Standard industry and occupation data elements within the EHR will
assist with the investigation of a range of chronic diseases and help
determine occupational causation.
For example, an assembler at an automobile manufacturing
facility works in the “automobile manufacturing” industry with
an occupation of “assembler.” Although a patient’s employer is
often recorded for administrative purposes (e.g., insurance billing), this information is often not enough to indicate what kind
of work the patient actually does and thus potential occupational exposures.
It is important to capture the industry and occupation for both
the patient’s current job and longest-held job whenever possible. Any of these jobs may be associated with exposures that
contributed to the patient’s medical condition. Acute conditions, such as dermatitis and asthma, are more likely to be associated with the patient’s current job. Chronic conditions, such
as cancer, hearing loss, or chronic renal failure, are more likely
associated with the patient’s longest-held job.
As EHRs become the norm and cumulative medical histories
follow individuals, it may become feasible to maintain a complete lifetime occupational history in the primary care record,
which could be reviewed by specialists seeing patients for conditions often associated with occupational exposures (e.g., on-cologists, pulmonologists).
In 1992 the Cancer Registries Amendment Act (Public Law
102-515) required central registries funded by the Centers for
Disease Control and Prevention to collect from the medical
record the occupation or industry for the job longest-held by
each cancer patient. 11 These data have the potential to greatly
increase the understanding of the occupational etiology of cancer but are often missing from the medical record. If EHRs include standard industry and occupation data elements, widespread availability of these data will assist with the investigation
of a range of chronic diseases and help determine occupational
The National Institute for Occupational Safety and Health
( www.cdc.gov/NIOSH) is working with public and private organizations engaged in developing standards and processes for
EHRs to develop efficient methods of recording information on
employment status, industry, and occupation in those records.
At the same time, the institute is exploring ways to enhance
these data through physician education in occupational history
taking and patient education to promote the recording of occupational histories in patient-generated records, such as personal health records. ¢
The authors acknowledge the work of the National Institute for
Occupational Safety and Health (NIOSH) Surveillance Coordination Group Electronic Health Records Subcommittee and the
NIOSH EHR Working Group.
A version of this article first appeared in Perspectives in Prevention, January 29, 2010.
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Sara E. Luckhaupt ( firstname.lastname@example.org) and Geoffrey M. Calvert are medical
officers and Marie H. Sweeney is a senior epidemiologist in the Division of
Surveillance, Hazard Evaluations and Field Studies, National Institute for
Occupational Safety and Health, Centers for Disease Control and Prevention.
The findings and conclusions in this article are those of the authors and do
not necessarily represent the views of NIOSH.