- One of the main reasons for physicians difficulty in recognizing occupational asthma is the large number of potentially causal agents. The work-relatedness of the patients asthma is not diagnosed because the physician lacks the information necessary to elicit a pertinent history. The move to computer-based patient records may help to solve this problem by allowing linkage of the patients occupational history with a toxicology knowledge base. The medical records of 96 patients coded as asthma from a large managed care organization were reviewed. Of the 30 patients classified as probable or possible occupational asthma based on the chart review, only three records contained documentation that the potentially causal agents were explored in the patients histories. Twenty-three patients had jobs known to be associated with agents that cause occupational asthma. With a computer-based patient record system, these patients could have been identified, and the physicians could have been alerted to the associated agents. The advantage of a computer-based patient record system is that it could help the physician to identify patients with high risk occupations and then to take a focused exposure history. By assisting the physician to target high risk groups, the computer is a tool that could improve the positive predictive value of the occupational history as a screening test for occupational asthma.
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