Structuring, Managing, and Using Patient Work Information in EHRs to Improve Patient Health and Heath Care

BACKGROUND:   Information about work can be used to inform individual patient care and population health, for both health issues directly related to occupation and those that are not. The potential effects on health of a wide variety of workplace exposures – from stress to chemicals - are well-documented. Work factors also can be important considerations in the management of chronic conditions, such as diabetes. In fact, work impacts nearly every domain of public health interest, including prenatal health, infectious diseases, and cancer. Standards and tools are needed to support the inclusion of patient work data in EHRs.

METHODS:   The CDC National Institute for Occupational Safety and Health (NIOSH) and others are using informatics to develop products that support the management and exchange of structured work information in EHRs, including: a relational information model; a Clinical Document Architecture (CDA) template; selected products of the Standards and Interoperability (S&I) Framework’s Public Health Reporting Initiative; and a Health Level Seven (HL7) EHR-S Functional Profile, with glossary entries for occupational terms. Implementation projects include: a preliminary study of capturing and coding industry and occupation in EHRs; a collaboration with a primary care network to use patient occupation collected by registration personnel; a project to modify an EHR to capture patient industry and occupation; and a 4-year project to develop Clinical Decision Support (CDS) for primary care clinicians treating patients with occupational conditions and conditions whose management can be affected by work.

RESULTS:   The information model provides the basic framework for structuring patient work information. The CDA template is published and tested as a draft standard through Integrating the Healthcare Enterprise (iHE). Additional interoperability standards are available via the S&I Framework. Functions for EHR system users to use work information for public health are available as an HL7 standard. Pilot projects continue to demonstrate methods for capturing work information and uses of that data. Currently, coded industry and occupation are included in the draft 2017 Edition EHR Certification Criteria proposed by the Office of the National Coordinator for Health IT (ONC).

CONCLUSIONS: NIOSH and partners are developing tools and products to ensure that patient work information can be captured by EHRs, stored, exchanged, and used to inform clinical care and public health.