Risk based recommendations for health surveillance
Many companies concerned about the health of their employees have health surveillance programs in place through which to monitor the health of employees. A typical program may require that all employees be tested thoroughly in an entry, exit and ad-hoc medical examinations.
These companies often find themselves spending an enormous amount of money on health surveillance without achieving the benefits which they would like to achieve – minimizing workplace risk and targeting health surveillance towards those employees who really need it.
As an occupational illness could be the result of unacceptable exposure in the workplace – the first focus need to be on identifying, analyzing and treating the exposures in the workplace. Second, in order to achieve a benefit from health surveillance – the employees at risk should be proposed / recommended for specific medical examinations and tests (protocols).
By introducing a concept of “Risk Based Health Management” – a company can ensure that they reap the benefit of their investment in Health Risk Assessments.
Technical solutions offered by SAP
SAP offers three technical solutions through which the concept of Risk Based Health Management can be implemented:
1.) An integration between SAP EH&S Industrial Hygiene and Occupational Health
2.) An integration between SAP EHSM Risk Assessment and SAP EH&S Occupational Health (SP03 EHSM300 and SAP ERP 6.0)
3.) An integration between SAP EHSM Risk Assessment and a third party OH solution (SP03 EHSM300)
Various best practices and regulations actually require that the results of the health risk assessment be used in order to determine which medical protocols to recommend for those at risk. In the USA, the National Institute for Occupational Safety and Health as well as OSHA published best practices / regulations in this regard. The German requirements (Verordnung zur arbeitsmedizinischen Vorsorge) seem to be the most specific – indicating that health surveillance should be based on the results of the health risk assessment, and that feedback should be provided after health surveillance has been conducted to indicate whether more workplace controls are needed. The South African Mines Occupational Hygiene Programme is also specific – indicating that there is a direct relationship between workplace exposures and occupational illness – and that health surveillance should follow if required by the risk assessment.
In all of the above – the concept is the same; identify and analyze workplace risk and then determine which health surveillance protocols are relevant for those at risk…
Information required in order to make risk based recommendations for Health Surveillance
In order to make risk based recommendations for health surveillance, you need to know WHO is exposed to WHAT WHERE in the organization. You should also decide (based on legal requirements) what the triggering level would be for making automatic (system-based) recommendations.
You therefore need the following:
– Risk information (Location, Agent, Operational Status, Risk Level or Exposure Rating)
– Workplace / Workforce information (Location / Job relationship with Position / Person)
– Recommendation Criteria (Information on which risk level / exposure rating per agent should trigger which medical protocol)
– Health Surveillance Protocols (consisting of the tests and examinations which should be carried out in case the protocol is recommended)
Implementing Risk Based Health Management with SAP EHSM RA / SAP EH&S OH
The new Risk Assessment functionality in SAP EHS Management allows you to maintain risk-based criteria for health surveillance protocols, which have been created in SAP EH&S OH. For each protocol, you can specify criteria which has to be met before the system can trigger the protocol on the basis of a risk level / exposure rating. Recommendation criteria can be maintained in SAP EHSM RA under Controls – Edit Recommendation Criteria for Health Surveillance Protocols.
The following information can be maintained as triggering criteria:
- Agent (one or more)
- Risk level
- Value type of the agent
- Exposure Rating
What makes the functionality really powerful and easy to use is the “AND” and “OR” logic which is build-in and which can be verified by requesting the system to display the maintained criteria in textual format. All criteria maintained within one row adds to the “AND” logic for a specific agent, and information between different rows implies “OR” logic. In addition, it is possible to limit the number of persons proposed for health surveillance by specifying Age and Gender information as additional criteria.
Risk based recommendations
Once the integration has been activated in the related customizing activity, you will see an additional tab (Health Surveillance Protocols) appear on the Review/Edit Existing Controls or Define New Controls risk assessment steps. Should all criteria be fulfilled on the related risk analysis, the protocol can be added by the system and will be recorded as part of the risk treatment measures. The system will also inform you which criteria have been fulfilled as the reason for adding the protocol as a control in the risk assessment. Manual assignment of protocols to a risk is also possible, in case the professional judgment of an Industrial Hygienist is applied.
A background job will communicate the names of the persons to SAP EH&S OH where the medical practitioner can review and process the recommendations of persons for specific health surveillance protocols.
As all recommendation logic has been implemented in a BAdI – a customer can change any logic as required – without changing any source code (and losing support as a result).
In addition, should a company have implemented the “Similar Exposure Group” functionality available in SAP EHSM – a summary of all protocols which apply per person will be listed on the “person” tab of the Similar Exposure Group. The personal exposure profile of each employee recommended for health surveillance could also be made available to the medical practitioner, so that the full exposure history of a person could be considered when health surveillance is being conducted.
Benefiting from the implementation
Companies who have implemented the approach of Risk Based Health Management have reported major savings due to fewer invitations to medical centers – as health surveillance are being targeted towards those individuals who really need it. In addition, the correct medical protocols are being proposed for the affected persons – ensuring more effective and pro-active health management.