Occupational Data for Health: A Win for Providers, Patients, and Population Health | | |
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FROM THE NACHC LENS
Work as a Social Driver of Health
Health starts where we live, work, learn, and play, with most adults spending a third of their lives working. Where and how we do our work can significantly impact and influence our health and lifestyles. “As an occupational health doctor, I see every day how important work is to your health,” says Michele Kowalski, MD, an Occupational and Environmental Medicine physician at the University of California, San Diego and Department of Wellness Director for UCSD Community Care.
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Work is one of the most impactful social drivers of health. It generates income and keeps us physically and mentally active. It can provide access to insurance and a social network. “However, there can be hazards at work and those need to be considered in the total care of the patient, including both psychological and physical stress. These stressors may include environmental exposures, repetitive physical demands, injury, and mental health concerns,” adds Dr. Kowalski.
Supporting Quality Care with Occupational Data for Health
Capturing, exchanging, and using standardized work information in electronic health records (EHRs) is a critical step for patient care, population care, and public health. Occupational Data for Health (ODH) is a framework for collecting and using interoperable data in EHRs and other health IT systems. It is a set of valuable information related to a patient’s occupation that can include employment status, job(s), usual (longest-held) work, voluntary work, retirement dates, unemployment, and even periods of working in a combat zone.
The ODH framework was developed by CDC’s National Institute for Occupational Safety and Health (NIOSH) and is now considered a best practice. This past January the HHS’ Office of the National Coordinator for Health Information Technology (ONC) established a final rule that implements the Electronic Health Record (EHR) Reporting Program provision of the 21st Century Cures Act by establishing new Conditions and Maintenance of Certification requirements for health information technology developers under the ONC Health IT Certification Program (Program). By January 1, 2026, all EHR systems used by health centers will be required to capture two new occupational health data points: occupation and occupational history.
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“A collection of occupational data allows us to objectively assess occupational categories and health outcomes. This helps clinicians understand the risk exposures and wellbeing of their patients,” says Katherine Chung-Bridges, MD, MPH, Chief Community Research Officer, Health Choice Network. As a health center-controlled network, Health Choice Network has been partnering with health centers and NACHC to learn integration strategies for the collection and use of ODH in their EHR. This work helped them identify a trend of respiratory risks and illness among dairy farm workers in New Mexico. “Collecting ODH also helps a patient connect the dots. They get a better sense of how their occupation and their job environment impacts their health. It can empower them to work toward improving work conditions that might not be ideal.”
Capturing occupational data in the health center’s EHR is not only being used to address work-related risks, but also to create personalized care plans and to enable health centers to look more holistically across their patient population for health trends and issues among patient groups (population health). Gathering ODH:
- Enables care teams to offer better patient-centered care, interventions, and services
- Provides insight into an individual’s social needs and financial security
- Identifies exposure to pollutants, toxins, injury, trauma, or disease
- Determines if patients have access to employer-sponsored health insurance or are unemployed
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Leverage Knowledge of a Patient’s Occupation to Achieve Better
Health Outcomes
- Consider heat exposure for patients who work outdoors, such as agricultural or construction workers, or for patients who are exposed to heat because they are experiencing homelessness and are not living in shelters
- Evaluate medications for truck drivers
- Consider work accommodations for patients with chronic illnesses such as long COVID or diabetes
- Evaluate trends in over-use injuries, musculoskeletal injuries, injuries related to slips, falls, burns, cuts, respiratory distress, and toxic exposures
- Assess the need for mental health care when a patient indicates job stress
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Considerations for Integrating ODH in EHRs
1. Determine what occupational data aside from employment status can be collected in the EHR
- Work with the health center’s informatics or QI team, and your registration staff, to learn what data fields are available or can be created such as a field for occupational roles.
- Then work with the EHR vendor to determine what customizations can be provided to collect work-related data using standards defined in ODH.
2. Determine if and how this new data collection is going to impact operations and workflow
- How can you efficiently capture the data without burdening the care team, front desk, or registration team who already work with time constraints (e.g. patients entering their work-related information themselves)?
3. Educate and empower
- Aside from educating care team members on how to use the EHR to collect and use ODH, everyone involved in data collection including front desk and informatics teams, should learn the value of occupational health data, how and where it can be easily collected, and how it can play a vital role in primary care and population health care.
- Care team members can be trained in trauma-informed and culturally competent communication, with explanations on confidentiality and why this data is collected.
4. Educate patients
- Many patients have privacy concerns and are often reluctant to disclose information about their employment.
- Patients need to understand that this data is part of their health history and that their data is privacy protected. This may be a particular concern to immigrants and migrant workers.
“It is helpful if EHR companies make sure that occupation and industry data are collected at a level of detail that is meaningful and easy for staff, taking the least amount of time. These companies should be thoughtful as to where the information lives in the EHR so clinicians and staff can access and act on it. And health centers should be prepared to collect ODH as it will soon become a required SDOH data element for patient care,” Katherine Chung-Bridges, MD, MPH, Chief Community Research Officer, Health Choice Network.
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Equanimity is defined as mental calmness, composure, and evenness of temper, especially in a difficult situation.
As a health care provider, when you practice mindfulness and find your inner calmness and composure, you can allow yourself to be skillful as well as empathetic and compassionate in the face of challenges. Here are two simple mindful exercises to help you tap into your strength and find calm and clarity in the midst of high pressure and stress.
Use the doorknob practice to pause throughout the day to enable you to intentionally engage in micro-moments of checking in with yourself. Each time you put your hand on a doorknob to enter a room for the next experience with a patient or staff member, try the S.T.O.P. practice:
S – Stop what you’re doing.
T – Take a few breaths.
O – Observe and check in with what’s going on around you.
P – Pick how to proceed. Ask yourself, “What’s the most skillful thing to be doing next?”
Take time to shift out of “work mode” and release lingering stress. Create a small transition ritual that gives you permission to disconnect from work when you get home such as having a short internal dialogue with yourself or taking a few moments to feel your feet when you reach your front door.
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