This is first post in what (I hope) to be a series of posts focused on actionable ideas cities, counties, and their partners can take. The Smart Communities movement, as chronicled by the ITE International President, Shawn Leight can be summed up like this:
“At its core, Smart Communities gather, integrate, and analyze data to enable informed and data-driven decision making.” Shawn Leight, ITE Journal, February 2017
So with that, let us get started into idea no. 1: Coordinate Transit with Medical Services.
“Envy is the antagonist of the fortunate” – Epictetus
It is no secret that I am envious of the Smart Columbus squad for putting up a bang-up proposal. I am impressed by the money the private entities put up, as well as the cadre of intelligent people on board. However, these do not hold a candle to the “ah ha” moment I had when I read their proposal. For most of you this is old news, but for some of you this is new. In their proposal, they saw a growing problem in their underserved community. Infant mortality rate was high due to the fact that mothers did not have adequate access to prenatal care. So, in order to curtail this, they are deploying BRT to help improve the headways along a route to a medical campus.
While this is well and good, it is a long way away from being deployable on a larger scale. Schemes like this usually take years to develop. Not only must you have the money, but you also must have the political support, staff know-how, will to make a change, etc. This is a heavy handed approach. What can we do with a smaller budget, less staff resources, and a quicker turn-around?
The idea: Data-Sharing
The idea is data-sharing, but not on a level that we have traditionally done. This would be a data share agreement with medical service providers (MSPs) (doctors, campuses, etc.) and the transit authorities. The goal would be to match appointment times of patients with recurring medical procedures to quality and on-time transit so that all residents have equitable access to high-quality healthcare.
That got me thinking: what other sort of medical procedures require consistent care, frequent visits to the doctor, and a long time frame? Are we only considering the prenatal care, which takes a process of less than 9 months, or should we look at other Do we be everything to everyone or be more focused?
Some key tenants of potential conditions would be:
- Habitual treatment at the same center
- Close to or directly on an existing bus route
- Requires zero to one transfers for
- Zero transfers between routes would not have the largest benefit, while one transfer may have the ability to save a multitude of time
Two such procedures come to a plebe like myself: kidney dialysis and chemotherapy.
You may be asking yourself: this is all well and good for the warm-glow altruistic person like yourself So why is this important? Why do medical services matter when trying to provide transportation? Shouldn’t we just focus on the home-based work trip and improve commute times?
Short answer: NO!
There are two reasons why we as an industry need to start considering a more nuanced approach to our transportation system by using Smart Communities style implementations. The first is that there is a growing population that does not have a vehicle. According to a 2014 study by FHWA, nearly 20% of trips by those in poverty are done by something other than a vehicle. As we are in the business of providing equitable access to transportation for all, we should consider the needs and concerns of this subset of the population base.
The second reason (and the more engineer-y reason) is that by optimizing routes based on the need of the service and not just on headway numbers, we can hopefully provide more transit with higher riders-per-bus than is normally done.
By matching market needs (demand) with the availability of the routes (supply), we can apply a more focused and market-based approach.
How it would work
Step 1 – Data sharing agreement
This data sharing agreement would be simple at first. As the lifecycle for a transit schedule is 3-5 years, it would be difficulty (nay impossible) to change this information on a near-real time basis. However, the first step would be to make an agreement to share critical data.
Step 2 – Validation
The second step, would be to validate a concern like this, either via anecdotal evidence & conversations with providers. By using kidney disease as an example, data would include:
- Rates of poverty in a certain area (usually correlate with time-based employment and would be
- Rates of missed appointments (extractable through the MSPs system, as they tend to discourage people with habitual missed appointments)
- Concentration of people on a wait-list for a kidney transplant
Step 3 – Integration
The third step would be the technical side, and would require the majority of funding. This would involve the integration of systems, including the institution of an Enterprise Data Management, staff resources for meetings, disclosures of NDAs, testing and validating, etc. etc. However, with a one-way data feed, and with the institution agreements in place, the process becomes much easier.
This, while seemingly simple in theory, is incredibly difficult in practice, which I believe is one of the main reasons more innovative approaches like this are not being taken. Again, not to discredit the transportation industry, but even I am having trouble understanding the benefit/cost of all this effort. If we share data, how much effort will it be to get information from all these different electronic medical systems? Will they be exportable in a XML format? How much time/research is needed to talk with vendors? Do I need software knowledge?
However, with all the complexities with this effort, and ITE’s push to link transportation and public health, I think, at the very least, we should be pushing the envelope and start developing the communities we would want to live in. Data, and data sharing, is the spark that ignites these possibilities.
So what do you think? Is this a viable solution? Too hard? Not hard enough? Share your thoughts below.
*These ideas and posts are not solely my own, and I borrow very liberally from the great work folks are doing across the industry. My goal is to try and attribute credit when and where it is due, and, if any of these ideas are old or already being done, I welcome critiques, thoughts, ideas, etc. to further the community.