New Compendium Highlights Development of Clinical Decision Support to Enhance Worker Health

Articles Describe NIOSH Effort to Develop and Evaluate Clinical Desision Support

A new compilation of articles published in the November 2017 issue of the Journal of Occupational and Environmental Medicine, describes an effort led by the National Institute for Occupational Safety and Health (NIOSH) to develop and evaluate clinical decision support (CDS) designed to assist primary care clinicians’ with care of their working patients using CDS tools in electronic health records. This is the first effort to systematically develop and assess the practicality and usefulness of providing clinical decision support linked to work through health information systems in the primary care setting.

“Primary care practitioners are often the first to see patients with work-related conditions, care for patients who may have trouble managing their health at work, or see patients whose health affects their ability to work,” said NIOSH Director John Howard, M.D. “The information presented in this compendium demonstrates the potential to put resources directly in the hands of primary care clinicians that can promote better care of working patients using 21st century information technology.”

The compendium, which is part of a larger NIOSH effort to facilitate recognition of the relationship between work and health and how to address it through health information technology, includes:

1. An overview of the project
2. Three articles that describe the process of producing proposed recommendations to introduce computer‐mediated CDS into health information systems, to assist providers in the care of working patients. Each article covers one of three topic areas:
  • The diagnosis and management of work-related asthma
  •  Workplace factors that affect diabetes management
  • Decisions about return-to-work after an episode of acute low-back pain not associated with work
3. Results of a qualitative evaluation that gathered feedback from five primary care settings representing various areas nationwide and types of clinical practices.

NIOSH selected these topics based on recommendations from a 2011 National Academies’ Institute of Medicine report, “Incorporating Occupational Information in Electronic Health Records.” NIOSH assembled three independent work groups of occupational health subject matter experts that each focused on one of three topic areas — work-related asthma, diabetes management, and return to work after acute low-back pain. Each work group reviewed relevant clinical practice guidelines, best practices, and published literature related to their respective topic area and proposed evidence-based recommendations designed for application in a primary care setting using a CDS tool.

The results of the evaluation, and the final piece of information presented in the compendium, indicate that primary care physicians and staff across a range of practice sites recognize the importance of factors encountered at work to their patients’ health, and they found the three proposed recommendations useful and feasible in their practice settings.

Visit the NIOSH website for more information on electronic health records and patient work information. The reports, or knowledge resources, referenced in the compendium, are available on the American College of Occupational and Environmental Medicine website.
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Filios, MS, Storey, E, Baron, S, et al. Enhancing worker health through clinical decision support (CDS): an introduction to a compilation. J Occup Environ Med. 2017;59(11):e227-30.

Harber, P, Redlich, CA, Hines, S, et al. Recommendations for a clinical decision support system for work-related asthma in primary care settings. J Occup Environ Med. 2017;59(11):e231-5.

Allen, A, Welch, L, Kirkland, K, et al. Development of a diabetes mellitus knowledge resource for clinical decision support assisting primary care physicians with work-related issues. J Occup Environ Med. 2017;59(11):e236-9.

McLellan, RK, Haas, NS, Kownacki, RP, et al. Using electronic health records and clinical decision support to provide return-to-work guidance for primary care practitioners for patients with low back pain. J Occup Environ Med. 2017;59(11):e240-e244.

Baron, S, Filios, MS, Marovich, S, et al. Recognition of the relationship between patients’ work and health: a qualitative evaluation of the need for clinical decision support (CDS) for worker health in five primary care practices. J Occup Environ Med. 2017;59(11):e245-50.