Towards Web-based Representation And Processing Of Health Information

Sheng Gao; Darka Mioc; Xiaolun Yi; Francois Anton; Eddie Oldfield; David J Coleman


Int J Health Geogr 

In This Article

Abstract and Background


Background: There is great concern within health surveillance, on how to grapple with environmental degradation, rapid urbanization, population mobility and growth. The Internet has emerged as an efficient way to share health information, enabling users to access and understand data at their fingertips. Increasingly complex problems in the health field require increasingly sophisticated computer software, distributed computing power, and standardized data sharing. To address this need, Web-based mapping is now emerging as an important tool to enable health practitioners, policy makers, and the public to understand spatial health risks, population health trends and vulnerabilities. Today several web-based health applications generate dynamic maps; however, for people to fully interpret the maps they need data source description and the method used in the data analysis or statistical modeling. For the representation of health information through Web-mapping applications, there still lacks a standard format to accommodate all fixed (such as location) and variable (such as age, gender, health outcome, etc) indicators in the representation of health information. Furthermore, net-centric computing has not been adequately applied to support flexible health data processing and mapping online.
Results: The authors of this study designed a HEalth Representation XML (HERXML) schema that consists of the semantic (e.g., health activity description, the data sources description, the statistical methodology used for analysis), geometric, and cartographical representations of health data. A case study has been carried on the development of web application and services within the Canadian Geospatial Data Infrastructure (CGDI) framework for community health programs of the New Brunswick Lung Association. This study facilitated the online processing, mapping and sharing of health information, with the use of HERXML and Open Geospatial Consortium (OGC) services. It brought a new solution in better health data representation and initial exploration of the Web-based processing of health information.
Conclusion: The designed HERXML has been proven to be an appropriate solution in supporting the Web representation of health information. It can be used by health practitioners, policy makers, and the public in disease etiology, health planning, health resource management, health promotion and health education. The utilization of Web-based processing services in this study provides a flexible way for users to select and use certain processing functions for health data processing and mapping via the Web. This research provides easy access to geospatial and health data in understanding the trends of diseases, and promotes the growth and enrichment of the CGDI in the public health sector.


Population growth, rapid urbanization, environmental degradation, and the misuse of antimicrobials have disrupted the equilibrium of the microbial world, causing the rise of new emerging diseases.[1] Health information is very useful in helping people to understand health phenomena, mitigate disease outbreaks, and analyze disease etiology. However, most public health departments typically collect data as needed and maintain it locally, and this unavoidably limits the access to important public health data for health researchers and the public.[2] World Health Organization[1] pointed out that keeping disease outbreaks secret is no longer feasible and sharing essential health information is one of the most feasible routes to global public health security. Sharing health information through the Web provides flexible and real-time data access, and assists people to discover and use this information. Currently, many health departments have begun to provide public access to their health statistics via the Internet, and this promotes interest in user involvement and data-set exploration.[3] Some health information like morbidity and mortality indicators has become obtainable to health professionals and the public by means of the Internet.[4] With the new updated health cases collected from hospitals or surveys, the Web can distribute this information to users in real time. Distributing and sharing health information via the Web can assist authorities and decision makers across health jurisdictions to collaborate in preventing, controlling, and responding to a specific disease outbreak at both the local and national levels. Current Web 2.0 technologies can further facilitate data sharing and collaboration between users, and the Web 2.0 mash-up allows the combination of multiple third-party services over the Web.[5,6] An example of a mash-up is the combination of bird flu case data with Google maps to visualize the distribution of disease for health surveillance.

Health information is collected through two kinds of georeferences. One kind is the point data which record the coordinates of disease case location. The other kind is region data which is collected as a summary for a geographical area. To represent health information, especially over the Web, the privacy and confidentiality concerns are given a lot of thought. Laws governing use and distribution of public health information should be respected in each jurisdiction, and yet the need for information to support critical decision making on public health threats like Tuberculosis, Avian Flu, and Influenza should be met. To keep the privacy of health information while maintaining highly informative data, health data should be represented at the aggregate level, with high privileges to see more detailed data.

Maps are powerful tools to classify, visualize, communicate and navigate space and/or spatial relations in the data which would be hard to explore otherwise.[7] With maps, it is easy to discover adjacent neighborhood similarities as well as spatial patterns that are hidden in health data. Two kinds of Web-based maps exist: view-only maps and interactive maps.[8] The view-only maps are the cartographical representation of data in images such as GIF, PNG or JPEG format. Interactive maps can respond to some mouse actions on the map, with the technologies such as Scale Vector Graphics (SVG,) Extensible 3D (X3D) Graphics, and Virtual Reality Markup Language (VRML). Kamadjeu and Tolentino[9] discuss the advantages of use the SVG in web cartographical representation, such as smaller and more compressible files, pure XML, human readability, scalability and support from major industries.

From our previous study for health mapping, we found that the quality of health data representation in Web-based GIS applications was still limited.[10] Even though many Web-based health applications dynamically generate view-only maps or interactive maps, certain information is missing for people to fully interpret the map such as the data source description and the method used in the data aggregation process. Consideration of the source and quality of the health data can help health practitioners, the general public, and policy makers to evaluate the trustworthiness of spatial analysis results.[3] In addition, scientific users want to know details about methodology when evaluating representations. For the representation of health information to users, the following issues should be considered:

  1. The metadata of the health information. The description of the health data is important in understanding data sources and quality.

  2. The statistical methodologies used. The description of the statistical methods for representing health data can be used to determine the quality of the results.

  3. The comprehensiveness of the representation. The representation which can combine many kinds of form of representations (text, maps, graphics, etc.) will assist people in exploring the health phenomena with less misinterpretation.

  4. The consistency of the cartographical representation. Health information should be mapped in the same patterns regardless of platform or system.

  5. The semantic meaning. Shared vocabularies or styles can eliminate different interpretations.

Thus, a health data representation format needs to be developed to fulfill these five requirements and enhance the sharing of health information via the Web. In the health decision-making process, usually we need to integrate health data from heterogeneous sources. With a suitable health data representation model that catches all the aspects of health information, we can more easily understand health data and integrate the health data from different sources together.

Meanwhile, Web-based processing could take advantage of net-centric and collaborative computing and let users select the processing tools flexibly.[11] In the case that local health departments are not familiar with statistical methodologies in health data processing, it may inevitably take a steep learning curve to apply the processing methodologies.[12] In addition, it is hard to build a system that includes every complex function. Web-based processing allows users to select the cost-effective processing and mapping tools to accomplish a task, without the need to purchase advanced hardware or software. However, to date Web-based processing has not been adequately utilized for flexible processing of health information.