Documementing Occupation
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
causation.
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. ¢
Acknowledgments
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.
Notes
1. Schulte, Paul A. “Characterizing the Burden of Occupational Injury and Disease.” Journal of Occupational and
Environmental Medicine 47, no. 6 (June 2005): 607–22.
2. Bureau of Labor Statistics. “Workplace Injuries and Illnesses—2008.” Press release. October 29, 2009. www.bls.
gov/ news.release/archives/ osh_10292009.htm.
3. Steenland, Kyle, et al. “Dying for Work: The Magnitude of
US Mortality from Selected Causes of Death Associated
with Occupation.” American Journal of Industrial Medicine
43, no. 5 (May 2003): 461–82.
4. Rosenstock, Linda, and Mark R. Cullen, eds. Textbook of
Clinical Occupational and Environmental Medicine. Philadelphia, PA: WB Saunders Company, 1994.
5. North American Association of Central Cancer Registries.
Standards for Cancer Registries, Volume II: Data Standards
and Data Dictionary. www.naaccr.org/StandardsandReg-istryOperations/ VolumeII.aspx.
6. Brooks, Stuart M., Thomas Truncale, and James McClusky.
“Occupational and Environmental Asthma.” In
Environmental and Occupational Medicine 4th ed. William Rom
and Steven Markowitz, eds. Philadelphia, PA: Lippincott
Williams & Wilkins, 2007.
7. Occupational Safety and Health Administration. “
Occupational Noise Exposure.” Standard 1910.95. In Regulations;
Standards, Code of Federal Regulations (CFR) 29. Washington, DC: US Occupational Safety and Health Administration (OSHA), 1970.
8. Tak, Sangwoo, and Geoffrey M. Calvert. “Hearing Difficulty Attributable to Employment by Industry and Occupation: An Analysis of the National Health Interview Survey—United States, 1997 to 2003.” Journal of Occupational
and Environmental Medicine 50, no. (Jan. 2008): 46–56.
9. Occupational Safety and Health Administration. “
Occupational Noise Exposure.”
10. Kern, David G., et al. “Flock Worker’s Lung: Chronic Interstitial Lung Disease in the Nylon Flocking Industry.”
Annals of Internal Medicine 129, no. 4 (Aug. 15, 1998): 261–72.
11. Centers for Disease Control and Prevention. “National
Program of Cancer Registries (NPCR).” www.cdc.gov/can-cer/npcr/ amendmentact.htm.
Sara E. Luckhaupt ( pks8@cdc.gov) 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.
