Wednesday, June 8, 2011

EHRs to Include Work History

Workers on the job are at risk for illnesses and injuries because of long hours, changing shifts, lifting and repetitive tasks, stress on the job, and exposure to infectious diseases and hazardous chemicals. Because of the many work-related health factors that exist, the National Institute for Occupational Safety and Health (NIOSH) and the Institute of Medicine (IOM) are conducting a study to examine the rationale and feasibility of incorporating work history information into patient EHRs by 2015.

“Inclusion of occupational information into EHRs is vital to accurately diagnosing and providing appropriate treatment for an individual,” said NIOSH Director John Howard M.D. “ As the Nation moves toward a 21st century system of interoperable electronic record systems, NIOSH appreciates having IOM as a partner to study the challenges and opportunities for incorporating work history information into such systems.”

Today, leaders in the healthcare field are beginning to realize how important it is to incorporate occupational information into EHRs to not only increase efficiency, reduce costs in healthcare, but to most importantly arrive at the correct medical diagnosis.

To discuss the issues, a public workshop was held on June 2, 2011 to discuss the following questions:

• What are the potential benefits to individual and public health for incorporating occupational information in EHRs?
• Are there any current systems that incorporate work history into EHRs that support clinical decision making and public health reporting
• What are the technical barriers to incorporating work history information into the patient’s EHR
• What steps are needed to advance this effort?

At the June 2nd workshop, James Tacci, MD, JD, MPH, Global Corporate Medical Director and Manager of Medical, Health, and Wellness Services for Xerox Corporation presented several case scenarios describing factors that can be missed simply because the work information is not included in the medical record.

To show how important it is to include occupational information in medical records, the correct diagnosis based not only on information in the medical record but also based on occupational information for the following cases would have saved the patient, doctor, and the employer valuable time and money.

A 45 year male came to the doctor due to a new onset of wheezing, coughing, with chest tightness and shortness of breath The diagnosis could be any one of a number of conditions, including asthma, bronchitis, COPD etc. The accurate diagnosis was new onset occupational asthma related to his new job. It turned out that the patient was working in a local supermarket bakery and was exposed to new air contaminants. He was working in the bakery temporarily to tide his family over, because he lost his engineering job. WHO and NHLBI estimate there are 300 million cases of asthma are reported worldwide and it is estimated that 15 to 23 percent of all new cases of asthma are work-related.

A 20 year old man came to the doctor due to a new onset of redness, swelling, and scaling of his hands. The patient told the doctor that his wife was using a new type of scented liquid soap so the doctor told him to switch back to the old soap. The real fact was that the man was developing new onset occupational contact dermatitis related to specific mechanical solutions he used while working on the job in a specialty metal-working shop. It is estimated that 3000 chemicals are well-documented causes of allergic contact dermatitis with 25 chemicals accounting for half of the cases.

A 60 year old male came to his doctor complaining about his hearing loss and was fitted with hearing aids by an audiologist. Without occupational data available, the doctor and the audiologist both thought that the man’s hearing loss was simply age related. It was found that the man actually has occupational noise induced hearing loss due to his occupation as a carpenter and his lifelong significant exposure to power tool noise on the job. NIOSH estimates that over 22 million U.S. workers are exposed to hazardous noise in the workplace.

A 36 year old female came to the doctor with excruciating low back pain after a fall on her front steps. The doctor prescribed anti-inflammatory medications, muscle relaxants and sent her to physical therapy. Actually, she was employed as a sales representative for a solar energy company where her job requires her to cover a three state territory and she spends up to five to six hours a day driving in her car plus making many trips by air which was not easy on her back. However, the real problem was that in her job, she had to lift demonstration solar panels weighing up to 35 pounds and roll a carry case with three panels and other equipment weighing up to 100 pounds to demonstrate products to her clients. This is what really caused her back pain.

A 45 year old male is three months post a myocardial infarction and balloon angioplasty. He has undergone a cardiac rehabilitation program, is following a new diet, and taking an anti-hypertensive and cholesterol-lowering drugs. He was permitted to go back to work with a release signed by his doctor but the release did not require the man to have any restrictions at work. Without occupational data, the doctor failed to realize that the patient was an interstate commercial truck driver and required some restrictions included in public safety laws when he returned to work.

A 50 year old female with a family history of adult-onset diabetes having failed a trial of diet and exercise as well as two trials of oral hypoglycemic agents was placed on insulin by her physician. Without her work medical history, her physician did not realize that the patient worked as an air traffic controller and worked different twelve hour shifts sometimes during the day and sometimes at night. Her irregular hours made it very difficult for her as a diabetic to exercise, adhere to a diet, and adhere to her medication schedule. The doctor needed to take all of this information into consideration when treating her diabetes.