Accomplishments, Challenges and Next Steps

1. Accomplishments, Challenges and Next Steps Marie Haring Sweeney, PhD, MPH National Institute for Occupational Safety and Health Counting Work-related Injuries& Illnesses: Closing the Gaps II Washington, DC April 17-18, 2013

2. This Hour • 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 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

3. NIOSH Surveillance Key Activities • Leverage existing databases and surveys • Enhance state occupational health surveillance • Communicate findings • Incorporate work into EHR data • Use WC data to supplement surveillance systems

4. 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

5. Leverage existing data and databases 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)

6. 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)

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

8. Leverage existing data and databases 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

9. Expand state occupational health surveillance 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

10. NIOSH and State-based Occupational Health Surveillance Programs, 2013 State-based programs NIOSH surveillance program locations

11. Communicate Findings 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

12. 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

13. Electronic Health Records 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

14. Workers Compensation 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

15. Challenges and Next Steps

16. Challenges • 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?

17. 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?

18. 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?

19. 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

20. Big Challenge ;: • Everything will be electronic! • Everything will be linked & interconnected! • Are we ready?

21. Next Steps • 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

22. 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

23. 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

24. Next Steps • Other ideas not yet presented or discussed?