Achieving Public Health Goals Through Information Technology Standardization:

Occupational Data

Eileen Storey, MD, MPH

Genevieve Luensman, PhD

National Institute for Occupational Safety and Health

November 8-9, 2012Public Health Data Standards Consortium

Annual Meeting

The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

Outline of Presentation

Why include occupational information?NIOSH engagement on this issue

How do we hope to accomplish this?

Work and Health Care are Inseparable

• Workers spend close to half their waking time at work– Work affects health

• Work-related injury • Work-related disease

– Health affects work• Return-to-work • Chronic disease management

– Families are affected– inadvertent exposures• Toxic materials brought home on work clothes• Prenatal exposure via parent’s occupation

– Work is a contributor to health disparities• Characteristics of work itself• Association with benefits, opportunities

Burden of Occupational Injury and Illness (OII)

• BLS 2011:– 3.1 million work-related injuries or illnesses– 4,547 deaths from work-related injury

• Steenland 2003:– 49,000 deaths from work-related diseases– Combined OII: 8th leading cause of death in U.S.

• Leigh 2011:– Costs = $250 billion in 2007

NIOSH Mission

• To generate new knowledge in the field of occupational safety and health and to transfer that knowledge into practice for the betterment of workers.– Conduct scientific research– Develop guidance and authoritative

recommendations– Disseminate information– Respond to requests for workplace health hazard

evaluations

EHRs: Implications for Occupational Health

• Integration of care to reduce personal and occupational (and environmental) risk factors, and

• Tremendous benefit in ability to identify and track work-related injuries and illnesses; assess population health; monitor programs

OR• Further distancing of occupational health from

main stream clinical care and public health

• Improve clinical care– Recognize links between work and health– Correct diagnoses– Appropriate treatment– Disability management– Intervention on risks

• Sentinel case identification and reporting• Co-worker protection

Desired outcomes

• Track trends –illness and injury by– Occupation– Industry– Work tasks– Exposures– Within a workplace

• Identify opportunities for intervention

Desired outcomes

• Identify risks– In occupations– In industries– In specific locations of employment– In connection with new

technologies/equipment/processes• Track patterns of disease transmission

Desired Outcomes

• Use workplace for effective intervention– Health promotion– Disease management– Education– Risk reduction

Desired Outcomes

• Clinical decision support• Integration of personal and occupational

health promotion• Case reporting• Population-based trends, risk

characterization

Opportunities

12

Institute of Medicine Report

Convened March, 2011 Report September 30, 2011

A free PDF file of the report available on the National Academies Press website: www.nap.edu

Cover image to be added

How do we hope to get there?

Primary Objectives

• Incorporate work history (industry and occupation) in a useful way in EHRs– Useful: individual patient care, population health,

and public health• Incorporate work information in public health

reporting• Support care of workers

How to Meet the Objectives• Advocacy and Partnerships• Define, define, define• Front door: Meaningful Use

– Proposed for Stage 3– TBD: certification criteria, MU objectives & quality measures

• The template data might generate a return-to-work letter on clinic letterhead for the patient to take to the employer. In this hypothetical example, specific EHR data points to assess “use of industry and occupation data for generating evidence based return-to-work recommendations” could include a count of the number of letters generated and the number of times the infobutton is used

• Back door: Interoperability Standards– Express user story, use cases– Develop structure/standard– TBD: test and revise– Incorporate in profiles/use cases

Partnerships and Advocacy• NIOSH EHR Work Group• CDC Meaningful Use Advisory/Core Groups• State and local public health partners

– phConnects• Professional Organizations

– CSTE position statement– American College of Occupational and Environmental Medicine (ACOEM) letter of

support to CDC• National Committee on Vital and Health Statistics (NCVHS) letter to Sec. Sebelius

– Work as a socioeconomic factor for health• Serve as experts

– NASA, FDA, Univ. of TX• Social Security Administration• National Center for Environmental Health• PHDSC

Healthcare Information Cycle

Care Provider

Provides Data

Public Health

Provides Knowledge

2) Report Work Information with Health Information

3) PopulationAnalysis

1) Collect Work History

4) Clinical Decision Support

Collect Work History• Assess current state

– AOEC member discussions– Request for Information

• Code industry and occupation– Recommendation for Census codes– Census coding system in PHIN VADS– NIOSH Industry and Occupation Computerized Coding System (NIOCCS)

• Recommend business requirements for user interface– How do you ask for industry and occupation?

• Model work information in a health record• NORA project to collect and use work information in an EHR• HL7 EHR and PHR Functional Models

– Glossary terms and definitions

• Public Health Functional Profile for EHRs• iHE Template for Occupational History

– TBD: Test (Connectathon)• Cancer Implementation Guide

– Usual industry and occupation• Public Health Reporting Initiative

– Core data elements for case reporting– TBD: define “occupational health” report

• Other S&I Framework Initiatives?– Query Health

• Mentioned as a future data set in the International Society for Disease Surveillance (ISDS) recommendations for syndromic surveillance

Report Work with Health Information

• Cambridge Health Alliance & Massachusetts Dept. of Health

• NORA proposal to pilot clinical decision support– Synthesize knowledge

• diagnosis and management of an occupational disease (occupational asthma)

• consideration of work environmental factors in managing a chronic disease (diabetes)

• guidance for return-to-work determinations

– Test feasibility

Population Analysis and Clinical Decision Support

• Work-relatedness– Ethics and Privacy workshop Spring, 2013

• Exposures/Risk Factors– Collaborate with NCEH

• Disability– Collaborate with SSA

Future Factors to Incorporate

How could we not be!

• Work and health experts

• Public health program

Why is NIOSH in this?