Health Exposure Records and Occupations (HERO) Summary: Development of Occupational Exposure Summary for clinical utility in Military Populations

IntroductionMilitary exposure summarization is critical for Veterans with complex environmental, occupational, or toxic exposures. Existing methods are limited by technical language, incompatible data formats, and difficulty in prioritizing information. Clinicians require concise, standardized, and easily interpretable exposure summaries to facilitate rapid assessment. This report is part of a broader programmatic effort to collate military exposure information from established, as well as new sources of data to improve VA exposure-informed healthcare. MethodsIn a collaborative effort, VA clinicians from multiple specialties participated in a structured clinical needs assessment interview to identify the most clinically useful information to be included in the Health Exposure Records and Occupations (HERO) summary. The interviews covered summary length, exposure prioritization, demographics, military occupational history, features characterizing exposure, resilience factors, health outcomes, and impact on clinical practice. ResultsConsensus recommendations prescribed a concise summary with clear language, basic military demographics, and critical military exposures that prioritize exposures that require further investigation. Based on recommendations, the HERO summary also includes types of exposure, proximity, route, symptoms at the time of exposure, exposure period, duration, frequency, and protective controls used. ConclusionThis perspective piece not only assesses the clinical need for exposure summarization and the optimal format for the HERO summary, but also highlights its potential impact. The HERO summary, as a tool, offers improved time efficiency, consistency in exposure-informed care across the VA, enhances communication between Veterans and providers, and improves understanding of the association between military exposures and health outcomes, potentially transforming the VA healthcare system.