Request for Information: Collection and Use of Patient Work Information in the Clinical Setting: Electronic Health Records, 38634-38635 [2012-15896]

Agencies

• Centers for Disease Control and Prevention
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 77, Number 125 (Thursday, June 28, 2012)]
[Notices]
[Pages 38634-38635]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-15896]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Docket Number CDC-2012-0008; NIOSH-251]


Request for Information: Collection and Use of Patient Work 
Information in the Clinical Setting: Electronic Health Records

AGENCY: The National Institute for Occupational Safety and Health 
(NIOSH) of the Centers for Disease Control and Prevention (CDC), 
Department of Health and Human Services (HHS).

ACTION: Request for public comments.

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SUMMARY: The National Institute for Occupational Safety and Health 
(NIOSH) of the Centers for Disease Control and Prevention (CDC), 
Department of Health and Human Services (HHS) requests public comments 
to inform its approach in recommending the inclusion of work 
information in the electronic health record (EHR). NIOSH requests input 
on these issues (including answers to the three questions listed 
below). The instructions for submitting comments can be found at 
www.regulations.gov. Written comments submitted to the Docket will be 
used to inform NIOSH with its planning and activities in response to 
the 2011 letter report ``Incorporating Occupational Information in 
Electronic Health Records'' written by the Institute of Medicine (IOM) 
Committee on Occupation and Electronic Health Records.

DATES: Public Comment Period: Comments must be received by August 27, 
2012. Comments should reference docket number CDC-2012-0008.

ADDRESSES: Written comments: You may submit comments by any of the 
following methods:
     Federal eRulemaking Portal: https://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: NIOSH Docket Office, Robert A. Taft Laboratories, 
MS-C34, 4676 Columbia Parkway, Cincinnati, OH 45226.
    Instructions: All submissions received must include the agency name 
and docket number. All relevant comments, including any personal 
information provided, will be posted without change to https://www.regulations.gov.
     Email: nioshdocket@cdc.gov.
    All information received in response to this notice will be 
available for public examination and copying at the NIOSH Docket 
Office, 4676 Columbia Parkway, Cincinnati, Ohio 45226.
    NIOSH includes all comments received without change in the docket, 
including any personal information provided. All material submitted 
should reference docket number CDC-2012-0008 and must be submitted by 
August 27, 2012 to be considered by the Agency.

I. Background

    Health care in the United States is undergoing a significant change 
as providers of health care transition from paper-based records to 
electronic health records (EHRs). EHRs represent the potential for cost 
savings and other efficiencies and improvements in the way that 
information is used to inform health care. The Office of the National 
Coordinator (ONC) for Health Information Technology promotes a 
nationwide health information technology (HIT) infrastructure that 
allows for the electronic use and exchange of health information. More 
information on the ONC and on electronic health records can be found at 
https://healthint.hhs.gov.
    NIOSH, along with other centers of CDC, works to promote and 
protect population health. Public health researchers and practitioners, 
including those promoting occupational public health, are working to 
ensure that public health goals are met through the use of EHRs. NIOSH 
is working to ensure that EHRs will contribute to improvements in 
individual and population health by meeting the need to support 
occupational considerations during clinical care and by enhancing 
public health professionals' understanding of work-related conditions 
so they can identify effective treatment and prevention strategies. 
Currently, systematic collection and recording of patient work 
information in the clinical setting is not widespread. Where work 
information is collected and recorded in the EHR, that information may 
not be standardized or converted to structured data (i.e., coded), thus 
limiting its utility for clinical decision making and public health 
surveillance. For example, standardized patient occupation and/or 
industry information could be linked to resources that provide clinical 
decision support, such as job-specific information about exposures and 
associated potential health problems, as well as information that would 
facilitate appropriate determination of return-to-work recommendations.
    In 2011, at the request of NIOSH, the Institute of Medicine (IOM) 
of the National Academies of Science appointed a committee to examine 
the rationale and feasibility of incorporating occupational information 
in the EHR. The committee concluded that inclusion of occupational 
information in the EHR ``could contribute to fully realizing the 
meaningful use of EHRs in improving individual and population health 
care''. The Committee provided NIOSH with a set of ten recommendations, 
including ``Recommendation 1: Conduct Demonstration Projects to Assess 
the Collection and Incorporation of Information on Occupation, Industry 
and Work-Relatedness in the EHR.'' The purpose of this Request for 
Information

[[Page 38635]]

(RFI) is to gather information from providers of primary care and 
occupational medicine, vendors and creators of EHR software, and the 
public to inform NIOSH's response to this and other IOM 
recommendations. Gathering information through this RFI will enable 
NIOSH to understand opportunities and challenges in collecting 
occupational information and how and why health care providers collect 
and use this information. The IOM report with the 10 recommendations 
can be downloaded at: https://iom.edu/Reports/2011/Incorporating-Occupational-Information-in-Electronic-Health-Records-Letter-Report.aspx.
    NIOSH has released this RFI to learn about how the following types 
of patient work information are collected and used:

Employment status (e.g., employed, unemployed, disabled, retired, part 
time/full time, shift)
Patient's current occupation(s)
Patient's current industry(s)
Patient's usual (longest held) occupation(s)
Patient's usual (longest held) industry(s)
Employer(s) name
Employer Address(es)
Work-relatedness of patient's health condition(s)

Other information about patient's work, such as information about 
exposures at work.

II. Questions of Interest

    Input from primary care providers, occupational and public health 
specialists, EHR vendors and others with interest in the topic is 
sought on the questions listed below pertaining to the collection and 
use of work information in the clinical setting. NIOSH is interested in 
input both from those who are currently using EHRs as well as those who 
are not.
    (1) For providers of primary health care: When do the clinicians in 
your practice setting currently ask patients about their work?
    Specifically, what information on patients' work is collected?
    If you currently use an EHR:
    Where in the health record (either paper or electronic) is patient 
work information stored and/or viewed? For example, is the work 
information entered in the `social history' section of an EMR? Where 
would you prefer patient work information to be stored and/or viewed in 
the EHR?
    Does your EHR maintain a history of the information so that you can 
identify how long and when a patient was in a given occupation?
    If you currently do not use an EHR, where do you record this 
information in the paper record? Is it available to the care provider 
during the patient encounter? Is there a history of the patient's work 
information available to the care provider?
    In your clinical practice, who (which personnel) besides the 
clinicians collect patients' work information (e.g., registration 
personnel or nursing assistants)?
    Have those personnel been trained specifically in how to collect 
information about patient's work i.e., how to gain an accurate job 
title etc.?
    Do you collect work information from teenagers?
    Do you collect work information from retirees?
    Are questions about work routine question or triggered based on 
specific complaints?
    How is work information used to inform patient care?
    Please provide an example/description of the usefulness of patient 
work information in providing care to a patient.
    Please provide any additional comments you have about collection or 
use of patient work information in the clinical setting.
    (2) For providers of occupational (specialty) health care: At your 
clinical facility, how is the patient's work information collected?
    Specifically, what information on patients' work is collected?
    Is the work information entered in the administrative record used 
for billing purposes?
    Is patient work information collected on paper or in an EHR? Is it 
available to the care provider during the patient encounter?
    Is there a history of the patient's work information available to 
the care provider?
    If you use a standardized form to collection information about 
patients' work, please briefly describe its main elements.
    In your clinical practice, who (which personnel) besides the 
clinicians collect (e.g., registration personnel or nursing 
assistants)?
    Have those personnel been trained specifically in how to collect 
information about patient's work i.e., how to gain an accurate job 
title, etc.?
    Where in the health record (either paper or electronic) is the 
information stored? For example, is the work information entered in the 
`social history' section?
    What are the most important ways that clinicians can use to inform 
clinical care of patients?
    Please provide an example of the usefulness of work information in 
providing care to a patient.
    Do you have any other comments about collection or use of patient 
work information in the clinical setting?
    (3) For developers and vendors of EHR/software: Does your base/
basic EHR product contain pre-ordained fields for Industry, Occupation, 
Employer or other information about patients' work? If not, have you 
been asked to provide these fields?
    Regardless of whether they are in the base system or added on 
request, how are the values in the fields for Industry, Occupation, or 
other work information formatted (e.g., narrative text, drop-down 
menus, other)?
    Are these values coded and if so, what coding schema are used 
(e.g., NAICS, SOC, Census codes, user defined)?
    To the best of your knowledge, how are the data captured in these 
fields used by end users of your EHR/product?
    Please share challenges you anticipate in managing a history of 
employer, industry and occupation (current and usual) for multiple 
employment situations as both text and coded fields in your system, if 
your system does not already perform these functions?
    Could your system access and retrieve information from another web-
based system via web services (such as an automated coding system for 
coding industry and occupation)?
    Your comments are appreciated. They will be used to improve NIOSH's 
electronic health records efforts.

FOR FURTHER INFORMATION CONTACT: Kerry Souza, NIOSH, 395 E Street SW., 
Suite 9257, Washington, DC 20002, telephone (202) 245-0639, Email 
hkv4@cdc.gov.

    Dated: June 20, 2012.
John Howard,
Director, National Institute for Occupational Safety and Health, 
Centers for Disease Control and Prevention.
[FR Doc. 2012-15896 Filed 6-27-12; 8:45 am]
BILLING CODE 4163-19-P