[MCOH-EH] Occupational health services and patient medical records

[Vaughn, Andrew I., M.D., M.P.H.]

DISCLAIMER: I am not a lawyer, and there is no legal advice here.  Please consult a lawyer for legal advice.


Occupational health recordkeeping is significantly more complex than 'standard' medical recordkeeping, in part because laws restricting the content of occupational health records can vary depending on who owns or has access to the content of the records, why the service they pertain to was performed, and how they are being used. For these and other reasons a separate (or at least a partitioned) record system is commonly used, with appropriate authorizations obtained when moving information between the records.

A major issue is posed by Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA), which prohibits genetic information discrimination in employment. "Genetic information" as defined in the law includes family history, and comingling occupational records with personal records that have family history or other genetic information may be problematic.  Note that GINA protections and confidentiality requirements cannot be waived by an employee. http://www.eeoc.gov/laws/types/genetic.cfm

The AAOHN has a nice (downloadable) summary of other issues in their Position Statement on "Confidentiality of Worker Health Information", accessible through google.

The following websites also have potentially useful information:

Occupational Medicine and Disability Law (e.g. section on WC Records)
http://biotech.law.lsu.edu/map/OccupationalMedicineandDisabilityLaw.html

The Privacy and Security of Occupational Health Records (American Health Information Management
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050145.hcsp?dDocName=bok1_050145



There's no question that providing occupational health services to healthcare workers creates unique situations and challenges. Please consult a lawyer for legal advice!


Andrew Vaughn, MD MPH
Medical Director, Occupational & Environmental Safety & Health
Mayo Clinic, Rochester MN
vaughn.andrew at mayo.edu




From: MCOH-EH [mailto:mcoh-eh-bounces+vaughn.andrew=mayo.edu at mylist.net] On Behalf Of Birkholz, Brenda M
Sent: Wednesday, July 01, 2015 5:08 PM
To: 'mcoh-eh at mylist.net'
Subject: [MCOH-EH] Occupational health services and patient medical records

Do your health systems' clinics or service areas, keep the documentation of occupational health related services in a location other than the patient's regular medical record?  We do not have an occupational health clinic  - but have small general medical clinics with contracts with area employers to provide some limited services for their employees.  Our clinics have been operating on the premise that these occupational health services could not go into the patients' general medical record.  The need to do this is being questioned now - and I've been asked if there are any standards dictating where the occupational health services need to be documented/retained.  OSHA's medical record keeping standard does not appear to address how a medical provider/clinic maintains occupationally focused services differently from other health services. I am thinking the service can go into the patient's medical record - but since I don't work with external occupational health services at this time - wanted to check with this group.  Are there any standards that would require keeping occupationally related services out of a patient's general medical record?  Thank you for your help.

Brenda Birkholz, MPH, RN, COHN-S
Manager, Employee Health
Hutchinson Health
1095 Hwy #15 S
Hutchinson, MN  55350
Ph: 320-484-4502
Fax: 320-484-4643


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