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Committee on Occupational Information and Electronic Health Records Board on Health Sciences Policy David H. Wegman, Catharyn T. Liverman, Andrea M. Schultz, and Larisa M. Strawbridge, Editors

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was requested by the National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention and supported by Award No. 211-2006-19152, T.O. #1, between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-21743-9 International Standard Book Number-10: 0-309-21743-1 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624- 6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2011 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2011. Incorporating occupational information in electronic health records: Letter report. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON OCCUPATIONAL INFORMATION AND ELECTRONIC HEALTH RECORDS DAVID H. WEGMAN (Chair), School of Health and Environment, University of Massachusetts (Professor Emeritus) LAURA O. BRIGHTMAN, Cambridge Health Alliance CURTIS L. COLE, Weill Cornell Medical College LETITIA K. DAVIS, Occupational Health Surveillance Program, Massachusetts Department of Public Health ROBERT A. GREENES, Arizona State University LAWRENCE HANRAHAN, Wisconsin Division of Public Health ROBERT HARRISON, University of California, San Francisco SUNDARESAN JAYARAMAN, Georgia Institute of Technology MATTHEW KEIFER, Marshfield Clinic Research Foundation CATHERINE STAES, Biomedical Informatics, University of Utah School of Medicine GEORGE STAMAS, Division of Occupational Employment Statistics, U.S. Bureau of Labor Statistics IOM Study Staff CATHARYN T. LIVERMAN, Project Director ANDREA M. SCHULTZ, Program Officer LARISA M. STRAWBRIDGE, Research Associate JUDITH L. ESTEP, Program Associate IOM Board on Health Sciences Policy ANDREW M. POPE, Director v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its pub- lished report as sound as possible and to ensure that the report meets in- stitutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confi- dential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: David Bonauto, University of Washington, Seattle Christopher Chute, Mayo Clinic College of Medicine, Rochester, Minnesota Carl Kesselman, University of Southern California, Marina del Rey, California Robert K. McLellan, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire Anna Orlova, Public Health Data Standards Consortium, Baltimore, Maryland Stephanie L. Reel, Johns Hopkins University, Baltimore, Maryland Jesse Singer, New York City Department of Health and Mental Hygiene, New York Walter G. Suarez, Kaiser Permanente, Silver Spring, Maryland Edward Zuroweste, Migrant Clinicians Network, State College, Pennsylvania vii

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viii REVIEWERS Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Linda Hawes Clever, California Pacific Medical Center, San Francisco. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this re- port rests entirely with the authoring committee and the institution.

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Contents LETTER TO NIOSH 1 STUDY PROCESS 6 BACKGROUND 7 Occupational Morbidity and Mortality, 7 EHR Use and Incentives for Meaningful Use, 9 BENEFITS OF INCORPORATING OCCUPATIONAL INFORMATION IN THE EHR 11 Improve Quality, Safety, and Efficiency of Care and Reduce Health Disparities, 11 Engage Patients and Families in Their Health Care, 16 Improve Care Coordination, 17 Improve Population and Public Health, 18 Ensure Adequate Privacy and Security Protections for Personal Health Information, 21 FEASIBILITY 22 Current Environment and Technical Considerations for Each Occupational Data Element, 25 Cross-Cutting Challenges and Opportunities, 36 Initial Requirements and Information Modeling, 41 CONCLUSIONS 42 ix

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x CONTENTS RECOMMENDATIONS 44 Initial Focus on Occupation, Industry, and Work-Relatedness Data Elements, 44 Enhance the Value and Use of Occupational Information in the EHR, 47 REFERENCES 49 APPENDIXES A Workshop Agenda 59 B Workshop Participants 65 C Committee Biographies 69