The Faculty of Occupational Medicine, the professional and educational body for occupational medicine in the UK, has issued important guidance about the use of COVID-19 risk scoring systems.
The guidance is well-timed, given the growing number of risk assessment or scoring systems being developed and marketed to businesses. Whilst many of the systems have potentially large benefits for employers, helping them to quickly identify employees at greatest risk of harm from COVID-19, there are some key factors that should be looked at closely if you’re considering using one of the services.
There are some very useful free risk stratification tools available for clinicians, which can easily be used by businesses too. If you are considering using a proprietary system, these are the key areas to consider:
Risk assessment stratification
An employee’s health risk factors (if they are exposed to or contract COVID-19) is a relevant data point when making occupational health recommendations, however, this must only be used in the context of the wider risk assessment of the employee’s personal and employment circumstances.
An employee working in a public facing role may be at significantly lower risk than another in a similar role, if appropriate risk-mitigation strategies are put in place for them in the workplace. The availability of PPE and the extent of social distancing that can be facilitated in the workplace are important considerations when assessing COVID risks and it’s important they are considered closely.
Risk scoring tools are not a substitute for clinical reasoning
Accountability for clinical decision-making and the consequences of any decision always rest with the clinician. The Faculty of Occupational Medicine considers that there is “a high risk of risk stratification tools being used as the final arbiter for a decision because of their ease of use, rather than as the ‘starting point’ for the decision-making process leading to a recommendation.”
Dr. Paul McGovern, the principle author of the guidance, continued “Clinicians must be suitably qualified to make recommendations and must recognise the limits of their clinical competence and not exceed them in practice.
“Clinical risk stratification tools can assist in discussions between clinicians and their patients, including in relation to decisions about work. Emergency measures taken at the start of the pandemic to cope with the immediate crisis may have necessitated managers seeking health information and undertaking assessment in relation to work placement without specialist support” he continued.
The evidence used for the risk scoring
Employers should carefully consider the evidence based used in the development of the risk assessment tool, as well as whether it has been peer-reviewed, validated or quality assured in any way.
Because COVID-19 has developed so quickly, there is sometimes little evidence available and the base of reference sources and knowledge is growing on a daily basis. That means it’s very easy for risk scoring systems to become outdated, if they are not adjusted regularly as the body of available evidence they are built upon improves.
Any COVID risk assessment tool which uses a variety of personal information (such as age, ethnicity, body mass index etc) and other sensitive information, including aspects of medical history, into an easy-to-interpret score is probably attractive for many businesses.
It is important to consider that the processing of occupational health data must always be done in line with relevant legislation and with appropriate security.
A ‘health score’ has a significant potential for misuse and potential harm. First, a score suggesting a given level of health risk could be misused to inappropriately deny care, insurance cover or other services. Secondly, any unauthorised disclosure of a risk score could lead to claims of direct or indirect discrimination. Lastly, any data breach containing such sensitive information has the potential to cause significant psychological harm due.
The Faculty suggest that all occupational health clinicians, and by extension the businesses they advise and support, should pay very close attention to these areas, before deciding how to use any risk scoring tools.
If you have an employee who could benefit from occupational health support or guidance, you can read more about our assessment service here. We do not currently provide or endorse any COVID-19 risk assessment tools.
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