Health Centers Are Leading Efforts to Incorporate Patient Work Information into Electronic Health Records

Kerry Souza and Michael Wittie | August 15, 2014

Community health centers are the largest providers of health care to underserved individuals in the United States and in many communities are at the forefront of health IT innovation. Health centers have long worked to improve the quality and efficiency of the care they provide, and have adopted health IT as a tool to facilitate that improvement.

According to data released this week, federally funded health centers provided care to more than 21.7 million patients (more than 62 percent of whom were racial/ethnic minorities, and almost 35 percent of whom are uninsured) in 2013. 96 percent of these centers have an electronic health record (EHR) in use at some or all sites, and 84.5 percent reported that their providers are receiving meaningful use payments. Health centers are not just using health IT, they are using it as part of clinical transformation: more than 54 percent of centers achieved recognition as Patient Centered Medical Homes, a key indicator of high-quality care.

Community health centers across the country are also using EHRs to capture and use patient work information to learn more about their patients’ work and health.

Americans spend nearly half their waking hours working. While work is an important determinant of health, information about patients’ occupation(s) and the industries in which they work or have worked is not typically present and systematically organized in health records. Recording industry and occupation data in EHRs not only allows providers access to this important information on patients, but it can also enable clinical decision support functions to assist providers in caring for patients based on each individual’s work history.

NIOSH goals for work information

The goal of Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health’s (NIOSH) EHR Working Group is to ensure that the patient work information most pertinent to patient care and population health is included in EHRs in a useful and retrievable manner. The working group learned about the work health centers and other health organizations are doing to improve care, and are working with leading centers to improve the collection and use of work information in EHRs.

A project between Cambridge Health Alliance and the Massachusetts Department of Public Health Occupational Health Surveillance Program highlights the value of this information. Under the 2010 program, occupation information was captured for more than 27,000 patients in a primary care practice’s EHR. The project was a success—Laura Brightman, M.D., a primary care physician and the principal investigator, said: “When we presented at … grand rounds, staff were excited about having data about their patients’ work, and the potential for this information to improve both clinical and population health.”

Having learned much from the Cambridge Health Alliance’s work, NIOSH set out to incorporate patient industry and occupation fields into a commercial EHR. A competitive process led to a contract with St. John’s Well Child and Family Center in Los Angeles, CA, a community health center with a long history of achieving health and social justice gains for its patients.

St. John’s pilot program

Launched last October, this project will modify the GE Centricity EHR used by the center to include patient industry and occupation information. St. John’s will collect one year of data, allowing staff to incorporate patient work information into clinical and population health activities and evaluate impacts upon health center workflow. The data will also support wider efforts at St. John’s to identify and treat work-related health concerns and provide advocacy on behalf of low-wage worker populations in their service area.

“The ability to collect patient industry and occupation data leads to more informed medical care and treatment, which perpetuates St. John’s’ mission to address salient structural determinants of health, promote health equity, and foster community well-being by providing comprehensive, evidence-based, high-quality care to the sick and poor in South Los Angeles,” said Shom Dasgupta-Tsinikas M.D., Director of Social Medicine and Health Equity for St. John’s.

NIOSH has also begun a project to develop occupationally related clinical decision support for health issues familiar to primary care: work-related asthma, diabetes, and return-to-work guidelines. In addition, the NIOSH-developed “Occupational Data for Health” information model (soon to be published) provides the structure for programming the work data elements that are most useful for patient care and population health and facilitate EHR modifications.

ONC and NIOSH staff are exploring avenues to capture industry/occupation data in EHRs. Data capture would be the first step to allow health-care organizations to develop programs aimed at meeting the occupational health needs of their patients, harnessing the power of EHRs for capturing, storing, tracking, exchanging, and reporting data.

Even before these data are routinely available in EHRs, health centers will undoubtedly continue to lead the way in bridging occupational health and primary care, and in using EHRs to help meet their patients’ needs.

Stay tuned for more on these exciting initiatives and pilot projects!