Environmental Exposure & EHR Systems

Introduction

There is growing evidence among scientists and the public about possible health risks associated with exposure to occupational or environmental hazards. There may be short term or long term consequences to people who have been exposed to radiation, chemicals, asbestos, pollution, electro-magnetic transmissions, and hazardous waste.  We need to better understand the impact of environmental exposure on children and adults with regards to autism, asthma, cancers, diabetes, obesity, and so many other conditions and diseases. The time has come to more systematically capture data on exposure to occupational and environmental hazards in electronic health record (EHR) and personal health record (PHR) systems.

Occupational & Environmental Exposure Defined

Occupational and environmental exposure involves the contact of people with a particular stressor for a specific duration of time. Stressors can include chemicals, radiation, asbestos, hazardous waste, electro-magnetic transmissions, traumatic events and much more. Exposure science studies the links between these occupational and environment hazards and target organisms such as the human body.  See http://www.epa.gov/nerl/who.html

Selected Exposure Projects & Software Solutions

There are a growing number of projects and software solutions related to the capture of occupational and environmental exposure information on patient populations. For example:

• Defense Occupational & Environmental Readiness System (DOEHRS) -  DOEHRS is an integrated Environmental, Safety, and Occupational Health application supporting the U.S. Department of Defense (DoD) initiatives to capture, store, and analyze environmental exposure history of military and civilian personnel. See http://health.mil/mhscio/programs_products/jmis/dhss/products/doehrs-ih.aspx
• My Family Health Portrait is a free internet based software tool developed by the National Human Genome Research Institute (NHGRI) and the Surgeon General's Office that provides a structured way to collect medical information about individual family members to help medical professionals trace inheritable conditions from generation to generation. See https://familyhistory.hhs.gov/fhh-web/home.action
• Research Program on Genes, Environment & Health, (RPGEH) - The NIH has awarded a large grant to conduct genotyping on 100,000 Kaiser Permanente (KP) members participating in the RPGEH project that includes the largest population-based bio-bank in the U.S.  See http://www.dor.kaiser.org/external/DORExternal/rpgeh/index.aspx
• ORAU Environmental Assessments, EMR Systems, and Worker Health - ORAU captures exposure data in their electronic medical record (EMR) system. See http://www.orau.org/occupational-exposure-worker-health-studies/capabilities/data-management.aspx

* Also check out the EPA Environment & Human Health and the APHA Environmental Health web sites.

Findings

Open Solutions – Much of the work done to date has been funded by the federal government and is collaborative in nature. An 'open community' has emerged around the projects and many of the software tools that have been developed are being shared and are in the public domain or 'open source' arena, e.g. GENII-LIN is used to calculate radiation dose and risk from radionuclides released to the environment. See http://www-rsicc.ornl.gov

Standards – Many organizations are now working on data standards. For example, the Healthcare Information Technology Standards Panel (HITSP) Personalized Healthcare Interoperability Specification has identified requirements to collect environmental exposure data. For more detail, see http://wiki.hitsp.org/docs/IS08/IS08-1.html

Conclusions & Recommendations

The situation is just going to get more complicated as new hazards emerge over time that could adversely affect humans. Consider the impacts of cell phones, new vaccines, bioengineered foods, and many other emerging man-made technologies have on humans. Not to mention what else nature may have in store for us after the tsunami in Japan and the nuclear disaster they are currently experiencing. Opportunities abound for those interested in this area.

Have you seen or done any work on environmental exposure systems? Especially ones that interact with electronic medical record (EMR) systems? Tell us about it.