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Incorporation of basic occupational information into electronic health records (EHRs), although currently rare, is expected to improve clinical care and public health activities. One option for improving the collection of a patient’s industry and occupation (I&O) information in EHRs is to create opportunities for patients to enter their own information, such as through a personal health record (PHR) or a patient EHR portal. With the goal of developing interface requirements that would allow patients to enter their own I&O information into an EHR, we aimed to determine the information required to support the assignation of I&O codes and how to phrase questions (i.e., field labels) to collect accurate I&O information with limited respondent burden.
METHODS:
We summarized existing questions used to gather occupational information in eight data collection instruments (e.g., The American Community Survey, National Health Interview Survey 2011, Death Certificates, etc.). We reviewed logic for assigning Bureau of Census (BOC) Occupation and Industry Codes from text, such as that used for coding I&O from death certificates as described in CDC ‘Instruction Manual Part 19’. We assessed a sample of computer entry screens from general EHRs. We evaluated I&O information required for three occupationally-related treatment guidelines to provide clinical decision support to care providers. These findings were synthesized to define the most important type of question and suggested wording to gather codable I&O information through a patient user interface (e.g., PHR or patient portal).
RESULTS:
We identified 15 concepts that may assist (when relevant) in obtaining I&O information consistent with BOC codes. The industry-related concepts included industry description (in 8/8 instruments), industry sector (2/8), employer name (6/8), types of employee (6/8), branch of armed forces, and place of home-based employment (own or other home) (1/8). The occupation-related concepts included occupation description (8/8), age (at least 5/8), education level (at least 4/8), job title (3/8), job duties (6/8), status of work (6/8), role (e.g., supervisor) (1/8), compensation (6/8), and occupation within armed forces(0/8). We found that while many surveys share a subset of questions, their number and wording is highly variable. Clinical guidelines revealed I&O information required to trigger decision support logic. Current EHRs interfaces were missing these questions, especially industry-related concepts.
CONCLUSIONS:
The analysis revealed target content to enhance collection of textual I&O information directly from patients with the goal of programmed conversion to structured I&O codes. This will inform interactive testing and recommendations for a patient interface.