What occupational health providers need to know mabout EHRs
“Knowing is not enough; we must apply. Willing is not enough; we must do.”
—Goethe
These wise words appear in the opening pages of a September 2011 Institute of Medicine report “Incorporating Occupational Information in Electronic Health Records.” The 74-page report, available at www.iom.edu, highlights the importance of including occupational data in electronic health records, EHRs, and the feasibility of doing so.
The report is important because it brings to the fore the issue of patient management and how occupational health fits into the total picture of a patient’s health. Providers are rapidly adopting EHRs. Yet, there is still a lot of uncertainty about what the federal government will require and how various systems will work together to best serve patients.
“We need to make sure occupational health is part of the transition to EHRs,” said Dr. Robert Harrison, clinical professor of medicine at the University of California San Francisco, who served on the 11-member IOM committee that drafted the report.
Driving the move towards EHRs is the HITECH Act of 2009. The law provides funds to the Office of the National Coordinator for Health Information Technology (ONC) to promote the implementation of health information technology in healthcare, and about $27 billion to the Centers for Medicare and Medicaid Services to use as incentive payments to physicians and hospitals to support adoption of EHRs.
The financial incentives require that most providers use a certified EHR and demonstrate “meaningful use” of EHRs. Certification requires data security, confidentiality, interoperability, and functional capabilities. Hospitals not in compliance by 2015 with meaningful use criteria will face reduced reimbursement from Medicare and Medicaid.
Meaningful use criteria are being rolled out in three stages. The first two stages include no specific elements for occupational health. So, there are no requirements in the core or menu options to collect information on a patient’s industry, occupation, or workplace.
But the IOM committee recommends these be included in stage three meaningful use criteria, expected in 2015 or 2016.
Why occupation matters in EHRs
The committee noted that each year nationwide, more than 4,000 occupational fatalities and more than three million injuries occur with more than 160,000 cases of occupational illnesses.
“Advances in incorporating occupational information in EHRs could lead to more effective policies, interventions, and prevention strategies to improve the overall health of the working population,” reads the IOM report.
For instance, knowing that a patient’s occupation is a house painter would help when he presents with symptoms of asthma, Dr. Harrison said.
“We recommended that, at a minimum, industry and occupation be included as a case variable in the EHR,” Dr. Harrison said.
However, there are technical and software hurdles to including these variables in EHRs, he said.
“It sounds easy but there are a lot of challenges in doing it,” Dr. Harrison said. “Like, how is that information coded? There may not be a code for a particular occupation.”
Also important is including past occupations in a person’s EHR, he said.
“At a minimum, ‘current occupation’ should be included and updated, and it should be able to be tracked instead of just doing delete and replace,” Dr. Harrison said. “We need the ability to track occupation because certain health conditions have latency periods.”
Knowledge of the work environment could help providers craft effective treatment plans, too. For instance, a night shift worker with diabetes might need additional monitoring because irregular hours tend to disrupt insulin management, according to the IOM report.
This type of data can also help tailor recovery and return-to-work efforts, reduce health disparities, better engage patients, and improve public health surveillance and monitoring, the IOM concluded.
Privacy and ethical concerns
While the benefits of including occupational data are profound, it is competing with a bevy of other information to be collected about individual patients. Also at issue is the myriad privacy and ethical concerns of including occupational information in patient EHRs.
The IOM committee recommended that the federal government convene a workshop including labor unions, insurers, providers, workers’ compensation-related organizations, and EHR vendors to look at implications of including work-relatedness data into EHRs, with respect to workers’ compensation. The IOM committee also suggested that this workshop propose guidelines and policies for protecting patients’ non-work-related health data from inadvertent disclosure and to respect HIPAA, workers’ compensation, and other privacy standards.
The American College of Occupational and Environmental Medicine agrees that privacy and security should be paramount. In a letter sent to Dr. John Howard, director of the National Institute for Occupational Safety and Health, NIOSH, in August 2011, the group wrote of these concerns.
“If OSHA or other federal agencies want to review medical records, employers rely on healthcare providers to disaggregate occupational from personal health information and open these job-related records to the auditing agency,” according to the letter. “A provider conducting mandated health assessments such as preplacement exams, DOT physicals, or medical surveillance is acting as an agent of the employer and should not, without consent, have access to an examinee’s personal health information. Providers need to be able to easily communicate work capacity statements stripped of personal health information to a variety of stakeholders. And finally, an employee/patient should be able to complete a health risk assessment at work or in their primary care office and expect that this data will populate both their personal health record and be aggregated for an employer for purposes of population health management.”
The ACOEM is currently developing a position paper on EHRs.
Do I need to comply?
These kinds of firewalls are absolutely crucial, agreed Mary Stroupe, co-founder of Integritas, a certified EHR vendor in Salinas, Calif.
Ms. Stroupe added that many occupational health professionals aren’t paying enough attention to meaningful use and EHRs at their own peril.
“Most occupational health providers dismiss EHRs and national standards because they say, ‘I can’t get reimbursed so it doesn’t apply to me,” Stroupe said. “But they will have to give patients access to their own records, she added, and patients will soon expect to get detailed personal health data electronically.
“Those without this will have a competitive disadvantage,” Ms. Stroupe said. “They will end up as a data island.”
She compared it to the first years of ATMs when some banks weren’t part of the ATM network so customers couldn’t withdraw money from their accounts at any kiosk.
“It’s all going towards being anywhere in the world and being able to access your data,” Ms. Stroupe said. “People are going to be left behind if they don’t pay attention to standards.”
Occupational health professionals should be paying attention and advocating for their industry, agreed Dr. Harrison. “We need to be aware of this and be involved in the process with NIOSH,” he said. “And we should be working locally with vendors and IT managers to see how they could be collecting and adding valuable information into EHRs.”
Dr. Harrison added, “We’re all preaching from the same hymn book.”
IOM recommendations on occupational health and EHRs:
- Conduct demonstration projects to assess the collection and incorporation of occupation and industry data into the EHR.
- Set requirements and develop information models for storing and communicating occupational information.
- Adopt industry coding standards for use in EHRs.
- Assess the feasibility of autocoding occupational information collected in clinical settings.
- Develop meaningful use metrics and performance measures.
- Convene a workshop to assess ethical and privacy concerns and challenges of including this information in EHRs.
- Develop and test methods to collect occupational information.
- Develop clinical decision-support logic, educational materials, and return-to-work tools.
- Develop and assess methods for collecting standardized exposure data.
- Assess the impact of incorporating occupational information into EHRs on overall meaningful use goals.
Source: Institute of Medicine
Binge eating hurts work productivity
Binge eating is costing companies millions, according to a study in the Journal of Occupational and Environmental Medicine. Binge eating, or overeating combined with a sense of loss of control, results in an annual productivity loss of nearly $108,000 for an average company with 1,000 employees, said the study, conducted by Wellness & Prevention, a Johnson & Johnson subsidiary.
Evaluating health risk assessment (HRA) responses from nearly 47,000 adult employees, researchers found that 9.4 percent of the workers reported binge eating. Frequent binge eating was the third-highest health risk associated with excess productivity impairment, after depression and stress. Binge eating was more common among obese employees.
“These findings suggest that efforts to improve the health, productivity, and performance of employee populations should include routine screenings and interventions for binge eating behavior,” said Richard Bedrosian, director of behavioral health and solution development at Wellness & Prevention.
Flame retardants found in common foods, study says
A common type of flame retardant showed up in common grocery items including salmon, turkey, and chili with beans, according to a study published in Environmental Health Perspectives. Researchers tested 36 samples of food sold at Dallas supermarkets in 2009 and 2010. Out of those, 42 percent, or 15 samples, had detectable levels of hexabromocyclododecane, or HBCD, said Dr. Arnold Schecter, professor of environmental and occupational health at the University of Texas School of Public Health in Dallas.
Samples tainted with the chemical included sardines in olive oil, smoked turkey sausages, fresh catfish, fresh deli turkey and ham slices, fresh salmon, and chili with beans. The industry disagreed with the findings, according to WebMD. “Based on these findings, the real story is that HBCD was not detected in the majority of the samples, and in those where it was, it was well below levels where one might see adverse health effects,” said Bryan Goodman, a spokesman for the North American Flame Retardant Alliance of the American Chemistry Council.
Most food workers receive low wages and few benefits
More than 86 percent of workers in food production, processing, distribution, retail, and service earn sub-minimum, poverty, and low wages, according to a June report by the Food Chain Workers Alliance. This sector employs 20 million people nationwide and comprises one-sixth of the U.S. workforce, according to the alliance.
But only 13.5 percent of food system workers earn a living wage, according to the report, based on 700 surveys and interviews. Some 79 percent don’t have paid sick days, and 58 percent lack health coverage; about 28 percent are on Medicaid, and one-third reported using the emergency room for primary healthcare, though 80 percent can’t pay these medical bills, according to the report. Additionally, 52 percent said they did not receive on-the-job health and safety training, the report found.
Pediatricians caution on sensory-based therapy
The American Academy of Pediatrics is cautioning physicians against using sensory processing disorder as an independent diagnosis, under new guidelines published in June. Occupational therapists use brushes, swings, balls, and other equipment to help treat children with developmental and behavioral disorders. But the academy states it is unclear whether children with sensory-based problems have an actual disorder related to specific pathways of the brain or if these problems are due to an underlying developmental disorder, according to the academy’s new policy statement.
As a result, the academy recommends that when sensory problems are present in a child, health providers should consider other developmental disorders, including autism, attention deficit/hyperactivity disorder, developmental coordination disorder, and anxiety disorder. “Occupational therapy is a limited resource, and families should work with pediatricians to prioritize treatments based on problems that affect a child’s ability to perform daily functions,” the academy wrote in its policy statement.
Some insurers promise to keep popular aspects of federal health law
UnitedHealth Group, Aetna, and Humana have announced that they will continue to offer several popular requirements of the federal health reform law no matter how the courts or Congress decide to repeal or change the law. The insurers said they would continue to allow dependents up to age 26 to gain coverage on their parents’ health plans, and would also offer preventative health screenings with no copayment. UnitedHealth Group also said it would not reinstate lifetime limits on coverage. The three insurers also said they would continue to follow new third-party appeals processes for claims denials. More insurers are expected to make similar pledges.
California grants $32 million to fight workers’ compensation insurance fraud
California Insurance Commissioner Dave Jones announced that nearly $32 million in grants will be distributed to District Attorneys in California to support their efforts in investigating and prosecuting workers’ compensation insurance fraud. “Without question, workers’ compensation insurance fraud is a problem that brings a significant cost with it in California,” Jones said. “During any time, but especially during these challenging economic times, this type of fraud places a significant added burden on the system. We have an obligation to provide protection to injured workers who require both care and compensation so they are able to get back to work as quickly as possible, while also rooting out fraud perpetrated by those seeking to game the system.”
Thousands of Americans dying prematurely because of a lack of health insurance
About 26,100 people between the ages of 25 and 64 died prematurely due to a lack of health coverage in 2010, according to a report released in June by Families USA, a not-for-profit group in Washington. Each and every state sees residents die prematurely due to a lack of health insurance. In 2010, the number of premature deaths due to a lack of health coverage ranged from 28 in Vermont to 3,164 in California, according to the report.
The five states with the most premature deaths due to uninsurance in 2010 were California (3,164 deaths), Texas (2,955 deaths), Florida (2,272 deaths), New York (1,247 deaths), and Georgia (1,161 deaths). The number of uninsured Americans reached an all-time high in 2010, as nearly 50 million Americans went without health insurance for the entire year. For many of these uninsured people, the consequences of going without coverage are dire. The uninsured frequently face medical debt or go without necessary care, and too many of them die prematurely, according to Families USA.
About 5.5 million more healthcare workers needed by 2020
The demand for healthcare services will grow twice as fast as the national economy over the next eight years, creating 5.6 million new jobs, according to a study by Georgetown University Center on Education and the Workforce. The healthcare industry will grow from 15.6 million jobs in 2010 to 19.8 million jobs in 2020, comprising 13 percent of all jobs. By 2020, we will spend 1 out of 5 dollars we earn on healthcare, according to the report.
A total of 82 percent of those new jobs will require postsecondary education and training, according to the report. “In healthcare, there really are two labor markets: professional and support,” said Anthony Carnevale, the director of the Georgetown Center and lead author of the report. “Professional jobs demand postsecondary training and advanced degrees while support jobs demand high school and some college. There is ‘minimal mobility’ between the two. And the pay gap is enormous. The average professional worker makes 2.5 times as much as the average support worker.”
Find the full report here:
http://cew.georgetown.edu/healthcare
