[MCOH-EH] OHS EHR programs

[wendy thanassi]

That's a great idea, Michael!

One of our responders has a list... I will reach out to her again. It could
be a jump-start on such an effort.

Wendy

On Tue, Oct 4, 2022 at 5:19 AM Hodgson, Michael - OSHA via MCOH-EH <
mcoh-eh at mylist.net> wrote:

> Hi, how would dyou two feel about hitting up the ACOEM IT group to develop
> a formal requirements list?  Zeke might bite at that …
>
>
>
> *From:* MCOH-EH <mcoh-eh-bounces+hodgson.michael=dol.gov at mylist.net> *On
> Behalf Of *wendy thanassi
> *Sent:* Tuesday, October 4, 2022 1:02 AM
> *To:* Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu>; MCOH-EH <
> mcoh-eh at mylist.net>
> *Subject:* Re: [MCOH-EH] OHS EHR programs
>
>
>
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>
>
> Limited! ?!
>
> It's a tome of wisdom!
>
> You're too much :)
>
> There's so much good information here, it needs to be distributed to the
> whole  List.
>
>
>
> Best, Wendy
>
> Colleagues, Please see Melanie's reply, below.
>
>
>
> On Mon, Oct 3, 2022 at 2:41 PM Swift, Melanie D., M.D., M.P.H. <
> Swift.Melanie at mayo.edu> wrote:
>
> Here’s my limited contribution:
>
>
>
> Both Vanderbilt and Mayo use home-grown systems with some advanced
> sophistication.
>
> Occupational Health does not maintain the OSHA log at either institution –
> that is done by Safety in a separate system.
>
>
>
>
>
> Vanderbilt’s system:
>
> Pros
>
>    - Organized on principles of occupational medicine for hazards and
>    hierarchy of controls.
>    - Nightly feed from HR system.
>    - Robust structural framework  with editable picklists allowed
>    expansion to any new hazard/program.
>    - Interaction with EHR “at arm’s length” and in the background. OHS
>    nurses would not log in to employee’s EHR. Providers would log in to the
>    EHR to document medical care for acute care/workers comp, or in a
>    sequestered portion of EHR for surveillance exams.
>
>
>    - Details for immunizations given were sent those to employee’s
>       personal EHR via automated process
>       - No import of vaccines from EHR into Occ health (would have
>       required consent)
>       - Lab tests ordered by OHS sent to a table for nightly query of EHR
>       – results matching the ordered test type/date would then import into the
>       OHS tracking system
>
>
>    - Aside from immunizations administered, did not track medical
>    details, only “metadata” within the OHS system.
>
>
>    - Respirator questionnaire documented as completed/due with date and
>       outcome and any restrictions. Not every question or any medical details
>       kept in the system (scanned for OSHA recordkeeping purposes.)
>       - Surveillance exams similar. Documented “Hazmat physical” as
>       completed on specific date, if normal/abnormal and if any restrictions
>       needed. Full exam entered in sequestered portion of the EHR.
>       - Work injuries were entered in the system with date, hazard,
>       mechanism of injury, body part, and work restrictions. Details of the
>       physical exam, treatment and any medical care was documented in the EHR as
>       a provider, not in the tracking system as the employer.
>
>
>    - Robust reporting using Business Objects/Crystal Reports.
>
>
>    - Reports could be run on demand or scheduled/automated.
>       - Complex reports required programming expertise but simpler ones
>       do not.
>       - Users could easily edit or filter existing reports to make new
>       ones.
>       - We had between 150 -200 reports that we used on a daily, weekly,
>       monthly, quarterly or annual basis. Many were QA reports to find/correct
>       data entry errors.
>       - Compliance reports fed into other systems – performance
>       evaluations, animal research protocol approval system, credentialing
>
>
>    - Integrated employee portal for access to records, work restrictions,
>    and wellness program.
>
>
>    - Messaging within portal could be set up for a defined population
>       (e.g. TB surveillance program, Service Due Soon could have one templated
>       message for everyone with a TB surveillance service coming due; TB
>       surveillance, Service overdue/noncompliant could have a different message
>       that went out on a specified interval to everyone who had fallen out of
>       compliance.)
>
>
>    - Integrated mobile app for onsite events
>
>
>    - iPad-compatible
>       - Employee record located via ID badge swipe/tap
>       - Display only Due services, with option to view history
>       - Customizable to limit services displayed based on intent of the
>       event (flu only, Tdap only, all vaccines, all vaccines and labs, etc)
>       - Template upon nurse sign-on to set default service location, date
>       of service, vaccine lot number/exp date. Allowed nurse to tap “flu vaccine”
>       then “left arm” and then Save and Close.
>       - Could be programmed to send confirmation email to employee upon
>       completion of service (vaccination record, once-upon-a-time TST placement
>       record with read instructions)
>
> Cons:
>
>    - Needed a separate EHR to manage delivering medical care to
>    employees, which Vanderbilt does.
>    - System did not have way to identify supervisor (HR input limitation
>    from PeopleSoft.)
>    - Limited documentation available for nurse instruction or
>    conversations with employees.
>
>
>
>
>
> Mayo’s system is quite different and not as well planned and organized.
> Mayo occupational health is not allowed to deliver any medical treatment to
> employees (we even have to refer for HIV PEP after a BBF exposure – but we
> refer to one of our occ med colleagues in “the practice” who facilitate the
> prescription via phone at our request. Very clunky but that’s a problem of
> the organizational rules not the system.) So OHS does not have any access
> to the employee’s EHR. We get the employee’s permission to send vaccines to
> the EHR. There is an immunization ROI that employees can sign
> electronically to allow their existing vaccines in the EHR to be shared
> with OHS, and we are still getting a lab feed of COVID tests, but those are
> the only ways we interact with the EHR.
>
>
>
> I would say Mayo’s system was a rushed attempt to find a solution when the
> occ health service was extracted from the occ med practice in 2016. They
> had a short timeline and chose to adapt the existing tracking system for
> case management. Mayo invests a LOT in all-cause disability management and
> there are dozens of case managers continually reaching out to employees to
> update work restrictions etc. So the system handles individual injury or
> illness cases, work restrictions, and long detailed conversation notes, but
> does not handle programs for groups or populations well.
>
>
>
> It does have some “bells and whistles” that are nice to have:
>
>    - Sophisticated and almost-fully-automated COVID contact tracing
>    module (but kind of siloed from the rest of the OHS database.)
>    - Accurate identification of supervisors and easy way to push
>    notifications to employees and supervisors.
>    - Employee portal that allows viewing of some records and uploading
>    COVID tests. It is not well-organized and getting a makeover now. But
>    supervisors can enter the portal as a supervisor and see compliance status
>    for COVID and flu vaccine for their employees. It is not a full compliance
>    dashboard like Vanderbilt has but we’re heading toward that.
>
> Despite some nice features and a lot of customization, it does not handle
> group exposures or surveillance programs very well. It’s a little
> overprogrammed in that there is a lot that happens behind the scenes that
> may or may not be correct, but the OHS team doesn’t have a clear line of
> sight into what it’s doing all the time.
>
>
>
> We’re going to look at a Cority and Enterprise as well, it’s either that
> or a major overhaul of the system. We compete for internal IT resources so
> that’s a drag. (Vanderbilt OHS has an IT budget and we were allowed to
> contract with an IT vendor, which allowed us to make a lot of progress
> faster.)
>
>
>
> Good luck with the spreadsheet!
>
>
>
>
>
>
>
> *Melanie*
>
>
>
> *From:* MCOH-EH <mcoh-eh-bounces at mylist.net> *On Behalf Of *Thanassi,
> Wendy via MCOH-EH
> *Sent:* Monday, October 3, 2022 11:58 AM
> *To:* MCOH-EH <mcoh-eh at mylist.net>
> *Cc:* Thanassi, Wendy <Wendy.Thanassi at va.gov>; McKenna, Patrick <
> Patrick.McKenna at nationwidechildrens.org>
> *Subject:* [EXTERNAL] Re: [MCOH-EH] OHS EHR programs
>
>
>
> Hello all,
>
> Just so you know, I AM trying to capture the jist of the opinions on the
> EMRs on a spreadsheet. I continue to update it as new information comes in,
> so please include your signature line, which EMR you use, do you like it or
> not, and what do you use it for? So far there’s almost no entries for
> Enterprise.
>
>
>
> THANKS
>
> Wendy
>
>
>
> *From:* MCOH-EH <mcoh-eh-bounces at mylist.net> *On Behalf Of *Robert K.
> McLellan
> *Sent:* Monday, October 3, 2022 6:59 AM
> *To:* MCOH-EH <mcoh-eh at mylist.net>
> *Cc:* McKenna, Patrick <Patrick.McKenna at nationwidechildrens.org>
> *Subject:* [EXTERNAL] Re: [MCOH-EH] OHS EHR programs
>
>
>
> Eileen Storey worked on a project to convince the ONC to include Industry
> and Occupation coded data fields as a requirement in certified Electronic
> Medical Records used for general medical practice.  It worked!  I and O
> will is included as a requirement in the USCDI (interoperability
> requirements) V3.  There is a long history behind this effort which holds
> promise to revolutionize the relationship between occupational medicine,
> primary care and other specialties. Those interested in the details can
> purchase the session at AOHC 2022 on this topic.  Search for McLellan as
> the faculty.  Or, you can await an article that a few of us are writing to
> be published in JOEM later this year.  We are planning a 2 part article,
> the first part will address I and O in the general medical record.  The
> second part will address current and future efforts for these general
> medical records to have robust occupational medicine modules.  This latter
> will include a compendium of the functions we all would want in an occ med
> EMR.
>
>
>
> Bob McLellan
>
>
>
> *From:* MCOH-EH <mcoh-eh-bounces at mylist.net> *On Behalf Of *Hodgson,
> Michael - OSHA via MCOH-EH
> *Sent:* Saturday, October 1, 2022 4:50 PM
> *To:* MCOH-EH <mcoh-eh at mylist.net>
> *Cc:* Hodgson, Michael - OSHA <Hodgson.Michael at dol.gov>; McKenna, Patrick
> <Patrick.McKenna at nationwidechildrens.org>
> *Subject:* Re: [MCOH-EH] OHS EHR programs
>
>
>
> Hm
>
> Wasn’t Eileen Storey, then at NIOSH, working with the Office of the
> National Coordinator to develop something like that?
>
>
>
> *From:* MCOH-EH <mcoh-eh-bounces at mylist.net> *On Behalf Of *Cockrum, MD
> David S
> *Sent:* Friday, September 30, 2022 2:34 PM
> *To:* MCOH-EH <mcoh-eh at mylist.net>
> *Cc:* McKenna, Patrick <Patrick.McKenna at nationwidechildrens.org>
> *Subject:* Re: [MCOH-EH] OHS EHR programs
>
>
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>
> With Miriam’s comments about setting up a list-serve, I wonder if ACOEM
> has ever taken on the task of building a standard for Occ Med (all asepcts,
> including MCOH) software? I was in the early talks with Epic as they began
> to consider options. A group of docs was online all shouting out different
> things. It seems that ACOEM could publish a standard against which any Occ
> Med software could be judged. Or am I just naïve?
>
>
>
> David
>
>
>
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> *From:* MCOH-EH <mcoh-eh-bounces+dcockrum=frhs.org at mylist.net> *On Behalf
> Of *Miriam Alexander
> *Sent:* Wednesday, September 28, 2022 7:25 PM
> *To:* MCOH-EH <mcoh-eh at mylist.net>
> *Cc:* McKenna, Patrick <Patrick.McKenna at nationwidechildrens.org>
> *Subject:* Re: [MCOH-EH] OHS EHR programs
>
>
>
> This email originated from outside of the organization. Do not click links
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>
>
> We use ReadySet as well and come hell or high water we're going to make it
> work.  It sounds as if we have wrung much more functionality out of it than
> some of you.  I had done extensive research when we were looking and do
> feel that it meets the needs of a multi-clinic academic health center the
> best.  For those of you who know me, I push and push until I get what I
> want.  I've done this somewhat with Cority but would love to get an email
> list serve together of other occ doc users so that we can all pressure them
> to do even more.  We all have essentially the same needs from an EMR but
> without one voice its easier for them not to meet our needs..  We are able
> to successfully get ReadySet to meet more of our needs than some of you
> seem to have.  We are able to run our OSHA reports, we do injury care for
> our employees successfully though its clunky, we are able to do the
> majority of our surveillance exams and we successfully do our Return to
> Work encounters both occ and non-occ.
>
>
>
> Anyone interested in a  sub group of ReadySet users?  I do think that if
> we join forces we can move the platform more and more to our needs.  We
> have been able to get them to do some customization and we have
> successfully gotten our labs both through labcorps and Cerner through our
> internal labs.  We also are able to get our first report of injury to our
> TPA etc etc..........  The product certainly is clunky and clearly not
> designed by real end users of an employee EMR but i do believe we can make
> them, make it better.  BTW: I have no idea how to set up a list-serve or an
> email group but Patrick maybe you do?  DIdn't your residency teach you :)
>
>
>
> On Wed, Sep 28, 2022 at 5:18 PM Denece O Kesler <DKesler at salud.unm.edu>
> wrote:
>
> We use Cority's ReadySet as well, and I believe we run into issues similar
> to what Dr. McKenna notes. I was very frustrated that before we purchased
> it we were told that we could customize all of our forms—such as for
> different surveillance exams—and then were told that is not possible.
>
>
> For patient injury or return to work evaluation encounters, we use our
> Health System's electronic medical record - Cerner - with a firewall.
>
>
>
> Denece
>
>
> ------------------------------
>
> *From:* MCOH-EH <mcoh-eh-bounces+dkesler=salud.unm.edu at mylist.net> on
> behalf of McKenna, Patrick via MCOH-EH <mcoh-eh at mylist.net>
> *Sent:* Tuesday, September 27, 2022 7:47 AM
> *To:* mcoh-eh at mylist.net <mcoh-eh at mylist.net>
> *Cc:* McKenna, Patrick <Patrick.McKenna at nationwidechildrens.org>
> *Subject:* [MCOH-EH] OHS EHR programs
>
>
>
> *[[-- External - this message has been sent from outside the University
> --]]*
>
>
>
> Hi Wendy,
>
>
>
> We here at Nationwide Children’s would certainly be interested in seeing the spreadsheet of replies.
>
>
>
> We currently use Cority’s ReadySet EHR and it is OK.  It seems to handle most of the routine MC employee health functions just fine and provides a separate system for housing employee health records.  We’ve recently run into challenges with running reports. There can be unpredictable delays, sometimes reports can be run in minutes, sometimes it takes hours.  The same thing has happened with mass email notifications that go out through the system.  Our flu vaccine campaign notifications took several days to go out to all of our members.  Cority’s IS support has not been particularly helpful, basically just tell us that they know that there is a problem and they are working on it, but no guarantees it won’t continue/happen again.  We have also run into problems with doing any kind of customization to the platform.  When we’ve asked to enhance the WC injury documentation, add templated notes, add WC forms, they’ve basically told us they can’t do it.  Currently we are trying to set up a unidirectional lab feed from our drug testing lab to report urine drug screen results.  They told us it would take about 20 hours of IT work to make it happen, they’ve now been working on it for approximately three months and it does not seem to be any closer to completion…
>
>
>
> Several other systems in the region have transitioned to Enterprise Health, and we are exploring that possibility as well.  Would love to get a timeline on when Epic plans to have an Occ Health module available as that is what the hospital uses for everything else, just need to ensure that it allows for a separate system so that staff are not able to access each other’s employee health records.
>
>
>
> Thank you for compiling all of this!
>
>
>
> Patrick
>
>
>
> Patrick McKenna, DO MPH FACOEM
>
> Employee Health Medical Director
>
> Nationwide Children’s Hospital
>
> 700 Children’s Drive Room  A1034
>
> Columbus, OH 43205-2664
>
> Office: 614-355-4135
>
>
>
>
>
>
>
>
>
>
>
>
>
> Hello Folks,
>
> I am making a spreadsheet of the replies and am happy to distribute it to the list if that's of help to you!
>
> Can I broaden the question and ask: Who's using an EHR and do you like or dislike? Please include "home-grown" EHRs and the platform it was built on if you know it.
>
>
>
> Thanks!
>
> Wendy
>
> Stanford
>
>
>
> On Fri, Sep 23, 2022 at 11:25 PM Enass Awad <umhaneen at gmail.com<mailto:umhaneen at gmail.com>> wrote:
>
> I am very interested in this discussion as I am new to our clinic and we just got approved to start transitioning to EPIC .
>
>
>
> Currently the clinic uses Agility for both EHS and WC and it?s not the most efficient system .
>
> I also am wondering if anyone is using both Agility for EHS and Epic for WC , can share their experience.
>
>
>
> Thanks ,
>
>
>
> Enass Arahman, MD,MPH,FACOEM
>
> Medical Director , Employee Health Services
>
> UC Davis Health
>
> Sacramento , CA
>
>
>
> On Thu, Sep 22, 2022 at 20:34 wendy thanassi <wendy.thanassi at gmail.com<mailto:wendy.thanassi at gmail.com>> wrote:
>
> Hello,
>
>
>
> I'm in a quandary having spent WAYYY too many years of my life suffocated by paper medical records and handicapped by the lack of adequate report methods....
>
>
>
> Would you please tell me what OHS EHR programs you're using AND IF YOU LIKE OR DON"T LIKE ... AND... IF YOU BUILT SOMETHING IN EPIC, how many years did it take and does it work yet?
>
>
>
> I am most interested in:
>
> Cority/Axion Ready-Set
>
> Enterprise Health
>
> or homegrown EPIC
>
>
>
> We just heard that
>
>
>
>   *   Brown is going to Enterprise
>
>   *   Stanford U uses Enterprise
>
>   *   UCLA is 3 years into a bifurcated (WC / EHS) Epic build, in progress
>
>   *   St. Luke's uses UL's OHM program (not happy)
>
>
>
> Feel free to reply to me directly if you don't think the answers are useful to others.
>
>
>
> Thanks!
>
> Wendy Thanassi
>
> Stanford (yep, new job!)
>
>
>
>
>
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> --
>
> Miriam Alexander
>
> (410) 206-0579
>
> ---------------------------------------
> The MCOH-EH List has always been moderated by members of the ACOEM Medical
> Center Occupational Health Section. It is currently moderated by Joe
> Fanucchi MD FACOEM.
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