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LHSFNA: Include Career Information in EHRs

“Our Fund has always recognized the potential for electronic health records (EHRs) to improve health care and save money,” says LIUNA General Secretary Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni. “Now, we’re asking the government to include industry and occupation records in EHRs.”

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LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni

Today, few workers have the same employer throughout their careers. And any change in employer usually means changing health plans and doctors as well. New doctors, then, need to reconstruct each new patient’s health record. In addition to wasted time and expense, reconstructing health records can lead to significant mistakes and omissions. Does the doctor ask all the right questions? Is the patient forthcoming with all the relevant information? Is an adequate record of a patient’s personal, health-related conditions established every time? Are specific, past medical test data available? Could important, strategic information be lost in the shuffle?

Since adoption of the Health Insurance Portability and Accountability Act (HIPAA) in 1996, the health care industry has moved steadily toward electronic recordkeeping, and electronic records are now the norm in most provider offices. However, when it passed the Patient Protection and Affordable Care Act (PPACA) in 2010, Congress directed HHS to standardize the information to be collected and included in EHRs. In turn, HHS requested comments from interested stakeholders.

The LHSFNA and a variety of other advocacy groups submitted comments last month asking the Office of the National Coordinator for Health Information Technology at HHS to include occupation and industry information in the EHR. Such information would establish a general (not employer-specific), career-long record of the kind of work each American performs.

From the time we leave high school until we go on Social Security, most of us spend roughly a third of our lives at work, subjected to whatever health risk exposures our occupation and industry present. Presuming that our doctors understand something of the nature of workplace exposures, inclusion of occupation and industry information will help them diagnose health problems that, otherwise, might not be so evident. Consider, for instance, a 49-year-old union business manager who has never smoked but whose breathing, for no apparent reason, has recently become difficult and erratic. What is going on? If the manager’s occupation and industry information shows that his first job, more than 30 years ago, was sandblasting for a building contractor, a doctor might immediately suspect silicosis, speeding treatment while saving time and money from wasted tests of other hypotheses.

While supporting more effective treatment of individual patients, collection of industry and occupation records can also assist the development of more targeted, cost-effective programs to protect workers in various industries. By routine correlating of industry and occupation records with illness and injury rates at the national, state and local levels, researchers can identify specific workplace safety and health concerns and recommend plans to address them. This has been the goal, for instance, of the Association of Occupational and Environmental Clinics (AOEC) since its inception in 1987. Yet, such efforts are always hampered by a lack of data. As noted in the LHSFNA’s comments, with over 11,000 workers suffering an injury or illness every day at work, considerable savings are possible if hazards can be identified and addressed beforehand. For example, anecdotally, it is well-known that hearing loss is a serious problem in construction, but quantitative data to document the problem is lacking. If a national database showed a strong correlation between hearing loss and length of employment in construction, workers, employers and regulators would have justification in adopting more careful efforts to prevent hazardous noise exposures.

With treatment benefits for patients and a foundational database to assist social and government planners, why would anyone oppose inclusion of occupation and industry information in EHRs? The chief objection is the cost of additional provider time to interview patients and enter the information in the patient’s record (once entered, the generation of “big picture” assessments from the database would be inexpensive). Yet, while health care providers are undoubtedly busy and pressed for time with each patient, the inclusion of check-off boxes for occupation and industry should make the process easy and efficient.

It may also be argued that it is impossible for doctors to know and understand the potential negative impacts on any worker’s health of all occupations and industries. Indeed, given the present organization of health care and the way doctors are trained, this shortcoming will take time to overcome. Yet, ways can be found to gradually raise the occupational health consciousness of the medical profession. For instance, the LHSFNA has long published a brochure – What Physicians Need to Know about Silicosis in Construction, Demolition and Renovation – for this specific purpose. No doubt, other industries and health advocates would devise creative programs to conduct this education.

“While every effort should be made to ease the EHR reporting requirements of health care providers,” says Sabitoni, “the forest should not be lost for the trees. Our nation’s goal is more economical and effective treatment of illness and injury. As the medical profession makes the difficult transition to universal EHR recordation, it should take the small extra step of including occupational and industry information as well. In the long run, patients and the country as whole will benefit.”

[Steve Clark]

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