KamelBoulos Lbsinhealth

A Location-based Health
Information Service
Applying geographic filters to enable access to immediately relevant
information
Maged N Kamel Boulos, PhD
Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

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
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.

• On the following two slides I am using GIDEON
(Global Infectious Disease and Epidemiology Network
—<http://www.gideononline.com/>) 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.



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.

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.

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 viewer’s location.
Fact: 75% of the world’s population do not speak English.

Location-based Services Defined
• Location-based services blend information about a
person’s 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 (<http://www.ovum.com/>), 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).

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).


• 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.

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 (Quova—
<http://www.quova.com/>).
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.

IP Geo-targeting - 2
• IP geolocation does not use any DNS reverse
look-ups, or WHOIS look-ups to determine a
visitor’s 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.
IP Geolocation Solutions - 1
Source: Quova GeoPoint—<http://www.quova.com/>

Source: Digital envoy NetAcuity—<http://www.digitalenvoy.net/>

Source: Geobytes GeoSelect—

<http://www.geoselect.com/>
• InfoSplit—<http://www.infosplit.com/>
• GeoIP City Edition—<http://www.maxmind.com/app/city>
• The National Security Agency: Network Geo-location
Technology—<http://www.nsa.gov/programs/tech/factshts/20020506.htm>
The National Security Agency, America’s 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 -
<http://www.geoinformatics.com/issueonline/issues/2001/07_2001/pdf_07_2001/28_31_iptar.pdf>
Hogeweg M. Relocation Based Services. GeoInformatics. September 2001
- <http://www.geoinformatics.com/issueonline/issues/2001/09_2001/pdf_09_2001/13_hogeweg.pdf>

Hypertag Technology - 1
• Location-based services need to know where

users are.
• Hypertag (<http://www.hypertag.co.uk>), 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.

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

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.

Objectives at a Glance
Metadata* Reasoning Optimised User

with Metadata** Experience
Collect/ Describe Select Present
Personal Profile
Goal:
For every user,
Device Profile Content (Resource)
always serve
Selection
the right
and Formatting
Location Profile personalised content
Models/ Rules
in suitable form
Resource Descriptions and format
Enabling access to information that is immediately relevant to users

*Including spatial (where) and temporal (when) metadata about user and resources
**User’s spatial history, if known, can improve results

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 technology–see
<http://www.geoselect.com/Demo.htm>);
• 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).

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
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.
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.

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
Visitor IP: 163.191.183.220
Location detected: Springfield, Illinois, USA
Location-specific Health Problem: West Nile Virus (WNV)

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

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

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).

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 user’s 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).

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 Preferences—
<http://www.w3.org/P3P/>).

User Privacy - 3
P3P is a machine-readable vocabulary and syntax for expressing a Web site’s data
management practices. A site’s 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 user’s 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: <http://p3ptoolbox.org/guide/section2.shtml#Iia>

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.

Presentation
Matters
Recognition Not Recall
Screenshot 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
Net’s way of representing each
resource directly on the map
using a distinct point symbol.
†
The author’s PhD
project. Only
HealthCyberMap
uses GIS and a
clinical ontology to
classify Web
resource data and
render the maps. Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>
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 needed—
this 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.

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 2001;3(1):e5
<URL: http://www.jmir.org/2001/1/e5/> [PubMed ID: 11720947]

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 <http://semanticweb.org>).
• 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 Jan;2:2 <URL:
http://www.ij-healthgeographics.com/
content/ pdf/ 1476-072X-2-2.pdf>
[PubMed ID: 12556243]
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
(<http://www.nelh.nhs.uk/>);
– Public Health electronic Library/ Network
(PHeL—<http://www.phel.gov.uk/>); and
– NHS Direct Online
(<http://www.nhsdirect.nhs.uk/>).

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.

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 Jun;34(3):195-219
<doi:10.1006/jbin.2001.1015 - URL: http://www.idealibrary.com/ links/ doi/
10.1006/ jbin.2001.1015> [PubMed ID: 11723701]
• Kamel Boulos MN, Roudsari AV, Carson ER. Towards a semantic medical
Web: HealthCyberMap’s tool for building an RDF metadata base of health
information resources based on the Qualified Dublin Core Metadata Set.
Medical Science Monitor 2002 Jul;8(7):MT124-36 <URL:
http://www.medscimonit.com/ pub/ vol_8/ no_7/2615.pdf> [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 Sep;27(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 Dec;19(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 Jan;2:1 <URL: http://www.ij-healthgeographics.com/
content/ pdf/ 1476-072X-2-1.pdf> [PubMed ID: 12556244]

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A Location-based Health

Maged N Kamel Boulos, PhD

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Location matters, and the Internet should be

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Fact: 75% of the world’s population do not speak English.

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Source: Quova GeoPoint—<http://www.quova.com/>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Source: Digital envoy NetAcuity—<http://www.digitalenvoy.net/>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Source: Geobytes GeoSelect—

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

• Location-based services need to know where

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Metadata* Reasoning Optimised User

Enabling access to information that is immediately relevant to users

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Metadata ontologies are needed to define and store user,

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

WNV Latest News

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

WNV Prevention Information

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

• As online information portals accumulate metadata

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

* Kamel Boulos MN. Location-based

• More pioneering publications are expected to

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

Concepts from HealthCyberMap—<http://healthcybermap.semanticweb.org>

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