NIOSH and Electronic Health Records

You’ve probably heard about ‘electronic health records’ or ‘EHRs’—either in the news or from people you know who work in the healthcare field. An electronic health record (EHR) (also electronic patient record (EPR) or computerized patient record) is defined as a systematic collection of electronic health information about individual patients or populations.¹ It is a record in digital format that is capable of being shared across different health care settings, by being embedded in network-connected enterprise-wide information systems. Such records may include a whole range of information including age, gender, ethnicity, health history, medications and allergies, immunization status, lab test results, radiology images, and billing information.² EHRs will soon be coming to a healthcare facility near you, if they haven’t already, and will allow your doctors and other providers to communicate essential information about your health more efficiently and more quickly. President Obama has ordered his Office of the National Coordinator for Health Information Technology (ONC) to set the nation on a course of electronic transmission of medical data, and wants all healthcare providers to use interoperable (meaning, systems that can communicate with each other) health records by the year 2014. A 2005 RAND funded article in the journal Health Affairs indicated Medicare would receive about $23 billion of the potential savings per year, and private payers would receive $31 billion per year in cost savings.³

What do EHRs have to do with NIOSH? In the clinical setting, the accurate diagnosis and management of work-related conditions is essential to an individual’s health. While the EHR does not replace the skilled health care provider, it can provide information to assist providers with evaluating the contribution and impact of work on health. For example, when a person’s job and workplace are recorded in the EHR, this information can help the provider evaluate the source of a patient’s injury or illness. Information about a person’s jobs and workplaces over time can be used to assess whether or not a chronic illnesses—such as cancer—may be related to exposures at their workplaces. In its just-released report entitled Reducing Environmental Cancer Risk, What We Can Do Now, the President’s Cancer Panel recommended that physicians routinely ask their patients about their previous and current work, and that this information be incorporated into the medical record. Programming the EHR to store and display information about a person’s job history will facilitate this.

Healthcare facilities can also use information available in the EHR system to identify common problems among the patients that they serve. For example, a community health center might identify dermatitis as a problem affecting its patients who work in a local furniture factory. Armed with this information, the health center can counsel its patients who perform this kind of work and can look for solutions that can benefit a segment of its patient population. The EHR, though no substitute for clinical expertise, can improve care by keeping a wealth of information at the provider’s fingertips. Efficient use of information also has a great potential to reduce healthcare costs by eliminating redundant tests and other waste.

Building capacity to promote prevention and enhance public health surveillance of work-related illness and injuries at the state and local levels is a widely recognized and urgent need. It is well known that occupational injuries cause 16 deaths per day and illnesses related to work account for nearly 50,000 deaths per year. Every day 11,000 people in the private sector in the U.S. suffer an injury or illness at work.⁴ Electronic health data could help us more effectively assess the nature and magnitude of the problem, provide the means to determine who is affected, where, and how, and could inform resource allocation. This is an important issue because currently a true all-encompassing national survey of workplace injury and illness does not exist. Use of data from medical records will be an additional source of data with which to assess occupational illnesses and injuries, particularly chronic illnesses. EHRs might be able to help overcome the underreporting and undercounting of workplace illnesses and injuries. Information could be used to direct intervention efforts aimed at prevention of occupational mortality and morbidity.

The promises of improved care and improved surveillance of occupational injuries and illnesses will only be realized if occupational information is included in the EHR. NIOSH is currently engaging with organizations, committees, and individuals who are identifying, developing and establishing the standards and systems for capturing relevant electronic clinical data to ensure the appropriate collection of occupational information. This involves a sustained effort of collaboration for which NIOSH has developed a strategy to articulate its goals for incorporating occupational information into EHRs. Challenges now include constructing a case for “Meaningful Use” of these data (the requirement for the EHR to provide complete and accurate information, better access to information through the EHR and sharing the EHRs health information securely with patients and providers⁵) as well as adopting standards for data capture, and piloting systems, which test these standards in clinical settings.

NIOSH has learned much about how existing electronic health records systems collect and store an individual’s occupational data by asking for assistance from a variety of healthcare systems. Kaiser Permanente, Mayo Clinic, The Regenstrief Medical Record System, Partners Healthcare, Indian Health Service, NASA, the Veteran Health Administration, and the Department of Defense were among those who gave insight to our next steps. These exchanges have been with leaders in the fields of medical and public health informatics (PHI) and health information technology (HIT), who have important perspectives on EHR data collection practices.

In addition to conversations with best practice leaders, NIOSH has joined several national level committees, including the Public Health Data Standards Consortium (PHDSC). We have submitted numerous comments to The Office of National Coordinator (ONC) though CDC, The Centers for Medicare and Medicaid, Healthcare Information Technology Standards Panel (HITSP) and the CDC-CSTE—Case Report Standardization Work Group (CRSWg). Our comments have begun to garner support for inclusion of industry and occupation into EHRs. We welcome our partners’ recommendation as to what organizations would be beneficial to our efforts.

Overall, NIOSH’s efforts have gained momentum in the national agenda. The President’s Cancer Panel Report has recommended physicians to routinely take occupational histories, “with inclusion of workplace factors” and to include these in the electronic health records systems nationally. It has realized that not only will the “data have the potential to improve diagnosis and treatment,” but it “would capture crucial information researchers need to study the impact of environmental exposures over time.” Such information can be invaluable in discovering underlying causes of disease.

Ms. Edmondson is a Public Health Informatics Consultant in the NIOSH Division of Respiratory Disease Studies.

References

1. Gunter, T.D. and Terry, N.P. 2005 The Emergence of National Electronic Health Record Architectures in the United States and Australia: Models, Costs, and Questions in J Med Internet Res 7(1)
2. HIMSS – Electronic Health Record (EHR). Retrieved June 6th 2010.
3. Hillestad, Richard et al.: “Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs,” Health Affairs, 2005 [1], http://www.eecs.harvard.edu/cs199r/readings/RAND_benefits.pdf. Retrieved September 30th 2010.
4. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2010. Retrieved September 30th 2020, from the World Wide Web: http://www.healthypeople.gov/document/html/volume2/20occsh.htm#_edn7.
5. Electronic Health Records and Meaningful Use. Retrieved October 1st 2010.