Work Information

A set of self-reported, related components about the work a person performed for the longest amount of time during his or her life, regardless of the person's current job and regardless of whether or not the person performed this work for a continuous time. It can span multiple work situations or training positions.

A Usual Work element includes one of each component: (1) Usual Occupation, (2) Usual Industry, (3) Usual Occupation Start Year, and (4) Usual Occupation Duration.

(1) Usual Occupation is 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). If an appropriate term is not available (e.g., a new type of work), then a text entry is used.

(2) Usual Industry is a self-reported term that identifies the kind of business, i.e., primary business activity, in which a person has worked for the longest time while in their Usual Occupation. For a military position, this is the self-reported branch of service. If an appropriate term is not available (e.g., a new kind of business), then a text entry is used.

(3) Usual Occupation Start Year is the self-reported year that a person started working in their Usual Occupation.

(4) Usual Occupation Duration is the self-reported total of all periods of time (in years) a person has spent in their Usual Occupation as of the date recorded, not including intermittent period(s) when the person was not working in that occupation. It is recorded as an integer to one decimal place.

Submitted By: Genevieve Luensman PhD / Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health
Data Element Information
Use Case Description(s)
Use Case Description	Work and health are inextricably related. On average, workers in the U.S. spend more than half their waking hours at work and (based on 2018 data) approximately 75% of adults have worked in the past 12 months and 95% have worked at some time in their lives. The Usual Work element supports recognition of new and known chronic conditions which evolve over many years and may become evident after the person is no longer performing that type of work. Related website: Institute of Medicine. Incorporating Occupational Information in Electronic Health Records: Letter Report. Washington, DC. National Academies Press; 2011. https://doi.org/10.17226/13207 Usual Work is 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 Patient Work, including a Usual Work template, 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. NIOSH has developed user stories describing the value of Usual Work information and examples will be provided on the NIOSH-EHR website (in preparation). Collecting and managing Usual Work separately from Job simplifies data collection (i.e., an entire job history isn’t needed to determine usual work). Current Job also cannot always be interpreted as Usual Work and a person might not think to mention their Usual Work in relation to a health concern; for example, a retired pipe welder might currently be working as a department store door greeter, but still suffering health effects of long-term exposure to welding fumes and vibration. The Usual Work template also is included in key interoperability standards as part of the ODH set of templates for Patient Work, which can reduce the burden of re-entering data for a new care provider to access. The Usual Work template is an option in the HL7 Consolidated CDA (C-CDA) Templates for Clinical Notes, Social History section. Within C-CDA, Social History is required in the Continuity of Care Document (CCD) and History and Physical Document; it is optional in the Consultation Note, Discharge Summary, Transfer Summary, Referral Note, and Procedure Note. The ODH set of templates, including a Usual Work template, also is an option in the IHE profiles for medical summary (XDS-MS), emergency department referral data (EDR), international patient summary (IPS), data query using FHIR (QEDm),and healthy weight (HW) data. Leveraging these implementation guides and profiles with the structured and standardized Usual Work element can improve the quality of care by providing a more complete picture of factors that may affect the patient’s health and supporting referrals; they can also reduce the burden of data reentry. Without the Usual Work element, care providers sometimes record some information about a patient’s work in their Notes, which makes it difficult to use outside of the initial consultation. This lack of standardization and collection as text make the information less amenable to use and reuse. Shifting to the structured and standardized Usual Work element will facilitate access to clinical decision support and reuse of the data for examination of populations, both in healthcare and public health. For example, the CCD and XDS-MS with the Usual Work template provide the opportunity to convey a more complete picture of the patient’s health factors when referring patients to specialty care (e.g., a cashier in a bicycle shop with symptoms of silicosis possibly related to their usual work in the manufactured countertop installation industry). This Usual Work element could contribute to patient matching.
Estimated number of stakeholders capturing, accessing using or exchanging	Based on 2018 data, approximately 75% of adults age 18 and older worked in the past 12 months and 95% worked at some time in their lives. 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 in the U.S. would potentially benefit from the capture, access, use, and exchange of Usual Work information. Not including primary care providers, there are another 415,000 physicians who are also primarily involved in direct patient care. Many specialty providers would also benefit from Usual Work information: e.g., those who care for patients with chronic diseases caused by occupational exposures, such as pulmonologists, neurologists, nephrologists, oncologists.
Link to use case project page	https://www.cdc.gov/niosh/topics/ehr/default.html
Use Case Description	The Usual Work element supports recognition of new and known chronic conditions which evolve over many years and may become evident after the person is no longer performing that type of work. Examples of known conditions include asbestosis, silicosis, berylliosis, and interstitial pulmonary fibrosis, cancer, and musculoskeletal disorders. Recognized earlier because of an exposure to a health hazard revealed by Usual Work information, these conditions can be managed more effectively and associated conditions can be prevented from occurring, such as TB with silicosis and cancer with asbestosis. Important administrative aspects can be addressed such as compensation for the illness and accessing benefits to assist in care of the illness. Related website: NIOSH Workplace Safety & Health Topics. https://www.cdc.gov/niosh/topics/default.html This Usual Work element also has the potential to support recognition of new work-related conditions and quickly identify at-risk populations to prevent further illness. For example, in 2000, an astute clinician’s knowledge of patients’ previous employment in a popcorn flavoring manufacturing facility led to recognition of the link between an irreversible fixed obstructive lung disease and inhalation of butter flavoring chemicals at work. If a structured Usual Work element had been available in an electronic heath record system, this link might have been recognized sooner; a review subsequently found the relationship between occupational hazard exposure and this condition as far back as 1985. MMWR 2002 Apr 26;51(16):345-7. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5116a2.htm The structured and standardized Usual Work element and its components are amenable to use in CQL and will facilitate automated access to clinical decision support. For example, Usual Occupation and Usual Industry components could be used to obtain decision support to help recognize, prevent, and treat conditions related to long-term work. The added specificity of Usual Occupation Start Year and Usual Occupation Duration makes it possible to consider the impact of time and extent of exposure for the individual patient and across populations.
Estimated number of stakeholders capturing, accessing using or exchanging	Based on 2018 data, approximately 75% of adults age 18 and older worked in the past 12 months and 95% worked at some time in their lives. 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 in the U.S. would potentially benefit from the capture, access, use, and exchange of Usual Work information. Not including primary care providers, there are another 415,000 physicians who are also primarily involved in direct patient care. Many specialty providers would also benefit from Usual Work information: e.g., those who care for patients with chronic diseases caused by occupational exposures, such as pulmonologists, neurologists, nephrologists, oncologists.
Link to use case project page	https://www.nap.edu/catalog/13207/incorporating-occupational-information-in-electronic-health-records-letter-report
Use Case Description	This Usual Work element can also support research and public health. For example, efforts to understand causes of interstitial lung disease and requirements for lung transplants have resulted in registries of patients where occupational information is lacking, creating a gap in ongoing investigative efforts. In recognition that Usual Work is important when available, the Usual Work template is an option in the HL7 CDA Release 2 and the FHIR Electronic Initial Case Report (eICR). Related websites: NIOSH Data and Statistics Gateway: https://www.cdc.gov/niosh/data/default.html Work-Related Lung Disease Surveillance System (e(WoRLD)): https://wwwn.cdc.gov/eworld Electronic Case Reporting (eCR): https://www.cdc.gov/ecr/index.html The ODH Usual Work template is required in FHIR Vital Records Death Reporting and CDA Reporting to Public Health Cancer Registries, per the respective HL7 implementation guides. These data are used by public health entities to investigate the relationship between conditions and exposures at work and causes of death or cancer. Collecting and recording these data as standardized data elements will reduce the burden of translating text into codes, which may include misspellings and inadequate information. Related websites: National Program of Cancer Registries: https://www.cdc.gov/cancer/npcr/ National Occupational Mortality Surveillance (NOMS): https://www.cdc.gov/niosh/topics/NOMS/ National Vital Statistics System, Mortality Statistics: https://www.cdc.gov/nchs/nvss/deaths.htm
Estimated number of stakeholders capturing, accessing using or exchanging	Based on 2018 data, approximately 75% of adults age 18 and older worked in the past 12 months and 95% worked at some time in their lives. 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 in the U.S. would potentially benefit from the capture, access, use, and exchange of Usual Work information. Not including primary care providers, there are another 415,000 physicians who are also primarily involved in direct patient care. Many specialty providers would also benefit from Usual Work information: e.g., those who care for patients with chronic diseases caused by occupational exposures, such as pulmonologists, neurologists, nephrologists, oncologists. As of 2018 AHA reported 6,146 hospitals in the US experiencing 36,353,946 admissions. All hospitals and physicians who diagnose or treat cancer are required to provide cancer-related information to state cancer registries, including Usual Work. Every year there are approximately 2.8 million deaths in the United States. Deaths are certified by the attending physician or the Medical Examiner/Coroner in the Electronic Death Registration System (EDRS). Vital records death reporting from EDRSs to multiple public health agencies, including NAPHSIS, the National Center for Health Statistics (NCHS), and surveillance programs such as cancer includes Usual Work.
Link to use case project page	https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html
Healthcare Aims	Improving patient experience of care (quality and/or satisfaction) Improving the health of populations Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s)	An information model of the Patient Work 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; https://loinc.org/) codes are available for each Patient Work Data Element and each component of the data elements. Usual Work: Usual Occupation, Usual Industry, Usual Occupation Start Date, Usual Occupation Duration. The ODH code set (https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.114222.4.5.327) provides value sets for Occupation and (includes military occupations) Industry (includes military branches of service) (https://phinvads.cdc.gov/vads/SearchValueSets_search.action?searchOptions.searchText=ODH). The PHIN VADS Hot Topics section provides downloadable files of the ODH Occupation and Industry value sets that are designed to support search algorithms (https://phinvads.cdc.gov/vads/SearchVocab.action). Interoperability standard formats for all of the Patient Work 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 2C, Tables, Tables 0954-0959 provide the Patient Work Data Element component value sets. Chapter 3, Patient Administration, section 3.4.17 describes Usual Work as an Occupational Health (OH) segment. The value sets for Occupation and Industry expressed in current interoperability standards are the CDC_Census2010 category value sets (https://phinvads.cdc.gov/vads/SearchValueSets_search.action?searchOptions.searchText=2010). However, the new ODH Occupation and Industry value sets assist with self-selection of coded entries that provide detail to support patient care. These new value sets are extensions of federal classification systems for Occupation and Industry. Crosswalks from ODH codes to CDC_Census2010 codes are available in the PHIN VADS Hot Topics section (https://phinvads.cdc.gov/vads/SearchVocab.action). A non-breaking “translation” in CDA or “slice” in FHIR can be used to transmit either or both ODH or CDC_Census2010 values; HL7 interoperability implementation guides and IHE interoperability content profiles are being updated accordingly. https://doi.org/10.1093/jamia/ocaa070
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 Patient Work 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 Patient Work 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 Patient Work 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 Patient Work Data Elements is an option) HL7 CDA R2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1 – US Realm; HL7 Draft Standard for Trial Use. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=398. (ODH Usual Work template is required) HL7 CDA R2 Implementation Guide: Vital Records Death Reporting, Release 1, STU 2.1 – US Realm; HL7 Standard for Trial Use. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=386. (ODH Usual Work template is required for reporting from vital statistics agencies to the national statistical agency) HL7 CDA R2 Implementation Guide: Public Health Case Report – the Electronic Initial Case Report (eICR), Release 1.1 – US Realm; HL7 Standard for Trial Use and Release 1, STU Release 2.0. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=436. (ODH Job and Usual Work templates are options) HL7 FHIR® Release 4.0.1 Implementation Guide: Electronic Case Reporting (eCR) – US Realm. Version 1.0.0 (Standard for Trial Use). http://hl7.org/fhir/us/ecr/STU1/. ODH Job and Usual Work templates are options) 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. Patient Work segments 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.
Current Use	In limited use in production environments
Supporting Artifacts	Promoting Interoperability Programs Eligible Hospitals and Critical Access Hospitals are required to, and Merit-based Incentive Payment System (MIPS) participants may optionally, report on any two measures under the Public Health and Clinical Data Exchange objective of these programs. The § 170.315 (f)(4) – Transmission to Cancer Registries and the § 170.315(f)(5) – Transmission to public health agencies – electronic case reporting certification criteria in the 2015 Edition Final Rule and the ONC Cures Act Final Rule are two such measures to meet this option. The current standard for § 170.315 (f)(4), as listed in ONC’s 2020 Interoperability Standards Advisory Reference Edition, is HL7 CDA® R2 IG: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, R1, DSTU Release 1.1 - US Realm. ONC’s Certified Health IT Product List (CHPL) lists 288 EHR or HIT Module products certified to (f)(4) using this standard (https://chpl.healthit.gov/#/search). The standard requires that Usual Work is included using the ODH format with static binding to CDC_Census2010 Occupation and Industry vocabulary plus text. Crosswalks from ODH Occupation and Industry codes to CDC_Census2010 codes are available in the PHIN VADS Hot Topics section. A non-breaking “translation” in CDA can be used to transmit either or both ODH and CDC_Census2010 values; the implementation guide will be updated accordingly. Usual Work has been included in every cancer reporting Connectathon and Interoperability Showcase/Demonstration to date. Related Reference: Cancer Reporting: http://datadictionary.naaccr.org/default.aspx?c=8&Version=21 The current standard for § 170.315(f)(5), as listed in ONC’s 2020 Interoperability Standards Advisory Reference Edition, is HL7® CDA® R2 Implementation Guide: Public Health Case Report, Release 2: the Electronic Initial Case Report (eICR), Release 1, STU Release 1.1. ONC’s CHPL lists 73 product/versions certified to (f)(5) using this standard. This implementation guide permits transmission of some job information in a loosely defined structure. Limited job information has been included in some electronic case reporting recently; over 5,400 facilities are now actively doing electronic case reporting for COVID-19. Because the job information is in text-form, it places an added burden on public health to translate the data into standardized codes for analyses. However, the next CDA and FHIR versions of the eICR implementation guide include the ODH templates for Job and Usual Work. The FHIR implementation guide has been Connectathon-tested. Related References: eCase Reporting: https://ecr.aimsplatform.org/about-us#:~:text=A%20US%20federal%20agency%20under,the%20United%20States%20and%20internationally 2020-09 Public Health Track, HL7 FHIR Connectathon: https://confluence.hl7.org/display/FHIR/2020-09+Public+Health+Track ODH interoperability templates for Patient Work 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, Patient Work was exchanged using the QEDm (FHIR) and CCD (CDA) formats. Related References: “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 eCaseReporting Use Case NACCHO_2020.pdf Immunization Scenario NACCHO_2020.pdf Opioid Abuse and Prevention NACCHO_2020.pdf
Number of organizations/individuals with which this data element has been electronically exchanged	5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts	The Certified Health IT Product List (CHPL) lists 288 product/versions that have attested to transmission to cancer registries using a standard that requires the ODH Usual Work template but with static binding to CDC_Census2010 Occupation and Industry vocabulary plus text (https://chpl.healthit.gov/#/search). Crosswalks from ODH Occupation and Industry codes to CDC_Census2010 codes are available in the PHIN VADS Hot Topics section. A non-breaking “translation” in CDA can be used to transmit either or both ODH and CDC_Census2010 values; the implementation guide will be updated accordingly. Usual Work has been included in every cancer reporting Connectathon and Interoperability Showcase/Demonstration to date (2010-2020) (https://connectathon-results.ihe.net/view_result.php?rows=company&columns=actor&title=integration_profile; search by integration profile, e.g., Physician Reporting to Cancer). The CHPL lists 73 product/versions that have attested to electronic case reporting. The currently used implementation guide (R1.1) permits transmission of some job information in a loosely defined structure. Limited job information has been included in some electronic case reporting recently; over 5,400 facilities are now actively doing electronic case reporting for COVID-19. Because the job information is in text-form, it places an added burden on public health to translate the data into standardized codes for analyses. However, the next CDA and FHIR versions of the eICR implementation guide include the ODH templates for Job and Usual Work. The FHIR eICR implementation guide with the ODH Job and Usual Work templates was tested at the HL7 FHIR Connectathon Sept. 2020 (https://confluence.hl7.org/display/FHIR/2020-09+Public+Health+Track). ODH interoperability templates for Patient Work 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 (e.g., https://product-registry.ihe.net/PR/pr/search.seam?integrationProfileOption=424&integrationProfile=372&domain=9&date=ANY|1601300810685|1601300810685). 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. Two electronic death registration systems (EDRSs) transmitted Usual Work in the ODH template to the national vital statistics system at the HL7 FHIR Connectathon, Sept. 2020 (https://confluence.hl7.org/display/FHIR/2020-09+Public+Health+Track). https://www.cdc.gov/niosh/topics/ehr/default.html
Potential Challenges
Restrictions on Standardization (e.g. proprietary code)	The value sets for Occupation and Industry expressed in current interoperability standards are the CDC_Census2010 category value sets. However, the new ODH Occupation and Industry value sets assist with self-selection of coded entries that provide detail to support patient care. Crosswalks from ODH to CDC_Census2010 codes are available in the PHIN VADS Hot Topics section. A non-breaking “translation” in CDA or “slice” in FHIR can be used to transmit either or both ODH or CDC_Census2010 values; HL7 interoperability implementation guides and IHE interoperability content profiles are being updated accordingly.
Restrictions on Use (e.g. licensing, user fees)	None
Privacy and Security Concerns	The Data Elements in the Patient Work 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 Patient Work Data Elements (Job, Usual Work, Employment Status and 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 Patient Work. 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 Patient Work collection prototype, initial entry of all Patient Work 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	The ODH value sets for Occupation and Industry are large, in order to provide recognizable terms. However, keyword text searches can be used to facilitate selection and NIOSH is preparing A Guide to Collection of Occupational Data for Health (ODH; aka Patient Work).