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OCR for page 5
assurance programs, collect and analyze regional
incidence and prevalence data, be alert to recognize
cases that represent significant sentinel events, serve as
first alert response centers for (episodic) toxic events, and
make timely reportings to state and local public health
agencies and governments. Provisions must be included
to publicize actively and broadly the availability of the
services of this O-E medical information system in the
health care sectors. The intent of this publicity would be
to increase the awareness about the merits of the system
among primary care physicians and other health officials;
so that these services will be recognized, and used widely
to enhance patient care and to promote personal health
across the nation.
Funding must provide for growth and expansion of
this service. The need for O-E medical information will
increase as public and health care providers' awareness
about the risks of exposure to hazardous substances
grows. The mode! multi-disciplinary information system
envisioned by the subcommittee would be the focal point
to meet the broad national needs of physicians for O-E
medical information.
A NATIONAL INFORMATION SYSTEM FOR
OCCUPATIONAL AND ENVIRONMENTAL HEALTH
Background
The vast and growing body of knowledge in the life
sciences presents a formidable challenge to health
professionals. The technical complexity and volume of
facts needed to identify and manage many health
problems often far outstrip any individual's ability to
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remember or use them effectively. This is particularly
evident in the diagnosis and management of O-E
exposures that induce illness or injury. In instances where
the number of disease-causing agents are large, the
specific agent in a clinical case of exposure is often
uncertain, the health risks difficult to quantify, and the
illness sometimes insidious, delayed, confounded by co-
existing medical conditions, or simply overlooked.
Compared to baker understood diseases, illness or injury
resulting from hazardous exposures often bring with them
additional requirements for information about treatment,
clinical referrals, consultation, compensation, reporting
requirements, and involvement of social and support
agencies.
A 1988 Institute of Medicine Committee looked at the
Role of the Primary Care Physician in Occupational and
Environmental Medicine and concluded that improved
medical information resources are essential to progress in
iclentifying and managing illness from toxic exposure:
"The most practice/ way to assist the primary care
practitioner to function effectively and
knowledgeably when confronted with a patient
suspected of having an occupational or
environmental disease is to have a single-access
point for necessary clinically pertinent information.
This single-access point should become the
central source through which all appropriate
clinical and nonclinical services available to the
practitioner could be elicited. The development
of such an access point for health care providers
needs to be designed so that a single telephone
call will satisfy the practitioner's need to access
the full range of information necessary to address
the patient's problem.~"
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Though the principal audience of such an information
system undoubtedly would be occupational physicians,
emergency medical staff, and primary care providers, an
increasingly educated public will demand more information
about the risks posed by both environmental and work-
related exposures. In addition, legislation, such as the
Emergency Planning and Community Right-to-Know Act
(TitIe It' of 1986 Superfund Amendments and
Reauthorization Act), specifically mandates that information
about industrial hazards and the environmental release of
chemicals must be made publicly available.
To determine the functional requirements for an O-E
medical information system, the subcommittee met with
general medical practitioners and other potential users
including representatives of organizations that currently
provide information services relevant to O-E medicine.
Also, the subcommittee examined in detail several existing
information dissemination programs, but none of them met
the criteria to serve as a mode' for the national system
envlslonec .
Findings
Since the objective of the committee was to enhance
the practice of O-E medicine, nothing in this report should
be construed as a critique of the inadequacies of any
existing information system or that any should be
supplanted by the system proposed. The members of
both the Committee and subcommittee preparing this
report agreed that the envisioned medical information
system described must be accessible, credible and
reliable, simple to use, available at all hours of the clay,
and capable of rapidly providing a timely response.
These objectives must be diligently sought in the design
and in the clevelopment of the recommended information
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resource, because, at present, they cannot be met by a
single database, computer program, or compilation of
printed material. it is particularly important that the
medical information developed and disseminated for use in
making patient care decisions meet the highest standards.
These high standards should be designed to establish
credibility -- the perception of users that the information is
authoritative, and trustworthy -- which will determine the
ultimate success of the system. Equally important, utmost
confidentiality in the information system records must be
maintained to insure the security of proprietary and
confidential physician-patient information.
The system should provide easy access to users;
should save physicians time in obtaining the needed
information, and should not overwhelm or burden the
physician. This criterion might be met by a 24-hour, toll-
free, 800 number.
Timeliness also is an important consideration. To be
an attractive resource for health professionals, the
system's response time must be equal or better than that
of a phone consultation with a physician's colleague.
Response time is a especially important in emergency
situations; sometimes decisions about whether to evacuate
an area must be made within a maker of minutes.
Information about hazardous exposures, should be
available in three categories:
Specific technical information as reported in the
literature; for example, the symptoms or adverse
health effects associated with hazardous
exposures, the exposure levels likely to cause
health effects, or the particular hazardous agents
known to cause particular signs or symptoms by
laboratory findings or physical examinations Oral
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answers given at the time of inquiry can be
supplemented by written documents distributed
by mail, facsimile, or electronic mail.
Risk assessment - interpretation and judoement
of pertinent information for example, what is the
best judgement of risk to human health given the
circumstances as described during the inquiry;
what is the likelihood of a resulting illness or
injury due to the exposure; what courses of
action or treatment might be pursued to reduce
the risk or eliminate it; what is the relative risk
[risks compared to another, perhaps more familiar
hazardous exposure]?
Referrals for additional help; for example,
specialized O-E health services, occupational
health clinics, social support services,
rehabilitation or specialized treatment centers, or
state or federal government agencies.
Realizing inquiries for information will come from
broad sectors of the medical community, the
subcommittee decided the information system should
provide for graded responses. Many inquiries wit! be
simple, and perhaps can be adequately addressed by
trained nonprofessional staff using concise information
sources such as brief fact sheets. Other inquiries will
require more complicated technical, administrative, or legal
information best obtained from experience and judgement
of professional staff. Thus, heterogeneity of information
requests could be met with an effective triage procedure,
with experts in all of the disciplines relevant to O-E illness
or injury available for more complex inquiries.
Because of liability concerns, tape recording or other
ways to validate the accuracy of information communi
9
Representative terms from entire chapter:
pertinent information
