Content and Quality of Free-Text Occupation Documentation in the Electronic Health Record

Recent recommendations for capturing social and behavioral information in electronic health record (EHR) systems for downstream applications, including research, highlight the need to better represent patient occupation. The objectives of this study were to characterize the content and quality of EHR social history module free-text occupation documentation. After developing categorization schemas, occupation entries with frequencies >5 (n=2,336) and a random sample of those with frequencies ≤5 (n=381) were analyzed. The information contained in the 2,336 entries fell into five groups: occupation (84.7%), occupation details (20.6%), employment status (2.5%), not in labor force (21.6%), and other (2.5%). Quality issues included use of acronyms/abbreviations (9.1%) and misspellings (1.6%). In comparison, quality issues with the 381 entries were: other (29.1%), acronyms/abbreviations (19.0%), and misspellings (9.0%). These findings suggest the need for EHR user training, system enhancements, and content standardization to support use of occupational information for clinical care and research.