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EXECUTIVE SUMMARY
Background
The 1988 Institute of Medicine Committee on the Rote
of the Primary Care Physician in Occupational and
Environmental Medicine addressed several problems
related to occupational and environmental factors. One of
several recommendations made by that committee was the
need to improve information sources available to the
physician confronted with patients suspected of having
occupational or environmental (O-E) disease.
Subsequently, the Institute formed the Committee on
Enhancing the Practice of Occupational and Environmental
Medicine which then appointed an Information Systems
Subcommittee to evaluate the requirements and design of
a national information system for O-E health. The
commidee's charge to this subcommittee was to examine
the O-E information needs of primary care physicians and
to develop a set of objectives and criteria for a national
system to facilitate their access to a "single" information
resource; to enhance the availability and visibility of a
A second subcommittee, the Subcommittee on
Physician Shortage, was formed to address the issue of
///ness From the Environment: Meeting the Growing Neec!
for C/inica/ Services (in press).
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responsive, peer-reviewed knowledge base of clinically
relevant information to improve clinical practice; and to
form firm links between established local clinical networks
(hospital, private, group practice, academically based, and
others) and a single information resource with the goal to
improve practice.
In the Preface, mention was mace of several
important existing information systems that have O-E
resource material that could be used by physicians.
However, physicians cannot take the time to learn the
unique accessing features of each of these systems.
Moreover, none of those examined by the subcommittee
met the functional criteria or objectives of the mode!
system described. Several of the poison control centers
(PCCs) were reviewed with special attention paid to those
which provide O-E medical information. The national
network of cancer information centers was also examined
as a mode' of system organization and administration, as
were selected state information systems.
Findings
Physicians seeing patients with suspected O-E
disease must obtain a quick response regarding causers)
of the disease; accurate diagnosis; and appropriate
therapy: therefore, a physician-talking-to-physician source
of information is envisioned. As mentioned previously,
these physicians cannot take time to learn the detailed
access procedures for these databases. There are
professional organizations and a diversity of resources
where the neecled information can be obtained if one
knows how to access the various databases and has the
time to do so. However, there is no single, organized,
national O-E information system dedicated to serving the
needs of medical practitioners whose patients would
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benefit from the information in this area of medicine. This
is a neglected area of medicine; with better information
and better recognition of O-E related illness, the national
incidence reports might surpass that for breast cancer, for
example.
The committee has envisioned a national information
system that will focus upon furnishing the breadth of
knowledge for hazardous substance information essential
to primary care physicians in the practice of O-E medicine.
In its broader extensions, the proposed system wit! be an
information resource to industry's medical staff; first
responders in accidents, spills, or other emergencies; and
perhaps, in the future, to the public as suggested by the
committee. Physicians may need to know a specific
technical fact about a hazardous substance, the risk of
exposure causing illness or injury, or whether a patient's
clinical manifestations could be related to exposure in the
workplace and or environment. Physicians frequently
need expert advice about diagnostic methods and plans
for medical management of persons exposed to
hazardous substances. The information needed also
includes hazardous substances produced by local
industry, geographical patterns of relevant clinical illness,
state and local governments' case reporting requirements,
and other legal makers. To be most useful, an O-E
medical information system must serve principally the
physicians, and state and local health care providers. As
the system develops, its services should be expanded to
emergency first responders situations, emergency program
planners, and then to the public. A national information
resource meeting these requirements must have available
a staff of experts in O-E medicine, industrial hygiene,
epidemiology, pharmacology, toxicology, biostatistics, risk
assessment, law, and education.
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Furthermore, to be effective, the subcommittee
stipulated that such a national O-E medical information
system must be simple and quick to use (in emergency
situations this is important, but it is important also as a
time saver for primary care physicians), the information
furnished must be easily accessible 24 hours per day, and
it must be credible and reliable. The system would collect
and assess data about the incidence and prevalence of
clinical cases involving exposure to hazardous substances,
and would maintain records to serve as useful tools for
epidemiological studies and public health planning at
national, state, and local levels.
Recommendations
Based on the findings of the subcommittee, the
committee recommends that Congress authorize and
appropriate funds within a governmental agency's budget
to establish a two-component national
O-E medical information system: a network of multi-
disciplinary regional information centers, whose services
would be available over a toll-free telephone line; and a
national center, whose primary role would be to
coordinate, oversee, provide quality assurance, and
administer the regional centers. The geographically
dispersed regional centers would provide the following:
information to physicians, industry, and first responders;
medical information to primary care providers on the best
available estimates of health risks due to hazardous
exposures; medical advice for clinical treatment in
emergency or nonemergency instances; and resources for
clinical data acquisition.
The national coordinating center would establish the
need and award the regional contracts, provide training,
build and share information resources. conduct quality
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Representative terms from entire chapter:
hazardous substances
