Abstract
BackgroundInformatics tools to support the integration and subsequent interrogation of spatiotemporal data such as clinical data and environmental exposures data are lacking. Such tools are needed to support research in environmental health and any biomedical field that is challenged by the need for integrated spatiotemporal data to examine individual-level determinants of health and disease.ResultsWe have developed an open-source software application—FHIR PIT (Health Level 7 Fast Healthcare Interoperability Resources Patient data Integration Tool)—to enable studies on the impact of individual-level environmental exposures on health and disease. FHIR PIT was motivated by the need to integrate patient data derived from our institution’s clinical warehouse with a variety of public data sources on environmental exposures and then openly expose the data via ICEES (Integrated Clinical and Environmental Exposures Service). FHIR PIT consists of transformation steps or building blocks that can be chained together to form a transformation and integration workflow. Several transformation steps are generic and thus can be reused. As such, new types of data can be incorporated into the modular FHIR PIT pipeline by simply reusing generic steps or adding new ones. We validated FHIR PIT in the context of a driving use case designed to investigate the impact of airborne pollutant exposures on asthma. Specifically, we replicated published findings demonstrating racial disparities in the impact of airborne pollutants on asthma exacerbations.ConclusionsWhile FHIR PIT was developed to support our driving use case on asthma, the software can be used to integrate any type and number of spatiotemporal data sources at a level of granularity that enables individual-level study. We expect FHIR PIT to facilitate research in environmental health and numerous other biomedical disciplines.
Highlights
Informatics tools to support the integration and subsequent interrogation of spatiotemporal data such as clinical data and environmental exposures data are lacking
A list of currently available feature variables can be found in Supplementary Table 1. This table and additional documentation are maintained and regularly updated on the Integrated Clinical and Environmental Exposures Service (ICEES) OpenAPI.) Importantly, the integration step is conducted within a secure environment and under a protocol that was approved by our institution’s Institutional Review Board because data integration necessitates the use of patient geocodes, date/time stamps, and patient identifiers—data elements that are considered Protected Health Information under the Health Insurance Portability and Accountability Act (HIPAA)
We examined prednisone use in relation to asthma exacerbations among African Americans and Caucasians
Summary
These results indicate that prednisone use was more common among patients with asthma exacerbations than among those without asthma exacerbations, as expected given that prednisone is generally reserved for patients with severe disease [22]. While this finding was true for both African Americans and Caucasian, the effect was more pronounced among African Americans than among Caucasians. We successfully applied FHIR PIT to integrate clinical and environmental data and openly expose the data for interrogation via ICEES, thereby replicating and extending published literature demonstrating the impact of exposure to airborne particulate matter on asthma (e.g., 4) and the existence of racial disparities in asthma exacerbations [23]
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