Patient Work Information Incorporated Into EHRs
By Christine Kern, contributing writer
Electronic health records are being used to capture and use patient work information to better understand their health.
According to data released this week by the U.S. Department of Health and Human Services, in 2013 federally funded health centers provided care to more than 21.7 million patients, more than 62 percent of whom were racial/ethnic minorities and almost 35 percent of whom are uninsured. The clear majority of these centers (96 percent) have an electronic health record (EHR) in use at some or all sites and 84.5 percent reported their providers are receiving meaningful use payments. Health centers are using health IT as part of clinical transformation with more than 54 percent of centers having achieved recognition as Patient Centered Medical Homes, a key indicator of high-quality care.
The HRSA report further revealed the health centers are using EHRs to enter and analyze patient work data to better understand the relationship between patients’ health and work. The Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (NIOSH) EHR Working Group is now working with health providers to improve the collection and use of work information in EHRs.
“While work is an important determinant of health, information about patients’ occupation(s) and the industries in which they work or have worked is not typically present and systematically organized in health records,” states an Aug. 15 blog from NIOSH. “Recording industry and occupation data in EHRs not only allows providers access to this important information on patients, but it can also enable clinical decision support functions to assist providers in caring for patients based on each individual’s work history.”
The value of this information is highlighted by a project between Cambridge Health Alliance and the Massachusetts Department of Public Health Occupational Health Surveillance Program. As part of the 2010 program, occupation information was recorded for more than 27,000 patients in a primary care practice’s EHR. According to Laura Brightman, M.D., a primary care physician and the principal investigator, the project was a success. “When we presented at … grand rounds, staff were excited about having data about their patients’ work, and the potential for this information to improve both clinical and population health.”
In an effort to incorporate patient industry and occupation fields into a commercial EHR, NIOSH awarded a contract with St. John’s Well Child and Family Center in Los Angeles. Launched in October 2013, the project modifies the GE Centricity EHR used by the center to include patient industry and occupation information. Under the project, St. John’s will collect one year of data, allowing staff to incorporate patient work information into clinical and population health activities and evaluate impacts upon health center workflow. The data also will support wider efforts at St. John’s to identify and treat work-related health concerns and provide advocacy on behalf of low-wage worker populations in their service area.
NIOSH also has started a project to develop occupationally-related clinical decision support for health issues such as work-related asthma, diabetes, and return-to-work guidelines. And, a NIOSH-developed “Occupational Data for Health” information model (soon to be published) will provide the structure for programming the work data elements that are most useful for patient care and population health and facilitate EHR modifications.
“Data capture would be the first step to allow health-care organizations to develop programs aimed at meeting the occupational health needs of their patients, harnessing the power of EHRs for capturing, storing, tracking, exchanging, and reporting data,” states the blog.