Classifying hospitals (Was: Deprecate healthcare=centre)

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Classifying hospitals (Was: Deprecate healthcare=centre)

Graeme Fitzpatrick
Following on from Joseph's discussion re healthcare=centres, I'd also like to have a similar discussion re hospitals.

On Sun, 10 Jan 2021 at 11:56, Joseph Eisenberg <[hidden email]> wrote:
If it has inpatient beds where you can stay overnight with a nurse on call, 24/7, if needed, then it is an amenity=hospital.

I've been doing some work on hospitals while also talking to our State Govt about getting approval to use their data-base to update everything state-wide.

On Sun, 10 Jan 2021 at 11:34, Paul Allen <[hidden email]> wrote:

In parts of the UK, "cottage hospitals" (small hospitals with a minor injuries
unit but no A&E, and with some beds) are being phased out and replaced
by "integrated care centres." 

We have similar sounding Health Centres in rural areas, with some named as "Hospital" & others not. The Health Dept classification seems to be that if it has an Emergency Room, it's a Hospital; if not, it's only a Clinic.

Since it is already hard enough to distinguish amenity=clinic from amenity=doctors, it would be hard to add a third level of outpatient facility larger than a clinic. (I would be interested in a new tag for outpatient surgery facilities which have specialized operating rooms but no inpatient beds,

One of the things that I've noticed while working with them was that there are a number of places tagged as hospitals.

The doctor's offices, dental surgery, ambulance stations, pharmacies & vet surgery!, that I found, are simply wrongly tagged, which is easy to correct.

I'm a bit concerned though about the other places that are more or less correctly tagged as hospitals.

As above, I think that we'd all agree that a "hospital", be it either Public or Private, accommodates inpatients in a bed with 24 hour nursing care, & also has an Emergency ward.

However, there are also a number of others:

Day Surgery Centres, where you go for an in & out surgical procedure, but where you don't actually stay overnight. Some of these do have a limited number of beds available so you can stay, if you're not well enough to go home, but that's apparently pretty rare.

Private facilities that aren't equipped for any form of surgery or emergency, but are intended to treat people for things like drug &/or alcohol dependency.

Similar to these, dedicated mental hospitals.

Should we distinguish better between places that you can go to for emergency medical treatment, & others that can't do anything for you, than just an emergency=yes?

That would then lead to a discussion on carto re rendering them.

ATM, all "hospitals" are rendered with the mini-Swiss flag / reverse Red Cross (which I know is also somewhat controversial). Should we also look at changing that?

Thanks

Graeme

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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Stefan Tauner
On Sun, 10 Jan 2021 15:15:52 +1000
Graeme Fitzpatrick <[hidden email]> wrote:

> Day Surgery Centres, where you go for an in & out surgical procedure, but
> where you don't actually stay overnight. Some of these do have a limited
> number of beds available so you can stay, if you're not well enough to go
> home, but that's apparently pretty rare.

*=clinic IMHO, even if there exist a few (rarely used) beds for
inpatients; or *=hospital if these beds are not so rarely used
or it is impossible to determine how often they are used.

> Private facilities that aren't equipped for any form of surgery or
> emergency, but are intended to treat people for things like drug &/or
> alcohol dependency.
>
> Similar to these, dedicated mental hospitals.

As a European I don't get why "private" is mentioned so often in these
discussions. It is completely irrelevant who pays for the treatment
when discussing the treatment facility itself. I bring this up because
there are of course numerous facilities as described above that are not
private around here, e.g., public needle exchanges and consulting
facilities for addicts.

While I don't like the variety for healthcare=* tags the most
conforming approach would be to add extra values for these things.

> Should we distinguish better between places that you can go to for
> emergency medical treatment, & others that can't do anything for you, than
> just an emergency=yes?

I don't see how something else would improve anything. In case of an
*emergency* I would definitely try any place that remotely looks like
there could be medical staff be around :)

> That would then lead to a discussion on carto re rendering them.
>
> ATM, all "hospitals" are rendered with the mini-Swiss flag / reverse Red
> Cross (which I know is also somewhat controversial). Should we also look at
> changing that?

Off-topic here IMO.

--
Kind regards/Mit freundlichen Grüßen, Stefan Tauner

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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Graeme Fitzpatrick



On Sun, 10 Jan 2021 at 20:33, Stefan Tauner <[hidden email]> wrote:

> Private facilities that aren't equipped for any form of surgery or
> emergency, but are intended to treat people for things like drug &/or
> alcohol dependency.

As a European I don't get why "private" is mentioned so often in these
discussions.

Good question!

It is completely irrelevant who pays for the treatment
when discussing the treatment facility itself.

That is the main distinction though, at least in Australia, although I know that it changes around the world. In a "private" hospital, you personally (or your health insurance fund) will pay for it, while a public hospital is funded by the Government so you won't pay for treatment.

In case of an *emergency* I would definitely try any place that remotely looks like
there could be medical staff be around :)

Except that these sort of facilities aren't equipped to treat emergencies :-(

Thanks

Graeme

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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

dieterdreist
In reply to this post by Stefan Tauner
Am So., 10. Jan. 2021 um 11:33 Uhr schrieb Stefan Tauner <[hidden email]>:
> Private facilities that aren't equipped for any form of surgery or
> emergency, but are intended to treat people for things like drug &/or
> alcohol dependency.
>
> Similar to these, dedicated mental hospitals.

As a European I don't get why "private" is mentioned so often in these
discussions.



I am also European and can assure you the situation in Europe really isn't homogenous at all, variations from one country to another vary by large (maybe not much between Austria and Germany, but definitely in other countries). I agree that "private" is not a clear term and is not the kind of information you are most interested in.

 
It is completely irrelevant who pays for the treatment
when discussing the treatment facility itself.


It is completely relevant for someone searching for a place to get medical treatment, whether they will have to pay the treatment themselves or if it will be paid for by someone else (national health service, health insurance etc.). I agree we should try to capture some aspects of this at least. For example in Italy there are many privately run places which have agreements / are recognized by the national health service and it will be paid as if you went to a publicly run structure. This is very relevant for almost everyone.


> Should we distinguish better between places that you can go to for
> emergency medical treatment, & others that can't do anything for you, than
> just an emergency=yes?

I don't see how something else would improve anything. In case of an
*emergency* I would definitely try any place that remotely looks like
there could be medical staff be around :)


There are also places which have only a specialized emergency departments, e.g. I have seen places for just gynocological emergencies, similarly if you have injured your eye it might be best to go to an ophthalmic hospital while for any other injury it will probably be a bad decision (assuming you have the comfort of choice, in most parts of the countryside and far from cities you might not find these highly specialized hospitals anyway).


Cheers
Martin


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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Frederik Ramm
Hi,

On 11.01.21 11:17, Martin Koppenhoefer wrote:
>     It is completely irrelevant who pays for the treatment
>     when discussing the treatment facility itself.
>
> It is completely relevant for someone searching for a place to get
> medical treatment, whether they will have to pay the treatment
> themselves or if it will be paid for by someone else (national health
> service, health insurance etc.).

But should we strive to make OSM the service where someone comes
searching for a place to get medical treatment?

I am against modeling free contracts between business entities in OSM.
Does a certain supermarket participate in a certain rebate scheme? Is a
certain hotel member of a certain tourist association? Does a certain
doctor have a contract with a certain health insurance? - All these, in
my opinion, do not belong in OSM.

If someone is looking for the right medical facility to treat them, they
should make their decision based on recommendations or on some
specialist directory for the medical profession, and they can then use
OSM to find out how to get there (or they can use OSM to first narrow
down the list to those that are within easy reach).

If every now and then someone goes over the top and tags business
details onto an object in OSM, let them do it, but let us not go so far
as to consider such uses when we set up tagging recommendations. OSM is
not a business (or medical facility, ...) directory.

Bye
Frederik

--
Frederik Ramm  ##  eMail [hidden email]  ##  N49°00'09" E008°23'33"

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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Stefan Tauner
In reply to this post by dieterdreist
On Mon, 11 Jan 2021 11:17:51 +0100
Martin Koppenhoefer <[hidden email]> wrote:

> > As a European I don't get why "private" is mentioned so often in these
> > discussions.  
>
>
> I am also European and can assure you the situation in Europe really isn't
> homogenous at all, variations from one country to another vary by large
> (maybe not much between Austria and Germany, but definitely in other
> countries). I agree that "private" is not a clear term and is not the kind
> of information you are most interested in.
>
>
>
> > It is completely irrelevant who pays for the treatment
> > when discussing the treatment facility itself.  
>
>
>
> It is completely relevant for someone searching for a place to get medical
> treatment, whether they will have to pay the treatment themselves or if it
> will be paid for by someone else (national health service, health insurance
> etc.). I agree we should try to capture some aspects of this at least. For
> example in Italy there are many privately run places which have agreements
> / are recognized by the national health service and it will be paid as if
> you went to a publicly run structure. This is very relevant for almost
> everyone.


The subject of the discussion is how we can better cover the overlaps/
gaps between healthcare=doctor, clinic and hospital. You are dragging my
statements completely out of that context. Let me be more blunt: I am
pretty sure nobody wants to propose heathcare=private_clinic,
healthcare:speciality=very_expensive_eye_surgery_only_covered_by_healthcorp
etc. These aspects can be covered if somebody feelds like it but they
are irrelevant when defining tagging schemes for globally-used
categories of healthcare facilities.

> assuming you have the comfort of choice

If you have the liberty to query OSM and decide where you want to seek
medical assistance then it is not a medical emergency in my book.

--
Kind regards/Mit freundlichen Grüßen, Stefan Tauner

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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Tagging mailing list
In reply to this post by Frederik Ramm
Jan 11, 2021, 11:30 by [hidden email]:
Hi,

On 11.01.21 11:17, Martin Koppenhoefer wrote:
It is completely irrelevant who pays for the treatment
when discussing the treatment facility itself.

It is completely relevant for someone searching for a place to get
medical treatment, whether they will have to pay the treatment
themselves or if it will be paid for by someone else (national health
service, health insurance etc.).

But should we strive to make OSM the service where someone comes
searching for a place to get medical treatment?

I am against modeling free contracts between business entities in OSM.
Does a certain supermarket participate in a certain rebate scheme? Is a
certain hotel member of a certain tourist association? Does a certain
doctor have a contract with a certain health insurance? - All these, in
my opinion, do not belong in OSM.
+1 And if someone really wants to maintain such info - then
it is possible to link such databases to OSM.

(external database may match OSM object via
recording location + type match or something smarter)
If someone is looking for the right medical facility to treat them, they
should make their decision based on recommendations or on some
specialist directory for the medical profession, and they can then use
OSM to find out how to get there (or they can use OSM to first narrow
down the list to those that are within easy reach).
OSM is not really suitable for such info, even opening_hours is on
border of usability

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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Tagging mailing list
In reply to this post by Graeme Fitzpatrick

I think you need to be careful here: what counts as a hospital will vary greatly according to the status of the healthcare system & population density.

The number of hospitals with emergency departments (a&e, trauma) is declining because the best patient outcomes occur in large centres with 24/7 coverage & a broader range of diagnostic tools. Notwithstanding this every local closure of an emergency department is fought fiercly (at least in UK & Ireland).

Just because a hospital does not have an emergency department, does not mean that it doesnt accept emergency admissions (better thought of as unplanned, although some will be true emergencies). Smaller hospitals in the UK are now likely to be GP-led (i.e., there are no dedicated consultant staff, but they will cover out-patient clinics (perhaps with a roving consultant), minor injuries, simpler diagnostics (biopsies, bloods etc), day case surgery (e.g., in-grown toenails), and will have a number of in-patient beds. They may even offer maternity services, but am not sure of that. So these are still hospitals not clinics. Case in point & the one I know best is Campbeltown Hospital which is needed because it's over 200 km over poorish roads to the big hospitals in Glasgow & true emergencies dont get an ambulance but a helicopter.

At the other end of the spectrum there are tertiary hospitals which only accept patients referred from another hospital. There are quite a number in London, such as the Royal Marsden (cancer), the National Hospital (neurology), Hammersmith (national tertiary centre), and a few others scattered across the country (e.g., Papworth in Cambridge).

Psychiatric hospitals are also of this type, and in some countries there are probably still centres treating TB.

The NHS data model has precise detailed definitions of the entire vocabulary of healthcare, and similar work was done some 30 years ago on a pan-European basis (RICHE Esprit project). The former at least is a useful place to check ideas for tagging on OSM.

tl;dr: absence of an emergency department does not stop something being a hospital.

J

On 10/01/2021 05:15, Graeme Fitzpatrick wrote:
Following on from Joseph's discussion re healthcare=centres, I'd also like to have a similar discussion re hospitals.

On Sun, 10 Jan 2021 at 11:56, Joseph Eisenberg <[hidden email]> wrote:
If it has inpatient beds where you can stay overnight with a nurse on call, 24/7, if needed, then it is an amenity=hospital.

I've been doing some work on hospitals while also talking to our State Govt about getting approval to use their data-base to update everything state-wide.

On Sun, 10 Jan 2021 at 11:34, Paul Allen <[hidden email]> wrote:

In parts of the UK, "cottage hospitals" (small hospitals with a minor injuries
unit but no A&E, and with some beds) are being phased out and replaced
by "integrated care centres." 

We have similar sounding Health Centres in rural areas, with some named as "Hospital" & others not. The Health Dept classification seems to be that if it has an Emergency Room, it's a Hospital; if not, it's only a Clinic.

Since it is already hard enough to distinguish amenity=clinic from amenity=doctors, it would be hard to add a third level of outpatient facility larger than a clinic. (I would be interested in a new tag for outpatient surgery facilities which have specialized operating rooms but no inpatient beds,

One of the things that I've noticed while working with them was that there are a number of places tagged as hospitals.

The doctor's offices, dental surgery, ambulance stations, pharmacies & vet surgery!, that I found, are simply wrongly tagged, which is easy to correct.

I'm a bit concerned though about the other places that are more or less correctly tagged as hospitals.

As above, I think that we'd all agree that a "hospital", be it either Public or Private, accommodates inpatients in a bed with 24 hour nursing care, & also has an Emergency ward.

However, there are also a number of others:

Day Surgery Centres, where you go for an in & out surgical procedure, but where you don't actually stay overnight. Some of these do have a limited number of beds available so you can stay, if you're not well enough to go home, but that's apparently pretty rare.

Private facilities that aren't equipped for any form of surgery or emergency, but are intended to treat people for things like drug &/or alcohol dependency.

Similar to these, dedicated mental hospitals.

Should we distinguish better between places that you can go to for emergency medical treatment, & others that can't do anything for you, than just an emergency=yes?

That would then lead to a discussion on carto re rendering them.

ATM, all "hospitals" are rendered with the mini-Swiss flag / reverse Red Cross (which I know is also somewhat controversial). Should we also look at changing that?

Thanks

Graeme

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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Graeme Fitzpatrick
In reply to this post by Stefan Tauner


On Mon, 11 Jan 2021 at 20:51, Stefan Tauner <[hidden email]> wrote:

The subject of the discussion is how we can better cover the overlaps/
gaps between healthcare=doctor, clinic and hospital.

Thanks!

nobody wants to propose heathcare=private_clinic, healthcare:speciality=very_expensive_eye_surgery_only_covered_by_healthcorp
etc.

I probably shouldn't have used the term Private, but I didn't intend it to refer to Private Health Insurance, I really meant Private as they are not usually open to the general public.

If you have the liberty to query OSM and decide where you want to seek
medical assistance then it is not a medical emergency in my book.

However, if you're in a strange town, have a medical problem, & open up the map on your phone, it will show you that there's a "hospital" "Here". It would be good to be able to specify that that place you're seeing on the map, is actually able to assist you, rather than driving up to it to find a mental facility.


Thanks

Graeme


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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Stefan Tauner
On Tue, 12 Jan 2021 12:51:10 +1000
Graeme Fitzpatrick <[hidden email]> wrote:

> However, if you're in a strange town, have a medical problem, & open up the
> map on your phone, it will show you that there's a "hospital" "Here". It
> would be good to be able to specify that that place you're seeing on the
> map, is actually able to assist you, rather than driving up to it to find a
> mental facility.

There should absolutely be a tag for that - and IMHO there is:
healthcare:speciality (=psychiatry, there is also child_psychiatry,
neuropsychiatry). They are not documented/approved for clinics or
hospitals though, and the healthcare=counselling and psychotherapist
tags do not fit the healthcare scheme very well at all (or my abstract
reality does not fit the healthcare scheme if you prefer ;)

However, this is still not the subject of this thread but to restate it:
I am absolutely in favor of classifying hospitals that have a certain
focus.

--
Kind regards/Mit freundlichen Grüßen, Stefan Tauner

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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Tom Pfeifer
On 12.01.2021 08:38, Stefan Tauner wrote:
> There should absolutely be a tag for that - and IMHO there is:
> healthcare:speciality (=psychiatry, there is also child_psychiatry,

For the target groups, we have an approach in the social_facility=* key that
works well, using social_facility:for=*

Thus we can lower the number of healthcare:speciality=* values if we tag the
target group separately, in this case:

healthcare:speciality=psychiatry
healthcare:for=child

tom


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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

dieterdreist
In reply to this post by Frederik Ramm
Am Mo., 11. Jan. 2021 um 11:32 Uhr schrieb Frederik Ramm <[hidden email]>:
But should we strive to make OSM the service where someone comes
searching for a place to get medical treatment?


it could serve for different purposes, for example to analyze the coverage and distribution, but also to replace what people are now doing in google maps: get an idea of the options around you.
 


I am against modeling free contracts between business entities in OSM.
Does a certain supermarket participate in a certain rebate scheme? Is a
certain hotel member of a certain tourist association? Does a certain
doctor have a contract with a certain health insurance? - All these, in
my opinion, do not belong in OSM.


I agree, for detail at this level, but I would see it differently when it is about the national health system, regarding literally every citizen of the country (this depends vastly how health care is organized). I would not map the individual agreements of health insurances, but if a country has an important national system, it may be a basic information whether a facility is recognized or not. For the example the German situation is quite different from the Italian situation in this regard, from my experience, it is not a question that seems important in Germany because you can basically go anywhere you want and will be covered by insurance (but it may depend where you want to go, I am not sure this is universally valid, surely there are treatments which are not covered).

 

If someone is looking for the right medical facility to treat them, they
should make their decision based on recommendations or on some
specialist directory for the medical profession, and they can then use
OSM to find out how to get there (or they can use OSM to first narrow
down the list to those that are within easy reach).


agreed. Just that I believe you could already separate all that provide basic coverage (public structures and those which are partnering / are accepting prescriptions) from the rest. If there is not basic coverage, you do not have to tag this. We are already doing something similar right from the start for pharmacies btw, dispensing=yes and no.

 

If every now and then someone goes over the top and tags business
details onto an object in OSM, let them do it, but let us not go so far
as to consider such uses when we set up tagging recommendations. OSM is
not a business (or medical facility, ...) directory.


Yes, as always there is a line behind which the detail is too much, a level we will not likely be able to manage, keep things up to date, get sufficient coverage to make sense of it, etc., and there is a more "general detail level" where we agree it is advisable to add this kind of information (business names and brands or webpage links, the distinction between a pub and a restaurant, for example). And there is a grey area in between, some people say, we do not need phone numbers as we are not a business directory, others are happy to make use of them. 

Cheers,
Martin

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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Joseph Eisenberg
In reply to this post by Tom Pfeifer
Child Psychiatry isn’t a psychiatrist who advertises their mental health services for children. They are a separate sub-specialty, just like how pediatricians are different from general practice or family medicine or internal medicine.

— Joseph Eisenberg

On Tue, Jan 12, 2021 at 3:33 AM Tom Pfeifer <[hidden email]> wrote:
On 12.01.2021 08:38, Stefan Tauner wrote:
> There should absolutely be a tag for that - and IMHO there is:
> healthcare:speciality (=psychiatry, there is also child_psychiatry,

For the target groups, we have an approach in the social_facility=* key that
works well, using social_facility:for=*

Thus we can lower the number of healthcare:speciality=* values if we tag the
target group separately, in this case:

healthcare:speciality=psychiatry
healthcare:for=child

tom


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Re: Classifying hospitals (Was: Deprecate healthcare=centre)

Tom Pfeifer
Without doubt the child psychiatrist has a different qualification than her colleague for adults.
However in OSM we don't tag peoples qualification or the suitability of staffing a facility,
we focus on the facilities. As you say yourself, it is a _sub_-speciality, thus _sub_-tagging
would be fine.

tom

On 12.01.2021 16:28, Joseph Eisenberg wrote:

> Child Psychiatry isn’t a psychiatrist who advertises their mental health services for children. They
> are a separate sub-specialty, just like how pediatricians are different from general practice or
> family medicine or internal medicine.
>
> — Joseph Eisenberg
>
> On Tue, Jan 12, 2021 at 3:33 AM Tom Pfeifer <[hidden email] <mailto:[hidden email]>>
> wrote:
>     Thus we can lower the number of healthcare:speciality=* values if we tag the
>     target group separately, in this case:
>
>     healthcare:speciality=psychiatry
>     healthcare:for=child

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