[MCOH-EH] Good information re: EPIC EMR for all EOHS work?

[Marenick,Cheryl]

FYI

Cheryl J Marenick RN BSN MPH CNIII

Women's Health Outpatient Pavilion, 2nd fl

Ph:860-679-1285

Fx:860-679-1494



[uconnhealth_stacked_blue_email]

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From: MCOH-EH <mcoh-eh-bounces at mylist.net> on behalf of Swift, Melanie, M.D. <Swift.Melanie at mayo.edu>
Sent: Tuesday, August 1, 2017 6:44 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Does anyone use EPIC EMR for all EOHS work?

I see that this issue has raised its head once again on the listserv. Below is my input on this that was posted about 6 months back.
For those interested, please see the MCOH archives for other prior discussion on this topic.
This is a really specific problem for medical centers who have an in-house EMR and are also doing occ/emp health for the medical center's employees. If you are a free standing occ health clinic seeing employee from the plant down the road on a contract, this would be easy. But for us, not so easy. As I see it there are these issues:


1.       HIPAA and OSHA privacy requirements for employment-related health records to prevent intentional or inadvertent access by coworkers.

2.       GINA and ADA risks for non-employment related health records to prevent access by the employer.

3.       Tracking of occupational services for compliance purposes.

The appropriateness of various software tools needs to be evaluated for each consideration.

For HIPAA and OSHA privacy, if you are taking care of external customers, a regular EMR should meet requirements as it does for any patient. However if you are documenting employment-required medical services for your own employees, extra measures need to be taken so that people outside your occupational health/employee health practice cannot see those records. That can be a privacy setting, a sequestered database, a firewall, or an alias system. Not just a "break the glass" feature where once someone is in the EMR to provide primary care, occupational records are still visible.

To minimize GINA and ADA risks to the employer, the person's private medical record should be off limits to the employer without a specific signed release. How you accomplish this can vary - your own internal legal counsel and other stakeholders need to be comfortable. Maybe you don't allow anyone who works on behalf of the employer doing occ/emp health to have access to the personal EMR at all. Or perhaps you establish tight policies and practices that ensure no information from that EMR is shared between occ/emp health and any other party without appropriate releases, and ensuring that nobody in occ/emp health is making employment/job decisions impacting that employee.

For tracking and reporting, an EMR is not the ideal tool anyway. EMRs are good at documenting medical care. They are lousy at identifying what wasn't done for patients that were never seen. Can you imagine an EMR that could show you all the county residents over 65 who have not had a pneumococcal vaccine? Not what they are designed to do. Nor are they designed to track people's jobs and occupational risks, much less their current employer and department. All of which you need to do if you are going to know the compliance rate for hepatitis B vaccination/declination for the MICU staff of your hospital. To track occupational compliance, you need a tracking system separate from the EMR. The holy grail is a system that can communicate in a HIPAA/OSHA compliant way, so that your staff don't need to double enter simple services like flu shots - and can enter them quickly and outside a traditional clinic-based encounter. But if you expect an EMR to do everything for you - track work restrictions, send email reminders to employees, populate compliance reports for all your programs, identify groups exposed to a common source patient, track outcomes of those exposures, etc - I don't think that's realistic.

I think the best we can hope for is a good tracking system that populates your employees automatically, ideally in real time or daily, knows where they work and what they do and what occupational health programs and services they need, allows you to track completion of those services and other "metadata" for all the services you do, and can produce routine and ad hoc reports. But that doesn't really replace a medical record. In the EMR you'll put vital signs, exam findings, prescriptions, imaging, etc. The tracking system just needs those key fields the employer needs to identify trends and track compliance - date of injury, hazard, route of exposure, object causing injury, etc. We built one and have tweaked it over the years to suit our needs, and found it's better in the long run than an off-the-shelf product. But whether that's the best solution will depend on your size, complexity, and resources.

I think you could use EPIC as the EMR and still accomplish the first two objectives. But use it for tracking purposes? No way.


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
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From: MCOH-EH [mailto:mcoh-eh-bounces+swift.melanie=mayo.edu at mylist.net] On Behalf Of Jerry Burleson
Sent: Tuesday, August 01, 2017 3:14 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Does anyone use EPIC EMR for all EOHS work?

Agree with the use of two systems.  We utilize EPIC for our Employee Sick Clinic and currently use Agility for the Employee Health tracking.  We are also preparing to switch to “Ready-Set”, a paperless EH software.

Jerry L. Burleson, RN, MBA
Manager, Employee Health and Clinic
New Hanover Regional Medical Center
PO Box 9000
Wilmington, NC 28403-9000
(910) 667-5663 – Office
(910) 612-8770 – Cell
(910) 667-5695 – Fax
Jerry.burleson at nhmrc.org<mailto:Jerry.burleson at nhmrc.org>

From: MCOH-EH [mailto:mcoh-eh-bounces+jerry.burleson=nhrmc.org at mylist.net] On Behalf Of Mazo, James
Sent: Tuesday, August 01, 2017 2:03 PM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] Does anyone use EPIC EMR for all EOHS work?

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There are issues with both GINA and ADA when using one EMR for both standard patient encounters and Occupational Health.  There needs to be firewalls to protect the employee family history in my opinion.   We use EPIC at the hospital (6,000 employee teaching hospital) and Systoc for occ health.

James E. Mazo, MD, FACOEM
Medical Director and Section Chief Occupational Medicine
Saint Francis Hospital and Medical Center
A Member of Trinity Health – New England
jmazo at stfranciscare.org<mailto:jmazo at stfranciscare.org>
W  860-714-5339
F  860-714-8068
114 Woodland Street
Gengras 4320
Hartford, CT 06105

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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Littell, Nancy T MD
Sent: Tuesday, August 01, 2017 1:49 PM
To: MCOH/EH
Subject: [MCOH-EH] Does anyone use EPIC EMR for all EOHS work?

Hi All,

Does anyone use EPIC for all of their OHS/Employee Health Services work?  We currently use EPIC system-wide, and for MD employee visits, but not to track immunizations/nurse visits/BBP’s etc.  Does anyone have experience with EPIC build for this?   Recommendations?  We areneeding to either use EPIC or a system that will easily work with it in a 12,000 employee Academic Teaching Center system.

Thanks!

Nancy Littell,MD,MPH

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Craig Thorne
Sent: Tuesday, August 01, 2017 12:49 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: [MCOH-EH] Does anyone use eClinicalWorks EMR for their practice?


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Everyone, is any of you currently use eClinicalWorks in your practice, please let me know as we may be converting to them as well.

Thank you!

Craig Thorne, M.D.
443-257-0903 (cell)
Craig.thorne at erickson.com<mailto:Craig.thorne at erickson.com>

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