[HN Gopher] Mapping hospital accessibility with OpenStreetMap
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       Mapping hospital accessibility with OpenStreetMap
        
       Author : wcedmisten
       Score  : 141 points
       Date   : 2023-04-04 03:00 UTC (1 days ago)
        
 (HTM) web link (wcedmisten.fyi)
 (TXT) w3m dump (wcedmisten.fyi)
        
       | sl-dolt wrote:
       | That's really cool. I'll probably end up trying to reproduce this
       | by following your work step-by-step. I'm not too familiar with
       | OSM, besides having used Nominatim.
       | 
       | Along the same lines we're crowdsourcing a database of hospital
       | prices, starting this week. I'm reviewing our first pull request
       | as we speak. You can follow our progress live. The data is here:
       | https://www.dolthub.com/repositories/dolthub/standard-charge...
       | 
       | We talked a little about the problems we're encountering here:
       | https://docs.google.com/document/d/1uMx1sUYwP_uE7ebd3PtGvF0t...
       | and here
       | https://docs.google.com/document/d/1NifwgKHBCeF35ZRZsfpgg4bE...
        
         | wcedmisten wrote:
         | Thanks! You're doing awesome work, I read the blog post about
         | the insurance data mess you're working through.
         | 
         | I'll see if I can incorporate that into my project!
         | 
         | I'd love to see what this map looks like filtered for specific
         | services.
        
           | sl-dolt wrote:
           | > I'd love to see what this map looks like filtered for
           | specific services.
           | 
           | Sure. I did something like that with our insurance data. Did
           | a quick folium visualization. You can start from here:
           | 
           | https://www.dolthub.com/repositories/dolthub/hospital-
           | prices...
           | 
           | A limitation of our dataset is it excludes percentage-based
           | contracts. So those won't show up.
           | 
           | Anyways, if you have the hospital NPI you want, you can look
           | up all of its dollar-amount negotiated rates in this table.
           | You can link that to the `hospital` table, geocode however
           | you want, and make a map of the different rates. Note,
           | however, that the insurance data published here is kind of a
           | mess and, I think, contains many many mistakes (originating
           | in the source data.)
           | 
           | BTW, I'm not sure if this insurance-derived hospital data
           | exists anywhere else. I believe it doesn't.
        
       | twic wrote:
       | > [The Global Human Settlement Layer (GHS) Population dataset 6.]
       | is formatted as an image of 100m x 100m squares, each containing
       | the estimated population residing in each square. [...] due to
       | the unconventional projection used (Mollweide 7), the image
       | appears slanted and skewed compared to a more traditional
       | projection.
       | 
       | How do you divide a Mollweide projection into 100m x 100m
       | squares? In fact, how do you divide any projected globe into 100m
       | x 100m squares?! Do they actually mean 10,000 m2 squares? Because
       | you could do that, they would just get narrower and longer
       | towards the poles.
        
         | wcedmisten wrote:
         | Apologies for the confusion!
         | 
         | I meant that the data is represented as an image (of square
         | pixels). But you're right, the actual land that each pixel
         | represents won't be a square.
         | 
         | The dataset just says "100m resolution", so that may have been
         | a misinterpretation on my part.
         | 
         | https://ghsl.jrc.ec.europa.eu/download.php?ds=pop
        
       | fsflyer wrote:
       | See https://github.com/emigre459/hospital-chargemaster for an
       | older study of hospitals. It gets the chargemaster prices that
       | hospitals are supposed to publish. The procedures offered could
       | be mapped to your "services".
        
         | wcedmisten wrote:
         | Awesome, thanks! I'll look into that
        
       | e4e5 wrote:
       | Awesome work, love stuff like this!
       | 
       | Also amazing to see how much open source software already exists
       | for GIS, lowering the entry requirements to almost zero.
        
         | wcedmisten wrote:
         | Thank you!
         | 
         | Being able to create interactive map visualizations without
         | needing a server or paying for an API key is a real game
         | changer!
         | 
         | Big shoutout to the Protomaps project and all the other open
         | source projects in the ecosystem.
        
       | chrisshroba wrote:
       | This is an amazing write-up and I'm super excited to play around
       | with a lot of the open source projects you referenced. Thanks so
       | much for sharing.
        
       | nerdponx wrote:
       | Great analysis, thank you for sharing.
       | 
       | A (maybe obvious) corollary is that you can use this data to
       | easily evaluate the effect of a hospital closure (or other change
       | in services/access) in terms of number of people affected.
        
       | mistrial9 wrote:
       | keyword search "medically underserved"
       | 
       | Similar to the recent news item "why does nobody live in 90% of
       | New Zealand" .. in the wealthy and wonderful US of A, there are
       | vast areas where there are no general practitioner doctors on
       | call, and some areas where there are no hospitals at all.
       | 
       | As mentioned in other comments, the road network is less than
       | half of the accessibility story, the rest is about money.
        
         | kwhitefoot wrote:
         | > in the wealthy and wonderful US of A, there are vast areas
         | where there are no general practitioner doctors on call,
         | 
         | If by that you mean doctors who make home visits then I have
         | news for you: there are entire western countries where doctors
         | do not make house calls. In Norway you are expected to to make
         | an appointment to visit your GP, or make your own way to an
         | outpatient clinic (legevakt) or the accident and emergency
         | department at a hospital. If you can't do any of that you are
         | expected to call an ambulance.
         | 
         | I haven't heard of GPs making home visits in the UK either in
         | recent and not so recent decades.
        
           | mistrial9 wrote:
           | great greetings to Norway ! .. no, I don't mean "house call"
           | .. that disappeared here more than fifty years ago. I mean
           | that in an entire area, there is not one single doctor in any
           | way.
        
       | edent wrote:
       | Fascinating - and well written.
       | 
       | Regarding the problem of roads "leaking" into neighbouring
       | states... is that an issue? If your nearest hospital was either
       | 60 minutes away in-state or 10 minutes away across state lines -
       | which would people generally choose?
        
         | wcedmisten wrote:
         | Thank you!
         | 
         | The roads leaking is only an issue for determining the
         | percentage of state residents within an area, because the
         | regions also include out of state residents.
         | 
         | But what you describe is another limitation of my approach.
         | Currently, only Virginia hospitals are considered in this, so
         | some regions will actually have better hospital accessibility
         | than presented here, particularly near state borders.
         | 
         | Now that I've polished this setup for one state, my plan is to
         | expand the project to the US (or maybe all of North America),
         | which should fix the issue you describe.
        
       | yumbrand wrote:
       | Interesting -- I have reservations on the breadth of OSM, but
       | maybe that's different for hospital locations. I've looked into
       | how representative it is for some large public companies like
       | Target and Walmart, but I've found that consistently, less than
       | half of all stores are actually represented; plus, with the
       | addition of smaller out-patient locations like urgent care
       | centers, I'm not sure how truthful this picture really is.
        
         | toomuchtodo wrote:
         | I think where OSM really shines is when you plug in other data
         | sources that have large institutional support keeping them
         | accurate and timely. You're then providing mapping data off of
         | that data, "drafting" off of it if you will.
         | 
         | For example, if you want to keep hospital state up to date,
         | ingest public payment data from Medicare/Medicaid and distill
         | down by location. When fiat is at stake, there is more at stake
         | wrt data accuracy.
         | 
         | Edit: fsflyer points this out in a below comment, mea culpa
         | 
         | https://news.ycombinator.com/item?id=35434775
        
         | autokad wrote:
         | hospitals can be challenging. lots get shut down, and the
         | smaller ones have severely misplaced coordinates because these
         | surveys go out to the hospitals and a clerk will fill them out
         | with an address, and that address gets geocoded. The address
         | they give is sometimes an address to a branch hospital, or a
         | different building than the treatment center of interest. Very
         | large hospitals have an issue in this way too, and since they
         | are so big that difference can effect the map and access a lot.
        
         | wcedmisten wrote:
         | Yeah, I think using another data source for hospitals would be
         | better, I'll look into using supplemental data as the other
         | comment suggested.
         | 
         | I suspect that hospitals are better represented than other POIs
         | because their building footprints are large and distinctive,
         | allowing them to be mapped from aerial imagery.
         | 
         | I limited this analysis to facilities providing inpatient care
         | to avoid that problem. I suspect clinics are less accurate
         | POIs. They're pretty much indistinguishable from other retail
         | businesses from aerial imagery alone.
        
       | samstave wrote:
       | This is awesome.
       | 
       | As someone who has designed and commissioned quite a few
       | hospitals over the years, this data is really interesting to me,
       | especially as I have been on the front of how much hospital
       | projects cost - from vendors selling "hospital grade" electronics
       | (snake oil), to managing design build of full facilities from
       | greenfield to clinical operations go live... Hospitals are
       | ridiculously expensive "just because thats how it is"
       | 
       | Another interesting data point to add to this would be the
       | mapping of reported income by city/county... I did this for
       | Cannabis Dispensaries a few years ago - where I mapped out all
       | the licenses granted by the BCC (now DCC) to dispensaries, and
       | the average income level of the population surrounding each
       | dispensary...
       | 
       | Then, I looked at reports to the BCC for reported income, where
       | the average dispensary (at the time) was making $2MM/y -- its got
       | to be much higher now....
       | 
       | It would be interesting to see the average income for the various
       | populations in each time-strata as well.
        
       | fabk wrote:
       | Nice to see the localhost solution! I (my team) did very similar
       | when I was a postdoc. In 2015 we used the HERE API (www.here.com)
       | to map geographical access to hospitals in the entirety of two
       | countries, USA and Brazil.
       | 
       | As starting point, I used the lat/lon of the population center of
       | each census block group as provided by Census.gov. In Brazil the
       | closest geographical equivalent is the setor censitario (census
       | sector). I used Haversine distance (great circle distance between
       | lat/lon's) to narrow the search space to the 5 closest hospitals,
       | from the hospital database by the American Hospital Association,
       | and the Brazilian CNES registry (Cadastro Nacional de
       | Estabelecimentos de Saude). From those 5 closest candidates, I
       | then asked the HERE API for the true driving time to their
       | address. Many many API calls.
       | 
       | We plotted average driving time against variables from the census
       | block group provided by the American Community Survey to show how
       | values change as driving distances change. Mostly just to
       | demonstrate the kind of analyses possible. I presented the work
       | at the NLM Informatics Training confereces, e.g. with many
       | pictures of maps:
       | https://github.com/fabkury/drithop/raw/master/Kury%20-%20dri... .
       | Source code (but not data) are in the GitHub repo `drithop`. The
       | maps are self-contained HTML files and interactive using
       | OpenStreetMap.
        
       | slazien wrote:
       | Related: me and my colleagues at Georgia Tech created something
       | similar for multiple types of Points of Interest and developed
       | and accessibility index. Our methodology was a bit different
       | though: https://arxiv.org/abs/2212.06954
        
       | autokad wrote:
       | I built a similar website when working for a research lab ~2009.
       | The lab is now closed, and thus so is the website but you can see
       | some screen shots in this old time article:
       | https://content.time.com/time/health/article/0,8599,2083636,...
       | 
       | What was interesting how many jurisdictions got mad at me,
       | because they thought I was targeting them. A hospital in Chicago
       | that shut down their trauma center to save money but caused the
       | south side of Chicago to loose 1 hour access thought I was
       | targeting them as revenge over that action. The Florida Keys was
       | mad at me because they had a hospital but no access and I'd be
       | like "I'm sorry but that hospital is not a Trauma center and this
       | is a Trauma Center access map, if the hospital gets certified I'd
       | be happy to update the data".
       | 
       | The hardest part was the data. I had to join the list of Trauma
       | centers (levels 1 - 5, about 500 hospitals) with a hospital
       | database (~5500 hospitals) to get additional information. I had
       | to verify manually all the joins as well as the GPS coordinates.
       | 
       | Its a shame the app got shut down, it had some useful tools. You
       | could see trauma center access via ambulance, air ambulance, or
       | both for 45 and 60 minutes. It also had overlays for hospitals,
       | trauma centers (levels 1, 2,..5), stroke centers, VA hospitals,
       | and helipads. I also built an additional tool in a similar app to
       | 'build your own hospital system' by clicking on available
       | hospitals and 'upgrading' them to a TC or stroke center and then
       | see how many people in the state gained access.
        
       | ljegou wrote:
       | The Malaria Atlas Project worked on a global hospital
       | accessibility dataset, base on OSM roads + other data :
       | 
       | Travel Time to Nearest Healthcare Facility with Access to
       | Motorized Transport
       | https://data.malariaatlas.org/maps?layers=Malaria:202206_Glo...
       | 
       | Paper :
       | https://researchonline.lshtm.ac.uk/id/eprint/4657237/1/weiss...
        
       | poulsbohemian wrote:
       | I applaud the effort, but the challenges of rural health are even
       | greater than just proximity to a hospital. For example, in my
       | area we have multiple hospitals and clinics, but... have heart
       | issues? Hour drive. Need cancer care? Likely driving between 3-5
       | hours toward one of the bigger metro areas. There is exactly one
       | (!!) urologist in town. Need some kind of basic surgery (gall
       | bladder, for example) guess what - there are a couple guys that
       | rotate here every few weeks from one of the major cities (where
       | they actually live). That's before we get into the clusterF that
       | is the American insurance system.
       | 
       | Our rural hospitals are basically triage care and basic
       | immunizations / antibiotics.
        
         | TulliusCicero wrote:
         | Isn't that a straightforwardly expected result of low
         | population density?
         | 
         | If your area doesn't have many people, that means less demand
         | for certain things, potentially not enough demand to keep
         | permanent staff for particular types of care.
         | 
         | Of course, the other issue is that doctors (and nurses?) may
         | simply not want to live in rural areas, even with the financial
         | advantages.
        
           | poulsbohemian wrote:
           | I don't really disagree, but for what it's worth within an
           | hour radius of my location there are roughly 400,000
           | people... so how dense do things have to be before it's
           | enough to support specialty care?
        
             | TulliusCicero wrote:
             | Hmm, that does seem like it should be enough to support
             | things like heart care or general surgery, there _should_
             | be enough demand. I imagine people who actually work in the
             | industry might have some insights on why this would happen.
        
       | zootboy wrote:
       | I'm curious how confident you are that all hospitals in the state
       | are listed in the OSM database. In my experience, the point of
       | interest data in OSM is highly variable, with many being totally
       | absent. I know you mentioned a few mis-tagged hospitals, but did
       | you look for missing ones?
        
         | wcedmisten wrote:
         | I don't have a great data source for hospitals to cross
         | reference, but I suspect hospitals are better represented than
         | other POIs in OSM. Hospitals generally have very large and
         | distinctive building footprints, which means "armchair mappers"
         | using aerial imagery can still map them.
         | 
         | If I was looking at clinics, I believe this would be a bigger
         | problem, because they're indistinguishable from other retail
         | businesses in the aerial imagery.
        
       | taveras wrote:
       | This is super cool!
        
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