A Result-Oriented Medical Information System

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Abstract
A result-oriented medical information system at the Gulf Oil Corporation [Texas, USA] is described. Mortality data acquired mostly from routine company operations were used to calculate standardized mortality ratios (SMR) and life expectancy. Male employees at the age of 20 have a life expectancy of 74.8 yr. Compared with the USA general population at age 20 with a life expectancy of 71.8 yr, Gulf employees have an advantage of exactly 3 yr. Such an advantage may seem small, but it is equivalent to the gain that could be achieved if all deaths from cancer were eliminated in the USA. These life expectancy data have the potential for use by the company to influence insurance premiums traditionally set by life insurance companies as well as to aid in the management of the company''s pension fund. The SMR for all causes for the male employees is 0.82, significantly decreased in comparison with that of the USA general population. This favorable experience has been referred to as "the healthy worker effect". Cause-specific SMR show a generalized pattern of deficits, some of which are statistically significant. None showed a significant increase. Seventy-six percent of the male deaths occurred among employees aged 65 yr or older. If these annuitants (those alive at the beginning of the study) were not included and only the active workers were studied, an SMR of only 0.54 would be obtained. Such a study design would result primarily in a study of the "healthy worker effect'''' of the active rather than in a study of adverse health effects, and one might not be able to detect occupationally related cancer with a long latency period unless the follow-up time were extended an additional 10-20 yr. Maintaining this information system in a functional status requires periodic updating of the data and the solution of several problems that are discussed. The medical surveillance information system described herein is adequate and flexible for a variety of purposes and is far less costly than a system developed de novo.