Data Element

Comment

NACHC fully supports the CDC…

NACHC fully supports the CDC-NIOSH ODH model, and believes occupational health is central to understanding patient risk and context in a patient-centered way.

  1. We firmly support the use of the code systems and codes described by CDC-NIOSH and we can further state we are working with 3 clinical organizations using 3 different EHRs to implement these codes in production at this time.
  2. We support all comments of CDC-NIOSH and CSTE.

Please see the attached document, summarizing NACHC's detailed comments on Occupation and Industry

2022-04-30 NACHC USCDIv3 Letter of Support_6.pdf

Request to reclassify.

CDC requests that the Job occupation and industry data elements (USCDI V3) be reclassified into a Job data class instead of Patient Demographics.

 

CDC requests the creation of Job and Usual Work data classes (USCDI V3 and Level 2) as submitted. The existing Work Information data class (Levels 1 and 2) includes data elements that are part of different “themes” (subjects) and are used differently. A Job (a work situation or position, including some volunteer positions) is a different subject than Usual Work (longest-held work). Most of the data elements for job or usual work are related to the respective theme (Job or Usual Work), not the person. This structure is borne out in the way the data elements are configured in interoperability standards and ensures that the data retain meaning and are not confused across themes. Job Occupation and Usual Occupation tie the respective themes to a person.

 

As data elements characterizing a Job, Usual Work or a person mature, having separate data classes will support data quality and reduce the possibility of the same information being collected in more than one way. For example, this proposed classification scheme could help clarify the variations in Employment Status. A person’s Employment Status (level 1, Work Information data class) is defined by ODH and supported by a value set that facilitates selection of a single entry about the person (mutually exclusive values). Employment, as defined by the Gravity Project (Comment level, SDOH data class), is based on the “type and conditions of employment,” i.e., Job. A person working multiple jobs, or who has retired and taken another job, cannot provide a single entry about themselves using the related value set under development. However, making the distinction between a person’s state of being employed vs conditions of employment within a Job would provide clarity in data collection and use.

CDC's Consolidated Comment

  • CDC requests that the original name for the draft V3 element “Occupation” be used, i.e., “Job Occupation.”  Naming the element “Occupation” can and does lead to substantial confusion because an occupation, or type of work, is defined by context. For example, it can refer to a person’s type of work at a job (a work situation or position, including some volunteer positions) or the type of work they’ve performed the longest amount of time, aka Usual Occupation. Other contexts include military occupation and employer-specific occupation (aka job title). Clear and distinct naming will help the data to be useful for both clinical care and public health. “Job Occupation” aligns with the many existing references to this data element, including interoperability standards, other ODH products, and discussions and presentations across a variety of audiences.
  • CDC encourages ONC to accept this data element in USCDI V3, given its value for clinical care and public health. Substantial work has been done to provide informatics products (ODH) to support its implementation: an information model and vocabulary, how-to guides, and interoperability templates for consistent use in data exchange transactions.

ADDITIONAL SPECIFICATIONS: REPLACE THE CURRENT LANGUAGE WITH THE TEXT BELOW (THE PROPOSED LANGUAGE UPDATES REFERENCES AND STANDARDS TO THEIR LATEST VERSIONS):

  • HL7 CDA® R2.1 IG: Consolidated CDA Templates for Clinical Notes; Occupational Data for Health, R2.1  – US Realm. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=522 (Modular template for non-breaking insertion of Job (and/or other ODH sections) for any CDA IG social history section)
  • HL7 FHIR R4.0.1 Profile: Occupational Data for Health (ODH), R1, STU 1.1. http://hl7.org/fhir/us/odh/  (Modular template for non-breaking insertion of Job (and/or other ODH profiles) for any FHIR IG social history section)

Public health case reporting IGs including Job:

  1. HL7 CDA R2 IG Public Health Case Report – the Electronic Initial Case Report (eICR), R2, STU R3  – US Realm. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=436
  2. HL7 FHIR R4 IG: Electronic Case Reporting (eCR) – US Realm, R2, STU 2. http://hl7.org/fhir/us/ecr/
  3. IHE Patient Care Coordination (PCC) Technical Framework (TF) Supplement: CDA Content Modules, Revision 2.8  – Trial Implementation. https://www.ihe.net/resources/technical_frameworks/#pcc (Modular template for non-breaking insertion of Job (and/or other ODH sections) for any CDA profile social history section)
  4. Wallace B, Luensman GB, Storey E, Brewer L. “A Guide to the Collection of Occupational Data for Health: Tips for Health IT System Developers” https://www.cdc.gov/niosh/docs/2022-101/ 
  5. HL7 EHRS-FM R2: Functional Profile; Work and Health, R1 – US Realm. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=498
  6. Marovich S, Luensman GB, Wallace B, Storey E. Opportunities at the intersection of work and health: Developing the occupational data for health information model. J Am Med Inform Assoc. 2020 Jul 1;27(7):1072-1083. https://doi.org/10.1093/jamia/ocaa070

Additional IHE PCC TF Supplements including Job https://www.ihe.net/resources/technical_frameworks/#pcc :

https://www.ihe.net/resources/technical_frameworks/#pcc :

  • IHE PCC TF Supplement to Volume 1, CDA Occupational Data Options, Revision 1.1 – Trial Implementation adds Job (and other ODH sections) to:
  1. Cross-Enterprise Sharing of Medical Summaries (XDS-MS)
  2. Exchange of Personal Health Record (XPHR)
  3. Emergency Department Referral (EDR) profiles
  • IHE PCC TF Supplement: Query for Existing Data for Mobile (QEDm), Revision 2.2  – Trial Implementation
  • IHE PCC TF Supplement: International Patient Summary (IPS), Revision 1.1 – Trial Implementation

Federal Health Information Model (FHIM), Person Domain. https://fhim.org/

  1. IHE Quality, Research and Public Health (QRPH) TF Supplement: Healthy Weight (HW), Revision 2.5  – Trial Implementation (includes Job) https://www.ihe.net/resources/technical_frameworks/#qrph
  2. HL7 Version 2.9 Messaging Standard – An Application Protocol for Electronic Data Exchange in Healthcare Environments, Normative. (includes Job) http://www.hl7.org/implement/standards/product_brief.cfm?product_id=516. Job is pre-adopted in:
  3. HL7 Version 2.6 IG: Early Hearing Detection and Intervention (EHDI) Results, R1, Normative. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=344
  4. HL7 Version 2.6 IG: Critical Congenital Heart Defects (CCHD) Pulse Oximetry Screening Results, R1, Normative. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=366

CSTE Comment:

  • CSTE is very supportive of including work information in USCDI. It is important for assessing the increase in risk for conditions that might be ascribable to industry and occupation. However, specific job title and place of work are distinct variables and should also be collected and included in USCDI v3, including the address and phone number of each place the patient currently works.

 

 

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