UDC 616-036.86«742»:313.13]:002:65.011.54/.56

N. V. Dogle, D. P. Zuikhin, Zh. S. Kanevskaya, V. P. Zotkina, I. K. Rapoport

Automated System for Processing Primary Information on Personnel and Their Morbidity with Temporary Disability

Moscow F. F. Erisman Research Institute of Hygiene

To develop health measures aimed at reducing morbidity with temporary disability, it is necessary to know the causes that maintain its high level and to have reliable evidence of the influence of various factors, primarily occupational and workplace factors, whose elimination or mitigation is most feasible.

Determining the importance of individual factors requires special studies that provide information on occupation, age, sex, length of service, living conditions, quality of medical care, and a number of other factors affecting health. To process and systematize these data, an in-depth method for studying temporary disability is used. It is based on individual-level records, which make it possible to form appropriate occupational groups for comparison and obtain a number of additional informative indicators.

There is an urgent need to develop new methodological approaches to studying morbidity with temporary disability using computers in order to optimize preventive measures. In recent years, methodological guidelines have begun to be developed for the automated processing of data on morbidity with temporary disability at industrial enterprises (Kyiv, 1977; Kazan, 1978; and others).

The development and implementation of an automated system for processing information on enterprise personnel and their temporary disability make it possible to obtain promptly all the necessary data on the level and structure of morbidity among employees in individual workshops and departments, taking into account occupation, sex, age, and length of service, both for those employed throughout the year and for those who have left the enterprise.

The most promising approach to implementing these methods of processing morbidity information is to build on automated enterprise management systems, which have begun operating at many enterprises, including those in the machine-building industry.

The resolutions of the 26th Congress of the Communist Party of the Soviet Union called for further development of the country’s machine-building industry through the construction of new enterprises and the reconstruction of existing ones, as well as through increased labor productivity and intensification of production. Consequently, protecting the health of workers and employees in this vital industry and conducting an in-depth, comprehensive study of the causes of temporary disability assume particular importance.

In 1982, an automated personnel management subsystem was brought into operation at the Mytishchi Machine-Building Plant, which we selected as the study site. On its basis, a subsystem entitled “Morbidity with Temporary Disability” began to be developed.

The plant’s personnel department first carried out extensive work to verify data on the number of employees, their sex, age, occupation, length of service, and educational level. At the same time, staff of the Moscow F. F. Erisman Research Institute, together with employees of the plant’s medical and sanitary unit, accounting department, and trade union organization, verified the data on each case of temporary disability. Before the primary information was transferred to machine-readable media, the institute’s staff, together with medical—

…together with the plant’s medical and sanitary unit, compiled a list of descriptors (the characteristics studied), established groupings for each, devised a coding system and instructions for coding the primary information, and developed a punch-card layout and algorithms for solving the entire problem.

In creating the automated system, special attention was paid to developing a logical workflow for the documents. When closing a certificate of incapacity for work, physicians at the medical and sanitary unit entered on its reverse a five-digit code for the final diagnosis, as well as a code for the medical institution that had issued the certificate (the medical and sanitary unit, a hospital, or another medical institution). The cause of the illness, established by the physician while taking the patient’s history, was also coded with a two-digit code. A code was then entered indicating whether the certificate was an initial certificate or a continuation. In all, a nine-digit code was entered in the bottom field on the reverse of the certificate. The first three digits of the five-digit code identified the diagnosis used in the detailed analysis of data on workers’ temporary incapacity for work. The coding scheme included a fairly comprehensive list of diseases—54 disease categories and groups—taking account of sex, age, occupation, length of employment, and other characteristics. The last two digits corresponded to the codes for diseases and other causes of incapacity listed in the report on temporary incapacity for work, Form No. 16 (З—1), making it possible to use a computer to produce a report in the approved format.

When taking a more detailed history, the physician, in accordance with the methodological guidelines approved by the Ministry of Health of the RSFSR (1979), questioned the patient to establish the specific conditions and circumstances—the specific causes—that contributed to the onset or exacerbation of an illness resulting in temporary incapacity for work. Given data on the hygienic characteristics of working conditions, a physician can identify only general factors in the work environment—chemical, physical, microclimatic, and others—and has difficulty discerning the effects of specific conditions and circumstances at the affected worker’s workplace. Moreover, in some cases temporary incapacity for work results from nonoccupational factors: chilling while washing clothes or cleaning, after a shower or bath, during sports, or in transit; consumption of cold water or ice cream; contact with a person with an infectious disease; and others. Including in the research program, as E. L. Notkin (1961) proposed, the collection of information for each case of incapacity about the specific cause that the patient believed had led to the illness not only expanded the possibilities for analysis but also helped improve preventive work by the medical and sanitary unit and its feldsher stations, which could not fail to affect the level of morbidity.

The certificates were sent from the medical and sanitary unit to the workshop timekeeping office, where a three-digit code for the workshop or department, the number of calendar days of incapacity, and two-digit codes for the month (01 to 12) and year of illness (79, 80, 81) were entered. When coding the certificates, a personnel department officer entered the worker’s personal record card number, which was assigned for the entire duration of employment at the enterprise. When a worker left, the personal record card number was not reassigned to a new employee for one year. After the accounting department calculated the amounts payable, the fully coded certificates were sent to the plant’s information and computing center for computer processing and production of output forms.

The program for an in-depth study of morbidity among persons who had worked at the plant for at least one year was developed by staff of the F. F. Erisman Moscow Research Institute of Hygiene and consisted of nine layouts for complex cross-tabulations. The program provided for output forms containing not only summaries of absolute data on the numbers of people of specified sex and age working in individual workshops, occupational groups, and the plant as a whole, but also the numbers of persons who had been ill and the numbers of cases and days of incapacity in each group. In addition, each output form (tabulation) was to contain all the principal indicators: the numbers of persons who had been ill and the numbers of cases and days of incapacity, calculated per 100 permanently employed workers, as well as the mean duration of incapacity per case and the standard errors of the resulting rates. This greatly facilitated assessment of the statistical significance of differences between indicators for individual groups of workers.

On the basis of a study of working conditions at the machine-building plant, occupational hygienists identified 10 production and occupational groups—machining and assembly, welding, foundry work, heat treatment, and others. This made it possible to examine the influence of particular working conditions on morbidity while eliminating the possible effects of differences in the sex and age composition of these groups.

On the basis of the program for processing and summarizing data on morbidity involving temporary incapacity for work, prepared by institute staff, a systems engineer and a programmer at the information and computing center developed a functional block diagram of the automated “Morbidity” subsystem, as well as data-processing programs in PL-I for the ES-1022 computer and programs for producing output forms (tabulations) in accordance with the aims and objectives of the study. Particular attention was paid to…

…efficient use of primary information and minimization of the output of processed information.

Two data sets were used to address these objectives. The first, the employee data set, was compiled when the “Personnel” subsystem was created, using information contained in employees’ personal record cards (form T-2). This data set was updated monthly to reflect changes affecting individual employees. The second data set, “Morbidity Associated with Temporary Disability,” included all cases of temporary disability. The personal record card number and the organizational unit code made it possible to link the two data sets during processing and obtain all the required absolute and relative measures.

For the first time, data on morbidity among employees at the machine-building plant were processed by computer. The individual-based method of studying morbidity that we used made it possible to eliminate the effect of staff turnover on morbidity levels. The programs developed were tested by processing morbidity data for persons who had worked at least one full year (1979, 1980, or 1981) in the five main workshops and in the production and occupational groups represented in those workshops. In 1981, the tabulations were printed sequentially, and all output forms were prepared separately for each year.

It should be noted that the computer made it possible to accomplish tasks that previously could not have been performed. This applies both to the volume of primary information processed and to its more comprehensive analysis, which yielded considerably more indicators, together with their confidence limits, than conventional manual processing, while requiring immeasurably less time and effort from medical personnel.

Automated processing yielded extensive information on morbidity, which was used to improve the effectiveness of efforts to combat temporary disability by both the medical and sanitary unit and the plant’s trade union organization. This extensive information can subsequently be used to improve the organization of medical care for employees and the system of preventive measures aimed at improving working conditions and preventing illnesses associated with temporary disability, thereby helping to increase labor productivity. These data can also be used to study the economic effectiveness of health-improvement measures by assessing changes in economic losses associated with reduced morbidity.

Thus, the creation of the automated system involved solving organizational, informational, mathematical, and technical problems. The system is being introduced at the enterprise; beginning in 1983, data on morbidity among plant employees will be processed routinely by computer, and output forms will be available for virtually any period (month, quarter, or year) and for any group of employees. The standardization of the design solutions allows them to be used at enterprises in other sectors that have an ES-1022 computer in their information and computing center.

References

All-Union Scientific Research Institute of Occupational Safety. Methodological Recommendations for the Automated Processing of Data on Morbidity Associated with Temporary Disability at Industrial Enterprises (Algorithms and Programs). Kazan, 1978.

Use of Medical History Data in the Study of Morbidity among Industrial Workers: Methodological Recommendations. Moscow, 1979.

Methodological Recommendations for the Study of Morbidity Associated with Temporary Disability Using the Developed Automated Information System and a Computer. Kiev, 1977.

Notkin E. L. On the Study of Specific Causes of Morbidity Using Medical History Data. Moscow, 1961.

Received February 9, 1983.