title: Industry and Occupation in the Electronic Health Record: An Investigation of the National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System.
abstract: BACKGROUND
  Inclusion of information about a patient's work, industry, and occupation, in the electronic health record (EHR) could facilitate occupational health surveillance, better health outcomes, prevention activities, and identification of workers' compensation cases. The US National Institute for Occupational Safety and Health (NIOSH) has developed an autocoding system for "industry" and "occupation" based on 1990 Bureau of Census codes; its effectiveness requires evaluation in conjunction with promoting the mandatory addition of these variables to the EHR.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the intercoder reliability of NIOSH's Industry and Occupation Computerized Coding System (NIOCCS) when applied to data collected in a community survey conducted under the Affordable Care Act; to determine the proportion of records that are autocoded using NIOCCS.
  
  
  METHODS
  Standard Occupational Classification (SOC) codes are used by several federal agencies in databases that capture demographic, employment, and health information to harmonize variables related to work activities among these data sources. There are 359 industry and occupation responses that were hand coded by 2 investigators, who came to a consensus on every code. The same variables were autocoded using NIOCCS at the high and moderate criteria level.
  
  
  RESULTS
  Kappa was .84 for agreement between hand coders and between the hand coder consensus code versus NIOCCS high confidence level codes for the first 2 digits of the SOC code. For 4 digits, NIOCCS coding versus investigator coding ranged from kappa=.56 to .70. In this study, NIOCCS was able to achieve production rates (ie, to autocode) 31%-36% of entered variables at the "high confidence" level and 49%-58% at the "medium confidence" level. Autocoding (production) rates are somewhat lower than those reported by NIOSH. Agreement between manually coded and autocoded data are "substantial" at the 2-digit level, but only "fair" to "good" at the 4-digit level.
  
  
  CONCLUSIONS
  This work serves as a baseline for performance of NIOCCS by investigators in the field. Further field testing will clarify NIOCCS effectiveness in terms of ability to assign codes and coding accuracy and will clarify its value as inclusion of these occupational variables in the EHR is promoted.
authors.affiliation: Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Matthew
authors.identifier: http://orcid.org/0000-0002-9296-2121
authors.initials: M
authors.lastname: Schmitz
authors.forename: Linda
authors.identifier: http://orcid.org/0000-0003-4966-1929
authors.initials: L
authors.lastname: Forst
keywords: NIOCCS; industry code; medical informatics; occupation code; occupation+electronic health record; occupational health