Health and Environmental Records System (HERS)

We are addressing the fragmented approach to public health that results from data isolated in healthcare and environmental siloes. 

Healthcare delivery systems serving displaced populations are fragmented, uncoordinated, and under-resourced, contributing to health inequities and poor health outcomes. A critical component of providing high-quality and equitable healthcare is the collection of data at both the clinic and the population level; individual data empowers providers to make accurate diagnoses for displaced populations over time and population data allows public health practitioners to coordinate interventions. Although there are significant challenges to collecting this data, digital systems like lightweight electronic health records systems are starting to be used more often. What’s missing, however, are tools to easily analyze, visualize, and gain insights from that data to inform population health. 

The accelerating impacts of climate change also strain healthcare delivery systems, worsen displacement, and compound health outcomes for high-risk populations. Although environmental data widely exists (temperature, precipitation, air quality, water quality, etc.), there are no systems that integrate both environmental and health data for displaced populations, allowing public health and clinical actors to more effectively allocate resources, intervene, and understand the unique challenges faced by these communities. Similarly, there is a gap in understanding how displaced populations affect their environment, contributing to climate change. This vicious cycle plays out disastrously in refugee settings, where preventable infectious diseases like cholera spiral due to environmental conditions - most notably the Lake Kivu outbreak that claimed the lives of 42,000 Rwandan refugees (Shannon, 2019).

The scale of this challenge is immense. We are currently experiencing the highest levels of displacement on record, with numbers anticipated to balloon to more than 700 million by 2050 at the current rate. The UNHCR estimates over 100 million people were forcibly displaced worldwide as of mid-2022, a record high. Lower-income countries host the vast majority of displaced populations, putting additional strain on already overburdened healthcare systems. Studies consistently show worsened health outcomes for displaced communities. There is a clear need for solutions that integrate population level health and environmental data to empower researchers, policy-makers, public health practitioners, organizations that serve displaced populations, and medical providers in these settings. Critically, these solutions must approach the problem through a health equity lens to ensure that community needs and values are taken into account. 

References: 

Shannon K, Hast M, Azman AS, Legros D, McKay H, Lessler J. Cholera prevention and control in refugee settings: Successes and continued challenges. PLoS Negl Trop Dis. 2019 Jun 20;13(6):e0007347. doi: 10.1371/journal.pntd.0007347. PMID: 31220084; PMCID: PMC6586254.

The Health and Environmental Records System (HERS) is an  integrated data platform that enables humanitarian stakeholders to create data-driven interventions at the intersection of public health, environment, and population displacement.

HERS provides data analytics and modeling tools to empower data-driven decision making at the individual, clinic, population, and environmental level. By providing integrated, actionable insights, we aim to bridge critical information gaps and enhance the decision-making capabilities of frontline healthcare workers and public health professionals.

The HERS platform works by integrating health records and environmental data within a secure system. There are two ways users can access insights through the HERS platform. The first is through a desktop application, where public health professionals and other health stakeholders can analyze data to answer complex questions at the intersection of population health and the environment. For clinicians on the ground, HERS insights are accessible directly through integration with an electronic health records (EHR) system. For example, HERS is already integrated into the Hikma Health EHR, the world’s first free, open-source mobile health data system for physicians and clinics serving refugees, migrants, and low-resource clinics in over 10 countries. 

HERS is designed for use by public health researchers, Community Health Workers, and clinicians in low-resource settings. For example, HERS enables public health researchers to analyze the relationship between extreme heat events, rainfall, vector-borne disease outbreaks (e.g., malaria, dengue), and displacement patterns, so they can understand how climate change influences disease transmission dynamics in these populations. Additionally, HERS empowers clinical providers in a refugee camp to see a flag on a patient's record if there is a history of asthma or COPD and the current air quality index is poor, so that they can proactively counsel the patient on reducing exposure and adjusting medications as needed.

HERS empowers Public Health Stakeholders, Community Health Workers, Clinical Providers in Low-Resource Settings, and Displaced Persons. 

Public Health Stakeholders: Lack of integrated health and environmental data hinders the ability for public health researchers, NGOs, and governments to understand the complex relationships between climate, displacement, and health outcomes. HERS Impact:

• Access to a comprehensive dataset combining health and environmental variables, facilitating analysis of correlations and risk modeling.

• Ability to track health trends over space and time, enabling them to identify emerging hotspots of disease and vulnerability.

• Tools for scenario analysis help them forecast the health impacts of potential climate events or changes in displacement patterns.

• Data to support stronger publications and grant applications, advancing the field as a whole.

Community Health Workers: Limited situational awareness and reactive decision-making in the face of health crises and resource constraints. HERS Impact:

• Real-time dashboards providing an overview of current health trends, environmental risks, and vulnerable population mapping within the camp.

• Configurable alerts notifying them of urgent health issues (e.g., water contamination, disease outbreaks, extreme heat events).

• Ability to quickly mobilize resources and target interventions to the most affected areas, potentially saving lives and preventing the spread of illness.

Clinical Providers in Low-Resource Settings: Difficulty in assessing individual patient risk factors, especially in the context of environmental hazards and fragmented medical histories. HERS Impact:

• Access to integrated patient health records, ensuring continuity of care and reducing information gaps.

• Automated flagging of patients with pre-existing conditions who may be more vulnerable to environmental stressors (e.g., asthma sufferers during air pollution episodes).

• Access to patient-friendly educational resources linked to environmental health, empowering providers to offer tailored advice.

• Overall improvement in the responsiveness and quality of care provided in a challenging environment.

Displaced Persons: Lack of access to timely health information and limited agency in managing their own health risks. HERS Impact:

• Targeted health alerts (via SMS, for example) about specific risks in their area, including contamination notices, heat warnings, or disease outbreaks.

• Educational components are designed for their context, promoting understanding of the links between environmental factors and their well-being.

• While direct interaction is limited, the overall effect of HERS is to create a more proactive, responsive healthcare system around them, improving their chances for better outcomes.

Overall, our solution promotes health equity and empowers communities by increasing access to quality healthcare services and improving public health outcomes. We’re working closely with communities and end-users to ensure that our solution solves their needs. 

Our team’s skills, experience, and proximity to the communities we serve make us exceptionally well-positioned to develop and implement HERS on a global scale. Our team is diverse and representative; a majority of our team comes from immigrant backgrounds and LMICs, giving us a strong connection to the communities we serve. Our Team Lead and members have worked closely with organizations, researchers, clinics, doctors, and patients in low-resource and displaced settings and have witnessed firsthand the various challenges faced that negatively impact health and environmental outcomes. We are committed to working closely with the communities we represent to ensure that our solution continues to meet their needs.

In addition to our proximity to the communities we serve, our team is made of digital health practitioners, public health program implementation experts, and individuals with backgrounds in medicine, software development, data science, and monitoring and evaluation. Our deep understanding of public health issues and the impacts of climate change inform every aspect of the HERS design. Furthermore, our diverse backgrounds, with a majority of our team coming from immigrant backgrounds and LMICs, provide us with the cultural sensitivity to build solutions that are context-specific and user-centered. 

We have a proven track record of working directly with displaced communities, developing technologies such as lightweight and offline electronic health records, public health education and behavior change programs, and AI-driven solutions that are both innovative and sustainable. This combination of expertise, lived experience, and a demonstrated commitment to impactful work sets us apart and gives us the confidence to deliver a solution that will address the most pressing public health concern of our time. 

Lastly, we are dedicated to a community-centered approach. We are already partnering with local organizations and leaders, prioritizing ongoing dialogue with those directly impacted. This collaborative process ensures our solutions remain adaptable, culturally respectful, and in continuous alignment with the priorities of the communities we're here to support.

We currently have a prototype of the HERS platform for demonstration to key stakeholders and to collect feedback from users. The prototype includes the core functionalities that address the most pressing needs of public health researchers, and will be publicly accessible in May 2024. After that, we will go through several iterations based on our ongoing engagement with end-users and extensive research on the interactions between climate change and health outcomes. 

We have prioritized a flexible design that allows for rapid incorporation of feedback, enabling us to refine features and interfaces accordingly as we learn from those on the ground. As we develop the prototype, ongoing engagement with public health researchers, camp coordinators, and clinical providers on the ground will provide valuable insights. This includes testing data visualizations, exploring potential API integrations, and refining the user flows for different stakeholder groups. By choosing the Prototype stage, we acknowledge the importance of early validation and continuous improvement throughout the development process.

We are applying to Solve because we are passionate about solution-driven collaboration and believe that Solve network of diverse partners can enhance our work and help us address current barriers, including:

• Data Access: Securing access to reliable, standardized environmental data streams is essential. Solve can facilitate connections to potential data resources and help us overcome challenges related to data accessibility.

• Interoperability: Ensuring compatibility between diverse health and environmental data sources is crucial for the success of HERS. Through Solve, we seek technical expertise and partnerships to address interoperability challenges.

• Outreach & Adoption: While we have strong connections within the public health and clinical sectors, expanding our reach to environmental organizations is critical. Solve's network can open doors to these stakeholders, fostering new collaborations and facilitating the adoption of HERS in the field.

We are particularly drawn to Solve's mentorship and partnership opportunities. As a team passionate about health equity, we believe Solve's collaborative model and focus on sustainable solutions can accelerate our progress and ultimately improve health outcomes for displaced populations.

HERS offers a paradigm shift in displaced population health and has the potential to be truly catalytic within the humanitarian sector. The platform directly addresses a critical gap – the lack of integrated health and environmental data for displaced populations. The HERS system is innovative in a number of ways:

• Seamless Data Integration: HERS integrates health records with real-time and predictive environmental data (air quality, heat, water contamination, disease vector forecasts). In this space, this approach is currently nonexistent, and allows for a comprehensive understanding of multifaceted health challenges.

• Actionable Insights Across Levels: HERS provides tailored decision-making tools for a wide range of stakeholders. Researchers can study complex interactions, camp coordinators can optimize resource use, and clinicians gain individual patient risk insights. This multi-level approach amplifies the impact of data and empowers action from the ground up.

• Environmental Interventions as Health Interventions: With integrated insights, HERS enables stakeholders to treat environmental conditions as core components of healthcare delivery. This could mean targeted cooling areas, mask distributions proactively linked to air quality events, and resource shifts during high-risk periods – steps usually not seen as immediate health responses.

Within the context of these innovations, HERS can have catalytic impact. First, it disrupts the current “reactive” status quo and empowers stakeholders to shift from crisis management to proactive, data-driven planning. This can drastically improve health outcomes in resource-constrained contexts. Additionally, the HERS model could foster new partnerships between health and environmental organizations, leading to more holistic responses in this space. Finally, detailed insights provided by EHRS can serve as a powerful advocacy tool, shedding light on the true costs of inaction when it comes to climate and displacement-related health crises.  This visibility has the potential to shift funding priorities and drive policy changes that improve the lives of displaced populations.

HERS aims to address the worsening health and environmental inequities faced by displaced populations, a problem exacerbated by the lack of integrated health and environmental data streams. Our core activities focus on securely collecting and integrating health data (from EHRs and other sources) with environmental data (air/water quality, climate data), building customizable dashboards for different users, and establishing an alert system for critical events. We also prioritize partnership building with health and environment NGOs, healthcare providers and clinics, governments, and universities. 

These activities directly result in a centralized data repository, user-friendly data visualization tools, timely alerts, and strong working relationships in the field. These immediate outputs lead to our longer-term outcomes:

• Improved clinical decision-making: Clinicians, guided by environmental insights, can proactively manage chronic conditions and reduce preventable complications.

• Resource optimization: Camp coordinators can target resources more effectively based on real-time health needs and environmental risk mapping.

• Data-driven public health: Researchers gain a more comprehensive understanding of the complex interactions between displacement, environment, and health within these populations.

• Climate-informed health interventions: Stakeholders can develop targeted interventions to mitigate the adverse health effects of climate change on displaced communities at the individual, clinic, population, and environmental levels. 

Previous research in this field shows the benefits of data integration in healthcare, the effectiveness of early warning systems for health crises, and the growing body of evidence linking climate change to adverse health outcomes for vulnerable groups.

Importantly, HERS approaches health equity by making visible the disproportionate impacts of environmental stressors, allowing for tailored interventions that reduce disparities. We emphasize ongoing engagement with communities and local organizations throughout development and deployment, ensuring that our solution addresses their specific needs and challenges in a culturally responsive manner.

The following impact goals exemplify our commitment to improved health and wellbeing for displaced populations. We measure progress towards our impact goals with a defined set of indicators; examples are shown below along with the SDG with which they are related. We plan to work closely with users and communities where we work to collect the appropriate data to inform our impact goals. 

Impact Goal 1: Improved Health Outcomes for Displaced Populations

Indicators include: 

• Reduction in the incidence of climate-related diseases (ex: malaria, respiratory illnesses, waterborne diseases, neglected tropical diseases) within populations served by clinics using HERS (SDG 3)

• Increased percentage of patients with chronic conditions receiving proactive, environmentally-informed care from clinics using HERS (SDG 3)

• Reduction in hospitalizations due to preventable environmental health events (SDG 3)

• Reduction in morbidity and mortality from hazardous chemicals and air, water and soil pollution and contamination

Impact Goal 2: Optimized Resource Allocation & Crisis Preparedness

Indicators include: 

• Percentage of sites using HERS reporting improved resource optimization based on data-driven insights (SDGs 11 and 3)

• Reduction in health service disruptions due to extreme weather events (SDG 13)

• Decrease in response time to water contamination events (SDG 6)

Impact Goal 3: Data-Driven Advocacy & Policy Change

Indicators include: 

• Number of research publications using HERS data to highlight the health impacts of climate change on displacement (SDGs 13, 10)

• Number of organization who report that HERS influenced decision-makers 

• Increased funding from donors for health-environment interventions in displaced settings, reflecting the influence of HERS data (SDGs 17)

At its core, HERS is an analytics platform custom built for the unique challenges at the intersection of climate change and migrant health. 

We use the following core technologies:

• Time series analysis and a suite of change-point analysis/ detection algorithms power all pattern recognition tools that give researchers insight into the relationships between a change in the environment and a change in the incidence rates. Currently we support autoregressive (AR), moving average models (MA), their combinations (ARIMA, SARIMA, SARIMAX), Gaussian Process change point detection (Argpcp) and Bayesian Changepoint detection (Bocpd).

• Geo-spatial algorithms power intervention planning for public health agents to understand the impact of migrant populations on local epidemiologies. Here we use directional graphs to represent migration patterns, K-Means based algorithms for clustering and Gaussian processes (and extensions) for geostatistical analysis with uncertainties.

• Agent based and counterfactual models power intervention planning and resource allocation for use by camp coordinators and public health organizations to explore “what if” scenarios in a cost effective and ethical simulation environment.

• Safe and highly parallelizable data analysis pipelines for efficient and fast data processing. This is made possible through the Rust programming language, which also makes the core technologies available to multiple platforms due to its ability to cross-compile.

• Cross-compilation allows for direct integration of analysis algorithms directly into multiple EHR tools providing clinicians with the necessary tools to flag patients whose conditions can be worsened by changes in the weather and environment.

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3 months

Our solution team, as well as our organization, is deeply committed to Diversity, Equity, and Inclusion (DEI) in alignment with our mission to serve immigrant and refugee populations globally. This commitment is upheld by our diverse team, which consists primarily of minority and underrepresented groups. We are proud that 87% of our team comes from minority backgrounds and that we speak 12 languages, empowering our understanding and responsiveness to the diverse needs of the communities we serve. 

Our organization’s founding vision reflects our dedication to ensuring that every team member receives respectful and equitable treatment, regardless of their background, identity, or circumstances. We actively foster a diverse workplace by continuing to recruit, retain, and promote individuals from varied demographics, including different races, ethnicities, genders, ages, religions, disabilities, and sexual orientations. We endeavor to create an inclusive culture where all employees feel valued and respected, and where their contributions are recognized and celebrated. Through ongoing education and open dialogue, we continually deepen our understanding of DEI principles and integrate them seamlessly into every aspect of our operations.

Our commitment to equity and inclusion extends beyond our team / organization. We also strive to break down barriers to health services by tailoring our programs to address the unique challenges faced by underserved and marginalized populations.

HERS operates with the open core business model. Under this model, the core set of features and functionalities are available under a permissive open-source license and advanced features and premium support are paid for. 

Through a tiered pricing model, the following advanced features are available to all paying organizations:

• Premium Support

  • Priority support for fixes, patches, and new feature requests.

  • Technical support for integrating complex workflows, connecting with new data sources and training of staff in the necessary skills to run the platform and troubleshooting.

  • Integration into clinic EHRs for seamless and secure data sourcing.

• Collaborative Features:

  • Teams can work together in real-time and communicate using messages and comments.

• Advanced modeling and analytics

  • Long term predictive modeling for disease trends with respect to health properties

  • Counterfactual modeling for intervention planning, and resource allocation simulations

  • Early access to migrant pattern analysis

• Compute-as-a-service

  • Access to cloud computing resources for large scale analytics and modeling.

• Advanced notifications system

  • Real-time polling of climate and health state and online risk calculations that can ping other services (such as EHR services, and national alert systems)

Initially, we plan to support the development of HERS through grants from the Sall Family Foundation and other partners. We received $12.5K from the Sall Family Foundation to develop a v1 prototype in March 2024 and continue to raise additional capital. Following the grant-funded development and first deployment of the HERS platform, we will shift to a self-sustaining model in 2026. We anticipate generating revenue through the open core business model by providing customization and cloud hosting services to large organizations, research institutions, and governments.