How EHRs can impact climate change [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

Join Earl Stewart, Jr., an internal medicine physician, as we discuss the critical need for electronic health record (EHR) systems to address the impact of climate change on patient health. Earl highlights the limitations of current EHRs and shares his vision for integrating climate education into these systems. Discover how EHRs can empower health care professionals and patients to confront the challenges posed by climate change.

Earl Stewart, Jr. is an internal medicine physician in Atlanta, Georgia, a 2023 Doximity Digital Health Fellow, and a 2023 Climate and Health Equity Fellow (CHEF) with the Medical Society Consortium on Climate and Health. He can be reached on E.S.J., M.D., LinkedIn, Twitter @EarlStewartJr, and Doximity.

He discusses his KevinMD article, “EHRs must do more to help combat climate change.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

With a growing physician shortage, increasing burnout, and declining patient satisfaction, a dramatic change is needed to make health care more efficient and effective and bring back the joy of practicing medicine. AI-driven ambient clinical intelligence promises to help by revolutionizing patient and provider experiences with clinical documentation that writes itself.

The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled, ambient clinical intelligence solution that automatically captures patient encounters securely and accurately at the point of care. Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 83 percent of patients say their physician is more personable and conversational.

Rediscover the joy of medicine with clinical documentation that writes itself, all within the EHR.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/gUMGND

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Earl Stewart Jr. He’s an internal medicine physician. Today’s KevinMD article is titled “EHRs must do more to help combat climate change.” Earl, welcome to the show.

Earl Stewart: Thanks so much, Kevin, for having me. It’s a delight to be here.

Kevin Pho: We’ll get to the article in a little bit. First off, briefly share your story and journey to where you are today.

Earl Stewart: Yes. So I’m originally from Augusta, Georgia, born and raised. I did my undergraduate studies at Mercer University in Macon, Georgia, med school at Meharry Medical College in Nashville, Tennessee, and residency at Brown University, and I’ve been practicing in various capacities in the state of Georgia since 2016, since finishing residency. I now serve as a primary care physician in Atlanta with the gargantuan Wellstar Health System, and I have other roles, including serving as a health equity fellow with the Medical Society Consortium on Climate and Health, funded by the American College of Physicians as well as the NMA. I also serve as founding president and CEO of our family foundation, my namesake, the Dr. Earl Stewart Jr. Family Foundation. But I’m very passionate today to meet with you to talk about the climate crisis and how EHRs can definitely do more to support us as physicians working in this vein of practice.

Kevin Pho: So like you, I also do internal medicine primary care, and we read so many things about physicians burning out and all the challenges that we face as primary care physicians. So let me ask you, what keeps you going in primary care?

Earl Stewart: My faith, the love and support of a wonderful network of friends, many of whom are physicians and many of whom are not, and just staying grounded. What keeps me grounded is tapping into the other part of my brain, outside of science, technology, mathematics, medicine, and health sciences. I love to garden. I love to travel. I love to just spend time with my family. I adore the beach. I read. I write. In another life, really, I’m a published poet and singer, and I’m a pianist. And so I try, even in my day-to-day practice of medicine, to bring my whole self to work and to taking care of my patients, and it makes me take a humanistic approach to the delivery of health care every day. So I would say that’s what really keeps me focused and helps to keep me away from getting burnt out, which, as a human being, is possible.

Kevin Pho: How did you get interested in that intersection with climate change?

Earl Stewart: I’ve always wanted to learn more about climate change. I know that I’ve always wanted to know more about how climate impacts health, and unfortunately much of that education does not come through traditional medical academia. I mean, you don’t really get that training in medical school, and none in residency. However, your patients are encumbered with the ravages of climate change. And so I was approached by leadership of the American College of Physicians to potentially accept this opportunity. Unbeknownst to me, many of my friends and colleagues and former medical school classmates, a few of them, had already done it, and even fellow physicians I work with here through the ACP in Georgia. I reached out to them and pretty much said, “Well, you know, how did you like this?” And then they were very candid. They said, “You know, it’s very intensive, but you will learn, and you will make a tremendous impact.”

Since the inception of this year’s cohort, we’ve really hit the ground running, tackling issues from air pollution, to the need for electric school buses to decarbonize the environment, to the need for a mental health focus in terms of how climate impacts mental health. Things like severe thunderstorms and severe weather of various types, how it causes anxiety. It can even be linked, I’ve learned since this fellowship started, to asthma exacerbations, which have a tendency to increase when severe thunderstorms happen and are even threatened.

So even more so in terms of how health equity is impacted and health inequities are impacted by climate change, that’s where this fellowship really gets us as physicians of color involved in basically offering a clarion call that we need to do better as a society and as a health care sector, but also as individual physicians, being on the front line to talk about how this impacts our communities and the patients that we serve.

Kevin Pho: All right. Let’s talk more about this topic in your KevinMD article, titled “EHRs must do more to help combat climate change.” Now, how did your article come together?

Earl Stewart: My article came together with a lot of input from the Climate and Health Equity Fellowship leaders, Dr. Mark Mitchell, Dr. Kimberly Williams, and Dr. Phineas Curry, in terms of giving me guidance on what I wanted my capstone project to be. But also their tutelage has been great, because it’s allowed each individual fellow, and I believe there are 13 of us this year who are doing this work, to really take an individualistic approach to how we want these projects to take shape.

I have always been remarkably passionate about patient education. I feel like we can sit in the office every day and pontificate to the patients about what they need to do and shake our long, righteous finger at them about, you know, changing how they eat. But unless you give the patient education and give them the opportunity to ask you questions, and you teach them. “Doctor,” from the original Latin term, means teacher, so we’re supposed to teach our patients.

And so this project took shape by meeting with the fellowship leaders, doing a literature search, and looking and delving into my own health system’s electronic medical records system, Epic, which is one of the foremost, if not the most foremost, electronic medical records that we use in the United States, and seeing what was there. I did not see much on climate change. There was a little bit there about, you know, asthma and environmental allergens, in terms of how they’re impacted by air pollution and how those conditions can develop and be exacerbated by those types of conditions, but it was very slim pickings. And so I said that this needs to change, especially at the point of care, being able to add patient education documents about how vulnerable populations are disproportionately impacted by the ravages of climate change, how Black, Indigenous, and people of color are impacted by the ravages of climate change, and even about the incentives that exist from the government through various acts and legislation, such as the infrastructure act, the Inflation Reduction Act, and the Infrastructure Investment and Jobs Act, passed recently by the Biden administration.

These are all acts that provided incentives, individually and as communities and organizations, to create greener environments: more sustainable agriculture, incentives for solarizing one’s home, incentives for creating green space, and incentives for purchasing and maintaining electric vehicles. And so I feel, honestly, that the vast majority of the American populace just does not know about this. And we as physicians, really physicians of color, who are taking care of these communities that are disproportionately impacted by the climate crisis, are the ones that they trust. They trust their family, they trust their neighbors, and they trust their church members first and foremost, usually, but they trust us a great deal, especially if we can empathize with them and understand their plight, because we as physicians of color may also have similar backgrounds.

And I say that to say, you know, since I’ve been doing this fellowship, since I’ve been learning a great deal intensively about how climate impacts health, I can tell you I’m thinking back to, you know, flooding in my own neighborhood. I grew up in the inner city in Augusta, and I think about how corporations were just right down the street and around the corner, and how, you know, we could smell the changes in the air when there was a lot of pollution, driving around. Now, when I go back to my hometown and I visit my neighborhood, I’m learning more and seeing the ravages of food deserts and what happens when we close a grocery store. I wrote an op-ed in the local Augusta Chronicle newspaper, I think it was in 2018, about how the closure of one grocery store significantly exacerbated an already existent food desert in my own childhood neighborhood.

So this project really was based on all of that taken together, and it’s still ongoing at this juncture. I’ve gotten a lot of great input and potential partnerships with Epic at the national level. We’re thinking of definitely implementing some of the climate education, the climate health education documents, into their foundation database. I’m working in my individual health system to have more of a regional and state-specific impact, to implement and build some of these patient handouts into Epic. And also we’re partnering with other physician groups in Wisconsin and Florida, and everybody has been really, really helpful and encouraging, even fellow physicians who are doing the fellowship with the Medical Society Consortium on Climate and Health. So it’s been a great journey to date, and I’m just delighted by how this is going to further take shape to impact physicians, but also the patients we serve.

Kevin Pho: Now, during the course of your day in primary care, give us some examples and stories of how you incorporate climate change education for your patients, the various touch points through the day where you’re able to do that. So just give some stories or examples.

Earl Stewart: Oh, absolutely. I just recently talked to a patient whom I’ve been taking care of for quite some time who all of a sudden developed a persistent cough. He lives in a highly wooded area, in an area that is kind of remote. Rural communities, we know, are also disproportionately impacted by the ravages of climate change, because sometimes they just don’t have the resources. They may not have as much air pollution, but corporations may be in their background and may pollute the water, and they may not necessarily always have sustainable food sources and access to certain types of health care. And so he drives all the way to Atlanta from about 45 minutes away.

We initially thought that the cough may have been, you know, gastroesophageal reflux disease causing a dry cough. And so we talked more, and his condition further developed, and, you know, I told him, “I think you have new-onset asthma.” He’d been providing a little bit more about his environment, and I said, “Your symptoms are pretty much consistent with that: nighttime cough, dry cough, occasionally productive of a grayish sputum.” He had gone to urgent care, and, egregiously, I think, they gave him antibiotics, thinking that it was community-acquired pneumonia, without doing a chest X-ray. I said, “I don’t think that’s what it is. Let’s give you an empiric course of albuterol, send you to have pulmonary function testing, and see how you do.” And I pretty much took that opportunity to educate him about how environmental allergens can impact the development of a bronchospastic disease and can exacerbate it.

And then I’ve had patients who come in with seasonal allergies, and we talk about living close to interstates and the exhaust from cars. A patient of mine had just recently bought a townhome here in Atlanta close to I-20, and she said, “Before I moved here, I didn’t have these issues.” She said, “I’m wondering if I should have bought the townhouse, now that I can, you know, barely breathe sometimes.”

And so we as physicians see these cases every day. We see these patients. We see our patients who we take care of who are experiencing the ravages of climate change, but we don’t really have the education or the knowledge. That’s why these types of training programs, like the Climate and Health Equity Fellowship, are so crucial, especially for physicians of color who are on the front lines taking care of these patients every day who otherwise would not have access to care. We need to be the greatest advocates for our patients, at the policymaking level and at the patient care level. We need to have a seat at the table. One of my quotes, by the late, great Shirley Chisholm, was, “If they don’t give you a seat at the table, bring a folding chair.” And we definitely need to be in the room where it happens, if you’ll pardon the Hamilton reference as well. We definitely need to be in the room where it happens, not just in the examination room, but in the room where policy is made. That’s why I wrote the op-ed; policy is important to have more of a systemic change.

And I work it in every chance I get, to talk about how climate impacts health. Now, I did not do it before, I’m going to be very honest with you, because I didn’t know what to say. But now I know. And there was always an inkling. You know, we know about environmental allergies. We know about pollen, mold, and fungal spores in the atmosphere. We read the articles. We get the emails about how environmental pollutants may fluctuate and how different plant pollens may fluctuate. And specifically here in Georgia, in the Southeast, there are all kinds of trees and vegetation, and so you’re going to get blankets of pollen every year that make people sick. But that was the extent.

But now we know we can talk about other things, such as the need for decarbonization, even in health care. We can talk about how it’s important to understand particulate matter, and expose our patients to resources such as the AirNow tool, where they can check the air quality in their own neighborhood, right where they live. It’s something that I’ve shared with my patients all the time now, and so they can take the necessary precautions to keep themselves from having worsening asthma exacerbations and, you know, allergic rhinitis symptoms. So I work it in a lot.

Kevin Pho: Now tell me, in your ideal world, what would you like to see EHRs do to help promote climate change education? You mentioned Epic. I use Epic as well. So in your ideal world, how much more work do these EHR systems need to do?

Earl Stewart: I think they can start by having a conversation with physicians who are devoted to eliminating and stopping the climate crisis in its tracks. And they are interested. We just need to let them know that, hey, we’re interested too, and we want to talk about this. And that’s what the op-ed, which you fortunately accepted to the KevinMD blog, is helping to do. It’s already having a tremendous impact, because I’m getting contacted about it. But then they also have to be willing to implement, not just have the conversation, but implement what physicians who have this expertise are saying, and definitely be at the table. And it’s time to affect the policy to stop climate change.

But, as we always say, the journey of a thousand miles begins with one step. I think the first step definitely is helping us as physicians who are devoted to this work educate our patients better, with a variety of different resources. It could just be one handout right now. It may be thousands in the future. And then, hopefully, at some point, the EHRs will be able to network with each other to share and extrapolate their individual data, as well as these handouts and materials, throughout, you know, other systems that may not use the same EHR. There’s really no incentive for them to talk to each other, and, you know, that’s another conversation, about creating a health information exchange. But I think definitely first things first.

Kevin Pho: And my final question here: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Earl Stewart: Physicians are crucial in this fight. We are our patients’ greatest advocates. We have to advocate for our patients, but also for ourselves. We need to become more comfortable having the conversation about how climate is, in fact, impacting health, and we need to be willing to have a seat at the table and speak truth to power about these issues. And I specifically issue a clarion call to physicians, all physicians definitely, but definitely physicians of color in a variety of different specialties, who can have a tremendous impact in helping us eliminate the climate crisis and its impact on health.

Kevin Pho: Earl, thank you so much for sharing your time and insight. Thanks again for coming on the show.

Earl Stewart: Thank you, Kevin, for having me. It’s a delight to be with you.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes