Data Element

Information from the submission form

Usual Occupation
Description
A self-reported, coded term for the type of work (paid or unpaid) done by a person for the longest amount of time during his or her life, not including voluntary work (done by choice for the benefit of others without compensation).

Comment

CDC's comment on behalf of CSTE for USCDI v4

CSTE agrees with CDC and strongly supports the collection of usual industry and occupation. But also recommends collection of standardized data on job/workplace.

CDC's Consolidated Comment for USCDI v4

CDC continues to recommend inclusion of this high priority data element in USCDI v4 CSTE Comment:
  • CSTE agrees with CDC and strongly supports the collection of usual industry and occupation. But also recommends collection of standardized data on job/workplace.

CDC's Consolidated Comment

  • CDC requests that Usual Occupation be considered for USCDI V3 to support both public health and clinical care. This element is required for reporting to cancer registries and supports identifying, understanding, and addressing relationships between work and cancer when they are related to the type of work the person performs or has performed. Cancer can develop after a long latency and be unrelated to a person’s current job; cancer exposure risks can also be affected by the length of time a person worked in that field, which is most easily captured as longest-held work and not requiring a full, retrospective work history. Usual Work is included in the recently-balloted MedMorph-sponsored HL7 FHIR Central Cancer Registry Reporting Content Implementation Guide (http://hl7.org/fhir/us/central-cancer-registry-reporting/2022Jan/ ), the recently published electronic case reporting standards, and death reporting interoperability standards. Finally, if only current job information is collected, veterans would not have the opportunity to record their military service and Usual Occupation paired with Usual Industry could help to identify those for whom military service is their longest-held work.
ADDITIONAL SPECIFICATIONS: REPLACE THE CURRENT LANGUAGE WITH THE TEXT BELOW (THE PROPOSED LANGUAGE UPDATES REFERENCES AND STANDARDS TO THEIR LATEST VERSIONS):
  1. HL7 CDA® R2.1 IG: Consolidated CDA Templates for Clinical Notes; Occupational Data for Health, STU R2.1  – US Realm. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=522 (Modular template for non-breaking insertion of Usual Work (and/or other ODH sections) for any CDA IG social history section)
  2. 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 Usual Work (and/or other ODH profiles) for any FHIR IG social history section)
Public health IGs including Usual Work:
  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 (also STU R3, to be published late 2021 and implemented starting in 2022)
  2. HL7 FHIR R4 IG: Electronic Case Reporting (eCR) – US Realm, R1, STU 1. http://hl7.org/fhir/us/ecr/ 
  3. HL7 CDA R2 IG: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, R1, Draft STU R1.1 – US Realm. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=398 (Usual Work is required)
  4. FHIR Release 4.0.1 Implementation Guide: Central Cancer Registry Reporting Content Implementation Guide, Release 0.1.0, STU 1 ballot. http://hl7.org/fhir/us/central-cancer-registry-reporting/2022Jan/
  5. HL7 FHIR R4.0.1 IG: Vital Records Mortality and Morbidity Reporting, R1, STU 1. http://hl7.org/fhir/us/vrdr/history.html (Usual Occupation and Usual Industry required in decedent demographics for reporting from vital statistics agencies to the national statistical agency)
  6. HL7 CDA R2 IG: Vital Records Death Reporting, R1, STU 2.1 – US Realm. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=386 (Usual Occupation and Usual Industry required in decedent demographics for reporting from vital statistics agencies to the national statistical agency)
  7. IHE Patient Care Coordination (PCC) Technical Framework (TF) Supplement: CDA Content Modules, Revision 2.7  – Trial Implementation. https://www.ihe.net/resources/technical_frameworks/#pcc (Modular template for non-breaking insertion of Usual Work (and/or other ODH sections) for any CDA profile social history section)
  8. 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/ 
  9. HL7 EHRS-FM R2: Functional Profile; Work and Health, R1 – US Realm. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=498
  10. 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 Usual Work: https://www.ihe.net/resources/technical_frameworks/#pcc :
  1. IHE PCC TF Supplement to Volume 1, CDA Occupational Data Options, Revision 1.1 – Trial Implementation adds Usual Work (and other ODH sections) to:
  • Cross-Enterprise Sharing of Medical Summaries (XDS-MS)
  • Exchange of Personal Health Record (XPHR)
  • Emergency Department Referral (EDR) profiles
  1. IHE PCC TF Supplement: Query for Existing Data for Mobile (QEDm), Revision 2.2  – Trial Implementation
  2. IHE PCC TF Supplement: International Patient Summary (IPS), Revision 1.1 – Trial Implementation
  3. Federal Health Information Model (FHIM), Person Domain. https://fhim.org/
  4. IHE Quality, Research and Public Health (QRPH) TF Supplement: Healthy Weight (HW), Revision 2.5  – Trial Implementation (includes Usual Work) https://www.ihe.net/resources/technical_frameworks/#qrph
  5. HL7 Version 2.9 Messaging Standard – An Application Protocol for Electronic Data Exchange in Healthcare Environments, Normative. (includes Usual Work) http://www.hl7.org/implement/standards/product_brief.cfm?product_id=516
CSTE Comment:  
  • CSTE strongly supports the collection of usual industry and occupation. But also recommends collection of standardized data on job/workplace.
NACCHO Comment:
  • In addition to cancer risk, Usual Industry and Usual Occupation data can be used to categorize risk of exposure/infection to communicable disease. This data can be used to design prevention and response initiatives. For example, we saw lots of COVID in manufacturing setting because they spent so much time in the same place/around the same people. We were able to target education and vaccination outreach to manufacturing facilities based on this knowledge – and businesses were particularly interested in working with us—so there is a good cost/benefit.

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