It would be useful to know where each healthcare:speciality=* is practiced inside a big hospital with multiple buildings. I went through the wiki, and found that this tag is recommended to be put together with amenity=hospital,clinic,doctors. But that removes the useful granularity.
So how do we map this? I thought maybe the “keep it simple” principle is the best, and just add healthcare:speciality=* to a building, building:part, or anything else inside a hospital. Maybe just a node. And then add all specialities to the hospital element itself.
If a building has healthcare:speciality=*, but isn’t inside a hospital or clinic, than it’s a useless tag. It would only make sense if it was inside a hospital, clinic or doctors.
In my area we use to place nodes with amenity=clinic inside bigger amenity=hospital complexes. Those are then tagged with healthcare:speciality=*. We usually do not use the building geometry to map what’s inside.
IMHO the solution is to represent these subdivisions and add the tag there, for universities this could be tags like “faculty”, “institute”, “department” and similar (and it is not easy or straight, because these institutions tend to be organized in different ways). If we do not have suitable tags available (clinic may be ok, but I am not sure, it is also used for standalone facilities, so maybe this would be a distinction we would somehow want to make), we should develop something new.
We need a general tag for a hospital part, like healthcare=hospital_part. If you know more about the part, you would specify with existing tags like healthcare=birthing_center or healthcare=laboratory, and maybe invent something new like healthcare=outpatient, healthcare=inpatient, healthcare=operating_rooms…
I think this is a strawman objection, and “perfect being the enemy of the good”. Most hospitals are mapped as areas and clinics within a hospital area can be readily filtered out if you want to count them.
Many clinics within hospitals work for the patient just as if they would if not located on the hospital grounds. In the main they work as stand-alone healthcare services. The primary use-case is for a patient to find where a clinic is within large hospital campuses. The node as clinic approach works well. Also note that some clinics are not departments (most outpatient clinics will be shared by multiple departments over the week, with consultants from given specialties having single out-patient sessions).
If you want to refine it you could use some subtag for the clinics (e.g., cliniic=standalone; clinic=hospital_facility …).
Note that hospital campuses with multiple hospitals are now quite common (e.g., Birmingham Edgbaston campus houses a military hospital, a regional teaching hospital (Queen Eliazabeth Hospital) and a womens’ hospital; Addenbrookes at Cambridge houses the main regional teaching hospital Addenbrookes itself, the Royal Papworth Hospital and the Rosie Maternity Hospital as well as two biomedical research centres and a regional blood transfusion centre). In the latter case the campus is mapped as a hospital (which it is not) and the only hospital within a hospital mapped is not a hospital either. All of these issues complicate counts as well as all kinds of health facilities in Africa and Asia being mapped as hospitals.
Depending on the healthcare system, that may not be entirely wrong. Certainly in the UK different departments within one building may be anywhere on a line between “essentially part of the main hospital” to “essentially independent” (they may be run by a completely separate company to the main hospital trust, for example).
However, trying to provide a better “patient-centric” view of what is where still makes sense.
Ok, I agree, there might be big hospital campuses where each department is actually a whole clinic. So there is probably a fuzzy line between those two cases, where you would stop using healthcare=clinic, and start using healthcare=department, and neither is wrong.
But even there, those clinics inside a hospital would themselves sometimes have different departments. So even in those cases we need this new tag.
I started writing the proposal for healthcare=department.
Isn’t the term “clinic” for ambulatory care? The wiki says explicitly that it “doesn’t admit inpatients”. Then it is not suitable for the situation of several departments / organizational units / specialties of a hospital in general (but just for some cases).
To be clear, the wiki says “does not admit inpatients”. How the admin is handled is an entirely different issue, often not observeable on the ground. I don’t see how “it is not suitable” follows from this - are you suggesting that most people who visit some part of a hospital for some reason are inpatients? In my part of the world at least, that is simply not the case.
No, what I meant to say was that a common situation is a “hospital” which consists of different departments, also specialized (e.g. brain cancer and similar neuro-problems, i.e. people who have had or will have chirugical interventions on the brain), and they will have inpatients. One of the most basic distinctions is between surgery and medical clinic (the former about people being “cut” and the latter about curing them without opening, said in simple language). Both types of departments will often have inpatients. Then there are lots of specialized hospitals (e.g. skin, eyes, teeth, “children”, women, orthopedy, etc.) which all may be operating independently or as part of a bigger structure.
The problem is, amenity=clinic was separated from amenity=hospital by giving it an intrinsic feature of not taking inpatients. And now if you want to tag a major high-level part of a hospital that does take inpatients, you have no tag.
Standard UK usage for hospital visits is out-patient, in-patient and day case. It is easy to tell the latter two from the first because you are given an identifying wrist bracelet with a hospital number on it (a few years ago I had a diagnostic test where the machine used was located in the day hospital and I had to be formally admitted as a patient, even though it was only for 30 minutes).
I think that ambulatory care may not only cover out-patients, but also other healthcare services provided by, for instance, GP practices, or in the US HMOs. The key thing for typical out-patient attendance is that the care is usually under a named consultant (from a given specialty). An out-patient visit might be part of a single “episode of care” (e.g., maternity services are a complex mixture of clinic visits, hospital stay etc) or a standalone episode.
Some hospital clinics may offer non-consultant led services for long-term conditions: for instance, ear cleaning (wax removal etc.) was provided at my local hospital.
I no longer have any idea if there is a good open data framework for healthcare in Europe which might help, although there were certainly initiatives 30 years ago and the NHS model is a very rich one which is always worth consulting.