Environmental health is here! No, I am not referring to the environmental health that had Jake Gyllenhaal running around Manhattan attempting to escape extreme weather. Nor am I referring to the inconvenient truths that Al Gore warned us not to ignore. That environmental health is incredibly important. With the ice storms, polar vortexes and frost quakes of 2014 it wouldn’t surprise me to find Mr. Gyllenhaal seeking shelter in my local library. However, I am referring to a different sort of environmental health: those environmental factors that affect human health outcomes and how the new capabilities available in Hospital Information Systems, HIS, can aide in the detection, isolation and resolution of environmental issues that contribute to negative health outcomes.

What is environmental health?

The environment affecting health is certainly not a new concept. The idea of air pollution affecting respiratory health has been well documented. In Smith, Corvalán and Kjellström’s 1999 article How Much Global Ill Health Is Attributable to Environmental Factors? the environmental impacts on human health are broken out into disability-adjusted life years, or DALYs. The article illustrates how environmental factors affect DALYs and ultimately human longevity. What is significant in their findings is that environmental factors contribute to nearly a quarter of all human disease.

The above graphic illustrates one dimension of the impact the environment has on human health, however it is limited in its scope. In a 2014 study the European Environment Agency makes further correlations to environmental impacts on human health. Disease is one manifestation of poor environmental health, but environmental factors can contribute to additional adverse outcomes that affect community health and general well-being. The following graphic outlines how environmental factors contribute to both physiological health and non-physiological health.

Whether it is noise, pollution, or stress, humans are deeply intertwined with their surroundings. Therefore, it isn’t a surprise that a poor surrounding environment can result in poor population health.

How does environmental health relate to hospital information systems?

Hospital Information Systems are undergoing a transformation. Most HIS’s are still operating using their DOS based beginnings. This implement of the late 20th century was, by modern standards, a rudimentary supply chain system that captures a patient’s transitions and interventions throughout their hospital journey.  Data captured in these systems are relatively disparate and not as robust as many of the data rich HIS solutions being offered in the market today. As these legacy systems transition to their modern counterparts it opens a new opportunities for environmental health.

One of the key value propositions that modern HIS vendors espouse is the availability of large data sets. In addition to large data sets, HIS vendors point to their now native capabilities to break down these data sets and analyze the information they hold from a variety of vantage points. But what does all this discussion about data mean? It’s more than a collection of buzz words, charts and tables. The real value proposition can be found in the real life stories that affect people.

I recall in particular one story a hospital leader shared about how their hospital leveraged health data to attempt to see trends in diagnoses among their patient population. In this instance the hospital discovered a rise in diabetes diagnoses in children. Upon reviewing the data further the organization was able to isolate these cases to a particular geography. The organization took this information and leveraged Geographic Information System, GIS, data. By overlaying the health data with municipal data the team was able to identify a ‘food desert’, or an area that had no easily accessible fresh food grocery options. The only immediately local possibilities were fast food restaurants. The hospital began working with local resources to provide fresh food ‘pop-up’ locations to provide the community with easily accessible healthy options.

I found this particular application of environmental health compelling. For people who are in healthcare we often focus on transformation of care delivery using the new tools available. However, these tools aren’t only limited to care delivery. The new capabilities that modern Hospital Information Systems offer have potential for  a much broader positive impact on population health.

The coordination challenge: local vs. provincial

The challenge with the implementation of these new capabilities is that they are localized in nature. Hospitals that are replacing their legacy information system are looking at their needs, not necessarily at the broader context of public health. This presents a coordination challenge that is common in Ontario healthcare. New capabilities should not be looked at in isolation. Combining data across multiple information systems have exponential impact and could provide new capabilities to public health agencies across the province.

The good news is that under eHealth 2.0 hospitals are banding their transformation efforts together.  These coordinated efforts will help regions better see environmental health factors affecting their patient population. If these efforts continue to broaden then Ontarians could have a system that is able to manage environmental health at a provincial level.

As healthcare transforms in Ontario it is important that the government leverages these positive change opportunities to so that all Ontarians can benefit from these capabilities today and not the day after tomorrow or beyond.



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