The meaningful use of incorporating occupation and industry in an electronic health records (ehr) database for epidemiologic research
Introduction: Few extensive, national clinical databases exist on the health of migrant and seasonal farmworkers (MSFWs). Electronic health records (EHRs) are increasingly utilized by Federally Qualified Health Centers (FQHCs) and have the potential to improve clinical care, as well as supplement current surveillance and epidemiologic studies of underserved populations, such as MSFWs. The goal of this study was to examine the feasibility of using an EHR database in a descriptive epidemiologic study of a vulnerable working population, MSFWs. The aims of this study were to describe the patients at a Colorado FQHC; to assess the feasibility of coding patient occupation using the National Institute of Occupational Safety and Health (NIOSH) Industry and Occupation Computerized Coding System (NIOCCS) and to describe cholinesterase values from a subset of patients, as a marker of pesticide exposure. Methods: Patients were described by MSFW status on demographics, social history, medical indicators, and diagnoses from a de-identified EHR database from a large, multi-site Colorado Migrant Health Center (MHC). Logistic regression models were constructed for hypertension diagnosis and separately for elevated blood pressure at the last clinic visit. Laboratory cholinesterase values were compared from baseline to exposure period. Results : 41,817 patients from 2012 were included in the study: 553(1.3%) MSFWs, 20,665(49.4%) non-MSFWs and 20,599(49.3%) had no information in the MSFW field. MSFWs were more often male, married, employed, Hispanic, and Spanish speaking compared to Non-MSFWs. The most frequent diagnoses for all patients were hypertension, overweight/obesity, lipid disorder, type 2 diabetes, back disorder. Risk factors for hypertension included mainly age, obesity, and sex, but did not include MSFW status. Laboratory cholinesterase values showed a decrease from baseline to after suspected exposure in the 12 patients. Discussion: Although there were significant missing values, this study was able to analyze medical data in a timely manner and show that meaningful use requirements can improve the usability of EHR data for epidemiologic research of MSFWs and other patients at FQHCs. The results of the study were consistent with current literature available for MSFWs. This innovative data source may be the next major development for occupational injury and illness surveillance and research.
Socias, Christina Maria, "The meaningful use of incorporating occupation and industry in an electronic health records (ehr) database for epidemiologic research" (2013). Texas Medical Center Dissertations (via ProQuest). AAI3611775.