[MCOH-EH] Occ Med EMR inquiries
hudson.warner at gmail.com
hudson.warner at gmail.com
Tue Oct 4 12:22:56 PDT 2022
Totally agree Melanie. Warner
-----Original Message-----
From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Swift, Melanie D.,
M.D., M.P.H. via MCOH-EH
Sent: Tuesday, October 4, 2022 11:55 AM
To: MCOH-EH <mcoh-eh at mylist.net>
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu>
Subject: Re: [MCOH-EH] Occ Med EMR inquiries
I think it's important to define the difference between an employer's
tracking system and an EHR that would be used for documenting clinical care.
If you are an agent of the employer and managing compliance and workplace
requirements, you need a tracking system.
If you are providing clinical occupational medicine services within our
outside your own employer, you need an EHR.
If you are doing both functions, then there's the temptation to try and get
one system that does both. I haven't really heard of any systems that do
both functions exceptionally well. It seems that from a national perspective
it would be much easier for us to have a tracking system that works well for
all worksites, and an EHR that handles occupational medicine clinical care
and documentation well. If you do both, then at most it would be double
entry for some services, but you don't have to repeat everything in a
tracking system, just date, outcome, etc.
I am wondering if we're at this impasse because we're trying to get one
product that does both extremely well. Maybe the holy grail is twofold: a
great EHR that works for occupational medicine (and this is probably how
they will be approaching it at EPIC) AND a great employer occ health
tracking database that handles every potential program with robust flexible
reporting. If we had both of those, some (but not all) OM clinics would want
to use both.
Melanie
-----Original Message-----
From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Galaid, Edward
Sent: Tuesday, October 4, 2022 9:43 AM
To: mcoh-eh at mylist.net
Subject: [EXTERNAL] [MCOH-EH] Occ Med EMR inquiries
There may be some update to the info I am about to share...at AOHC out at
Disneyland, a a group about 20 got together to talk about EMR, and wanted to
put together a formal special interest group or section. It was brought up
to the Medical Informatics Section, and ACOEM leadership pretty much said
EMR was too narrow to have its own section, so it would be under Medical
Informatics.
https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Facoem.org%
2FMembership%2FSpecial-Interest-Sections%2FHealth-Informatics&data=05%7C
01%7CSwift.Melanie%40mayo.edu%7Ce351c4e92cbf4c86673f08daa631c47c%7Ca25fff9c3
f634fb29a8ad9bdd0321f9a%7C0%7C0%7C638005029963058936%7CUnknown%7CTWFpbGZsb3d
8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7
C%7C%7C&sdata=SZrG83Od99%2FyB%2Fk6T4KQ4z605cIjdE4dkztkQydwpLA%3D&res
erved=0
That's all I got.
Ed
Edward I. Galaid, MD, MPH, FACOEM
ABIM, ABPM (OM)
Medical Director, Occupational Medicine
Roper Saint Francis Healthcare
Charleston, SC 29401
Vice Chair, Public Safety Medicine Section, American College of Occupational
and Environmental Medicine Special Expert, NFPA Fire Service Occupational
Safety & Health (FIX-AAA) Committee
843-402-5053
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Today's Topics:
1. Re: OHS EHR programs (wendy thanassi)
----------------------------------------------------------------------
Message: 1
Date: Tue, 4 Oct 2022 07:18:32 -0700
From: wendy thanassi <wendy.thanassi at gmail.com>
To: MCOH-EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] OHS EHR programs
Message-ID:
<CAD7mm_bP_P3VfFUwpdYaEA1WzWpcbR8vYw1HeJG4WsD0AAM4zA at mail.gmail.com>
Content-Type: text/plain; charset="utf-8"
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
>
>
>
> *CAUTION: This email originated from outside of the Department of Labor.
> Do not click (select) links or open attachments unless you recognize
> the sender and know the content is safe. Report suspicious emails
> through the "Report Phishing" button on your email toolbar.*
>
>
>
> 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
>
>
>
> *CAUTION: This email originated from outside of the Department of Labor.
> Do not click (select) links or open attachments unless you recognize
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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
na?ve?
>
>
>
> David
>
>
>
> *DAVID*
>
> *COCKRUM*
>
> *, *
>
> *MD*
>
> *Physician*
>
> *Faith Regional Physician Services*
>
> *Occupational Medicine*
>
> *(402) 844 8300* <(402)%20844%208300>
>
> 2024 Pasewalk Avenue, Suite 2
>
> ,
>
> Norfolk
>
> ,
>
> NE
>
>
>
> 68701
>
>
>
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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
>
>
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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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> Send administrative requests to: drjoe at meditrax.com
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>
>
> --
>
> Miriam Alexander
>
> (410) 206-0579
>
> ---------------------------------------
> The MCOH-EH List has always been moderated by members of the ACOEM
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