Geographic & Resources Analysis in Primary Health Care GRAPHC . National Centre for     Geographic & Resources Analysis in Primary Health Care Paul Konings: Senior Researcher at GRAPHC GRAPHC is the National Centre for Geographic & Resources Analysis in Primary Health Care We are part of APHCRI @ ANU which is the Australian Primary Health Care Research Institute. Our main role and objective is to build a national GIS Resource Hub and To undertake research that highlights and exploits geography, spatial analyses and location in health research. Our Vision is: To enhance the capacity of primary health care, by using geographically based tools, methods, data and web-based mapping platforms to support research into primary health care issues. Paul Konings Vision: To enhance the capacity of primary health care, by using geographically based tools, methods, data and web-based mapping platforms to support research into primary health care issues. Paul Konings, Michael Hewett, Le Ma, Aparna Lal, Soumya Mazumdar, Nasser Bagheri National Centre for Geographic & Resource Analysis in Primary Health Care (GRAPHC), Australian Primary Health Care Research Institute (APHCRI), Australian National University (ANU)

Spatial Analysis Tools. Map-based Visualisation. Location as data. WHAT Public Health & demographic datasets. Spatial Analysis Tools. Map-based Visualisation. Location as data. GRAPHC is a national resource, not bound by jurisdictional, administrative or geographic boundaries. GRAPHC is a resource for all stakeholders and is funded at a national level. GRAPHC aims to meet the needs of stakeholders by providing: Paul Konings: GRAPHC, APHCRI, ANU

GRAPHC Resources Data, Data, Data 11,513,439 registered GTAGS WHAT GRAPHC Resources Maps / Visualisations INFRASTRUCTURE GRAPHC aims to meet the needs of Australian researchers and health administrators by providing: A single point of access for core health, socio-economic and demographic related data: ** Tools that enable unit record data to be spatially enabled while protecting privacy and confidentiality. ** Spatial Functionality ** High quality interactive thematic map display and data visualisation tools ** All of this is built on infrastructure hosted and managed by GRAPHC directly. All based on MS-SQL & ArcGIS Spatial Data environment ** We currently have over 750,000 indicators variously attached to over 50 different administrative boundaries. ** There are currently over 11 million registered GTAGS against more than 750,000 addresses, 370,000 of which are geocoded. I will now try to give you a brief functional overview of the G-Tag System. Functionality 11,513,439 registered GTAGS 776,526 addresses 378,720 geocoded to date G-Tag System: Geo-Attribution / Geo-Linking Data, Data, Data 750,000 spatially enabled indicators or variables. 57 Geographic regions Paul Konings: GRAPHC, APHCRI, ANU

G-Tag System Principles HOW G-Tag System Principles Small Geography is Important. Privacy is Critical. No Variation Variation The principal purpose for the G-Tag System is to offer a means by which precision location information can be made available to researchers without necessarily compromising the de-identified nature of the research data. ** The two principles that drove the development of the G-Tag System are: That precision geography affords the best opportunity of meaningful research AND That protection of privacy and confidentiality is critical. Location data, is more than maps. As an element of analysis, location affords researchers the capacity to incorporate concepts such as proximity, distance and contiguity. Location can also be used to link research data and a broad range of public health, socio-economic, demographic, environmental and other relevant spatial data sets. The challenge for researchers interested in location, has been that residential addresses compromise individuals’ privacy. The G-Tag System solves this problem and enables research data to be linked to geographies which are broad enough to protect privacy, but narrow enough to enable useful linking or analysis, without individual addresses being in contact with the research data. The degree of spatial granularity can be tailored by users to fulfil ethical and privacy factors. ** You can see here that diabetes and socio-economic status research, would not have identified relationships or variation, had the research been based on Postcodes instead of SA1s. GTags make this research possible. Postcodes SA1s Paul Konings: GRAPHC, APHCRI, ANU

G-Tag System: Geo-attribution / Geo-linking General Practice 3. Researcher takes de-identified clinical data including GTAGs & undertakes research enquiry 1. Extract clinical data using extraction tool ie Pen- CAT Patient Identifiable Data De-Identified Clinical Data The principal purpose for the G-Tag System is to offer a means by which precision location information can be made available to researchers without necessarily compromising the de-identified nature of the research data. The system was developed for attributing region_id’s other than postcode to clinical records from general practices, but can be applied to any situation where a database contains detailed address information together with confidential information. The G-Tag System is designed to enable the research data to be linked to geographies which are broad enough to protect privacy, but narrow enough to enable useful linking or analysis, without individual addresses being in contact with the research data. The degree of spatial granularity can be tailored by users to fulfil ethical and privacy factors. This is how it works in overview: 1. The process firstly involves extraction of two separate datasets: Patient identifiable data, including addresses AND de-identified clinical data. Both files share a link_id field that links the clinical data back to individual patients. 2. Each address is submitted to the G-Tag server with the link_id, nothing else. There is no attached clinical or other identifying information. 3. GRAPHC returns a GTAG, which is just a global unique identifier with the link_id. The GTAG is NOT an encrypted address, it’s NOT the address coordinates. It has no qualities that can be used to determine or derive an address. 4. Now the GTAG is appended to the de-identified clinical data via the link_id. The de-identified unit record data with GTAGs can leave the practice. 5. Next is the process of applying spatial or other attributes via the G-Tag System to the unit record data. 6. This is achieved by the researcher submitting GTAGs for selected individual records to GRAPHC including details of required statistical indicators or region id’s. 7. The G-Tag system returns requested information for each GTAG, to be attached to the relevant clinical record. 8. With the, now extended, dataset, researchers and administrators can perform spatial analyses with precision location attributes or undertake statistical and other analyses with clinical data linked to indicators derived from area based collections like ABS’s Socio-economic Index for Areas (SEIFA) and PHIDU’s Social Health Atlas. 9. These analyses can then be simply aggregated on applied region_ids and visualised using GRAPHC visualisation tools. The G-Tag System gives researchers renewed opportunities to engage research questions that are either spatially motivated or that rely on access to linked data that might only be accessible via small area geo-linking. 4. GTAG -> Spatial attributes using Geo-Attribution or Link to Statistics via Geo-Linking GRAPHC G-UI 2. Register Addresses using GRAPHC G-Tag Registration tool Health Research / Administration GRAPHC G-UI Address GTAG GTAG GRAPHC Database Geo-Attribution / Geo-Linking / Geo-Processing Tools Region ID &/or Statistical Indicators 5. Review data spatially using GRAPHC Quick Themes tool 2 (a) GRAPHC Server-side geo-coding NB coordinates are NOT available. Paul Konings: GRAPHC, APHCRI, ANU

GRAPHC . Paul Konings http://GRAPHC.APHCRI.ANU.EDU.AU WHO National Centre for Geographic & Resources Analysis in Primary Health Care Acknowledgement: The research reported in this presentation is a product of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health under the Primary Health Care Research, Evaluation and Development Strategy. The information and opinions contained in it do not necessarily reflect the views or policies of the Australian Government Department of Health. The G-Tag System gives researchers renewed opportunities to engage research questions that are either spatially motivated or that rely on access to linked data that might only be accessible via small area geo-linking. It is designed to enable research data to be spatially analysed or geo-attributed to geographies which are broad enough to protect privacy, but narrow enough to enable useful geo-linking, without individual addresses ever being in contact with the research data. Finally, I should point out that all of the G-Tag System functionality is available and accessible now. Documentation is available on-line through the GRAPHC Portal. And we are more than happy to explain detailed work-flows. Because Pen Computer Systems have incorporated the G-Tag System into their Practice Audit Tool effectively all GP’s who use Pen CAT (& I gather that is most) have the capacity to GTag practice de-identified data. Thank You http://GRAPHC.APHCRI.ANU.EDU.AU Paul Konings National Centre for Geographic & Resource Analysis in Primary Health Care (GRAPHC), Australian Primary Health Care Research Institute (APHCRI), Australian National University (ANU) Credits: Paul Konings, Michael Hewett

GRAPHC Work Flow Model G-ET G-Tag HLA HOW GRAPHC Work Flow Model Register Authorise Geocode Geo-Attribution / Geo-Linking Analyse MAP Geocoded & Authorised GTAGs ATAGS/GTAGS GTAGS/Account Addresses Required Info Granularity Evaluation Geocoded GTAGs Only Geo-attributed Demographic & socio economic data. CSV Geo-attributed & Linked topic data. CSV Researcher So that’s the G-Tag System overview. I have not explored all facets of the system today. There are several other facets of that need to be understood in order to fully engage the capabilities such as: ** GTAG Authorisation and Administration Geo-coding & GTAG Spawning. The G-Tag System also offers tools to assist in determining viable levels of spatial granularity and sub-setting, according to predefined spatial thresholds. These tools help to quantify and control re-identification risk profiles and to determine with increased confidence, what spatial information should or can be achieved in addressing research questions. 1 1 2 3 GRAPHC Services HLA Quick Themes Map Visualisation G-ET G-Tag Paul Konings & Michael Hewett: GRAPHC, APHCRI, ANU

Paul Konings: GRAPHC, APHCRI, ANU Notes: ASGS Paul Konings: GRAPHC, APHCRI, ANU