Occupational health and technology

Are you getting the most out of IT? There is no doubt that it can help occupational health (OH) professionals deal with staff more efficiently, identify patterns of sickness or stress across an organisation, and develop a more proactive and targeted service. And with employers now looking even harder at the bottom line, an IT system can enable an OH function to prove its worth in terms of increased productivity and reduced absence, at a time when most employers are looking for ways to cut costs.


Although understanding all the options out there can be daunting, it is an investment of time and effort that is worth making. According to Occupational Health’s sister publication IRS Employment Review, the ability of employers to manage absence is being hampered by ineffective record-keeping systems. Last summer, it carried out a survey of 195 employers – covering a combined workforce of almost 900,000 people. The results showed that 21% reported problems with recording absence.

Difficulties they came up against included line managers’ unwillingness or inability to manage absence in accordance with organisational policies and procedures; absences that were reported late with incomplete details, or not reported at all; and inconsistencies in reporting between an organisation’s departments, businesses and locations. And line managers’ lack of effective involvement in absence management was cited as the single biggest hindrance by 40% of the respondents.

So what are the choices? Software systems currently on the market include Cohort, supplied by Tempus Software, Medgate from Medgate, Opas from Warwick IC Systems and Orchid, supplied by Chi Systems.

Making the right choice requires careful assessment of your organisational needs. According to Graham Johnson, operations manager at Bupa Wellness, the demand for early intervention to tackle sickness absence is driving innovation in IT. “Our clients are looking for early intervention in terms of sickness absence management and health surveillance measures,” he says. “This is resulting in a greater demand for meaningful, evidence-based robust management information to achieve our key performance indicators. OH providers are relying on IT systems to support them in these initiatives.”

Absence management provider Active Health Partners (AHP) has a bespoke reporting system providing detailed information on the absenteeism within its organisation. Using the live data received by its call centre, AHP can compare absence rates within different departments or multi-site locations, at certain times of the year, or by illness. This enables companies to analyse trends or identify issues quickly. Companies can also monitor the compliance of HR policies: whether managers are completing back-to-work interviews, for instance.


A web-based software application ensures real-time notification to managers, and the use of integrated IT processes, to eliminate the risk of someone ‘falling between the cracks’, as well as standardised tools for both nurses and managers, further improve outcomes and mitigate time-consuming litigation.

Jo Henderson, Cohort account manager at Cohort Team (Tempus Software Limited) says suppliers have to be flexible and responsive to increasingly sophisticated demands from OH professionals and employers. “Any system worth its salt should be able to produce the reports that the OH department wants,” she says. “IT systems should also produce different reports for different uses. For example, an income-­generating OH department needs to be able to create a report that gives an overall picture of what it has done, and also needs to be able to break those reports down by customer, to issue a report to the customer.

“If reports are ‘fixed’ within the software system, there is no flexibility, and the OH department ends up with reports that have been designed by ‘techies’ and are not relevant to what they need,” Henderson stresses.

Cohort packages can include touch-screen registration, online pre-employment systems, online management referrals and SMS text messaging for appointment reminders. Another trend is a shift towards paper-light or paperless OH by scanning information directly into the OH software. Tempus, for example, is piloting the use of digital pens and voice recognition software.

Pilot schemes

Online management referrals are currently being piloted north of the border by NHS Borders and NHS Forth Valley. The Scottish government is funding the pilot scheme, which is assessing the effectiveness of IT in improving the process of receiving, managing and reporting on OH absence referrals. Pilot organisations are using the Cohort system as this is the most widely used by the NHS in Scotland.

The project was set up in late 2008, and is expected to run until the end of March. Just over 20 OH professionals are involved. The system will consist of a web front end which will enable the manager or HR professional to make referrals online directly to the OH service. The OH service will then be able to accept the referral, which will then match with the employee record and be held there.

The triage of the referral, appointments, tacking of requested reports and outcomes will all be managed within the system. Reports will be able to be e-mailed directly back to the manager, using the NHS net.

In addition, the team will feed back to OH services that use other systems such as Opas, so they can discuss future service developments with their own software providers. If successful, the next step would be to extend the system to all other NHS employers in Scotland.

“The manager/HR will still refer the client, but it will be done instantaneously,” says Dorothy Bell, occupational health service manager at NHS Forth Valley. “And the referral data will migrate directly into the employee’s record, so no double-handling of data. It also gives the opportunity to reduce the paper records held and move towards a paperless system.

“I feel that IT offers any healthcare service – not just OH – great opportunities. At the moment, both Forth Valley and Borders use IT to manage clinics, record immunisations, and record and recall health surveillance, but there is still about 30% of our work which could be better undertaken by more use of IT – managerial referral and pre-employment assessments being the others.”

Bell and her colleagues are optimistic about the scheme, but she is keen to stress that IT is not a panacea. “OH professionals know how to run an OH service and what tools they need to do the job,” she says. “IT can be a very effective tool, but it needs to be able to support OH practice, rather than OH practice having to mould to meet the needs of the IT system,” she says.

Best practice

Best practice will include the need to ensure security of data held within the system. The system itself should be able to offer support to key performance indicators and audit. But Bell points out that in this respect, IT is not an optional extra.

“As with all healthcare delivery in the NHS, the move to e-records is continuous,” she says. “All OH staff, not just those based in the NHS, need to consider how to move over to a paperless record system. Embracing IT is an inevitable requirement if OH professionals are to modernise – rather than running the risk of being left behind.”

However, Dr Mark Simpson, medical director of OH service provider AXA ICAS, warns that clarity on the part of both provider and client is essential if such developments are to succeed.

“OH and employers need to have a good understanding of why they want an IT system – and it’s up to the provider to explain what the client can get out of it,” he says. “You have to be clear about what you want to get out of the system.”

AXA ICAS developed its own in-house system, WorkFlow, in 2003, and also offers a wellbeing programme, HealthInsight, which is hosted separately. One recent innovation is a wellbeing management system which includes data on “readiness to change”.

“We conduct a health risk appraisal, then look at an employee’s readiness to change,” says Simpson. “For example, if someone is not interested in giving up smoking, but will consider taking more exercise, we would filter out anti-smoking updates, but send regular information about keeping fit.”

Another innovation available from AXA ICAS is the online cognitive behavioural therapy tool Beating the Blues, developed by the Institute of Psychiatry. The programme provides an eight-week computer-based course of therapy, and is recommended by the National Institute of Health and Clinical Excellence (NICE) as a treatment option for all people seen with mild and moderate depression. AXA was the first private provider to offer this, but its exclusivity agreement ended in 2008, and Beating the Blues is now used by a number of NHS Trusts.


So what of the future? Much of the current agenda is being driven by Dame Carol Black’s Health, Work and Wellbeing Review: Working for a Healthier Tomorrow. The widely publicised ‘fit notes’ are a response to this, putting the emphasis on fitness to work and rehabilitation, rather than an employee’s sickness and inability to carry out a particular role (see box above).

But IT can also help employers get a more strategic view of their staff’s “fitness to work”. One example of this is Warwick Systems’ occupational health database ‘Constructing Better Health’ (CBH), launched in January.

Its national database will form the basis for site management and contractors to obtain ‘fitness for task’ outcomes for the construction workforce. OH providers will be able to upload and access information from the health surveillance checks. Key benefits of the database will be the ability of OH service providers to accurately monitor individuals’ health over the long-term – which is crucial to aims of enabling employers to manage occupational health risks at site level.

And while technical innovation is essential, the ‘human factor’ is equally important. OH professionals must communicate with senior managers and their IT colleagues if they are to introduce the right systems – and get the best out of them. Andrew Gilbey is assistant director of occupational health for York Hospitals NHS Foundation Trust and national delivery and operations adviser with NHS Plus. He is adamant that opening up the lines of communication between different functions is essential.

“IT can help OH staff to identify problem areas in an organisation very quickly, and provide data to back this up,” he says. “In the past, they may have had a gut feeling that one particular part of a business was presenting a problem – now they can track this very quickly and efficiently.

Top tips

“It’s important to work closely with your IT team to ensure that both OH and IT are happy with the package you bring in, and that the IT team is able to support the package once it is in place. And you must make sure that you customise the system in a way that works for your organisation. Don’t make it too complex or difficult to use.”

And his final piece of advice is that there are no short cuts. “Get to know the market, and make sure you have up-to-date information about what the various packages can offer. You have to do your homework.”

Henderson points out that IT ‘homework’ is an ongoing job for any OH professional who wants to continue to get the best out of an IT system, even when it is in place. “You get out of the system what you put in,” she says. “So make sure you attend the user groups set up by your software providers. And ensure that there is a procedure manual and that personnel input the same data – this ensures that the reports that are produced are relevant.

“And ask your supplier to keep you updated. Don’t just use a small part of the system – find out what it can do.”

Watch this space

Fit notes: A pilot scheme in Wales, run by the Department for Work and Pensions (DWP) used electronically generated notes in 20 GP surgeries. Critics included the Trades Union Congress (TUC), which believes that sick or injured workers are being short-changed, and that “bad” employers will ignore the scheme. The jury is still out on whether GPs and OH will be able to collaborate effectively on this. But Dr Mark Simpson, medical director of AXA ICAS, sees potential in the scheme. “The primary function of a fit note is just to make sure that someone going off sick is paid,” he said. “Fit notes enable this to happen, but will also get people into rehabilitation as soon as possible.”

Avatars: Workplace health and productivity provider Vielife has just completed a pilot project in the US, which is looking at the use of a virtual conference centre which will offer advice on health and wellbeing to staff. Employees can anonymously enter a virtual world, asking health questions via their own personal avatar. “Participants can take part in real time, using their own voice and interacting with the host directly,” says Jessica Colling, product director at Vielife. “Staff can send messages to the group, or to the presenter, and it’s less embarrassing if they want to ask personal health questions.” The three-month pilot has just ended, and Vielife is currently assessing the results.

Facebook: Billed as help for weak-willed smokers, Facebook’s application QuitClock has been introduced by Bupa Wellness to help people track the time since their last cigarette, and offer an instant view of how much money has been saved by not smoking. The idea is that friends, family and colleagues can post messages of support to someone struggling to kick the habit. And anyone who has stopped smoking in the past can used the system to see how much money they have saved since they quit.

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