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Board on Health Sciences Policy September 29, 2011 John Howard, M.D. National Institute for Occupational Safety and Health Patriots Plaza 1 395 E. Street, S.W., Suite 9200 MS P12 Washington, DC 20201 Dear Dr. Howard: At the request of the National Institute for Occupational Safety and Health (NIOSH), the Institute of Medicine (IOM) appointed the ad hoc Committee on Occupational Information and Electronic Health Records (EHRs). The overarching charge to the committee was to examine the rationale and feasibility of incorporating occupational information in EHRs and to develop recommendations on next steps for NIOSH and other partners to achieve this goal. More specifically, the committee was asked to analyze the potential benefits of including occupational infor- mation in EHRs, examine systems that are currently collecting these data in their EHR in useful ways, and explore the technical challenges that must be overcome in order to facilitate the incorporation of occupational information in EHRs. Implementation and use of EHRs have increased rapidly since pas- sage of the 2009 Health Information Technology for Economic and Clin- ical Health (HITECH) Act. The transition from paper to electronic records offers the potential for providing clinicians with relevant and necessary information about their patients’ occupations, as well as possi- bilities for links to an array of clinical decision-support tools that could improve the health care and safety of individuals. Additionally, the inclu- sion of occupational information in EHRs offers a significant opportunity to advance and expand public health surveillance in order to provide a better understanding of occupational illness and injury. Each year in the United States, more than 4,000 occupational fatalities and more than 3 1
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2 OCCUPATIONAL INFORMATION IN ELECTRONIC HEALTH RECORDS million occupational injuries occur along with more than 160,000 cases of occupational illnesses (BLS, 2010b, 2011b). Advances in incorporat- ing occupational information in EHRs could lead to more informed clini- cal diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population. After gathering and reviewing the available evidence, the committee concluded that occupational information could contribute to fully realiz- ing the meaningful use of EHRs in improving individual and population health care. The report examines the challenges that are inherent in this important advance and makes recommendations (Box 1) focused on moving forward the efforts to incorporate occupational information into EHRs including feasibility studies, demonstration projects, and other actions. BOX 1 Recommendations Initial Focus on Occupation, Industry, and Work-Relatedness Data Elements Recommendation 1: Conduct Demonstration Projects to Assess the Collection and Incorporation of Information on Occupation, Industry, and Work-Relatedness in the EHR NIOSH, in conjunction with other relevant organizations and initiatives, such as the Public Health Data Standards Consortium and Integrating the Healthcare Enterprise (IHE) International, should conduct demonstration projects involving EHR vendors and health care provider organizations (diverse in the services they provide, populations they serve, and geographic locations) to assess the collection and incorporation of occupation, industry, and work-relatedness data in the EHR at different points in the workflow (including at registration, with the medical assistant, and with the clinician). Further, to examine the bidirectional exchange of occupational data between administrative databases and clinical components in the EHR, NIOSH in conjunction with IHE should conduct an interoperability-testing event (e.g., Connectathon) to demonstrate this bidirec- tional exchange of occupational information to establish proof of concept and, as appropriate, examine challenges related to variable sources of data and reconciliation of conflicting data. Recommendation 2: Define the Requirements and Develop Information Mod- els for Storing and Communicating Occupational Information NIOSH, in conjunction with appropriate domain and informatics experts, should develop new or enhance existing information models for storing occupational information, beginning with occupation, industry, and work-relatedness data and later focusing on employer and exposure data. The information models should consider the various use cases in which the information could be used and use the recommended coding standards. For example, NIOSH should
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3 LETTER REPORT BOX 1 Continued consider how best to use social history templates to collect a work history and the problem list to document exposures and abnormal findings and diagnoses with optional work-associated attributes for possible, probable, or definite causes; exposures; and impact on work. Recommendation 3: Adopt Standard Occupational Classification (SOC) and North American Industry Classification System (NAICS) Coding Standards for Use in the EHR NIOSH, with assistance from other federal agencies, organizations, and stakeholders (e.g., Bureau of Labor Statistics, Census Bureau, Council of State and Territorial Epidemiologists [CSTE], National Library of Medicine, National Institute of Standards and Technology, National Uniform Billing Committee, Health Level 7 International [HL7]), should recommend to the Health Information Technology (IT) Standards Committee the adoption of SOC and NAICS to code occupation and industry. Furthermore, NIOSH should de- velop models for reporting health data from EHRs by occupation and industry at different levels of granularity that are meaningful for clinical and public health use. Recommendation 4: Assess Feasibility of Autocoding Occupational Informa- tion Collected in Clinical Settings NIOSH should place high priority on completing the feasibility assessment of autocoding the narrative information on occupation and, where available, indus- try that currently is collected and recorded in certain clinical settings, such as the Dartmouth-Hitchcock health care system, Kaiser Permanente, New York State Occupational Health Clinic Network, Cambridge Health Alliance, and hospitals participating in the National Electronic Injury Surveillance System. Recommendation 5: Develop Meaningful Use Metrics and Performance Measures Based on findings from the various demonstration projects and feasibility stu- dies, NIOSH, with the assistance of relevant professional organizations and the Health IT Policy Committee, should develop meaningful use metrics and health care performance measures for including occupational information in the meaningful use criteria, beginning with the incorporation of occupation, industry, and work-relatedness data, and later expanding as deemed appro- priate to include other data elements such as exposures and employer. Recommendation 6: Convene a Workshop to Assess Ethical and Privacy Con- cerns and Challenges Associated with Including Occupational Information in the EHR NIOSH should convene a workshop involving representatives of labor unions, insurance organizations, health care professional organizations, workers’ compensation-related organizations (e.g., International Association of Industri- al Accident Boards and Commissions, National Council on Compensation In- surance), and EHR vendors to Continued
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4 OCCUPATIONAL INFORMATION IN ELECTRONIC HEALTH RECORDS BOX 1 Continued assess the implications for the patient and clinician of incorporating work-relatedness in the EHR, with respect to workers’ compensation; and propose guidelines and policies for protecting the patient’s non-work- related health information from inadvertent disclosure and to ensure compliance with the Health Insurance Portability and Accountability Act, workers’ compensation, and other privacy standards. Enhance the Value and Use of Occupational Information in the EHR Recommendation 7: Develop and Test Innovative Methods for the Collection of Occupational Information for Linking to the EHR NIOSH should initiate efforts in collaboration with large health care provider organizations, health insurance organizations, EHR vendors, and other stake- holders to develop and test methods for collecting occupational data from in- novative sources. Specifically, NIOSH should evaluate collection methods that involve patient input through mechanisms such as web-based portals and personal health records, and other means such as health-related smart cards, health insurance cards, and human resource systems. Recommendation 8: Develop Clinical Decision-Support Logic, Education Ma- terials and Return-to-Work Tools NIOSH, relevant professional organizations, and EHR vendors should begin to develop, test, and iteratively refine and expand clinical decision-support tools for common occupational conditions (e.g., work-related asthma); tools and programs that could be easily accessed for education of pa- tients and caregivers about occupational illnesses, injuries, and workplace safety; training modules for administrative staff to collect occupational infor- mation in different care settings; and tools to improve and standardize functional job assessment and re- turn-to-work documentation in EHRs, including standards for the transmission of these forms. Recommendation 9: Develop and Assess Methods for Collecting Standardized Exposure Data NIOSH should continue to work with occupational and environmental health clinics and other relevant stakeholders to develop and assess methods for collecting standardized exposure data for work-related health conditions. NIOSH should explore the feasibility of
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5 LETTER REPORT BOX 1 Continued listing possible or probable exposures in the problem list or elsewhere in the EHR; linking occupational information in the EHR to online occupational, toxicological, and hazardous materials databases, such as the Occu- pational Information Network (O*NET), the Association of Occupa- tional and Environmental Clinics, and Haz-Map, to enhance diagnosis and treatment of work-related illnesses and injuries; and automatically generating codes for exposures based on narrative text entries. Recommendation 10: Assess the Impact of Incorporating Occupational Infor- mation in the EHR on Meaningful Use Goals NIOSH, in conjunction with relevant stakeholders (e.g., Public Health Data Standards Consortium, CSTE, Association of State and Territorial Health Offi- cials), should develop measures and conduct periodic studies to assess the impact of integrating occupational information in EHRs, and estimate the economic impact of EHR-facilitated return-to-work prac- tices for both work-related and non-work-related conditions. I would like to thank NIOSH and its staff members for supporting this study and for the information they provided to the IOM committee in the course of its work. Appreciation also is due to the IOM committee and staff members for their work in planning the information-gathering workshop that was held in June 2011 and in developing the report and its recommendations. I hope that NIOSH will find this report helpful as it continues to work toward incorporating occupational information in EHRs. Sincerely, David H. Wegman, Chair Committee on Occupational Information and Electronic Health Records
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6 OCCUPATIONAL INFORMATION IN ELECTRONIC HEALTH RECORDS STUDY PROCESS In early 2011, NIOSH requested that the IOM conduct a study to ex- amine the rationale and feasibility of incorporating occupational1 infor- mation into EHRs and to develop recommendations on next steps for NIOSH and other partners to achieve this goal (see Box 2). This letter report and its recommendations contribute to a larger effort to ensure widespread adoption and meaningful use of EHRs in health care, which has been prompted by incentives that were created by the HITECH Act of 2009. This study was conducted by the 11-member ad hoc IOM Committee on Occupational Information and Electronic Health Records. The com- mittee included members with expertise in occupational medicine, elec- tronic health records, primary care, public health, biomedical informatics, information technology, and epidemiology (see Appendix C for committee biosketches). Over the course of the study, the committee held three meetings to gather and review available information, plan and conduct a public workshop, and draft and refine this report’s recommendations. The committee’s second meeting included a public information-gathering workshop, held June 2, 2011, in Washington, DC (see Appendix A for the workshop agenda and Appendix B for a list of registered attendees). The workshop provided the committee with insights from experts in pri- mary care, occupational medicine, public health surveillance, and infor- mation technology. Presentations and discussion focused on the potential benefits and challenges of including occupational information in EHRs to improve health care delivery and public health surveillance, the extent to which and the manner in which this information is currently being recorded in EHRs, and technical considerations related to standardizing and maximizing the value of the data. Additional information on occupa- tional morbidity and mortality, as well as on EHRs and meaningful use, was collected in a literature search and reviewed by the committee to inform its deliberations. 1 Throughout this report, “occupational” is used broadly to describe attributes related to one’s occupation (e.g., secretary), industry (e.g., mining), employer (e.g., Ford), and work environment (e.g., exposure to asbestos). Occupational illness, injury, and fatalities are used to denote morbidity and mortality related to employment and work environment.
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7 LETTER REPORT BOX 2 Statement of Task At the request of the National Institute for Occupational Safety and Health (NIOSH), the Institute of Medicine (IOM) will conduct a study to examine the ra- tionale and feasibility of incorporating work history information into patient elec- tronic health records. NIOSH seeks to ensure meaningful use of occupational information in electronic health records by 2015. This will require the agency’s demonstration of feasibility by 2013. An ad hoc committee will plan and hold data-gathering meetings, including a public workshop; conduct analysis; hold deliberations; and prepare a letter report with findings and recommendations that will address the following issues: Significance—What are the potential benefits to individual and public health of incorporating occupational information in electronic health records? Current environment—Are there current systems which incorporate work history into the record in a manner which supports clinical decision mak- ing and public health reporting activities? Technical issues—What are the perceived technical barriers to incorpo- rating work history information into the patient’s electronic health record? What are the barriers to using current systems of coding indus- try and occupation? What are alternatives to current methods? How would the technical issues be best addressed by electronic health record system vendors and researchers? Next steps—What steps are needed to advance this effort? What efforts by NIOSH in conjunction with government and non-governmental part- ners are needed? BACKGROUND Occupational Morbidity and Mortality Employed Americans spend almost half of their waking hours at work (BLS, 2011a). The nature of the work environment and work tasks can have a significant impact on workers’ health and even on the health of family members. Physical, chemical, radiological, biological, and er- gonomic hazards can cause injury and illness, as can organizational attributes of the workplace, such as stress and other psychosocial factors. The work environment can also influence personal lifestyle choices. Health care professionals need to understand their patients’ work envi- ronment in order to diagnose and treat certain illnesses and injuries and to recommend medical restrictions or work environment modifications
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8 OCCUPATIONAL INFORMATION IN ELECTRONIC HEALTH RECORDS that will help them recover and prevent additional harm. Identification and documentation of work-related health problems by health care pro- fessionals can also lead to interventions that protect other workers at risk. Work demands can contribute to common health problems not gen- erally associated with employment. For example, Church and colleagues (2011) suggested that decreasing energy expenditures at work over the last 50 years could explain a significant portion of Americans’ increase in body weight. On the other hand, the workplace can offer health pro- motion and disease prevention benefits, including wellness programs (e.g., stress reduction classes, smoking cessation programs) and facilities (e.g., exercise rooms). These types of programs have been demonstrated to be successful when interventions for behavior change occur in the workplace (Okechukwu et al., 2009; Sorensen et al., 2009, 2010). U.S. estimates of the annual number of nonfatal injuries at work range from 3.1 million to 5.5 million (BLS, 2010b; Schulte, 2005; Smith et al., 2005), with more than 3 million of these leading to at least a partial day out of work (Smith et al., 2005). The Bureau of Labor Statistics (BLS) reported 4,547 deaths in 2010 due to occupational injury (BLS, 2011b).2 BLS (2010b) estimates the annual number of acute occupational illnesses to be about 166,000. Steenland and colleagues (2003) estimate more than 55,000 U.S. oc- cupational deaths per year, including 6,200 from injuries and 49,000 from known occupational illnesses, making occupational causes the na- tion’s eighth leading cause of death. An estimated 15 percent of asthma deaths, 14 percent of deaths due to chronic obstructive pulmonary dis- ease, and 2.4 to 4.8 percent of all cancer deaths are attributable to occu- pational exposures (Steenland et al., 2003). The costs of occupational injuries, illnesses, and deaths are high. In 2008, employers paid $78.9 billion in workers’ compensation premiums (Sengupta et al., 2010). The overall costs to workers and their employers, when taking into account direct health care costs and indirect costs, such as lost productivity, range from $128 billion to $170 billion per year (Schulte, 2005; Thomsen et al., 2007). The current surveillance systems for occupational health, including BLS and workers’ compensation databases, do not fully capture the im- pact of occupational injuries and illnesses (GAO, 2009). The BLS Sur- vey of Occupational Injuries and Illnesses (SOII) derives its non-fatal 2 The Census of Fatal Occupational Injuries, conducted by the BLS, integrates data from 25 sources (e.g., death certificates, government agency administrative reports, the Current Population Survey) to estimate mortality due to occupational injury.
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9 LETTER REPORT workplace injury and illness data from a sample of Occupational Safety and Health Administration (OSHA) logs kept by employers, which ena- ble estimates across states. The SOII undercounts occupational injuries and illnesses for several reasons, including scope (e.g., these estimates do not cover self-employed workers, federal government employees, and others) and delayed recognition of cases, including those with long laten- cy periods (Boden et al., 2010; GAO, 2009; Hilaski, 1981; Oleinick and Zaidman, 2010; Rosenman et al., 2006). Less severe conditions, requir- ing workers to miss less than a week of work, also have a lower probabil- ity of being recorded (Boden et al., 2010). A key factor that contributes to underreporting of occupational mor- bidity, particularly illnesses, is that reporting relies on the health care professional’s recognition of a health condition as work related.3 Many such connections are overlooked or misdiagnosed (Landrigan and Baker, 1991; Steenland et al., 2003) and thus go unreported or are misclassified. This is especially true for chronic conditions and diseases with a long latency period, such as many types of cancer (Ruser, 2008; Souza et al., 2010a). For any number of reasons, patients may not suggest to their clini- cian that an injury or illness may be work related. They may not be aware that they could be eligible for workers’ compensation or the bene- fits may be too small to warrant the time and effort to report a minor problem (Azaroff et al., 2002; Fan et al., 2006). They may fear employer retaliation or stigma if they report health problems (Azaroff et al., 2002; Boden and Ozonoff, 2008; Boden et al., 2010; Fan et al., 2006). Employ- ers that offer incentives based on the length of time without injuries may create incentives not to report (Azaroff et al., 2002). Employers also have incentives to avoid reporting: high injury rates may result in a loss of business, more frequent OSHA inspections, or high workers’ compensa- tion insurance rates (Azaroff et al., 2002; Boden et al., 2010). EHR Use and Incentives for Meaningful Use The transition to EHRs is moving ahead rapidly. Health care provid- er organizations (primary care and specialist physician offices, hospitals, health systems, specialty clinics, and community and public health clin- ics) are in the midst of adopting new EHR systems, and health care pro- 3 Throughout this report, “work related” is used to denote caused by or aggravated by work (WHO Expert Committee, 1985).
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10 OCCUPATIONAL INFORMATION IN ELECTRONIC HEALTH RECORDS fessionals and staff are establishing habits of working with the new sys- tems. The percentage of office-based physicians with basic EHR capabil- ity rose from 11 percent in 2006 to an estimated 21 percent in 2009 (ONC, 2010). In 2008, 8 percent of U.S. hospitals reported having basic EHR capability (ONC, 2010). Driving EHR development and providing financial incentives for implementation is the HITECH Act of 2009. The Act provides funds to the Office of the National Coordinator for Health Information Technolo- gy (ONC) to promote the implementation of health information technol- ogy and an estimated $27 billion for the Centers for Medicare and Medicaid Services (CMS) to use as incentive payments for physician’s offices and hospitals to support adoption of EHRs4 (CMS, 2010b). The incentives require that providers use a certified EHR product and fulfill a set of objectives that demonstrate “meaningful use” of EHRs.5 ONC has detailed a set of certification criteria for EHRs that stipulate the technical capabilities required to ensure data security, confidentiality, interopera- bility, and capability to perform specific functions. Its EHR certification process is conducted by private-sector organizations approved as ONC- Authorized Testing and Certification Bodies (HHS, 2010). Hospitals that are not using certified EHRs according to meaningful use criteria by 2015 will face reduced reimbursements. Several of the Stage 1 objectives are particularly relevant to the in- clusion of occupational information in EHRs, including the requirement that electronic records “maintain up-to-date problem list of current and active diagnoses,” “use certified EHR technology to identify patient- specific education resources and provide those resources to the patient, if appropriate,” and have the “capability to submit electronic data on re- portable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice” (CMS, 2010c). 4 Health care professionals who do not see Medicare or Medicaid patients are not eligible for the CMS incentives (CMS, 2010a). 5 ONC expects to implement the meaningful use requirements in three stages (42 CFR 412, 413, 422, and 495). The first stage was released in July 2010 (45 CFR 170) and focuses on EHR functionality, including data capture. For Stage 1, the maximum incen- tive per eligible health care provider is $18,000; for hospitals, the base incentive payment is $2 million (CMS, 2010a). Although the timelines are somewhat flexible, Stage 2 im- plementation is anticipated for 2013 (CMS, 2011) and is expected to focus on structured health information exchange (42 CFR 412, 413, 422, and 495). Stage 3 implementation is anticipated for 2015 (CMS, 2011) and is expected to focus on patient-centered health information exchange and clinical decision support (42 CFR 412, 413, 422, and 495).
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11 LETTER REPORT BENEFITS OF INCORPORATING OCCUPATIONAL INFORMATION IN THE EHR As part of its statement of task, the committee was asked to respond to the question: What are the potential benefits to individual and public health of incorporating occupational information in electronic health records? The committee organized its response around the five health care outcomes and policy priorities used to categorize the Stage 1 “mea- ningful use” objectives (CMS, 2010c): 1. Improve the quality, safety, and efficiency of care and reduce health disparities. 2. Engage patients and families in their health care. 3. Improve care coordination. 4. Improve population and public health. 5. Ensure adequate privacy and security protections for personal health information. In responding to the second part of the task on technical feasibility, the committee decided to examine the individual occupational data ele- ments that are commonly used in occupational health data collection and are considered the most useful for clinical and public health purposes— occupation, industry, work-relatedness, employer, and exposures. The committee also explored the steps, such as information modeling, that need to occur to provide detailed specifications for each of the data ele- ments. These data elements are defined and described in depth later in the report, but they are introduced here to provide context for the follow- ing section, which outlines a number of potential benefits of incorporat- ing occupational information in EHRs. Improve Quality, Safety, and Efficiency of Care and Reduce Health Disparities Providing occupational information to the clinician could increase the likelihood of arriving at a correct diagnosis and improve the man- agement, treatment, and return to work of patients, regardless of the eti- ology of their health condition. Several examples of the potential benefits were presented and discussed at the IOM’s June 2011 workshop (Box 3).
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48 OCCUPATIONAL INFORMATION IN ELECTRONIC HEALTH RECORDS dors, and other stakeholders to develop and test methods for collect- ing occupational data from innovative sources. Specifically, NIOSH should evaluate collection methods that involve patient input through mechanisms such as web-based portals and PHRs, and other means such as health-related smart cards, health insur- ance cards, and human resource systems. Recommendation 8: Develop Clinical Decision-Support Logic, Education Materials, and Return-to-Work Tools NIOSH, relevant professional organizations, and EHR vendors should begin to develop, test, and iteratively refine and expand clinical decision-support tools for common occupational conditions (e.g., work-related asthma); tools and programs that could be easily accessed for educa- tion of patients and caregivers about occupational illnesses, injuries, and workplace safety; training modules for administrative staff to collect occupa- tional information in different care settings; and tools to improve and standardize functional job assessment and return-to-work documentation in EHRs, including stan- dards for the transmission of these forms. Recommendation 9: Develop and Assess Methods for Collecting Standardized Exposure Data NIOSH should continue to work with occupational and environmen- tal health clinics and other relevant stakeholders to develop and as- sess methods for collecting standardized exposure data for work- related health conditions. NIOSH should explore the feasibility of listing possible or probable exposures in the problem list or elsewhere in the EHR; linking occupational information in the EHR to online occu- pational, toxicological, and hazardous materials databases, such as O*NET, AOEC, and Haz-Map, to enhance diagnosis and treatment of work-related illnesses and injuries; and automatically generating codes for exposures based on narra- tive text entries.
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49 LETTER REPORT Recommendation 10: Assess the Impact of Incorporating Occu- pational Information in the EHR on Meaningful Use Goals NIOSH, in conjunction with relevant stakeholders (e.g., Public Health Data Standards Consortium, CSTE, Association of State and Territorial Health Officials), should develop measures and conduct periodic studies to assess the impact of integrating occupational information in EHRs, and estimate the economic impact of EHR-facilitated return-to- work practices for both work-related and non-work-related conditions. REFERENCES AOEC (Association of Occupational and Environmental Clinics). 2011. Expo- sure code lookup. http://www.aoecdata.org/ExpCodeLookup.aspx (accessed July 12, 2011). Archer, N., U. Fevrier-Thomas, C. Lokker, K. A. McKibbon, and S. E. Straus. 2011. Personal health records: A scoping review. Journal of the American Medical Informatics Association 18(4):515-522. Azaroff, L. S., C. Levenstein, and D. H. Wegman. 2002. Occupational injury and illness surveillance: Conceptual filters explain underreporting. Ameri- can Journal of Public Health 92(9):1421-1429. BLS. 2010a. Standard Occupational Classification. http://www.bls.gov/soc/ (accessed July 14, 2011). ———. 2010b. Workplace injuries and illnesses—2009. http://bls.gov/ news.release/pdf/osh.pdf (accessed December 23, 2010). ———. 2011a. American Time Use Survey summary: 2010 results. http://www.bls.gov/news.release/atus.nr0.htm (accessed July 27, 2011). ———. 2011b. National Census of Fatal Occupational Injuries in 2010 (preliminary results). http://bls.gov/news.release/cfoi.nr0.htm (accessed September 1, 2011). Boden, L. I., and A. Ozonoff. 2008. Capture-recapture estimates of nonfatal workplace injuries and illnesses. Annals of Epidemiology 18(6):500-506. Boden, L. I., N. Nestoriak, and B. Pierce. 2010. Using capture-recapture analy- sis to identify factors associated with differential reporting of workplace in- juries and illnesses. http://www.bls.gov/osmr/pdf/st100300.pdf (accessed May 26, 2011). California Department of Public Health. 2010. Infectious diseases case report forms. http://www.cdph.ca.gov/pubsforms/forms/Pages/CD-Report-Forms. aspx#infectious (accessed September 6, 2011).
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51 LETTER REPORT Dolin, R. H., L. Alschuler, S. Boyer, C. Beebe, F. M. Behlen, P. V. Biron, and A. Shabo Shvo. 2006. HL7 clinical document architecture, release 2. Jour- nal of the American Medical Informatics Association 13(1):30-39. Doyle, T. J., M. K. Glynn, and S. L. Groseclose. 2002. Completeness of notifia- ble infectious disease reporting in the United States: An analytical literature review. American Journal of Epidemiology 155(9):866-874. Dun and Bradstreet. 2010. Company look-up. https://iupdate.dnb.com/iUpdate/ companylookup.htm (accessed July 25, 2011). EXTOXNET. 2011. EXtension TOXicology NETwork. http://extoxnet.orst.edu/ ghindex.html (accessed July 12, 2011). Fan, Z. J., D. K. Bonauto, M. P. Foley, and B. A. Silverstein. 2006. Underreport- ing of work-related injury or illness to workers’ compensation: Individual and industry factors. Journal of Occupational and Environmental Medicine 48(9):914-922. Fronstin, P. 2010. Sources of health insurance and characteristics of the uninsured: Analysis of the March 2010 Current Population Survey. http://www.Ebri.org/pdf/ briefspdf/EBRI_IB_09-2010_No347_Uninsured1.pdf (accessed July 25, 2011). Frost and Sullivan. 2010. Smart cards for healthcare in Europe http://www.frost. com/prod/servlet/market-insight-top.pag?docid=200942088 (accessed August 15, 2011). Fung, K. W., C. McDonald, and S. Srinivasan. 2010. The UMLS-CORE project: A study of the problem list terminologies used in large healthcare institutions. Journal of the American Medical Informatics Association 17(6):675-680. GAO (Government Accountability Office). 2009. Enhancing OSHA’s records audit process could improve the accuracy of worker injury and illness data. GAO-10-10. http://www.gao.gov/new.items/d1010.pdf (accessed August 15, 2011). Guo, H. R., S. Tanaka, L. L. Cameron, P. J. Seligman, V. J. Behrens, J. Ger, D. K. Wild, and V. Putz-Anderson. 1995. Back pain among workers in the United States: National estimates and workers at high risk. American Jour- nal of Industrial Medicine 28(5):591-602. Haz-Map. 2011. Benzene, aplastic anemia, and leukemia. http://www.haz- map.com/benzene.htm (accessed August 1, 2011). Healthy People 2020. 2010. Healthy People 2020 summary of objectives: Respi- ratory diseases. http://www.healthypeople.gov/2020/topicsobjectives2020/ pdfs/RespiratoryDiseases.pdf (accessed July 12, 2011). Henneberger, P. K., S. J. Derk, S. R. Sama, R. J. Boylstein, C. D. Hoffman, P. A. Preusse, R. A. Rosiello, and D. K. Milton. 2006. The frequency of workplace exacerbation among health maintenance organisation members with asthma. Occupational and Environmental Medicine 63(8):551-557. Henneberger, P. K., C. A. Redlich, D. B. Callahan, P. Harber, C. Lemiere, J. Martin, S. M. Tarlo, O. Vandenplas, and K. Toren. 2011. An Official
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52 OCCUPATIONAL INFORMATION IN ELECTRONIC HEALTH RECORDS American Thoracic Society statement: Work-exacerbated asthma. American Journal of Respiratory and Critical Care Medicine 184(3):368-378. HHS (Department of Health and Human Services). 2010. ONC-authorized test- ing and certification bodies. http://healthit.hhs.gov/portal/server.pt?open =512&mode=2&objID=3120 (accessed June 20, 2011). ———. 2011. HIT Policy Committee: Meaningful use workgroup request for comments regarding meaningful use stage 2. http://healthit.hhs.gov/media/ faca/MU_RFC%20_2011-01-12_final.pdf (accessed May 12, 2011). Hilaski, H. J. 1981. Understanding statistics on occupational illnesses. http://www.bls.gov/opub/mlr/1981/03/art3full.pdf (accessed August 17, 2011). HL7 (Health Level 7). 2007. HL7 standards. http://www.hl7.org/implement/ standards/index.cfm?ref=nav (accessed July 12, 2011). ———. 2011. HL7 Reference Information Model. http://www.h17.org implement/standards/rim.cfm (accessed September 6, 2011). Holmes, C. 2011. The problem list beyond meaningful use. Part I: The problems with problem lists. Journal of American Health Information Management Association 82(2):30-33. Hsu, M. H., J. C. Yen, W. T. Chiu, S. L. Tsai, C. T. Liu, and Y. C. Li. 2011. Using health smart cards to check drug allergy history: The perspective from Taiwan’s experiences. Journal of Medical Systems 35(4):555-558. Huff, S. M., R. A. Rocha, B. E. Bray, H. R. Warner, and P. J. Haug. 1995. An event model of medical information representation. Journal of the American Medical Informatics Association 2(2):116-134. ICD-10 (International Classification of Diseases, Tenth Revision). n.d. ICD-10- CM diagnosis code Z57.0. http://www.icd10data.com/ICDI0CM/Codes/ Z00-Z99/Z55-Z65/Z57-/Z57.0 (accessed July 12, 2011). ILO (International Labour Office). n.d. ILO encyclopedia of workplace health and safety information. http://www.ilocis.org/en/contilo.html (accessed July 16, 2011). Intermountain Healthcare. 2010. A patient-entered family health history pro- gram. http://intermountainhealthcare.org/services/genetics/informatics/Pages/ ClinicalDataResearch.aspx (accessed July 25, 2011). IOM (Institute of Medicine). 1988. The future of public health. Washington, DC: National Academy Press. Kliff, S. 2010. The smart set: Could medical information stored on wallet-sized cards cure the country’s health-care woes? Newsweek, February 16. Kreiss, K. 2011. Finding new associations between work and health. Power- Point presentation at the IOM Workshop on Occupational Information and Electronic Health Records, Washington, DC, June 2. http://iom.edu/~/ media/Files/Activity%20Files/Environment/OccupationalHealth Records/ Panel%202%20Kreiss.pdf (accessed July 25, 2011).
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53 LETTER REPORT Landrigan, P. J., and D. B. Baker. 1991. The recognition and control of occupa- tional disease. Journal of the American Medical Association 266(5):676- 680. Lawrence, R. C., D. T. Felson, C. G. Helmick, L. M. Arnold, H. Choi, R. A. Deyo, S. Gabriel, R. Hirsch, M. C. Hochberg, G. G. Hunder, J. M. Jordan, J. N. Katz, H. M. Kremers, and F. Wolfe. 2008. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis and Rheumatism 58(1):26-35. Luckhaupt, S. E., G. M. Calvert, and M. H. Sweeney. 2011. Documenting occu- pational history: The value to patients, payers, and researchers. Journal of the American Health Information Management Association 82(7):34-37. McCauley, L. A. 2005. Immigrant workers in the United States: Recent trends, vulnerable populations, and challenges for occupational health. American Association of Occupational Health Nurses Journal 53(7):313-319. McLellan, R. 2011. Improving the quality of care for the Dartmouth-Hitchcock workforce:The role of occupational health data in the electronic medical record. PowerPoint presentation at the IOM Workshop on Occupational Infor- mation and Electronic Health Records, Washington, DC, June 2. http:// iom.edu/~/media/Files/Activity%20Files/Environment/Occupational Health Records/Panel%201%20McLellan.pdf (accessed July 12, 2011). Moorman, J. E., H. Zahran, B. I. Truman, and M. T. Molla. 2011. Current asth- ma prevalence: United States, 2006-2008. Morbidity and Mortality Weekly Report Surveillance Summaries 60(Suppl.):84-86. MSDSonline. 2011. MSDS search. http://www.msdsonline.com/msds-search/ (accessed September 6, 2011). NAACCR (North American Association of Central Cancer Registries). 2011. Standards for cancer registries, volume II: Data standards and data dictio- nary, sixteenth edition. http://www.naaccr.org/LinkClick.aspx?fileticket= HCCaP9gRXIk%3D&tabid=133&mid=473 (accessed July 25, 2011). National Business Group on Health. 2011. Institute on Innovation in Workforce Well-Being. http://www.businessgrouphealth.org/about/obesity.cfm (accessed July 25, 2011). National Center for O*NET Development. 2011. About O*NET. http://www. onetcenter.org/overview.html (accessed July 14, 2011). National Library of Medicine. 2011. Haz-Map: Occupational exposure to ha- zardous agents. http://hazmap.nlm.nih.gov/ (accessed July 12, 2011). National Survey on Drug Use and Health. 2009. Cigarette use among adults employed full time, by occupational category. http://oas.samhsa.gov/2k9/ 170/170Occupation.htm (accessed July 12, 2011). NCHS (National Center for Health Statistics). 2003. U.S. Standard certificate of death. http://www.cdc.gov/nchs/data/dvs/death11-03final-acc.pdf (accessed September 6, 2011). New York State Workers’ Compensation Board. 2010. New York Mid and Low Back Injury Medical Treatment Guidelines, first edition. http://www.wcb.
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54 OCCUPATIONAL INFORMATION IN ELECTRONIC HEALTH RECORDS state.ny.us/content/main/hcpp/MedicalTreatmentGuidelines/MidandLowBack InjuryMTG2010.pdf (accessed July 12, 2011). NIOSH (National Institute for Occupational Safety and Health). 2004. Prevent- ing lung disease in workers who use or make flavorings. NIOSH Publica- tion No. 2004-110. Cincinnati, OH: NIOSH. http://www.cdc.gov/niosh/ docs/2004-110/ (accessed July 12, 2011). ———. 2011a. Industry and occupation coding and support: Industry and oc- cupation coding software. http://www.ced.gov/niosh/topics/coding/software. html (accessed August 15, 2011). ———. 2011b. NIOSH industry and occupation computerized coding system. PowerPoint Presentation to the IOM Committee on Occupational Informa- tion and Electronic Health Records, June 21, 2011. Okechukwu, C. A., N. Krieger, G. Sorensen, Y. Li, and E. M. Barbeau. 2009. MassBuilt: Effectiveness of an apprenticeship site-based smoking cessation intervention for unionized building trades workers. Cancer Causes Control 20(6):887-894. Oleinick, A., and B. Zaidman. 2010. The law and incomplete database informa- tion as confounders in epidemiologic research on occupational injuries and illnesses. American Journal of Industrial Medicine 53(1):23-36. ONC (Office of the National Coordinator for Health Information Technology). 2010. Measuring health IT adoption. http://healthit.hhs.gov/portal/server.pt/ community/healthit_hhs_gov__adoption_and_meaningful_use/1152 (accessed August 17, 2011). Overhage, J. M., S. Grannis, and C. J. McDonald. 2008. A comparison of the completeness and timeliness of automated electronic laboratory reporting and spontaneous reporting of notifiable conditions. American Journal of Public Health 98(2):344-350. Papanek, P. 2011. Occupational medicine and the EHR. PowerPoint presenta- tion at the IOM Workshop on Occupational Information and Electronic Health Records, Washington, DC, June 2. http://iom.edu/~/media/Files/ Activity%20Files/Environment/OccupationalHealthRecords/Panel%203%20 Papanek.pdf (accessed July 12, 2011). Pransky, G., T. Snyder, A. Dembe, and J. Himmelstein. 1999. Under-reporting of work-related disorders in the workplace: A case study and review of the literature. Ergonomics 42(1):171-182. Rosenman, K. D., A. Kalush, M. J. Reilly, J. C. Gardiner, M. Reeves, and Z. Luo. 2006. How much work-related injury and illness is missed by the current national surveillance system? Journal of Occupational and Environmental Medicine 48(4):357-365. RSNA (Radiological Society of North America). 2011. RadLex: A lexicon for uniform indexing and retrieval of radiology information resources. http://www.rsna.org/radlex/ (accessed July 13, 2011). Ruser, J. W. 2008. Examining evidence on whether BLS undercounts workplace injuries and illnesses. Monthly Labor Review August:20-32.
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55 LETTER REPORT RWJF (Robert Wood Johnson Foundation). 2008. Issue brief 4: Work and health. Work matters for health. http://www.commissiononhealth.org/PDF/ 0e8ca13d-6fb8-451d-bac8-7d15343aacff/Issue%20Brief%204%20Dec%2008 2008%20-%20Work%20and%20Health.pdf (accessed June 6, 2011). Schackman, B. R., Z. Dastur, D. S. Rubin, J. Berger, E. Camhi, J. Netherland, Q. Ni, and R. Finkelstein. 2009. Feasibility of using audio computer-assisted self-interview (ACASI) screening in routine HIV care. AIDS Care 21(8):992-999. Schulte, P. A. 2005. Characterizing the burden of occupational injury and dis- ease. Journal of Occupational and Environmental Medicine 47(6):607-622. Sengupta, I., V. Reno, and John F. Burton, Jr., with the Study Panel on National Data on Workers’ Compensation. 2010. Workers' compensation: Benefits, coverage, and costs, 2008. Washington, DC: National Academy of Social Insurance. Silk, B. J., and R. L. Berkelman. 2005. A review of strategies for enhancing the completeness of notifiable disease reporting. Journal of Public Health Management and Practice 11(3):191-200. Smith, G. S., H. M. Wellman, G. S. Sorock, M. Warner, T. K. Courtney, G. S. Pransky, and L. A. Fingerhut. 2005. Injuries at work in the U.S. adult popu- lation: Contributions to the total injury burden. American Journal of Public Health 95(7):1213-1219. Sorensen, G., L. Quintiliani, L. Pereira, M. Yang, and A. Stoddard. 2009. Work experiences and tobacco use: Findings from the Gear Up for Health Study. Journal of Occupational and Environmental Medicine 51(1):87-94. Sorensen, G., A. Stoddard, L. Quintiliani, C. Ebbeling, E. Nagler, M. Yang, L. Pereira, and L. Wallace. 2010. Tobacco use cessation and weight manage- ment among motor freight workers: Results of the Gear Up for Health Study. Cancer Causes Control 21(12):2113-2122. Souza, K., L. Davis, and J. Shire. 2010a. Chapter 3: Occupational and environ- mental health surveillance. In Occupational and environmental health: Re- cognizing and preventing disease and injury. Sixth ed., edited by B. S. Levy, D. H. Wegman, S. L. Baron, and R. K. Sokas. New York: Oxford University Press. Souza, K., A. L. Steege, and S. L. Baron. 2010b. Surveillance of occupational health disparities: Challenges and opportunities. American Journal of Indus- trial Medicine 53(2):84-94. Staes, C. J., P. H. Gesteland, M. Allison, S. Mottice, M. Rubin, J. H. Shakib, R. Boulton, A. Wuthrich, M. E. Carter, M. Leecaster, M. H. Samore, and C. L. Byington. 2009. Urgent care providers’ knowledge and attitude about public health reporting and pertussis control measures: Implications for informat- ics. Journal of Public Health Management and Practice 15(6):471-478. Steenland, K., C. Burnett, N. Lalich, E. Ward, and J. Hurrell. 2003. Dying for work: The magnitude of U.S. mortality from selected causes of death asso-
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57 LETTER REPORT WHO (World Health Organization). 2006. ICD-10: External causes of morbidi- ty and mortality (V01-Y98). http://apps.who.int/classifications/apps/icd/ icd10online/index.htm?gv01.htm+s20v01 (accessed July 12, 2011). WHO Expert Committee. 1985. Identification and control of work-related dis- eases. WHO technical report series No. 714. Geneva, Switzerland: World Health Organization. Zuroweste, E. 2011. Migrant Clinicians Network. PowerPoint presentation at the IOM Workshop on Occupational Information and Electronic Health Records, Washington, DC, June 2. http://iom.edu/~/media/Files/Activity% 20Files/Environment/OccupationalHealthRecords/Panel%203%20Zuroweste. pdf (accessed August 24, 2011).
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