A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century (2018) / Chapter Skim
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7 Key Actions to Move Forward with an Ideal National Occupational Safety and Health Surveillance System
7 Key Actions to Move Forward with an Ideal National Occupational Safety and Health Surveillance System
Pages 215-248
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This chapter examines four actions essential for moving forward with the national occupational safety and health (OSH) surveillance system that is needed to improve worker safety and health: 1.
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. Given the enormity of this recent estimate, a regular national report on the financial and health burdens of occupational illnesses, injuries, and fatalities is essential for monitoring whether the United States is making measurable and meaningful progress in improving worker safety over time.
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The surveillance system can then be used to monitor progress toward reducing the total economic burden of occupational illnesses, injuries, and fatalities over time. Conclusion: Identifying the areas of greatest need for OSH interventions through use of an improved national surveillance system and then targeting effective OSH interventions based on previous research and evidence is likely to produce significant and substantial savings to employers, employees, and society and increase worker health and well-being.
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Enhancing Return from Current Resources Regular national reporting on the economic burden of occupational illnesses, injuries, and fatalities can also assist federal agencies, state and local governments, employers, and employee groups to address surveillance objectives more effectively with existing resources. Burden-of-illness studies have been conducted in the United States for decades and have estimated the economic burden of diseases for the entire population (e.g., Rice, 1967; Cooper and Rice, 1976; Rice et al., 1985)
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Allocation of Resources Another benefit of a regular national report on the economic burden of occupational illnesses, injuries, and fatalities would be to establish funding priorities by federal agencies with OSH responsibilities. The challenge when new resources become available or resources are newly constrained is to determine the most cost-effective way to allocate changing resource levels.
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COORDINATE SURVEILLANCE STRATEGIES AND OPERATIONS AMONG KEY AGENCIES, ORGANIZATIONS, AND STAKEHOLDERS As was described in Chapter 1, surveillance entails the collection and analysis of data, followed by the interpretation and dissemination of information to relevant actors to meet public health and prevention objectives. The legal and organizational context in the United States, and to a lesser extent in other countries, is such that many aspects of OSH surveillance are under the mandate of different agencies, which may have different objectives.
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. In that example, city and state syndromic surveillance systems adopted a common model for reporting aggregated data to a central system, which then combined the data to produce summaries and identify trends at a national scale.
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The NIOSH surveillance home page includes links to NIOSH webpages for its various surveillance systems and functions that enable the user to query BLS employment, CFOI and SOII data, and several of the NIOSH surveillance data sources. NIOSH also maintains a clearinghouse for surveillance reports and educational materials and surveillance tools generated by all the state-based surveillance programs.
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The committee returns to the topic of dissemination of surveillance information in the following section, where we consider the potential for informatics to enable OSH surveillance processes, including dissemination. USE INFORMATION TECHNOLOGY EFFECTIVELY An informatics perspective, where the focus is on the optimal use of data and knowledge to meet OSH surveillance objectives, allows a principled assessment of the potential benefit of new technologies to enable OSH surveillance processes.
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There is limited direct evidence in the biomedical literature about the effective use of existing and emerging information technologies for OSH surveillance, but it is possible to draw relevant insights from the literature on public health surveillance, from biomedical informatics more generally, and from advances in data management and analysis in domains beyond health and health care (e.g., electronic health records, machine learning, and social networks) .These insights are important in identifying potential roles of new technologies in individual OSH surveillance systems and to understand how these technologies can contribute to the development of a national OSH surveillance system.
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Recommendation J: NIOSH should build and maintain a robust internal capacity in biomedical informatics applied to OSH surveillance. In the near term: • Assess the need within the agency for expertise in biomedical informatics in the context of current and future demand, recognizing that it will be important to train informatics talent in OSH surveillance and then to work to retain talented individuals who develop knowledge at the intersection of the informatics discipline and OSH applications; • Create an organizational strategy for deploying and making optimal use of expertise in biomedical informatics to support the planning and conduct of OSH surveillance; • Develop a plan for hiring, including consideration of steps such as reaching out to academic programs, advertising in different venues, and offering internships; and • Develop a plan for retention, including opportunities for continuing education.
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within OSH surveillance systems, including the International Classification of Disease (ICD, with modifier codes to represent details of an injury) , the Occupational Injury and Illness Classification System (OIICS)
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, representation standards for interventions that target workplaces or populations are not available. A standard for these interventions would allow public health officials and others to record actions taken to prevent and control occupational injury and disease in a systematic manner.
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Another rich source of data is the electronic health record (EHR) , and novel methods for converting free text to structured codes can play an important role in processing EHR data to make them usable for OSH surveillance.
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For example, in the context of infectious disease surveillance, routine tests such as blood smears to detect parasites can be performed with acceptable accuracy using mobile devices (Pirnstill and Coté, 2015)
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Individual types of occupational injury and illness tend to occur less frequently, so additional research is required to determine the extent to which these events can be monitored through social media. EHRs and Electronic Reporting EHRs are increasingly used routinely in primary care and other settings, such as in emergency departments.
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The quality of the data in EHRs can be variable, so methods are needed to assess and assure the quality of OSH data extracted from EHRs. Recommendation L: NIOSH should lead efforts to establish data standards and software tools for coding and using occupational data in electronic health records.
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There is also the potential to influence future rules if "industry standard" approaches can be identified for extracting OSH text from electronic health records. Recommendation M: NIOSH and BLS, working with other relevant agencies, academic centers, and other stakeholders should coordinate and consolidate, where possible, efforts to develop and evaluate state-of-theart computational and analytical tools for processing free-text data found in OSH surveillance records of all types.
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specified as a supplement to the CPS will help to fill several analytical needs of a comprehensive national surveillance system for occupational safety and health. As currently envisioned by BLS, the proposed sample size
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All in all, NIOSH concluded that the hot spots indicated a need for improvements in prevention of CWP. This and other NIOSH surveillance data provided an important impetus for MSHA to promulgate a new Coal Mine Dust ranging from 51,000 to 57,000 individuals was specified to simultaneously satisfy the multiple objectives of sample representativeness, data quality, timeliness, and cost.
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Rule in 2014 to improve protections against respiratory disease caused by coal mine dust. These included improved exposure assessment using new technology (a real-time Continuous Personal Dust Monitor)
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Despite these challenges, as is done in other types of public health surveillance, OSH surveillance systems could take advantage of advanced statistical and machine learning methods together with data processing methods to automatically analyze OSH data as they are collected.
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Such coordinated analysis within a system of systems could help to identify emergent occupational illnesses and hazards that currently go unnoticed due to the lack of integration across surveillance systems and the inability to analyze data in real time. Recommendation N: To identify emerging and serious OSH injuries, illnesses, and exposures in a timely fashion, NIOSH (in coordination with OSHA, BLS, and the states)
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The MIFACE program issued a 21-page investigation report and a one-page haz ard alert, and published an article in Morbidity and Mortality Weekly Report in col laboration with NIOSH and OSHA. Recommendations were made that methylene chloride products should not be used to perform bathtub refinishing.
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New information technologies can aid greatly in this regard as most people are now instantly accessible via mobile devices and technologies such as social media and the EHR allow messages to be tailored to specific audiences and contexts. Mobile Devices The ubiquitous nature of mobile devices makes them well suited to disseminating knowledge and information.
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Once identified, it would be possible to direct those people to a website where they could provide further data, and analysis of those data could trigger an assessment of their workplace. Electronic Health Records While electronic health records are a technology that can greatly facilitate the capture of data, they also present an opportunity for disseminating information produced through the analysis of surveillance data.
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Rapid Alert Networks As in other areas of public health surveillance, an early warning alert network could use any or all of the strategies described above to disseminate important findings to the OSH community at large. Doing so could promote fast-track situational awareness of emergent occupational illnesses and hazards, accelerate more focused analyses to determine the level of imminent risk, and stimulate decisions on prompt responses and interventions to mitigate the danger.
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, however, it is taught to varying degrees across education institutions, and the specific aspects of informatics relevant to OSH surveillance are not taught routinely in many academic institutions. Recommendation P: NIOSH, OSHA, and BLS should work together to encourage education and training of the surveillance workforce in disciplines necessary for developing and using surveillance systems, including epidemiology, biomedical informatics, and biostatistics.
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Bos ton, MA. Available online at https://apha.confex.com/apha/141am/webprogramadapt/ Paper288596.html (accessed July 18, 2017)
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:1156. Available online at https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4371422 (accessed July 18, 2017)
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2011. Economic burden of occupational injury and illness in the United States.
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2010. Using electronic health record alerts to provide public health situ ational awareness to clinicians.
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Available online at https://www.osha.gov/oshstats/index.html (accessed July 18, 2017)
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2014. MDPHnet: Secure, distributed sharing of electronic health record data for public health surveillance, evaluation, and planning.
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