Accomplishments, Challenges and Next Steps

Marie Haring Sweeney, PhD, MPHNational Institute for Occupational Safety and Health

Counting Work-related Injuries& Illnesses: Closing the Gaps II Washington, DCApril 17-18, 2013

Review briefly NIOSH progress since 2009 meeting (see NIOSH Accomplishments)

Discuss challenges & next steps – prelude to

afternoon breakout groups

Audience participation welcome throughout the session

This Hour

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the National Institute for Occupational Safety and Health

Leverage existing databases and surveys

Enhance state occupational health surveillance

Communicate findings

Incorporate work into EHR data

Use WC data to supplement surveillance systems

NIOSH Surveillance Key Activities

Leverage existing databases and surveys◦ Recommendations 1,4 &6

Enhance state occupational health surveillance◦ Recommendation 2

Communicate findings◦ Recommendations 7,8 & 9

Incorporate work into EHR data◦ Recommendations 3

Use WC data to supplement surveillance systems◦ Recommendation 5

NIOSH Surveillance Key Activities

Recommendation 1: Include an annual nationwide survey of the labor force to identify occupational injuries and illnesses among interviewed workers as an essential component of a comprehensive national surveillance system

Nationwide Survey of labor force: Probably not in our lifetime

Building on existing national health & special population surveys

NHIS – Occupational Health Supplement & other work BRFSS – Work-related asthma via BRFSS asthma call-back

survey National Agricultural Workers Survey (NAWS)

Leverage existing data and databases

Recommendation 4: Routinely collect information about industry and occupation in all National Center for Health Statistics and National Institute of Health morbidity surveys and the BRFSS

NIOSH provided testimony to federal advisory committee about value of I/O in relation to SES. Recommendation to SECHHS Sebelius to include I/O in all federal health surveys

Improve I/O coverage: Add I/O to BRFSS & NIH surveys Improve I/O data quality: Created training material Improve coding: Developed & released NIOSH Industry &

Occupation Computerized Coding System (NIOCCS)

Leverage existing data and databases

NIOCCS: Codes industry & occupation text to Census Industry & Occupation

Recommendation 6: Expand use & utility of existing National health data bases

Collaborated on National Ambulatory Medical Care Survey of physicians on knowledge & behavior in recognition of WRA

Collaborate w/NHTSA – injuries among EMS workers (ED visits)

Collect occupational injury/illnesses info from ED data via NEISS-Work & conducting 3 surveys using NEISS-work data base

Would like to collect I/O from trauma registries – issues with data capture and quality

Leverage existing data and databases

Recommendation 2: Expand state-based surveillance using multiple data sources and use data from selected states and on selected conditions to provide periodic estimates of the undercount in the annual employer based – survey.

Increased OSH surveillance program to 23 states◦ Expanded OSH surveillance capacity at fundamental level

Fund topic specific surveillance efforts◦ Exposures: Pesticides, Lead◦ Outcomes: Asthma, Silicosis, Fatal Injuries, Chronic disease

mortality, Cancer

Expand state occupational health surveillance

NIOSH and State-based Occupational Health Surveillance Programs, 2013

NIOSH surveillance program locations

State-based programs

Recommendations 7,8,9 Market surveillance findings in creative formats and

venues Provide direct and timely access to available surveillance

data in user friendly formats Put NIOSH surveillance data in one place: NIOSH

Workplace Data and Statistics Gateway Showcase state surveillance activities: State-based

Occupational Health Surveillance Clearinghouse Produce and disseminate a comprehensive annual

surveillance report on work-related injuries and illnesses in the U.S.

Sector based reports using NHIS general health survey eChartbook

Communicate Findings

Electronic Health Records: Recommendation 3 Facilitate identification

of occupational diseases and injuries

Facilitate care and treatment of workers

Enhance prevention & intervention efforts

Enhance occupational health, injury & exposure surveillance

Recommendation 3: Work with those establishing standards for electronic health records and advocate with policy makers to insure that information about a patient’s work and indicators of work-relatedness of health conditions are collected as standardized variables in all electronic health records. Following directives of IOM report Establishing critical partnerships – ONC, PHDSC, PHRI, HL7

Commented on policy-related notices Developed Occupational Glossary for HL7 Worked with states for input on PHRI requests

Ethics and Privacy Workshop – June 2013 Projects: I/O collection (many); CDS for OHS conditions

Electronic Health Records

Recommendation 5: Use workers’ compensation data to supplement other surveillance systems.

2 public workshops Establishing partnerships w/key players Established virtual WC data center at NIOSH Developing primer on use of WC for OSH intervention More to come

Workers Compensation

Challenges and

Next Steps

No nationwide health survey of workforce◦ If use only existing data systems and surveys to assess

worker health, what do issues & populations we miss? ◦ If we have the opportunity to conduct a national

survey, what issues should be integral to the survey design?

Occupational chronic disease surveillance Piecemeal approach

Death certificates, cancer registries, survey data What data & issues are we missing?

Challenges

Occupational injury surveillance Piecemeal approach What data & issues are we missing? Value of WC data to fill the gaps? ICD-10 work, causes and activity codes in EHRs

Estimating burden of OII◦ Most appropriate illness, injury or health data?◦ Most appropriate economic models?

Challenges

Expand state-based health surveillance capacity

Expand use of state-based surveillance data to assess undercount◦ How can this be accomplished?

Making the case to include work in all health surveys & data collections◦ Illustrating that work impacts health◦ Wording of questions appropriate to the data collection situation◦ Data quality issues

Communication◦ One size does not fit all◦ Best approaches?◦ New technologies?

Challenges

Challenges Electronic Health

Records◦ Many layers of the onion to

peel◦ I/O only a small part of the

EHR record must justify need and

meaningful use of I/O to prevention and treatment outcome

Short time frame to put required actions into play

;:

Everything will be electronic! Everything will be linked & interconnected! Are we ready?

Big Challenge

Find new data sources to explore worker health & exposure issues – government data, private enterprise data

Promote inclusion of I/O in all federal health surveys & EHRs

Improve I/O data quality ◦ Training & outreach ◦ Application of new technologies

Continue refining NIOCCS – enhancing capacity to code more types of data, e.g. WC

Next Steps

Create new ways to collect data electronically & automatically◦ Occupational Health & Safety Network (OHSN)

Collect existing information, e.g. worker injury data from all types of health care facilities/systems

Create standard occupational data architecture for occupational health/injury-related data (SODA)

Analyze data & feedback to facilities – provide information for interventions

Address confidentiality issues related to collecting work-relatedness information

Next Steps

Electronic Health Records

◦ Demonstrate that I/O can be collected and used in clinical settings

◦ Demonstrate that knowing about work enhances clinical care by building clinical decision support modules related to occupation and other work-related variables

◦ Build simple prototype to collect I/O using drop down menus

◦ Build information model for vendors to include I/O in EHR software

Next Steps

Other ideas not yet presented or discussed?

Next Steps