So I'm going to just start. Well, hello, everybody. This is one of the largest audiences that I've ever spoken to, I think. So this is a good opportunity for me to practice my new aria, I think. I've just got the score. I really am not a very good singer, but I think I'm going to try it out. What do you say? Either that or on my Medium feed this morning, there was a story on jokes that were so funny that people died laughing, literally died laughing, of cardiac arrest, or they choked to death, or something like that. So that's another opportunity I have. I could do that. It's also good we've got people all in this row. This would be great if we were all in this row, and no one was over there in the back corner. So I'm just going to keep talking, because it's great to hear my voice magnified like this. Doesn't seem to be drawing many people in. I don't know what the problem is there. Anyway, so I did see that Brett had signed up for this. So I hope he does show up, because it'd be good to show him off, I think. I see a few more people who are going to other rooms. Kathy Fagan? Kathy Fagan's here. Kathy Fagan's here, but she doesn't hear. She's here, but she can't hear. I'm going to wait a couple more minutes, because we have the time. Well, there's already, like, about 15 questions. I think people are choosing to watch this online, just joking. I just wish they'd given us a bigger room. I don't know if you can see it, but there's a lot of people in this room. I'm going to try to make it a little bit bigger. I don't know if you can see it, but there's a lot of people in this room. I'm going to try to make it a little bit bigger. I don't know if you can see it, but there's a lot of people in this room. I'm going to try to make it a little bit bigger. I don't know if you can see it, but there's a lot of people in this room. I'm going to try to make it a little bit bigger. I don't know if you can see it, but there's a lot of people in this room. I'm going to try to make it a little bit bigger. I don't know if you can see it, but there's a lot of people in this room. I'm going to try to make it a little bit bigger. I don't know if you can see it, but there's a lot of people in this room. I'm going to try to make it a little bit bigger. I don't know if you can see it, but there's a lot of people in this room. I'm going to try to make it a little bit bigger. I don't know if you can see it, but there's a lot of people in this room. And a few here. And a few here. I'm glad to see that. And the reason why I have actually devoted so much time to this project over probably the last, I don't know, at least five years, maybe longer that, because I think this is one of the greatest opportunities that we have in occupational medicine to actually explore. This could be one of a number, but I think one of the more important game changers in occupational medicine as we go forward. So first of all, please take a minute now to log in to Poll Everywhere. You can either do it on a device or on a laptop or on your phone. And this will also appear on the top of each of the Poll Everywhere slides. And just stay logged in, because the next speaker is going to be the one who will be quizzing you. And please put your name in so that we know who's gotten the answers right and who wrong. Just joking again. No one's going to laugh to death in this session. Okay, does everyone have the login? So, okay, so what we're going to try to do in this session is to, one, understand the importance of standardizing work information, not just for us in OCMED, but for the general medical community, for the purposes of clinical care, to improve our ability to do epidemiologic research that goes beyond simply the OCMED only, but includes all of the richness of data in the general medical record, which includes a number of diseases that are oftentimes hard to track down, like cancer, for example, and for public health purposes. So, for example, if you think during the context of the pandemic, think how helpful it would have been to be able to push a button and pull everyone out who's a meatpacker, for example. We want to explain how we can operationalize this thing called Occupational Data for Health Framework, which Michelle is going to go into some detail. And notice the name here. This is ODH, not OHD. It's not Occupational Health Data. It's Occupational Data for Health, meaning it's for the broad health of populations and individuals, not just their narrowly conceived occupational health. And we want to contribute to efforts to include ODH in the primary electronic health record. So, with me today is Michelle Kowalski-McGraw, who's an Associate Physician Diplomat at UC San Diego Health, and Monty Berenji, who's the Chief of Occupational Health at the VA Long Beach Health and Assistant Clinical Professor at UC Irvine. And I am Robert McClellan. I'm a Professor Emeritus at the Geisel School of Medicine at Dartmouth. So, a little bit of historical context. We know now how inextricably linked work and health are, as if that was a new idea, that chronic diseases that we're now suffering from is a new idea that actually work may have something to do with that. Well, actually, there's this guy, Ramazidi, who many centuries ago said that occupational health data is critical to high-quality health care and public health. But certainly in our lifetimes, as we've grown up, occupational health has been segregated in all kinds of ways from general health. And certainly that is very true with respect to medical records. And recently, again, within the lifetime of our careers, there are a variety of laws, including HIPAA and GINA, most famously, but others too, that have reinforced this segregation to protect, and appropriately, to protect privacy. And we know that the full integration of occupational and general health record with visibility to everyone for everything risks violating some of these privacy laws. But firewalls can, and in some systems today, have been created to constrain access to EMR's information based on your role. So what have been the consequences of having these two different types of records? Well, first of all, clinically important information documented in one record is absent from the other. This could include medications, immunizations, interventions, exposures, diagnoses, labs, as well as INO. Occupational health data, which means industry, and occupation, and exposures, usually has been absent from, or if it's present, it's usually kind of buried someplace in the general health record that requires many clicks to get to. And there is no mechanism within the general medical record to make that information useful to the viewer of that information. And public health and OEM research has been unable to rely on the general richness of, the richness of the general medical record, and that has been a huge constraint in terms of furthering OEM epidemiology. As well, I think it has been yet one other factor that has segregated OEM from mainstream medicine. We are different. We are outside of mainstream medicine, literally physically outside, which raises, what the heck do you do? You take care of VACs, right? That's what you do. You do workers' comp. That's what you do. So, much of my career, I have at various times had funding to try to improve the taking of the occupational history in primary care. In fact, it's been a frequent target of early healthy people agendas, but with little success so that it no longer appears in 2020, and I don't think it's going to be in 2030. That is a goal of increasing the frequency that occupational history appears in the primary care record. There's a lot of research that says that non-occupational physicians globally, not just in the U.S., do a poor job documenting the history. Occupational data elements are present in only about a quarter of records at major U.S. academic medical centers, similarly in Singapore, and a third of medical records of lung cancer patients, presumably where you would want to know whether there were exposures to chemicals or physical agents or radiation that might impact people in the country of Colombia. So, back in 2011, NIOSH sponsored what was then called the Institute of Medicine, what's known as a letter report. You may be familiar with consensus studies. Consensus studies are highly detailed, evidence-based reports that take quite a while to generate. A letter report is similar to that, a little bit like kind of a diet, a diet version of that consensus report. And this report was, they asked a panel, NIOSH asked the panel to say, what are the benefits, if any, of incorporating occupational information in the EHR? And there was considerable evidence put together in this report that, in fact, it would improve quality, safety, and efficiency of care, help reduce health disparities, engage patients and families in their health care, improve care coordination, and improve population and public health. So out of the report came 10 recommendations to NIOSH of what they could do with it. What we'll be talking about today is one particular aspect of that and the outcomes from this work. Over these years, NIOSH has worked vigorously to put together what is called an Occupational Data for Health Framework, which has three key components. First, there is a NIFTI system that facilitates the collection of self-reported, meaning patient-reported, standardized, and structured industry and occupation data. They have published the vocabulary. So some of the words here are very kind of I.T. jargony, but this basically means the codes, the U.S. Census codes that are crosswalked with the NAICS and SOC codes and OHNet, if you're familiar with those. And so the way that this would go into the record means it's not simply going to be I'm a painter, but actually a specific code associated with that so that we know that you're a house painter versus a fine arts painter, et cetera, et cetera. And along with that, how-to guides that can be very helpful for the I.T. people involved with this process. And extremely importantly, they've also put together what's known as a functional profile, this one specific to work and health. And what functional profiles do for the general record, and there are many different ones, is tell the machine how to use the data elements in it in ways that are useful to the people interacting with the system or the whole data set. And this guide to the collection of occupational data for health is meant to assist health I.T. systems developers who are going to be implementing collection of ODH in a system such as an EHR. So the good news is this is not just a pie in the sky. This is actually going to happen. It is going to happen. The key elements of this is going to be incorporated in the next version of the United States core data for interoperability. This is the kind of the standard which says these are the data elements that should be in each EHR, and the EHR should be able to talk to each other with respect to these data elements. So that certified EMRs under HITECH must use this vocabulary. And it will be included in the interoperability template such as a medical summary that can be seen, say, in an ED distant from wherever your home health care system may be. So the good news for us and why I have been so interested in this for as long as I have been is, first of all, it's consistent with, I think, what we now are understanding as the future of OCMED. It's really present right now, and that is the total worker health premise of this inextricable link of work and health. It will increase the visibility of OEM because now it's not just going to be us who sees the occupation and industry, but it's going to be other physicians and, most importantly, primary care physicians and pulmonologists, et cetera. And, in fact, they may not know exactly what to do with this information. We have a disease or symptoms, and we have this INO. Maybe this is a good time to, oh, yeah, I heard that there's an OCMED person in the health system. Maybe I should call that person, and maybe I should refer to that person for some assistance. So I think it may actually increase OEM consults that will go way beyond a low back pain situation. And I think this will clearly say to the world that occ health is part of medicine. It is an integral part of taking care of the working population. So I'm going to turn it over to Michelle, who's going to tell you exactly the details of how all this works. Thank you, Bob. Yeah. Let's see if any questions have come in. So, yeah, thank you all for coming today, and I want to thank Dr. McClellan. I was so excited when he said he was going to help me and Manny with this session because he has worked, as he said, for at least five years on the ODH project, but for most of his career on this message, which is basically that we need to integrate occupational health with the rest of medicine because it's going to benefit our patients that way. So I've always been passionate about this. I'm super excited about this Occupational Data for Health framework because I think it leverages the power of what we do in occupational medicine with the power of informatics. We know now, you know, all of the data is in the medical record. You know, there's a wealth of information there. But what's missing is quality work data. So this is a way we can get it in there and, again, enter the mainstream, as Dr. McClellan said. I love this quote from the Robert Wood Johnson Foundation. Health starts where we live, learn, work, and play. The Sappington lecture brought that out. You know, it's really the environment. Unless you look at the context in which people are, you're not going to affect change. So, again, that's where we, as occupational medicine doctors, we have the big environment of work. People spend a lot of their time at work. So that's a big area where we can really practice preventive medicine. But, unfortunately, as Dr. McClellan pointed out, we're often siloed in what we know doesn't get in there. So Occupational Data for Health is a way to get it in there. Again, to get all the rest of our colleagues to know about what we do and also what our patients do. Before we go any further, I want to dedicate this presentation to Dr. Eileen Story. She is the one who got Manny and I involved in this project. Dr. McClellan knew her for many years. She was a leader in our field, very, very passionate about the health of workers. And her idea was basically, how do we do this in this day and age? How do we help our workers? And so she was a pioneer in the Occupational Data for Health framework. She founded the project 10 years ago and worked tirelessly on how we can get this information into the EMR. Unfortunately, we didn't get to spend enough time with her, Manny and I. She passed away this past fall. But very much thanks goes to her for her inspiration. And, again, we want to keep this going forward for her and let this come to fruition. Fortunately, I have had the opportunity over the past almost a year to work with the rest of the team. Again, they've worked for 10 years on this project, and I now have some dedicated time where we are working on a pilot program that I'll tell you all about. We want more pilot programs. That's part of the gist of this talk, too. So, you know, please do consider starting them in your own institutions. And I'll tell you what our experiences have been thus far on the one that I'm working on. The team, again, Dr. McClellan brought it up, but it's the Guide to Collection of Occupational Data for Health. It is now online. You can see everything they've done. It's freely accessible. The team is available if you have questions or would like to know more. So now we get into... Oh, good. I guess people have responded in the chat already. So have you heard of the NIOSH ODH project before this meeting? I guess I should stay at the podium. You can hear me better that way. Okay, so it seems like the majority have not heard of ODH. So I'm excited to tell you about it. Does the main organization with which you are affiliated use one medical record for both occupational medicine, including employer-mandated exams and testing, and general medicine practice? And we do have a question in the chat. Does the occupational data for health include a question about who is your OH provider at work? The answer is no, not yet, but certainly, again, that's something that, you know, once we get the ODH framework in there, then perhaps we can do that. Okay, so it looks like most places have separated records, and that was my experience as well. At UCSD, recently, we have integrated our own records at UCSD, recently, we have integrated our occupational health data into EPIC. Some of you might have been at the talk yesterday. There's still two different systems within EPIC. We have a big firewall between those two systems. They don't necessarily communicate yet. If the organization uses one record, does it use firewalls to restrict access to parts of the record based on the occupational medicine provider's role? I guess a lot of you don't use one record, but I just basically told you we do have one record at UCSD now. We definitely do have the firewall. Anybody in the chat? All right, any questions on the firewall before I go on further? I guess most of you all know what that is and are familiar with that. Can I go back? I thought I saw something come up there. Does the main organization with which you're affiliated routinely capture occupation and industry in its general medical record for clinical use? So yeah, I guess this is basically what we're saying with this ODH. It's not in most general medical records. I did want to bring out the point too, Dr. McClellan did say when we started this presentation he would only be there if we emphasize it's for the primary medical record. It's not for occupational health records. I keep saying, you know, again, we know what our patients do. They're coming to us because of that. But most other doctors don't. So again, the answers here reflect that. All right, so yeah, basically now I'll go into what ODH is and basically what I want you to take away from this is the fact that you would advocate for this within your system to bring occupation and industry into the general medical record. A lot of what I'll go through you already know. You know how we can use it and the value of it. We'd like you to be ambassadors to communicate that to your organizations. Why do we need this information in there? I know I just talked to a non-medical friend of mine. She's like, oh, so doctors care what you do at work. They use it to determine your treatment. And I'm like, yeah, yeah, that was evident to me. But it's not always evident to our patients, even to our colleagues sometimes. I also have a friend who's an orthopedic surgeon, and I told him about this project. And he said, yeah, that's a great idea. I would love to have that into my patients' records, because I ask my patients what they do. If they're a jackhammer operator, I'm going to do a different shoulder surgery than if they're a desk worker. But he said a lot of his partners don't, so he gets a patient who has no idea what they do or what surgery would be best for them. So what I want you to take back to your organizations is the importance of this and, again, be able to advocate for it. I don't know how many of you were at the lecture yesterday afternoon, but Dr. Emmett pointed out moving forward in occupational medicine, it's those people that can change and adapt to the circumstances that are going to survive the best. All of Darwin said that in occupational medicine. I think that the circumstances are the electronic record. So again, we have to adapt. The fact that most of medicine is based around this electronic record now. We need to get what we do in there, and then again, that will show our value and help our patients. Again, we want to practice preventive medicine, and we have a big leverage area to do that. So what is it? What is occupational data for health? It's basically, you know, many of you are familiar with total worker health. Basically the idea is to go, correct me if I'm wrong, in total worker health, you go into the workplace and you say, okay, we have this group of people. What can we do to make these people healthier? We can't look just within the workplace. We have to look at everything else that affects them, the community, their personal health behaviors. I like to think of occupational data for health as kind of the other way looking, instead of the inside out, outside in. You have this big data in the electronic record. We need to find out how does work get in there? So we're looking at, you know, personal health behaviors, home, community, environment. Where can we put the workplace, psychosocial conditions, and physical, chemical environment into that record? This is just my little fantasy of what this might be in the future, but does anyone know who that is? Yes. So that was Dr. Beverly Crusher, and she was always an idol of mine because it's what a great job. You know, you travel the galaxy just with this little scanner. You go around and, you know, diagnose people with a handheld computer. Well, it's not too far from the truth. Look at how far we've come in electronic records now and in health informatics. Moore's Law, again, we're going to get there. We're going to get to the point where, you know, we can actually sit and look our patients in the eye, have a little scanner, and it can pop up, you know, just like our iPhones, tell us more about this person. So Dr. Crusher had this wonderful little medical tricorder, you know, and if you Google one of these, it tells you, it can even tell you about different people from different planets. Well, why couldn't it tell about people that work in different environments? So again, this is how I envision, again, you don't want to have to be looking all this stuff up every time you see a patient, and our primary care colleagues certainly don't want to be doing that. So again, if the electronic record can help you with that and direct you to the next steps, then you can actually, you know, look at your patient, really do that, you know, great patient care that, you know, boost your satisfaction scores, enjoy medicine more. Unfortunately, we're not there yet. As many of you know, this is more the state with electronic health records. The patients complain. The doctor's always looking at the computer, didn't even look at me, didn't even touch me. Again, the records aren't real agile yet. That's again the beauty of this occupational data for health framework. They really looked at this. They didn't want it to be a burden on the clinician or the staff. It's patient-centered, patient-facing. So the idea is the patient gives you all this information through drop-down menus. It's coded, as Dr. McClellan brought up the codes, which I'll go into later. And then it's in the record so that when the patient comes to the room, the doctor has all that already. So again, hopefully we won't be at this state very long. So more on what this is. Well, again, it's all in the guide. I know Dr. Story was very adamant on having me communicate. It's not a how-to. The guide is not a how-to because they realize that every system is different. This may not work step-by-step for your system. So it has to be customized. But what you have to go back to is what you're going to do with it. So again, you want that interoperability. Free text isn't going to cut it. Again, we don't want to have somebody go in Boston and fill out a whole form that I'm a carpenter and then they go to California and they have to do the same thing again. We want it to transfer over. We want it to be interoperable between, even not just different states, but within systems. Certainly we want the occupational medicine doctor and the orthopedic doctor to have the same information. It may be in the record that the guy's an engineer, but is that somebody that drives a train or do they build buildings? So it has to be interoperable. So the whole point of the guide is that that keeps that in mind. It keeps the fact that we want this to be used for care, research, and public health. And then it can be customized to your system within your institution. It's broken down into topics. Number one topic is employment status. Are they working or not? We have to ask our patients every time they come in, are you working? Are they accommodating your restrictions? Other doctors don't necessarily have the time to do that, but how important is that? Sometimes patients don't want to tell you that they lost their job or there's not enough time even to get into that sometimes. So that's number one. Past or present work or voluntary work. Certainly what you did for all your life may not be what you're doing right in that particular instant. If you worked in a factory all your life and now you're working in Walmart as a cashier, certainly different exposures. So we want to capture not just what you're doing now, but what you might have been exposed to in the past. What if you worked on a ship? You know, your asbestos certainly was something that may need to be screened. Your longest held work, again, that plays into what I said about the usual work, what you were exposed to most. Retirement dates, if you did retire. Med zones. Again, this is something that doesn't have to be in every single occupational data for health in every system, but it's useful. Certainly we know that. And then for our pediatric patients, work of the household. Certainly what your parents do makes a big difference in terms of children's health. So we want to capture that as well. Or even if you're not the primary worker, certainly the lead is a perfect example within our field. You know, the people that work with lead came home with it on their clothes. Certainly the rest of the family had to worry about it as well. This slide I put up there just to show you that when they created this framework, there was a lot of stakeholders, many of whom are still involved. But I think this slide emphasizes how widely occupational data for health can be used. There are a lot of different organizations that are very excited about this. I know that the research community is extremely excited about it, because if any of you have tried to do research on occupational health, it's hard. I know I did research on opioids and benzodiazepines, and to try to break that down into which work groups would be most at risk was hard. We're making inroads on that now, but there wasn't a lot in the literature because, again, we don't have the job in the rest of the record. So when we do have it, it's going to be big. As Bob said, the big news is that this is going to be a requirement moving forward. Many of you may be familiar with this core data set for interoperability that basically they're saying it has to be in all medical records now. Every year, they go through and, okay, what is the core data, certainly medications, smoking status. Well, we are now in draft level version three. Within the next several months, they're going to say industry and occupation need to be a core data element. That's a big win for us and very excited to see it happen, because, again, it's so important. Think of all the stuff we capture now for social determinants of health. This is going to augment that tremendously. You can see the comments from the Office of the National Coordinator, who basically is where these core data elements come from. So the three pillars of how this can be used. I just talked about the research. The three pillars are clinical care, population health, and public health. I was most passionate about it when I found out about it for the clinical care. I'll go through some examples. Again, you guys have probably seen these patients or know even more examples, but I want you to think about them in terms of communicating how we can use occupational data for health to your institutions. Population health, certainly if we knew, like Dr. McClellan said, all the meat packers, we would have been able to help that group much better. And then public health, you know, cancer reporting, even other infectious disease reporting. So NIOSH actually has a few models, and these are the three big ones, the asthma, diabetes, and return to work for lower back pain. Models on how we can potentially use this occupational data for health. And basically, you know, you have seen a lot of work-related asthma, I'm sure, throughout your careers, but unfortunately, they come to us too late. So this would basically, if you had their occupation in there, it would trigger you to ask about temporal relationships between asthma and work earlier on for, you know, those triggers, if asthma began in the last two years or there are emergency or unscheduled visits. Diabetes, say they're uncontrolled, their hemoglobin A1C is high, or they're demonstrating hypoglycemia. So then maybe you can, it will trigger you to ask about conditions that may affect your diabetes. What if that person is a shift worker, you know, and the timing of their medications is off? Again, trying to get them early before, if it's a problem. And return to work. Certainly, we're a big pet peeve of our specialty is, you know, when doctors just put people off with a back injury. If there was some clinical decision support in there to really find out about what job they're actually going back to and what activities, you know, could be good versus problematic, that would be huge. Other patient care examples, Lyme disease in patients working outdoors. I know I used to practice in Pennsylvania, and Lyme is very prevalent there. A lot of times, you know, people would get rashes that would then later be found to be Lyme. Perhaps, you know, if we can ask them, are you, you know, an outdoor worker, then we can think of Lyme first. Truck driver's medication use. I don't know how many of you know, but Epic actually has a, I guess, module or modification that you can make to your system to alert clinicians if they're seeing a person that has seizures and is also a driver. There was an incident that prompted this, and unfortunately, it was a school bus driver who did have a seizure. And so Epic, at that prompting, made a clinical decision support tool where, again, if they are a driver, you put that in there, and then again, if they have a seizure medication or seizure disorder, that can be alerted. So that's huge. I mean, that's a public safety thing as well. What about accommodations during pregnancy? Certainly that could help our patients. And then the big one, successful return to work after illness or injury. Again, we know it's bad for people to be off work. Work promotes health. Health is work. And work promotes your health. So we don't want them off work. We want to get them back to work. We want to assist our colleagues in getting them back to work. So population health. There's also a study in which they were able to, I think it was the Massachusetts Public Health Department, they did like a pilot where they found that a lot of their custodial workers were Portuguese. They were able to collect the occupation and link it with the nationality. And so they targeted education in the native language so that people, again, would have less work injuries. And they showed that this worked. House painters with exposure to lead. You know, if you know they're a house painter, you want to certainly make them aware of that. Screen them. There's a big one now, COVID-19 and vaccinations for public health workers. And that plays into this pilot project that I'm on now. We're identifying essential workers. So that's huge. And then silicosis. Certainly that's a big area of our field right now, too. I know I just talked to a company that wasn't even aware, you know, they moved sand. They said, well, are you screening for silicosis? You know, they were like, oh, okay, we better start looking into that. But again, where are those patients now? Maybe if their primary doctors had some prompting to say, hey, you know, you may want to look at this. That's preventive medicine. That's what we can do. In terms of public health, certainly work information would assist tremendously in reducing the spread of infectious diseases. The meatpacking example was a great one. I know I've seen personally a lot of law enforcement with COVID. So if we were able to help these guys better, if we knew where they worked, it would have been useful. And then the long-term care facilities as well. So again, that would also help. In terms of public health reporting, we already do a lot of this public health reporting. Cancer registries utilize usual industry and usual occupation. It would facilitate that reporting if we had that in the record. Electronic case reports that are needed for whatever, occupational information in terms of employer, employer address would assist with that for the public health reporting. And then what about pesticide poisoning? Certainly that's a reportable condition as well. And if they had the occupational data there, we could certainly facilitate it for them. Again, showing the value of what we can do, how we can make things move smoother through our occupational health knowledge. So where are we now with NIOSH efforts? The big one is we want to socialize the value of occupational data for health and healthcare. I know there's a lot of talk now about electronic records in occupational medicine. And believe me, I'm thrilled that we are electronic. I started out on paper, and I don't like that. I love the fact that we're now on Epic. But this is more than that. This is really, it's for the rest of medicine. As much as I love our specialty, we are a very small piece of the pie of medicine. What we do is huge, and you've heard that throughout the theme of this conference. I think our value is being realized, but we can really leverage it with this electronic record. So NIOSH's efforts is to try to get that message out there that this information needs to be in the rest of healthcare. Another key point is that this is personal health information. So it's not occupational data for billing or occupational data for the employer. It's occupational data for health. It's the same as offering to your doctor, yes, I'm a smoker, or yes, I have high cholesterol. It's going to be protected, protected health information. So NIOSH really wants to get that information out there that it's to have patients feel good about giving the information, and then have doctors feel good about using it, like they do the rest of the personal health information. The informatics blueprints, that's the guy, you know, it's out there. And then our big thing now is just demonstrating proof of concept, you know, certainly on my slide about the guy sitting on the exam table, the doctor looking at the computer, we know there's a burden to get this into the computer, to have the electronic health systems utilize this information. But we need to see how it works, you know, how can we tailor this? How can we make it work? And then securing ODH and regulations for EHR certification, which again, we're moving forward with rapidly. So I think that's a big win. So more about this pilot program that I'm on. I work with NIOSH and National Association for Community Health Centers on this project. And National Association for Community Health Centers is basically the support for community health centers throughout the U.S. They provide the informatics, the organizational support for the people that are seeing, the frontline workers. And so we have the unique opportunity to be working with three different areas, Oregon, Miami and Chicago, on how we can collect occupational data and the workers they see in their community health centers. And it's been exciting, but it's also been somewhat frustrating in that it's hard. You know, certainly there's, the primary care is very limited by that time limit visit that they see. The administrative staff is limited by the multitude of things that they do need to collect now. Where do we fit the ODH into that workflow? NAC is known for their patient-centered framework. NIOSH also, again, created this program to be patient-centered. So that's our focus. Again, we want to try to move it away from the administrative side and then have it available to the clinicians as they use it. But it's been hard. The default is that they're finally realizing, you know, a lot of these different health centers, the importance, or maybe not finally, I shouldn't say that, they know the importance of collecting occupational data, but they don't really know how yet. So even though we have this framework, we have these codes, the O-Net, the SOC, the NAICS codes that are interoperable that we want them to use and that the program will actually support, a lot of times it's still free text. And again, free text is great, you know, I'm glad for that visit that you know what that person does. But it's not going to help at the next visit. It's not going to help for research. It's not going to help your colleagues. It's not going to help us to know, to identify problems, have the computer help us identify problems before they happen. So the big struggle in this pilot has been getting to use the actual codes that are in the framework. And again, there's issues with epic processing speed. I know that just came up on a call that was on yesterday. One of the systems is trying to do that. And supposedly it slows Epic down as they're, you know, it's synthesizing all this information. My hope is that, you know, as we do this more, Epic is going to figure out other systems as well. They'll figure out how to do this faster. You know, again, demand creates better product. So again, that's why I'm here talking to you guys today. We want to create demand for this so that we can get it into Epic, Cerner, whatever other medical record you're using, so that it's fast, so that it's available to the clinicians, to the people that need to see this information. The big thing, big four that we're working on now, again, this is a customizable framework, so we didn't go for, you know, combat zone or work of minors right off the bat for all the reasons I just mentioned. It's a big lift to start, to begin with. We went for employment status, what their job occupation is, what their job industry is, and the employer name and address. So again, that emphasizes that you can customize this framework to your needs, and these are the top four we picked for the National Association of Community Health Center Partners. So more to come on that, you know, we are continuing to work. One of the organizations that is working on it actually is very excited about it because they hope to then bring community education. For instance, they have people that are working out on the farms that are exposed to, let's say, air quality issues. So they hope to be able to then push out air quality reminders to the clinicians working with these patients as they, or the workers as they see them as patients. So exciting. The partners do realize what they can do with the data, and we're excited to be able to get it in there. More to come on that. I'll be here next year telling you guys more about it. So I neglected to say on the last slide, the last bullet point, the big gist of the project with the National Association for Community Health Centers now is what they're going to do is once they have the data, they'll be able to identify essential workers. And again, all our partners are people that see frontline community health workers. They're people who see the grocery store workers, the people that work outside. So we need to identify who are the essential workers. So we've crosswalked what the U.S. government has deemed as an essential worker with these codes that are in the ODH framework. And that's the ultimate goal of the project is that we'll be able to identify the essential workers. Beyond that, though, again, there's so much you can do once you get that data in there. And I want to start with this figure that came from an article that Dr. McClellan wrote about 10 years ago, I think it was. It was basically advocating for the concept of the patient-centered medical home and how work should be an integral part of that. I love this figure because it really shows, again, the center, you know, the patients and their families. You can't just reach patients and their families if you're just doing occupational medicine. You can't reach them if you're just doing primary care. You can't reach them if you just look at public health. You really need to look at the intersection of all these things to see where people are. So you see what a big portion the workplace pays in that. We need to make sure we're integrating with primary care and public health. And ODH is the way we can do it in this day and age. Once we do it, in addition to identifying these essential workers, for instance, health care workers, well, what if this health care worker works night shift and they are also diabetic? You know, all through the COVID pandemic, working long hours, does their primary doctor know that? Do they know that they're a health care worker that works, you know, night shifts? Could they perhaps have tailored their medications better? What about this person who's doing all the cleaning? Hopefully he doesn't have a back injury and won't be seeing occupational medicine, but some training on ergonomics would be huge at this point. Even what to do when his back hurts so that he can keep working or modify his work before he has a work injury. If we know what he does, we can help him with that. What about this person? In the grocery stores, I'm sure you guys saw this, especially early in the pandemic, they were spraying and cleaning like crazy. You know, I know I personally saw some occupational dermatitis from all this. So what if this person is seeing her primary care doc and saying, you know, what is this rash? Is the primary care doc triggered to think of, you know, what she's doing at work? Firefighters, I work in California, Cal Fire does a great job of surveillance and keeping their people healthy. But, you know, we weren't doing spirometry for many months there. So I was wondering, again, if these people are having respiratory issues, they go to the urgent care, the urgent care does a COVID test, of course, but do they know they're a firefighter? Are they, you know, then reaching out to occupational medicine saying, hey, you know, maybe you need to make an exception and do spirometry on this guy. So the bottom line is, in addition to identifying that they're essential workers, we can identify all these other conditions that, again, can help population health show the value of what we can do as occupational medicine docs. So if you're going to do this within your own organization, again, the scope of work is totally determined by that organization. It's patient-entered information. So I know that's been an issue that's come up as I've worked on this. You know, how much time is this going to take? We don't want other forms, you know, and certainly registration doesn't want to have to do anymore. The ideal is to have the patient enter it ahead of time. My thought was even a MyChart questionnaire, and again, there's a lot of competition right now for MyChart questionnaires, but how important is work information? Really, you know, when you think about it, if you ask a person, you know, if you want to know about a person, what's one of the first questions you ask? You know, what do you do? We don't really ask that now in medicine. So again, get that in there. Enter it by the patient. And then, again, how this collection will fit into their clinical workflow. That's going to be the big lift, because that's what I'm seeing now with the pilot program I'm in now, is we really want to see how this fits into what they already know, what they're already doing, really have them understand the value of it. So how does it look? This is a prototype that NIOSH has developed, and these are just screenshots. If any of you would like to see a full demonstration of it, I've asked the NIOSH team, and they would be happy to walk you through that. But this is just an example. Basically, you know, the patient would be prompted to say, you know, okay, are you employed or not? Are you retired or not? Retired or not, it would pop up as such. Then you would find your job, you know, through your industry. What industry do you work in? This one, you know, Department of Homeland Security. It would then drop down to further job categories. You pick one of those job categories, keep drilling down to when were you employed there? How long were you employed there? It could, the work and health functional profile pops up, you know, perhaps what your job hours are, your duties. And again, you could say, yes, this is it, or no, this is not it. Find the next one. There is an option for free text as well if you don't find what you do, but again, that will have to be something that's incorporated later on because we don't want the free text to stay there. This is an example of, let's say, a nurse. And again, the beauty of ODH is that it really does drill down. You guys know a nurse can do many, many different things. She can be seeing patients or not seeing patients. She can be working in a school or an ICU, a clinical manager versus, you know, a frontline. So it drills down on that as well. So the framework includes the information model and vocabulary. And that's the big thing, again, because we want it interoperable. We don't want every system to create their own code and find out, you know, how it's going to work for that system. We want it to work across all systems. It gives you an idea of how to collect and use this information. Again, you guys are the experts on how to use it. And then data sharing standards. Again, it's going to be a requirement in U.S. CDI interoperability. So, you know, how do you report, you know, when you're sending that report and it has the INO information, how do you report it? So what will the next pilot programs be? And that's where Dr. Manny Berenji is going to tell us her experiences in reaching out to colleagues on creating a pilot program and how we can advocate for it. »» All right, I'm the closer. So thank you, Dr. Kowalski-McGraw. This was an excellent discussion of occupational data and health. And I'm just so amazed at what you've been doing in this space. So thank you for that great presentation. So really, at least for my segment, I'm just going to talk about how you all can reach out to your stakeholders at your respective healthcare institutions to get them, you know, to understand the value of capturing occupational data for health. So as many of you may or may not know, I used to work at Boston Medical Center. It was a safety net hospital in New England. They serviced millions of patients, many of them patients of color. And I had been working as an occupational medicine physician there for a number of years. So I was working within the Department of Orthopedics. I managed the worker injury clinic. And it really kind of came to my understanding that we had a lot of different workers from different worker populations that we weren't systematically capturing their job descriptions and their job titles and what they were doing for a living. So this kind of resonated with me on many different levels. So from my experience, developing those relationships with primary care is so important. My orthopedic colleagues, you know, they're focused on the surgeries and that's what they should be doing. But I was the liaison between our department and the primary care department. And being able to ensure that, you know, folks who had other comorbid conditions after their surgical procedures, they would come to see me, you know, for post-operative care, making sure that we could tie the loop and get them to see their primary care doctors to take care of some of their underlying medical conditions. So that's how I really started to get to know my colleagues in primary care. I primarily interfaced with general internal medicine. And one of my colleagues in particular was focused on the social determinants of health. So I was able to kind of leverage that relationship to kind of bridge the topic of work as a social determinant of health. And I know Dr. McKenzie has been on the forefront of this particular concept. How do we incorporate work as a social determinant of health? And I think that's a way where we can start those conversations with our primary care colleagues. And really understanding the culture of your primary care colleagues and how they operate. I was very fortunate at my institution that we had a lot of champions of occupational health. Many of them had experiences working in occupational health, whether it was through a rotation as a resident or having, you know, interactions with people like myself. So I think if you're able to start cultivating those relationships, educating your colleagues, I think that's key. So once you establish that rapport, you know, how do you build up on that? I highly recommend doing an educational seminar. I actually did a Zoom a couple years back for my colleagues. Just, you know, short and sweet during the lunch hour. Doesn't have to be fancy. But you can bring up a lot of the topics that we discussed today and, you know, at least try to pique their interest. You know, try to identify a topic that may have relevance for them. You know, maybe they have a lot of patients who have low back pain and, you know, they kind of, you know, identified that many of these people work in specific occupations. So try to understand, you know, what kind of patients they're seeing and then custom tailor that presentation to your audience. And then making sure that you're, you know, continuing to follow up. I know we get excited, we love to talk, but then we kind of, you know, we don't follow up. So I think that would be key to ensure that you're continuing those dialogues through time. And clearly you need to get buy-in from your leadership, the C-suite. So in my experience, I actually was able to foster a relationship with our chief medical informatics officer at Boston Medical Center. And she actually was a strong proponent of capturing occupational data for health. Unfortunately, COVID kind of sidetracked her because she had to focus, you know, clearly on getting, you know, information to the respective healthcare officials on COVID and, you know, trying to capture all those metrics within EPIC, which was our electronic health record. So, you know, clearly timing wasn't perfect, but our interactions, she did value what we were doing and she really was trying to get this pilot off the ground. I made a strong pitch for it. Unfortunately, it did not come to fruition, but it doesn't mean that we give up and, you know, continue to engage your leaders, you know, find someone that you can potentially develop that rapport with. In my case, it was the chief medical informatics officer. For some of you all, it might be, you know, someone else, but, you know, don't be afraid to take that leap of faith. Don't stop believing. That's all I have to say about that. So, conclusions, I wasn't sure who was doing this, I can do it, okay. So at the end of the day, we want to make sure that you have a couple of takeaways from this presentation. I know we presented a lot of different concepts. So really understanding the importance of standardizing work information. I'm big on standards, I know my colleagues are as well. It's important to be able to develop those metrics and clearly within ACOM, that's something that is of major importance as well. Objective number two, explain how to operationalize the occupational data for health framework. So this is something that's still a work in progress. I know Michelle has been doing some really great work in this space, but perhaps, you know, trying to build up some literature, continuing the work of Dr. McClellan, you know, as we get into the next phase of this project, you know, making sure that we standardize those terms that people can understand. Not just us, but our primary care colleagues and our public health colleagues. Just developing that standard language. Yes, this is just kind of presenting the information on the NIOSH occupational data for health framework. Objective number three, so how do we contribute to efforts to include ODH in the primary electronic health record? I think this is the ongoing battle. I know many of us work for healthcare institutions. A lot of us have our own independent practices. We all come from different perspectives. But really trying to understand the importance of capturing occupational data for health is vital. And it really increases our visibility in the occupational environmental medicine space. So at least, you know, trying to take some of these, you know, tidbits from our presentation today and, you know, start those conversations with your primary care colleagues or, you know, your other medical colleagues, you know. Try to kind of build up this momentum, if you will. And start a pilot program today. Michelle's email is right there. So don't be afraid to reach out to us. We're all very available and accessible. And, you know, we want to be able to kind of talk some of this through with you. If you have questions or concerns about how to approach your colleagues at your institution, you know, we need to get those pilots. And I know a lot of us, you know, are busy with our respective clinical practices and other obligations. But this is a team sport. And we need as many people to participate as possible. Thank you so much for your attention. Hopefully, we have some time for questions. Yeah. I think there might be some. Yeah. Sure. It looks like we got some questions on the chat here in the swap card. So let's see here. It looks like Dr. DeWilde asked a question about, oh, I guess this is more of a comment. We also have systems which are of the workplace, in my case, Dow Chemical Company. So absolutely. I mean, we would definitely want to encourage, you know, not just healthcare institutions, but other stakeholders like corporations, for instance. So we can definitely reach out to this particular individual to kind of see if there may be some interface here. Oh, sure. Absolutely. Yeah. And through this conference, too, I've had the opportunity to hear some of the corporations on what their response to COVID. And I know I'd be interested to hear, you know, within a corporation, how do you code those job occupations to know, again, within your own organization, say, the COVID cases. I know, I forget which presentation it was, but obviously, there was a disparate group, those that were actually out there versus those that were at home, which you'd expect. So I would be interested to know, you know, how are you using the codes within your own organization? Are you using SOC or O-NET, or is it just unique to that organization? So, yeah, there's a question from Elizabeth Murphy. What's the argument for a firewall? How are medical conditions and medications not relevant for occupational health providers? So it really, this is kind of the state right now, legally, there are clearly elements in the general medical record, which is an occupational medicine provider, when you are working as an agent of an employer, that you are not allowed, because of a variety of privacy laws, to have access to that information, unless the patient him or herself provides that information. So it is the state of the legal world right now, do you have anything? And I will say that there are examples right now, yesterday's meeting, I forget the name of it, but Marcia has, we were at the University of California in San Diego, has done a fantastic job in creating those role-based firewalls, so that you can have access, depending upon your role. And I know many of us have more than one role. Sometimes we're acting as an agent of the employer, and sometimes we're acting as an agent for the patient. And generally, you have two different logins for that purpose. I'll take some questions from the room, Neil. Thank you. I'm Neil Haas, occupational physician from Maine, and I have a lot of questions, actually, but I'll limit it to two. It seems that you have enough work to do already, but have you, in my experience, a lot of potentially valuable information about occupation, disability, employers meeting requirements for surveillance aren't necessarily on electronic health records, but are on human resources or other employer records? Have you looked into accessing and integrating employer records with occupational health or electronic health records? And the other one is, at least from my perspective, I know that a lot of us use electronic health records that are specific to occupational medicine. For example, at Maine General Medical Center, where I work, we use SysDoc. As bad as it is, it has its virtues, as far as an occupational health medical record goes. And I haven't looked into it, but presumably you have large EHRs like Epic and Allscripts that use standard information exchange protocols like HL7 FHIR. I don't know whether our occupational health databases use that information exchange. How much of a challenge do you have with integrating occupational health records or occupational electronic health records with general purpose health records? Two questions. Do you want to take them both? Yeah. I'll take both. Go ahead. So yeah, your first question. We were actually talking about that just yesterday, a group and I, about the records that HR might have. And they have a wealth of information. That's true. But back to the firewall, right now, I think, and others can comment, but it's still being worked out with the whole data privacy issue. And right now, we can't just pull that information into the primary medical record. So the whole gist of ODH was to have the patient volunteer it. Once the patient volunteers that information, it becomes protected health information. It's not like something that you got through HR or anybody else. So the best way right now is to basically have the patient volunteer that same information. You know, even if they are telling you straight from their HR record, it's different than if HR gives it to you. So that's my understanding of question one. Can I add something about that too? So I don't know how many of you have done a pre-placement exam or a medical surveillance exam or even a work injury exam and been provided by the employer who complains that you as a physician don't ever provide them any information. Have you ever been given by the employer a detailed job description, functional job description about what they do and the exposures they have? The number of times that's happened in my career is zero. Even though, even in OSHA regs, it says, Kathy, you know, thou shalt provide that information to the examining physician. I mean, where are the compliance officers anyway, but I will say that I think, Neil, you were working with me on one of the return to work issue, the clinical decision report that we worked on for acute low back pain. The idea is that there actually will be information that goes to the employer from the medical record that traditional kind of work restriction format would actually come out of the record. It's one of the expectations of a functional, a work and health functional profile, that it would enable communication, not just amongst clinicians, but to other need to know people about appropriate information that's legally, you know, they're due, they should have, whether it's the public health department or an employer. The other thing, and I'm not sure if you caught it, but how many of you are familiar with O-Net? So O-Net, you can Google it, just say O-Net, and you'll find it. And it is a list of a bazillion different, all the jobs and job codes, and with it a job description, as well as kind of educational background and this, that, and the other thing. So this system pulls in O-Net functional job description into the record. So the things that you saw that Michelle showed was not because the patient slash employee had typed in, you know, their job description, it's because it actually got sucked in because of the use of a code that O-Net would recognize and then it could get pulled in. So what does that mean? That means the employer hasn't provided you the information, but because the patient has entered their job and it's coded, you now know what their job description is. I think a fantastic, O-Net's not so great about exposures, I don't think, but more about the physical and cognitive demands of work. Question two. I know it had to do with SysDoc, which is, SysDoc is a trigger for me, too, so. Yes, so, yeah, so ODH is compatible with HL7 and FHIR capability, SysDoc is not, you know, as you know, so again, the idea is not necessarily to get the information from SysDoc into the primary medical records, it's to recollect it from the patient, but using these codes, and again, once it's in the framework, it has that HL7 capability and FHIR. Just a comment. Patients' memories are not, are very intuitive. Do you want to say, because online people can't hear you. Just a comment about getting information from patients rather than some verifiable source, presumably from original records, is that patient records are very inaccurate. I was working at a small critical care access hospital for, with a shared EMR, and I have a number of colleagues who claim that they, as occupational physicians, shared the same EMR with other practices, including primary care. We had our risk managers look into it, and they didn't seem to have any problem with me being on, as an occupational physician running an exclusive occupational medicine clinic that wasn't a mixed practice, with me being on the same EHR as the rest of the practices at the hospital. I recently am working with a colleague that is, who is now working in Maine, but he came from Washington Permanente, who claims that he has the same experience. So it's not clear to me, and I'm really not too sure, for as much as I was able to look into the laws about shared data, how strong the firewall is, and if it is, who's monitoring the use of data from other sources that wouldn't be consistent with the laws. When the rollout of electronic medical records happened, many institutions, including large institutions, told their OCMED departments that they needed to use the general medical record. At that time, ACOM wrote a letter to EEOC about the integration of employee health records with those available EHRs at the time. And although they did not make an official ruling, they said, beware, not a good idea. And clearly there are laws that are out there that say they should not be combined. And especially large health systems putting their own employee health records and combining that and giving you, if you're working as an agent of the employer, it's really not cool for you to have ready access to all the rest of the person's medical record without their permission, without their permission. If they give you permission, you can see that, but otherwise not. Now, I'm very aware that if you go across the whole nation, there are institutions that have one record. And the people doing OCMED can, but, I mean, I'm not a lawyer, but I've been around this circus several times around this issue, and it's pretty clear that there should be firewalls. That does not mean that depending upon what you're doing with that patient in your exam room that you might not legitimately have access to. So if you're doing a work-related injury, my experience has been that's not an issue of you having general access to the general record. But if you're doing a pre-placement exam or doing a DOT exam or whatever, that's where the firewalls come up. And so you can have two different logins is how I think it's usually done that gives you different types of access to that information. Did you want to add anything? Yeah, I just want to say I share the frustration that we are siloed. And, again, there is so much information that we have, you know, within SysDoc, within HR, within the employee health records that could be useful for general medicine. But right now we can't transfer that over. You know, you need the firewall. So you have to start somewhere. And I think that's what Dr. Eileen's story always brought up, too. Again, we know there's a dearth of where to start now on the side that's not occupational medicine, but you've got to start, you know, and that's what ODH is. So hopefully there will be a wealth of information as ODH is implemented, maybe even to match what's now in employee health records. Just one other point. I mean, those of you who have used some of these big general medical records recognize they, you know, they were not helpful for a lot of the things that we do in OCMED. And so there has been an ongoing panel of advisors to one of the largest medical records on how to make it more useful. And, in fact, there are now a module created that is much more OCMED-friendly to do the kind of things and kind of ways that we would use records in our own practice. Hi. Kathy Fagan, Ohio. Thank you so much for this presentation and for honoring Eileen's story, who's a giant in occupational health. We miss her so much. My question is that I, back, I was talking with her two years ago about trying to start this in a neighborhood practice that's a federally qualified health center in Cleveland, Ohio. So I want to, and they were just overloaded with COVID and also asking things like, well, you know, a lot of our people don't work, so why do this? But so I wanted to find out where you are. I'm not sure I understood where you are in the pilots. And, you know, I want to go back and talk with them again. So, yeah. So, yeah, the pilot we have with the National Association of Community Health Centers really just kind of started over the last several months. So the whole idea was to first educate these partners throughout the country on what ODH is. And then, again, the biggest lift right now is socializing the value, you know, really getting them to understand why we want this. And then, again, their health systems. There's one that's on Epic. A lot of them are not. So we don't know, again, if they can basically process what ODH is intended to process. And, again, back to what Eileen said, you have to start somewhere. You have to see where you are with this. And so really we are just at the very beginning on this National Association of Community Health Centers. If anything, there's been some frustration from the NIOSH team because, you know, they're not the clinicians. So I try to keep standing up for the clinicians. But the NIOSH team is like, why are you not using the codes? Use the codes. And, again, when you're just patients in the room, you're happy just to have them tell you what they do. That's the first step. So that's basically where we are right now. I don't know if, Manny, you wanted to say anything more about pilots? I wanted to say something about pilots. And that is that Brett Perkison at the University of Texas has convinced his organization, a very large health system, to actually do a pilot. So that is underway right now. I mean, they're just starting. But they actually have signed on. And so it's very exciting because that will be a huge health system that will be on it. So let's take another question here, and then I'll go to the online because there's some questions there as well. Go ahead. I hope I can ask two. We may not remember them both, so do one at a time. One at a time. You had mentioned the industry and occupation data fields within the cancer registries. At least in my state, they're not required. And when we had looked into trying to do a study, they were completed at only a third of the patients, and of those retired was the most common occupation. So is there any kind of movement toward trying to make those required fields? Well, I think it's a state-based situation. So I think it depends on the state. I mean, it's an internal political kind of situation. But that's the whole point of this whole project is that if, in fact, ODH was in the system, INO, in the general medical records, part of the huge idea is you have the industry and occupation today, hopefully passed as well, and family member as well in the full-blown version, and you also have diagnoses. I mean, that's really one of the key values of this that would obviate the need to go state by state. No, that's a good point. The program does prompt you, like say I'm retired. Well, it keeps asking you, you know, what did you do before? What did you do before that? And it was also brought up, how long is the patient going to spend with this? They can still just say, okay, fine, I'm done. You know, when you fill out a survey, you can say I'm done now. You know, whatever data we get is good. But it keeps prompting you for more and more and more information. My second question is I really think that primary care, having that information, the opportunity to counsel is really important. I will say primary care physicians have a problem in that they're often given only 15 minutes and have to address, you know, treatment for hypertension, diabetes. Has there been any partnership with family practice, internal medicine colleges, to work together to see how that might be practically implemented? Yeah, that's a great question, and I've actually had some experience with this. So when I was at Boston Medical Center, I did work with my general internal medicine colleagues as well as my family medicine colleagues. We did start having those initial discussions about having them introduce these topics to their respective organizations. That included ACP as well as the American Academy of Family Practice. Unfortunately, COVID kind of derailed some of those efforts, and I left Boston Medical Center. But I still have those relationships, and I think that's a great point. We need to kind of cultivate, you know, those relationships and kind of keep this momentum going. So I appreciate that. I'm definitely going to follow up on that. So the return to work clinical decision support that we put together drew heavily on Kaiser Permanente's system that actually was spread throughout the entire system for primary care providers to use, and it basically facilitated the completion of a return to work form. So I don't know, you know, they looked a little different in every state, but they basically have similar aspects that actually requires a fair amount of thinking and time to complete the system that if they actually incorporated one of these clinician decision support tools, clinical support tools, actually would facilitate the completion by a primary care provider in a way that has been successful already with a, I don't know how many primary care providers Kaiser has, but a lot, you know, may have thousands probably. And it was well adopted, actually. It was not required, but it was well adopted because, and it actually, primary care physicians complete not just return to work forms, but they don't call it a return to work form at Kaiser Permanente. I think it's return to function or return to, or it's called a, what's it called? An activity prescription is what they call it. Because it may be a high school football player who's had an ankle injury. It could be someone who's going to camp. It could be a retired person who wants to go on a mountain trek. There's a frequent request for primary care providers to provide some type of an activity prescription, and this particular system, which was incorporated into an electronic medical record that many of us use, was very much enjoyed and used by primary care providers and saved them time. So I don't know if you have ever talked to anyone about that from Kaiser Permanente. Just a comment. Michael Malley from UC Davis. I went to one of the HL7 fire meetings. Up-to-date was there, and they had integrated this clinical decision support with vocabulary. They term it in informatics jargon, clinical decision support books, which is basically based on vocabulary terms that appear in the medical record, and then that would generate an up-to-date page popping up to the provider. So, I mean, there's people working on this kind of thing, and it's really people trust up-to-date, and I know residents at UC Davis kind of base all their notes on information from up-to-date. So, I mean, that's a ready tool for people to get into and trust if they have the combination of the vocabulary, the up-to-date subscription, and all this other stuff that people already trust. So, there's ways to do this that would seem familiar to people. That's, I think, a really interesting idea that should be brought back to NIOSH because it is universally used, I think, and trusted, et cetera, et cetera. That's a great, great comment. Up-to-date isn't really up-to-date on occupational health, so there's a lot of need for us to put in our oar there. So, that would be a fantastic, again, opportunity to make ourselves useful and people know about it. I had a comment, actually. So, I'm actually an editor, actually an associate editor for occupational health with Dynamed, which is the competitor to up-to-date. I'm not pushing up-to-date. I'm just mentioning that as an example. But I think we should, you know, if we actually have relationships with some of these folks, like I'm happy to broach the subject because they have actually reached out to me to do some editing around occupational health-related subjects and disability. So, I'm happy to kind of, you know, at least bring this up because I do think this is a great idea. Yeah, I've been working on a vocabulary set for, you know, pesticide exposures, and that part of it's a poster I did here at the conference, but it's just a little smidgen of what the project involves. But the vocabulary may be more important than all the other stuff in there, and it's based on a fairly widely accepted industry classification that includes pesticide mode of action, which people aren't generally aware of, which is extremely helpful in trying to assess what's going on with people that are exposed. Because most primary care doctors think all pesticides are the same. They're either cholinesterase inhibitors or fumigants. So, that's an example where, but it applies to all kinds of topics. And so, making that CDS folks work with your, was it Dynamed? Dynamed, yeah. Dynamed or Up to Data, one of those systems would be a huge way of facilitating. Yeah. The other comment was based on the discussion on the community health centers. I just wonder whether currently they all have EMRs of some sort because when I worked in one of those things in the past, the one I worked at didn't have any kind of medical record system at all. Yeah, they do all have EMRs, not all fantastic EMRs. Yeah. All right, guys. I know we've got about two minutes left. I know the next session is about to start, so I'll just go through these questions-slash-comments quickly. Anamiki DeWald also provided a comment. She says she agrees corporate OCDocs may be able to influence their hospital community health systems 100%. And then we got a question from Dr. Craig Thomas. Oh, sorry, Dr. Craig Thorne, rather. Do you communicate directly with PCP specialists through EPIC, example work clearances, et cetera? So in my experience at Boston Medical Center, I actually did. If I had a worker who had an injury and happened to be getting his or her primary care services at our hospital, I would send secure messages to that person's respective PCP just to make sure that, you know, they were helping that particular worker manage their respective condition. Go ahead. So, and Craig, actually, I think I presented at a session that you offered on NCQA certification for med clinics, and there is a certification for specialty practices that comes through the patient-centered medical home. The idea that primary care providers not just, they don't only not have a lot of communication with med people, but in general the communication back and forth between specialists has not been ideal. So NCQA set up this certification for specialty organizations to better integrate appropriate information with the primary care referring or providing physician. And we did that actually at Dartmouth, the exact same thing. Are we done with all the questions? Oh, did you answer the question about immunization registries above? So there was a question about, what was the question? How do I get up there? I don't know how to. I think you have to use the arrow. Oh, I see. I don't see a question about immunization registries. I'm sorry. I think the question was related to med access to immunization information. I think we probably have to just e-mail them because we actually have to wrap. Well, we're going to have to wrap up. We're going to have to wrap up. We're going to have to wrap up. We're going to have to wrap up. We're going to have to wrap up. We're going to have to wrap up. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.

ODH framework

occupational health data

electronic health records

patient care

employment status

work history

household work

implementation challenges

pilot programs

primary care providers

occupational data

healthcare organizations

population health