Workers' Compensation

Wednesday, October 5, 2011

Now Available On-Line: Complete Letter Report On Incorporating Occupational Information in Electronic Health Records

Incorporating Occupational Information in Electronic Health Records: Letter Report

The National Academies Press

The National Academies Press (NAP) was created by the National Academies to publish the reports issued by the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council, all operating under a charter granted by the Congress of the United States. The NAP publishes more than 200 books a year on a wide range of topics in science, engineering, and health, capturing the most authoritative views on important issues in science and health policy. The institutions represented by the NAP are unique in that they attract the nation’s leading experts in every field to serve on their award-wining panels and committees. The nation turns to the work of NAP for definitive information on everything from space science to animal nutrition.

http://www.nap.edu/catalog.php?record_id=13207

Author:

David H. Wegman, Catharyn T. Liverman, Andrea M. Schultz, and Larisa M. Strawbridge, Editors; Committee on Occupational Information and Electronic Health Records; Institute of Medicine

84 pages PAPERBACK $35

Each year in the United States, more than 4,000 occupational fatalities and more than 3 million occupational injuries occur along with more than 160,000 cases of occupational illnesses. Incorporating patients' occupational information into electronic health records (EHRs) could lead to more informed clinical diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population. At the request of the National Institute for Occupational Safety and Health, the IOM appointed a committee to examine the rationale and feasibility of incorporating occupational information in patients' EHRs. The IOM concluded that three data elements - occupation, industry, and work-relatedness - were ready for immediate focus, and made recommendations on moving forward efforts to incorporate these elements into EHRs.

Front Matter (R1-R10)

Incorporating Occupational Information in Electronic Health Records (1-58)

Appendix A: Workshop Agenda (59-64)

Appendix B: Workshop Participants (65-68)

Appendix C: Committee Biographies (69-74)

Recommendations:
Initial Focus on Occupation, Industry, and Work-Relatedness Data Elements

Recommendation 1: Conduct Demonstration Projects to Assess the Collection and Incorporation of Information on Occupation, Industry, and Work-Relatedness in the EHR

NIOSH, in conjunction with other relevant organizations and initiatives, such as the Public Health Data Standards Consortium and Integrating the Healthcare Enterprise (IHE) International, should conduct demonstration projects involving EHR vendors and health care provider organizations (diverse in the services they provide, populations they serve, and geographic locations) to assess the collection and incorporation of occupation, industry, and work-relatedness data in the EHR at different points in the workflow (including at registration, with the medical assistant, and with the clinician). Further, to examine the bidirectional exchange of occupational data between administrative databases and clinical components in the EHR, NIOSH in conjunction with IHE should conduct an interoperability-testing event (e.g., Connectathon) to demonstrate this bidirectional exchange of occupational information to establish proof of concept and, as appropriate, examine challenges related to variable sources of data and reconciliation of conflicting data.

Recommendation 2: Define the Requirements and Develop Information Models for Storing and Communicating Occupational Information

NIOSH, in conjunction with appropriate domain and informatics experts, should develop new or enhance existing information models for storing occupational information, beginning with occupation, industry, and work-relatedness data and later focusing on employer and exposure data. The information models should consider the various use cases in which the information could be used and use the recommended coding standards. For example, NIOSH should consider how best to use social history templates to collect a work history and the problem list to document exposures and abnormal findings and diagnoses with optional work-associated attributes for possible, probable, or definite causes; exposures; and impact on work.

Recommendation 3: Adopt Standard Occupational Classification (SOC) and North American Industry Classification System (NAICS) Coding Standards for Use in the EHR

NIOSH, with assistance from other federal agencies, organizations, and stakeholders (e.g., Bureau of Labor Statistics, Census Bureau, Council of State and Territorial Epidemiologists [CSTE], National Library of Medicine, National Institute of Standards and Technology, National Uniform Billing Committee, Health Level 7 International [HL7]), should recommend to the Health Information Technology (IT) Standards Committee the adoption of SOC and NAICS to code occupation and industry. Furthermore, NIOSH should develop models for reporting health data from EHRs by occupation and industry at different levels of granularity that are meaningful for clinical and public health use.

Recommendation 4: Assess Feasibility of Autocoding Occupational Information Collected in Clinical Settings

NIOSH should place high priority on completing the feasibility assessment of autocoding the narrative information on occupation and, where available, industry that currently is collected and recorded in certain clinical settings, such as the Dartmouth-Hitchcock health care system, Kaiser Permanente, New York State Occupational Health Clinic Network, Cambridge Health Alliance, and hospitals participating in the National Electronic Injury Surveillance System.

Recommendation 5: Develop Meaningful Use Metrics and Performance Measures

Based on findings from the various demonstration projects and feasibility studies, NIOSH, with the assistance of relevant professional organizations and the Health IT Policy Committee, should develop meaningful use metrics and health care performance measures for including occupational information in the meaningful use criteria, beginning with the incorporation of occupation, industry, and work-relatedness data, and later expanding as deemed appropriate to include other data elements such as exposures and employer.

Recommendation 6: Convene a Workshop to Assess Ethical and Privacy Concerns and Challenges Associated with Including Occupational Information in the EHR

NIOSH should convene a workshop involving representatives of labor unions, insurance organizations, health care professional organizations, workers’ compensation-related organizations (e.g., International Association of Industrial Accident Boards and Commissions, National Council on Compensation Insurance), and EHR vendors to
.. assess the implications for the patient and clinician of incorporating work-relatedness in the EHR, with respect to workers’ compensation; and
.. propose guidelines and policies for protecting the patient’s non-workrelated health information from inadvertent disclosure and to ensure compliance with the Health Insurance Portability and Accountability Act, workers’ compensation, and other privacy standards.

Enhance the Value and Use of Occupational Information in the EHR

Recommendation 7: Develop and Test Innovative Methods for the Collection of Occupational Information for Linking to the EHR

NIOSH should initiate efforts in collaboration with large health care provider organizations, health insurance organizations, EHR vendors, and other stakeholders to develop and test methods for collecting occupational data from innovative sources. Specifically, NIOSH should evaluate collection methods that involve

.. patient input through mechanisms such as web-based portals and personal health records, and
.. other means such as health-related smart cards, health insurance cards, and human resource systems.

Recommendation 8: Develop Clinical Decision-Support Logic, Education Materials and Return-to-Work Tools

NIOSH, relevant professional organizations, and EHR vendors should begin to develop, test, and iteratively refine and expand

.. clinical decision-support tools for common occupational conditions (e.g., work-related asthma);
.. tools and programs that could be easily accessed for education of patients and caregivers about occupational illnesses, injuries, and workplace safety;
.. training modules for administrative staff to collect occupational information in different care settings; and
.. tools to improve and standardize functional job assessment and return- to-work documentation in EHRs, including standards for the transmission of these forms.

Recommendation 9: Develop and Assess Methods for Collecting Standardized Exposure Data

NIOSH should continue to work with occupational and environmental health clinics and other relevant stakeholders to develop and assess methods for collecting standardized exposure data for work-related health conditions. NIOSH should explore the feasibility of

.. listing possible or probable exposures in the problem list or elsewhere in the EHR;
.. linking occupational information in the EHR to online occupational, toxicological, and hazardous materials databases, such as the Occupational Information Network (O*NET), the Association of Occupational and Environmental Clinics, and Haz-Map, to enhance diagnosis and treatment of work-related illnesses and injuries; and
.. automatically generating codes for exposures based on narrative text entries.

Recommendation 10: Assess the Impact of Incorporating Occupational Information in the EHR on Meaningful Use Goals

NIOSH, in conjunction with relevant stakeholders (e.g., Public Health Data Standards Consortium, CSTE, Association of State and Territorial Health Officials), should

.. develop measures and conduct periodic studies to assess the impact of integrating occupational information in EHRs, and
.. estimate the economic impact of EHR-facilitated return-to-work practices for both work-related and non-work-related conditions.

Tuesday, October 4, 2011

The Need to Incorporate Occupational Histories Into Electronic Medical Records

Each year in the United States, more than 4,000 occupational fatalities and more than 3 million occupational injuries occur along with more than 160,000 cases of occupational illnesses. The use of electronic health records (EHRs) has increased rapidly since the passage of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. Incorporating patients’ occupational information into EHRs could lead to more informed clinical diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population.

At the request of the National Institute for Occupational Safety and Health, the IOM appointed a committee to examine the rationale and feasibility of incorporating occupational information in patients’ EHRs. The committee focused on the potential benefits of the inclusion of occupational information to individual and public health, current systems that use this information, and technical barriers to incorporating occupational information into the EHR. The IOM concluded that three data elements – occupation, industry, and work-relatedness – were ready for immediate focus. To incorporate these data into EHRs, recommendations were made that include assessment of data collection and incorporation, requirements for storing and communicating occupational information, development of metrics and performance measures, and assessment of privacy concerns, among others.

Monday, October 3, 2011

Employer Co-Op Pays OSHA Fines after 26 Industry Employee Deaths

US Labor Department's OSHA reaches settlement with Wisconsin-based Cooperative Plus to improve grain bin safety training, abate hazards Cooperative to pay $550,000 in penalties for grain violations

The U.S. Department of Labor's Occupational Safety and Health Administration has filed a settlement agreement with the Occupational Safety and Health Review Commission between the agency and Cooperative Plus Inc., after the farmer-owned Wisconsin cooperative agreed to pay $550,000 in penalties, increase employee grain bin safety training and abate all safety issues at its grain handling facilities in Whitewater, Burlington, East Troy and Genoa City.

"At least 26 workers were killed in grain entrapments nationwide last year, the highest number of any year since researchers started collecting data in 1978, but there are well-known safety practices that can be implemented to prevent these tragedies," said Mike Connors, OSHA's regional administrator in Chicago. "We are pleased to reach this agreement. The procedures and training that Cooperative Plus agreed to implement will ensure that these often deadly entrapments will not happen again."

As part of the settlement agreement, Cooperative Plus will provide site-specific training for all employees exposed to potential hazards identified by OSHA's grain handling, permit-required confined space and lockout standards. The cooperative also will schedule confined space and bin entry rescue drills semiannually, and provide 10 hours of training to newly hired and current employees whose duties expose them to potential hazards addressed by these standards.

Additionally, the cooperative will develop and implement a program to manage the risk of grain handling that includes safe methods to inspect grain and dislodge clumps of grain to empty the bin; develop lockout/tagout procedures for augers, conveyors and other equipment prior to bin entry; and develop engineering controls to abate hazards posed by bridged and castled grain. The company will audit work to ensure that all employees are properly trained in program rules and OSHA safety standards.

Finally, the company agreed to retain at least one independent safety consultant and to comply with OSHA follow-up inspections over a two-year period.

OSHA cited Cooperative Plus Inc. for a total of 14 willful, 23 serious and two other-than-serious safety violations in August 2010 for lacking proper equipment and procedures, thereby exposing workers to the risk of being engulfed and suffocated in grain storage bins.

Since 2009, OSHA has fined grain operators in Wisconsin, Illinois, Colorado, South Dakota, Ohio and Nebraska following preventable fatalities and injuries. In addition to enforcement actions and training, OSHA Assistant Secretary Dr. David Michaels sent a notification letter in August 2010 to grain elevator operators warning them not to allow workers to enter grain storage facilities without proper equipment. For a copy of the letter, visit http://www.osha.gov/asst-sec/Grain_letter.html.

Burlington-headquartered Cooperative Plus has locations throughout southeastern Wisconsin, including in Clinton, East Troy, Elkhorn, Genoa City, Union Grove and Whitewater. The company has a combined member-ownership of more than 10,000 and annual sales of more than $50 million.

To ask questions, obtain compliance assistance, file a complaint, or report workplace hospitalizations, fatalities or situations posing imminent danger to workers, the public should call OSHA's toll-free hotline at 800-321-OSHA (6742) or the agency's Milwaukee Area Office at 414-297-3315.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit http://www.osha.gov.

Trade Association Labels Formaldehyde Unsafe & Advocates Removal from Hair Straightening Products

After a long period of deliberation the mostly unregulated cosmetic industry's own trade association, through its reviewing agency, the Cosmetic Ingredient Review Expert Panel (CIR) has declared formaldehyde and methylene glycol unsafe and requested its removal from hair straightening products. US government regulators have labeled the substance as carcinogenic and warned both users and workers of the hazards.

"In concept, therefore, limits on the concentration of formaldehyde/methylene glycol in hair smoothing products, control of the amount of product applied, use of temperature lower than 450 o F, and approaches to mandate adequate ventilation, are among the steps that could be taken to ensure that these products could be used safely in the future. However, in the present practices of use and concentration (on the order of 10% formaldehyde/methylene glycol, heating to 450 o F, inconsistent ventilation, resulting in many reports of adverse effects), hair smoothing products containing formaldehyde and methylene glycol are unsafe."

The CIR continues to advocate that formaldehyde and methylene glycol are safe for use in other products.

Work Injury During Sex: Ridiculous?

Guest Blog by Thomas M. Domer

Not really. From time to time lurid headlines raise eyebrows about employees who claim workers' compensation for injuries occurred during sex. The most common response is “How ridiculous . . . The employee is not being paid to have sex (unless she is a hooker).”

A most recent headline notes an Australian woman who had hotel sex with an acquaintance and was injured when a wall-mounted light fell on her during the encounter. She sought workers' compensation because the incident occurred during a business trip and she claimed having sex on a business trip is “an ordinary incident of life” that entitles her to payment under workers' compensation law.

Traveling employees receive broad workers' compensation coverage in Wisconsin under a 3-step analysis:

Traveling employees are deemed to be in the course of employment at all times while on a trip (portal to portal);
Except when engaged in deviation for a private or personal purpose;
Acts reasonably necessary for or incidental to living are not deviations.

Skeptics may note that sex may or may not be reasonably necessary for living, but the last clause provides that acts merely incidental to living are not deviations and therefore coverage should be provided.

The traveling employee provision was created to remedy situations in which employees, whose work required them to live away from home for periods of time, were not compensated for injuries sustained during normal activities of daily living on a business trip. Wisconsin Supreme Court has issued a presumption that a traveling employee performs services incidental to employment at all times on a trip, with the burden of proving deviation falling to the employer.

Such widely varied activities as skiing, shopping, drinking, and swimming have been found compensable under the traveling employee statute. Recent court cases confirm that traveling employees may participate in reasonable recreational activities without deviating from their employment.

Many employee trips have a “dual purpose,” both personal and business. The Court’s criteria for coverage: If the business purpose could necessitate the trip even if the personal trip were cancelled, compensation is awarded.

Thomas M. Domer practices in Milwaukee, Wisconsin (www.domerlaw.com). He has authored and edited several publications including the legal treatise Wisconsin Workers' Compensation Law (West) and he is the Editor of the national publication, Workers' First Watch. Tom is past chair of the Workers' Compensation Section of the American Association for Justice. He is a charter Fellow in the College of Workers' Compensation Lawyers. He co-authors the nationally recognized Wisconsin Workers' Compensation Experts Blog.

Employee Death From MRSA Infection Spreads Fear Among Co-Workers

A 28 year old employee's death caused by a MRSA infection has spread fear among co-workers at a NJ Motor Vehicle office. The infection, Methicillin-Resistant Staphylococcus Aureus (MRSA), is a highly contagious disease. Co-workers allege that the dead employee was infected by a customer.

See the NJ Journal Article: http://bit.ly/q9zHwp

Sunday, October 2, 2011

New CMS Policy Announced: Asbestos Exposure, Ingestion, and Implantation Issues and December 5, 1980

The Centers for Medicare & Medicaid Services has consistently applied the Medicare Secondary Payer (MSP) provision for liability insurance (including self-insurance) effective 12/5/1980. As a matter of policy, Medicare does not assert a MSP liability insurance based recovery claim against settlements, judgments, awards, or other payments, where the date of incident (DOI) occurred before 12/5/1980.

When a case involves continued exposure to an environmental hazard, or continued ingestion of a particular substance, Medicare focuses on the date of last exposure or ingestion for purposes of determining whether the exposure or ingestion occurred on or after 12/5/1980. Similarly, in cases involving ruptured implants that allegedly led to a toxic exposure, the exposure guidance or date of last exposure is used. For non-ruptured implanted medical devices, Medicare focuses on the date the implant was removed. (Note: The term “exposure” refers to the claimant’s actual physical exposure to the alleged environmental toxin, not the defendant’s legal exposure to liability.)

In the following situations, Medicare will assert a recovery claim against settlements, judgments, awards, or other payments, and the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) Section 111 MSP mandatory reporting rules must be followed:

• Exposure, ingestion, or the alleged effects of an implant on or after 12/5/1980 is claimed, released, or effectively released.

• A specified length of exposure or ingestion is required in order for the claimant to obtain the settlement, judgment, award, or other payment, and the claimant’s date of first exposure plus the specified length of time in the settlement, judgment, award or other payment equals a date on or after 12/5/1980. This also applies to implanted medical devices.

• A requirement of the settlement, judgment, award, or other payment is that the claimant was exposed to, or ingested, a substance on or after 12/5/1980. This rule also applies if the settlement, judgment, award, or other payment depends on an implant that was never removed or was removed on or after 12/5/1980.

When ALL of the following criteria are met, Medicare will not assert a recovery claim against a liability insurance (including self-insurance) settlement, judgment, award, or other payment; and MMSEA Section 111 MSP reporting is not required. (Note: Where multiple defendants are involved, the claimant must meet all of these criteria for each individual defendant in order for a settlement, judgment, award, or other payment from that defendant to be exempt from a potential
MSP recovery claim and MMSEA Section 111 reporting):

•All exposure or ingestion ended, or the implant was removed before 12/5/1980; and

•Exposure, ingestion, or an implant on or after 12/5/1980 has not been claimed and/or specifically released; and,

•There is either no release for the exposure, ingestion, or an implant on or after 12/5/1980; or where there is such a release, it is a broad general release (rather than a specific release), which effectively releases exposure or ingestion on or after 12/5/1980. The rule also applies if the broad general release involves an implant.

For Specific Examples Click Here To Read the CMS Memo

REPORTING REMINDER:

Information related to the MMSEA Section 111 MSP reporting requirements can be found at
www.cms.hhs.gov/MandatoryInsRep. When reporting a potential settlement, judgment, award, or other payment related to exposure, ingestion, or implantation, the date of first exposure/date of first ingestion/date of implantation is the date that MUST be reported as the DOI. This is true for purposes of individual self-identification of a pending claim to the Centers for Medicare & Medicaid Services’ Coordination of Benefits Contractor, as well as for MMSEA Section 111 reporting.
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