A Location-based Health Information Service

1
A Location-based Health Information Service

• Applying geographic filters to enable access to
  immediately relevant information
• Maged N Kamel Boulos, PhD

2
Agenda

• Background
• Location Matters
• The Power of Where
• Location-specific Health Information
• Location-based Services Defined
• Knowing Where Users Are
• Stopgap Solutions Choose Your Location
• IP Geo-targeting/ Geolocation Solutions
• Related Technology Hypertag
• Aim
• Objectives
• Example Scenario
• Important Issues and Concerns Related to the
  Proposed Service
• Different Device Capabilities
• User Privacy
• Resource Pool Visualisation and Navigation Issues
• Other Issues of Concern
• Research Potentials and Opportunities
• Conclusion

3
Location Matters - 1

• The concept that location can influence health is
  well known in medicine and public health science.
• Certain diseases tend to occur in some places and
  not others. Health information needs and services
  also vary with location.
• Different places on Earth are usually associated
  with different profiles that can also change with
  time physical, biological, environmental,
  economic, linguistic, social, cultural, and
  sometimes even spiritual profiles, that do affect
  and are affected by health, disease, and
  healthcare.

4
Location Matters - 2

• On the following two slides I am using GIDEON
  (Global Infectious Disease and Epidemiology
  Networklthttp//www.gideononline.com/gt) to
  diagnose a case of splenomegaly (no other
  clinical findings were input to the program).
• The two screenshots show the Diagnosis Results
  (with probabilities) for the same patient but
  with a different country of disease acquisition
  in each screenshot (Kenya and United Kingdom in
  this example).
• You can clearly see how the differential
  diagnosis and probabilities differ in each case
  by just changing the geographical location of
  disease acquisition.

5
Location Matters - 3
6
Location Matters - 4
7
The Power of Where - 1

• Brute health information delivery risks
  overloading users with unnecessary information
  that does not answer their actual needs, and
  might even act as noise, masking any other useful
  and relevant information delivered with it.
• Caregivers need to know not only the history of
  patients they treat but also information about
  the social and environmental context within which
  those patients live.

8
The Power of Where - 2

• Patients and the public in general also have
  similar needs that vary with location.
• A big challenge for online health information
  services today remains to find and push
  location-specific knowledge to users based on
  their location and associated needs (location
  awareness).

Location matters, and the Internet should be no
exception to this rule.
9
Location-specific Health Information

• Examples include
• local disease rates, maps and guidelines
• targeted health education
• addresses of local healthcare facilities
• local health news
• local weather, pollen and air quality alerts and
  maps (e.g., for asthmatics)
• local health risks and hazards
• travellers health information
• local drugs/ drug trade names and prices (in
  local currency)
• information whose digital distribution rights are
  limited to some location(s)
• in addition to serving up content (and interface)
  in language(s) relevant to the viewers location.

Fact 75 of the worlds population do not speak
English.
10
Location-based Services Defined

• Location-based services blend information about a
  persons location with other useful content,
  providing relevant, timely and local information
  to consumers when and where they need it (IBM).
• The market for location-based services is
  expected to reach US 20 billion by 2005,
  according to industry analyst Ovum
  (lthttp//www.ovum.com/gt), especially with the
  advent of the wireless Web and the convergence of
  different information delivery media.
• Location-based services need not be limited to
  mobile devices or to routing (e.g., where is/ how
  to reach the nearest pharmacy) and service
  dispatch functions. The field of application of
  location-based services is much wider than mobile
  devices only (Hogeweg, 2001).

11
Choose Your Location - 1

• The inability of online information services to
  deliver relevant content on the fly has forced
  the adoption of stopgap solutions like asking the
  user to choose location (Parekh, 2002).
• After Web site visitors have made the effort to
  choose their city, country and language, they try
  to find the information they are looking for. The
  effort is entirely made by the visitor, but on
  the Internet usually visitors do not want to make
  too much effort. If the effort required is too
  high, visitors will leave, and maybe go to see
  what competitors are offering (van Leeuwen, 2001).

12
Choose Your Location - 2
13
Choose Your Location - 3

• Allowing the user to manually enter his/ her
  location (and other user profile information if
  they wish so) remains a good option
  (complementary to automatic IP geolocation) and I
  am not excluding it, e.g., to offer visitors the
  possibility to choose a different language and/
  or set of location-specific content other than
  that automatically chosen by the service.

14
IP Geo-targeting - 1

• Internet Protocol (IP) geolocation is the science
  of determining the location (up to city and
  sometimes postal code levels) of a Web site
  visitor based on his/ her IP address
  (Quovalthttp//www.quova.com/gt).

IP addresses consist of four blocks of numbers,
e.g., 138.40.220.250. They can be compared to
telephone numbers and are needed by computers on
the Internet to communicate with each other. It
is impossible to communicate without IP
addresses. A maximum of 4.25 billion IP addresses
can be issued because the four blocks range from
0 to 255.
15
IP Geo-targeting - 2

• IP geolocation does not use any DNS reverse
  look-ups, or WHOIS look-ups to determine a
  visitors location. They use very frequently
  updated proprietary databases to resolve a
  visitor's IP address to the corresponding
  geographical location.
• IP Geo-targeting can be seen as the GPS (Global
  Positioning System) of the Internet. Internet
  services that make use of geo-targeting will
  travel with (and adapt to) users, wherever they
  go (Hogeweg, 2001).
• IP targeting enables Web information services to
  recognise the geographical location of visitors
  in real-time and serve content relevant to
  location.

16
IP Geolocation Solutions - 1
Source Quova GeoPointlthttp//www.quova.com/gt
17
IP Geolocation Solutions - 2
Source Digital envoy NetAcuitylthttp//www.digita
lenvoy.net/gt
18
IP Geolocation Solutions - 3
Source Geobytes GeoSelect lthttp//www.geoselect.
com/gt
19
IP Geolocation Solutions - 4

• InfoSplitlthttp//www.infosplit.com/gt
• GeoIP City Editionlthttp//www.maxmind.com/app/cit
  ygt
• The National Security Agency Network
  Geo-location Technologylthttp//www.nsa.gov/progra
  ms/tech/factshts/20020506.htmgtThe National
  Security Agency, Americas cryptologic
  organisation, claims its methodology is very
  accurate, does not produce any false positive
  results and will scale well compared to other
  methods when the world moves from IP version 4
  with 32 bits of address space to IP version 6
  with 128 bits.

Related Articles van Leeuwen A. Geo-targeting on
IP Address - Pinpointing Geolocation of Internet
Users. GeoInformatics. July/August 2001 -
lthttp//www.geoinformatics.com/issueonline/issues/
2001/07_2001/pdf_07_2001/28_31_iptar.pdfgt
Hogeweg M. Relocation Based Services.
GeoInformatics. September 2001 -
lthttp//www.geoinformatics.com/issueonline/issues/
2001/09_2001/pdf_09_2001/13_hogeweg.pdfgt
20
Hypertag Technology - 1

• Location-based services need to know where users
  are.
• Hypertag (lthttp//www.hypertag.co.ukgt), a
  Cambridge-based company, has created cheap, smart
  tags that can be installed in information posters
  and adverts on the street to beam Web links to
  mobile phones and PDAs.
• Consumers who see an interesting advert can point
  and click their phone or PDA at the advert to
  instantly access corresponding Web-based
  information.
• Online content is thus delivered where it will be
  most useful and relevant.

21
Hypertag Technology - 2
Targeted health education example(Idea MN Kamel
Boulos)
Link to http//www.cdc.gov/ChooseYourCover/
22
Aim

• To develop a pilot location-aware online health
  information service targeting caregivers,
  patients and the public in general (with
  different content for different user roles).
• This implies the development of a localised
  clinical/ health content server with the
  functionality to customise content to the
  location and needs of the viewer in real time.

23
Objectives at a Glance
Reasoningwith Metadata Select
Metadata Collect/ Describe
Optimised UserExperiencePresent
Personal Profile
Content (Resource)Selection and
FormattingModels/ Rules
Goal For every user, always serve the
right personalised content in suitable form and
format
Device Profile
Location Profile
Resource Descriptions
Enabling access to information that is
immediately relevant to users Including spatial
(where) and temporal (when) metadata about user
and resources Users spatial history, if known,
can improve results
24
Objectives - 1

• To apply suitable methods for gathering and
  storing user profiles, including detecting their
  location (online user-filled forms and automatic
  location detection using for example GeoSelect IP
  geolocation technologysee lthttp//www.geoselect.c
  om/Demo.htmgt)
• To determine the different location profiles of
  target users (a location profile describes the
  language, health and healthcare makeup/ problems
  and corresponding clinical/ health information
  needs associated with that location)

Metadata ontologies are needed to define and
store user, device, location and resource
characteristics and relationships (profiles or
descriptions).
25
Objectives - 2

• To develop the necessary content selection models
  or rules for different locations
• To create a suitable clinical/ health content
  (metadata) pool for the proposed service based on
  existing, freely accessible Web resources and
  health news sources (plus any suitable resources
  developed in-house). Selected resources must be
  adequately indexed regarding topic, provenance,
  coverage or scope, language, intended audience
  and other relevant aspects, in order for the
  proposed service to be able to unambiguously
  match content to location and user

If you do not index it, it does not exist. It is
out there but you cannot find it, so it might as
well not be there.Barbara Quint, ASI San Diego
Conference, 1994
26
Objectives - 3

• To implement a suitable language, interface and
  content customisation engine that can act on all
  of the above metadata and selection rules to
  always serve the right content in suitable form
  and format
• To continually evaluate the service during its
  development and
• To regularly document and publish results of the
  above steps in internal reports and appropriate
  peer-reviewed journals.
• There is also a possibility of submitting the
  clinical/ health-specific metadata frameworks
  that are expected to arise out of this project to
  the appropriate standards bodies.

27
Example Scenario - 1

• IP targeting enables Web information services to
  recognise the geographical location of visitors
  in real-time, e.g., at the instant someone enters
  a Web site, it is recognised that the visitor is
  from Illinois, USA. Based on that knowledge,
  content can be shown which is likely to be
  relevant to visitors from this country, region or
  city.

28
Example Scenario - 2
Health content tailored to suit the needs of a
visitor accessing the proposed IP-based/
location-based health information service from
Illinois, USA, on 23 October 2002 Location-spec
ific Health Problem West Nile Virus (WNV)
Visitor IP 163.191.183.220Location detected
Springfield, Illinois, USA
29
Example Scenario - 3
Health content tailored to suit the needs of a
visitor accessing the proposed IP-based/
location-based health information service from
Illinois, USA, on 23 October 2002 WNV Latest News
30
Example Scenario - 4
Health content tailored to suit the needs of a
visitor accessing the proposed IP-based/
location-based health information service from
Illinois, USA, on 23 October 2002 WNV Prevention
Information
31
Different Device Capabilities

• User devices used to access a service might
  change with location, e.g., a desktop or laptop
  computer at home or in the clinic and a more
  limited mobile device on the road.
• The drawback of the small size of mobile devices
  is that display is considerably smaller and input
  much more difficult (e.g., no full-scale
  keyboard).
• Location-based services should ideally take into
  consideration the input and output
  characteristics of different devices by carefully
  choosing, personalising and formatting the
  content to display on such devices.

Photo Caption The first phone powered with
Microsoft SPV Smartphone 2002 will be available
at retail on 11 Nov 2002 in the UK for 180 (SPV
Sound Pictures Video).
32
User Privacy - 1

• IP geolocation alone does not rely on cookies,
  profiles, registration data, or any other
  privacy-invasive techniques to identify the
  geographic location of an Internet users IP
  address and is incapable by itself of collecting
  other personally identifiable information.
• Moreover, because IP addresses can be shared by
  hundreds of different devices (users) over the
  course of a few hours, individual privacy is
  further ensured (van Leeuwen, 2001).

33
User Privacy - 2

• Consumers personal privacy becomes an issue of
  concern when extra personal information is
  collected besides IP location for enhanced health
  content personalisation (e.g., age, gender,
  occupation, etc., using user-filled forms) and
  when cookies are used to memorise preferences and
  track users.
• Services should publish their Privacy Policy and
  respect consumers choices in this regard, or
  better still adopt the emerging P3P initiative
  (Platform for Privacy Preferenceslthttp//www.w3.o
  rg/P3P/gt).

34
User Privacy - 3

• P3P is a machine-readable vocabulary and syntax
  for expressing a Web sites data management
  practices. A sites P3P policies present a
  snapshot summary of how the site collects,
  handles and uses personal information about its
  visitors. P3P-enabled Web browsers and other P3P
  applications will read and understand this
  snapshot information automatically, compare it to
  the Web users own set of privacy preferences,
  and inform the user when these preferences do not
  match the practices of the Web site he or she is
  visiting.Figure and Caption Source
  lthttp//p3ptoolbox.org/guide/section2.shtmlIiagt

35
Resource Pool Visualisation and Navigation Issues

• As online information portals accumulate metadata
  descriptions of Web resources, it becomes
  necessary to develop effective ways for
  visualising and navigating the resultant huge
  metadata repositories as well as the different
  semantic relationships and attributes of
  described Web resources. Interactive graphical
  maps provide one good method to visualise,
  understand and navigate a world that is too large
  and complex to be seen directly like the
  Web.Maps based on familiar metaphors taken from
  users everyday life are much easier to
  understand. Associative and pictorial map icons
  that enable instant recognition and comprehension
  are preferred to geometric ones and are key to
  successful maps for browsing medical/ health
  Internet information resources.

36
Presentation Matters Recognition Not
RecallScreenshot of parts of HealthCyberMap and
Visual Net navigational maps for resources on
heart diseases. Notice the difference in map
iconicity between HealthCyberMap and Visual Net
approaches, and the map clutter resulting from
Visual Nets way of representing each resource
directly on the map using a distinct point symbol.
The authors PhD project. Only HealthCyberMap
uses GIS and a clinical ontology to classify Web
resource data and render the maps.
37
Other Issues of Concern - 1

• The overall accuracy of IP geolocation varies
  between 95 and 98 depending on the currency,
  coverage, and granularity/ resolution of the
  underlying geolocation provider database. This
  figure will never become 100 due to the
  existence of dynamic IP addresses and
  organisations that enter the Internet through one
  proxy server (van Leeuwen, 2001).
• Users should be allowed to manually override IP
  locations determined by the service (if
  neededthis could be done once then stored in a
  personal profile that can be updated as often as
  necessary).
• Country only vs. country, region/ state, city
  and maybe also postal code.

38
Other Issues of Concern - 2

• Other issues information quality, maintaining
  service currency, scalability of developed
  solutions, etc. See Kamel Boulos MN,
  Roudsari AV, Gordon C, Muir Gray JA. The Use of
  Quality Benchmarking in Assessing Web Resources
  for the Dermatology Virtual Branch Library of the
  National electronic Library for Health (NeLH).
  Journal of Medical Internet Research 20013(1)e5
  ltURL http//www.jmir.org/2001/1/e5/gt PubMed ID
  11720947

39
Research Potentials and Opportunities - 1

• There are great potentials and opportunities for
  research into this innovative, cross-disciplinary
  topic that brings together the health
  informatics, health geographics, geoinformatics
  and Semantic Web communities.
• Location-based information means information that
  is immediately relevant, which is the essence of
  the Semantic Web (see lthttp//semanticweb.orggt).
• Research literature on location-based health
  information services is currently very scarce
  (only one peer-reviewed paper by the author in
  PubMed/MEDLINE as of March 2003).

Kamel Boulos MN. Location-based health
information services a new paradigm in
personalised information delivery. International
Journal of Health Geographics 2003 Jan22 ltURL
http//www.ij-healthgeographics.com/ content/
pdf/ 1476-072X-2-2.pdfgt PubMed ID 12556243
40
Research Potentials and Opportunities - 2

• More pioneering publications are expected to
  arise out of this research, besides its potential
  strategic value to international and national
  online health information services, for example
• National electronic Library for Health
  (lthttp//www.nelh.nhs.uk/gt)
• Public Health electronic Library/ Network
  (PHeLlthttp//www.phel.gov.uk/gt) and
• NHS Direct Online (lthttp//www.nhsdirect.nhs.uk/gt)
  .

41
Conclusion

• Delivering real-time, location-enhanced and
  personalised health information and services can
  help consumers and providers accelerate and
  optimise their decision-making process in many
  medical/ health situations and problems.
• The integration of a carefully selected variety
  of medical/ health Internet information services
  and resources with users tasks, needs,
  preferences and their device capabilities should
  enable users to focus more on informed
  decision-making and result in better health
  outcomes.

42
Some Related Peer-reviewed Papers by the Author

• Kamel Boulos MN, Roudsari AV, Carson ER. Health
  Geomatics An Enabling Suite of Technologies in
  Health and Healthcare (Methodolical Review).
  Journal of Biomedical Informatics 2001
  Jun34(3)195-219 ltdoi10.1006/jbin.2001.1015 -
  URL http//www.idealibrary.com/ links/ doi/
  10.1006/ jbin.2001.1015gt PubMed ID 11723701
• Kamel Boulos MN, Roudsari AV, Carson ER. Towards
  a semantic medical Web HealthCyberMaps tool for
  building an RDF metadata base of health
  information resources based on the Qualified
  Dublin Core Metadata Set. Medical Science Monitor
  2002 Jul8(7)MT124-36 ltURL http//www.medscimoni
  t.com/ pub/ vol_8/ no_7/2615.pdfgt PubMed ID
  12118210
• Kamel Boulos MN, Roudsari AV, Carson ER. A
  Dynamic Problem to Knowledge Linking Semantic Web
  Service Based on Clinical Codes. Medical
  Informatics The Internet in Medicine 2002
  Sep27(3)127-137 PubMed ID 12507259
• Kamel Boulos MN, Roudsari AV, Carson ER.
  HealthCyberMap A Semantic Visual Browser of
  Medical Internet Resources Based on Clinical
  Codes and the Human Body Metaphor. Health
  Information and Libraries Journal 2002
  Dec19(4)189-200 PubMed ID 12485148
• Kamel Boulos MN. The use of interactive graphical
  maps for browsing medical/ health Internet
  information resources. International Journal of
  Health Geographics 2003 Jan21 ltURL
  http//www.ij-healthgeographics.com/ content/
  pdf/ 1476-072X-2-1.pdfgt PubMed ID 12556244