A Shot in the Arm: COVID-19 Immunization Management

good afternoon everybody and thank you for attending a shot in the arm which is a covid19 vaccine webinar my name is jeff dinell and i'm president of enterprise health and i'd like to welcome all of you to today's webinar where we're going to talk about the role of technology in managing covid19 vaccinations today we have a fantastic panel that i'm going to moderate and our speakers include dana flitch who is from northwell health and she's the senior manager of product services and management and human resource technology we also have emily mccomb who's the director of customer success in enterprise health and also alice urich who is a deployment consultant at enterprise health just to give you a little bit of context about our organization starting with our elevator pitch which of course we would only share in a well ventilated elevator with three or fewer people all wearing masks and here goes we're the only cloud-based healthit solution that combines occupational health and compliance clinical care and employee engagement all on a single interoperable certified electronic health record platform and our focus is on equipping our enterprise clients and their employees for a healthier future and we work primarily with blue chip global corporations government agencies and hospitals and health systems and our clients tend to operate their own on-site employee health clinics and many of them also provide employer health services to other organizations now before we get started just a couple of housekeeping items we've muted everybody except our moderators and panelists on entry so that we minimize background noise and we are recording this session so after today we're going to email everybody with a link so you can access the recording and i will uh let you know that most of our presenters are coming to you from their home offices so we apologize in advance if there's any barking dogs or screaming children it just goes with the territory today and we're really excited because we've assembled a group of speakers who've really been on the front lines of preparing for the rollout of covid19 vaccinations and we've asked each of our speakers uh to to share some of their observations about today's topic and then we're going to open it up for q a and if you have questions you can submit those via the chat feature in webex and we're going to try to get to as many as we possibly can before we end the webinar so you know there is no doubt that the entire world could really use a shot in the arm right now and this coveted pandemic has been persistent and it's really getting more and more difficult to keep count of wave after wave of positive cases hospitalizations and unfortunately the death toll covid fatigue is very real and our physical and mental health and well-being have been profoundly affected and uh while the significant impact of this pandemic is now really seared into our collective conscience one could easily argue that the individuals who are attending today's webinar have an acute level of awareness of the severity of this thing and you are all the occupational and employee health professionals who have the responsibility within your organizations to keep your employees present productive and healthy so whether you work in a corporate setting at a government agency or in a hospital or health system that's taking care of the people who take care of patients you have both a personal and a professional stake as you respond to this once in a hundred years event now at enterprise health we've been collaborating closely with our client community to respond to this this pandemic really since january or february and fortunately we started with an occupational health it solution that already had the core building blocks in place so we've been able to pretty rapidly reconfigure our pandemic response employee engagement case management and reporting and other capabilities to support a wide variety of different client requirements and use cases and that includes the management of employee symptom reporting testing travel return to work contact racing etc and most recently we've been able to take our existing mass immunization capability and make adjustments to it to support the administration of the covid19 vaccine now we didn't do this in a vacuum we've done it working very closely yet still remotely with our clients and as we've done since really the beginning of this year we've operated on a very agile footing as the the ground is constantly shifting beneath our feet and really never more so than with the covet vaccine and when it became apparent a little over a month ago that a vaccine was on the near term horizon we work closely with a number of our clients to build out workflows based on what we knew recognizing however that we still act on many critical pieces of information so imagine if you will a mound of puzzle puzzle pieces with the instructions to start to assemble but you know that two-thirds of the pieces aren't available to you yet and you don't even have a picture on the puzzle box that depicts the finished product so we've configured as we could we made refinements along the way as more and more guidance emerged and it's really just in the last week or so that we've been engaged in an all out sprint as the final details have become apparent so i have to take it just a second to recognize the really hard work of our clients and the enterprise health staff as people have managed to set aside their coveted fatigue and working very collaboratively these people have collapsed normal development cycles from months to weeks to days to even hours we worked really hard over the last few weeks and even through this last weekend and you can't help but be impressed by the by the efforts made to prepare for the administration of this vaccine and as the holidays approach i'm i'm reminded of an episode from the tv show seinfeld uh and there's an episode where the characters uh celebrate a holiday which they call festivus which is a made-up holiday that features both the airing of grievances and feats of strength and our collective community has been able to set aside their well-deserved coveted fueled grievances and what they've demonstrated is an awe-inspiring amount of feats of strength and this is actually the eighth webinar we've conducted this year that's focused on cobit and we've had several hundred people register for for today's session and frankly we got lucky on the timing because we only decided about a week ago to try and pull this off and because it's all come together in record time it may not be our most polished webinar but it will no doubt be the the most topical and of the moment and of course as as it turns out the administration of vaccines in the united states started just yesterday morning and the first individual in the u. s to receive the vaccine was a woman named sandra lindsey and she's the director of critical care nursing at long island jewish medical center in queens new york and that's part of the northwell health system and in the last 24 hours photos and footage of miss lindsey getting her shot in the arm have appeared in major newspapers all over the national news all over the internet and miss lindsay actually led a team of hundreds of critical care nurses who've been caring for covin 19 patients since the very first wave of this pandemic started and as the new york times reported yesterday miss lindsay volunteered to go first in an effort to appeal to men and women of color who were skeptical of vaccinations in general so this picture of her receiving the very first vaccine is a very powerful symbol on multiple levels so uh not only is the timing of this webinar fortuitous but we're really lucky today to have dana flitch from northwell health here to talk to us and as we contemplated trying to squeeze this webinar in before the holidays one of our challenges was to find a client who could spare enough time to prepare and present and i'm not sure how we did it but we persuaded dana to do so and she did it with with little notice and of course in the midst of frenzy prep preparations to begin uh vaccine administration yesterday but she she managed to find the time to manufacture the time i know she worked on this over the weekend to be able to share her insights with us today so the stars and planets kind of align for us and today we get to hear from one of the individuals who is part of a big collaborative team at northwell that paved the way for them to be able to administer the very first vaccine given in the u. s just a little over 24 hours ago so with that dana i'm going to turn it over to you and i will bring up your slide deck here and advance them as you direct me thank you very much for such a wonderful introduction i'm very pleased to be here this afternoon to certainly share northweld's experience and some of the bumps and bruises along the way um i think jeff you summarized it up very well um there was a lot more questions than answers as this was going forward at lightning speed so i'm very happy to present uh where we are now and and how we got here actually so uh you go to the next slide so just a little bit of quick background on northwell health in case there's anybody who's actually not familiar with us although after this morning i i can't imagine across the country anybody wouldn't be um we're the new york's largest private employer health care provider in our area we consist of 23 hospitals specialty hospitals as well as psychiatry we have a children's hospital our hospitals also go across counties as well as new york city we have over 800 outpatient facilities we service over 11 million people on a 13.

5 billion annual operating budget our employees are 72 000 plus um we do have some other hospitals that have joined that are actually not in this count uh always increasing our footprint and growing we have over 6 000 independent credential providers that certainly use our facilities in the hospital care for our patients and well over 5000 volunteers so and from this map you can also see that we have affiliates in other countries um we're affiliated with the cleveland clinic in ohio um and also well-renowned research facilities that we work with and uh you know continuing advancing next slide so the goal was basically in this lightning operation it's for everyone to easily get vaccinated as soon as we have the quantities available however there wasn't really a lot of direction i think many institutions were left up to their own devices to kind of figure out how to roll this out um we had more questions than answers that's for sure next slide so this was some of the things that we had to certainly sit back reflect on and act upon immediately even as just jeff was saying you know three quarters of the information wasn't really out there so some of the things that we had going on was when were we really going to get those vaccines in our hands whether or not it was going to come from multiple manufacturers another issue was if it was single dose or multi-dose for tracking which definitely introduced another complexity because we usually didn't have a single dose or multiple dose vaccine that i can think of at this point for like surveillance to be able to um follow up on people to make sure they get their second dose well were they fully immunized after the first dose we also didn't know what volume we were getting from for the distribution so you know being a large healthcare organization that led us to have to start thinking immediately about how we're prioritizing our employees um and certainly any other other affiliates we have a lot of vendors that work for us as well as we have joint ventures all of these people needed to be put in some sort of priority on who's going to get that vaccine first according to what was the actual volume that we were going to get again all unknowns adverse reactions although even though the trials were advancing quickly there seemed to be minimal adverse reactions but you know we certainly didn't know um a lot of information on that from the studies yet except that it was going at lightning speed and all seem to be going well we also don't know at the time what our vaccine demand was going to be how many people were going to line up was it going to be a huge demand or you know certainly wanted that demand but we really didn't know how that was gonna what kind of reaction we were gonna get back and then of course to prepare communication education both to people who have to do the vaccinations as well as those who are receiving the vaccinations which leads us into the legality and consent um so there was really no standard for that either except for other immunization consents and we didn't know how this was going to be different and then of course the the the big one for us is um everybody is reporting to their state immunization registries we also have a dual reporting obligation because we also have to report for our city hospitals directly to new york city as well that also gave us another layer of complexity because vaccine distribution was hinging on us certainly being able to let them know what we're giving from two different sources so both for our city sites as well as the state sites so in all honesty we had a lot more questions um than answers during planning so but again it was a go um and we had to certainly make a lot of decisions on the fly next slide so i just want to bring everybody a little bit back on where we were at when we started this um so enterprise health was probably one of our fastest contracts ever done known to mankind um especially in our institution because it usually takes a while to do the contracting we love the product so we had contracted very quickly over the summer knowing that covid resurgence was coming currently right now back in april especially when this all hit new york um being the epicenter of this um you know of this disease and and and all that we had to do especially on the back end to support our frontline people with uh i. t tracking tracing uh testing it was back in i would say probably really took off in april we were doing studies on antibody testing creating homegrown databases and surveys and things of that nature to be tracking this so we were very excited to find the enterprise health product the channel 19 we immediately contracted for it so there was a couple of things that needed to be done beforehand we needed to address that we have the flu campaign especially during covid we wanted to be able to offer those flu shots and and stress the importance of you know the health personal health of taking a flu shot so we have a campaign that we offer free vaccines to all of our workforce employees and non-employees that all needed to be tracked in lightning speed i would say probably in less than four weeks we had that campaign up and running for our september launch which is usually right after labor day it was quite a feat couldn't have done it without the cooperation of enterprise health who were so generous with their time their expertise integrations all of it to help us get this launched and then right after as we were doing that we also launched our system survey questionnaire for covid19 because it was a requirement and the thought with this was we wanted to ensure employees are testing their well before they came to work and we went live with that in october and it's it's funny to say that it was a very much a success we actually removed about four people from duty before they even got on site um just from the symptoms questionnaire so again that was four people that were not circulating in the hospital that possibly could have been carrying covet and we needed to test so again another success um given to the partnership between northwell and enterprise health so right after that um as that was happening we got word that we're really getting close to vaccination launch so again speeding up into high gear because we needed to now plan for that as well so luckily we were able to model the flu module that we already had up and running for covet vaccinations enterprise health again was extremely helpful there was a lot of things to work out such as what questionnaires what were the consents going to look like communication emails we wanted people to be able to get on a portal do self-service scheduling to the sites that were given out covid vaccines we needed a separate surveillance profile for single and multi-dose formats and also we had to work on our population priority matrix for vaccines and what we did with that is we had this was a real big team effort we brought in on our side analytics committee to help us with that and we had actually made a vaccine matrix for all the employees that were dependent on several factors one was work county um where they worked what type of department what was their job function and role um and that as well as with their age we then took all those factors and we weighted them so we said if you were in a hot spot in a work county that was worth 20 of your grade if you were working in a department type like critical care emergency or icu that might have been worth 40 of your grade and through that we took our whole workforce and we created and assigned everybody a priority so the priority was between one and five depending on vaccine release volume and how quickly we can push that out so um that was the way that we approached it for the actual um priority to decide who was going to get that and then we also needed to make sure that we had our feedback loop as far as the distribution we had hooked in our system analytics team who's creating dashboards across the system on an hourly updates to make sure that we're constantly on top of what the vaccine distribution is who's receiving the vaccine and then the last part of course was to be able to report to new york state and the city again great partnership with our vendor because i don't think this could have ever happened without all the technical resources that have been put into it to ensure that we had the proper messages the testing getting the state and city on the line with us to do this type of testing and hook it up to the vaccine actual distribution and then lastly and this has only been within the last few days as we were getting ready to launch getting emails ready just scheduling we also had to put together vaccine education both for the people who are getting vaccinated as well as our vaccinators we had to set up security profiles for that and enterprise health being a fully mobile software is is absolutely key to being able to just take this program anywhere and be able to vaccinate as our sites were popping up and are still popping up frankly today as we're adding sites and and sending vaccinators out so again i it it couldn't have been done without the partnership of our software vendor and i know it's been said as well um from our leadership if we were in the same position we were in an april where we were building homegrown databases to track all this i don't think we could have ever gotten where we are at such light speed to see the result that you saw that we were ready to go yesterday and start vaccinating okay so i'll turn it back over to you jeff but that was the northwell experience on this and as your sites are getting ready um i i can't emphasize enough how having the right i. t technology can spring you forward to get this done great thank you very thank you very much dana really appreciate it um and you know one of the things i'll just stress is that uh on on the immunization register registries we literally were getting changes to the uh some of the registry protocols uh this weekend so uh you know this this really did come down to the wire uh you know certainly not normal course of operations but it is what it is um and and uh as dana said you know we're still making tweaks and adjustments uh even today and in fact when we right before we kicked off the the webinar i know dana was kind of emailing furiously with some of her team members uh about some issues so uh you know we'll i'm sure we will continue to refine over the the next couple of weeks as this thing unfolds um our next panelist is uh emily mccomb and emily is the director of customer success at enterprise health and she and her team have been working with a number of our existing clients over the last 45 days or so to prepare for the cova vaccine and so she's just going to share a few insights from that experience great thank you jess can you hear me okay loud and clear all right so our deployment and application support teams have been working with our customers for months in preparation of the vaccine rollout we built a model using our existing flu module as the framework and as more was uncovered about the vaccine we tweaked and changed things to suit and as you heard from dana even though our customers have been running employee vaccination programs for years for flu and hepatitis the majority of the people we spoke with still have significant gaps to fill in for this vaccine specifically and the first really being just identifying who to offer the vaccine to especially for wave one no one knew the number of vaccines that would be delivered and that was a huge question that kept most of our customers from really understanding who they would offer this vaccine to in the first wave so we spent a lot of time with these customers making sure that we had rules built based on their job and department but also just filled in the gaps with imports of spreadsheets for additional staff who you know our customers knew needed to be a part of wave one but maybe just didn't meet the criteria of those very specific rules and i think now that we have a lot more information about supply those rules will become a bit more scientific and predictable like they have been in years past for flu and that will be i think a welcome change for many many of our customers another hurdle that we had to clear was around the vaccine administration reporting state to state there is a lot of variability in immunization registry say maturity you heard from dana that northwell had great collaboration with their state and their city but unfortunately that just was not everyone's experience and some of our customers have had an existing immunization registry interface for years and in those cases they didn't have to give this topic much of a second thought but others hadn't either pursued those integrations yet or their states had placed them on years-long waiting lists and we were just not going to have that interface in place in time so we've seen some really rapid and creative solutions around those issues one of the things that we did with a few customers was to actually build an integration to their hospital and the hospital then in turn passed along that immunization record to their states registry through their existing fees to the registry and this worked great for states whose registries couldn't accommodate a new interface very quickly and it eliminated the need then for those customers to have to hand key those records in which is a huge time saver and if you are looking in today and you have not yet sorted out how you're going to report your vaccine administration i would highly encourage you to make that a top priority in your planning because it really can vary so widely state to state and it is something we found unfortunately some states were just more capable of accepting kind of quick turnaround integrations than others additionally when workspeed took off we joked actually with northwell that it would take them longer to get legal approval for their consent form that it would be for us to roll out the entire program and unfortunately for some of our customers we were not wrong we've been working with a lot of our customers right up until very literally the final hour to make changes to the consent form which employees are filling out on the portal even as recently as late last night we had team members working to adjust consent language so that one of our health systems out west um could launch today and that's just been the name of the game it's been very difficult to get those approved and pushed through and everything this year just seems to come down to the wire we're really proud of how everyone is pulled together to make these rollouts happen but we know this is just wave one and we're gonna have to keep our head on a swivel as we move into the next phase of the covid response and also as availability of the vaccine becomes more widespread we do anticipate that a lot of our critical infrastructure customers like folks in energy food supply et cetera um they're going to have very specific needs around the vaccine that are going to be unique to either their industry their region or just their unique employee population and we've scratched the surface with a lot of those folks to understand what their needs are but we're really looking forward to digging deeper and learning more about what this will be like in a non-healthcare setting because i think there are going to be kind of a a whole new exciting set of challenges and configurations and integration projects around that so thank you jeff for giving me an opportunity to just catch everyone up on how far we've come and some of the variability that we've seen um customer to customer and i'll pass that back to you and alice okay great thank you emily so last but certainly not least is uh is alice urich and alice is an enterprise health deployment specialist and she works with clients to configure our solution to meet their workflow requirements and alice has really been the one working most closely with northwell as they prepare for the covid vaccine administration so alice is going to give you just a high level overview of some of the functionality that we've been developing in collaboration with our clients okay thank you jeff um i think you'll have to give me presenting right that what might we share let me do that all right um thank you can you see my screen then yes okay perfect thank you thank you so today we're going to review the covet 19 injection program again this is just a high level overview and then we can take questions at the end so emily kind of touched on this a little earlier and that was that we are using our health surveillance module to manage this program and as far as enrolling employees into this program we have two ways that you can do that one would be by implicit rules based off of demographic data and we do have some customers that are sending us that priority employee priority matrix that dana spoke of through their hr demographic feed and when we have that data available we can set up automated membership rules so that you don't have to manually manage that but we realize that isn't always possible um if you're managing that outside of the application and so we do have a method that you can manually add your members as well as a import tool so if you were to populate a spreadsheet using the import tool template then you can import all of those employees into the program once the program um and the employee has been added into the program we have an automated process that will evaluate the panel membership and when this happens we have the panel configured to generate a questionnaire for the covet injection as well as an order for the injection when we create the injec the orders we also create a waitlist appointment and that waitlist appointment is actually what is responsible for generating an email to the employee to invite them to go to the portal and to schedule their coveted vaccination we also have additional reminders that can be sent typically a three or a ten day and or ten day reminder can be sent and then we also have the ability to send um a post-injection educational follow-up email so as the employees with this being such a new injection and um again i think we've talked about some of the allergic reactions some people have had to that that we really want to make sure the employees have that education that they know that if they have issues that they can call to the clinic and report those so in addition to just giving them like a viz handout when they're given the shot we're also sending them a post injection educational email as well once the employee receives the invitation they can log on to the employee portal where they have an option to schedule a covid vaccination appointment and to take the questionnaire and we have done some additional configuration to our scheduling module which would allow only those employees with a waitlist appointment to schedule being that demand is very limited right now and we talk about that priority only being able to offer to certain number of employees that you have shots available for we needed a way to be able to open up the schedule to just those with the the wait list appointment with that receive that invite and not allow all other users within the organization to go and try and schedule their appointment so we do have this additional configuration that can be completed with the scheduler to limit the the scheduling of appointments to just those individuals that receive the invitation the questionnaire is configured to have a consent it can be a declination as well as allow the employee to submit an exemption request or to upload proof of their of a vaccination completed elsewhere and with many health care workers it's not unusual for a staff to ha also work pretty much another location or have two part-time jobs and it's possible for an employee to receive the injection at one facility or maybe you transfer employers and you have started the series but you need to get your second shot so we do have the ability for the employees to be able to submit proof of a prior documentation over the portal and again we did kind of fashion this very similar to our flu program where we have the consent the declination exemption but with this being a new program and employers not really at a point where they can require employees to take the cova vaccine like they would have flew that we have had several of our customers actually remove the declination and exemption request options and really just leave this order for the questionnaire out there for employees and let them opt to complete it or not obviously if they wanted to receive the vaccine they would fill it out if not right now we are just leaving those out there um and that time that we leave those orders out there can be defined within the panel configuration so if you want to leave it out there for a year for your employees to change their mind and receive it later though that can definitely stay out there so again how you want to uh you know attack this from your organization standpoint is configurable but i think again most people are are leaving it at the consent and the questionnaire and only requiring employees to fill it out if they choose to have the injection when the employee completes their questionnaire and they schedule their appointment and arrive then we have the covent injection program side menu tab here and this is where the clinical staff can come in and enter the patient injection when you enter the patient name off to the side we do have links to navigate to the patient chart if for any reason the clinic the clinician needs to review any other data we list any meds allergies and conditions and then we also show the questionnaire along with their responses and then we also show a list of the injections at the bottom and this is really important that the clinical staff have this visibility when they're administering so that they know if they're giving the first or second dose because if you've started the pfizer shot then you need to have pfizer shot as your second shot you can't mix manufacturers and have one one dose from pfizer and a second dose from moderna so it's important that the clinician is checking this information to ensure that they are properly administering the correct medication if you do not have portal access or if you choose to have your employees have that ability to complete consents or declinations once they arrive you can configure the covid consent in a chart tab where you can ask your questionnaires and using a touch screen or a mouse or stylus that they can check off the questions the responses and then manually sign for it so we do have that ability available with you know being in these times with social distancing and using styluses or touch screens and not having many people wanting to do that i think we're seeing fewer people move in that direction and they want to have them do that all online but we still do have this as an offering um for any of the you know if you have the declination exempt requests or if you're allowing your employees to submit proof of the vaccination from outside of the organization we do automatically task any of those requests to a department called the vaccine the kova 19 vaccine program reviewers department and from there the clinical staff can come in and grab these tasks review them and set a determination reason and these determination reasons um are typically that they've been already had one um that the documentation that has been reviewed is not adequate it's denied they may submit multiple or you know duplicate documentation so there's a little bit of flexibility here and configuration as to these determination reasons and you can list whether the employee has completed the series or if they have just had the first shot only and based on those reasons we do have an automated process that will send a confirmation to the employee once the clinical staff has either accepted or denied the documentation and we will send that confirmation letter that you see here here's the approved vaccination our approved documentation and here is the denied and if your organization um allows employees to send in or drop by the clinic which we all know that happens um that they bring in a paper consent or that paper documentation you can fill out or rather obtain those paper documents from the employee and scan those into the system as well regardless of how your employees are filling out their surveys or co-signing their consent forms we do have an automated process that will look at those will look at the data that you are entering into the system and the automated job will go ahead and complete all of those orders for you so you can see here on this example the patient's information has all been obtained and then these orders have been marked completed for you and we're we want to make sure that those orders are being tracked appropriately so that we can run reports and see who has completed their information their vaccination and questionnaires and who has not once the employee has had their injection their first injection we do have the health surveillance the health surveillance panel configured to generate a second set of orders for the second injection and a second consent and questionnaire to be generated so you can see here in our programming that four weeks after the mederna injection we will populate a second set of orders or we at three weeks we will set a created second set of orders for the fizer injection and once we do that you'll see here just to show you on the do list what that looks like that the employee has those orders that are generated and they generate new due dates for that employee to complete those so essentially what happens at that point for the second injection is the exact same workflow that i just reviewed so that waitlist appointment is going to display the employee has sent that invite to schedule their second injection and to complete their questionnaire sorry what a little step further so the next thing is uh reporting from a reporting standpoint we have uh essentially two reports and the first is the coven vaccine exemption request determination so this is for any of those requests that have been received via the portal and reviewed by the clinical staff as to whether it was approved or not approved and and all of those determinations are here so you can track any of those determinations that were submitted from outside the organization as far as inside the organization here we do have the standard out of the box to do list weighting report where you can run a report of all of the cova vaccines injections and from that you can actually pivot this or filter this information really to get different data so you could sort and just see the number and you know the discrete listing of each employee that still has pending injections meaning they have not chosen to get the injections and those that have completed them um if you don't put a filter on then you would obviously see a list of of both completed and pending so you know what the total offering was so that's that is my high level overview of the covert injection program great thank you very much alice appreciate it all right great um and uh we we we told alice uh knowing that uh all of this functionality is is literally you know coming together just in the last couple of days as we've been finalizing it uh she felt it was safer to show screenshots today rather than go and go in and demo uh just because we're still making a lot of tweaks and improvements on a on a regular basis um and again want to want to thank all of our presenters for sharing with us today and we and we now have uh you know some time set aside for q a uh and remember you can pose questions uh there's a there's a q a or chat feature in webex and of course we'll get to uh to as many as we can uh and i'll go ahead and just uh just kind of kick us off here um you know with a with a question and then we'll we'll go from there um and dana i want to start with you um you know the the the term work speed has been used to describe you know the operation that was used to develop and roll out the vaccine and of course you know we're seeing organizations move in an amazing clip to be able to administer uh starting yesterday uh but but i will say there's fast and there's northwell fast and can i just like to hear a little more about the effort and and maybe the the part of the culture at northwell that enabled you to be the first organization in the us to vaccinate one of your employees yeah so it it sounds a little cliche but i i have to say everybody has to be working in sync you need everybody engaged from senior leadership to your technology group to your analytics group to employee health services again i can't tell you your team was just amazing with the engagement helping us along with all the technology pieces of it i mean especially with designing this all on the fly but i i have to say you have to have engagement from from all the way through to make this really happen so there it was not uncommon um you know you could be in the middle of one call and somebody's texting you ringing you chatting you and you're just kind of almost schizophrenic to a point but you're answering every question um everybody was pretty much on call and i think one of the most important things is when you needed to make a decision the right people were at the table even virtually to make a decision right then and there to keep moving so i think that had a lot to do with it i think also the support of senior leadership if there were any obstacles at that point they were able to clear them for us um and that was also extremely important as well hey emily i think you've got a couple of questions from the chat we sure do a quick one for dana how many employees are there at northwell so right now it's funny because you know any way you look you'll see a different number um but currently right now on the northwest system payroll there's over 72 000 however we do have a couple of acquisitions that will be moving on to payroll next year so the number's actually higher a couple quite a few yeah we just keep going and going uh so yeah but uh right now definitely well over 70 000.

great thank you and another one for you dina um as you feel comfortable answering um if you get the vaccine can you still be an asymptomatic carrier and still should wear a face covering in public that last piece was a question asking if once you're vaccinated if you should still continue to wear face covering in public if you feel comfortable with any of that so the answer with that is and i'm also a physician assistant working with closely with employee health services so clinically right now um yes you are to continue using your social distancing mask washing sanitizer when needed all precautions are still followed even if you still get the vaccine um although the vaccine is incredibly effective until we get direction that the immunity is you know long-term and there are still things that are coming out about that we know the vaccine right now is safe um there certainly were no shortcuts in releasing that vaccine however um all the other precautions still remain and even when we had our press conference yesterday morning when we were vaccinating uh that was also reminded as we take right now it is one step towards the light at the ends of the tunnel so until we have absolutely affirmative then we continue doing everything we're doing today great thank you um great question on the q a again dana for you um did northwell send out any type of survey to get an idea of just interest from the staff on a you know a rough estimate of how many people you thought might be early adopters of the vaccine i wish we had time to do that normally we would have and we do do that we usually do pre and post surveys trying to get engagement opportunities for education but i have to tell you a lot of this moving at such a you know speed of light here there really wasn't a lot of time to do that i will say however um the actual and like i brought up in the sly presentation we really had no idea what the demand would be but we are finding demand um and vaccination is going very smoothly um our tier one people are going first but there is a lot of interest in getting the vaccine throughout the health system so unfortunately we stick to our priority but we are definitely seeing demand from our employees and non-employees as well like where they are on the wheel they're they're all set to make that appointment and roll up this sleeve so it is wonderful to see yeah absolutely um a question from the chat here is there a period of time post-injection of the vaccine that the patient must be observed for specific signs and symptoms how have you guys done that dana have you structured kind of that post vaccine overwatch and like i said there really was no shortcuts in delivering this it was just done extremely quickly um side effects that are usually noticed or common side effects that can happen with any vaccine for muscle aches soreness at the site over in uh london i think there were two people that did have an anaphylactic reaction both have pulled through again that's uh par for the territory there are some people that may be allergic to components of the vaccine so so far at north well i have not had any word that we've had that issue but um there really honestly isn't any different from any other vaccine so um it is the same i just want to check in that i answered the question if there was any other parts to that well i was going to say too i know i've seen a couple of reports that say you know especially based on on a couple of those uh uh cases reported in britain you probably ought to have a you know a brief observation period of maybe up to 15 minutes just to you know just to make sure that the with the recipient is okay and again that you know that that kind of thing is fairly standard as well and i was going to say the same thing it's no different from any other vaccination procedure so i i you know again um i would imagine and this is just a clinical but sometimes you have to be sensitized i would imagine if there are allergic reactions or issues you may actually see it on the second one for allergies versus the first one but it remains to be seen yeah thanks dana a really interesting question in the chat i wish that dimitri and folks from rit team we're here to answer this dina i'll give it my best shot no i think this is a great question and you kind of spoke to it when you talked about the leadership engagement but the question is how would you describe the roles of your ip department compared to the employee health department during the implementation and also for ongoing support you have a very engaged ip team who really partnered with you can you speak to kind of the roles there oh absolutely so um my role is i support the business and technology from the business end um the role of dimitri was that he supports healthcare applications infrastructure throughout all the healthcare applications so ehs is a part of that so it definitely needs um high i. t engagement we also are able to through dimitri if there are any hold ups or issues i mean we can bring that directly to our you know cio um and that is very important to have should there be any you know problems or concerns and it can go anywhere from i am having diff you know signing out of the software on an ipad for a vaccinator to we need to be able to hook up with this registry and we need a connection with senior leadership to pull some strings to get that testing done so i can't emphasize the importance of having it infrastructure involved um it could be even single sign-on into you know you may need your network team all of it so very very important and great question and yes they were incredibly engaged and part of the team great thank you okay um you know i and and dana you alluded to this a little bit uh in one of your previous responses but of course we've seen a lot of media coverage about some of the potential risks and and you know and people are understandably hesitant to be among the first to take the vaccine i'm just kind of wondering uh you know what what's being done to address some of those employee concerns and also to address the fact that you know some employees are just gonna elect not to get the vaccine uh you know have you guys started to kind of think through you know how are you gonna kind of handle the folks that maybe decide not to to do that and kind of what maybe describe some of the educational efforts you have underway and it's a great question so um right from the start even during the press conference um multicultural you know multi-ethnicity was addressed um so that is definitely even from the icu nurse the very first person who was vaccinated was certainly self-attesting um what's going on in her life and the dark history of that as she said it with her both personally and professionally um that she had no hesitation so right from the beginning we're putting that message out what i think most people did not see is that there are five doses in that vaccine vial which aren't going to go to waste so there were actually five people that got vaccinated um across the cultural and ethnic uh backgrounds but you know she just happened to be on the forefront from the start to absolutely start addressing that so that messaging will continue to go out i think a lot of it is as this time goes on that people start being even more comfortable with it because sometimes you know you still have people who uh you know won't take a flu vaccine because they still feel you know i get the i get the flu from the flu vaccine so it's always a constant education effort but i think truly as people who are vaccinated and as the numbers start going up and like i said we are seeing demands i think that'll also give reassurance to those people who are hesitant and right now we have some time for that because priority one people are going first uh depending on the matrix factors that i discussed so there still is some time but um i think that's going to be a very main component aside from the education that's constantly being driven out there to everybody that this is a safe and effective vaccine great well and you know and you can't underscore i think the importance and and i think what what happened yesterday at northwell just just really emphasizes that if you can get key individuals within your organization to raise their hand and volunteer and say i'll go first you know so i think that's a critical message for uh you know for leadership within any employer organization uh you know certainly the folks that are involved in occupational and employee health uh but if you can get someone you know it at the executive team and also identify those folks within your organization uh that are that are well respected and that people will tend to follow uh you know that goes a long way so uh obviously there can only be one organization who was the very first one to get vaccinated and get all this coverage so i i'm sure that's going to help with northwell's effort but i think for everybody else it's you know it it it there's a good lesson here in terms of making sure that you have uh senior leadership involved engaged but also you know have have some people in leadership who are willing to go first absolutely i would have liked to have seen our ceo michael dowling get his vaccine out of those first five but i think they chose healthcare workers yeah yeah probably makes sense although i have to tell you he sent out a video to everybody just you know and he was very emotional about the whole thing it was really nice to see and like i said all that engagement yes absolutely um you know emily i i know and you alluded to this in your comments but i know uh many of our health system clients you know have been sort of first in line to uh to get their employees vaccinated and get this underway but i know i know we've also started to have some interest from some of our corporate clients uh you know what differences are you seeing between the two segments in terms of you know what they're what they're wanting to accomplish with uh with their vaccination programs yeah so there's certainly a lot of crossover um but when you look at you know say a petroleum company you know that spans multiple states all over the country maybe all over the globe um you start to get into some level of complexity that a typical health care system doesn't and that's you know what we've implemented so far are you know our healthcare partners most of our healthcare partners are very regionalized so they really are encompassed all in one state typically not always but most of the time and that's just not the case when you have you know pipelines all over the country again maybe all over the globe and so the vaccine reporting requirements actually become much more complex because you might have now you know not only like dana had um i think it was new york city and the state to report back to but now that's going to be across multiple states so that has been certainly early conversations that we've had of getting each of those states engaged to understand how we can work with them to get those vaccines reported but also a lot of our non-healthcare customers they actually provide clinical services to dependents as well so now we are looking to incorporate you know in later waves of the vaccine rollout how we can assist with tracking dependents for their vaccines and their consent forms and getting them reminders to come back for their second vaccine and all of that so i think the um the the spread out nature kind of presents its own really unique challenges actually for our non-healthcare customers where um at healthcare it's typically you know you have such a concentration of people under just several roofs on the non-healthcare side they tend to be spread out all over the place and just making sure that we're really targeting critical people within those organizations with communications um that's been top of mind and like i said just getting getting the state requirements um fulfilled for the reporting i think is going to be the most unique challenge there and it's something that we're you know trying with most of those customers to get ahead of just as much as we can okay great thank you um and a question probably for emily and dana you know i i know that certainly most organizations already have forms and protocols for consent and declination that they use for things like mass flu campaigns uh you know what are some of the changes that had to be made around that to administer kovitt and i know you know emily you you alluded to uh you know clients that are like having legal review that lasted until you know late last night on on consent forms uh you know what what are some of the big maybe legal policy you know just operational differences that we're seeing between something like flu and covid yeah from the northwell perspective um i wasn't too involved on those legal planning so i probably couldn't speak to it very intelligently but i will say this though one of the big hurdles that we had to pass from the i. t standpoint is that we must release these to the state and city to get replenished with that vaccinations so we had to and technically on the registries you are able to opt out so we did have to overcome that hurdle where we said you know this is part of the consent you are opting in or you're going to need to get your vaccination elsewhere because otherwise we couldn't get replenished so i would say that was from the i.

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