Data Element
Employment Status
Description

This data element includes a coded concept, Employment Status, with time and date stamp and/or start date and end date. A person can be both employed and retired, and can have a different employment status for each job. Employment Status is a person's self-reported, coded relationship to working for pay, family earnings, or training (e.g. having one or more jobs, searching for work, etc.). A person’s Employment Status is independent of Job characteristics, e.g., not “full-time work” or “part-time work,” because many people have more than one job.
Submitted By: Genevieve Luensman / Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health
Data Element Information
Use Case Description(s)
Use Case Description Employment Status is a social determinant of health that can be indicative of job security and access to work benefits. It can be used to examine populations within a healthcare organization, for example to identify individuals who would benefit from community referrals or to identify and address related health disparities and mental health. For persons who are unemployed, this Employment Status component provides information regarding their efforts to participate in the labor force in a way that’s consistent with Bureau of Labor Statistics data. The Gravity Project plans to address employment (scheduled for late 2020; https://www.hl7.org/gravity/).

Employment Status 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 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 Patient Work 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 Patient Work 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
Use Case Description Combat Zone Period: Both those who have served in the military and civilian workers can have experienced working in a combat zone. Combat zones present unique health hazards, many of which can have long-term consequences. Retrospective studies have shown correlations between combat zone deployments and health concerns such as respiratory conditions, certain types of cancer, post-traumatic stress disorder, sleep disorders, and others.

Many people who have served in the military seek care first outside of the Veterans Health Administration system, but may neglect or be reluctant to mention their military service unless asked. This situation can lead to misdiagnoses and poor health outcomes. The American Academy of Nursing “Have You Ever Served?” initiative includes a question about deployment in a combat zone in recognition of the special health risks that can be raised. Examples from the American Academy of Nursing, “Have You Ever Served?” initiative (https://www.aannet.org/initiatives):
https://jamanetwork.com/channels/health-forum/fullarticle/2760455
https://www.chamberlain.edu/blog/nurses-must-ask-patients-ever-served-military
https://www.dhhs.nh.gov/veterans/documents/atq-part-3.pdf

Collecting self-reported dates of working in a combat zone can facilitate important conversations about possible related health concerns, potentially prompting referral to the Department of Veterans’ Affairs (VA) healthcare system. The HL7 Military Service History and Status reporting project, sponsored by the VHA, is extending this FHIR specification as part of a FHIR implementation guide to share service member data (https://confluence.hl7.org/display/CGP/Military+Service+History+and+Status+FHIR+Profiles+Project+Page).

The option to collect Combat Zone Period is expected to be made available to adults at or prior to registration. Subsequently, the opportunity to review and update is to be presented as appropriate. 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 Combat Zone Period 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.

The Combat Zone Period template is included as part of the ODH set of templates for Patient Work that is 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 Patient Work The Combat Zone Period template is similarly included as part of the ODH set of templates for Patient Work that is an option 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 Combat Zone Period can improve the quality of care by providing a more complete picture of factors that may affect the patient’s health and supporting referrals. The data entry burden can be reduced by sharing the information across care providers using one of these standards and by using the XPHR profile to share information from a personal health record to a care provider.
Estimate the breadth of applicability of the use case(s) for this data element According to the 2019 American Community Survey (https://data.census.gov/cedsci/table?q=S2101&tid=ACSST1Y2019.S2101) there are 17.4 million veterans living in the U.S. and it has been documented that many veterans seek care outside of the VHA. This information suggests that most of the 209,000 primary care providers 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 Combat Zone Period data.
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
  • 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, including Employment Status.

The ODH code set (https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.114222.4.5.327) provides a value set for Employment Status as well as other Patient Work Data Elements (https://phinvads.cdc.gov/vads/SearchValueSets_search.action?searchOptions.searchText=ODH). The PHIN VADS ODH Hot Topics section provides downloadable files with Preferred Concept Names and Easy Read Descriptions for Employment Status values (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, sections 3.4.15 and 3.4.18 describe the Patient Work Data Elements Employment Status and Combat Zone Period as Occupational Health (OH) segments; Retirement Date is included in the PD-1 segment.

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 Version 2.9 Messaging Standard – An Application Protocol for Electronic Data Exchange in Healthcare Environments, Normative. 2019 Dec. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=516. Patient Work 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.
Current Use In limited use in test environments only
Supporting Artifacts 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 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
Extent of exchange 4
Supporting Artifacts 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. 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
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 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 None

Comment

Submitted by nedragarrett_CDC on

CDC's Comment for draft USCDI v6

Employment Status is a social determinant of health that can be indicative of job security and access to work benefits. This data element captures whether a person is: employed, not in the labor force, or unemployed.
The CDC collaborated with the National Association of Community Health Centers (NACHC) to support collection of Employment Status data among patients seen by three large Health Center Controlled Networks (HCCNs). Two of the HCCNs used the Epic Electronic Health Record (EHR), and one used the athenahealth EHR. Among 34,777 unique patients seen in affiliated community health centers, Employment Status was recorded for 26,221 (75.4%). Notably, there was a 10% increase in collection of this variable across the three-year project period, an indicator of increasing buy-in among implementing partners.
Comments proposing Employment Status be moved to Level 2:
• Employment status has been shown to provide insight into factors that contribute to variations in workers' health status, be an important social determinant of health, impact mental health, and provide a measure of job security. (Journal of the American Medical Informatics Association, Volume 27, Issue 7, July 2020, Pages 1072–1083,https://doi.org/10.1093/jamia/ocaa070)
• Employment status is associated with access to healthcare; more than half of U.S. adults have healthcare through an employer or a union. (Keisler‐Starkey K, Bunch LN. Health Insurance Coverage in the United States: 2019. US Census Bureau; 2020. Health Insurance Coverage in the United States: 2019 (census.gov).
• Unemployment is associated with physical and mental health problems that worsen as the duration of unemployment increases (Silver SR, Li J, Quay B. Visual representation of work as a social determinant of health: Augmenting Silver et al., Employment status, unemployment duration, and health-related metrics among US adults of prime working age. Am J Ind Med. 2022 Aug;65(8):697-698. https://doi.org/10.1002/ajim.23398).
• Since employment status is the “screening” question for Industry (type of business) and Occupation (type of job), collection of employment status provides more efficient and accurate Industry and Occupation data. It would reduce the burden on collection of Industry and Occupation data, as those who have never worked would not need to be asked about their Industry and Occupation. 
• Formally collecting employment status and coding this information in the EHR is gaining attention as an important data set for healthcare. (Weiss, E., Uy, R. Work: An Important Social Driver of Health – NACHC. https://www.nachc.org/work-an-important-social-driver-of-health/).
Data element is represented by the Occupational Data for Health Employment Status value set which is aligned with SNOMED CT concepts. 
An example of a vocabulary/terminology standard to represent a Laboratory Test is LOINC
®. Examples of a structural standard representing laboratory test/report are FHIR US Core Diagnostic Report and C-CDA R2.1 Result Organizer entry template.

Occupational Data for Health Value Sets: 
• Employment Status Question (LOINC code 74165-2)
• PHVS_EmploymentStatus_ODH (urn:oid: 2.16.840.1.114222.4.11.7129)
• HL7 ValueSet: employmentStatusODH (urn:oid: 2.16.840.1.113883.1.11.20562)
• HL7 FHIR Profile: Occupational Data for Health (ODH), Release 1, STU 1.3 (Standard for Trial Use)
• HL7.FHIR.US.ODH\Artifacts Summary - FHIR v4.0.1
The collection of Employment Status is common practice within the healthcare workflow. Anticipated burden stems from the integration of a standardized value set to allow interoperable exchange. The Employment Status value set is very small and is anticipated to be an easy lift to integrate within existing health IT systems.
 

Submitted by nedragarrett_CDC on

CDC comments on Employment Status

CDCs requests the inclusion of Employment Status in USCDIv6.  

Justification: Employment Status is a social determinant of health that can be indicative of job security and access to work benefits. This data element captures whether a person is: employed, not in the labor force, or unemployed. 

The National Institute for Occupational Safety and Health (NIOSH) collaborated with the National Association of Community Health Centers (NACHC) to support collection of Employment Status data among patients seen by three large Health Center Controlled Networks (HCCNs). Two of the HCCNs used an Epic EHR, and one used athenahealth. Among 34,777 unique patients seen in affiliated community health centers, Employment Status was recorded for 26,221 (75.4%). Notably, there was a 10% increase in collection of this variable across the three-year project period, an indicator of increasing buy-in among implementing partners. 

NIOSH EHR webpage: How Work Information and Electronic Health Records Works | EHRs | CDC 

Employment Status is an artifact in the HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm 

2.1.1 - STU 2.1.1: 10.0.9 ODH Employment Status Example: observation-odh-employment-status-ecr-eve-everywoman 

Employment Status is a social determinant of health that can be indicative of job security and access to work benefits. It can be used to examine populations within a healthcare organization, for example to identify individuals who would benefit from community referrals or to identify and address related health disparities and mental health. For persons who are unemployed, this Employment Status component provides information regarding their efforts to participate in the labor force in a way that’s consistent with Bureau of Labor Statistics data. The Gravity Project addresses employment in their Employment Status domain; https://www.hl7.org/gravity   

Employment status has been shown to provide insight into factors that contribute to health disparities, be an important social determinant of health, impact mental health, and provide a measure of job security. (Journal of the American Medical Informatics Association, Volume 27, Issue 7, July 2020, Pages 1072–1083,https://doi.org/10.1093/jamia/ocaa070) 

Employment status is associated with access to healthcare— more than half of U.S. adults have healthcare through an employer or a union. (Keisler‐Starkey K, Bunch LN. Health Insurance Coverage in the United States: 2019. US Census Bureau; 2020. Health Insurance Coverage in the United States: 2019 (census.gov). 

Unemployment is associated with physical and mental health problems that worsen as the duration of unemployment increases (Silver SR, Li J, Quay B. Visual representation of work as a social determinant of health: Augmenting Silver et al., Employment status, unemployment duration, and health-related metrics among US adults of prime working age. Am J Ind Med. 2022 Aug;65(8):697-698. https://doi.org/10.1002/ajim.23398). 

Employment status is the “screening” question for Industry and Occupation – collection of employment status provides more efficient and accurate Industry and Occupation data. It would reduce the burden on collection of Industry and Occupation data, as those who have never worked would not need to be asked about their Industry and Occupation.  

Formally collecting employment status—and coding this information in the EHR is gaining attention as an important data set for health care. (Weiss, E., Uy, R.Work: An Important Social Driver of Health – NACHC. https://www.nachc.org/work-an-important-social-driver-of-health/). 

The Bureau of Labor Statistics reported as of August 2024, 62.7% of persons aged 16 and older were participating in the labor force, whereas the unemployment rate measured 4.2% or 7.1 million. Since work and health are interrelated, most of the 989,320 physicians and many of the 258,230 licensed nurse practitioners and the 236,516 psychologists in the U.S. would potentially benefit from the capture, access, use, and exchange of Employment Status. Knowing about a patient's work could help clinicians recognize the relationship between work and health.  

Having standardized employment status data available at the population level will support public health research and policy. Employment status is a social determinant of health and a health equity indicator, particularly because healthcare access and other health-related needs vary greatly by employment status. Stable employment helps provide workers with the ability to live in healthier neighborhoods, secure quality education and childcare services for their children, and buy nutritious food (rwjf.org).  

https://www.bls.gov/news.release/pdf/empsit.pdf. 

https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/state-of-the-health-workforce-report-2023.pdf 

Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, et al. Social determinants of risk and outcomes for cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2015;132(9):873–98. doi:10.1161/CIR.0000000000000228 

Occupational Data for Health Value Sets:  

Employment Status is a codeable concept with a 0..1 cardinality. The binding is required to the HL7 value set: employmentStatusODH 

Examples of use within EHRs or other Health IT: Findings from the NIOSH/NACHC collaborative resulted in 2 Health Center Controlled Networks (HCCN)s using the Epic EHR; 1 HCCN using the athenahealth EHR to collect Employment Status data. 

Use of proprietary code does not prohibit its inclusion in USCDI, but a higher barrier to adoption such as this would require a more substantial justification of the use case and value to nationwide interoperable exchange.  The value sets are not proprietary. Another example of challenges related to standardization is a lack of clear consensus about how to represent or exchange this data element, or where there are different and/or conflicting uses by different stakeholders. Currently there are duplicate value sets for Employment Status. These duplications will be corrected in 2024 ODH vocabulary update. 

Licensing or user fees may impact either inclusion in Level 2 or addition to next version, especially if fees are significant relative to the impact on nationwide interoperable exchange.  An example is payment of licensing fees to use a standard. 

There are no licensing or user fees. Privacy and/or security concerns must be addressed here.  These concerns may invoke existing privacy and security regulations or restrictions such as HIPAA or 42 CFR Part 2.  If a new data class/element is not specifically covered by these, this must be stated clearly, not assumed to be not applicable. 

No privacy concerns. 

How hard has it been, or would it be to access and exchange the data element? 

The collection of Employment Status is common practice within the healthcare workflow. Anticipated burden stems from the integration of a standardized value set to allow interoperable exchange. The Employment Status value set is very small and is anticipated to be an easy lift to integrate within existing health IT systems. 

Is the data element only available in a system external to an EHR, such as a lab reporting system?   

No, it is widely available and freely accessible. 

Does the data element value need to be calculated by the patient or provider, or can it be automatically retrieved or calculated by the system in a production environment? 

At current, the data element needs to be selected by the registration, patient or provider. 

Does accessing or collecting the data element require significant time on the part of patient or provider, or does it require an interruption in normal workflow to collect? 

No. 

Does support for the data element require significant developer time to implement in EHR systems? 

The value sets are available for immediate use.  

Answers to these questions may be unknown to the submitter and additional information would be needed from industry or may be discovered as part of the ONC consideration process. 

The only barrier foreseen is replacing the exiting Employment Status value sets, or free text box with a standardized value set based collection capacity. 

USCDI-ONDEC-Submission-Form-Prep-Sheet - Employment Status USCDI v6.docx

Submitted by nedragarrett_CDC on

CDC's Comment for draft USCDI v5

CDC supports the inclusion of Employment Status in USCDI V5. This data element provides mutually exclusive possible answers, moving away from an approach where users are forced to select only one from choices that are not mutually exclusive. It can be coupled with other ODH data elements (e.g., Retirement Date), to collect complete information.  

Employment status as part of a social history has 3 possible terms in its value set. ODH currently codes these values using its own codes but will change to using the Systematized Nomenclature of Medicine -Clinical Terms (SNOMED CT) codes for the same terms, in alignment with the Gravity Project. Epic has implemented the same approach in its Social History section. 
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. 

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment

  • CDC requests that Employment Status (Level 1) be reconsidered for inclusion in USCDI V3. It is well supported by the ODH informatics products and is represented in multiple interoperability standards. Collecting Employment Status of a person can reduce the burden of data collection- people who are not employed would not be asked to provide job information. Knowing a person’s Employment Status can also help to explain missing job data, which helps public health data analyses. In addition, it can assist clinicians to know more about their patient without taking time during the visit to ask about it and might help overcome patients’ reluctance to say that they are not working.
  • The Employment Status (Level 1) data element is distinct from the Employment (Comment level, SDOH data class) data element in ONDEC. Employment Status (Level 1) is a single status per person (mutually-exclusive values). Employment (Comment level, SDOH data class) is based on the “type and conditions of employment,” i.e., a 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.
  • As noted by the Gravity project and CDC/NIOSH, Employment Status is a SDOH. Unlike the Employment data element in the SDOH data class (Comment level), the ODH value set for Employment Status (Level 1) provides an option to identify people who are not in the labor force vs unemployed, which can be an important distinction regarding a person’s health and benefits (Silver SR, Li J, Quay B. Employment status, unemployment duration, and health‐related metrics among US adults of prime working age: Behavioral Risk Factor Surveillance System, 2018–2019.Am J Ind Med. 2022;65:59‐71. https://onlinelibrary.wiley.com/doi/full/10.1002/ajim.23308).

 

 

IN THE FIRST USE CASE DESCRIPTION, AFTER THE FIRST PARAGRAPH (ENDING WITH “…HTTPS://WWW.HL7.ORG/GRAVITY/) AND BEFORE THE SECOND PARAGRAPH (BEGINNING WITH “EMPLOYMENT STATUS IS EXPECTED…”) ADD THE FOLLOWING LANGUAGE:

 

  • "The ODH value set for Employment Status provides an option to identify people who are not in the labor force vs unemployed, which can be an important distinction regarding a person’s health and benefits (Silver SR, Li J, Quay B. Employment status, unemployment duration, and health‐related metrics among US adults of prime working age: Behavioral Risk Factor Surveillance System, 2018–2019.Am J Ind Med. 2022;65:59‐71. https://onlinelibrary.wiley.com/doi/full/10.1002/ajim.23308). It also provides mutually-exclusive entries for a person, which is not the same as for a job (e.g., a person who is both retired and working in a part-time job is employed)."

 

REPLACE THE ADDITIONAL SPECIFICATIONS FIELD (ENTIRE SECTION) WITH:

  • 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 Employment Status (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/ecr/ (Modular template for non-breaking insertion of Employment Status (and/or other ODH profiles) for any FHIR IG social history section)
  • 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
  • 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 Employment Status (and/or other ODH sections) for any CDA profile social history section)
  • 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/
  • HL7 EHRS-FM R2: Functional Profile; Work and Health, R1 – US Realm. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=498

Submitted by nedragarrett_CDC on

Unified Comment from CDC

CSTE supports inclusion of this measure into USCDI v3: Very supportive of including work information in USCDI – important for assessing increased risk of conditions related to I/O

  • Specific job title and workplace address are also critical for outbreak investigation

Submitted by nedragarrett_CDC on

Unified Comment from CDC

  • In the preamble to the 2015 Rule, ONC expressed support for collection of employment status of “unemployed” could lead to referral for services. The Occupational Data for Health (ODH) value set for Employment Status distinguishes between unemployed (seeking employment) and not in labor force (not seeking employment). 
     
  • Potential champions from more than 13 healthcare organizations have expressed interest in piloting collection and use of ODH, which include employment status, if it were available in their EHR. The complexity of implementing and maintaining ODH as a unique build within their EHR has been the roadblock.  

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