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Thursday, July 5, 2012

NIOSH Seeks Occupational History for Inclusion in Electronic Health records

NIOSH logo
NIOSH logo (Photo credit: Wikipedia)
The National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS) requests public comments to inform its approach in recommending the inclusion of work information in the electronic health record (EHR). NIOSH requests input on these issues (including answers to the three questions listed below).
The instructions for submitting comments can be found at www.regulations.gov. Written comments submitted to the Docket will be used to inform NIOSH with its planning and activities in response to the 2011 letter report “Incorporating Occupational Information in Electronic Health Records” written by the Institute of Medicine (IOM) Committee on Occupation and Electronic Health Records.

Input from primary care providers, occupational and public health specialists, EHR vendors and others with interest in the topic is sought on the questions listed below pertaining to the collection and use of work information in the clinical setting. NIOSH is interested in input both from those who are currently using EHRs as well as those who are not.

(1) For providers of primary health care: When do the clinicians in your practice setting currently ask patients about their work?Show citation box

Specifically, what information on patients' work is collected?Show citation box

If you currently use an EHR:Show citation box

Where in the health record (either paper or electronic) is patient work information stored and/or viewed? For example, is the work information entered in the `social history' section of an EMR? Where would you prefer patient work information to be stored and/or viewed in the EHR?Show citation box

Does your EHR maintain a history of the information so that you can identify how long and when a patient was in a given occupation?Show citation box

If you currently do not use an EHR, where do you record this information in the paper record? Is it available to the care provider during the patient encounter? Is there a history of the patient's work information available to the care provider?Show citation box

In your clinical practice, who (which personnel) besides the clinicians collect patients' work information (e.g., registration personnel or nursing assistants)?Show citation box

Have those personnel been trained specifically in how to collect information about patient's work i.e., how to gain an accurate job title etc.?Show citation box

Do you collect work information from teenagers?Show citation box

Do you collect work information from retirees?Show citation box

Are questions about work routine question or triggered based on specific complaints?Show citation box

How is work information used to inform patient care?Show citation box

Please provide an example/description of the usefulness of patient work information in providing care to a patient.Show citation box

Please provide any additional comments you have about collection or use of patient work information in the clinical setting.Show citation box

(2) For providers of occupational (specialty) health care: At your clinical facility, how is the patient's work information collected?Show citation box

Specifically, what information on patients' work is collected?Show citation box

Is the work information entered in the administrative record used for billing purposes?Show citation box

Is patient work information collected on paper or in an EHR? Is it available to the care provider during the patient encounter?Show citation box

Is there a history of the patient's work information available to the care provider?Show citation box

If you use a standardized form to collection information about patients' work, please briefly describe its main elements.Show citation box

In your clinical practice, who (which personnel) besides the clinicians collect (e.g., registration personnel or nursing assistants)?Show citation box

Have those personnel been trained specifically in how to collect information about patient's work i.e., how to gain an accurate job title, etc.?Show citation box

Where in the health record (either paper or electronic) is the information stored? For example, is the work information entered in the `social history' section?Show citation box

What are the most important ways that clinicians can use to inform clinical care of patients?Show citation box

Please provide an example of the usefulness of work information in providing care to a patient.Show citation box

Do you have any other comments about collection or use of patient work information in the clinical setting?Show citation box

(3) For developers and vendors of EHR/software: Does your base/basic EHR product contain pre-ordained fields for Industry, Occupation, Employer or other information about patients' work? If not, have you been asked to provide these fields?Show citation box

Regardless of whether they are in the base system or added on request, how are the values in the fields for Industry, Occupation, or other work information formatted (e.g., narrative text, drop-down menus, other)?Show citation box

Are these values coded and if so, what coding schema are used (e.g., NAICS, SOC, Census codes, user defined)?Show citation box

To the best of your knowledge, how are the data captured in these fields used by end users of your EHR/product?Show citation box

Please share challenges you anticipate in managing a history of employer, industry and occupation (current and usual) for multiple employment situations as both text and coded fields in your system, if your system does not already perform these functions?Show citation box

Could your system access and retrieve information from another web-based system via web services (such as an automated coding system for coding industry and occupation)?Show citation box

Your comments are appreciated. They will be used to improve NIOSH's electronic health records efforts.