How Health Informatics, HIE Can Mitigate Impacts of Climate Change

Siloed data across the healthcare industry presents challenges for health information exchange (HIE). However, when a crisis strikes, the health informatics community can optimize data infrastructure to drive interoperability, according to Titus Schleyer, DMD, PhD, a research scientist at the Center for Biomedical Informatics of the Regenstrief Institute.

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"We can build bridges where there were no bridges, and we can put data together to solve a problem, but we are best when there's a real crisis," Schleyer said in the most recent podcast episode of Healthcare Strategies.

Take the COVID-19 pandemic, for example.

COVID-19 spurred healthcare organizations and HIEs to streamline case reporting with state health departments and create community dashboards to address disparities in COVID-19 infections.

At Regenstrief Institute, researchers utilized an open-source EHR to collect and forward patient data to the Indiana Health Information Exchange (IHIE) to aid emergency medical services with an influx of COVID-19 patients. The system was available in less than two weeks.

"What I hear from my hospital and healthcare system colleagues is that COVID-19 made things happen in a matter of days and weeks that would've taken us years and decades without it," said Schleyer, who also serves as a biomedical informatics professor at Indiana University School of Medicine.

According to Schleyer, it's time for health informatics and public health to team up to address one of the most urgent public health challenges of our lifetime: climate change.

"More and more people, especially younger generations, are concerned about climate change and are asking what we can do about it," he said. "The rising level of interest in the informatics community in climate change is a very encouraging sign."

Informatics can help address or mitigate the health impacts of climate change in several ways, Schleyer said.

For instance, if public health departments knew who was at risk for heat stroke, they could direct resources in a more targeted fashion during heat waves. Similarly, integrating environmental data with public health data could help health departments mitigate the health impacts of wildfires among vulnerable populations. 

"If I knew where the wind blows during a wildfire, I would know which areas would likely experience a decrease in air quality," said Schleyer. "Then I would focus on the people with asthma or other respiratory diseases in that area so I can make sure that they don't get too sick."

Health informatics could also aid in monitoring the migration of diseases due to climate change. For example, scientists anticipate the appearance of malaria, dengue, and Chagas in areas where they have never been due to the shifting weather around the globe. Health informaticians could monitor EHR databases to track those diseases and deliver targeted support to clinicians.

"We can help physicians and other clinicians with advice on how to diagnose Chagas," he suggested. "Most people have not seen a case of Chagas in their lives."

However, harnessing data to address the health impacts of climate change is challenging due to disconnected data across healthcare systems, public health authorities, and emergency response systems like fire departments.

"If we had a magic wand and, in an instant, could connect all the data systems we wanted to connect, I think the impact would be huge," Schleyer added.

While there is no quick fix to connecting siloed data systems across public health and emergency response systems, Schleyer said the encouraging thing is informaticians, public health leaders, and healthcare systems are coming together to discuss the path ahead.

"We need to work on systems that exchange data much more fluidly," Schleyer said. "That means we need to get the people who own the data and who collect the data together."

Recently, Regenstrief Institute co-hosted a mini-summit at the American Medical Informatics Association (AMIA) 2023 Annual Symposium to address how informatics can help resolve health issues caused by climate change. 

The mini summit, co-led by AMIA, the International Medical Informatics Association (IMIA), and the International Academy of Health Sciences Informatics (IAHSI), took place at the AMIA annual symposium in New Orleans.

Schleyer noted that the symposium's location allowed for unique perspectives on the impact of climate change on health. With wildfires, floods, heat events, and saltwater intrusion into the Mississippi, Louisiana is a microcosm of climate change effects, he said.

A panel discussion with representatives from the Louisiana Department of Health and the Tulane University School of Public Health and Tropical Medicine provided context for the discussion on climate and health informatics.

"They talked about coping with disasters, predicting where events such as heat events and wildfire-associated disease or respiratory events would take place," Schleyer noted. "That gave us a real flavor for what it is like to live with the effects of climate change."

From there, event attendees brainstormed their ideas on what healthcare and health informatics can do to adapt or mitigate climate change. The group then created an early action framework and research agenda for climate, health, and informatics, which will be the topic of an editorial for a major journal.

"We're going to work with our partners to create more awareness," Schleyer said. "I want to follow up with a larger conference that will develop a much more robust action framework and research framework for this area. Hopefully, we can make an impact as soon as possible."