Occupational Data for Health Data Elements and Structure for Consolidated CDA Social History Section

The project will facilitate the use of work information collected in health information systems, such as electronic health record systems. 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.

Currently, work information collected to facilitate patient care is typically recorded in free text notes and is not described in the same way across records. Therefore it is not easily referenced by care providers over time or when a patient is seen by multiple care providers. In addition, structuring work information would facilitate care by providing a means to review population health based on key factors. When organized as structured and defined data elements, work information could be utilized by the system to assist the provider with recognition and treatment of conditions related to or exacerbated by work, as well as treatment decisions for conditions that are not related to work but can be affected by work, such as diabetes management.

There is regulatory interest and intent to include some ODH data elements in EHR certification criteria (see Office of the National Coordinator for Health IT Interoperability Roadmap, ONC 2017 EHR Certification criteria, and Institute of Medicine report (2014. Capturing social and behavioral domains in electronic health records: Phase 1. Washington, DC: The National Academies Press). There is an opportunity to establish a preferred structure and definition for ODH in a CDA format before the regulatory requirements are put in place and the data are widely captured and shared. Acting now will facilitate interoperable implementation across systems when certification criteria are put in place. Because of the current regulatory requirements to produce a C-CDA document, C-CDA is seen as the de facto place for this template to serve as the preferred structure for ODH.

Providing structure to content about patient work that is sometimes already collected will make it more useful, benefiting both patients and providers. Collection of structured ODH may be accomplished in multiple ways. The simplest mechanism for collecting work information would be by patient data entry, which would be similar to a person providing information for job applications, which are often completed online.