Rationale for Including Work Information in EHRs

When work history is available in EHRs, healthcare providers can use it to access information on health hazards associated with various jobs and the types of health problems related to those jobs. Additionally, management of many non-occupational conditions can be improved for working patients. For example, work schedules and working conditions may need to be considered in strategies to control a diabetic patient’s blood glucose levels and take their medication. Healthcare providers also can use information about work tasks and demands to make decisions about how to safely return their patients to work following an illness or injury.

Work history in EHRs can assist healthcare organizations to improve the health, such as identifying groups of working patients that may benefit from preventive or diagnostic care. EHRs are often used to generate patient lists (e.g., lists of patients with certain health conditions) in order to identify those with the greatest need for follow-up or additional care. Developing patient lists by industry or occupation also could be very valuable. For example, a healthcare organization could identify all patients working in construction or house painting occupations and use this list to identify workers who might benefit from a blood lead test.

Surveillance is ongoing monitoring of the health of populations, such as groups of workers defined by occupation (e.g., nurse) or industry (e.g., physician offices). Work history in EHRs can enable public health agencies or other authorized users of aggregated health data to track the health status of worker groups. Making the knowledge gained by these analyses available to healthcare providers (through EHR clinical decision support tools or by other means) can improve patient health.

Examples

Cancer is a disease for which work information is useful for surveillance. When medical records contain patient industry and occupation information, public health agencies can determine which worker groups are experiencing higher rates of cancer, and form hypotheses about occupational causes of cancer.  The law that establishes cancer registries (the Cancer Registries Amendment Actexternal icon) requires recording the usual occupation and industry of the patient when reporting a cancer case, when this information is available in a medical record. Therefore, including patient industry and occupation information in EHRs can improve cancer registries.

Work histories in EHRs will also support reporting cases of occupational health conditions to state health departments. Currently, 30 states require healthcare providers to report select occupational health conditions (injuries, illnesses, and clusters of disease related to work) to state health departments. Case-based reporting can help public health practitioners to assist workers and employers with targeted interventions to prevent injury or illness and to identify emerging or new occupational health problems.

Work histories in EHRs can also enhance surveillance of non-occupational conditions, such as infectious diseases. All state public health departments report cases of certain illnesses (nationally notifiable conditions) to the Centers for Disease Control and Prevention (CDC). Reporting information about a patient’s work with other case information allows public health experts to identify routes of transmission in cases where infectious diseases are spread through workplaces.