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@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@mayo.edu>; MCOH-EH <mcoh-eh@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@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@mylist.net> On Behalf Of Thanassi, Wendy via MCOH-EH
Sent: Monday, October 3, 2022 11:58 AM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: Thanassi, Wendy <Wendy.Thanassi@va.gov>; McKenna, Patrick <Patrick.McKenna@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@mylist.net> On Behalf Of Robert K. McLellan
Sent: Monday, October 3, 2022 6:59 AM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: McKenna, Patrick <Patrick.McKenna@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@mylist.net> On Behalf Of Hodgson, Michael - OSHA via MCOH-EH
Sent: Saturday, October 1, 2022 4:50 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: Hodgson, Michael - OSHA <Hodgson.Michael@dol.gov>; McKenna, Patrick <Patrick.McKenna@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@mylist.net> On Behalf Of Cockrum, MD David S
Sent: Friday, September 30, 2022 2:34 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: McKenna, Patrick <Patrick.McKenna@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

 

DAVID COCKRUM ,  MD Physician Faith Regional Physician Services Occupational Medicine (402) 844 8300 2024 Pasewalk Avenue, Suite 2 ,  Norfolk ,  NE   68701 Click on the logos to learn more about our services. This message and any attachments are confidential, may contain privileged or legally protected communications or information, and are intended solely for the recipient named above. If you are not the intended recipient, you are notified that any review, distribution, dissemination or copying of this message or any attachment is prohibited. If you have received this message in error, you should immediately notify the sender by a return e-mail and delete the message from your computer system.

From: MCOH-EH <mcoh-eh-bounces+dcockrum=frhs.org@mylist.net> On Behalf Of Miriam Alexander
Sent: Wednesday, September 28, 2022 7:25 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: McKenna, Patrick <Patrick.McKenna@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@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@mylist.net> on behalf of McKenna, Patrick via MCOH-EH <mcoh-eh@mylist.net>
Sent: Tuesday, September 27, 2022 7:47 AM
To: mcoh-eh@mylist.net <mcoh-eh@mylist.net>
Cc: McKenna, Patrick <Patrick.McKenna@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@gmail.com<mailto:umhaneen@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@gmail.com<mailto:wendy.thanassi@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.
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.