Connecting Occupational Public Health and Patient Care Through Electronic Health Records (EHRs)

This week is Health IT Week which recognizes efforts to improve the quality of healthcare delivery, increase patient safety, decrease medical errors, and strengthen the interaction between patients and healthcare providers via electronic health records (EHR).  NIOSH is working to improve occupational safety and health through health information technology.

In 2007, NIOSH undertook a seemingly straightforward task: to incorporate work information in electronic health records (EHRs). The vision is to improve worker health by improving clinical care and treatment of workers with work-related diseases and injuries, and enhance research and surveillance of such conditions. In the beginning, NIOSH was faced with the task of convincing others that information about work and the work environment is important, can benefit a patient’s treatment and case management, and should be included in all health records. This concept was vetted by the Institute of Medicine in 2011 ⁽¹⁾ and other partners. ^{(2, 3)}  The incorporation of work information in federal health surveys was supported by the National Committee on Vital and Health Statistics (NCVHS), in a 2012 letter to then-U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius. ⁽⁴⁾  However, this is just part of the story.

To further address the challenge, NIOSH is working through standards development organizations (SDOs) and publications to describe and define basic information for software developers and users interested in incorporating and using work information in EHRs. This basic information includes: data flow- when, where, and how data move; data format – the structure or organization of the data; data content – which data elements are needed and their definitions; and data use—what EHR software needs to be able to do in order for the health care providers to collect and use the data. Currently, the NIOSH EHR Work Group is partnering with other key organizations and agencies on a number of projects to incorporate work information in broader heath data standards and demonstrate how to use the information to support clinical decisions. NIOSH is:

• Piloting ways to prepare and provide knowledge about the relationship of work to patient health through clinical decision support
• Preparing guidance and requirements for capturing and immediately coding industry and occupation
• Testing and evaluating the collection of patient work information in clinical settings
• Improving the standards describing EHR software functions that support use of the data by care providers and organizations
• Incorporating work information in the most frequently used data sharing standard, Health Level Seven International (HL7®) Consolidated-Clinical Document Architecture (C-CDA ®)
• Improving guidance for coding external causes of injury and poisoning
• Presenting the case for including work information in EHRs to numerous organizations and agencies
• Communicating with the public about NIOSH work.⁽⁵⁾ Look for more information, including technical products, on the NIOSH web site this Fall!

What can you and your colleagues do to help us realize this great potential for mobilizing 21st Century information technology to advance modern occupational health and safety?

We encourage the public health community to become more engaged with health care providers and EHR-related organizations to discuss and help demonstrate the importance of, and demand for, work information in EHRs.

We also encourage workers to engage health care providers about your job, to ensure the health care provider will consider how your work may be impacting your health.

Finally, we are very interested in your ideas and examples of novel ways of improving patient health through the use of work information, both at the clinical level (direct care and population health) and at the public health level. We invite you to share your thoughts and experiences below.

Margaret Filios, M.Sc., RN; Genevieve Barkocy Luensman, Ph.D.; John R Myers, MS; Marie Haring Sweeney, Ph.D.; Kerry Souza, Sc.D., MPH

Capt. Filios is a Senior Scientist in the  NIOSH Division of Respiratory Disease Studies.

Dr. Barkocy Luensman is a Health and Occupation Informatics Analyst in the  NIOSH Division of Respiratory Disease Studies.

Mr. Myers is  Chief of the Surveillance and Field Investigations Branch in the NIOSH Division of Safety Research.

Dr. Haring Sweeney is Chief of the  Surveillance Branch in the  NIOSH Division of Surveillance, Hazard Evaluations & Field Studies.

Dr. Souza is an Epidemiologist in the NIOSH Division of Surveillance, Hazard Evaluations and Field Studies.

References

1. IOM (Institute of Medicine) [2011]. Incorporating occupational information in electronic health records: Letter Report. Available at: http://www.nap.edu/catalog.php?record_id=13207 .
2.  APHA (American Public Health Association) [2012]. Incorporating occupational information in Electronic Health Records, October 30, 2012. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1435 .
3.  ACOEM (American College of Occupational and Environmental Medicine) [2012] Public Affairs: ACOEM urges inclusion of occupational health data in proposed Stage 3 list for Electronic Health Records, October 9, 2012. Available at: http://www.acoem.org/Comments_OccupationalHealthDataStage3.aspx .
4.  NCVHS (National Committee on Vital and Health Statistics) [2012]. Letter to Kathleen Sebelius “Development of Standards for the Collection of Socioeconomic Status in Health Surveys Conducted by the Department of Health and Human Services”, June 22, 2012. Available at: http://www.ncvhs.hhs.gov/120622lt.pdf .
5.  http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/health-centers-leading-efforts-incorporate-patient-work-information-electronic-health-records/