Employee health benefits of electronic health records

More power to understand effective interventions

Increasing numbers of hospital employee health departments will move to electronic health records (EHRs) in coming years as health systems see the need for "big data" to better inform population health decisions.

Occupational health use of EHR is the wave of the future, says Madeleine Kerr, PhD, RN, an associate professor at the University of Minnesota.

Arguments for switching to an EHR address how electronic files give hospital employee health departments the information model they need to holistically tackle population health issues.

"Once we have this big data — de-identified data from our individual health records — we’ll have so much more power to understand what is effective from interventions and which high risk groups we may be missing," Kerr says.

Switching to EHR can reap benefits from a workflow perspective. For some, the benefits of having detailed information and real time trends at their fingertips outweigh some of the implementation, privacy, and staff buy-in issues.

"It’s wonderful," says Joanna Krasinski, MSN, ANP-BC, COHN-S, director of occupational health services at Brigham and Women’s Hospital in Boston, MA.

Before Brigham and Women’s Hospital implemented the electronic health record for occupational health in the fall of 2013, everything was on paper, Krasinski says.

"For our clinic in a very large organization, our paper records needed to be kept off site, and we’d have records picked up and dropped off twice a day," she says. "That burden of going back and forth and all of the storage is gone, and from that perspective it’s been a tremendous improvement."

It’s also a big time-saver: when Krasinski needs to prepare for a Worker’s Compensation meeting, she can review a chart instantly with the electronic files.

The goal is to create an integrated record that captures the patient’s and service provider’s perspective, so that everybody can see the employee health needs, plan of care, and meaningful progress towards outcomes, says Karen A. Monsen, PhD, RN, FAAN, co-director of the Center for Nursing Informatics at the University of Minnesota in Minneapolis, MN.

The main reason to use EHRs is to access more detailed data and the possibility of creating decision support systems to easily and quickly identify populations at risk from any particular hazard, Kerr says.

"The reason behind decision support systems is to have built-in prompts for care providers and employees," Kerr says. "There can be health messages to promote life style changes and to get new screening tests done."

For example, an organization with wellness programs can track employees’ blood pressure and cholesterol levels on a population basis, while each individual worker could track his or her own progress on reaching health goals, Krasinski says.

"We will see from the information whether we need to do individual health counseling or implement new exercise programs," she says. "I think this would be exciting for any facility."

Data usefulness is dependent on how the system is created, Kerr notes.

Privacy, HIPAA concerns

The key is to use standardized, common language that is embedded in these electronic systems, Kerr adds. Chief concerns about implementing EHR for occupational health center around privacy and confidentiality. Health care worker list services recently have featured debates about electronic collection of employee health data. Critics point to the HIPAA Privacy Rule and the possibility of employees’ private information being breached by health care workers who are not involved in the worker’s medical treatment.

While breaches can occur, proponents of electronic records say standard security and confidentiality measures should provide adequate protection. For instance, the EHR at Brigham and Women’s Hospital is a closed system with a firewall that prevents unauthorized staff from accessing information, Krasinski says.

In addition, the occupational health department’s electronic medical record is a stand-alone system that is not interfaced with the hospital’s patient electronic medical record, Krasinski explains.

"The system is tested and monitored, and there have not been any breaches," she says. "Through auditing and policies, you can make sure employees know they are not allowed to look through anybody’s medical records, including records for celebrities. I would reassure people that this is how the system is protected and how we make sure the right people are using it."

Once employees are reassured of the system’s privacy, staff buy-in is more easily achieved. From Krasinski’s perspective, the initial organizational buy-in was the bigger challenge.

"It was a many-year endeavor," she says. "We presented [to leadership] that having a completely paper medical record would not allow us to meet standards, and we built our case around the efficiencies that would be gained," Krasinski says. "Having an electronic record helps with compliance: before we had a system that tracked blood borne pathogens exposure and another system with Workers Compensation cases, so you were constantly working in different systems."

"The beauty of an EHR is it becomes a single system," she adds.

It’s also useful from an individual employee’s perspective. The system has a patient portal where each employee can look up his or her own personal information and schedule appointments, she adds.

Although the employee health EHR is separate from the health system’s EHR, there should be interoperability between various electronic health systems, Krasinski says.

"A patient should be able to take that data and let it be read and used by another system," she explains.

"Let’s say I’m getting medical care at Brigham, but I am seeing a specialist who is 10 states away, they’ll give me my medical record electronically so I can take it to that new specialist," she says. "We built our system to be interoperable because the information is important and if the system is interoperable, then the information can be shared in a way that’s meaningful and helpful to the provider giving the care."

Interoperability contributes to the goal of better informing treatment and screening, Monsen notes.

"We need to work towards a coordinated approach that has an information model supporting it," she says. "Right now we have a lot of siloes, and we don’t see each other’s notes, and we don’t have a place where it all comes together."

Ideally, there would be a patient-centered health record where the whole team can come together, she adds.