Incorporating industry and occupation into electronic health records (EHRs): An update from the NIOSH EHR workgroup

The Department of Health and Human Services has made the implementation and use of health information technology a major goal, including the conversion from paper to electronic health records (EHRs) and the enhanced electronic exchange of health information. This provides many opportunities for promoting improved recognition, treatment and monitoring of the interface between work and health. In 2011, NIOSH requested the Institute of Medicine (IOM) to examine the rationale and feasibility of incorporating occupational information in EHRs. The IOM's Letter Report concluded that incorporating occupational information in the EHR could improve both individual and population health and made 10 recommendations regarding feasibility studies, demonstration projects, and other next steps. Since 2011, NIOSH has initiated a number of EHR-related projects including: 1) developing interface requirements that would allow patients to enter their own occupational information into an EHR, 2) conducting pilot studies that demonstrated the ability of central registration clerks to collect useful occupational information, 3) developing national and international consensus standards to incorporate data structure and operations for capturing, maintaining, and using occupational information in information and functional models and profiles including through Health Level 7 and the Public Health Data Standards Consortium, 4) exploring the privacy, security and other ethical concerns through a stakeholder workshop in June 2013, and 5) a software development initiative to evaluate approaches to the automatic coding of industry and occupation text in a real time environment for EHR systems. Major accomplishments from these activities and important next steps will be summarized.