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Today on This Week Health.

A hospital system in Northern California during one of these blackouts had to decide if they wanted to use their generator power.

To either power their EHR or to power their fridges,

If we know there's going to be a wildfire, if we know there's going to be a heat wave, how do we use predictive analytics and tools to be able to better connect those data?

get ahead of those disasters. 

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Hey, everybody. I'm Jake Lancaster. I'm an internal medicine physician and chief medical information officer for BAPTIS based out of Memphis, Tennessee. And today I'm glad to be back with one of my friends, Sarabu, to talk about climate change informatics. Chetan, welcome to the program.

Thank you so much, Jake.

Thanks for having me today.

We have known each other since we're both Clinical Informatics Fellows, and we had a podcast back in the day called Go Live that I think the fellows are still running. But for those that are not familiar with our prior work, can you tell us just a little bit about your background and what you do?

Yeah. Thanks so much, Jake. And it's been great to be on this journey with you and in this new field of clinical informatics. So I am a primary care pediatrician. I'm a clinical assistant professor at Stanford, where I work as a general pediatrician. And then I also have a role at a digital health company called ShareCare, where I'm a senior medical director and director of clinical informatics.

But for my, journey today and discussion about climate health informatics. I also wanted to mention that prior to starting medical school, I studied landscape architecture and so have had a long standing interest in the links between environmental health and human health.

I'm glad we're talking about this.

This has come up recently in one of the episodes we did, and it was a new concept for me. You know, Obviously, climate change is something that we've been hearing about for, for years, but it had not connected it with informatics or really even too much in health care. Just haven't heard as much coming from health care systems.

But what can you tell us about what we've learned over the last few years about the impact of climate on health and then maybe what health care systems are doing? To impact

it. Yeah, thanks so much for asking and framing it that way. And I agree that while there's been a lot of discussion about climate change from the scientific perspective and what we might need to do about it from a societal perspective, there hasn't been as much attention given to the health impacts of climate change.

And that's become increasingly recognized as an area that needs more focus. We know that with a warming planet, there are going to be increased natural disasters. We're already seeing that in place. And with the direct impacts of heat, there are A range of health impacts directly on people, on communities, on health systems, health systems that are in a zone of flooding are susceptible to having operations disrupted by natural emergencies.

People who live in areas and coastal areas and other climate disaster prone areas, such as where I am in California are susceptible to fires. There are a whole range. Of different factors that are exacerbated by climate change that directly impact the health of people in the United States and globally, and we also know that these impacts are felt inequitably communities that are most vulnerable that often have the least means, whether within the US or globally are often the most vulnerable to the health impacts of climate change.

And so that's really how climate change can affect the health of people and communities, or what we might call adaptation, or how do we think about adapting to climate change. And then on the other side of mitigation, which is how do we contribute to climate change, health systems also have a huge role to play.

Currently in the United States, healthcare system is An extremely significant contributor to greenhouse gases. Usually when we think about greenhouse gas emissions, people might think of transportation might think of other, sectors like housing. But our healthcare system accounts for 10% of our country's greenhouse gas emissions which is a pretty significant, significant amount.

If, If the, US healthcare system was its own country, it would be the 13th most polluting country in the world in terms of greenhouse gas contributions.

And what is that? Is that just the footprint? I know hospitals are large, they use a lot of energy, but are there other things unique within healthcare systems that produce greenhouse emissions?

Yeah, so a lot of it does come down to the operations of a healthcare system and the way we Breakdown different emissions are using this system called scope one scope two and scope three scope one and two emissions really have to do with the energy use, which is really the energy that a hospital may generate or the energy it purchases, but then scope three emissions are everything else.

And for health care systems, 85% of the greenhouse gas emissions are scope 3 emissions, and that includes things like transportation of supplies over to the hospital to all of the different clinical operations that go on from the, medications to the supplies that are used. And there are many unique aspects to health care scope 3 emissions.

For example, there are certain anesthetic gases. Which actually are significant greenhouse gases in terms of their potency, and I think one of your other guests, Dr. Priya from UCSF had previously discussed those in the work that's been going on there, and there's a lot of work that's going on right now for exploring the choices that healthcare professionals make, the care decisions that we make, the materials we use, the materials that we can reuse.

Thank All can significantly reduce the greenhouse gas emissions our health care systems.

Those are some great examples. But, I'm sitting here thinking I'm a chief medical information officer. There's a lot of CIOs listening to this, others in informatics and IT. And Most of us don't really feel like we have power to intervene on how much energy the hospital is using.

But what are some of the things that you've seen or you've seen others do to intervene from, I guess, an I. T. perspective?

Yeah. So I think the connection to informatics is not. Immediately obvious, but as you start to dig into it, you realize that there's a lot that informaticians have to offer in addressing climate change from both the adaptation side of how people and communities respond to health disasters from climate, as well as the mitigation side of how we can reduce our health systems impact because if you think about it, what informatics professionals are really good at is we're really good at being able to You break a problem down into measurable quantifiable chunks.

We're able to then drive behavior change and nudges through standardized processes that are scaled. For example, think about what the electronic health record can offer in terms of clinical decision support. And so to make it a little bit more concrete. One of the initiatives that is going on right now across many health systems and has been identified by IHI or the Institute for Healthcare Improvement as a key target area for intervention is to reconsider the use of metered dose inhalers for patients with asthma.

Meter dose inhalers, the asthma inhalers that have the gas propellant actually are significant greenhouse gas contributors. And there's a significant amount of research that shows that if you switch meter dose inhalers to dry powdered inhalers you can significantly reduce greenhouse gas emissions, and some studies actually estimate meter dose inhaler prescriptions to be three percent of a hospital or healthcare system's greenhouse gas footprint.

And so if we want to think about an intervention to change the prescription of meter dose inhalers to dry powder inhalers, There are a number of informatics considerations at play. So there may be an opportunity for having a clinical decision support system or alert that might alert a primary care physician, a pulmonologist who's prescribing an inhaler to consider a greener choice.

Just like on Google Maps, when you, Look at a route between two destinations. You get an option with a green leaf, and that's the more fuel efficient router, the greener route. And so I actually currently have a seed grant exploring this at Stanford, looking at how we might take some of these sustainable care choices and consider them as Clinical decision support interventions that could be integrated into the EHR.

, we're still at this stage of exploring what the best way to do that is, does integrating into the EHR as CDS makes sense or are there other pathways to consider the one other thing to all say here on, on this just on the subject of where informatics plays a key role to be able to measure and quantify a healthcare system or hospitals.

impact reducing greenhouse gas emissions. There's a huge role for quantification to build dashboards, to be able to show people across the healthcare system, how we're achieving some of these goals that health systems are setting.

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Yeah, no, that's a good point. You know, Usually when we're starting something new, we'd like to look at the current state and look at the data related to it.

How do you get data on, I guess, what you're doing as a health system as far as carbon emissions go?

Yeah, that's another key challenge and an important area for informaticians to be involved. Right now the process of identifying the greenhouse gas emissions from different interventions from different treatments within this, the scope three framework are very heterogeneous.

There are some standardized frameworks that have come from organizations like Practice Green Health that's been looking at this for the past 20 years, where they create specific assessments. To be able to quantify and measure these, emissions, but the way one healthcare system applies these calculations and another applies them may be different.

And so there's a role for informaticians to actually help with the standardization of some of this data collection so that we can actually better compare the progress that we're making.

That's a good point. I saw your presentation at Sanford recently where you're talking about this topic, and one of the things you mentioned as an intervention was the difference in telehealth versus in person office visits.

Can you talk about that and how, that plays a role in climate change informatics?

Yeah, definitely. So this is another example of change that may be a greener option, just like I mentioned, using dry powder inhalers instead of meter dose inhalers as a more greener or sustainable care option clinicians have the opportunity to maybe choose a telehealth visit over an in person visit.

And a number of organizations, including Stanford, and I believe the University of Ohio, and a few other institutions have developed calculators to look at the reduction.

The large portion of reductions in emissions are really from decreased travel from the decreased travel of a patient to a clinic decreased travel of a clinician to a clinic if they're able to work from home or reduce the Of travel they have to make as well as not having to prepare an exam room, not having just to sterilize an exam room and change all the supplies there.

So there are a couple of different models that look at the reduction there. But again, each model has its own unique intricacies. And then, because the significant savings is in decreased patient travel time, there's a lot of complexity to how that's calculated. Some of these models just use average patient distance from the hospital.

Some of them may start to get a little bit more granular in looking at the exact mileage Driven, but then you have other considerations of the patient. Get there using public transit that they get there in an electric vehicle. And so, just beginning to explore that. You can see how these models can have a huge variability in the numbers they produce.

Yeah, it just gets me back to the data question about, you know, even just getting your baseline, it will be tricky and could take years. So you provided a lot of good examples, and I think that the idea for clinical decision support for the, anesthetic gases, that one was an amazing example of a way that, But do this and without really causing any significant clinical change or increased costs, which everybody's so conscious of right now.

But where do you see the future of this movement going? Is there anything at the national level that hospitals and healthcare systems need to be aware of?

Yeah, exactly. there is. There's a lot of momentum happening for this. From a national level. There's also a lot of bottom up advocacy going on, but from a, national level the white house and through the office of health and human services have started a organization, an office of climate change and health equity.

And they have put together a pledge. That health care systems from around the country have signed and the pledge largely follows the framework of the Paris climate agreement to get organizations to reduce their greenhouse gas emissions by 50% by 2030 and to be able to get to net zero by 2050. And so, that's a pledge that's That's coming directly from HHS that a lot of healthcare systems have signed on to.

And they recently reopened the pledge. It was initially closed, but it's been reopened. So a number of healthcare systems new healthcare systems are signing on. Then you also have from this office, there's direction at the research level, the NIH and other national research organizations and leaders like AHRQ have started to direct funds to more exploration of climate and health.

Some of this has a informatics component to it as well. And then you have organizations like the National Academies of Medicine and the I, and IHI, the Institute for Healthcare Improvement. Both of them have started collaboratives around decarbonizing the U. S. health sector. And so I'm involved with the IHI collaborative.

So those are some of the. Top down initiatives that are happening really in reducing healthcare systems, carbon footprint. So that's really kind of that top down approach and really on the mitigation side. And then there's also a lot happening on the adaptation side, which is how do health systems prepare for a changing climate.

There's organizations like Crisis Ready that are really... Bringing data driven approach to health systems. I'm thinking about disaster response in communities, but also for health systems themselves out here in California with the number of wildfires we've had over the past few years and continue to see in an increasingly accelerating fashion.

There have been numerous blackouts. Some of them have been planned blackouts to actually prevent fires , from happening. And there was a great article recently, maybe from a few years ago that showed a hospital system in Northern California near Sacramento during one of these blackouts driven by these, these climate driven factors had to decide if they wanted to use their generator power.

To either power their EHR or to power their fridges, which stored vaccines and other perishable medications. And so you could see how that's an informatics decision , that's coming in, in,, into play. I'm really thinking about how do we keep all of these as we increasingly digitize.

It's every aspect of health care. How do we think about how those systems work in events of disasters? But then how do we also use the data? How do we better connect environmental data? If we know there's going to be a wildfire, if we know there's going to be a heat wave, how do we use predictive analytics and tools to be able to better connect those data?

Get ahead of those disasters, both for the health systems, but also the communities that we serve.

Yeah, unfortunately, I still think a lot of our, my physicians would choose to divert power to the refrigerators and away from the EHR. They'd be more than happy to do that. But um, It's been great having you on I've learned a lot about this subject.

Can you tell the listeners where to go if they want more information on climate change and informatics and healthcare?

Yeah, definitely. So I will say there isn't one single resource right now. That is something that I am working , on setting up on being able to create a website that brings more of these, these resources together.

So I would say right now, you can find me on Twitter or LinkedIn if you just search for my name, but then I think if you search for some of the organizations I mentioned from a top down perspective, the office of, health and human services office of climate change and health equity.

The IHI and NAM decarbonizing healthcare initiatives, I think are starting to, to link to some more of the informatics resources that are there, but hoping to, bring this all together in a more singularly accessible place soon.

Well, thank you. And thank you everybody for listening. Have a great day.

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