This page is part of the Occupational Data for Health (ODH) FHIR IG (v0.1.0: STU 1 Ballot 1) based on FHIR R3. The current version which supercedes this version is 1.2.0. For a full list of available versions, see the Directory of published versions

HL7 FHIR Profile: Occupational Data for Health (ODH), Release 1 (Standard for Trial Use)

Occupational Data for Health Implementation Guide

This Implementation Guide contains guidance, new logical models, profiles and extensions to implement support for Occupational Data for Health (ODH). ODH is primarily designed to facilitate clinical care, including population health; ODH also can be used to support public health reporting, population health, and similar value-based care. ODH is not designed to support billing activities. This STU Ballot for the Occupational Data for Health (ODH) Implementation Guide (IG) is sponsored by the National Institute of Safety and Health (NIOSH), a federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is a part of the Centers for Disease and Prevention (CDC). The project to define ODH was done with a group representing a variety of stakeholders including NIOSH subject matter experts, epidemiologists, occupational health providers, and vendors.

Background

The majority of adults in the U.S. spend more than half their waking hours at work. Therefore, health and work are inextricably inter-related. For example, the management of chronic conditions requires taking the patient’s work environment into consideration. Furthermore, the recognition of new conditions related to previously unknown workplace hazards has often come from astute clinicians, which requires knowledge of the patients’ work-setting. ONC has indicated recognition of the value of work information for health care.

The incorporation of self-reported ODH into Electronic health records (EHRs) and other IT healthcare systems provides an opportunity to improve health in relation to work. ODH has not been broadly recognized as a social determinate of health and has not yet been a priority for inclusion in IT healthcare systems in a structured way that fully supports direct patient care and occupational public health activities.

Though research has been conducted and guidance is available to support clinicians, the IT healthcare systems they work in are unable to efficiently identify patients that would benefit the most from this knowledge.

This project seeks to address this gap of system and awareness by modeling ODH in a way so that it supports diagnosis, treatment, research and surveillance of work-related injury and illness.

Scope

The Occupational Data for Health (ODH) FHIR IG covers information about a patient’s work or a patient's family member's work. ODH is designed for the social history section of a medical record, to facilitate clinical care in most/all disciplines and delivery environments. ODH also can be used to support public health reporting, population health activities, clinical decision support, and similar value-based care. ODH is not designed to support billing activities. The scope of the work information includes:

• Employment status
• Retirement date
• Combat Zone Period
• Past or Present Job for the patient or a household member which includes
  • Past or Present Occupation
  • Past or Present Industry
  • Work Classification
  • Work Schedule, including
  • Weekly Work Days
  • Daily Work Hours
  • Job Duties
  • Occupational Exposures
  • Employer name
  • Employer address
  • Related Subject
• Usual Work of the patient or a household member which includes
  • Usual Occupation
  • Usual Industry
  • Usual Occupation Duration
  • Related Subject

Known Issues and Limitations

This IG includes more extensive occupational data than typically collected in current systems. The content and structure of this IG is intended to inform clinical care, support population health and contribute to public health activities. While there may be some overlap with administrative and billing information maintained by some systems, the information in this IG is not designed to support billing and administrative needs.

This profile is specified as a composition resource, but it is not intended to be used as a stand-alone composition. Rather, the content should be included in broader health information summary and other compositions, and available as a response to requests for occupational data for health information.

Some of the value sets in this IG are preliminary. If no code exists for a given concept (e.g. a new occupation), text should be used to describe the concept and the coded value should be omitted.

A value set for combat zone location that meets the purpose of supporting patient care, population health, and public health needs has not been identified. Therefore, only start and end dates are included.

Retirement date is captured as how it relates to a person, not to a specific job.

Questions for Reviewers

Both general and specific comments regarding this material are invited.

While this profile is specified for the US Realm, the design is intended to support international needs. Three of the referenced value sets supporting Occupation, Industry, and Supervisory Level are necessarily US specific, and the remaining three supporting Work Schedule, Employment Status, and Work Classification are defined to support international concepts. Input is requested regarding whether these should be specified as ‘extensible’, ‘required’ (using ‘text only’ where a concept does not yet exist such as a new occupation), or as an ‘example’ for those US specific concepts.

 

Credits:

 

 

Contributors include participants HL7 HIR Management Group, Structured Documents Work Group, Patient Administration Workgroup, Orders and Observations Work Group and the Public Health Workgroup:

 

Co-Editor:	Genevieve Barkocy Luensman CDC/NIOSH/RHD/SB Respiratory Health Division (RHD), National Institute for Occupational Safety and Health (NIOSH) bve2@cdc.gov	Co-Editor:	Eileen Storey AECOM/Professional Staffing Partners Plus Contractor
Co-Editor:	Barbara Wallace AECOM/Professional Staffing Partners Plus Contractor okt5@cdc.gov	Co-Editor:	Margaret S. Filios Respiratory Health Division (RHD), National Institute for Occupational Safety and Health (NIOSH)
Co-Editor:	Stacey Marovich, MHI, MS, PMP, MCTS CDC/NIOSH/DSHEFS smarovich@cdc.gov	Co-Editor:	Marie Haring Sweeney Division of Surveillance, Hazard Evaluation, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH)
Co-Editor:	Angela C. Crovetti Sr. Consultant, Attain/CDC/NIOSH/WTCHP nut3@cdc.gov	Co-Editor:	John Myers Division of Safety Research (DSR), National Institute for Occupational Safety and Health (NIOSH)
Co-Editor:	Lori Reed-Fourquet e-HealthSign, LLC lfourquet@ehealthsign.com	Co-Editor:	Kerry Souza Division of Surveillance, Hazard Evaluation, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH)
Co-Editor:	Rob Hausam Hausam Consulting rob@hausamconsulting.com	Co-Editor:	Christina Socias-Morales Division of Safety Research (DSR), National Institute for Occupational Safety and Health (NIOSH)
Co-Editor:	Mark Kramer MITRE mkramer@mitre.org	Co-Editor:	Sherry Baron DSHEFS, NIOSH. Currently Queens College, City University of New York, Flushing NY USA

Douglas Trout	Division of Surveillance, Hazard Evaluation, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH)
Kristin Yeoman	Western States Division (WSD), National Institute for Occupational Safety and Health (NIOSH)
Sara Luckhaupt	Division of Surveillance, Hazard Evaluation, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH)
Carissa Rocheleau	Division of Surveillance, Hazard Evaluation, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH)
Claire Caruso	Division of Applied Research and Technology (DART)), National Institute for Occupational Safety and Health (NIOSH)
Nicole Edwards	Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH)
Deborah Hoyer	Office of the Director (OD), National Institute for Occupational Safety and Health (NIOSH)
E. Michael Goldcamp	DSR, NIOSH. Currently OD, NIOSH

 

Acknowledgements:

Yvonne Boudreau, Western States Division (WSD), National Institute for Occupational Safety and Health (NIOSH)

Susan Nowlin, Division of Surveillance, Hazard Evaluation, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH)

Anna Orlova, Public Health Data Standards Consortium (PHDSC). Currently Visiting Associate Professor, Division of Health Sciences Informatics, Johns Hopkins School of Medicine

 

This IG was produced by Mark Kramer using the Clinical Information Modeling and Profiling Language (CIMPL), a free, open source toolchain from MITRE Corporation..