On Tue, Jun 6, 2017 at 8:32 AM, <mcoh-eh-request@mylist.net> wrote:

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Today's Topics:

1. Re: Color blindness screening (Swift, Melanie, M.D.)
2. Re: [EXTERNAL] MCOH-EH Digest, Vol 252, Issue 189
(Mitchell, Peter)
3. Re: Color blindness screening (Linda Clark, MD)

----------------------------------------------------------------------

Message: 1
Date: Tue, 06 Jun 2017 13:22:53 +0000
From: "Swift, Melanie, M.D." <Swift.Melanie@mayo.edu>
To: "mcoh-eh@mylist.net" <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Color blindness screening
Message-ID: <9153c6$6t9o8p@ironport10.mayo.edu>
Content-Type: text/plain; charset="us-ascii"

Darn, I loved "screening mythology" - I might use that. Particularly apt for color vision screening.

A couple of things to bear in mind:

* Color vision testing in a clinical setting is a medical test under the ADA.

* Competency demonstration in the workplace is not a medical test.

Chew on that a minute. Now a few more background things to note:

* Color vision deficiency can occur in different spectra - red-green, blue-yellow are the main types. Ishihara and most commercially available color vision screening tests are focused on red-green which is most common congenital deficiency. Point of care tests often use the yellow-blue spectrum more.

* Even if the colors you test do match those the person uses in their job (and the ADA expects you not to be doing a medical test unless it relates directly to the job function) that does not mean that they can correctly perform and interpret the test. For patient safety you still have to do a competency test.

* People with color vision deficiency can often compensate. If the test includes a key or legend, they may still be able to accurately match the key, even if what they are seeing looks olive to them instead of pink. Therefore someone who fails a color vision test still needs a competency test to determine if they can do this job function safely.

* While some color vision deficiencies are genetic, others are acquired, most often through a chronic disease process like diabetes. So if you are going to rely on color perception testing, you would need to do it periodically, not just at hire.

* Lighting is a huge factor in color vision perception. Someone with a partial deficit could perform well in a well-lit exam room where you are going screening, but be completely unable to discriminate those same colors in a poorly lit area.

In short, for color vision screening to make sense and be ADA compliant, you'd need to perform the testing in a setting that mimics their work environment, using the same colors that they would be using in the tests they perform and not just what is in the Ishihara plates, and you'd need to repeat testing periodically. And they would still need to do competency testing periodically to demonstrate that they can accurately perform and interpret the test.

I'd urge you to resist the temptation to do standard color vision screening test, and to consider doing good competency testing annually. That's another rock to look under - what does the competency testing entail. There should be positive and negative controls, and everyone should have adequate lighting to do the task, both in the competency test area and in the clinical area where the test is performed, which are ideally the same place.

Melanie

Melanie Swift, MD
Senior Associate Consultant
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org<http://www.mayoclinic.org/>

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Holley, Stephanie A
Sent: Monday, June 05, 2017 6:24 PM
To: mcoh-eh@mylist.net
Subject: Re: [MCOH-EH] Color blindness screening

Ok-screening is not a myth:) How about sharing your methodology, please. Thanks! Steph

From: Holley, Stephanie A
Sent: Monday, June 05, 2017 5:59 PM
To: 'mcoh-eh@mylist.net'
Subject: Color blindness screening

Good Evening,

We are interested in knowing if your facility screens health care providers for color deciphering (i.e. Ishihara or Farnsworth). If so, would you please share what screening mythology you use and if you have a product that works well (vendor for purchases).
Thanks much!

Stephanie Holley MBA, BSN, RN, CIC, FAPIC
Nurse Manager, University Employee Health Clinic
University of Iowa Hospitals and Clinics
319.384.9584
stephanie-holley@uiowa.edu<mailto:stephanie-holley@uiowa.edu>

[https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-signature-2016.jpg]

________________________________
Notice: This UI Health Care e-mail (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is intended only for the use of the individual or entity to which it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If you are not the intended recipient, any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender immediately and delete or destroy all copies of the original message and attachments thereto. Email sent to or from UI Health Care may be retained as required by law or regulation. Thank you.
________________________________
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Message: 2
Date: Tue, 6 Jun 2017 13:28:37 +0000
From: "Mitchell, Peter" <Peter.Mitchell@va.gov>
To: "mcoh-eh@mylist.net" <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] [EXTERNAL] MCOH-EH Digest, Vol 252, Issue 189
Message-ID:
<8C605126729C3B42B3AED025267ED9BF2847C268@VAPNSMSGD53S01.vha.med.va.gov>

Content-Type: text/plain; charset="us-ascii"

We use Ishihara as loaded in a TiTmus machine.

Peter T. Mitchell, APRN, CNP, COHN-S
Employee Occupational Health (111H)
Veterans Affairs Health Care System
Minneapolis, MN
612-467-2986 (direct)
peter.mitchell@va.gov

-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces+peter.mitchell=va.gov@mylist.net] On Behalf Of mcoh-eh-request@mylist.net
Sent: Tuesday, June 06, 2017 7:29 AM
To: mcoh-eh@mylist.net
Subject: [EXTERNAL] MCOH-EH Digest, Vol 252, Issue 189

Send MCOH-EH mailing list submissions to
mcoh-eh@mylist.net

To subscribe or unsubscribe via the World Wide Web, visit
http://mylist.net/listinfo/mcoh-eh
or, via email, send a message with subject or body 'help' to
mcoh-eh-request@mylist.net

You can reach the person managing the list at
mcoh-eh-owner@mylist.net

When replying, please edit your Subject line so it is more specific than "Re: Contents of MCOH-EH digest..."

Today's Topics:

1. Color blindness screening (Holley, Stephanie A)
2. Re: Color blindness screening (Holley, Stephanie A)
3. Re: Color blindness screening
(SherriLynn.Davidson@hcahealthcare.com)
4. Re: Color blindness screening (Senior, Cathy (Employee Health))

----------------------------------------------------------------------

Message: 1
Date: Mon, 5 Jun 2017 22:58:43 +0000
From: "Holley, Stephanie A" <stephanie-holley@uiowa.edu>
To: "mcoh-eh@mylist.net" <mcoh-eh@mylist.net>
Subject: [MCOH-EH] Color blindness screening
Message-ID:
<1968FE2C56092444865BCBE94FEA64CD7F4CF77F@hc-mailboxc1-n2.healthcare.uiowa.edu>

Content-Type: text/plain; charset="us-ascii"

Good Evening,

We are interested in knowing if your facility screens health care providers for color deciphering (i.e. Ishihara or Farnsworth). If so, would you please share what screening mythology you use and if you have a product that works well (vendor for purchases).
Thanks much!

Stephanie Holley MBA, BSN, RN, CIC, FAPIC Nurse Manager, University Employee Health Clinic University of Iowa Hospitals and Clinics
319.384.9584
stephanie-holley@uiowa.edu<mailto:stephanie-holley@uiowa.edu>

[https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-signature-2016.jpg]

________________________________
Notice: This UI Health Care e-mail (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is intended only for the use of the individual or entity to which it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If you are not the intended recipient, any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender immediately and delete or destroy all copies of the original message and attachments thereto. Email sent to or from UI Health Care may be retained as required by law or regulation. Thank you.
________________________________
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Message: 2
Date: Mon, 5 Jun 2017 23:23:39 +0000
From: "Holley, Stephanie A" <stephanie-holley@uiowa.edu>
To: "mcoh-eh@mylist.net" <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Color blindness screening
Message-ID:
<1968FE2C56092444865BCBE94FEA64CD7F4CFB11@hc-mailboxc1-n2.healthcare.uiowa.edu>

Content-Type: text/plain; charset="us-ascii"

Ok-screening is not a myth:) How about sharing your methodology, please. Thanks! Steph

From: Holley, Stephanie A
Sent: Monday, June 05, 2017 5:59 PM
To: 'mcoh-eh@mylist.net'
Subject: Color blindness screening

Good Evening,

We are interested in knowing if your facility screens health care providers for color deciphering (i.e. Ishihara or Farnsworth). If so, would you please share what screening mythology you use and if you have a product that works well (vendor for purchases).
Thanks much!

Stephanie Holley MBA, BSN, RN, CIC, FAPIC Nurse Manager, University Employee Health Clinic University of Iowa Hospitals and Clinics
319.384.9584
stephanie-holley@uiowa.edu<mailto:stephanie-holley@uiowa.edu>

[https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-signature-2016.jpg]

________________________________
Notice: This UI Health Care e-mail (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is intended only for the use of the individual or entity to which it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If you are not the intended recipient, any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender immediately and delete or destroy all copies of the original message and attachments thereto. Email sent to or from UI Health Care may be retained as required by law or regulation. Thank you.
________________________________
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Message: 3
Date: Tue, 6 Jun 2017 11:57:09 +0000
From: <SherriLynn.Davidson@hcahealthcare.com>
To: <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Color blindness screening
Message-ID:
<3E6B29246184AD4290C8D65E6808AEDB22B2EC97@XRDCWPMSGHCMD2C.hca.corpad.net>

Content-Type: text/plain; charset="us-ascii"

We use Ishihara in our facilities.

Sherri Davidson, MSN, ARNP-BC, COHN-S
Nationally Certified DOT Medical Examiner Clinic Mannager Company Care at Blake Medical Center
2010 59th Street West
Suite 3600
Bradenton, Fl 34209

CONFIDENTIAL - Contains proprietary information. Not intended for external distribution.

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Holley, Stephanie A
Sent: Monday, June 05, 2017 7:24 PM
To: mcoh-eh@mylist.net
Subject: [EXTERNAL] Re: [MCOH-EH] Color blindness screening

Ok-screening is not a myth:) How about sharing your methodology, please. Thanks! Steph

From: Holley, Stephanie A
Sent: Monday, June 05, 2017 5:59 PM
To: 'mcoh-eh@mylist.net'
Subject: Color blindness screening

Good Evening,

We are interested in knowing if your facility screens health care providers for color deciphering (i.e. Ishihara or Farnsworth). If so, would you please share what screening mythology you use and if you have a product that works well (vendor for purchases).
Thanks much!

Stephanie Holley MBA, BSN, RN, CIC, FAPIC Nurse Manager, University Employee Health Clinic University of Iowa Hospitals and Clinics
319.384.9584
stephanie-holley@uiowa.edu<mailto:stephanie-holley@uiowa.edu>

[https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-signature-2016.jpg]

________________________________
Notice: This UI Health Care e-mail (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is intended only for the use of the individual or entity to which it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If you are not the intended recipient, any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender immediately and delete or destroy all copies of the original message and attachments thereto. Email sent to or from UI Health Care may be retained as required by law or regulation. Thank you.
________________________________
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Message: 4
Date: Tue, 6 Jun 2017 12:28:54 +0000
From: "Senior, Cathy (Employee Health)" <CESenior@phhealthcare.org>
To: 'MCOH/EH' <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Color blindness screening
Message-ID:
<4d75c0442fd94e0498f4f71967c6ad40@EX13DB01.phhealthcare.org>
Content-Type: text/plain; charset="us-ascii"

We use Quick Six Color Vision Test Pseudoisochromatic Plates.

Cathy Senior RN BSN CDE
Employee Health Director
Penn Highlands DuBois
100 Hospital Avenue
P.O. Box 447
DuBois Pa 15801
Phone 814-375-3392
Fax 814-372-2610
cesenior@phhealthcare.org
www.phhealthcare.org
[PHH ESig Logo 150dpi]

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of SherriLynn.Davidson@hcahealthcare.com
Sent: Tuesday, June 06, 2017 7:57 AM
To: mcoh-eh@mylist.net
Subject: Re: [MCOH-EH] Color blindness screening

We use Ishihara in our facilities.

Sherri Davidson, MSN, ARNP-BC, COHN-S
Nationally Certified DOT Medical Examiner Clinic Mannager Company Care at Blake Medical Center
2010 59th Street West
Suite 3600
Bradenton, Fl 34209

CONFIDENTIAL - Contains proprietary information. Not intended for external distribution.

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Holley, Stephanie A
Sent: Monday, June 05, 2017 7:24 PM
To: mcoh-eh@mylist.net<mailto:mcoh-eh@mylist.net>
Subject: [EXTERNAL] Re: [MCOH-EH] Color blindness screening

Ok-screening is not a myth:) How about sharing your methodology, please. Thanks! Steph

From: Holley, Stephanie A
Sent: Monday, June 05, 2017 5:59 PM
To: 'mcoh-eh@mylist.net'
Subject: Color blindness screening

Good Evening,

We are interested in knowing if your facility screens health care providers for color deciphering (i.e. Ishihara or Farnsworth). If so, would you please share what screening mythology you use and if you have a product that works well (vendor for purchases).
Thanks much!

Stephanie Holley MBA, BSN, RN, CIC, FAPIC Nurse Manager, University Employee Health Clinic University of Iowa Hospitals and Clinics
319.384.9584
stephanie-holley@uiowa.edu<mailto:stephanie-holley@uiowa.edu>

[https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-signature-2016.jpg]

________________________________
Notice: This UI Health Care e-mail (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is intended only for the use of the individual or entity to which it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If you are not the intended recipient, any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender immediately and delete or destroy all copies of the original message and attachments thereto. Email sent to or from UI Health Care may be retained as required by law or regulation. Thank you.
________________________________

This email and any attached files are sensitive in nature and intended solely for the intended recipient(s). If you are not the named recipient you should not read, distribute, copy or alter this email. Any views or opinions expressed in this email are those of the author and do not represent those of Penn Highlands Healthcare or its affiliates.. Warning: Although precautions have been taken to make sure no viruses are present in this email, the company cannot accept responsibility for any loss or damage that arise from the use of this email or attachments.

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Subject: Digest Footer

---------------------------------------
The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh@mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc): http://www.mcoh-eh.net
MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
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List archives (public): http://mylist.net/archives/mcoh-eh/
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Send administrative requests to: drjoe@meditrax.com
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When replying to a message, PLEASE delete all footers, and all messages to which you're NOT replying, so the topic of your reply is immediately clear to other list members.

------------------------------

End of MCOH-EH Digest, Vol 252, Issue 189
*****************************************

------------------------------

Message: 3
Date: Tue, 6 Jun 2017 13:32:09 +0000
From: "Linda Clark, MD" <lclark@doctorclark.org>
To: MCOH/EH <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Color blindness screening
Message-ID:
<DM5PR19MB1035C8B0A750E3B68E43C739C3CB0@DM5PR19MB1035.namprd19.prod.outlook.com>

Content-Type: text/plain; charset="us-ascii"

I agree with you 100% Melanie, and made such an argument to a client of mine, a multi-site FQHC. However, they were "dinged" from the Joint Commission for not conducting color vision screening pre-employment. I argued the point, for many of the reasons you mention below, and per the health center, they would not budge on this opinion. So, we perform a 6-plate Ishihara through our Titmus for their employees, with the caveat that they still must complete all competency training requiring color interpretation - as you point out, many can still perform the tests accurately.
Linda

Linda L. Clark, MD, MS
Occupational and Preventive Medicine
(585) 227-0072 P
(585) 227-9585 F
lclark@doctorclark.org<mailto:lclark@doctorclark.org>

[065_clark_occ_logo_long_color]

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Swift, Melanie, M.D.
Sent: Tuesday, June 6, 2017 9:23 AM
To: mcoh-eh@mylist.net
Subject: Re: [MCOH-EH] Color blindness screening

Darn, I loved "screening mythology" - I might use that. Particularly apt for color vision screening.

A couple of things to bear in mind:

* Color vision testing in a clinical setting is a medical test under the ADA.

* Competency demonstration in the workplace is not a medical test.

Chew on that a minute. Now a few more background things to note:

* Color vision deficiency can occur in different spectra - red-green, blue-yellow are the main types. Ishihara and most commercially available color vision screening tests are focused on red-green which is most common congenital deficiency. Point of care tests often use the yellow-blue spectrum more.

* Even if the colors you test do match those the person uses in their job (and the ADA expects you not to be doing a medical test unless it relates directly to the job function) that does not mean that they can correctly perform and interpret the test. For patient safety you still have to do a competency test.

* People with color vision deficiency can often compensate. If the test includes a key or legend, they may still be able to accurately match the key, even if what they are seeing looks olive to them instead of pink. Therefore someone who fails a color vision test still needs a competency test to determine if they can do this job function safely.

* While some color vision deficiencies are genetic, others are acquired, most often through a chronic disease process like diabetes. So if you are going to rely on color perception testing, you would need to do it periodically, not just at hire.

* Lighting is a huge factor in color vision perception. Someone with a partial deficit could perform well in a well-lit exam room where you are going screening, but be completely unable to discriminate those same colors in a poorly lit area.

In short, for color vision screening to make sense and be ADA compliant, you'd need to perform the testing in a setting that mimics their work environment, using the same colors that they would be using in the tests they perform and not just what is in the Ishihara plates, and you'd need to repeat testing periodically. And they would still need to do competency testing periodically to demonstrate that they can accurately perform and interpret the test.

I'd urge you to resist the temptation to do standard color vision screening test, and to consider doing good competency testing annually. That's another rock to look under - what does the competency testing entail. There should be positive and negative controls, and everyone should have adequate lighting to do the task, both in the competency test area and in the clinical area where the test is performed, which are ideally the same place.

Melanie

Melanie Swift, MD
Senior Associate Consultant
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org<http://www.mayoclinic.org/>

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Holley, Stephanie A
Sent: Monday, June 05, 2017 6:24 PM
To: mcoh-eh@mylist.net<mailto:mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Color blindness screening

Ok-screening is not a myth:) How about sharing your methodology, please. Thanks! Steph

From: Holley, Stephanie A
Sent: Monday, June 05, 2017 5:59 PM
To: 'mcoh-eh@mylist.net'
Subject: Color blindness screening

Good Evening,

We are interested in knowing if your facility screens health care providers for color deciphering (i.e. Ishihara or Farnsworth). If so, would you please share what screening mythology you use and if you have a product that works well (vendor for purchases).
Thanks much!

Stephanie Holley MBA, BSN, RN, CIC, FAPIC
Nurse Manager, University Employee Health Clinic
University of Iowa Hospitals and Clinics
319.384.9584
stephanie-holley@uiowa.edu<mailto:stephanie-holley@uiowa.edu>

[https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-signature-2016.jpg]

________________________________
Notice: This UI Health Care e-mail (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is intended only for the use of the individual or entity to which it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If you are not the intended recipient, any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender immediately and delete or destroy all copies of the original message and attachments thereto. Email sent to or from UI Health Care may be retained as required by law or regulation. Thank you.
________________________________
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------------------------------

Subject: Digest Footer

---------------------------------------
The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh@mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc): http://www.mcoh-eh.net
MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
---------------------------------------
List archives (public): http://mylist.net/archives/mcoh-eh/
---------------------------------------
Send administrative requests to: drjoe@meditrax.com
---------------------------------------
When replying to a message, PLEASE delete all footers, and all messages to which you're NOT replying, so the topic of your reply is immediately clear to other list members.

------------------------------

End of MCOH-EH Digest, Vol 252, Issue 190
*****************************************