A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century (2018) / Chapter Skim
Currently Skimming:
6 Promising Developments and Technologies
6 Promising Developments and Technologies
Pages 161-214
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From page 161... ...
This chapter discusses ongoing efforts that offer promise for improving occupational health and safety surveillance. Seven areas are focused on: • Exploration and implementation of a household survey, • Use of electronic health records, • Coding of occupational information, • Electronic reporting initiatives, • Use of workers' compensation data, • Leveraging existing surveys and data systems, and • Improving occupational hazard and exposure surveillance.
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From page 162... ...
The household survey under development has been designed on a statistically valid platform that will provide better demographic data as well as present the opportunity to ask occupational safety and health questions directly of employees, facilitate special studies, allow for rotating topics and questions, and obtain improved descriptions of acute events. Nonresponse will likely be a challenge, thus BLS has proposed several methods to improve response rates for the household survey, including the use of dialing protocols that rotate calls through different times of day and days of week, increasing the number of attempts of contact, and maximizing use of highly-trained interviewers (https://www.reginfo.gov/public/do/DownloadDocument?
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From page 163... ...
This option offers more flexibility in targeting selected industries and occupations, not possible with the first two options that add questions to the CPS, but at a higher cost, due to increased respondent burden and additional fixed costs of administering a separate survey rather than adding to an existing survey. According to NORC's estimates, the first two options based on adding questions to the CPS would produce 51,000 to 57,000 completed interviews within a $1 million budget, while the third option would yield less than 50,000 completed interviews within the same budget (NORC, 2016b)
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From page 164... ...
From these data, the HSE computes injury rates for all work-related accidents and injury rates from "reportable" workplace accidents (>3 day work absence and >7 day work absence; the latter is the same as what is required to be reported to the UK R IDDOR–equivalent of SOII)
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From page 165... ...
With insights from the NCHS experience regarding disease and chronic health conditions, BLS could consider including these questions in the HSOII. BLS would also need to consider the HSOII's potential to collect information about work environment hazards that have not been available nationally since the National Institute for Occupational Safety and Health (NIOSH)
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From page 166... ...
economy; • A statistically valid platform to ask occupational safety and health questions through special studies, rotating topics and questions, better demographic data, and improved description of the event; and • Self-reported data on occupational injuries or illnesses that provide 2 he European Foundation for the Improvement of Living and Working Conditions's T (Eurofound's) 2015 European Working Conditions Survey was administered in 35 countries to nearly 44,000 subjects through computer-assisted interviews conducted in 49 languages (Eurofound 2017a,b)
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From page 167... ...
, BLS should also expand this effort to include a periodic nationwide household survey to identify and track reports of occu pational exposures and should determine how best to identify and track chronic work-related illnesses. In the near term: • BLS should survey occupational injuries and acute illnesses (as in SOII)
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From page 168... ...
• BLS should prepare and implement a specific plan for routine analysis, interpretation, and preparation of a report on the findings from the HSOII along with a plan for dissemination and appropriate database access by researchers and the public. ELECTRONIC HEALTH RECORDS Passage of the 2009 Health Information Technology for Economic and Clinical Health (HITECH)
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The report recommended NIOSH focus initially on developing feasible means to incorporate an appropriate level of data on occupation, industry, and work-relatedness into the EHR and subsequently consider what efforts were needed to enhance the value and use of occupational data that would be available in the EHR in the future. In response to the recommendations in that report, NIOSH undertook a series of projects to build support for the capture of occupational data using EHR systems primarily focused on demonstrating the feasibility of capturing these data in the record, modifying or developing guidance regarding software systems for efficient management and retrieval of occupational data in the electronic record, and developing model systems of clinical decision support for the specific examples of asthma, musculoskeletal disorders,
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From page 170... ...
. The occupational data that minimally meet the needs identified in the IOM report are current occupation and industry (useful for acute occupational injury, short-latency occupational illnesses, and management of current medical conditions)
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From page 171... ...
Further efforts are critical to ensure that industry and occupation are included in the EHR meaningful use data. CODING OF OCCUPATIONAL DATA Data relevant to occupational health and safety surveillance have three basic dimensions: occupation, industry, and a description of the case characteristics of an occupational injury, illness, or fatality.
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From page 172... ...
. Coding of type of work and workplace is complemented by classification systems to characterize the occupational injury or illness.
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From page 173... ...
. Occupation and industry are often recorded as free text in death certificates, some birth certificates, and in several national surveys (e.g., NHIS, the Behavioral Risk Factor Surveillance System [BRFSS]
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174 A SMARTER NATIONAL SURVEILLANCE SYSTEM has developed guidance for funeral home directors concerning completion of this section (NIOSH, 2012)
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NIOSH is also starting new projects on coding cancer registry information from a small number of states and piloting use of real-time coding for death certificates in a sample of a few states. Building on the same knowledge base, NIOSH is adapting this approach for electronic health records to better serve clinician needs by preserving more of the rich details in occupation and industry titles with real-time coding.
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From page 176... ...
The initiative was suspended in 2012 due to a combination of a reduced budget and OSHA's intention to replace it with expanded electronic reporting under the injury reporting rule. In May 2016, OSHA issued a new rule requiring certain employers to report electronically injury and illness information required under OSHA recordkeeping regulations annually (29 CFR 1904)
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From page 177... ...
Establishments with 20-249 employees in industries with historically high injury and illness rates will now be electronically submitting information from the OSHA Form 300A–Summary of Work-Related Injuries and Illnesses.4 The electronic reporting rule covers more industries than were covered by the earlier OSHA Data Initiative, including many more industries in the service sector, which will provide valuable data for surveillance and intervention in this growing sector of the economy. For example, hospitals and ambulatory health care facilities, which both have high injury rates, are required to report injuries and illnesses to OSHA.
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From page 178... ...
Such feedback might be implemented as part of the Injury Tracking Application that OSHA is designing to collect occupational injury data directly from employers. Among concerns raised about the new electronic reporting requirement, two are relevant to its potential role for occupational safety and health sur
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From page 179... ...
As one response to the 1987 report, OSHA developed and implemented the OSHA Data Initiative, collecting summary injury data from 80,000 employers and utilizing the information for inspection targeting. As OSHA develops its system to receive and manage the electronic records, the agency will need to consult with BLS to assure that coding of the newly available case and demographic data that are submitted to OSHA as free text is compatible with the current methods that are in use for the BLS-SOII.
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With experience from participants in this electronic reporting, OSHA should explore feasibility to expand electronic reporting to all employers required to maintain OSHA logs. MOBILIZING USE OF WORKERS' COMPENSATION DATA Historically, the state and national occupational health community has recognized the value of workers' compensation data despite their limitations (Utterback and Schnorr, 2010, 2013)
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From page 181... ...
. Workers' compensation data are usually analyzed to determine how to price an insurance product for a single employer rather than using the data to focus on ways to lower the rate of injury and the associated social and economic costs that accompany occupational injuries.
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Current advances in technology, electronic reporting and billing of workers' compensation claims data, development of standardized formats, and promotion of the value of workers' compensation data to the public health surveillance community are making workers' compensation data more desirable and usable for public health surveillance. Workers' compensation information is currently used in 3 of the 22 occupational health indicators recommended by the Council of State and Territorial Epidemiologists (CSTE, 2017)
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T 9 nternational Association of Industrial Accident Boards and Commissions' Electronic Data I Interchange Claims Standards "are used by claims administrators to report workers' compensation first report of injury and subsequent report of injury claims data to U.S. jurisdictions" (IAIABC, 2017)
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From page 184... ...
In most states, in contrast to voluntarily collected data under the BLS SOII system, there is no collection of race and ethnicity information. Other challenges to using workers' compensation data in national surveillance efforts are challenges to comparability: differing scopes of coverage or varying waiting period before temporary total disability benefit receipt begins or when injuries need to be reported to administrative agencies.
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From page 185... ...
Opportunities for Incorporating Insurance Data and Improving Workers' Compensation Data for Occupational Safety and Health Surveillance Insurers can both contribute to and benefit from the increased amount of risk information that comes from improved surveillance. Insurers can combine their own information on site-specific hazards from safety engineering and industrial hygiene resources within their companies, with improved information from broader industry focused exposure surveillance and industry-wide injury statistics.
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From page 186... ...
The center is working to bring state public health epidemiologists associated with OSH surveillance programs together with workers' compensation data experts to focus the data on primary, secondary, and tertiary prevention of work-related injury and illness. Conclusion: Workers' compensation data have potential value for surveillance of occupational injuries at the state level and have been specifically used to this end in three states (Michigan, Ohio, and Washington)
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From page 187... ...
LEVERAGING EXISTING SURVEYS AND DATA SYSTEMS NIOSH's surveillance strategy places importance on leveraging existing surveys and data systems. Such efforts provide a valuable addition to the limited resources that NIOSH has available to dedicate specifically to occupational safety and health surveillance.
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From page 188... ...
Administration and BLS to link CFOI and FARS data for comprehensive data on fatal occupational crashes across industries and vehicle types. of national surveys that NIOSH is taking advantage of, as opportunity and resources allow, to incorporate additional questions and generate new occupational safety and health information.
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Further support for maintaining and enhancing these tools is needed. Occupation and industry are core sociodemographic variables collected in the decennial census and other population and economic surveys including, among others, the Current Population Survey and the American Community Survey.
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NIOSH has had some success in recent years working with other CDC programs and state partners to promote collection of industry and occupation information in additional data sources used for public health surveillance. A major critical initiative is NIOSH's ongoing work to incorporate industry and occupation information in electronic health records (described 10 he CDC PRAMS survey, conducted in partnership with state health departments, collects T information annually on approximately 83 percent of all U.S.
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BOX 6-4 Example: Collection of Industry and Occupation Information in the Behavioral Risk Factor Surveillance System (BRFSS) BRFSS is a national continuous health survey, conducted by telephone, of a representative sample of U.S.
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Box 6-4 describes another initiative working with the states on the Behavioral Risk Factor Surveillance System that is illustrative of both the opportunities and the challenges in incorporating occupational information in public health data systems. The CSTE has recommended that "occupational and industry and other work information as appropriate be included within CDC surveillance systems where feasible" (CSTE, 2014b)
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From page 193... ...
occupational safety and health surveillance is collection and analysis of data on occupational hazards and exposures. Hazard and exposure data are leading indicators for anticipating and preventing work-related chronic disease and, to a lesser extent, acute disease and injuries.
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Collection of such routine exposure data can be integrated into an employer's occupational health program to ensure compliance with regulatory limits, as well as being part of a government agency's routine collection of compliance information. Thus, a surveillance system can be built as part of other programmatic goals and does not have to be solely dedicated to surveillance.
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Figure 6-1 shows a Venn diagram of the many sources of data and the overlap among the systems that collect these data for occupational exposure surveillance. It provides an overview of the roles and relationships for many of the systems further discussed in this chapter.
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NET) and Occupational Requirements Survey (ORS)
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. Expansion on the types of exposure information collected using the Household Survey of Occupational Injuries and Illnesses could be integrated with exposure measurement databases, and thus the overlap of the individual and public agency data sources.
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The biggest challenge for this approach is its complexity and expense. Exposure Measurement Databases Quantitative measurement of exposure intensity using personal sampling methods provides the "gold standard" for industrial hygiene monitoring and standards compliance and provides the most accurate means of evaluating current exposure levels.
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PROMISING DEVELOPMENTS AND TECHNOLOGIES 199 routinely collected quantitative measurements into databases, which could then be used for surveillance activities. For instance, the compilation of MSHA data on silica or coal dust during various mining activities has allowed for active surveillance of conditions and risks, intervention at locations with high exposures, and for epidemiology studies of dust-related health conditions.
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NET is a publicly available online database that describes occupational features across U.S. job titles (O*
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NET has been partially validated, the Bureau of Labor Statistics, National Compensation Survey (NCS) program has initiated a refined "Occupational Requirements Survey" (ORS)
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a range of questions concerning employment status, work organization, learning and training, working time duration and organization, physical and psychosocial risk factors, health and safety, work-life balance, worker participation, earnings and financial security, as well as work and health and trends in these exposures were reported. Next Steps Several of the systems discussed above have potential for contributing to a comprehensive exposure and hazard surveillance.
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Such a survey could be modeled on the European Working Conditions Survey, which has provided very substantial information for European policy makers and researchers. Missing from a survey based on self-reported responses are quantitative exposure-level data, and risk factors that are not easily perceived by respondents.
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A precedent for this may be found in regulations concerning reporting injury and illness through the OSHA logs. If these two systems -- a periodic comprehensive population-based survey of working conditions and a publicly available compilation of exposure measurement data -- could be linked together through common variables (e.g., industry, occupation, location, organizational type and size, etc.)
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From page 205... ...
As an intermediate goal: • NIOSH, in collaboration with OSHA and other agencies as appropriate, should construct an integrated exposure database to include the multiple sources of exposure measurement data already available, specifically MSHA's MSIS, Department of Energy and Nuclear Regulatory Commission personal exposure data, and relevant data from others conducting research with federal funds. In the long term: • NIOSH should link the integrated exposure database with the comprehensive survey data obtained in the recommended expanded HSOII
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Also pertinent are new employer-based electronic reporting initiatives that will provide greater data for tracking work-related illness and injury targeting and thereby enhancing prevention and treatment efforts. Worker's compensation data and programs contribute valuable occupational safety and health information, and enhanced use of those systems could help move surveillance efforts forward.
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2017. Development of a diabetes mellitus knowledge resource for clinical decision support assisting primary care physi cians with work-related issues.
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2017. Enhancing worker health through clinical decision support (CDS)
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Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications, 80 Federal Register 16804-16921, March 30, 2015.
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2017. Using electronic health records and clinical decision support to provide return-to work guidance for primary care practitioners for patients with low back pain.
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2015. Utilization of the NH Behavioral Risk Factor Surveillance System (BRFSS)
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2015. Adding industry and occupation questions to the Behavioral Risk Factor Surveillance System: New opportuni ties in public health surveillance.
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, 2014 Vermont Behavioral Risk Factor Surveillance System. Available online at http:// www.healthvermont.gov/sites/default/files/documents/2016/12/data_brief_201611_work site_genl.pdf (accessed June 12, 2017)
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