Occupation Health Data Encoding Brief Profile Proposal for 2012/13 presented to the Patient Care Coordination (PCC) Planning Committee Lisa R. Nelson October, 2012

Patient Care Coordination (PCC) Planning Committee The Problem The CDA templates for exchanging occupational data for health (ODH) are inadequate and inconsistent across existing document standards – –negative impact on information exchange and interoperability – –The IHE CDA templates that include ODH represent only occupation and industry and in an inconsistent manner – –Templates do not maintain occupation and the associated industry together when multiple entries are enabled, and don’t specify inclusion of other needed info about Employer and work location Standard encoding of patient’s occupations offers care benefits: – –Consistently representing ODH in interoperability standards will facilitate structuring of ODH in EHRs and enable clinicians and patients to use/re-use ODH in their healthcare communications – –links to clinical decision–support tools that could improve the health care and safety of individuals. – –Advances for public health surveillance in order to provide a better understanding of occupational illness and injury.

Patient Care Coordination (PCC) Planning Committee Use Case Patient worked for 20 years as a Plant Operating Technician at the lead battery manufacturing plant. Since retirement 2 years ago, the patient has been working part- time as a cook in the family restaurant and also working as a Certified Nursing Assistant at the local long-term care nursing facility. – –This occupation and industry information data structures need to support representation of scenarios like this unambiguously and consistently across the health information ecosystem of documents. – –Data structures also need to evolve to include encoding standards for information such as employer and other data such as exposures that may represent risk assessments.

Patient Care Coordination (PCC) Planning Committee Proposed Standards & Systems IHE Content Profile NameDomainCurrent occupation and industry template(s) used APHP LDHP MDS NDS PPVS PRPH-Ca PCC QRPH Documents that use the CodedSocialHistory section which include machine readable entries that use the IHE SocialHistoryObservation entry PRPH-CaQRPHDefines additional constraints on the PCC SocialHistoryOberservation template These further constraints are cited in an un-templated way to represent occupation information using US BLS Standard Occupation Codes, and to represent industry using US Census NAICS codes. XDSMS Referral PCCDocuments that use the uncoded SocialHistory section, recommended for inclusion in the scope of this work Define new templates representing new versions or alternative templates for:

Patient Care Coordination (PCC) Planning Committee Discussion Level of development effort: Moderate to Minor – –Modeling review and assessment of usage/versioning issues in PCC – –Close coordination and information sharing expected with QRPH domain Profile editor: Lisa Nelson Organizational support – –Public Health Data Standards Consortium – –NIOSH Profile development within PCC essential for success – –Affects CDA template repository and template usage – –Achieve greater consistency across all CDA documents