Document 86mZ4epVzjb2eKNBVNE06kBm

FILE NAME: Ford (FD) DATE: 1982 Oct DOC#: FD302 DOCUMENT DESCRIPTION: Journal Article - The Ford Motor Company Environmental Health Surveillance System Texas Womans University ILL Borrower: IHS Lending String: *IWUlTXHIIXA>OKH,TXJLF>OUU,SHH,IUA,TMV,L NM,TMLfLTM,LMS,TYR,IUA 247369 Patron: Journal Title: Journal of occupational medicine : official publication of the Industrial Medical Association. Volume: 24 Issue: Month/Year: October 1982Pages: o> Article Author: Stephen J. Kuritz co CO Article Title: The Ford Motor Company CM Environmental Health Surveillance System Call#: 78.61 A Location: Denton Journals Charge Maxcost: 20.00 Shipping Address: Library ILL UT Southwestern Medical Center 5323 Harry Hines Blvd Dallas, Texas 75390-9138 Odyssey: illiad.swmed.org E-Mail: LIBILL@MEDNET.SWMED.EDU Need to update by 3 days after: 20220302 TJ (0 ILL Number: 212448074 212448074 Medical Information Systems The Ford Moto r Com pany Environmental Health Surveillance System Stephen J. Kuritz The Employee Health Services Department of the Ford Motor Company has responsibility for protecting worker health and for ensuring company compliance with various governmental regulations regarding employee health and safety. Additional department responsibilities are to identi fy and evaluate emerging regulatory issues, to enhance the management and monitoring of health and safety programs and to respond to potential problems in a timely and effi cient manner. Given these goals and a work force of 250,000 employees to be covered, a company-wide computerized health records system became essential. Thus was born (in-house beginning in 1977) the Environmental Health Surveillance System (EHSS). The EHSS is a group of subsystems designed to encom pass the basic components of an occupational health and safety surveillance system: (1) exposure data; (2) health adnatda.safety status/effects data; and (3) worker status/history A detailed description of each subsystem would be too lengthy to be presented here. Instead attention is concen trated on those subsystems believed to have special in tberrieefslty.and unique aspects, while the others are discussed Materials and Toxicology Exposure data are included in two of the EHSS subsys tems. The Materials and Toxicology (MATS) subsystem contains a hazardous materials catalogue to provide rapid retrieval of information on hazardous/toxic/critical chemi cals in products associated with the company and assistance in ensuring compliance with the regulations issued by agen cies such as the Occupational Safety and Health Adminstration (OSHA), the Department of Transportation (DOT), and the Environmental Protection Agency (EPA), and with legislation such as the Toxic Substances Control Act (TOSCA). This is an on-line system with all file mainte nance performed by corporate staff. Input information is From Ford Motor Company, 900 Parklane Towers West, One Parklane Blvd., Dearborn, Ml 48126 (Mr. Kuritz, Biostatistician). 844 obtained from material and safety data sheets. Retrieval capability exists at the plant level through local terminals. Industrial Hygiene The Industrial Hygiene subsystem contains information obtained from all environmental sampling that is performed. is includes exposure to physical and chemical agents in t e workplace. This (and every other) subsystem is oper ated in batch mode. Input information is obtained from orms completed by the hygienists and keyed onto com puter tape, which is used to update the industrial hygiene master file. The Industrial Hygiene and MATS subsystems when utilized together, can provide insight regarding par ticular exposure. For example, the MATS subsystem can s w 'n what products a specific chemical is used and in w ich plants it can be found. The Industrial Hygiene sub system can then reveal the exposure levels noted on all occasions when appropriate sampling was performed. Safety Health and safety status/effects data reside in five of t e EHSS subsystems. The Safety subsystem is currently in t e planning stage. OSHA requires that all " recordable*' injuries and illnesses be reported on a log that is open for inspection. A primary objective o f the Safety subsystem is to ensure that this mandated activity is being carried out correctly and accurately. In addition, a work injury experi ence report w ill be generated automatically, showing inci dence and severity data for each location. Biological Monitoring The Biological Monitoring subsystem is used to record t e results o f all tests (performed on employees) for the body burden o f biological contaminants. Over 90% of this su system, however, is dedicated to the monitoring o f one contaminant -- blood lead. Specimen analysis, formerly one within the company, is now performed by an outsi e contractor. Forms are completed by the plant medical aci ity and forwarded, with the specimens, to the contrac or est results and accompanying information are keyec n o a computer tape that is sent to corporate staff on < Ford s Environmental Health Surveillance System/Kuritz weekly basis (a hard copy result form goes immediately from the contractor to the plant medical facility). This tape is run through a special conversion program to make it compatible with the already existing biological monitoring update program. This subsystem is utilized heavily both to m onitor the blood lead status o f company employees and to comply with the OSHA blood lead standard. An example o f the first use is the blood lead summary report. This report shows, for each job classification in each plant location, the number o f tests results w ithin a range o f values and pro vides certain summary statistics o f interest. An example o f the second type o f use o f the file is medical surveillance scheduling. Medical Records The Medical Records subsystem is the storehouse o f medical data (history and physical findings) fo r employees in plant locations utilizing the subsystem. Currently about half o f the company locations are included. All employees receiving a physical examination at these plant medical facilities must complete a health history form. When appro priate, the physician completes a health screen form . Copies of these forms are sent to the corporate health group where they are reviewed and International Classification o f Dis eases (ICD)-9-CM codes are assigned to the diagnoses. On a weekly basis these forms are keypunched onto tape that updates the medical records master file. The history portion of an employee's record is o f fixed length and is written over by each succeeding history. A part o f the history form, the return-lo-work portion, is completed fo r all employees taking personal medical leaves o f three or more days. The health screen is a variable length record that is maintained in historical fashion. The return-to-work summary report is a good example of the utilization o f data from the Medical Records sub system. This report analyzes the primary reasons for employees' medical leaves in a statistical summary. In cluded are incidence and severity rates for each diagnosis code at every location included in the subsystem. In addi tion, medical record inform ation is vital to the functioning of the Medical Surveillance subsystem. Medical Surveillance The Medical Surveillance subsystem is essentially respon sible for maintaining a massive appointment calendar. With automatic input from the Medical Records and Biological Monitoring subsystems and manual input from plant medical facilities, the Medical Surveillance subsystem produces monthly schedules identifying all employees due for each type o f screen (involving a unique series o f medical tests) and providing certain work status inform ation and the last-performed date fo r that screen. This is a relatively new subsystem, which to date covers only six plants. It is hoped that this subsystem w ill reduce substantially the time and effort that have been required fo r manual sched uling and auditing o f these examinations. The purpose o f the M ortality subsystem is to provide a database containing pertinent inform ation on the deaths o f all active and retired employees. Input information is ob tained through an agreement w ith the company's life insurance carrier, which sends to corporate health staff on a m onthly basis copies o f the death certificates and claim forms for all eligible employees on whom a benefit claim has been made. The death certificates are then sent to the Michigan Department o f Health where the underlying cause o f death is coded according to the ICD (9th revision). The company's data are coded by the same nosologists who code the m ortality data for the state, and thus consistency and uniform ity in coding are achieved. This lends added confidence to comparisons o f the company's data with Michigan standards. Records o f approximately 10,000 deaths are currently in the database, which is growing at a rate o f about 4,000 records per year. The data are analyzed by cause o f death and location o f last employment as well as by age, race and sex. In addition, life-table analysis programs purchased from Harvard University have been valuable in performing preliminary analyses (PMR studies) on the data. Work History The worker status/history data are maintained in one subsystem. The Work History subsystem is the largest and most complex o f all those in the EHSS. Because o f the difficulties involved in the design, implementation and maintenance o f such a subsystem, and the enormous vol umes o f records it must be capable o f handling, the Work History subsystem is o f particular interest. The Work History subsystem is designed to capture and maintain work-related inform ation for both hourly and salaried employees. It is the heart o f Ford's surveillance system, providing inform ation to and retrieving information from almost every other component. Initially, it serves an edit checking function as it verifies that the social security number o f a particular transaction is that o f a valid Ford employee. When a match occurs, selected portions o f the file are fed to the querying subsystem. Maintaining such in form ation (i.e., birth date, department, job classification code) in a single subsystem is thought to be more efficient than regenerating and correcting these data within each o f the other databases and has significantly reduced the developmental and maintenance costs o f the system as a whole. In addition to providing data fo r other files, the Work History subsystem (containing longitudinal employ ment information) is very useful for other purposes. Epi demiologic studies often use w ork history inform ation in conjunction with that from other files, while certain special requests can be addressed through the work history database alone. One o f the reports generated from the work history file is the annual company census, which provides statistics on (1) active and inactive employees at each plant, grouped by age, sex, race and Michigan v non-Michigan w ork locations; (2) the same, in each division; (3) the same for the total company; and (4) the number o f workers per job type w ith in a given plant and depart ment, their average age and their average seniority. The Work History subsystem and update processing flow contain some unique features (Fig. 1). A work history master record consists o f both demographic information o f a fairly stable nature and work-related information o f a highly variable nature. For this reason it was decided to partition the master record in to three segments. The first, Journal of Occupational Medicine/Vol. 24, No. 10/0ctober 1982 845 ? I t T,ST,CS REPOHT ERROR REPORT Fig. 1 --Work history monthly processing. or employee, segment has only one occurrence and is unique for each employee. This segment identifies the worker as an individual by containing information such as social security number, name, birth date, company service date, sex/race code, hourly or salaried code, and home zip code. The second, or plant, segment has up to 999 occur rences for each employee. This segment contains a plant code, a division code and a seniority date. Every time an employee moves to a new plant, an additional plant seg m ent record is created as part of his master record. The third, or job, segment also has up to 999 occurrences tor each employee. Contained within the job segment are departm ent code, roll status code, job classification code and effective date. When one or more of these items change for an employee, an additional job segment record is created as part o f his master record. Input to the Work History subsystem comes from ex tracts of two primary sources created by payroll functions: an hourly work force profile and a salaried personnel master. The capability for manual input from corporate health personnel is also present. Both the hourly and salaried files used as input generate transactions by compar ing their current week's store of information with that of the previous week and noting any differences. These trans actions are then moved to the first stage of the Work pHriosctoersysinsgubpsroygstreamm'.s monthly updating procedure, the pre The preprocessor launders and tailors the data so it will be acceptable to the update program (the second stage of monthly processing). It edits field by field all the data in the generated transactions. In a sense, the preprocessor is unique in that it edits data that have already been edited by its originating system. The preprocessor performs six major functions: (1) edits input transactions; (2) provides an error report; (3) converts certain fields to assure uni formity; (4) generates specific fields; (5) sets pointers to determine necessary action for a transaction; and (6) out puts a uniform file to the update program. On completion of the preprocessor function, the newly created uniform file is ordered through a sort routine and then passed on to the update program. This program's primary function is to update the work history master file I Sf ? n t *le *ncom ing transactions, and is run on amonthy asis. In addition, an update error report is produced ai ing all transactional errors (such as unmatched changes o f e etions or attempts to add a social security number already on the file). A ll successful updating (the result o f a transaction being sta ffCST k *S ,ssued on m icrofiche for the corporate health th* ' I . update Program also maintains file integrity through the use o f header and trailer records. . us' ach m onth the work history master file is upe w it new transactions. However, when the size of the r .orce is considered together with the number of segn s (each a separate record) possible for every employee, e v o um e o f records (already in the millions) to be m and processed quickly becomes a major con- n* is has been dealt w ith through several approaches. as described earlier, the other subsystems are w . , a6a,nst work history information on a regular m y J?.r m n th ly basis, an alternative to reading the full bei Gr 'a W3S desired. When these other subsystems are curre t P ate^ ' t^le^ require only information on the most histrn ?ta^us anV employee and would pass over all n r,Ca p'ant and job segments. To eliminate this un- ssary passing o f all records each time, the work history has hmaStCr W3S devised- Each month, after the master file snanJ^? updated, the mini-master is created by taking a I each active employee's current location record. contaSe^ Ce,f t*1e m,n,' rnastcr is a replica o f the master file Dlanr m i^ . r each employee segment only the most recent t^ a, an y segments. Thus, it is actually the mini-master m itt !SfUSe t0 perform edit checking and data trags- othrr ^ nct,ons f work history for the updating of the conrin,SU,, SyStemS- Whereas the size o f the master file will seem Uf l ^ ' ncrease with the addition o f new plant and job const!1t* th^ S,2C tbe m 'ni' master will stay relatively reali7oH * a,?d therefore the cost and efficiency savings mastpr W- COntinue to Srw . Each quarter the mini staff Th* '*sued on microfiche fo r the corporate health refpi-Pnr '! 3S proven to be invaluable for quick and easy erence to an employee's status. Epidemiology t r a c k i n g * dl f t or y subsystem provides the means for his career w i t ^ Job and p,ant status throughout system, however th3Cf mPanJ ' 'S the ^ P '^ " 1'0'0^ sub' information Arl- /provides the means for utilizing this the other s u b s y s t e m s ' * 3 database manager foJ investigations in t o ^ h l ! m ' gY W3S Created t0 permit o f disease and rPb t a ,nLc,dence, distribution and control and retired work fo rce ^0^ TM Within the companV's active file delh n i f i o n T ' ^ ^ Sl/ bsystem is actually a collection of select, sort list a h " *' *ty programs that can be used to porting system is used'Thnc^ ^ ? 1 fi,es' The Mark ,V Epidemiology has no b ^ Un ,ke the other subsystems, extract data from the oth master o f its own, but will study files for specific a a d create sPecial temporary signed so that simple select YSCS' . ^ b,s subsystem was demaster file (the bulk o f th,, and list requests from a single w ithout the support o f a Dr requests) may be user operated a user might request fro m 'fhrarilmer/analyst. For example, J( c . ------ ---- l- n l ' ' r n n m o n * , l ( l 6 medical records master file f*9- 2 - Environmental health surveillance system -- overview. records for all employees who answered " yes" to smoking on the health history form. This would assist in providing a very crude estimate o f the number o f smokers in the com p ly . In addition to select and list capabilities, Epidemiology offers the user the fle xib ility o f choosing portions o f several master files to combine in a temporary work file for special study purposes, such as conducting m ortality studies. Epidemiology could provide a list o f employees with spe cific causes o f death, and some matched controls, from the m ortality file and add on all the work history and medical record inform ation available fo r them. Many o f epidemiology's capabilities in this area have yet to be fully utilized. Summary Ford's EHSS is a complex interaction o f several sub systems (Fig. 2). MATS and Industrial Flygiene provide exposure data; Medical Records and Surveillance, Biological Monitoring, M ortality and projected Safety provide health and safety effects data; Work History provides what its name indicates; and Epidemiology coordinates the effective use o f all the others. Highlights have been presented here, but it should not be assumed that either the creation or main tenance o f such a vast system is w itho ut problems. No project o f this magnitude could possibly avoid them and systems and programming work is ongoing to correct problems as they arise. Efforts to improve the system are already under way. These include plans to make Industrial Hygiene and MATS more compatible so that better communication is possible and to make Epidemiology even more user-oriented. Keep ing a computerized medical inform ation system in working order to the user's satisfaction requires a great deal o f time and money, but such a system is invaluable in comparison with the alternative o f manual effort. This is especially true in view o f the number o f federal (and local) health regula tions passed and pending and the current level o f worker awareness o f the p riority o f occupational health issues. urnal of Occupational Medicine/Vol. 24, No. 10/0ctober 1982 847