| Submitted By: Genevieve Luensman PhD
/ Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH)
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| Data Element Information |
| Use Case Description(s) |
| Use Case Description |
A Retirement Date, regardless of current Employment Status, provides information regarding a patient’s perceived relationship to work and potential access to benefits and financial security.
Employment Status and Retirement Date are expected to be collected/reviewed/updated at or prior to registration for every adult. The use of a patient portal or in-office kiosk or tablet is expected to facilitate this process. In addition, the Occupational Data for Health (ODH) set of templates for Work Information, including Employment Status and Retirement Data templates, is an option in the IHE Exchange of Personal Health Record Profile (XPHR), allowing the patient to enter the data in their personal health record and share it with care providers to reduce the burden of data collection in the clinical setting.
The Employment Status and Retirement Date templates also are included as part of the ODH set of templates for Work Information that are an option in the HL7 Consolidated CDA (C-CDA) Templates for Clinical Notes, Social History section. Social History is required in the C-CDA Continuity of Care Document (CCD) and History and Physical Document. Social History is optional in the C-CDA Consultation Note, Discharge Summary, Transfer Summary, Referral Note, and Procedure Note.
The Employment Status and Retirement Date templates are similarly included within the optional ODH set of templates for Work Information in the IHE profiles for: data query using FHIR (QEDm), CDA or FHIR for international patient summary (IPS), CDA for medical summary (XDS-MS), CDA for personal health record data (XPHR), CDA for emergency department referral data (EDR), and CDA for healthy weight (HW) data.
Leveraging these implementation guides and profiles with structured and standardized Employment Status and Retirement Date can improve the quality of care by providing a more complete picture of factors that may affect the patient’s health during referrals. The data entry burden also can be reduced by sharing the information across care providers using one of these standards.
Related website: Institute of Medicine. Incorporating Occupational Information in Electronic Health Records: Letter Report. Washington, DC. National Academies Press; 2011. https://www.nap.edu/catalog/13207/incorporating-occupational-information-in-electronic-health-records-letter-report |
| Estimate the breadth of applicability of the use case(s) for this data element
|
In 2018, approximately 75% of adults age 18 and older had worked in the past 12 months and on average approximately 60% of adults in the U.S. currently are working. Since work and health are interrelated, most of the 209,000 primary care physicians and many of the 120,000 certified physician assistants and 290,000 licensed nurse practitioners in the U.S. would potentially benefit from the capture, access, use, and exchange of Employment Status and Retirement Date. |
| Link to use case project page |
https://www.cdc.gov/niosh/topics/ehr/default.html |
| Healthcare Aims |
- Improving patient experience of care (quality and/or satisfaction)
- Improving the health of populations
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| Maturity of Use and Technical Specifications for Data Element |
| Applicable Standard(s) |
An information model of the Work Information data elements, called Occupational Data for Health (ODH), has been published ( https://doi.org/10.1093/jamia/ocaa070) and the data are represented in the Federal Health Information Model (FHIM; https://fhim.org/). An HL7 informative EHR-S Functional Profile has been published (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=498). A Guide to Collection of Occupational Data for Health (ODH) is in preparation.
Logical Observation Identifiers Names and Codes (LOINC) codes are available for each Work Information Data Element and each component of the data elements, including Retirement Date (https://loinc.org/).
Interoperability standard formats for all of the Work Information Data Elements are published as aligned HL7 CDA, V2, and FHIR ODH templates as well as an IHE CDA profile ODH template. Related References:
HL7 CDA® R2 Implementation Guide: Consolidated CDA Templates for Clinical Notes; Occupational Data for Health, Release 1 – US Realm; STU. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=522
IHE Patient Care Coordination (PCC) Technical Framework Supplement: CDA Content Modules, Revision 2.6 – Trial Implementation. https://www.ihe.net/resources/technical_frameworks/#pcc
HL7 FHIR Release 4.0.1 Profile: Occupational Data for Health (ODH), Release 1.0 STU. http://hl7.org/fhir/us/odh/STU1/
HL7 Version 2.9 Messaging Standard – An Application Protocol for Electronic Data Exchange in Healthcare Environments, Normative. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=516. Chapter 3, Patient Administration: Retirement Date is included in the PD-1 segment.
https://doi.org/10.1093/jamia/ocaa070
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| Additional Specifications |
IHE Patient Care Coordination (PCC) Technical Framework Supplement to Volume 1, CDA Occupational Data Options, Revision 1.1 – Trial Implementation. https://www.ihe.net/resources/technical_frameworks/#pcc. This adds the Occupational Data for Health (ODH) template of all Work Information Data Elements as an option to three profiles in the PCC Technical Framework: Cross-Enterprise Sharing of Medical Summaries (XDS-MS), Exchange of Personal Health Record (XPHR), Emergency Department Referral (EDR).
IHE Patient Care Coordination (PCC) Technical Framework Supplement: Query for Existing Data for Mobile (QEDm), Revision 2.2 – Trial Implementation. https://www.ihe.net/resources/technical_frameworks/#pcc. (ODH template for all Work Information Data Elements is an option)
IHE Patient Care Coordination (PCC) Technical Framework Supplement: International Patient Summary (IPS), Revision 1.1 – Trial Implementation. https://www.ihe.net/resources/technical_frameworks/#pcc. (ODH template for all Work Information Data Elements is an option)
IHE Quality, Research and Public Health Technical Framework Supplement: Healthy Weight (HW), Revision 2.3 – Trial Implementation. https://www.ihe.net/resources/technical_frameworks/#qrph. (ODH template for all Work Information Data Elements is an option)
HL7 Version 2.9 Messaging Standard – An Application Protocol for Electronic Data Exchange in Healthcare Environments, Normative. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=516. Work Information segments and Retirement Date are included as options in: Chapter 3, Patient Administration, 13 ADT/ACK message events; Chapter 4, Orders, 1 OMG, 4 OML and 1 OMI message events; Chapter 7, Observations, 7 ORU, 2 OUL, and 1 OPU message event.
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| Current Use |
In limited use in production environments |
| Supporting Artifacts |
ODH interoperability templates for Work Information have been used to demonstrate exchange at HIMSS Interoperability Showcases annually since 2016 and the PHI Conference Interoperability Showcases in 2016 and 2018 using the IHE Healthy Weight (HW) profile. These transactions and demonstrations have involved four personal health records, one interface engine, one public health representative, one provider portal, and one EHR. One personal health record and the interface engine used production environments; the others used test environments. For three 2020 NACCHO 360X Interoperability Demonstrations, Work Information was exchanged using the QEDm (FHIR) and CCD (CDA) formats.
Related websites:
“Health and Fitness,” Interoperability Showcase. Health Information Management and Systems Society (HIMSS) Annual Conference. Feb 19-24, 2017. Video at https://www.youtube.com/watch?v=ZxRx1UECUkg&list=PLFB222C2B798A2877&t=0s&index=22
“Value-Based Care,” Interoperability Showcase. Health Information Management and Systems Society (HIMSS) Annual Conference. Las Vegas, NV. Mar 5-8, 2018. Video available at https://www.youtube.com/watch?v=JH4Y4pV3mw8&t=0s&index=7&list=PLGFNwETCTdKlvMmCk0XjXksTDMW57kxUx
“Patient-Centered Interoperability,” Interoperability Showcase. Health Information Management and Systems Society (HIMSS) Annual Conference. Orlando, FL. Feb 11-15, 2019. Video available at https://www.youtube.com/watch?v=0ZCyjHG8Kpo&t=584s
https://www.cdc.gov/niosh/topics/ehr/default.html
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| Extent of exchange
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4 |
| Supporting Artifacts |
ODH interoperability templates for Work Information have been tested at IHE Connectathons and demonstrated at annual HIMSS and bi-annual PHI Conference Interoperability Showcases since 2016 using the IHE Healthy Weight (HW) profile. The 2020 NACCHO 360X Interoperability Demonstrations used the FHIR QEDm and CDA CCD standards. These transactions and demonstrations have involved four personal health records, one interface engine, one public health representative, one provider portal, and one EHR. One personal health record and the interface engine used production environments; the others used test environments.
https://product-registry.ihe.net/PR/pr/search.seam?integrationProfileOption=424&integrationProfile=372&domain=9&date=ANY|1601300810685|1601300810685
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| Potential Challenges |
| Restrictions on Standardization (e.g. proprietary code) |
None |
| Restrictions on Use (e.g. licensing, user fees) |
None |
| Privacy and Security Concerns |
The Data Elements in the Work Information Data Class are intended to be a part of the medical record and protected as such. |
| Estimate of Overall Burden |
We estimate that it will take approximately 600 hours to implement all of the Work Information Data Elements (Job, Usual Work, Employment Status, Retirement Date, and Combat Zone Period) as described in the HL7 EHR-S Work and Health Functional Profile and A Guide for Collection of Occupational Data for Health (ODH, aka Work Information. NIOSH, in preparation). The functional profile suggests system features to manage the information (including rendering, storing, etc.) so that it will be most useful and accessible to the care provider at the right time.
Initially, data collection will likely occur primarily via patient self-entry, e.g., during preregistration in their patient portal or via a kiosk on arrival in the clinic. Based on user testing of a Work Information collection prototype, initial entry of all Work Information Data Elements (Job, Usual Work, Employment Status and Retirement Date, and Combat Zone Period) takes 5-30 minutes. As with other data classes, such as medications and family history, the opportunity to review previously entered information will be key to reducing the collection burden. Leveraging interoperability standards will also help to minimize the collection burden by sharing the information across systems. |
| Other Implementation Challenges |
None |
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Submitted by nedragarrett_CDC on
CDC's comment for USCDI Draft v5
CDC supports the inclusion of Retirement Date in USCDI V5. Retiring can be independent of employment status, and knowing Retirement Date provides key information regarding a patient’s perceived relationship to work and potential access to benefits. This information also supports mental health management because of retirement’s association with risk factors that can contribute to the development of depression.
CDC suggests moving the data element to the new Observations data class to align with their representation in Fast Healthcare Interoperability Resource (FHIR) standards, improving visibility for implementers.