Using Electronic Health Records For Surveillance Of Vector-Borne Infectious Disease In The Context Of Climate Change

Climate change is a threat multiplier, making storm systems more extreme, ecosystems more vulnerable, and human impacts more profound. We can now project temperature and precipitation scenarios several decades into the future, and at geographically granular levels, thus informing a range of critical infrastructure efforts. Health surveillance and responses that are climate-informed will be important to develop to increase health resilience in the face of climate change. For example, vector-borne infectious diseases (VBIDs) are becoming an increasingly urgent public health problem in the context of climate change. We have tools in hand to help track and predict the spread of VBIDs through electronic health record (EHR) databases. Changes in climate affect the incidence and prevalence of VBIDs in many ways, such as through effects on vector habitat, frequency of vector breeding or mating, replication rates and frequency of vector feeding. Compounding these trends, downstream consequences of climate change, such as food and water insecurity, and conflict and violence, can lead to large-scale migration and the spread of VBIDs.

Multiple sources of data, ranging from entomological field surveys to environmental variables, are available to predict trends in vector populations, and VBID outbreak prevalence and location. At the same time, the emergence of local, regional, national and international repositories of EHR data opens the possibility to track human cases of VBID at scale. The goal of this project is to stimulate the development of effective partnerships that influence understanding of the interplay between climate change and human health (in this case, VBIDs), and to help us approach this intersection from a holistic and synergistic, not siloed, perspective, including. We will present three aims that we are pursuing:

Aim 1: Assess the feasibility of connecting data sources for vector surveillance to EHR data repositories: Currently, data sources used to track vectors and human health are not integrated in a way that would make it easy to ask integrated questions. Vector-focused data sources include field surveys, and GIS, climate and environmental, epidemiological, genetic and molecular, and entomological data. These data are often collected by multiple, unconnected organizations and efforts. EHR data, on the other hand, are primarily generated during healthcare encounters and recorded by healthcare facilities. Healthcare data about the same patient are, especially in the United States, typically not connected to each other. The purpose of Aim 1 is to document and catalog vector-focused and EHR data, with the goal of establishing the feasibility of connecting data sets from multiple sources in order to be able to conduct studies and answer questions related to tracking, measuring and predicting incidence and prevalence of vector-borne diseases. The outcome of Aim 1 will be an initial approach for connecting data sources for vector surveillance to EHR data repositories for disease surveillance and prediction.

Aim 2: Determine feasibility of a study that relates vector surveillance data to EHR data: To enable a future proof-of-concept, Aim 2 will determine the feasibility of conducting a pilot study that relates data about blacklegged tick prevalence to the incidence of human cases of Lyme Disease in Indiana. The data about tick prevalence will come from the Indiana State Department of Health and the EHR data from the Indiana Health Information Exchange. Data about ticks will include county, life stage, infectivity and density. EHR data will include patient address, demographics, laboratory tests, diagnoses, medication orders and other clinical parameters. EHR data come from the Indiana Network for Patient Care, a comprehensive health information exchange data repository that covers approx. 66% of the Indiana population. The outcome of Aim 2 will be a design for a rigorous study that relates vector surveillance data to EHR data.

Aim 3: Assess feasibility of connecting data sources for vector surveillance to EHR data repositories in different geographic regions: Vector-borne diseases are a worldwide problem, but the availability, data content and geographic coverage of data sources for tracking, measurement and prediction vary widely across the globe. The purpose of this exploratory aim is to begin determining (1) which data sources are available in different regions and what their characteristics are; (2) which commonalities could lend themselves to the development of generalizable methods and approaches; and (3) which gaps exist, either in vector-borne or EHR databases, that would need to be remedied over time to achieve effective global surveillance and vector-borne diseases and human health. The outcome of Aim 3 will be an assessment of facilitators for and barriers to building a global surveillance and prediction system.

This project is significant because it will begin to establish an integrated, organic connection between databases for vector-borne diseases and human health for surveillance and public health. This connection will allow us to generate meaningful and impactful insights that can inform policy and intervention development. Our project is innovative because it leverages increasingly sophisticated approaches for surveillance of vector-borne diseases and human health using data sources that, to date, have not been used in concert.

This project is significant because it will begin to establish an integrated, organic connection between databases for vector-borne diseases and human health for surveillance and public health. This connection will allow us to generate meaningful and impactful insights that can inform policy and intervention development. Our project is innovative because it leverages increasingly sophisticated approaches for surveillance of vector-borne diseases and human health using data sources that, to date, have not been used in concert.