancial statementsE )inancial rati& anal+sis and &'erati&nal %d(etin(!
National Physician %atabase
T$e National Physician %atabase
A**2B
c&ntains data &n )ee7)&r7service '$+sician 'a+ments in Canada!
T$e data c&mes )r&m 'r&vincial medical $ealt$ care ins%rance 'lans! T$is dataase c&ntains s&ci&7
dem&(ra'$icE 'a+ment and service %tili<ati&n data &) )ee7)&r7service '$+sicians andR service %tili<ati&n
dataE + a(e (r&%' and se4E &) t$eir 'atients! T$e '%r'&se &) NPDB is t&D c&llectE 'r&cess and anal+se
#2"
s%mmar+ data &n '$+sician services and 'a+mentsR )acilitate '$+sician res&%rce and service %tili<ati&n
'lannin(R and s%''&rt related a''r&ved anal+sis and researc$!
It s$&%ld e n&ted t$at n& real7time H dail+ data is availale )&r '$+sicians t$at are &n sta)) I t$is is a
critical (a' in assessin( t$e ca'ailit+ &) $&s'itals and clinics t& res'&nd t& in)ecti&%s disease &%trea2s
and nat%ral disasters >im'l+in( immediate s%r(e in demandE relie) and l&n( term re$ailitati&n?!
National Prescription %rug 8tili<ation 9n2or5ation 1yste5
T$e Canadian Instit%te )&r Healt$ In)&rmati&n and t$e Patented -edicines Prices Revie1 B&ard are
1&r2in( c&lla&rativel+ t& devel&' and maintain t$e National Prescription %rug 8tili<ation
9n2or5ation 1yste5
A***B
R a 'an7Canadian in)&rmati&n s+stem $&%sin( in)&rmati&n related t& dr%( ene)it
)&rm%lariesE dr%( claimsE dr%( 'lans and '&'%lati&n statistics! T$e NPDUIS 1ill 'r&vide access t&
c&m're$ensive and c&m'arative in)&rmati&n &n t$e %se &) 'rescried dr%(s acr&ss t$e c&%ntr+! Eac$
&r(ani<ati&n is ta2in( t$e lead in areas in 1$ic$ it $as t$e e4'ertiseHe4'erience! T$e NPDUIS Steerin(
C&mmittee 'r&vides advice t& CIHI and P-PRB re(ardin( t$e devel&'mentE t$e anal+tical directi&n and
'ri&rities and t$e strate(ic directi&n &) NPDUIS! T$e Steerin( C&mmittee als& c&nstit%tes a mec$anism
t& all&1 sta2e$&lders and %sers t& ma2e s%((esti&ns )&r im'r&vement and t& raise iss%es related t& t$e
NPDUIS )&r c&nsiderati&n and res&l%ti&n in &rder t& ens%re t$at t$e s+stem c&ntin%es t& e relevant t&
t$eir in)&rmati&n needs! Over t$e last t1ent+ +earsE dr%(s $ave ec&me an increasin(l+ si(ni)icant )act&r
in t$e stat%s &) t$e Canadian $ealt$ care s+stem! T$is is re)lected + t$e dramatic rise in &%r dr%(
s'endin(E 1$ic$ re'resented 5!"N &) t&tal $ealt$ e4'endit%res in #53"E and $as since alm&st d&%led t&
&ver #/N &) t&tal $ealt$ s'endin(! -&re&verE t$e ma;&rit+ &) t$is s'endin( is &n 'rescried dr%(s!
Clearl+E n&1 m&re t$an everE t$ere is a need t& etter %nderstand t$e r&le t$at 'rescried dr%(s 'la+ in t$e
F%alit+ &) CanadaQs $ealt$ care! H&1everE c&m'arale in)&rmati&n &n dr%( c&vera(eE '%lic )&rm%lariesE
and descri'ti&n &) '%lic dr%( 'lans and dr%( %tili<ati&n is rare d%e t& a lac2 &) standardi<ed data!
9it$&%t t$is vital in)&rmati&nE CanadaQs $ealt$ care leaders are limited in t$eir ailit+ t& mana(e &%r
'%lic dr%( 'r&(rams and ma2e decisi&ns ar&%nd '$armace%tical7related '&licies!
National 7ealth /3penditure %atabase
Dr%( e4'endit%re data are &tained )r&m t$e National 7ealth /3penditure %atabase
A**,B
maintained +
t$e Canadian Instit%te )&r Healt$ In)&rmati&n! Dr%( e4'endit%re data in NHEJ are macr&7level data and
d& n&t all&1 )&r dec&m'&siti&n &) 'rescri'ti&n c&sts &r dr%( classes! T$e re'&rt %'dates trends in dr%(
s'endin( in CanadaE 'rimaril+ )r&m retail estalis$mentsE in t&talE + '%lic and 'rivate 'a+ersE and +
t+'e &) dr%( >'rescried and n&n7'rescried?! Pr&vincial and territ&rial c&m'aris&ns are incl%ded!
Internati&nal trends are %'dated ased &n data )r&m t$e OECD!
7/AL.7 1/-;9,/1 %A.ABA1/1
,anadian Joint -eplace5ent -egistry
T$e ,anadian Joint -eplace5ent -egistry
A**"B
ca't%res in)&rmati&n &n $i' and 2nee ;&int re'lacements
'er)&rmed in Canada and )&ll&1s ;&int re'lacement 'atients &ver time t& m&nit&r t$eir revisi&n rates and
&%tc&mes! Data are c&llected 1it$ 'atient c&nsent at t$e time t$e+ receive ;&int re'lacements!
Partici'atin( )acilities and 'r&vincial re(istries s%mit data v&l%ntaril+ >1$ere estalis$ed?! T$is dataase
c&ntains data &n $i' and 2nee re'lacement 'atients! T$e dataase incl%des in)&rmati&n &nD dem&(ra'$ics
and administrati&nR t$e t+'e &) re'lacementR s%r(ical a''r&ac$R )i4ati&n m&des andR im'lant t+'es! T$e
'%r'&se &) t$e Re(istr+ is t&D c&llectE 'r&cess and anal+se s%mmar+ data &n $i' and 2nee re'lacement
'r&ced%res 'er)&rmed in CanadaR s%''&rt evidence7ased decisi&n ma2in( t& im'r&ve t$e F%alit+ &) care
)&r ;&int re'lacement reci'ientsR )acilitate c$an(e in '$+sician 'ractice 'atterns t& res%lt in l&1er revisi&n
#2/
ratesR c&nd%ct '&st7mar2et s%rveillance &) &rt$&'edic devices and tec$n&l&(iesR s%''&rt &rt$&'edic7
related a''r&ved anal+sis and researc$!
,anadian &edication 9ncident -eporting and Pre4ention 1yste5
Recent researc$ )indin(s $ave raised c&ncerns re(ardin( t$e n%mer &) adverse events e4'erienced +
'atients in CanadaE incl%din( t$&se related t& medicati&n incidents! N&t &nl+ $ave t$ese incidents
&ccasi&nall+ res%lted in si(ni)icant 'atient $armE %t t$e+ $ave als& led t& increased $ealt$ care deliver+
c&sts! Better in)&rmati&n &n t$e t+'esE s&%rcesE ca%ses and &%tc&mes &) medicati&n incidents is needed in
Canada t& assist inD identi)+in( areas reF%irin( c$an(eR identi)+in( '&tential 'reventative strate(iesR
im'lementin( strate(ies t$at $ave een s$&1n t& red%ce t$e ris2 &) incidentsR and eval%atin(
im'lementati&n &%tc&mes! T$e ,anadian &edication 9ncident -eporting and Pre4ention 1yste5
A**/B
is
envisi&ned t& e an an&n+m&%sE v&l%ntar+ re'&rtin( 'r&(ram t$at enc&%ra(es &'ennessE in)&rmati&n
s$arin( and learnin( 1it$in t$e $ealt$ s+stem! T$r&%($ t$e c&llecti&nE anal+sisE s$arin( and re'&rtin( &)
medicati&n incident dataE t$e C-IRPS 1ill en$ance &%r %nderstandin( &) 1$+ t$ese events $a''en and
$&1 t& 'revent t$em in t$e )%t%re! T$e Canadian Instit%te )&r Healt$ In)&rmati&n is res'&nsile )&rD
identi)+in( in)&rmati&n needs related t& medicati&n incident re'&rtin( and 'reventi&n in CanadaR
devel&'in( and maintainin( data standards and transmissi&n 'r&t&c&lsR devel&'in( a s+stem ca'ale &)
F%er+ and anal+sisR devel&'in( a data F%alit+ 'lan and assessin( &n(&in( data F%alit+R c&nd%ctin(
anal+tical st%dies and 'r&vidin( sta2e$&lders 1it$ c&m're$ensive re'&rtsR and res'&ndin( t& ad $&c
reF%ests )&r in)&rmati&n! Once t$e C-IRPS $as een la%nc$edE CIHI 1ill 'r&vide 'artici'atin( $&s'itals
1it$ a c&m're$ensive client s%''&rt service!
,anadian 0rgan -eplace5ent -egister
T$e ,anadian 0rgan -eplace5ent -egister
A**0B
rec&rdsE anal+<es and re'&rts &n t$e level &) activit+
and &%tc&mes &) vital &r(an trans'lantati&n and renal dial+sis activities in Canada! Data c&me )r&m
'artici'atin( dial+sis centresE trans'lant centres and &r(an 'r&c%rement &r(ani<ati&ns in Canada! Data
elements incl%deD 'atient7s'eci)ic treatment and &%tc&me data &n c$r&nic 2idne+ )ail%re 'atients
receivin( renal re'lacement t$era'+ in Canada >e1g1E 'atient dem&(ra'$icsE ris2 )act&rsE )&ll&17%'E (ra)t
)ail%res?R and &r(an trans'lantati&n data >e1g1E n%merE t+'e and &%tc&me &) vital &r(an trans'lantsR
n%mer &) livin( and cadaver &r(an d&n&rsR n%mer &) 'atients &n t$e trans'lant 1aitin( list?! T$e
'%r'&se &) t$e Canadian Or(an Re'lacement Re(ister is t&D c&llectE 'r&cess and anal+se s%mmar+ data &n
end7sta(e &r(an )ail%re and &r(an trans'lantsR 'r&vide a nati&nal vie1 &n end7sta(e &r(an )ail%re
statistics )&r c&m'arative anal+ses and researc$ st%diesR increase t$e availailit+ &) c&m'arative material
t& )acilitate etter treatment decisi&nsR 'r&vide statistics &n l&n(7term trends t$at can e %sed )&r 'lannin(
and &'timi<in( 'r&(ramsR 'r&vide a )eedac2 mec$anism t& )acilitiesE a F%alit+ ass%rance )%ncti&n )&r
treatmentE and a nati&nal standard )&r c&m'aris&nR 'r&vide statistics t& t$e $ealt$ care ind%str+E t&
en$ance %siness decisi&ns s%c$ as 'lannin( and res&%rce all&cati&n )&r renal treatment and trans'lant
servicesR s%''&rt related a''r&ved anal+sis and researc$!
,ontinuing ,are -eporting 1yste5
T$e ,ontinuing ,are -eporting 1yste5
A**3B
is desi(ned t& c&llect and re'&rt data &n residents in
desi(nated c&ntin%in( care eds acr&ss Canada! T$is is t$e nati&nal versi&n &) t$e Ontari& C$r&nic Care
Patient S+stem! N%rsin( sta)) &r &t$er $ealt$ 'r&viders c&nd%ct assessments &) individ%als in desi(nated
edsE 1$et$er in )ree7standin( c$r&nic &r l&n(7term care )acilitiesE &r in $&s'itals! T$e data are c&llected
%sin( t$e m&di)ied Resident Assessment Instr%ment -inim%m Data SetE >-DS 2!6?E ` interRAI >#550E
#555?! T$e RAI -DS 2!6 ` clinical assessment t&&l c&nsists &) &ver "66 data elementsE incl%din(D
dem&(ra'$icsR c&(nitive and e$avi&%ral dataR '$+sical )%ncti&nin(R medicati&n %seR n%triti&nal stat%sR
s'ecial treatments and 'r&ced%res! T$e C&ntin%in( Care Re'&rtin( S+stem s%''&rts mana(ement
decisi&n7ma2in( at t$e )acilit+E re(i&nal and 'r&vincial levelsR s%''&rts t$e devel&'ment and %se &) case7
#20
mi4 and res&%rce %tili<ati&n (r&%'in( met$&d&l&(iesR )acilitates )acilit+E re(i&nalE 'r&vincial and nati&nal
c&m'arative re'&rtin(R s%''&rts related a''r&ved anal+sis and researc$!
7o5e ,are -eporting 1yste5
H&me care is rec&(ni<ed as a critical c&m'&nent &) an e))icient and e))ective $ealt$ care s+stem! T& meet
t$e need )&r c&nsistentE c&m'arale $&me care in)&rmati&nE t$e Canadian Instit%te )&r Healt$ In)&rmati&n
devel&'ed t$e 7o5e ,are -eporting 1yste5
A**5B
t& c&llectE 'r&cess and anal+<e data &n '%licl+ )%nded
$&me care servicesR s%''&rt mana(ement decisi&n7ma2in( at t$e &r(ani<ati&nalE re(i&nal and 'r&vincial
levelsR )acilitate 'r&vincial and nati&nal c&m'arative re'&rtin(R and s%''&rt related a''r&ved anal+sis and
researc$! T$e HCRS ca't%res data )r&m vari&%s t+'es &) &r(ani<ati&ns t$at are res'&nsile )&r 'r&vidin(
'%licl+ )%nded $&me care services! Data s%missi&ns t& HCRS ma+ )l&1 )r&m 'r&vincial ministries &)
$ealt$ &r )r&m re(i&nal &r(ani<ati&ns >s%c$ as RHAsE CCACs &r CLSCs?! Data elements incl%deD
standardi<ed client7s'eci)ic clinicalE dem&(ra'$icE administrative and res&%rce %tili<ati&n in)&rmati&n
1it$in a sin(le re'&rtin( )rame1&r2! A 2e+ c&m'&nent &) t$e HCRS is t$e Resident Assessment
Instr%ment 7 H&me Care >RAI7HC`?! T$e RAI7HC is &ne &) a s%ite &) assessment instr%ments devel&'ed
+ interRAIE an internati&nal researc$ c&ns&rti%mE t& assess and meas%re &%tc&mes and res&%rce %se
acr&ss t$e c&ntin%%m &) care! HCRS in)&rmati&n 1ill e %sed t& 'r&d%ce indicat&rsE re'&rts and anal+sis
&n t$e )&ll&1in(D access t& $&me care servicesR $ealt$ and )%ncti&nal stat%s meas%resR clinical &%tc&mes
and 1aitin( timesR F%alit+ &) careR in)&rmal s%''&rtR and service %tili<ati&n + settin( and 'r&vider t+'e!
7ospital &ental 7ealth %atabase
T$e 7ospital &ental 7ealth %atabase
A*,6B
c&ntains $&s'itali<ati&n data )&r mental illness acr&ss
Canada! Data are (at$ered )r&m administrative se'arati&n rec&rds &) 's+c$iatric and (eneral $&s'itals!
T$e+ are &tained electr&nicall+ t$r&%($ selected e4tracts &) t$e Disc$ar(e Astract Dataase )&r t$&se
'r&vinces 'artici'atin( in DAD! Data )&r t$e remainin( $&s'itals are s%mitted + t$e a''r&'riate
'r&vince &r territ&r+! Data c&nsist &) dem&(ra'$ic and medical dia(n&sis in)&rmati&n &n in'atient
$&s'ital sta+s! All 'r&vinces and territ&ries are re'resented! T$e '%r'&se &) t$e H&s'ital -ental Healt$
Dataase is t&D c&llectE 'r&cess and anal+se s%mmar+ data &n $&s'ital mental $ealt$ se'arati&ns
>disc$ar(es and deat$s?R s%''&rt mana(ement decisi&n ma2in( at t$e $&s'italE re(i&nal and 'r&vincial
levelsR )acilitate $&s'italE re(i&nalE 'r&vincial and nati&nal c&m'arative re'&rtin(R s%''&rt related
a''r&ved anal+sis and researc$ + &t$ers!
National -ehabilitation -eporting 1yste5
T$e National -ehabilitation -eporting 1yste5
A*,#B
c&ntains client data c&llected )r&m 'artici'atin(
ad%lt in'atient re$ailitati&n )acilities and 'r&(rams acr&ss Canada! Data are c&llected at time &)
admissi&n and disc$ar(e + service 'r&viders in 'artici'atin( )acilities! T$ere is als& an &'ti&nal '&st7
disc$ar(e )&ll&17%' data c&llecti&n 'r&cess! Partici'ants in t$e NRS m%st si(n an end %ser license
a(reement 1it$ t$e Canadian Instit%te )&r Healt$ In)&rmati&n! Data elements are &r(ani<ed %nder t$e
)&ll&1in( cate(&riesD s&ci&7dem&(ra'$ic in)&rmati&nR administrative data >e1g1E re)erralE admissi&n and
disc$ar(e?R $ealt$ c$aracteristicsR activities and 'artici'ati&n >e1g1E ADLE c&mm%nicati&nE s&cial
interacti&n?R interventi&ns! T$ese elements are %sed t& calc%late a variet+ &) indicat&rs incl%din( 1aitin(
times and client &%tc&mes!
National .rau5a -egistry
T$e National .rau5a -egistry
A*,2B
'r&vides nati&nal statistics &n in;%ries in Canada! Data c&me )r&m
t$e H&s'ital -&ridit+ DataaseE 'l%s data )r&m 'r&vincial tra%ma re(istries &r tra%ma centres in
Canada! T$ere are t$ree data setsD t$e -inim%m Data Set incl%des dem&(ra'$icE dia(n&stic and
'r&ced%ral in)&rmati&n &n all admissi&ns t& ac%te care $&s'itals in Canada d%e t& in;%r+R t$e
C&m're$ensive Data Set c&ntains data &n 'atients $&s'itali<ed 1it$ ma;&r tra%maR t$e Deat$ Data SetE
#23
c%rrentl+ %nder devel&'mentE 1ill c&ntain data &n all deat$s in Canada d%e t& in;%r+! T$e '%r'&se &) t$e
Nati&nal Tra%ma Re(istr+ is t&D c&llectE 'r&cess and anal+se s%mmar+ data &n $&s'ital tra%ma
se'arati&ns >disc$ar(es and deat$s?R c&ntri%te t& t$e red%cti&n &) in;%ries and related deat$s +
'r&vidin( data )&r st%dies &) nati&nal in;%r+ e'idemi&l&(+R )acilitate 'r&vincial and internati&nal in;%r+
c&m'aris&nsR increase a1areness &) in;%r+ as a '%lic $ealt$ 'r&lem in CanadaR assist in;%r+ 'reventi&n
and treatment 'r&(ramsR s%''&rt in;%r+7related a''r&ved anal+sis and researc$!
.herapeutic Abortions %atabase
T$e .herapeutic Abortions %atabase
A*,*B
is a nati&nal data $&ldin( t$at ca't%res administrativeE clinical
and dem&(ra'$ic in)&rmati&n &n 1&men &tainin( an ind%ced a&rti&n in Canada! It als& incl%des data
&n Canadian 1&men 1$& &tained an ind%ced a&rti&n in selected 2e+ US statesE 'rimaril+ al&n( t$e
United States7Canada &rder! Its '%r'&se is t& c&llectE 'r&cess and anal+<e n&n7identi)iale rec&rd level
and s%mmar+ data &n t$era'e%tic a&rti&nsR 'r&vide data t& '%lic de'artments )&r t$e calc%lati&n &) teen
're(nanc+ rates and )&r assessin( t$e im'act &) 'lanned 'arentin( initiativesR s%''&rt related a''r&ved
anal+sis and researc$! Data elements incl%de administrative data elements >e1g1E admissi&n and disc$ar(e
dates?R clinical data elements >e1g1E 'r&ced%re?R dem&(ra'$ic data elements >e1g1E 'atient a(e?! Data
s&%rce s%''liers incl%de 'r&vincial and territ&rial ministries &) $ealt$E $&s'italsE inde'endent a&rti&n
clinics in CanadaE and selected de'artments &) $ealt$ in t$e United States!
7ealth 9ndicators
Healt$ indicat&rs data are &tained )r&m vari&%s s&%rces + Statistics Canada and t$e Canadian Instit%te
)&r Healt$ In)&rmati&n! Indicat&r data sets incl%de $ealt$ stat%sR n&n7medical determinants &) $ealt$R
$ealt$ s+stem 'er)&rmanceR and c&mm%nit+ and $ealt$ s+stem c$aracteristics!
A*,,B
7ealth status
Wellbeing
1tatistics ,anada ,979
a
a Sel)7esteem

7ealth conditions
1tatistics ,anada ,979
a B&d+ mass inde4 >B-I?
a C$r&nic c&nditi&ns
a L&1 irt$ 1ei($t
a Cancer incidence
a In;%ries
a In;%ries
a F&&d and 1ater&rne diseases
7u5an 2unction
1tatistics ,anada ,979
a DisailitiesHlimitati&ns
a Disailit+7)ree li)e e4'ectanc+

%eaths
1tatistics ,anada ,979
a In)antH'erinatal m&rtalit+
a Li)e e4'ectanc+
a -&rtalit+ + selected ca%ses
a P&tential +ears &) li)e l&st

#25
Non5edical deter5inants o2 health
7ealth beha4iours
1tatistics ,anada ,979
#*6
a Sm&2in(
a Drin2in(
a P$+sical activit+
a Breast)eedin( 'ractices
a Dietar+ 'ractices

Li4ing and working conditions
1tatistics ,anada ,979
a Ed%cati&n
a La&%r )&rce
a Inc&me
a H&%sin(
a Decisi&n latit%de at 1&r2
a Crime

Personal resources
1tatistics ,anada ,979
a Sc$&&l readiness
a S&cial s%''&rt
a Li)e stress

/n4iron5ental 2actors
1tatistics ,anada ,979
a E4'&s%re t& sec&nd7$and sm&2e
#*#
7ealth syste5 per2or5ance
Acceptability
1tatistics ,anada ,979
Accessibility
1tatistics ,anada ,979
a Disease 'reventi&n and detecti&n a Disease 'reventi&n and detecti&n
Appropriateness
1tatistics ,anada ,979
a .a(inal irt$ a)ter caesarean secti&n
a Caesarean secti&n
,ontinuity
1tatistics ,anada ,979
/22ecti4eness
1tatistics ,anada ,979
a Deat$s d%e t& medicall+7treatale
diseases
a C&mm%nicale diseases
a Pne%m&nia and in)l%en<a
$&s'itali<ati&ns
a Am%lat&r+ care sensitive c&nditi&ns
a *67da+ in7$&s'ital m&rtalit+
a Readmissi&ns
/22iciency
1tatistics ,anada ,979
a -a+ n&t reF%ire $&s'itali<ati&n
a E4'ected c&m'ared t& act%al sta+
1a2ety
1tatistics ,anada ,979
a Hi' )ract%re $&s'itali<ati&n
,o55unity and health syste5 characteristics
,o55unity
1tatistics ,anada ,979
a P&'%lati&n attri%tes
a Ge&(ra'$ic attri%tes

7ealth syste5
1tatistics ,anada ,979
a C&ntact 1it$ alternative $ealt$ care
'r&viders
a C&ntact 1it$ $ealt$ 'r&)essi&nals
a In)l&1H&%t)l&1 rati&s
a Utili<ati&n rates
-esources
#*2
1tatistics ,anada ,979
a Healt$ e4'endit%res
a Healt$ 'r&)essi&nals
-espiratory %isease in ,anada
Res'irat&r+ Disease in Canada
A*,"B
'r&vides access t& t$e latest nati&nal s%rveillance in)&rmati&n &n
c&mm%nicale and c$r&nic res'irat&r+ disease in Canada t& '&liticiansE $ealt$ 'r&)essi&nalsE t$e mediaE
academics and st%dentsE and mana(ers in (&vernmentE ind%str+E and &t$er &r(ani<ati&ns! 9$ile
individ%al re'&rts &n s&me res'irat&r+ diseases are availaleE t$ere is n& recent d&c%ment t$at
s%mmari<es t$e 'resent state &) res'irat&r+ disease in Canada! T$is d&c%ment 1ill serve as t$e startin(
'&int )&r re(%lar re'&rtin( &n res'irat&r+ disease in Canada! Res'irat&r+ Disease in Canada is a
c&lla&rative e))&rt &) t$e Canadian L%n( Ass&ciati&nE Healt$ CanadaE Statistics CanadaE and t$e
Canadian Instit%te )&r Healt$ In)&rmati&n!
,anadian ,ancer -egistry
A

'!6

B

Statistics Canada maintains a Nati&nal Cancer Re(istr+ 1it$ in)&rmati&n s%mitted + all 'r&vincial
cancer re(istries! T$e re(istr+ incl%des dem&(ra'$ic data as 1ell as cancer t+'es! A variet+ &) data
s&%rcesE incl%din( la&rat&r+ and '$+sician re'&rtsE are %sed t& identi)+ individ%als incl%ded in t$e
re(istr+!
,anadian Patient %ata -egistry
A

'!6

B

T$e Canadian C+stic Fir&sis F&%ndati&n mana(es t$e Canadian Patient Data Re(istr+E a c&m'%teri<ed
dataase c&ntainin( medical in)&rmati&n &n all 2n&1n individ%als 1it$ c+stic )ir&sis attendin( a c+stic
)ir&sis clinic in Canada! Data are s%mitted ann%all+ + t$e *0 c+stic )ir&sis clinics in t$e c&%ntr+E and
are maintained + t$e F&%ndati&n! An&n+m&%sE a((re(ate statistics are availale t& CCFF7s%''&rted
cliniciansE in an e))&rt t& c&ntri%te t& im'r&ved clinical careE and event%all+E t& a c%re &r c&ntr&l )&r
c+stic )ir&sis!
,anadian .obacco 8se &onitoring 1ur4ey
A

'!"

B

T$e Canadian T&acc& Use -&nit&rin( S%rve+ 1as initiated in #555 t& 'r&vide Healt$ Canada and its
'artners 1it$ reliale data &n t&acc& %se and related iss%es! T$e 'rimar+ &;ective is t& trac2 c$an(es in
sm&2in( stat%s and am&%nt sm&2edE es'eciall+ )&r '&'%lati&ns m&st at ris2 )&r ta2in( %' sm&2in(E s%c$
as #"72, +ears &ld! T$e tar(et '&'%lati&n is all 'ers&ns #" +ears &) a(e and &lder livin( in CanadaE
e4cl%din( residents &) C%2&nE N%nav%t and t$e N&rt$1est Territ&riesE and )%ll7time residents &)
instit%ti&ns! In &rder t& all&1 'r&vincial c&m'aris&ns &) a''r&4imatel+ eF%al reliailit+E t$e &verall
sam'le si<e &) t$e s%rve+ is divided eF%all+ acr&ss all #6 Canadian 'r&vinces! In #555E t$e sam'le 1as
22E6#* individ%als! T$e res'&nse rate 1as 32N!
,anadian .uberculosis -eporting 1yste5
Fr&m #52/ t& #55/E Statistics Canada 1as res'&nsile )&r data c&llecti&n and anal+sis &) active
t%erc%l&sis disease cases in Canada! A)ter #55/E eac$ 'r&vince and territ&r+ re'&rted cases &)
t%erc%l&sis t& t$e Divisi&n &) T%erc%l&sis Preventi&n and C&ntr&lE Healt$ Canada! Dem&(ra'$icE
clinical and la&rat&r+ in)&rmati&n &n eac$ re'&rted case are c&m'iled and anal+sed! Treatment &%tc&me
eval%ati&n 1as added in #553!
#**
&ortality %atabase
Pr&vincial and territ&rial &))ices &) vital statistics s%mit in)&rmati&n ann%all+ &n all deat$s )r&m all vital
statistics re(istries in Canada! An in)&rmantE %s%all+ a relative &) t$e deceasedE c&m'letes t$e 'ers&nal
in)&rmati&n '&rti&n &) t$e deat$ re(istrati&n )&rm! T$e medical 'ractiti&ner c&m'letes t$e '&rti&n &) t$e
)&rm c&m'risin( t$e medical certi)icate &) deat$ last in attendanceE &r + a c&r&ner i) an inF%est &r
enF%ir+ 1as $eld! T$e dataase incl%des dem&(ra'$ic in)&rmati&n and t$e %nderl+in( ca%se &) deat$
attri%ted + t$e attendin( '$+sician!
National Air Pollution 1ur4eillance 1yste5
T$e Nati&nal Air P&ll%ti&n S%rveillance S+stem 1as estalis$ed ;&intl+ in #5/5 + t$e )ederalE 'r&vincial
and m%nici'al (&vernments! Air F%alit+ data )r&m t$e net1&r2 (ives (&vernments and t$e '%lic
essential in)&rmati&n a&%t air '&ll%ti&n t$at all&1 t$em t& assess 1$et$er Nati&nal Air =%alit+
O;ectives are ein( met! In #555E t$e net1&r2 c&nsisted &) 2"2 stati&ns in #"* citiesE 1it$ ,3"
c&ntin%&%s anal+<ers and #50 sam'lers!
National Longitudinal 1ur4ey o2 ,hildren and @outh
-ana(ed + H%man Res&%rces Devel&'ment CanadaE t$e 'rimar+ &;ect &) t$e Nati&nal L&n(it%dinal
S%rve+ &) C$ildren and C&%t$ is t& devel&' a nati&nal dataase &n t$e c$aracteristics and li)e e4'eriences
&) Canadian c$ildren as t$e+ (r&1 )r&m in)anc+ t& ad%lt$&&d! T$e s%rve+ c&llects cr&ss7secti&nal
in)&rmati&n as 1ell as l&n(it%dinal data! Data c&llecti&n e(an in #55,75" and 1ill e re'eated ever+ t1&
+ears t& )&ll&1 t$e c$ildren &ri(inall+ s%rve+ed in #55,! In s%seF%ent +earsE a cr&ss7secti&nal sam'le
1ill e added )&r a(e (r&%'s n& l&n(er c&vered + t$e l&n(it%dinal sam'le! T$e tar(et '&'%lati&n
incl%des c$ildren in all 'r&vinces and territ&riesE e4ce't c$ildren livin( in instit%ti&nsE &n First Nati&n
reservesE &n Canadian Armed F&rces Bases and in s&me rem&te areas &) t$e c&%ntr+! T$e s%rve+ c&llects
in)&rmati&n &n t$e c$ild )r&m t$e $&%se$&ld memer m&st 2n&1led(eale a&%t t$e c$ild! U' t& )&%r
c$ildren 'er $&%se$&ld are c$&sen rand&ml+! T$e s%rve+ is 'rimaril+ desi(ned )&r nati&nalE re(i&nal and
'r&vincial level anal+sis! Anal+sis &) s%7'&'%lati&ns is limited + ins%))icient sam'le si<es!
National Perinatal 1ur4eillance 1yste5
-ana(ed + Healt$ Canada and Statistics CanadaE t$e NPSS %ses t$e data )r&m t$e Statistics Canada
Birt$ Dataase in t$e Canadian .ital Statistics S+stem! Eac$ +ear 'r&vinces and territ&ries send t$eir
irt$ re(istrati&n data t& Statistics Canada )&r incl%si&n in t$e Healt$ Canada dataase! T$e Birt$
Dataase c&ntains dem&(ra'$ic and &stetrical in)&rmati&n &n t$e m&t$erE as 1ell as in)&rmati&n &n t$e
in)ant!
National Population 7ealth 1ur4ey
-ana(ed + Statistics CanadaE t$e NPHS c&llects in)&rmati&n related t& t$e $ealt$ &) t$e Canadian
'&'%lati&n and related s&ci&7dem&(ra'$ic in)&rmati&n! T$e NPHS is c&m'&sed &) t$ree c&m'&nentsD t$e
H&%se$&ld S%rve+E t$e Healt$ Care Instit%ti&n S%rve+ and t$e N&rt$ern Territ&ries S%rve+! T$e NPHS
H&%se$&ld S%rve+ $as t1& secti&nsD a l&n(it%dinal 'anel &) individ%als 1$& are s%rve+ed ever+ t1&
+ears >#,E566 in #55/ and #,E266 in #553?E and a cr&ss7secti&nal c&m'&nent >#0E/66 in #55,!"E 3#E366 in
#55/!0 and #0E266 in #553H5?! T$e NPHS $&%se$&ld c&m'&nent incl%des $&%se$&ld residents in all
'r&vincesE 1it$ t$e e4cl%si&n &) '&'%lati&ns &n First Nati&n reservesE &n Canadian Armed F&rces Bases
and in s&me rem&te areas &) t$e c&%ntr+! T$e )irst c+cle &) data c&llecti&n e(an in #55, and data 1ill e
c&llected ever+ sec&nd +earE )&r a''r&4imatel+ 26 +ears in t&tal! T$ree c+cles &) c&llecti&n are n&1
c&m'leted )&r eac$ c&m'&nent!
#*,
Noti2iable %isease -eporting 1yste5
-ana(ed + Healt$ CanadaE ever+ 'r&vince and territ&r+ s%''lies a((re(ate data &n n&ti)iale
c&mm%nicale diseases + a(e (r&%' and (ender &n a m&nt$l+ asis t& t$e Centre )&r In)ecti&%s Disease
Preventi&n and C&ntr&l! T$e a(e (r&%'s and t$e list &) m&st n&ti)iale disease $ave c$an(ed &ver time in
res'&nse t& disease trends! T$is s%rveillance H sentinel s+stem als& $el's Canada t& re'&rt t& t$e 9&rld
Healt$ Or(ani<ati&nE in acc&rdance 1it$ Anne4 #E &) t$e 9&rld Healt$ Or(ani<ati&nQs Pandemic
In)l%en<a Dra)t Pr&t&c&l )&r Ra'id Res'&nse and C&ntainment!
National Population 7ealth 1ur4ey: Asth5a 1upple5ent
-ana(ed + Statistics Canada and Healt$ CanadaE t$e Ast$ma S%''lement S%rve+ 1as c&nd%cted as a
F%arterl+ s%''lement t& t$e #55/H0 NPHS! C&llecti&n c&mmences in Se'temer #55/ and ended in @%l+
#550E t$ree m&nt$s )&ll&1in( eac$ NPHS data c&llecti&n 'eri&d! Data 1ere c&llected %sin( a c&m'%ter7
assisted intervie1in( s&)t1are 'ac2a(e )r&m a centrali<ed tele'$&ne &'erati&n at Statistics CanadaQs $ead
&))ice in Otta1a! Eli(ile 'artici'ants 1ere t$&se 1$& indicated t$e+ $ad een dia(n&sed 1it$ ast$ma +
a $ealt$ care 'r&vider and $ad seen a '$+sician &r een &n medicati&n )&r ast$ma in t$e 'revi&%s +ear!
T$e main &;ective &) t$e Ast$ma S%rve+ 1as t& 'r&vide in)&rmati&n a&%t t$e severit+ &) ast$ma
s+m't&msE ass&ciated ris2 )act&rsE and mana(ement and treatment 'ractices! Data 1ere als& c&llected
a&%t t$e %tili<ati&n &) medical services and ast$ma ed%cati&n!
,ANA%9AN 9N1.9.8./1 0* 7/AL.7 -/1/A-,7
T$e Canadian Instit%tes &) Healt$ Researc$ is t$e ma;&r )ederal a(enc+ res'&nsile )&r )%ndin( $ealt$
researc$ in Canada! It is t$e s%ccess&r t& t$e -edical Researc$ C&%ncil &) Canada! It aims t& create ne1
$ealt$ 2n&1led(eE and t& translate t$at 2n&1led(e )r&m t$e researc$ settin( int& real 1&rld a''licati&ns!
Created in 2666E t$e CIHR rin(s t&(et$er e4istin( (&vernment activities! It is a De'artmental
C&r'&rati&n listed in Sc$ed%le II &) t$e Financial Administrati&n ActE and is acc&%ntale t& Parliament
t$r&%($ t$e -inister &) Healt$! -ana(ed + t$e President and t$e G&vernin( C&%ncilE 1$& are assisted
+ vari&%s Standin( and Advis&r+ C&mmitteesE it c&nsists &) t$irteen instit%tesE eac$ $eaded + a
Scienti)ic Direct&r and assisted + an Instit%te Advis&r+ B&ard! 9&r2in( t&(et$er t& s$a'e a nati&nal
$ealt$ researc$ a(enda )&r CanadaE t$ese instit%tes rin( t&(et$er researc$ersE $ealt$ 'r&)essi&nals and
'&lic+7ma2ers )r&m v&l%ntar+ $ealt$ &r(ani<ati&nsE 'r&vincial (&vernment a(enciesE internati&nal
researc$ &r(ani<ati&ns and ind%str+ and 'atient (r&%'s )r&m acr&ss t$e c&%ntr+!
T$ese instit%tes c&m'rise )&%r $ealt$ researc$ )&ciD i&medicalR clinicalR researc$ res'ectin( $ealt$
s+stems and servicesR and t$e s&cialE c%lt%ral and envir&nmental )act&rs t$at a))ect t$e $ealt$ &)
'&'%lati&ns! A ma;&r c$allen(e )&r t$e instit%tes is t& )&r(e relati&ns$i's acr&ss disci'lines t& stim%late
inte(rativeE m%lti)aceted researc$ a(endas t$at res'&nd t& s&ciet+:s $ealt$ 'ri&rities 1$ile ad$erin( t& t$e
$i($est et$ical standards! T$e CIHR s%''&rts m&re t$an 5E666 researc$ers and researc$ers in trainin( as
'art &) t$e )ederal (&vernment:s investment in $ealt$ researc$! T$e 'eer revie1 'r&cess is a vital as'ect
&) CIHR! Revie1 + 'anels &) 'eers )r&m t$e researc$ c&mm%nit+ ens%res 'r&'&sals a''r&ved )&r
)%ndin( + CIHR meet internati&nal acce'ted standards &) scienti)ic e4cellence!
-emer instit%tes incl%deD
#nstitute of ,boriginal %eoples5 0ealth
#nstitute of ,ging
#nstitute of "ancer +esearch
#nstitute of "irculatory and +espiratory 0ealth
#nstitute of Gender and 0ealth
#nstitute of Genetics
#*"
#nstitute of 0ealth Services and %olicy +esearch
#nstitute of 0uman -evelopment, "hild and <outh 0ealth
#nstitute of #nfection and #mmunity
#nstitute of )usculos.eletal 0ealth and ,rthritis
#nstitute of 'eurosciences, )ental 0ealth and ,ddiction
#nstitute of 'utrition, )etabolism and -iabetes
#nstitute of %opulation and %ublic 0ealth
#*/
B9BL90+-AP7@
#*0
#
Centre )&r C$r&nic Disease Preventi&n and C&ntr&l 266" ,hronic -espiratory %iseases! ]$tt'DHH111!'$ac7
as'c!(c!caHccd'c7c'cmcHcrd7mrcHast$maYe!$tml^!
2
Kamel B&%l&sE -a(ed Nai$ 266, Descri'tive revie1 &) (e&(ra'$ic ma''in( &) severe ac%te res'irat&r+
s+ndr&me >SARS? &n t$e Internet! International @ournal o& 5ealth Geo(raphics *D2!
*
Statistics Canada 266" A(e7standardi<ed m&rtalit+ rates + selected ca%ses! ]$tt'DHH111,6!statcan!caHO1
,
Cam'ellE C&mmissi&ner >H&n&%rale -r! @%stice Arc$ie? 266, The ars .ommission* Interim Report* !R
and Public 5ealth in 9ntario! T&r&nt&D Inde'endent SARS C&mmissi&n!
"
Nati&nal Advis&r+ C&mmittee &n SARS and P%lic Healt$ 266/ ]$tt'DHH111!sarsc&mmissi&n!caH^
/
Bra<ilE K!R and -! Anders&n #55/ Assessin( $ealt$ service needsD t&&ls )&r $ealt$ 'lannin(! 5ealthcare
0ana(ement Forum* .anadian .olle(e o& 5ealth er8ice )=ecuti8es 5>#?D22720!
0
BedardE C!R P! G&sselinE S! RivestE -!@! Pr&%l4E -! Nadea%E G! Leel and -!F! Ga(n&n 266* Inte(ratin( GIS
c&m'&nents 1it$ 2n&1led(e disc&ver+ tec$n&l&(+ )&r envir&nmental $ealt$ decisi&n s%''&rt! International
@ournal o& 0edical In&ormatics 06>#?D0575,!
3
B%c2erid(eE David L!R R! -as&nE A! R&erts&nE @! Fran2E R! Gla<ierE L! P%rd&nE C!G! Amr$einE N! C$a%d$%riE E!
F%ller7T$&ms&nE P! G&<d+raE D! H%lc$ans2iE B! -&ld&)s2+E -! T$&m's&n and R! 9ri($t 2662 -a2in( $ealt$
data ma'sD a case st%d+ &) a c&mm%nit+H%niversit+ researc$ c&lla&rati&n! ocial cience B 0edicine "">0?D##357
#26/!
5
Elli&ttE S!@!R @! E+les and P! DeL%ca 266# -a''in( $ealt$ in t$e Great La2es areas &) c&ncernD a %ser7)riendl+ t&&l
)&r '&lic+ and decisi&n ma2ers! )n8ironmental 5ealth Perspecti8es #65>DecR S%''l /?D3#0732/!
#6
Pa&lin&E L!R -! Seill& and G! Crin(&li 266" Ge&(ra'$ical in)&rmati&n s+stems and &n7line GIS services )&r
$ealt$ data s$arin( and mana(ement! Parassitolo(ia ,0>#?D#0#7#0"!
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V1a2$alsE S!L!R H! GiesersE E! -acGillavr+E P!F! van B&ven and A!A! van der .een 266, T$e D%tc$ Nati&nal
Atlas &) P%lic Healt$! 7undes(esundheitsblatt Gesundheits&orschun( GesundheitsschutJ ,0>5?D3327335!
#2
Kla%ssE G%nnarR L%2a Sta%E -arcel 9idmer and Andrb B%sat& 266" H&s'ital service areasD a ne1 t&&l )&r $ealt$
care 'lannin( in S1it<erland! 70. 5ealth er8ices Research ">#?D**!
#*
Kamel B&%l&sE -a(ed Nai$ 266" Researc$ 'r&t&c&lD EB7GIS,HEALTH UK 7 )&%ndati&n evidence ase and
&nt&l&(+7ased )rame1&r2 &) m&d%larE re%sale m&dels )&r UKHNHS $ealt$ and $ealt$care GIS a''licati&ns!
International @ournal o& 5ealth Geo(raphics ,>#?D2!
#,
-ill1ardE A!A!R and @!E! -erse+ 266# C&nservati&n strate(ies )&r e))ective land mana(ement &) 'r&tected areas
%sin( an er&si&n 'redicti&n in)&rmati&n s+stem >EPIS?! @ournal o& )n8ironmental 0ana(ement /#>,?D*257*,*!
#"
Sa%c$+nE D!@! 266# -&delin( t$e $+dr&climatic dist%rance &) s&il landsca'es in t$e s&%t$ern Canadian PlainsD
t$e 'r&lems &) scale and 'lace! )n8ironmental 0onitorin( and !ssessment /0>#72?D200725#!
#/
Sa%c$+nE D!@!R B!N! @&ss and 9!N! N+ir)a 266* S$arin( t$e (e&7re)erenced res%lts &) climate c$an(e im'act
researc$! )n8ironmental 0onitorin( and !ssessment 33>#7*?D*357*50!
#0
Od&iE A!R S!9! -artinE P! -ic$elE D! -iddlet&nE @! H&lt and @! 9ils&n 266, Investi(ati&n &) cl%sters &) (iardiasis
%sin( GIS and a s'atial scan statistic! International @ournal o& 5ealth Geo(raphics *>#?D##!
#3
TinlineE R!R R! R&satte and C!D! -acInnes 2662 Estimatin( t$e inc%ati&n 'eri&d &) racc&&n raiesD a time7s'ace
cl%sterin( a''r&ac$! Pre8enti8e ;eterinary 0edicine "/>#?D357#6*!
#5
TinlineE R!R!R and C!D! -acInnes 266, Ec&(e&(ra'$ic 'atterns &) raies in s&%t$ern Ontari& ased &n time series
anal+sis! @ournal o& Wildli&e #iseases ,6>2?D2#2722#!
26
Levall&isE Patric2R -! T$eria%ltE @! R&%))i(natE S! TessierE R! Landr+E P! A+&tteE -! GirardE S! Gin(rasE D! Ga%vin
and C! C$iass&n #553 Gr&%nd1ater c&ntaminati&n + nitrates ass&ciated 1it$ intensive '&tat& c%lt%re in =%eec!
cience o& the Total )n8ironment 2#0>#72?D5#7#6#!
2#
LiE C!R!R G!H! H%an(E C!F! LiE @! Str%(er and @!D! Fisc$er 266* A 'esticide r%n&)) m&del )&r sim%latin( r%n&))
l&sses &) 'esticides )r&m a(ric%lt%ral lands! Water cience and Technolo(y * @ournal o& the International
!ssociation on Water Pollution Research ,0>#?D**7,6!
22
DennisE I!F!R T!A! ClairE C!T! Drisc&llE N! KammanE A! C$almersE @! S$anle+E S!A! N&rt&n and S! Ka$l 266"
Distri%ti&n 'atterns &) merc%r+ in la2es and rivers &) n&rt$eastern N&rt$ America! )coto=icolo(y #,>#72?D##*7
#2*!
2*
Le&nE L!F!R E!D! S&%lisE N! K&%1en and G!@! FarF%$ar 266# N&n'&int s&%rce '&ll%ti&nD a distri%ted 1ater F%alit+
m&delin( a''r&ac$! Water Research *">,?D5507#660!
2,
Le&nE L!F!R E!D! S&%lisE N! K&%1en and G!@! FarF%$ar 2662 -&delin( di))%se '&ll%ti&n 1it$ a distri%ted
a''r&ac$! Water cience and Technolo(y * @ournal o& the International !ssociation on Water Pollution
Research ,">5?D#,57#"/!
2"
LiE @! 266# A GIS 'lannin( m&del )&r %ran &il s'ill mana(ement! Water cience and Technolo(y * @ournal o&
the International !ssociation on Water Pollution Research ,*>"?D2*572,,!
2/
-acLe&dE -!R D!G! 9&&d)ineE D! -ac2a+E T! -cK&neE D! Bennett and R! -addalena 266# BETR N&rt$
AmericaD a re(i&nall+ se(mented m%ltimedia c&ntaminant )ate m&del )&r N&rt$ America! )n8ironmental cience
and Pollution Research International 3>*?D#"/7#/*!
20
T&&seE L!R D!G! 9&&d)ineE -! -acLe&dE D! -ac2a+ and @! G&%in 266, BETR79&rldD a (e&(ra'$icall+ e4'licit
m&del &) c$emical )ateD a''licati&n t& trans'&rt &) al'$a7HCH t& t$e Arctic! )n8ironmental PollutionE >Bar2in(E
Esse4?! #23>#72?D22*72,6!
23
9arrenE C!R D! -ac2a+E -! 9$elan and K! F&4 266" -ass alance m&dellin( &) c&ntaminants in river asinsD a
)le4ile matri4 a''r&ac$! .hemosphere >@%l #5R E'% a$ead &) 'rint?!
25
9&&d)ineE D!G!R -! -acLe&d and D! -ac2a+ 2662 A re(i&nall+ se(mented nati&nal scale m%ltimedia
c&ntaminant )ate m&del )&r Canada 1it$ GIS data in'%t and dis'la+! )n8ironmental PollutionE >Bar2in(E Esse4?!
##5>*?D*,#7*""!
*6
9&&d)ineE D!G!R -! -acLe&dE D! -ac2a+ and @!R! Brimac&me 266# Devel&'ment &) c&ntinental scale
m%ltimedia c&ntaminant )ate m&delsD inte(ratin( GIS! )n8ironmental cience and Pollution Research
International 3>*?D#/,7#02!
*#
C$enE V!R G!H! H%an( and @!B! Li 266* A GIS7ased m&delin( s+stem )&r 'etr&le%m 1aste mana(ement! Water
cience and Technolo(y * @ournal o& the International !ssociation on Water Pollution Research ,0>#?D*657*#0!
*2
L%2as$e$E A!F!R R!L! Dr&ste and -!A! 9arit$ 266# Revie1 &) e4'ert s+stem >ES?E (e&(ra'$ic in)&rmati&n s+stem
>GIS?E decisi&n s%''&rt s+stem >DSS?E and t$eir a''licati&ns in land)ill desi(n and mana(ement! Waste
0ana(ement B Research * @ournal o& the International olid Wastes and Public .leansin( !ssociationH IW!!
#5>2?D#007#3"!
**
.erterE .!R and B!C! Kara 266# A GIS7ased )rame1&r2 )&r $a<ard&%s materials trans'&rt ris2 assessment! Ris2
!nalysis * !n 9&&icial Publication o& the ociety &or Ris2 !nalysis 2#>/?D##657##26!
*,
-ee$anE T!R @!T! Gierma2&1s2i and P! Cr+an 266, GIS7ased m&del &) stale $+dr&(en is&t&'e rati&s in N&rt$
American (r&1in(7seas&n 'reci'itati&n )&r %se in animal m&vement st%dies! Isotopes in )n8ironmental and
5ealth tudies ,6>,?D25#7*66!
*"
A%ltman7HallE L!R and -!G! Kaltenec2er #555 T&r&nt& ic+cle c&mm%ter sa)et+ rates! !ccident* !nalysis and
Pre8ention *#>/?D/0"7/3/!
*/
BedardE C!R P! G&sselinE S! RivestE -!@! Pr&%l4E -! Nadea%E G! Leel and -!F! Ga(n&n 266* Inte(ratin( GIS
c&m'&nents 1it$ 2n&1led(e disc&ver+ tec$n&l&(+ )&r envir&nmental $ealt$ decisi&n s%''&rt! International
@ournal o& 0edical In&ormatics 06>#?D0575,!
*0
B%c2erid(eE David L!R R! -as&nE A! R&erts&nE @! Fran2E R! Gla<ierE L! P%rd&nE C!G! Amr$einE N! C$a%d$%riE E!
F%ller7T$&ms&nE P! G&<d+raE D! H%lc$ans2iE B! -&ld&)s2+E -! T$&m's&n and R! 9ri($t 2662 -a2in( $ealt$
data ma'sD a case st%d+ &) a c&mm%nit+H%niversit+ researc$ c&lla&rati&n! ocial cience B 0edicine "">0?D##357
#26/!
*3
F%lc$erE C!R and C! Ka%2inen 266" -a''in( and vis%ali<in( t$e l&cati&n HI. service 'r&vidersD an e4'l&rat&r+
s'atial anal+sis &) T&r&nt& nei($&r$&&ds! !I# .are #0>*?D*3/7*5/!
*5
Hat$&%tE S! 2662 T$e %se &) GIS )&r m&nit&rin( and 'redictin( %ran (r&1t$ in east and 1est St Pa%lE 9inni'e(E
-anit&aE Canada! @ournal o& )n8ironmental 0ana(ement //>*?D22572*3!
,6
K&c$E T!R and K! Deni2e 266# GIS a''r&ac$es t& t$e 'r&lem &) disease cl%stersD a rie) c&mmentar+! ocial
cience B 0edicine "2>##?D#0"#7#0",!
,#
Sc&ttE P$illi' A!R C!@! Tem&vs2+E K! La1renceE E! G%daitis and -!@! L&1ell #553 Anal+sis &) Canadian
'&'%lati&n 1it$ '&tential (e&(ra'$ic access t& intraven&%s t$r&m&l+sis )&r ac%te isc$emic str&2e! tro2e
25>##?D2*6,72*#6!
,2
Cianna2&%liasE N!R B!H! R&1eE L!9! Svens&nE D!P! Sc$&')l&c$erE K! Kell+ and D!C! .&a2lander 266* V&nes &)
'reventi&nD t$e (e&(ra'$+ &) )all in;%ries in t$e elderl+! ocial cience B 0edicine "0>##?D26/"7260*!
,*
Heinric$E @&ac$imR U!Ge$rin(E @! C+r+sE -! Bra%erE G! H&e2E P! Fisc$erE T! Bellander and B! Br%ne2ree) 266"
E4'&s%re t& tra))ic related air '&ll%tantsD sel) re'&rted tra))ic intensit+ vers%s GIS m&delled e4'&s%re!
9ccupational and )n8ironmental 0edicine /2>3?D"#07"2*!
,,
En(lis$E P!R R! Ne%traE R! Scal)E -! S%llivanE L! 9aller and L! V$% #555 E4aminin( ass&ciati&ns et1een
c$ild$&&d ast$ma and tra))ic )l&1 %sin( a (e&(ra'$ic in)&rmati&n s+stem! )n8ironmental 5ealth Perspecti8es
#60>5?D0/#70/0!
,"
Ge$rin(E U!R @! C+r+sE G! SedlmeirE B! Br%ne2ree)E T! BellanderE P! Fisc$erE C!P! Ba%erE D! Rein$ardtE H!E!
9ic$mann and @! Heinric$ 2662 Tra))ic7related air '&ll%ti&n and res'irat&r+ $ealt$ d%rin( t$e )irst 2 +rs &) li)e!
The )uropean Respiratory @ournal* 9&&icial @ournal o& the )uropean ociety &or .linical Respiratory
Physiolo(y #5>,?D/567/53!
,/
G&rdianE -!E!R S! Hane%se and @! 9a2e)ield 266" An investi(ati&n &) t$e ass&ciati&n et1een tra))ic e4'&s%re
and t$e dia(n&sis &) ast$ma in c$ildren! @ournal o& )=posure !nalysis and )n8ironmental )pidemiolo(y >@%n 25R
E'% a$ead &) 'rint?
,0
AllacciE -!S! 266" Identi)+in( envir&nmental ris2 )act&rs )&r ast$ma emer(enc+ careD a m%ltilevel a''r&ac$ )&r
ec&l&(ical st%d+! @ournal o& !mbulatory .are 0ana(ement 23>#?D27#"!
,3
CraeE HelenR A! BarerE R! Ba+)&rdE R! Hamilt&nE D! @arrett and N! -ac$in 266, T$e %se &) a E%r&'ean
telemedicine s+stem t& e4amine t$e e))ects &) '&ll%tants and aller(ens &n ast$matic res'irat&r+ $ealt$! The cience
o& the Total )n8ironment **,H**">Dec #?D,#07,2/!
,5
Hr%aE F!R E! Faian&vaE K! K&''&va and @!@! .andener( 266# C$ild$&&d res'irat&r+ s+m't&msE $&s'ital
admissi&nsE and l&n(7term e4'&s%re t& air&rne 'artic%late matter! @ournal o& )=posure !nalysis and
)n8ironmental )pidemiolo(y ##>#?D**7,6!
"6
9ellieE O!R H! D%$meE U! StreitE E! v&n -%ti%sE U! Keil and S!K! 9eiland 2666 A''licati&n &) (e&(ra'$ical
in)&rmati&n s+stems in e'idemi&l&(ical st%dies e4em'li)ied + t$e ISAAC st%d+ in -%nic$ Ain GermanB!
Gesundheits:esen /2>375?D,2*7,*6!
"#
BernsteinE C!N!R A! 9a;da and @!F! Blanc$ard 266" T$e cl%sterin( &) &t$er c$r&nic in)lammat&r+ diseases in
in)lammat&r+ &1el diseaseD a '&'%lati&n7ased st%d+! Gastroenterolo(y #25>*?D32073*/!
"2
O+anaE T!@!R P! R&(ers&n and @!S! L1e%(a7-%2asa 266, Ge&(ra'$ic cl%sterin( &) ad%lt ast$ma $&s'itali<ati&n
and residential e4'&s%re t& '&ll%ti&n at a United States7Canada &rder cr&ssin(! !merican @ournal o& Public
5ealth 5,>0?D#2"67#2"0!
"*
O+anaE T!@!R and P!A! Rivers 266" Ge&(ra'$ic variati&ns &) c$ild$&&d ast$ma $&s'itali<ati&n and &%t'atient visits
and 'r&4imit+ t& amient '&ll%ti&n s&%rces at a U!S!7Canada &rder cr&ssin(! International @ournal o& 5ealth
Geo(raphics ,>@%n 3?D#,!
",
-&E Fran2R C! R&ins&nE B!C! C$&i and F!C! Li 266* Anal+sis &) 'revalenceE tri((ersE ris2 )act&rs and t$e related
s&ci&7ec&n&mic e))ects &) c$ild$&&d ast$ma in t$e St%dent L%n( Healt$ S%rve+ >SLHS? dataaseE Canada #55/!
International @ournal o& !dolescent 0edicine and 5ealth #">,?D*,57*"3!
""
-&E Fran2R C! R&ins&nE B!C! C$&i and F!C! Li 266, C$ild$&&d ast$ma mana(ement and c&ntr&l! International
@ournal o& !dolescent 0edicine and 5ealth #/>#?D257,6!
"/
-an)redaE @!R -!R! SearsE -!R! Bec2la2eE -! C$an7Ce%n(E H! Dimic$79ardE H!C! SierstedE P! ErnstE L! S1eetE L!
van TilE D!-! B&1ie and N!R! Ant$&nisen 266, Ge&(ra'$ic and (ender variailit+ in t$e 'revalence &) r&nc$ial
res'&nsiveness in Canada! .hest #2">"?D#/"07#//,!
"0
-cLeanE 9!R @! Gillis and R! 9aller 266* T$e BC C&mm%nit+ P$armac+ Ast$ma St%d+D a st%d+ &) clinicalE
ec&n&mic and $&listic &%tc&mes in)l%enced + an ast$ma care 'r&t&c&l 'r&vided + s'eciall+ trained c&mm%nit+
'$armacists in Britis$ C&l%mia! .anadian Respiratory @ournal* @ournal o& the .anadian Thoracic ociety
#6>,?D#5"7262!
"3
B%c2erid(eE David L!R R! Gla<ierE B!@! Harve+E -! Esc&arE C! Amr$ein and @! Fran2 2662 E))ect &) m&t&r ve$icle
emissi&ns &n res'irat&r+ $ealt$ in an %ran area! )n8ironmental 5ealth Perspecti8es ##6>*?D25*7*66!
"5
Haic2E B!F!R -!-! Pi<<ic$iniE B! Ta+l&rE D! RennieE A! Sent$ilselvan and -!R! Sears #555 Prevalence &)
ast$maE r$initis and ec<ema am&n( c$ildren in 2 Canadian citiesD t$e Internati&nal St%d+ &) Ast$ma and Aller(ies
in C$ild$&&d! .0!@* .anadian 0edical !ssociation @ournal #/6>#*?D#32,7#323!
/6
B%c2erid(eE David L!R R! Gla<ierE B!@! Harve+E -! Esc&arE C! Amr$ein and @! Fran2 2662 E))ect &) m&t&r ve$icle
emissi&ns &n res'irat&r+ $ealt$ in an %ran area! )n8ironmental 5ealth Perspecti8es ##6>*?D25*7*66!
/#
Can(E =!R C! C$enE D! Kre1s2iE R!T! B%rnettE C! S$i and K!-! -cGrail 266" E))ect &) s$&rt7term e4'&s%re t& l&1
levels &) (ase&%s '&ll%tants &n c$r&nic &str%ctive '%lm&nar+ disease $&s'itali<ati&ns! )n8ironmental Research
55>#?D557#6"!
/2
Estar&&2sE C!A!R 9!K! -id&d<iE G!G! C%mmin(sE K!L! Ric2er and P! Gi&vannetti 266" T$e im'act &) $&s'ital
n%rsin( c$aracteristics &n *67da+ m&rtalit+! -ursin( Research ",>2?D0,73,!
/*
SinE D!D!R H!-! S$ar'eE R!L! C&1ie and S!F! -an 266, S'ir&metric )indin(s am&n( sc$&&l7a(ed First Nati&ns
c$ildren &n a reserveD a 'il&t st%d+! .anadian Respiratory @ournal* @ournal o& the .anadian Thoracic ociety
##>#?D,"7,3!
/,
C$enE C!R =! Can(E D! Kre1s2iE C! S$iE R!T! B%rnett and K! -cGrail 266, In)l%ence &) relativel+ l&1 level &)
'artic%late ar '&ll%ti&n &n $&s'itali<ati&n )&r COPD in elderl+ 'e&'le! Inhalation To=icolo(y #/>#?D2#72"!
/"
C$%r(E A!R -! Bra%erE -! del Carmen Avila7Casad&E T!I! F&rt&%l and @!L! 9ri($t 266* C$r&nic e4'&s%re t& $i($
levels &) 'artic%late air '&ll%ti&n and small air1a+ rem&delin(! )n8ironmental 5ealth Perspecti8es ###>"?D0#,7
0#3!
//
Li''mannE -!R K! It&E A! Nadas and R!T! B%rnett 2666 Ass&ciati&n &) 'artic%late matter c&m'&nents 1it$ dail+
m&rtalit+ and m&ridit+ in %ran '&'%lati&ns! Research ReportE Healt$ E))ects Instit%te! 5">A%(?D"732!
/0
StieE Dave -!R R!C! Beverid(eE B!H! R&1eE S!D! 9alter and S! @%de2 #553 Assessin( dia(n&stic classi)icati&n in
an emer(enc+ de'artmentD im'licati&ns )&r dail+ time series st%dies &) air '&ll%ti&n! !merican @ournal o&
)pidemiolo(y #,3>0?D///7/06!
/3
StieE Dave -!R R!C! Beverid(eE @!R! Br&&2E -! Smit$7D&ir&nE R!T! B%rnettE R!E! DalesE S! Bea%lie%E S! @%de2
and A! -amed&v 2666 Air '&ll%ti&nE aer&aller(ens and cardi&res'irat&r+ emer(enc+ de'artment visits in Saint
@&$nE Canada! @ournal o& )=posure !nalysis and )n8ironmental )pidemiolo(y #6>"?D,/#7,00!
/5
O:NeillE L! 266* Estimatin( &%t7&)7$&s'ital m&rtalit+ d%e t& m+&cardial in)arcti&n! 5ealth .are 0ana(ement
cience />*?D#,07#",!
06
.ii27Ka;anderE -!R E! -&ltc$an&vaE .! Sal&maaE @! T%&mile$t&E -! Ket&nenE P! Pal&ma2iE H! -iettinenE K!
P+&rala and -! Karv&nen 266* Ge&(ra'$ical variati&n in t$e incidence &) ac%te m+&cardial in)arcti&n in eastern
Finland 7 a Ba+esian 'ers'ective! !nnals o& 0edicine *">#?D,*7"6!
0#
A%liciemsE A!R and D! Fr&st #535 Tem'erat%re and cardi&vasc%lar deat$s in -&ntreal! International @ournal o&
7iometeorolo(y **>*?D#"#7#"/!
02
Fr&stE D!B!R and A! A%liciems #55* -+&cardial in)arct deat$E t$e '&'%lati&n at ris2E and tem'erat%re $ait%ati&n!
International @ournal o& 7iometeorolo(y *0>#?D,/7"#!
0*
Persin(erE -!A!R S!E! Ballance and -! -&land #55* Sn&1 )all and $eart attac2s! @ournal o& Psycholo(y
#20>2?D2,*72"2!
0,
S$et$E T!R C! NairE @! -%ller and S! C%s%) #555 Increased 1inter m&rtalit+ )r&m ac%te m+&cardial in)arcti&n and
str&2eD t$e e))ect &) a(e! @ournal o& the !merican .olle(e o& .ardiolo(y **>0?D#5#/7#5#5!
0"
.r&vaE L!R E!@! Cri($t&nE -! -amdaniE R! -&ineddin and R!E! U's$%r 266" Tem'&ral anal+sis &) ac%te
m+&cardial in)arcti&n in Ontari&E Canada! .anadian @ournal o& .ardiolo(y 2#>#6?D3,#73,"!
0/
Estar&&2sE C!A!R 9!K! -id&d<iE G!G! C%mmin(sE K!L! Ric2er and P! Gi&vannetti 266" T$e im'act &) $&s'ital
n%rsin( c$aracteristics &n *67da+ m&rtalit+! -ursin( Research ",>2?D0,73,!
00
DaviesE H!9!R K! Tesc$2eE S!-! Kenned+E -!R! H&d(s&nE C! Hert<man and P!A! Demers 266" Occ%'ati&nal
e4'&s%re t& n&ise and m&rtalit+ )r&m ac%te m+&cardial in)arcti&n! )pidemiolo(y #/>#?D2"7*2!
03
BernsteinE C!N!R A! 9a;da and @!F! Blanc$ard 266" T$e cl%sterin( &) &t$er c$r&nic in)lammat&r+ diseases in
in)lammat&r+ &1el diseaseD a '&'%lati&n7ased st%d+! Gastroenterolo(y #25>*?D32073*/!
05
H%tc$is&nE B!R T! Ost+eE @! Barnsle+E -! Ste1artE -! -at$e1sE -!K! Cam'ellE E! .a+daE S!B! HarrisE .!
T&rrance7R+nard and C! T+rrell 266* Patient satis)acti&n and F%alit+ &) care in 1al27in clinicsE )amil+ 'ractices
and emer(enc+ de'artmentsD t$e Ontari& 9al27In Clinic St%d+! .0!@* .anadian 0edical !ssociation @ournal
#/3>3?D500753*!
36
B%c2erid(eE David L!R R! Gla<ierE B!@! Harve+E -! Esc&arE C! Amr$ein and @! Fran2 2662 E))ect &) m&t&r ve$icle
emissi&ns &n res'irat&r+ $ealt$ in an %ran area! )n8ironmental 5ealth Perspecti8es ##6>*?D25*7*66!
3#
F&((inE P!-!R and N! A%rill&n #535 Res'irat&r+ $ealt$ indicat&rs and acc%lt%rati&n am&n( t$e In%it and Cree &)
n&rt$ern =%eecD a re(i&nal a''r&ac$ %sin( (e&(ra'$ic seriati&n anal+sis! ocial cience B 0edicine 25>"?D/#07
/2/!
32
K&<+rs2+;E A!L!R C!A! -%stard and A!B! Bec2er 266* C$ild$&&d 1$ee<in( s+ndr&mes and $ealt$care data!
Pediatric Pulmonolo(y upplement */>2?D#*#7#*/!
3*
LevesF%eE Ben&itR P! La;&ieE -! R$aindsE T! K&sats2+E A!-! GrenierE P! Ernst and N! A%det #553 =%eec S&cial
and Healt$ S%rve+D determinants &) c$r&nic res'irat&r+ diseases Ain Frenc$B! .anadian @ournal o& Public 5ealth
52>*?D22372*2!
3,
-asle+E -!L!R K!-! Semc$%2E A! Sent$ilselvanE H!H! -cD%))ieE P! Han2eE @!A! D&smanE A!@! CessnaE -!F!
Cr&ssle+E D!G! IrvineE A!-! R&sener( and L!-! Ha(el 2666 Healt$ and envir&nment &) r%ral )amiliesD res%lts &) a
C&mm%nit+ Canvass s%rve+ in t$e Prairie Ec&s+stem St%d+ >PECOS?! @ournal o& !(ricultural a&ety and 5ealth
/>2?D#6*7##"!
3"
B&ad1a+E B!T!R @! -acP$ail and C! @ac&s&n #553 Ontari& -edical Ass&ciati&n '&siti&n 'a'er &n $ealt$ e))ects
&) (r&%nd7level &<&neE acid aer&s&ls and 'artic%late matter! .anadian Respiratory @ournal* @ournal o& the
.anadian Thoracic ociety ">"?D*/07*3,!
3/
L&n(E 9!R R!B! TateE -! Ne%manE @! -an)redaE A!B! Bec2er and N!R! Ant$&nisen #553 Res'irat&r+ s+m't&ms in
a s%sce'tile '&'%lati&n d%e t& %rnin( &) a(ric%lt%ral resid%e! .hest ##*>2?D*"#7*"0!
30
D&c2er+E D!9!R @! C%nnin($amE A!I! Dam&2&s$E L!-! NeasE @!D! S'en(lerE P! K&%tra2isE @!H! 9areE -! Rai<enne
and F!E! S'ei<er #55/ Healt$ e))ects &) acid aer&s&ls &n N&rt$ American c$ildrenD res'irat&r+ s+m't&ms!
)n8ironmental 5ealth Perspecti8es #6,>"?D"667"6"!
33
SternE B!R!R -!E! Rai<enneE R!T! B%rnettE L! @&nesE @! Kearne+ and C!A! Fran2lin #55, Air '&ll%ti&n and
c$ild$&&d res'irat&r+ $ealt$D e4'&s%re t& s%l)ate and &<&ne in #6 Canadian r%ral c&mm%nities! )n8ironmental
Research //>2?D#2"7#,2!
35
AndradeE A!L!R S!A! SilvaE C!-! -artelliE R!-! OliveiraE O!L! -&rais Net&E @!B! SiF%eira @%ni&rE L!K! -el& and
@!L! Di Fai& 266, P&'%lati&n7ased s%rveillance &) 'ediatric 'ne%m&niaD %se &) s'atial anal+sis in an %ran area
&) central Bra<il! .adernos de aude Publica 26>2?D,##7,2#!
56
Hr%aE F!R E! Faian&vaE K! K&''&va and @!@! .andener( 266# C$ild$&&d res'irat&r+ s+m't&msE $&s'ital
admissi&nsE and l&n(7term e4'&s%re t& air&rne 'artic%late matter! @ournal o& )=posure !nalysis and
)n8ironmental )pidemiolo(y ##>#?D**7,6!
5#
-i2el&vaE L!K!R S!A! Hal'erinE D! Sc$ei)eleE B! Smit$E E! F&rd7@&nesE 9! .a%dr+E T! @adav;iE B! La1 and D!
-&&re 266* Predict&rs &) deat$ in in)ants $&s'itali<ed 1it$ 'ert%ssisD a case7c&ntr&l st%d+ &) #/ 'ert%ssis deat$s in
Canada! @ournal o& Pediatrics #,*>"?D"0/7"3#!
52
B%c2erid(eE David L!R R! Gla<ierE B!@! Harve+E -! Esc&arE C! Amr$ein and @! Fran2 2662 E))ect &) m&t&r ve$icle
emissi&ns &n res'irat&r+ $ealt$ in an %ran area! )n8ironmental 5ealth Perspecti8es ##6>*?D25*7*66!
5*
Die2emaE Daniel @!R -!A! P)allerE F!@! Sc$mit<E @! Sma+evs2+E @! BellE R!N! @&nes and -! Beac$ 266# S%rve+ &)
in)ecti&ns d%e t& Sta'$+l&c&cc%s s'eciesD )reF%enc+ &) &cc%rrence and antimicr&ial s%sce'tiilit+ &) is&lates
c&llected in t$e United StatesE CanadaE Latin AmericaE E%r&'eE and t$e 9estern Paci)ic re(i&n )&r t$e SENTRC
Antimicr&ial S%rveillance Pr&(ramE #5507#555! .linical In&ectious #iseases * 9&&icial Publication o& the
In&ectious #iseases ociety o& !merica *2>S%''l 2?D##,7#*2!
5,
.e%(elersE P!@!R K!A! Pa(eE B! TindallE -!T! Sc$ec$terE A!R! -&ssE 9!9! 9in2elstein @r!E D!A! C&&'erE K!@!
CraiE E! C$arle&isE R!A! C&%tin$&E et al! #55, Determinants &) HI. disease 'r&(ressi&n am&n( $&m&se4%al men
re(istered in t$e Tric&ntinental Ser&c&nverter St%d+! !merican @ournal o& )pidemiolo(y #,6>3?D0,070"3!
5"
EversE S!E!R and C!G! Rand #532 -&ridit+ in Canadian Indian and n&n7Indian c$ildren in t$e )irst +ear &) li)e!
.anadian 0edical !ssociation @ournal #2/>*?D2,572"2!
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.i&%dE C!R R!F! GraisE B!A! La)&ntE -!A! -iller and L! Sim&nsen 266" -%ltinati&nal im'act &) t$e #5/3 H&n(
K&n( in)l%en<a 'andemicD evidence )&r a sm&lderin( 'andemic! @ournal o& In&ectious #iseases #52>2?D2**72,3!
50
U'$&))E Helm%tR I! Stalleic2enE A! BarteldsE B! P$iesel and B!T! Kistemann 266, Are in)l%en<a s%rveillance data
%se)%l )&r ma''in( 'resentati&nsG ;irus Research #6*>#72?D*"7,/!
53
Harc&%rtE Sall+ E!R D!E! Ed1ardsE D!-! Flemin(E R!L! Smit$ and G!E! Smit$ 266, H&1 re'resentative is t$e
'&'%lati&n c&vered + t$e RCGP s'&tter 'ractice sc$emeG Usin( Ge&(ra'$ical In)&rmati&n S+stems t& assess!
@ournal o& Public 5ealth >O4)&rdE En(land?! 2/>#?D3375,!
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E$lersE -!R -! -&llerE S! -aran(&n and N! Ferre 266* T$e %se &) Ge&(ra'$ic In)&rmati&n S+stem >GIS? in t$e
)rame &) t$e c&ntin(enc+ 'lan im'lemented d%rin( t$e #5557266# avian in)l%en<a >AI? e'idemic in Ital+! !8ian
#iseases ,0>* S%''l?D#6#67#6#,!
#66
.i&%dE C!R R!F! GraisE B!A! La)&ntE -!A! -iller and L! Sim&nsen 266" -%ltinati&nal im'act &) t$e #5/3 H&n(
K&n( in)l%en<a 'andemicD evidence )&r a sm&lderin( 'andemic! @ournal o& In&ectious #iseases #52>2?D2**72,3!
#6#
-&&reE K! 266, Real7time s+ndr&me s%rveillance in Ontari&E CanadaD t$e '&tential %se &) emer(enc+ de'artments
and Tele$ealt$! )uropean @ournal o& )mer(ency 0edicine* 9&&icial @ournal o& the )uropean ociety &or
)mer(ency 0edicine 266, FeR##>#?D*7##!
#62
Sattens'ielE L!R and D!A! Herrin( 266* Sim%latin( t$e e))ect &) F%arantine &n t$e s'read &) t$e #5#37#5 )l% in
central Canada! 7ulletin o& 0athematical 7iolo(y /">#?D#72/!
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Sattens'ielE L!R A! -&arr+ and D!A! Herrin( 2666 -&delin( t$e in)l%ence &) settlement str%ct%re &n t$e s'read &)
in)l%en<a am&n( c&mm%nities! !merican @ournal o& 5uman 7iolo(y* 9&&icial @ournal o& the 5uman 7iolo(y
.ouncil #2>/?D0*/70,3!
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Kamel B&%l&sE -a(ed Nai$ 266, T&1ards evidence7asedE GIS7driven nati&nal s'atial $ealt$ in)&rmati&n
in)rastr%ct%re and s%rveillance services in t$e United Kin(d&m! International @ournal o& 5ealth Geo(raphics
*>#?D#!
#6"
R&(ersE David @!R and S!E! Rand&l'$ 266* St%d+in( t$e (l&al distri%ti&n &) in)ecti&%s diseases %sin( GIS and
RS! -ature Re8ie:s* 0icrobiolo(y #>*?D2*#72*0!
#6/
A))&ns&E D!D!R G!@! Andre1s and L! @e))s 266, T$e %ran (e&(ra'$+ &) SARSD 'arad&4es and dilemmas in
T&r&nt&:s $ealt$ care! @ournal o& !d8anced -ursin( ,">/?D"/37"03!
#60
Fan(E L!=!R 9!C! Ca&E H!J! C$enE B!G! 9an(E J!-! 9%E H! Can( and J!T! V$an( 266* St%d+ &n t$e a''licati&n
&) (e&(ra'$ic in)&rmati&n s+stem in s'atial distri%ti&n &) $em&rr$a(e )ever 1it$ renal s+ndr&me in C$ina Ain
C$ineseB! Chon(hua Liu Din( 7in( Due Ca Chi 2,>,?D2/"72/3!
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Kamel B&%l&sE -a(ed Nai$ 266, T&1ards evidence7asedE GIS7driven nati&nal s'atial $ealt$ in)&rmati&n
in)rastr%ct%re and s%rveillance services in t$e United Kin(d&m! International @ournal o& 5ealth Geo(raphics
*>#?D#!
#65
-cLa))ert+E S!L! 266* GIS and $ealt$ care! !nnual Re8ie: o& Public 5ealth 2,D2"7,2!
##6
R%i<E -!O!R and D! Remmert 266, A l&cal de'artment &) '%lic $ealt$ and t$e (e&s'atial data in)rastr%ct%re!
@ournal o& 0edical ystems 23>,?D*3"7*5"!
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V%ietaE @!C!R R! S2inner and A!G! Dean 266* Initiatin( in)&rmatics and GIS s%''&rt )&r a )ield investi(ati&n &)
i&terr&rismD t$e Ne1 @erse+ ant$ra4 e4'erience! International @ournal o& 5ealth Geo(raphics 2>#?D3!
##2
GilertE Nic&las L!R -!S! G&lder(E B! Bec2ermanE @!R! Br&&2 and -! @errett 266" Assessin( s'atial variailit+ &)
amient nitr&(en di&4ide in -&ntrealE CanadaE 1it$ a land7%se re(ressi&n m&del! @ournal o& the !ir B Waste
0ana(ement !ssociation "">3?D#6"57#6/*!
##*
O+anaE T!@!R and P!A! Rivers 266" Ge&(ra'$ic variati&ns &) c$ild$&&d ast$ma $&s'itali<ati&n and &%t'atient visits
and 'r&4imit+ t& amient '&ll%ti&n s&%rces at a U!S!7Canada &rder cr&ssin(! International @ournal o& 5ealth
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Kre1s2iE D!R R! -allic2E @!-! Vielins2i and E!G! Let&%rnea% 266" -&delin( seas&nal variati&n in ind&&r rad&n
c&ncentrati&ns! @ournal o& )=posure !nalysis and )n8ironmental )pidemiolo(y #">*?D2*,72,*!
##"
BartlettE K!H!R S!-! Kenned+E -! Bra%erE C! .an Netten and B! Dill 266, Eval%ati&n and a 'redictive m&del &)
air&rne )%n(al c&ncentrati&ns in sc$&&l classr&&ms! !nnals o& 9ccupational 5y(iene ,3>/?D",07"",!
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O+anaE T!@!R P! R&(ers&n and @!S! L1e%(a7-%2asa 266, Ge&(ra'$ic cl%sterin( &) ad%lt ast$ma $&s'itali<ati&n
and residential e4'&s%re t& '&ll%ti&n at a United States7Canada &rder cr&ssin(! !merican @ournal o& Public
5ealth 5,>0?D#2"67#2"0!
##0
Br%nE G%+ L!R O!C! .aid+a and -!G! Le(er 266, Atm&s'$eric de'&siti&n &) '&l+c+clic ar&matic $+dr&car&ns t&
Atlantic CanadaD (e&(ra'$ic and tem'&ral distri%ti&ns and trends #5367266#! )n8ironmental cience B
Technolo(y *3>0?D#5,#7#5,3!
##3
HallE A!H!R K! Tesc$2eE H! DaviesE P! Demers and S! -ari&n 2662 E4'&s%re levels and determinants &) s&)t1&&d
d%st e4'&s%res in BC l%mer millsE #53#7#550! !I5! @ournal* @ournal &or the cience o& 9ccupational and
)n8ironmental 5ealth and a&ety >Fair)a4E .a?! /*>/?D06570#,!
##5
Sc&ttE H!-!R C!L! S&s2&lneE S! 9a+ne -artinE E!A! Elle$&;E R!9! C&''&c2E T!L! G%id&tti and K!D! Lissem&re
266* C&m'aris&n &) t1& atm&s'$eric7dis'ersi&n m&dels t& assess )arm7site e4'&s%re t& s&%r7(as 'r&cessin(7'lant
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#26
B%c2erid(eE David L!R R! Gla<ierE B!@! Harve+E -! Esc&arE C! Amr$ein and @! Fran2 2662 E))ect &) m&t&r ve$icle
emissi&ns &n res'irat&r+ $ealt$ in an %ran area! )n8ironmental 5ealth Perspecti8es ##6>*?D25*7*66!
#2#
D%c$aineE C!R A! -eria%4E P!S! -eria%4 and C! C&rmier 2666 Assessment &) 'artic%lates and i&aer&s&ls in
eastern Canadian sa1mills! !I5!@* @ournal &or the cience o& 9ccupational and )n8ironmental 5ealth and
a&ety /#>"?D02070*2!
#22
StieE Dave -!R @! Pa&la and K! Ne%man #55/ D& sm&( advis&ries 1&r2G Res%lts &) an eval%ati&n &) t$e Canadian
Sm&( Advis&r+ Pr&(ram! .anadian @ournal o& Public 5ealth 30>*?D#//7#/5!
#2*
-an)redaE @!R -!R! Bec2la2eE -!R! SearsE -! C$an7Ce%n(E H! Dimic$79ardE H!C! SierstedE P! ErnstE L! S1eetE L!
van TilE D!-! B&1ieE N!R! Ant$&nisen and R!B! Tate 266# Prevalence &) ast$ma s+m't&ms am&n( ad%lts a(ed 267
,, +ears in Canada! .0!@* .anadian 0edical !ssociation @ournal #/,>0?D55"7#66#!
#2,
D&l&vic$E -! #555 Ne1 deliver+ s+stems and 'r&'ellants! .anadian Respiratory @ournal* @ournal o& the
.anadian Thoracic ociety />*?D256725"!
#2"
Rain$amE Daniel G!C! 266" Ec&l&(ical c&m'le4it+ and 9est Nile vir%sD 'ers'ectives &n im'r&vin( '%lic $ealt$
res'&nse! .anadian @ournal o& Public 5ealth 5/>#?D*07,6!
#2/
Sa%c$+nE D!@! 266# -&delin( t$e $+dr&climatic dist%rance &) s&il landsca'es in t$e s&%t$ern Canadian PlainsD
t$e 'r&lems &) scale and 'lace! )n8ironmental 0onitorin( and !ssessment /0>#72?D200725#!
#20
KellerE C!F! 266* Gl&al 1armin(D t$e alance &) evidence and its '&lic+ im'licati&ns! A revie1 &) t$e c%rrent
state7&)7t$e7c&ntr&vers+! cienti&ic World @ournal *>-a+ "?D*"07,##!
#23
Rain$amE Daniel G!C!R and Karen E! Sm&+er7T&mic 2662 H%man $ealt$ im'acts )r&m %ran $eat! Pa'er 'resented
t& t$e Uran Heat Island S%mmitD -iti(ati&n &) and Ada'tati&n t& E4treme S%mmer HeatE T&r&nt&!
#25
G&lder(E -!S!R and R!T! B%rnett 266" A ne1 l&n(it%dinal desi(n )&r identi)+in( s%(r&%'s &) t$e '&'%lati&n
1$& are s%sce'tile t& t$e s$&rt7term e))ects &) amient air '&ll%ti&n! @ournal o& To=icolo(y and )n8ironmental
5ealth* Part ! /3>#*7#,?D####7##2"!
#*6
Pen(ell+E DavidR C$ad C$en( and -&nica Cam'ell CJJD In&luence o& Weather and !ir Pollution on 0ortality
in Toronto* ummary Report o& #i&&erential and .ombined Impacts o& Winter and ummer Weather and !ir
Pollution due to Global Warmin( on 5uman 0ortality in outh1.entral .anada! T&r&nt&D T&r&nt& P%lic
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Rain$amE Daniel G!C!R and Karen E! Sm&+er7T&mic 266* T$e r&le &) air '&ll%ti&n in t$e relati&ns$i' et1een a
$eat stress inde4 and $%man m&rtalit+ in T&r&nt&! Envir&nmental Researc$ 5*>#?D57#5!
#*2
Sm&+er7T&micE Karen E!R Daniel G!C! Rain$am and @!N! He12& 2666 Heat7stress7related m&rtalit+ in )ive cities
in s&%t$ern Ontari&D #5367#55/! Internati&nal @&%rnal &) Bi&mete&r&l&(+ ,,>,?D#567#50!
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StieE Dave -!R R!C! Beverid(eE @!R! Br&&2E -! Smit$7D&ir&nE R!T! B%rnettE R!E! DalesE S! Bea%lie%E S! @%de2
and A! -amed&v 2666 Air '&ll%ti&nE aer&aller(ens and cardi&res'irat&r+ emer(enc+ de'artment visits in Saint
@&$nE Canada! @ournal o& )=posure !nalysis and )n8ironmental )pidemiolo(y #6>"?D,/#7,00!
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Ne1 Br%ns1ic2 )i(%res are ased &n estimates derived )r&m Canadian data!
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Et2inE DavidR Emdad HaF%eE Lianne Bellisari& and Ian B%rt&n 266* !n !ssessment o& -atural 5aJards and
#isasters in .anada* ! Report &or #ecision10a2ers and Practitioners! Canadian Centre )&r Emer(enc+
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Sm&+er7T&micE Karen E!R and Daniel G!C! Rain$am 266# Beatin( t$e $eatD devel&'ment and eval%ati&n &) a
Canadian $&t 1eat$er $ealt$7res'&nse 'lan! )n8ironmental 5ealth Perspecti8es #65>#2?D#2,#7#2,3!
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.illene%veE P!@!R @! Leec$ and D! B&%rF%e 266" FreF%enc+ &) emer(enc+ r&&m visits )&r c$ild$&&d ast$ma in
Otta1aE CanadaD t$e r&le &) 1eat$er! International @ournal o& 7iometeorolo(y AA'r 22R E'% a$ead &) 'rintB!
#*3
9a(nerE -!-!R @! PavlinE @! BrillmanE D! Stets&nE S! -a(r%der and -! Cam'ell 266, ynthesis o& Research on
the ;alue o& ,ncon8entional #ata &or )arly #etection o& #isease 9utbrea2s! DARPA! // 'a(es 'l%s a''endi4!
#*5
9a(nerE -!-!R @!U! Es'in&E F!7C! Ts%i and R! Ar+el 266, Public 5ealth ur8eillance* The Role o& .linical
In&ormation ystemsH in 5ealthcare In&ormation 0ana(ement ystems* .asesH trate(iesH and olutions! Ne1
C&r2 Cit+ >NC?D -! BallE Edit&r! S'rin(er7.erla( Press!
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Nis2aE R!9!R and C!9! B%rt 266* Bi&terr&rism and mass cas%alt+ 're'aredness in $&s'italsD United StatesE 266*!
!d8ance #ata */,>Se' 20?D#7#,!
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B%c2erid(eE D!L!R P! S1it<erE D! O1ensE D! Sie(ristE @! Pavlin and -! -%sen 266" An eval%ati&n m&del )&r
s+ndr&mic s%rveillanceD assessin( t$e 'er)&rmance &) a tem'&ral al(&rit$m! 0orbidity and 0ortality Wee2ly
Report ",>A%( 2/D S%''l?D#657##"!
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De<ielE -!R!R H! HeineE A! L&%ieE -! Ka&E 9!R! B+rneE @! BassetE L! -illerE K! B%s$E -! Kell+ and G!L! Dr%san&
266" E))ective antimicr&ial re(imens )&r %se in $%mans )&r t$era'+ &) Bacill%s ant$racis in)ecti&ns and
'&ste4'&s%re 'r&'$+la4is! !ntimicrobial !(ents and .hemotherapy ,5>#2?D"6557"#6/!
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N&rdinE @!D! 266" Sim%lated ant$ra4 attac2s and s+ndr&mic s%rveillance! )mer(in( In&ectious #iseases
##>5?D#*5/7#,66!
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Ca(%'s2+E P!R and E!@! Bar&n 266" La&rat&r+ e4'&s%res t& r%cellae and im'licati&ns )&r i&terr&rism!
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Ant&n&vE .!A!R and .!I! Ili%2$in 266" -&lec%lar7(enetic a''r&ac$es t& dia(n&sis and intras'eci)ic t+'in( &)
ca%sative a(ents &) (landers and meli&id&sis Ain R%ssianB! 0ole2uliarnaia Geneti2aH 0i2robiolo(iia i
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G%il$&tE A!R F! Bricaire and P! B&ssi 266" GlandersE meli&id&sis and i&1ar)are Ain Frenc$B! Presse 0edicale
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Clar2eE S!C! 266" Bacteria as '&tential t&&ls in i&terr&rismE 1it$ an em'$asis &n acterial t&4ins! 7ritish @ournal
o& 7iomedical cience /2>#?D,67,/!
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Smedle+E @!G!E IIIR D!@! Fis$erE S! Sa+eedE G! C$a2raarti and B!A! -cClane 266, T$e enteric t&4ins &)
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H&r&1it<E B!V! 266" B&t%lin%m t&4in! .ritical .are .linics 2#>,?D32"73*5!
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Fa%ciE A!S!R N!A! T&%c$ette and G!K! F&l2ers 266" Emer(in( in)ecti&%s diseasesD a #67+ear 'ers'ective )r&m t$e
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Gla<%n&vaE O!R .! R&%4E O! Fre+li2manE V! Se2e+&vaE G! F&%rn&%sE @! T+c<2aE N! T&2arevic$E E! K&vacavaE T!@!
-arrie and D! Ra&%lt 266" C&4iella %rnetii (en&t+'in(! )mer(in( In&ectious #iseases ##>3?D#2##7#2#0!
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K! Na2ada 266, Clinical )eat%res &) = )ever 'ne%m&nia! Respirolo(y 5>2?D2037232!
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Da+aE -!R and C! Na2am%ra 266" P%lm&nar+ disease )r&m i&l&(ical a(entsD ant$ra4E 'la(%eE = )everE and
t%laremia! .ritical .are .linics 2#>,?D0,070/*!
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B&l2enE T!C!R S! LaF%erreE C! V$an(E T!R! Baile+E D!C! PevearE S!S! Kic2nerE L!E! S'er<elE K!F! @&nesE T!K!
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and D!E! Hr%+ 266" Identi)icati&n and c$aracteri<ati&n &) '&tent small m&lec%le in$iit&r &) $em&rr$a(ic )ever
Ne1 9&rld arenavir%ses! !nti8iral Research >N&v 23R E'% a$ead &) 'rint?!
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Sc$latterE @! 266, T&4icit+ data relevant )&r $a<ard c$aracteri<ati&n! To=icolo(y Letters #"*>#?D3*735!
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Bi(al2eE H!R and A! R%mmel 266" -edical as'ects &) t&4in 1ea'&ns! To=icolo(y 2#,>*?D2#67226!
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C$ristensen 266" B&t%lin%m and ricin t&4ins Ain Danis$B! ,(es2ri&t &or Lae(er #/0>*/?D**307**35!
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Hee(aardE N!H!R N!H! Be+erE E! K&(%t&1s2aE @!T! TanassiE S!-! @ensenE K! Andresen and @!@! H&iset$E G!R and S!
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Ale)antisE T!R P! Gre1alE @! As$t&nE A!S! K$anE @!@! .aldes and .!G! del .ecc$i& 266, A ra'id and sensitive
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@a$rlin(E P!B!R E!A! Frit< and L!E! Hensle+ 266" C&%ntermeas%res t& t$e i&terr&rist t$reat &) small'&4! .urrent
0olecular 0edicine ">3?D3#0732/!
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Da+aE -!R and C! Na2am%ra 266" P%lm&nar+ disease )r&m i&l&(ical a(entsD ant$ra4E 'la(%eE = )everE and
t%laremia! .ritical .are .linics 2#>,?D0,070/*!
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N&rdinE @!D! 266" Sim%lated ant$ra4 attac2s and s+ndr&mic s%rveillance! )mer(in( In&ectious #iseases
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B%c2erid(eE D!L!R P! S1it<erE D! O1ensE D! Sie(ristE @! Pavlin and -! -%sen 266" An eval%ati&n m&del )&r
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In&ormation ystemsH in 5ealthcare In&ormation 0ana(ement ystems* .asesH trate(iesH and olutions! Ne1
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BreimanE R!F!R P!K! Streat)ieldE -! P$elanE N! S$i)aE -! Ras$id and -! C%n%s 266, E))ect &) in)ant imm%nisati&n
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CatesE S!P!R R! @&r(ensenE G!R! Andersen and A!R! -errill 266/ Stealt$ and mimicr+ + deadl+ acterial t&4ins!
Trends in 7iochemical ciences >@an /R E'% a$ead &) 'rint?!
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Centers )&r Disease C&ntr&l and Preventi&n 266" Gl&al -easles and R%ella La&rat&r+ Net1&r2E @an%ar+ 266,7
@%ne 266"! 0orbidity and 0ortality Wee2ly Report ",>,*?D##667##6,!
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Neles&neE T!R D!N! D%rr$eimE R! S'eareE T! Kiedr<+ns2i and 9!D! -elr&se 266/ Stren(t$enin( s%7nati&nal
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Tr&ttierE H!R and P! P$ili''e 266" Scalin( 'r&'erties &) c$ild$&&d in)ecti&%s diseases e'idemics e)&re and a)ter
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HannaE @!N!R and R!@! Hea<le1&&d 266" T$e e'idemi&l&(+ &) ac%te r$e%matic )ever in Indi(en&%s 'e&'le in n&rt$
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Ara$ams&nE S!D!R S! Can<ian and F! Br%net 266" Usin( sim%lati&n )&r trainin( and t& c$an(e 'r&t&c&l d%rin( t$e
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S$enE CannaR 9en(7Keen 9&n( and Gre(&r+ F! C&&'er 266" A (enerali<ati&n &) t$e standard A-OC c%rve!
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Hamilt&nE @! #55, Time eries !nalysis! Princet&n >N@?D Princet&n Universit+ Press!
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Ri))en%r($E R!H!R and K!-! C%mmins 266" A sim'le and (eneral c$an(e7'&int identi)ier! tatistics in 0edicine
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Can(E T!C!R and T!B! S1art< 266" A''licati&ns &) inar+ se(mentati&n t& t$e estimati&n &) F%antal res'&nse
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Hamilt&nE @! #55, Time eries !nalysis! Princet&n >N@?D Princet&n Universit+ Press!
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Harris&nE R!F!R and R!L! Kenned+ 266" Arti)icial ne%ral net1&r2 m&dels )&r 'redicti&n &) ac%te c&r&nar+
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Research 0ethodsH InstrumentsH B .omputers *0>*?D,2/7,*"!
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RaaE G!-!R and I! B%tc$er 266" Rand&mi<ati&n in)erence )&r alanced cl%ster7rand&mi<ed trials! .linical Trials
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N&reE F!F!R A!B! -&nteir&E P!R! Telles and G!D! 9illiams&n 266# D+namic linear m&del and SARI-AD a
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n%mer &) la&rat&r+ reF%ests )&r c&n)irmati&n &) den(%e dia(n&sis as an indicat&r &) den(%e activit+! )uropean
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Ser)lin(E R!E!R #5/* -et$&ds )&r c%rrent statistical anal+sis &) e4cess 'ne%m&nia7in)l%en<a deat$s! Public 5ealth
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C&$enE G!R -! Hilari&E H! Sa4E S! H%(&nnetE C! Pelle(rini and A! Geiss%$ler 266, An a''licati&n &) &ne7class
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7iostatistics ">2?D22*72*0!
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Disc$ar(e Astract Dataase 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSservicesYdadYe
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H&s'ital -&ridit+ Dataase 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSservicesY$mdYe
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Nati&nal Am%lat&r+ Care Re'&rtin( S+stem 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'G
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Re(istered N%rses Dataase 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eS$$rdataYrndYe
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Nati&nal Healt$ E4'endit%re Dataase 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSs'endYn$e4Ye
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OECD Healt$ Dataase 266/ $tt'sDHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSs'endY&ecdYe
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Canadian -IS Dataase 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSs'endYcanmisYe
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Nati&nal P$+sician Dataase 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eS$$rdataYn'dYe
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Nati&nal Prescri'ti&n Dr%( Utili<ati&n In)&rmati&n S+stem 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'G
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Canadian @&int Re'lacement Re(istr+ 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSservicesYc;rrYe
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Canadian -edicati&n Incident Re'&rtin( and Preventi&n S+stem 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'G
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Canadian Or(an Re'lacement Re(ister 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSservicesYc&rrYe
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C&ntin%in( Care Re'&rtin( S+stem 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSservicesYccrsYe
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H&me Care Re'&rtin( S+stem 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSservicesY$crsYe
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H&s'ital -ental Healt$ Dataase 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSservicesYm$dYe
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Nati&nal Re$ailitati&n Re'&rtin( S+stem 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'G
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Nati&nal Tra%ma Re(istr+ 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSservicesYntrYe
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T$era'e%tic A&rti&ns Dataase 266/ $tt'DHHsec%re!ci$i!caHci$i1eHdis'Pa(e!;s'Gc1Y'a(eSservicesYtadYe
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Healt$ indicat&rs 266/ $tt'DHH111!statcan!caHen(lis$H)ree'%H32722#7JIEH)ree!$tm
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Res'irat&r+ Disease in Canada 266/ $tt'DHH111!'$ac7as'c!(c!caH'%licatHrdc7mrc6#H'd)Hrdc656#e!'d)
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Canadian Cancer Re(istr+ 266/ $tt'DHH111!statcan!caHc(i7inHimdH'2S.!'lG
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Canadian Patient Data Re(istr+ 266/ $tt'DHH111!cc))!caH'a(e!as'GidS2",
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Canadian T&acc& Use -&nit&rin( S%rve+ 266/ $tt'DHH111!$c7sc!(c!caH$l7vsHt&ac7taacHresearc$7
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