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Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice




Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
Northwestern University
Nicole Bammel and Venkatesh Ekambaram
September 1, 2013
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Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
Introduction
Malpractice data has always been a big thing for people who are looking for a physician.
There are many restrictions on being able to view the data; no one can really feel safe. A cloud-
based geographic information system (GIS) map that displays collective data on medical
malpractice is the upcoming technology to find this information. The Health Resources Services
Administration would like to create this application. This gives the general public a way to view,
analyze, and understand the information that is shown to support the creation of new tools and
strategies to increase a patients care and protection. It can be seen by the researchers as well so
they can analyze the data. One would be able to view malpractice data for the area in which they
live very easily and without much hassle.
Objectives Breakdown Structure
Cloud Geographic Information Systems (GIS) is a combination of running GIS software
and services on the cloud infrastructure and accessing the GIS capabilities using the internet
(Cloud GIS, n.d.). Just like Dropbox, cloud computing is a different way to compile and share
data with consumers. Cloud GIS allows you to run your software and services on an
infrastructure and they are made available through web technologies (Cloud GIS, n.d.). There
are many benefits to using cloud GIS instead of hosting everything on your own infrastructure.
Some of these benefits include no need for software updates, you have easier access to the
services provided, and you only need to pay for what you use.
Cloud GIS can help the public access medical malpractice data that had been taken away
in 2011 (Wapner, 2011). The National Practitioner Data Band (NPDB) was available for public
access but it was limited on what information was available. The factors that could identify a
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Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
physician were removed. There were no names are included with the data, and ages of
individuals are presented as ranges, not as a specific number (Wapner, 2011). The removal of
the public file was triggered by research that was done by Alan Bavley, who is a health reporter
at the Kansas City Star (Wapner, 2011). He was noticing that you could trace the data back to a
particular area and maybe a particular hospital. This could lead to finding the specific doctor
based on the age range and other information provided.
The goal of this project is to make the malpractice trend data, which relates to patient
safety and protection, more reachable, open, and clear to the public and researchers (Cloud-
Based GIS Maps Displaying Aggregate Data on Medical Malpractice, n.d.). Cloud GIS is very
useful for marketing, especially with this project. This promotes a certain hospital more than
others because the data shows that they have better physicians and care than other physicians
who have higher malpractice rates. Another useful benefit to Cloud GIS is safety and community
relations which ties into marketing. The public can see how safe a hospital is and this promotes
more business for the hospital, which in turn creates a better relationship with the community.
Once one person sees how good a hospital is, they will spread the word and that brings in more
people.
Resource Needs
The resources behind this project are not limited to developers and coders. There needs
to be at least two to three people to gather all of the malpractice data and transfer it into
information the rest of the team can work with or reference in their code. The solution architects
will make the functional design of the application and deal with the requests that come in from
the customers. Software architects need to deal with the technical design of the application and
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Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
create the guidelines. The developers should follow the software architects design and
guidelines to make sure everything is done the way it has been laid out. The testers test
everything about the application. Their job is to try to break the application. If they find a way
to break it then they have to take it back to the rest of the team so they can figure out how to fix
it.
This project will need people who have experience designing web-based GIS applications
using new and upcoming GIS technologies. These people will be the bread and butter of the
project. They can put the application together from what the developers create. They will
monitor and keep the Cloud GIS up and running. They will also be responsible for updating the
product that comes from the developers. Everyone that is part of the group should have some
cloud-based computing experience. Without this knowledge, it will be very difficult to create the
best product possible.
The end-users will be a big part of the project. They are the true testers because they give
the most feedback. All they have to do is download the application and start using it. There are
no pre-requisites, except for having a smartphone such as an iPhone or Android. The application
will use the users GPS coordinates to locate them and display the data that is pertinent to their
location. The user can veer away from their current location and view other areas if they choose
to do so.
This application is fairly inexpensive to produce since GIS Cloud only charges $55 per
month to subscribe to their premium map creation services (Map Editor Subscription, n.d.). Data
reports are kept confidential, but according to the American Medical Association (AMA),
information may be available upon written request through the state licensing boards (who) are
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Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
even releasing this or similar data through their web sites (National Practitioner Data Bank, n.d.
b). The application development would cost $50,000, the design cost would be $10,000, and the
services would be $5,000 (Thomas, n.d.).
Risk Management
This application will fulfill the stated goals of the National Practitioner Data Bank
(NPDB) and will be created in adherence to the laws to which the Health Resources Services
Administration (HRSA) abides by (About Us, n.d.). Developers are well-aware of the fact that
they must apply for eligibility to view data, beginning with approval from the HRSA to create
the application, because access to this data is regulated.
Since this application will attempt to report on at least five different types of information,
it must strive to acknowledge that some NPDB reports are more serious than others, although
there is an element of uncertainty in making these determinations. In some cases, the data may
not accurately reflect the quality of health care in an area with poor provider availability. Reports
themselves do not always prove that harm was caused by the practitioners, particularly in cases
of voluntary surrender or restriction of a license or privileges while under investigation or in
lieu of investigation (About Us, n.d.). On the one hand, physicians, nurses, and dentists have
been known to manipulate the system and have been successful in finding loopholes in the
National Practitioner Data Bank. Examples of loopholes include the ability to move to another
state before a report is filed, the tendency of hospitals or colleagues to keep incidences
confidential, the lack of enforcement of the rule to report incidences- or of penalties when this
does not occur- by government officials, the instances when names were removed from the final
lawsuit, and the limiting of sanctions on the accused to thirty days (Thompson, 2005). The
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NPDB data has been compiled from data gathered by state medical boards and they, in turn, have
relied upon the judgment of organizations such as peer review groups; therefore, there are
differences between state policies (Adler, n.d.). Lastly, the first NPDB reports start in 2004
because that is when data regarding the age and gender of patients and severity of injury
became available for the first time (Medical Malpractice Payouts Not Driving Up Health Costs:
Study, 2013).
Developers run the risk of relying on data which may not be thorough, and also face the
prospect of backlash from health care workers advocacy groups. Since this application will
increase distribution of the NPDB database contents, this opens the door for some news
organizations to use this database with other public data, including court records, to determine
the identity of individual practitioners (National Practitioner Data Bank, n.d. a). Some
practitioners who were found to be liable in a medical malpractice case may not be accounted for
by the state boards. The NPDB data is also limited to numerical figures, which provide a partial
story but exclude, for better or worse results, the wording (which) can have a great impact on a
subsequent employer or state licensing board (About Us, n.d.). A serious drawback of this data
is that it only accounts for individuals and not for organizations, since treatment errors and other
mistakes made in the provision of health care to Medicare patients are reported by hospitals in
only 14% of cases, said a 2012 study released by the U.S. Department of Health and Human
Services (Goguen, n.d.). Finally, unreported cases will be missed as long as violators employ
strategies that can avoid a result requiring a report to the NPDB (About Us, n.d.).


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Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
Timetable
Adoption of this application is projected to occur rapidly in as soon as three months post-
release, not only among researchers, but also among women, since most lawsuits involve
obstetrician-gynecologists; they are the public demographic most likely to use the application.
American moms spend more time in education apps than the general population; also, moms
who own an iPhone or an Android device spend a greater share of their app time in health and
fitness apps (Gordon, 2013).
Positive outcomes are estimated to result within a year of release because the impact of
applications has been greater during recent years when 70% of mobile searchers act within an
hour (while) only 30% of PC searchers do (Mobile Marketing Statistics, 2012). The impact on
health care professionals is more difficult to estimate, but this application should contribute to
the positive overall impact of the Affordable Care Act on health care quality, beginning in 2015.
Ethical Guidance
In the interest of fairness, an oversight committee will be assembled and will consist of a
representative from each of the four primary stakeholder entities, namely the federal government
and the healthcare, informatics, and legal communities. Its role will be two-fold: first, to assess
the applications adherence to the primary principles for which it was created and second, to
resolve disputes over any ethical concerns voiced by a concerned party. This application has
been designed with specific goals which include developing a patient-centered tool, providing a
performance-oriented deterrent to malpractice, seeking no profits from the distribution of the
application, preventing the tool from being manipulated by third-parties, promoting quality-care
awareness, and reducing the costs of medical outcome-tracking.
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Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
Certain ethical dilemmas could possibly arise from this project. Data used by the App
will be restricted to what the NPDB has collected and the development team will secure the legal
right to acquire, use, and display this information. NPDB data accessed to create maps will have
its security reinforced, but in case of a breach, a procedure will take effect which begins with
system shutdown, breach repair, source investigation, and potential criminal prosecution.
Physicians implicated in malpractice cases as well as affected patients may voice concerns about
the confidentiality of case details, but the NPDB and this development team will maintain
HIPAA compliance, using only the minimum amount of data necessary to construct the map.
Surveillance software will ensure that the App is used for its intended purposes and misuse will
trigger notification reports sent to the oversight committee for review. If deemed necessary, the
development team will acquire FDA approval for the App. In accordance with the NPDB
mandate, which requires individual states to report cases, this App encourages their involvement.
Stakeholders Roles
The HRSA will certainly receive more scrutiny from the stakeholders mentioned below
along with greater public exposure and interest as a result of this application. The primary public
stakeholders are the patients. The NPDB was created, according to the AMA, to consolidate
claim and event information and create a flagging or alert mechanism to put parties on notice
that the physician may have competence or professional misconduct problems (National
Practitioner Data Bank, n.d. b). This data must be made understandable and useful. The news
media may demand that more information be provided than is permitted by law.
Private stakeholders include health care workers who will continue to object to the NPDB
since any incident involving a health care professional is reported; the AMA implicitly believes
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Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
that medical liability claims data is a poor indicator of quality (National Practitioner Data Bank,
n.d. b). This application has the potential to impact practitioner behavior and could possibly
contribute to professional migrations to different areas, depending on their individual needs.
These workers are well-aware that an NPDB record can affect licensure, medical staff
privileges, contractual arrangements with health plans, and future insurability by traditional
carriers (National Practitioner Data Bank, n.d. b). The AMA webpage describing the NPDB
suggests that placing this information in the public domain will increase information access and
promote better practices among professionals, specifically the call to reduce health care
expenditures, although this data could also encourage practitioners to make greater demands for
tort reform.
Lawyers, especially malpractice lawyers, may be concerned about how this information
reflects upon their profession, since the impact could be both positive, if it reflects success, or
negative, if it promotes harmful stereotypes. A cause for concern regarding the data is the fact
that an attorney appointed by the malpractice carrier to defend the physician is not necessarily
representing the interest of the physician and, if the carrier or employer prefers, will settle a case
to avoid further expense or for other reasons (National Practitioner Data Bank, n.d. a).
Accreditation entities such as the Joint Commission and the National Committee for
Quality Assurance could object to use of their data, which they contributed in order to add to the
NPDBs pool, unless approval for this project is acquired from them beforehand. Local
representatives, such as hospital administrators and officers of medical societies, and government
officials may be concerned that their region is portrayed in an inappropriate manner. State boards
of nursing, medicine, and dentistry may also object to displays of litigation data in their region.
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Part 2 Final: Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
References
About us. (n.d.). Retrieved from The National Practitioner Data Bank: http://www.npdb-
hipdb.hrsa.gov/topNavigation/aboutUs.jsp
Adler, E. (n.d.). The national practitioners data bank: What physicians should know. Retrieved
from Physicians Practice: http://www.physicianspractice.com/blog/national-practitioners-
data-bank-what-physicians-should-know
Cloud-Based GIS maps displaying aggregate data on medical malpractice. (n.d.). Retrieved
from HHS: http://www.hhs.gov/open/initiatives/entrepreneurs/gis_maps.html
Cloud GIS. (n.d.). Retrieved from ESRI: http://www.esri.com/products/technology-topics/cloud-
gis
Goguen, D. (n.d.). National medical malpractice statistics. Retrieved from Medical Malpractice:
http://www.medicalmalpractice.com/National-Medical-Malpractice-Facts.cfm
Gordon, M. E. (2013, July 2). How to reach america's mobile moms. Retrieved from Flurry
Blog: http://blog.flurry.com/?Tag=Usage%20Statistics
Map editor subscription. (n.d.). Retrieved from GIS Cloud: http://www.giscloud.com/map-
editor-subscription-comparison
Medical malpractice payouts not driving up health costs: Study. (2013, May 8). Retrieved from
Insurance Journal:
http://www.insurancejournal.com/news/national/2013/05/08/291259.htm
Mobile marketing statistics. (2012). Retrieved from Snap Hop: https://snaphop.com/2012-
mobile-marketing-statistics#revenue
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National practitioner data bank. (n.d. a). Retrieved from Investigative Reporters & Editors:
http://www.ire.org/nicar/database-library/databases/national-practitioner-data-bank/
National practitioner data bank. (n.d. b). Retrieved from American Medical Association:
http://www.ama-assn.org//ama/pub/physician-resources/legal-topics/business-
management-topics/national-practitioner-data-bank.page
Thomas, C. (n.d.). How much does it cose to develop an app? Retrieved from Blue Cloud
Solutions: http://www.bluecloudsolutions.com/blog/cost-develop-app/
Thompson, C. W. (2005, April 12). Poor performance records are easily outdistanced. Retrieved
from The Washington Post: http://www.washingtonpost.com/wp-dyn/articles/A44899-
2005Apr11.html
Wapner, J. (2011, September 16). Governemnt restricts public access to malpractice data.
Retrieved from Plos: http://blogs.plos.org/workinprogress/2011/09/16/government-
restricts-public-access-to-malpractice-data/