JCAHO becomes Formal Partner with The Leapfrog Group

AMA, JCAHO, and NCQA To Focus on Measuring Effectiveness of Appropriate Pain Management

Aerobic Exercise and Carpal Tunnel Syndrome

Recent Recommendations on AEDS

OSHA Recordkeeping Rule in Effect

Changing Fortunes in Internet Companies Affecting Occupational Health

This new partnership, as announced on January 16, 2002, formalizes a previously informal relationship with the healthcare purchaser group and means that the healthcare purchaser group will seek input from JCAHO (Joint Commission on the Accreditation of Healthcare Organizations) on its patient safety initiatives. The Leapfrog Group was established following the 1999 Institute of Medicine report, "To Err is Human," which makes the reduction of errors a top United States priority. One important area targeted is Computer Physician Order Entry, aimed at reducing medication errors.

The Leapfrog Group is a consortium of more than 90 Fortune 500 companies and other large private and public healthcare purchasers founded by The Business Roundtable. For more information, visit www.jcaho.org or www.leapfroggroup.org.

AMA, JCAHO, and NCQA To Focus on Measuring Effectiveness of Appropriate Pain Management

These healthcare professional organizations have teamed up to develop a common set of evidence-based measures for evaluating the appropriateness and effectiveness of pain management for patients suffering from cancer, back pain, and arthritis. This two-year project is a major effort to improve the quality and consistency of pain management. The March 2001 Institute of Medicine report, "Crossing the Quality Chasm," identified back problems, arthritis, and cancer among 15 therapeutic areas prioritized for improvement in care. For more information, visit www.jcaho.org, www.ama-assn.org, and www.ncqa.org.

Aerobic Exercise and Carpal Tunnel Syndrome

A recent study published by in the Journal of Occupational and Environmental Medicine suggests that starting an exercise program may be good for your hands as well as your heart. A ten-month aerobic exercise program significantly improved nerve function and reduced hand symptoms in patients with Carpal Tunnel Syndrome (CTS). As patients lost weight and improved their physical fitness, their median nerve function improved as well. Repeat testing shows that nerve electrical conduction improved for patients who reduced their body fat and improved oxygen consumption capacity. Other symptoms such as pain, tightness, and clumsiness of the hand improved, too. See www.acoem.org/news for details.

Recent Recommendations on AEDS

Since the article in the Tracker (vol. 3, no. 4), ACOEM (American College of Occupational and Environmental Medicine) has issued a position paper and the U.S. Department of Labor Occupational Safety and Health Administration has issued a technical bulletin. The ACOEM guideline urges employers to consider using AEDs (Automated External Defibrillators) in selected workplaces beyond the scope of federal buildings. The guideline was developed to increase awareness of the value of AEDs and provide instruction on their use in the workplace. These recommendations are available at www.acoem.org/news.

The stated purpose of the Technical Information Bulletin promulgated by the Department of Labor is to inform employers about the use of AEDs and to assist in making decisions regarding these devices at individual worksites. Visit www.osha.gov for more information.

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OSHA Recordkeeping Rule in Effect

On January 1, 2002 the Occupational Safety and Health Administration’s (OSHA) new regulations to improve the system employers use to track and record workplace injuries and illnesses took effect.

The new regulations affect approximately 1.3 million establishments. Like the former rule, employers with ten or fewer employees are exempt from most requirements of the new rule, as are a number of industries classified as low hazard: retail, service, finance, insurance, and real estate sectors. The new rule updates the list of exempted industries to reflect recent industry data. (All employers covered by the Occupational Safety and Health Act must continue to report any workplace incident resulting in a fatality or the hospitalization of three or more
employees.)

The new recordkeeping regulations accomplish the following:

1. Update three recordkeeping forms: (a) OSHA Form 300 Log of Work-Related Injuries and Illnesses was simplified and printed on smaller, legal sized paper; (b) OSHA Form 301 Injury and Illness Incident Report includes more data about how the injury or illness occurred; (c) OSHA Form 300A, Summary of Work-Related Injuries and Illnesses, was updated to make it easier to calculate incidence rates.

2. Eliminate different criteria for recording work-related injuries and work-related illnesses; one criteria to be used for both.

3. Require records to include any work-related injury or illness resulting in one of the following: death, days away from work, restricted work or transfer to another job, medical treatment beyond first aid, loss of consciousness, or diagnosis of a significant injury/illness by a physician or other licensed healthcare professional.

4. Include new definitions of medical treatment, first aid, and restricted work to simplify recording decisions.

5. Require a significant degree of aggravation before a preexisting injury or illness becomes recordable.

6. Add additional exemptions to the definition of work relationship to limit recording of cases involving the eating and drinking of food and beverages, common colds and flu, blood donations, exercise programs, mental illnesses, etc.

7. Clarify the recording of "light duty" or restricted work cases. Require employers to record cases when the injured or ill employee is restricted from their "normal duties," which are defined as work activities the employee regularly performs at least once weekly.

8. Require employers to record all needlestick and sharps injuries involving contamination by another person’s blood or other bodily fluids.

9. Include separate provisions describing the recording criteria for cases involving the work-related transmission of tuberculosis or medical removal under OSHA standards.

10. Eliminate the term "lost workdays" and focus on days away or days restricted or transferred. Also includes new rules for counting that rely on calendar days instead of work days.

11. Require employers to establish a procedure for employees to report injuries and illnesses and tell their employees how to report. Employers are prohibited from discriminating against employees who do report. For the first time, employee representatives will have access to those parts of the OSHA 301 form relevant to the employees they represent.

12. Protect employee privacy by (a) prohibiting employers from entering an individual’s name on Form 300 for certain types of injuries/illnesses (e.g., sexual assaults, HIV infections, mental illnesses, etc.); (b) providing employers the right not to describe the nature of sensitive injuries where the employee’s identity would be known; (c) giving employee representatives access only to the portion of Form 301 that contains no personal identifiers; and (d) requiring employers to remove employees’ names before providing the data to persons not provided access rights under the rule.

13. Require the annual summary to be posted for three months instead of one. Require certification of the summary by a company executive.

14. Change the reporting of fatalities and catastrophes to exclude some motor carrier and motor vehicle accidents.

On October 12, 2001 OSHA announced that it will delay for one year the effective date of provisions of its recordkeeping rule that relate to the criteria for recording cases of work-related hearing loss and the definition of "musculoskeletal disorders" (MSDs).

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Changing Fortunes in Internet Companies Affecting Occupational Health

Recently the changing fate of three Internet-related companies has affected occupational medicine.

On December 26, 2001 WebMD finalized its deal with MedicaLogic/Medscape. WebMD will pay $10 million for the portals’ business assets, including the "Medscape" trademark and the two related healthcare information portals, Medscape.com and Medscape Health For Consumers.

On December 16, 2001 Dr. Koop LifeCare Corp, another troubled on-line health information provider, announced that it would cease operations and liquidate its assets after failing to come up with additional financing. Founded in 1998 by former U.S. Surgeon General C. Everett Koop, the company’s stock climbed as high as $45 per share before collapsing.

These two events solidify WebMD’s position as the leading medical Internet portal.

More specifically related to occupational medicine, an official for eStellarNet, a highly visible occupational medicine electronic transaction company, reported in early November, 2001, that the company had dramatically downsized and stopped accepting new business after losing additional funding because it was failing to meet its revenue targets.

The future for eStellarNet had, at one time, looked extremely promising. For example, in November, 2000, eStellarNet announced it had raised $30 million in financing led by Capital Z Financial Services Fund II, a global private equity fund focused on the financial services industry. Though we have not been provided an official statement, it is our belief that eStellarNet is no longer in business.

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