Title: Development of Internet-Based Mining Industry Database for Audiograms

Transcription

1 Safety in Mines Research Advisory Committee Final Project Report Title: Development of Internet-Based Mining Industry Database for Audiograms Phase 1 and Phase 2 AUTHOR: Arthur Begley Project number : SIM Date : 28 th April 2006

2 TABLE OF CONTENTS 1. Executive summary page 3 2. Introduction page 5 3. Methods page 6 4. Results page Discussion page Recommendations page Acknowledgements and roles page References page Appendix 1 and 2 (Separate Documents Attached)

3 1. Executive summary OVERVIEW Project SIMRAC was commissioned in 2001 to develop an Internetbased mining-industry database for audiograms. The project was divided into 2 phases. Phase 1 of the project concerned development or modification of an existing software programme providing for the record of baseline audiograms from facilitates both in the mining industry and elsewhere. This would assist Rand Mutual Assurance (RMA) in complying with the requirements of the Department of Labour in terms of Instruction 171 (1) (published in Government Gazette No of 16 November 2001). The Primary Output can be described as consisting of 4 sections: Phase 1 Development of Screening Audiometric database of Baseline Audiograms. Phase 2 Development of Screening Audiometry software management facility which would allow an employer to carry out screening audiograms as part of a medical surveillance programme Provision of Reports both standard and ad hoc reports. Over time generation of statistics on hearing loss deterioration. PRODUCT DELIVERED; (PHASE 1 AND 2) The Audiometric Test Result Repository System (inclusive of Database, Applications with Internet On-line Module) and 2 interfaces to import test results from participating mines directly into the Database) SERVICE FUNCTIONALITY OF THE INTERNET-BASED MINING INDUSTRY DATABASE FOR BASELINE AUDIOGRAM REPOSITORY (PHASE 1) An electronic software system which can capture, safely store and retrieve Audiometric Test Results from the Repository. This software may be used by smaller mines to conduct and record screening audiograms of employees provided a suitable audiometer and computer was available. If required by participating mines, a Notification Service to inform employers and/or employees of possible compensable claims due to 10% Percentage Hearing Loss (PHL) deterioration (potentially compensable) has been provided. Documentation Templates or forms in respect of potentially compensable hearing loss are available for download if required: These templates consist of various standard forms: notification to employer of potential compensable hearing loss, notification to employee of potential compensable hearing loss A service which can be used to store records of Authentication of Audiometric Technician and Equipment producing the Test Result.

4 STANDARD REPORTS FROM INTERNET-BASED MINING INDUSTRY DATABASE FOR AUDIOGRAM REPOSITORY (PHASE 2) Standard Reports available as defined by participating mines for example: Report of employees with 10% PHL deterioration and information of diagnostic test requirements for claim submission purposes. Report of employee with 5% PHL deterioration to assess Hearing Conservation Programme. Report of Audiometric Technician level of testing activities which is currently not utilized by participating members as this functionality exists elsewhere in their occupational health medical surveillance systems, Record of Audiometric equipment certification and validity periods which is currently not utilized by participating members as this functionality exists elsewhere in their occupational health medical surveillance systems. Report of Registered Employers and their various sites (e.g. mines shafts). Other Reports: Ad-hoc Reports for incidence and prevalence analysis Availability of data for research purposes. There are currently available are data in respect of 378,738 baseline audiograms and 331,768 subsequent Audiograms. The population of subsequent audiograms into the Repository (though not a requirement of SIM ) is provided to demonstrate the value which can accrue from the initial development of an Internet based Database for Audiograms. CONCLUSION The internet-based mining industry database for baseline audiogram repository has an electronic store of 378,738 audiograms and subsequent audiograms are being collected. From the information available from the repository hearing deterioration in various commodities can be accessed for individual members and for groups. Furthermore a management software system for screening audiograms for an employer has been made available.

5 2. Introduction Mining by its nature involves the generation of noise caused by drilling and blasting of rocks and processing rock material in the beneficiation of metals. Sound and vibration both originate in the mechanical movement or application of machinery and components (2). When the energy caused by this vibration is directly or indirectly transmitted to surrounding air at a generation frequency of 20 to Hz (cycles per second), it is perceptible via the ear as sound. Sound is regarded as noise if it has the potential to interfere with communication or damage people s hearing. Noise is unwanted or harmful sound. No employer shall require or permit an employee to work in an environment in which he is exposed to an equivalent noise level equal to or exceeding 85 db(a). In South Africa noise induced hearing loss (NIHL) is a scheduled compensable disease in terms of Schedule 3 of the Compensation for Occupational Injuries and Diseases Act 1993 (COID Act) (3). Impairment of hearing claimed to result from exposure to excessive noise at work usually manifests itself over a number of years and results in binaural impairment of hearing; i.e. both ears are affected more or less equally. Immediate loss of hearing produced by one or more exposures to sudden intense forms of acoustic energy such as explosions, blasts, or changes in atmospheric pressure in the workplace is also potentially compensable (acoustic trauma / barotrauma). NIHL is one of the most common occupational diseases that remain a challenge to the South African mining industry. NIHL is responsible for ±15% of all occupational disease claims submitted to the Rand Mutual Assurance Company (RMA), excluding lung diseases, and accounts for ±45% of compensation benefits paid out by the RMA to claimants. (4) In terms of the Mine Health and Safety Act (5), the employer must establish and maintain a system of medical surveillance of all employees in any working place where the equivalent, continuous A-weighted sound pressure level, normalised to an 8 hour working day or a 40 hour working week, does not exceed 85 db (A). With the change in compensation legislation occurring on 16th May 2001 (Instruction 171) and again on 16 th November 2001 (with Instruction 171 Supplement) the need for an Electronic repository of screening audiograms became apparent. In order to pro actively facilitate submission and processing of future NIHL claims documentation, Rand Mutual Assurance proposed introduction of an electronic centralized Repository of Baseline Audiograms to the industry stakeholders which would be available initially to the mining industry but had the capability of being extended to general industry. This led to the commissioning of the project which was partly funded by the Mine Health and Safety Council (MHSC). The baseline audiogram or hearing test is one which was carried out on existing mineworkers exposed to excessive noise at work by the occupational medical centres at the mines. The Baseline Audiogram is also carried out on new employees. For existing mine workers a two-year window period from 16 th November 2001 to 15 th November 2003 was provided by which all existing employees should be base-lined. (Furthermore Instruction 171 required that from 1 st May 2001 all new employees who had not worked previously should have a Baseline Audiogram within one month of commencing employment.

6 PURPOSE OF PROJECT To customise and populate a database of baseline and medical surveillance audiograms within the mining industry in accordance with the requirements of the Department of Labour in terms of Instruction 171 (published in Government Gazette No of 16 November 2001). To capture audiometry data for individual and groups of miners in order to track hearing deterioration through their working careers in the different commodities within the industry (gold, coal, diamonds and platinum). These data would mainly come from electronic download from participating medical surveillance units with electronic screening audiometry facilities. To facilitate an audiogram data management system within the mining industry that will facilitate correct apportionment of compensation amounts back to premiums for noise induced hearing loss for RMA as the licensed insurer of Workers Compensation within the industry. By analysing hearing deterioration trends valuable feedback could be provided to participating organizations in respect of the effectiveness of Hearing Conservation programmes. 3. Methods Extensive research and development were successfully concluded regarding the development of a noise induced hearing loss repository for the mining industry. The technical team did an extensive website search for organizations throughout the world that had existing software packages which might be adapted to become a repository for baseline audiograms in South Africa. Additionally a search for local suppliers was made by the Information Technology (IT) Department to elicit custom software development. Two developed package options and three custom development proposals containing broad based price estimates ranging from R1.2 million to R5 million were considered. Whilst all proposals provided the requisite solutions, the most cost effective proposal was that made by Work Cover Australia. This is the standard system used in Australia for screening audiometry and offered RMA the following benefits: Instruction 171 was based on the Australia system. Browser based Online Input means Audiograms could be collected via the Internet. SQL Server & Windows 2000 Platform was similar to RMA's technology platform. An Established Data Base meant saving on time and costs associated with DB design and development. Visual Basic Code meant access to local IT skills for changes and maintenance. The prototype software had been functioning for over 8 years in Australia with proven track record which made it attractive. Established Documentation & Service Model which could be modified to suit RMA's requirements. Excellent System Specification Documents to assist in analysis. Ready Developed User Interfaces, Reports and Standard Letters meant cost saving in terms of design and development.

7 The total purchase and development cost of the NIHL Repository with interfaces to clients cost R1, The specification and development time frame from receipt of the NIHL System code from Australia was estimated to be no less than 25 months. The NIHL Repository maintenance cost (excluding the cost of one data maintenance operator) was anticipated to be R5,000 per month. Information regarding the existence of international database systems for audiograms was identified from Western Australia and no other international such databases for audiograms could be identified. The development of a bespoke system was investigated but costs were prohibitive. Quotations were obtained from Red Screen and from MediTech. Summary of typical features included workshop discussions with RMA Medical and IT Department workshops/discussions Software was purchased from WA WorkCover to be customized for South African needs. A Confidentiality Agreement and Services Agreement awarded to IT Software Customization partner to RMA SOLIT (Pty) Ltd after a RPF process for the customization of the WA WorkCover NIHL: Repository System software to meet SA (Instruction 171) and SA Mining Industry The complete Upload File Profile and Upload mechanism were defined and developed. The facility was tested with data provided by Everest Software from various SA Mining and audiometric data facilities operating the Everest Software. This work resulted in the identification of Pre-requisites for participating mines requiring this upload facility. This was communicated to the wider Stakeholder group. When the participating mining houses fulfilled the pre-requisites for participation, the mass upload of audiograms occurred into the repository on an ongoing basis from the individual occupational health medical centres. The reporting functionality of the system was modified to allow reports of 5% deterioration in hearing loss in individuals and medical surveillance centres to assist with a Hearing Conservation Programme. Customization by Solit occurred in conjunction with the RMA IT project Manager, Anna Harrington, to effect the customisation of the Australian system to meet the requirement of South African legislation and in particular the requirements of Instruction 171 of the Compensation Commissioner. The development of an audiometric repository can be described as the development of a system in which data (screening audiograms) can be stored but in itself the development of a repository is not a research project but rather a tool for future ongoing research. It formed the creation of a platform from which useful information to be used in future regarding deterioration of hearing of mine workers exposed to excessive noise occurs. A Repository can be compared to the building of a library with the physical infrastructure of shelves to house books in which information is contained. However, a library is not of benefit unless the bookshelves are populated with books containing the relevant information. Similarly an audiometry repository is only of value when populated with initial (baseline) audiograms and subsequent audiograms at annual intervals to track the hearing status of individuals and groups over time. Hence the delay in the final report to enable hearing deterioration results to be included. Unlike other research projects the building of the repository with inclusion of baseline audiograms did not provide information on hearing loss deterioration but established a Baseline. The ongoing population of the repository with subsequent annual audiograms will provide information of the deterioration of hearing within the individual

8 working groups and commodities such as hard-rock mining where noise exposure can reach up to 110 db(a) for certain groups, especially rock drill operations. Notices via fax, post and telephonic conversations from the RMA Medical team have been disseminated during September and October 2003 regarding the facility and a marketing campaign to upload Baseline Audiograms began. Baseline audiograms could be uploaded manually by the repository administrator (Suren Moodley) or preferably by electronic upload of results from the medical surveillance screening audiograms. There are 2 audiometric system software management facilities available in the South African mining industry namely the Everest and SOFTOIT systems. The electronic upload was facilitated through the collection by Everest and SOFTOIT of the baseline audiograms and HR data to enable baseline audiogram upload into the NIHL Repository only As part of the marketing campaign visits were made to all the medical surveillance centres operated by members of RMA. The essential finding was that the bigger operations (catering for >500 employees) had invested in screening audiometric facilities which could test up to 8 12 employees in one sitting. This necessitated having software systems to manage these processes and the Everest and Softoit systems were invariably found to be the operational systems. This meant that there was not a demand to use the repository as a frontline screening audiometry tool. When this repository project was initially envisaged, it was not anticipated that the software could be used as a frontline screening audiometric tool, but, one of the advantages of customising the Australian system was that this possibility was now available at no extra cost. The smaller mines were utilising manual screening systems with no electronic management system. This meant that the smaller mines proposed submitting paper copies of Baseline Audiograms to be uploaded manually into the repository by the system administrator. The functionality of the repository has catered for both types of upload. All the medical surveillance units visited were welcoming and offered full access to the screening audiometry facilities. Many of the facilities did not have a written screening audiometry procedure with various checks in place (e.g. check if employee has been removed from excess noise for the required period of time, inspection of ear canal, tympanogram for cases with loss etc.) and were very grateful to receive a generic procedure which could be customised to suit their own purposes. Six regional seminars were held on the baseline requirement of Instruction 171 of the compensation for Occupational Injuries and Diseases Act and a demonstration of the functionality of the repository software occurred. Seminars were held in Welkom, Careltonville, Rustenburg, Witbank, Klerksdorp and Johannesburg. The training manuals were disseminated (Appendix 1 & 2) Standard template forms to facilitate the follow up process were issues (Appendix 3, Excel spreadsheet)

9 STAKEHOLDER CONSULTATION Having discussed the setting up of an industry NIHL repository with a number of the mining industry medical surveillance centres a list of demographic information identifying workers was made as follows: Personal Identifiers: Work History: Date of Baseline: Name of Mine where Baseline was done: Occupation at time of Baseline: Full Baseline Audiogram Coded Comment on Medical Status: Exit Audiogram from mine where appropriate Periodic Audiograms Name in format of surname and first names ID Number Passport Number Industry Number (PF Number) Company Number (The cost of having a relational data base using fingerprints should be investigated) Date of first Employment Job title (code) in each job worked giving commencement date and completion date. Noise exposure level in each job worked (if available) Job title (code) In Graphical or other format giving hearing threshold values for 500Hz, 1,000hz, 2,000Hz, 3,000Hz, 4,000Hz, 5000Hz and 6000Hz for both right and left ears. Only the better baseline audiogram (the one showing the least loss) of the two baseline audiograms done need be retained. e.g. normal, sclerotic tympanic membrane, otitis media, tympanic membrane perforation, exposure to ototoxic drugs etc. Date, audiogram details as per Baseline Audiogram Exit Percentage Hearing Loss (PHL) Annually

10 4. Results The NIHL Repository On-Line has been created to allow look up facilities for registered users. Each user is given a password and has access through the Internet to examine only the results of the institution. RMA Claims Assessors also have a look up facility at each Branch to search for baseline screening audiometric results once a claim for compensation has been initiated. This facility greatly assists prompt processing of claims for compensation. The repository also facilitates future apportionment of compensation deterioration amounts to the offending employer s premium and it is planned to continue this into the future although not a specific requirement of the project. In addition RMA IT has developed the following necessary documentation for NIHL Repository use purposes: a. Registration Procedure for the setup and use the NIHL Repository by users. b. Data required (Form) to successfully capture audiogram information into the Repository c. Customized User Guide for Audiometrist (based on the Australian Documentation) d. User Guide for the NIHL Repository System Administration e. User Guide for the NIHL Repository On-Line (WEB) System f. NIHL Repository Registration and Audiogram Data Capture Forms (Appendix 3) The real value of the SIM Project became apparent in August 2005 when a total of baselines and subsequent audiograms were registered on the repository. Of the total, (71%) of these baselines are in respect of RMA members, the remainder (29%) belong to non RMA members. During the initial scoping of the number of anticipated baselines which would be collected the projected RMA members workers at risk were This means that the project achieved an upload of 29% more baseline audiograms than anticipated. The excess (29%) baseline records may represent baselined audiograms from workers not exposed to excessive noise in the workplace subsequent audiograms has been uploaded to date representing (56%) of the baseline records uploaded. Of concern is the fact that approximately subsequent audiogram records cannot be uploaded into the repository as it is impossible to identify the original baseline audiograms to which these records belong. The graph below depicts the number of baseline audiograms in relationship to the subsequent audiograms which have been collected and placed on the repository. It also shows the commodity from which the records emanate from. It can be seen that the greatest support for placing audiograms into the repository comes from the platinum industry and the gold mining industry. This probably results from these industries have sophisticated occupational health medical surveillance systems which are computerized and allow for the transfer of information into the repository electronically. The number of subsequent audiograms from independent contractors is approximately 25% of the original baselines obtained and highlights the difficulty of contract employers providing follow up medical surveillance records into the repository.

11 Commodity Baseline Subsequent Gold Platinum Independent Contractors Coal Diamond Non-Mining Iron Ore Quarrying Total Perhaps the greatest benefit obtained from the repository can be seen from the deterioration of hearing levels per commodity as identified by the repository from the initial baseline completed in 2004 to the first subsequent audiogram in Of interest, it will be noted that hard rock mining represented by platinum and gold commodities has a deterioration level of 4.8% percentage hearing loss (PHL) and 4.1 PHL respectively. This information relates to the data analysed. This would seem to indicate that a compensable claim for the deterioration of hearing in the gold and platinum industries can be anticipated in a period of approximately three years from the initial baseline. On the other hand, deterioration to a compensable level of PHL in the diamond industry will take approximately four more years from the initial baseline. These figures may be not be truly represented of the time frame as the baseline audiogram for workers already exposed to excessive noise in the workplace occurred over a two year period. The average hearing deterioration for the entire industry including non mining sectors was found to be 2.97% PHL on an annual basis.

12 DETERIORATION LEVELS WITHIN COMMODITIES Commodity Average Baseline PLH Average Subsequent PLH Platinum Gold Coal Independent Contractors Diamond Quarrying Iron Ore Non Mining Average Average Deterioration DETERIORATION LEVELS GRAPHICAL REPRESENTATION The graph below depicts the relationship between the number of baseline audiograms received per commodity in comparison to the subsequent audiograms received for the same commodity during the period 2004 to The graph below represents the average deterioration per commodity from the baseline obtained up to 2004 in comparison to the subsequent audiograms obtained during 2005.

13 Many challenges lie ahead for the repository team but in particular the continued support of the industry in providing subsequent audiograms from which deterioration can be monitored throughout the industry and the commodities comprising the mining sector. Clearly there is a challenge to the industry to implement reduction of noise exposure to the workforce but in particular to the hard rock sectors of gold and platinum. The creation of the repository as a vehicle to assist in this process has been a worthwhile achievement and Rand Mutual Assurance Company is committed to maintaining the database at its own cost and will not rely on further support from SIMRAC 5. Discussion Once baseline audiometric data began to be put into the repository many deficiencies with regard to occupational health database structure and content became apparent. One of the significant problems is that there is no standard demographic data set used by the different occupational health centres conducting medical surveillance examinations. Most occupational medical surveillance centres have a combination of both a paper system and an electronic system in which data is collected but there is often poor correlation between the two systems. To get a holistic view of an individual worker medical surveillance record it is often necessary to view both the paper and the electronic systems in conjunction with one another. The initial anticipation had been that the electronic system would contain all the information necessary for detailed exposure and occupational health effect within one system. In reality this was not found to be the case, particularly with respect to audiometry records. Although the electronic medical surveillance systems used by the mining houses consist mainly of two types those managed by the Everest and Softoit (Ruskal) systems, most of the medical surveillance centres visited do not record electronically the noise exposure to which individual workers are exposed in the audiometry system. This means that a valuable opportunity to correlate the deterioration with respect to the noise exposure has been lost. The repository demographic profile system provided for the entry of the noise exposure into the baseline and subsequent audiometric records which has not occurred.

14 A problem is also encountered with regard to the individual style of capturing demographic data used at different mines. There is no uniform system throughout the industry for the capture of demographic information. This results in one operator using the initial of the worker for the first name whilst another worker may use the full spelling of the first name. A variant of this identification problem occurs in that all the initials of the first names may be used on one occasion and the complete first name may be used on a subsequent audiometry test. There is a need to introduce uniformity into the methodology of demographic database collection to prevent it becoming impossible to follow individual workers who have been identified slightly differently over a period of time. Another problem encountered was the duplication of baseline audiometry records within the medical surveillance system of a number of mines visited. This resulted in a tedious manual process to cleanse the data which became time consuming and expensive. Many medical surveillance centres submitted baseline audiograms for the entire workforce even those who were not exposed to excessive noise in the course of their work. As the repository did not contain the noise exposure records of the workforce it became difficult to identify the target exposed group to noise in excess of 85 db(a) or excessive noise as contemplated in Instruction 171. A serious problem exists with regard to the collection and storage of occupational medical surveillance data in respect of contract workers. Contract workers generally come from small employers who do not have an occupational medical practitioner or occupational nursing centre designated to assist with the collection and maintenance of occupational medical surveillance records. This means that the contract employer does not have a record of the medical surveillance of his workforce. What is happening is that the medical surveillance i.e baseline audiograms of contract workers are contracted out to the medical surveillance centre of the mine on which the worker is employed at that specific time. This results in a baseline audiogram for a contract worker being carried out in one centre e.g. Welkom whilst his subsequent audiometric examinations may be carried out at a different geographic location e.g. Rustenburg. This makes the tracking of contract group hearing status over a period of time difficult to interpret. It can be compared to having a book with chapters of that book residing in different countries. One would have to visit the countries to read the chapters in order to be able to read the entire book. Contract worker baseline audiograms are frequently not delineated by the medical surveillance system of a particular mine doing the baseline audiogram. This means that the baseline audiograms of contract workers cannot be separated out from the Baseline audiograms of full time workers. This results in further difficulty tracking contractor group workers in respect of hearing loss and deterioration over time. It was enlightening to learn the culture with regard to occupational baseline audiometry collection in the mining industry. In general, workers being sent for medical surveillance are given the entire day in which to have this surveillance carried out at the medical centre. There is a culture of all the workers coming to the centre early in the morning and attempting to have medical surveillance completed by lunch time of that day. This is the expectation of the individual worker and staff doing the surveillance also sees the advantage of getting the work done quickly in the first half of the day. However, this creates pressure on the screening audiometrists to do a large amount of work in a relatively short period of time. This results in an increase in the number of keyboard finger errors which occur further corrupting the demographic information when following trends over a period of time. It is recommended that better scheduling of medical

15 surveillance examinations occurs over a full 8 hour working day rather than trying to do this surveillance in the first 4 hours prior to lunch time. Whilst uploading data from the mine medical surveillance systems the following issues were identified: A lack of Audiogram quality in favour of quantity was noted at many occupational health centres. A need to improve the awareness regarding the technical Audiogram recording practices was noted. There is a need for further in-house training for audiometric technicians, occupational health nurses and doctors. This repository system was used to demonstrate wider capabilities at all the Stakeholder representation workshops (SIMRAC, MOHRAC, DME, WCC, SASOM) and stimulate additional improvements and the development of a data warehouse facility to enable research programmes from the captured data. It has further potential to be used to develop and disseminate training, skills transfer and audiogram requirements to the Mining Occupational Health Centre personnel PowerPoint training modules on Noise Induced Hearing Loss and Instruction 171 and Improving Screening Audiometry Skills were developed for the training of health and safety personnel as well as training modules on the use of the repository. Functionality available in the repository is a software package allowing screening audiometrists to input and manage audiometry records on an ongoing basis. This functionality has not been used in South Africa as all the current medical surveillance centres have pre-existing software (Everest and Softoit) which manage the collection of audiometric records on an ongoing basis. The possibility exists that smaller mines need not buy software required to manage the input of medical surveillance audiograms but rather approach the repository to provide this software for free to them initially. The maintenance of such software could either be provided by RMA or an independent software support company which the client would pay for. There has been a delay in the furnishing of the final report of SIM but this has been caused by the need to demonstrate the value of the data in the repository rather than providing a report on the completion of the system without demonstrable value clearly being provided to the part Funders of the project. 6. Recommendations Deficiencies with regard to occupational health database structure and content with the South African Mining industry need to be studied further with a view to correcting the deficiencies. It would be beneficial to develop a standard demographic data set to be used by the different occupational health centres conducting medical surveillance examinations in the mining industry. There is a need to have better unity of the occupational medical surveillance data in the written employee medical surveillance file and that on the electronic data as currently both systems have to be viewed independently to obtain a full occupational health status of the individual. It would be ideal to have an electronic record of the complete data set.

16 There is a need to introduce uniformity into the methodology of demographic database collection to prevent it becoming impossible to follow individual workers who have been identified slightly differently over a period of time. Contractor employers should be obliged to keep ongoing medical surveillance records of contract employees in a single file per employee on a chronological basis as the storage of occupational medical surveillance data in respect of contract workers is currently geographically fragmented and may prejudice the individual. A need to improve the awareness regarding the technical Audiogram recording practices was noted. There is a need for further in-house training for audiometric technicians, occupational health nurses and doctors. A possible solution to the irregularity of demographic information being captured at mine medical surveillance centres might be to use the human resources demographic data available for such workers if this is in electronic format. However, this solution tends to be expensive as the merging of the demographic database into the medical surveillance database is technically time consuming and expensive. Another problem is that the updating of demographic detail when this changes becomes difficult to integrate into the repository setting. Another hurdle that had to be overcome and remains an ongoing challenge is the need to make the upload of subsequent audiograms into the RMA repository as easy as possible. To assist in this regard a piece of software has been developed by Danie Du Toit of Softoit in conjunction with Roger Mettam of Everest whereby the mine medical surveillance centre can purchase on a one off basis an upgrade allowing the batching of subsequent audiograms into a flat file format which can be ed to the repository or sent as a CD. This development holds great potential for encouraging occupational medical centres to supply subsequent audiograms to the repository. 7. Acknowledgements and roles Mine Health and Safety Council (MHSC) for partially funding the project especially for the sponsorship of obtaining and customizing repository software package as well as providing server for setup of repository. Prof. Mary Ross, Dr. AV Banyini and Ms N Woods for the administrative support. Anna Harrington for sourcing and assisting with software modification. Suren Moodley for becoming repository administrator and uploading the audiograms into the repository. The many appointed occupational medical practitioners in the mining industry who attended the workshops and provided assistance with the rollout of the project at the medical surveillance centres participating in the project. Dr Mary Ross for invaluable advice and encouragement. Francois Theron for accompanying team to medical surveillance centres and organizing regional workshops. Personnel of Everest and Softoit software vendors for assistance with electronic upload of Baseline Audiograms

17 8. References 1. Government Gazette No of 16 November R. M. Franz - South African Mining Journal 1998 (Ref. Comoro UGN1) 3. Compensation for Occupational Injuries and Diseases Act (COID Act) Act 130 of Rand Mutual Assurance year book Mine Health and Safety Act, Act 28 of 1996.