Collection and recording of patient occupation information in the EHR: A pilot project in a primary care setting

Background: Information about patients' occupation is important for prevention, improved diagnosis and treatment of conditions that may be work-related. However, occupation information has not been incorporated systematically into medical records. Electronic health records (EHRs) allow for collection of more patient data, and for display, reporting, and retention of that data over time. Methods: In 2010, Cambridge Health Alliance (CHA) worked with the Massachusetts Department of Public Health's (MDPH) Occupational Health Surveillance Program to pilot systematic collection of occupation information for approximately 27,000 CHA patients through central registration. We partnered with the National Institute for Occupational Safety and Health (NIOSH) to trial their program for automated coding of industry and occupation information (NIOCCS). Results: More than 10,000 records were coded correctly by NIOCCS using this occupation information; additional records were coded manually. In total, more than 70% could be coded to Bureau of Census (BOC) codes. Frequencies were calculated by occupational and demographic groups. The most common CHA occupations are Students, Teachers, and Managers for English-speakers; Cleaners, Painters and Childcare workers for Portuguese-speakers; Cleaners, Cooks and Homemakers for Spanish-speakers; and Cleaners, Health Aides and Cashiers for Haitian Creole-speakers. Conclusions: This project demonstrates that occupational information can be collected from patients through telephone registration. Though NIOCCS has been optimized to code industry and occupation information together, a significant proportion of records were able to be coded to BOC codes. These data are being used to target education for patients and providers and to improve prevention, diagnosis and treatment of work-related conditions.