Hi all,

I'm dual boarded in occmed and informatics. I've been a  CMIO and regional medical director and consultant for GE. Also a self professed policy wonk. In all my experiences, the matter isn't legislated specifically (although here in California it is a bit more tricky due to extra privacy laws). Any JDs out there please weight in. Keep in mind that protecting discoverable material from legal proceedings is a factor. Employment data (safety records or OSHA surveys should be protected from discovery in medical legal proceedings).

In a fee for service occ med/urgent care commercial clinic, the original matter doesn't arise much because the electronic system only contains medical and administrative information for the employees of client/customer employers. (For clarity, assume the commercial clinics doesn't do any services for their own employees).

The issue is the maintenance of the administrative separation between medical information and "HR". 

Usually it is just easier to separate the health system employee information from the main ehr to protect from privacy breeches.

For clarity, I will specify that "employee health"  is the nonmedical administrative exams and such (vaccinations etc) that do not constitute a typical "doctor patient" relationship. The services are geared toward th employer and the employee is in the clinic for consideration for conditions of employment. Again for clarity I will define EHR as "employee health record" to distinguish it from EMR "electronic medical record".

My recommendation is also to have a separate system for urine drug screening. Then one would only put the final determination statement into the EHR. It is tempting to employers and IT to treat a UDS as a Lab result and it simply isnt. Also EMRs lack the proper chain of custody features that would stand up in court.

The EHR may contain information that is sensitive to HR and should not be disclosed even to a physician without need to know. For example, a DOT look back for a driver preemployment physical. Safety concerns contained in the look back must be protected from anyone without need to know. Front and back office staff do not have a need to know. The CME (certified medical examiner) does need to know the nature of the safety concern to Tailor the physical exam and documentation requirements to successfully meet the FMCSA regulations.

To differentiate from the use of an EMR for medical treatment under a work injury or exposure. In this setting the doctor patient relationship is established.

Usual privacy practices are often sufficient in this setting for the purposes of medical treatment. There should be only a limited number of situations where there is exclusively employment information collected in a situation where employee health data is separated out into a EHR. 

One example would be documents around employee performance or suspicion of fraudulent work comp claims. If the employee was issued a PIP or layoff notice and immediate had a poorly defined injury, and this factors into clinical approach.

Another example might be a for cause medical evaluation. Some employers require that any injury have an exam and determination. 

Something like ADA evaluations is a grey area and I'll leave that aside.

Epic is just poor at this. The Epic company itself has demonstrated a lack of policy knowledge so I'd be glad to give you more information if anyone is interested.


  In addition to the article by Fazen et al here are 2 additional citations to review:

    Hunter, Euzelia S. "Electronic Health Records in an Occupational Health Setting—Part I. A Global Overview." *Workplace Health & Safety*, vol. 61, no. 2, 2013, pp. 57-59.

    Isakari, Marcia, et al. "Benefits and Challenges of Transitioning Occupational Health to an Enterprise Electronic Health Record." *Journal of Occupational and Environmental Medicine*, vol. 65, no. 7, July 2023, pp. 615-620.

(Apologies for any errors in this document, it was created using voice recognition software from my Android phone, I did not have access to a computer to type it) 

Mike
Michael Gallagher, MD, MBA, MPH

https://www.linkedin.com/in/mpgmdmba/details/experience/
Diplomate, ABPM Occupational Medicine
Diplomate, ABPM Clinical Informatics
Board Eligible ABAIM AI in Medicine
Occupational Health Physician

Oakland, CA 94610
C: (916) 601-8089
Email mpgmdmba@gmail.com

On Oct 19, 2025 at 6:15 AM, efia james <efiajames@gmail.com> wrote:

Hi Angeli,

I found the article cited below to be very helpful regarding EHR implementation. 

Fazen LE, Martin BE 4th, Isakari M, Kowalski-McGraw M, McLellan RK, Ahsan R, Berenji M. Occupational Electronic Health Records: Recommendations for the Design and Implementation of Information Systems in Occupational and Environmental Medicine Practice-ACOEM Guidance Statement. J Occup Environ Med. 2024 Nov 1;66(11):e614-e627. doi: 10.1097/JOM.0000000000003236. Epub 2024 Sep 26. PMID: 39378367.

Efia 


On Fri, Oct 17, 2025 at 11:28 PM Angeli Mancuso via MCOH-EH <mcoh-eh@mylist.net> wrote:

Hi all,

 

I’ve been away from the Employee Health game for a few years and find myself back in the deepend in the midst of an Epic build for occupational health services. We are starting with our own pre-hires and evaluating if we want to expand services to other area employers. We are not purchasing the Occ Med module of Epic.

 

I’m in California – which may add to the complexity here.

 

Can someone point me to the regulation that states that medical provider cannot perform pre-employment physicals using the regular medical record for a patient? Our Urgent Care providers are anxious about seeing any medical history that the post-offer patient does not disclose themselves. Are they to go solely off what the employee says is their history or can they see “the full picture” of the health of the new hire?

 

Things may have changed since I was in this game before Epic was so prolific.

 

Thanks for the guidance.

 

Angeli Mancuso, RN | Cottage Health
Manager, Workforce Development
Interim Director, Employee Health & Safety
Retain | Recruit | Reimagine
805-319-0359, Ext. 48928
a1mancus@sbch.org



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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/
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Send administrative requests to: drjoe@meditrax.com
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When replying to a message, PLEASE delete all footers, and all messages to which you're NOT replying.