ELECTRONIC HEALTH RECORDS (EHRs) AND PATIENT WORK INFORMATION

Work team around computer

Current Projects

Occupational Data for Health and Interoperability Standards

NIOSH staff have led the effort to include Occupational Data for Health (ODH) in the three key Health Level Seven® HL7 interoperability standards used in healthcare and the Integrating the Healthcare Enterprise (IHE) technical framework. These standards are used by electronic health record and other health information system vendors and implementers to share information within and across health information systems. Including ODH in each interoperability standard ensures that these data are consistently formatted to retain the same meaning whenever they are shared.

  • The ODH HL7® Consolidated Clinical Document Architecture (C-CDA) Supplemental Template can be used to include ODH in the social history section of any CDA ‘document’ that is electronically transmitted by an EHR or other health IT system, e.g., a patient summary.
  • The HL7 Version 2.9 Messaging Standard (V2.9) has been modified to include ODH. The V2.9 standard is used to send messages from clinical sources to public health agencies.
  • A draft ODH Implementation Guide has been proposed for an observation resource in the HL7®  Fast Healthcare Interoperability Resources (FHIR) standard.  FHIR provides access to health information to healthcare providers, business associates, patients, and public health.

More information:

Collaboration with Health Level 7® (HL7) to Provide Technical Guidance for Including Work Information in Electronic Health Records

NIOSH staff have led the effort to develop the HL7 Work and Health, Electronic Health Record (EHR) Functional Profile, which is a set of technical instructions for EHR system software developers to build features for the collection, management, and use of Occupational Data for Health (ODH). Like all HL7 documents, this functional profile has gone through a multi-step review (or ballot) process by HL7 membership before publication for use by software developers. As active members of HL7, NIOSH has reconciled hundreds of comments over three ballot cycles from various stakeholders, e.g., physicians, epidemiologists, health IT experts, who represent many types of academic, government, and private industries around the world. NIOSH has used these comments to refine the functions and criteria within the Work and Health EHR Functional Profile.

The functional profile is:

  • A set of technical instructions for EHR software developers. These instructions are grouped by functions and include criteria by which an EHR must conform.
  • A hierarchical framework of criteria. Each criterion is nested within a function.
  • Organized by discrete sections to describe the behavior of an EHR System in user-oriented language.
  • A way to express optionality of features. The criteria have three levels of conformance (SHALL, SHOULD, MAY) that guide developers to include at least the basic attributes in order to conform (SHALL) and also criteria that add extra value (SHOULD, MAY).
  • Organized around the ability of the system. Each criteria must use specific verbs to describe how information will be managed by the EHR system, e.g., “The system SHALL manage occupational data for health.”

The functional profile is NOT:

  • An instructional document for health information messaging from one provider to another. Instead, NIOSH is also leading the efforts in HL7 messaging standards including Consolidated-CDA, HL7 V2, HL7 FHIR.
  • A set of definitions for the types of information collected. Instead, the ODH information model outlines the definitions and value sets that developers should consider using when developing an EHR system.

More information:

A Prototype to Demonstrate Collection of Self-Reported Occupational Data for Health (ODH) in a Standardized Way

NIOSH is working to develop a prototype that will demonstrate the features and the necessary ODH value sets to collect self-reported ODH to be included in Electronic Health Records (EHRs) and other Health Information Systems.  It aligns with the instructions found in the HL7 Work and Health, Electronic Health Record (EHR) Functional Profile. The goal is to encourage healthcare providers and software vendors to build the functionality and include ODH value sets into their solutions.

Benefits of this include:

  • Inform practitioners about their patient’s work and how it could impact their patient’s health
  • Support Research-to-Practice (R2P) dissemination through clinical decision support (real-time, automated assistance with clinical decision-making tasks at the point of patient care)
  • Encourage consideration of work and health in patient care through health system quality measures that utilize ODH
  • Support population health management tools used by health systems to improve the health outcomes of a group of patients
  • Improve structured ODH data available to support occupational public health activities, including surveillance and research
  • Structured ODH enables health system data analytics, supporting surveillance

Electronic Case Reporting of Occupational Illnesses and Injuries

NIOSH staff are working with CSTE and state partners to define specifications, value sets and rules logic for the electronic reporting of occupational conditions. These have been defined for silicosis and are under development for acute pesticide poisoning, lead exposure, and work-related asthma.

More information:

Page last reviewed: July 29, 2019