Developing a WebBased Pesticide Illness Reporting, Management, and Analysis System

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Developing a Web-Based Pesticide Illness
Reporting, Management, and Analysis System

• PesticideRelated Illness Data Exchange

Joy A. Wisniewski, Ph.D. Office of Environmental
Health Hazard Assessment California Environmental
Protection Agency
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Many Thanks to Our Partners, Past and
Present Robert Schlag, M.Sc. and Robert Haas,
Ph.D. California Department of Public Health
(CDPH) Marylou Verder-Carlos, D.V.M., M.V.P.H.
and William Ngai, M.D. Office of Environmental
Health Hazard Assessment (OEHHA) Gary
Arstein-Kerslake and John Yonemura Cal/EPA Depart
ment of Pesticide Regulation (DPR) California
Poison Control System (CPCS) Western Center for
Agricultural Health and Safety University of
California, Davis And Many Others
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PRESENTATION OUTLINE

• Introduction Pesticide Illness Reporting
• Vision for Sharing Pesticide Illness Data
• NEIEN Grant Project Objectives
• Progress (and Regress) to Date
• Anticipated Tasks for 2008-09
• Questions

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INTRODUCTION
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Why Report Pesticide Illness?

• Establishes history and trends in poisonings
• Helps identify problem pesticides
• Can serve as an early warning system
• Provides evidence to conduct health-based
  investigations
• Establishes rationale for new pesticide use
  regulations
• Requirement of California Health and Safety Code

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Why Dont Physicians ReportPesticide Illness?

• People dont see a physician (esp. if non-work
  related)
• Pesticide illness low priority for many
  physicians
• M.D.s may not recognize pesticide illness
• M.D.s unaware of reporting requirement or how to
  report
• Confusion over what is a pesticide
• Cumbersome reporting process
• M.D.s overburdened with paperwork dont have
  time
• Concern about patient confidentiality
• Loss of capture of California workers who seek
  medical treatment in Mexico

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Problems with Current Pesticide Illness Reporting
System

• Underreporting of pesticide illness by
  physicians.
• Cumbersome, slow, mostly paper-based system.
• Inconsistent, non-standard data reporting

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OEHHA VISION PESTICIDE ILLNESS DATA EXCHANGE
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Overall Project Goal
Diminish the incidence and minimize the impact of
pesticide-related illness by improving
information exchange among physicians, poison
control centers, local health officers, county
agricultural commissioners, and state regulatory
and public health agencies.
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Model for Web-basedPesticide Illness Reporting
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Key Elements to Program Improvement

• Modify the PIRMake it unambiguous, useful,
  accessible, with a feedback mechanism.
• Integrate pesticide illness reporting into a
  common reporting system used by physicians.
• Improve physician recognition, management, and
  reporting of pesticide illnesses.
• Improve local health officer participation and
  county agricultural commissioner use.
• Design and construct system to improve
  timeliness, accuracy, and completeness.
• Develop interoperable, secure, web-based PIR
  reporting system for local health officers,
  poison control centers, and physician groups.

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NEIEN GRANTPROJECT OBJECTIVES
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U.S. EPA 2004 NEIEN Challenge Grant
PesticideRelated Illness Data Exchange
Project Objectives

• Design and integrate the web-based Pesticide
  Illness Reporting system (WebPIR) into the
  web-based Confidential Morbidity Reporting system
  (WebCMR).
• Re-engage participation of the California Poison
  Control System and integrate information into the
  WebPIR.

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PesticideRelated Illness Data Exchange Project
Objectives (cont.)

• Develop and pilot test an integrated web-based
  pesticide incident investigation system with
  three county agricultural commissioners and local
  health officers.
• Integrate or link the physician training modules
  to the WebPIR.

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PesticideRelated Illness Data Exchange Project
Objectives (cont.)

• Integrate WebPIR into Existing Cal/EPA Exchange
  Network.
• Establish data linkages with the Environmental
  Public Health Tracking Program and the
  Environmental Information Exchange Network via
  the WebPIR system.

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PROGRESS TO DATE
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On-Line Training Courses with Continuing Medical
Education Credits

• I. Recognition, Management and Reporting of
  Pesticide Illness
• ?http//www.mededpesticide.org/
• II. Recognition, Management and Reporting of
  Pesticide Illness (Spanish)
• III. Medical Supervision
• (Available Summer 2008)

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On-Line Training Courses with Continuing Medical
Education Credits

• Pesticides Health Series I
• Recognition, Management and Reporting Pesticide
  Illness
• Pesticides Health Series II
• A Practical Approach to Acute Pesticide Illness
• Available soon at
• ?http//www.ucdmc.ucdavis.edu/cme/

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ANTICIPATED TASKS FOR 2008-2009
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Anticipated Tasks for 2008-09

• Complete testing of WebCMR/PIR software in San
  Diego county
• Release software for use by other six counties
  using Atlas WebCMR
• Purchase WebCMR Nurse Case Management software
  for OEHHA/DPR use
• Conduct provider outreach/training on WebPIR
• Enter paper PIRs from all counties into CalEPA
  WebCMR
• Interface with San Diego and Monterey counties to
  receive electronic reports
• Complete development and begin field testing of
  Pesticide Incident Investigation tools using Epi
  Info or (OMS) incl. PIR, PEIR, General
  Follow-up Survey, ability to download data into
  WebPIR

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LESSONS LEARNED

• Keep your eye on the goal
• Murphy is alive and well!
• What can go wrong will
• Be creative!
• Be flexible!!

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Contact Information

• Joy Wisniewski
• jwisniew_at_oehha.ca.gov
• [phone]

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QUESTIONS???
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ADDITIONAL INFORMATION

• Forms CMR, PIR, DFR
• Screen shots
• San Diego Co HD Visual CMR
• California Poison Control PIR Site
• On-line Provider training sites

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Pesticide-related Illness
Providers may use the Confidential Morbidity
Report form to report a pesticide-related illness
or injury to the local health department.
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Pesticide-related illness or injury added to
Confidentiality Morbidity Report in August 2005.
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The pesticide illness report form was revised
more standardized data fields, more consistent
with CMR and DFR forms for future web-based
reporting and mapping data fields.
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Page 2 of PIR. Pesticide exposure information
is necessary for patient treatment, for
determining any pesticide use violations, for
work-related cases, etc.
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WebCMR Supplemental PIR form (cont.)
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WebCMR Supplemental PIR form (cont.)
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For work-related cases, physicians will often
complete the DFR, but not the PIR. ?Financial
incentive DFR must be completed for medical
reimbursement through the Workers Compensation
Program.
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DFR form imbedded in WebPIR, allowing physicians
the option of completing the form. Data fields
from PIR that are common to DFR are auto-filled.
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E-mail notification for pesticide incident
report from California Poison Control System
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PIR access Secure domain User name Password.
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