PH+Reporting+User+Story+-+Impact+of+Work+on+Health

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Contact Info:
Kerry Souza, ScD, MPH (ksouza@cdc.gov, phone: 202.245.0639) -- Epidemiologist, Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), US Centers for Disease Control and Prevention (CDC)

Genny Barkocy Luensman (bve2@cdc.gov, phone: 404.488.5585) -- CDC/NIOSH/DRDS

Date Received:
11/18/2011

This user story covers one setting in which data are collected: Physician Offices or Community Health Centers (CHCs).
 * 1.2 User Story Narrative**

An adult patient with respiratory symptoms registers for an appointment with a physician. The intake demographic data includes date of birth, gender, home address, work address, current occupation, and current industry. Intake clinical data includes height and weight.

The physician interviews the patient regarding the presenting symptoms and suspects that the patient has developed asthma in the previous 12 months. The physician inquires about the temporal patterns of symptoms – when they are worse, when they are less troublesome. The physician enters relevant information about the patient, the encounter, and develops a diagnostic strategy. This involves spirometry testing in the office or by referral to a pulmonary function laboratory. It will include testing with a bronchodilator to evaluate airway responsiveness if there is evidence of obstruction. It may involve a methacholine challenge test if the symptoms persist at future visits and the spirometry is normal.

If the physician confirms that the patient has developed asthma, the physician will inquire as to potential exposures to allergens and irritants at home, work, and in other environments frequented by the patient. If the patient’s occupation is associated with exposures known to cause asthma or the temporal nature of the symptoms suggests that work may be playing a role, serial peak flow monitoring for two to three weeks will be conducted to look for evidence of variation in airway obstruction in relationship to work. Patterns of reduced flow within the first hours of work or 6-10 hours after starting work suggest a relationship. In the absence of variability, similar testing after two weeks away from work entirely may be informative.

The physician documents an exposure at work known to cause asthma. He/she determines that it is likely that the history and/or patterns of lung function test are consistent with work-related asthma. The physician completes a report of work-related asthma to the state department of health. This form is generated by the electronic health record when the physician indicates “work-relatedness” at the end of a visit.

Thirty states require health care providers to report selected occupational illnesses* to a state agency. Occupational health programs, (in the form of state health departments or, less frequently, state labor departments) routinely receive case reports of those reportable conditions. The goals of this reporting are to identify risk factors for occupational illness, identify populations at increased risk, and help estimate the incidence of selected occupational conditions.
 * 1.2.1 Goal**

Most state surveillance programs built around reportable conditions follow the NIOSH Sentinel Event Notification System for Occupational Risk (SENSOR) model. NIOSH provides case definitions that drive the collection of a set of common data elements. Data are shared with NIOSH and may be aggregated in order to provide information about broader trends in occupational exposures and/or illness.

Reports to health departments are triggered either by identification of cases of occupational illness by a provider at the point of care (e.g., a provider diagnoses an individual with work-related asthma) or by identification of all recently treated cases that meet a case definition (e.g., submission of data on all cases of injuries to minors for whom the payor on record is workers’ compensation).
 * 1.2.2 Data reporting triggers**

Currently, health care providers (individual providers, hospitals etc.) submit data to public health departments in paper or electronic format; the method of submission varies by state and by condition. For example, following diagnosis by a health care provider, a report of occupational illness, such as work related asthma, may be submitted by an emailed or faxed form. Laboratory reports of elevated blood lead findings may be submitted electronically and in batches. State public health laws set the requirements for occupational disease reporting; there are minor variations by state in the data elements collected. In general, required data elements include provider information, patient information (//name, age, gender, race and ethnicity, address//) patient employer and occupation, industry of employer, diagnosis, and details of incident such as place of injury, known or suspected exposures that causes the illness etc. A sample reporting form (New Jersey Department of Health and Senior Services) can be found at the following link: []
 * 1.2.3 Data**

Presently, many of the data elements (i.e., patient personal information and demographics, provider information) required by these reports are captured in the EHR. Employer information is typically present in the Electronic Health Record (EHR) System, however it may not appear in the clinical module. Efforts are currently underway to ensure useful inclusion of occupation and industry information in the clinical module. A recent Institute of Medicine report details findings of a committee that studied the rationale for and feasibility of including occupational information in the EHR. The IOM report can be found at the following link: []

//__Codes__// Classification systems exist that could support the exchange of structured industry and occupation (I/O) data (data elements required for case reports of occupational conditions). Structured I/O data is not yet exchanged by most EHRs. However, fields for I/O data appear in cancer registries and death certificates. Additionally, I/O data are collected by many national surveys as text and subsequently coded. Efforts are underway to optimize the standardization and coding of I/O data for EHRs. Standardized classification and coding systems for exposure information exist (e.g., Bureau of Labor Statistics, Association of Occupational and Environmental Clinics). Assessment of the application of such classification and coding schemes for the EHR is planned.

Current classification systems/standards:
 * 1.2.4 Other Information**

NAICS: The North American Industry Classification System (NAICS) is used to classify business establishments and contributes to an accurate picture of a worker’s employment situation, in conjunction with occupational information.

SOC: The Standard Occupational Classification system is used to classify jobs and contributes to an accurate picture of a worker’s employment situation, providing additional detail that further clarifies risk. Work has an enormous impact on the health of the U.S. population. Americans spend 50% of waking hours at work. Beyond income, it provides a context for human creativity, application of skills and talents, social networks, and growth of the national economy. It also poses substantial risks – physical, biological, chemical, and psychological – which can result in injury or illness that significantly interferes with productivity and quality of life. A daily gathering place, the workplace can be an effective venue in which to deliver programs to promote health and manage chronic disease, but can also serve as a locus of transmission of infectious disease.

The U.S. lags behind many nations in documenting the risks and casualties of work. Systems of “counting” work-related events are fragmented and designed primarily to recognize injury. Systems for compensating workers for injuries and illnesses similarly are primarily focused on acute injury –readily tied to a place, time, and specific event. Work contributes to the burden of chronic disease to an even greater extent than to injury, yet there are no systems in place to track these diseases, document their trends, and provide a mechanism to assure efforts at prevention.

Efforts to estimate work-related events indicates that nearly 16 workers in the United States die each day from injuries sustained at work, and 134 die from work-related diseases. Each day approximately 9,000 workers are treated in emergency departments for occupational injuries or disease. Work-related disease and injury account for a considerable fraction of total direct and indirect costs related to health outcomes. For example, work-related chronic obstructive lung disease and asthma account for $6.6 billion in direct and indirect costs per year. In 2005, workers’ compensation costs for employers totaled an estimated $89 billion.

The NAICs code source is an approved external code source defined for use in the ANSI ASC X-12 standard. The SOEC code source received approvals at the January 2011 ANSI ASC X-12N meeting.
 * 1.3 Stakeholder Commitment**

Kerry Souza, ScD, MPH Epidemiologist Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS) National Institute for Occupational Safety and Health (NIOSH) US Centers for Disease Control and Prevention (CDC) Patriots Plaza Building 395 E St. SW Suite 9257 Washington, DC 20201 Ph: 202-245-0639 Fax: 202-245-0648 Email: ksouza@cdc.gov
 * 1.4 Contact Information**

Genny Barkocy Luensman (formerly Gallagher) CDC/NIOSH/DRDS 513-841-4228 Blackberry: 404-488-5585 Email: bve2@cdc.gov

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - Impact of Work on Health - November 18 2011.docx]] ||  ||

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