COVID-19: The California Experience

well good afternoon everyone and happy friday my name is jeff donnell and i'm president of enterprise health and i'd like to welcome you to covid from california and today's webinar is focused on covet 19 legal clinical and digital trends coming out of the west coast i'm going to moderate today's panel discussion and we have a great slate of speakers with us today and they include dean freeders and dean is the general counsel at mobile med work health solutions and he's going to cover the legal topics we also have erin davis and she's a nurse practitioner and manager of occupational health clinic operations at stanford university and she's going to talk about clinical matters and we also have emily mccomb and emily is account management director at enterprise health and she will cover using digital solutions to to navigate covid19 and today's webinar is sponsored by both mobilemed and enterprise health and it's part of a coven 19 themed webinar series that we've been running over the past seven months or so to share insights and experiences from organizations that are involved in the intersection of this pandemic and its impact on occupational and employee health we really want to thank the team at mobilemed for suggesting this topic as they are certainly knee-deep in helping employers manage manage their way through the kobit 19 pandemic and mobilemed is an occupational health provider that specializes in on-site employee health programs for large employers their organization is gaining a national and international reputation and is delivering customized medical services that are delivered either via mobile bands or at on-site clinics that are housed in employer facilities and mobilemet is working with manufacturers software companies construction firms large amusement parks international airports government agencies and other employer organizations and then enterprise health is actually the only cloud-based healthit solution that combines occupational health and compliance clinical care and employee engagement on a single interoperable certified electronic health platform built to equip enterprise health clients and their employer employees for a healthier future and we work with blue chip global organizations government agencies and hospitals and health systems who operate their own on-site employee health clinics and provide employee health services to other organizations as well so just a few housekeeping items for today we muted everyone except our moderator and our panelists on entry so that we minimize background noise we are going to record today's session and we will email uh everybody who registered and everyone who attends uh early next week with a link so you can access the recording also we've assembled a great panel so we have a group of occupational and employee health experts who really have been in the thick of addressing covid19 and we've asked each of our panelists to make some initial remarks about their observations on today's topic and then at the end we'll have a q a session so you can submit questions via the chat feature in webex and we'll get to as many as we possibly can at the end of today now we know uh just based on the folks that pre-registered uh that we certainly have plenty of people from california who are attending today's webinar but we also have attendees from all over the united states and while today's session certainly emanates from the golden state we all recognize that this is a global pandemic however california you know is is always recognized as both the wellspring of innovation but also as as kind of a first mover oftentimes when it comes to regulation so our intent today is to shed light on what is happening on the west coast when it comes to managing employee health during this pandemic recognizing that the california experience certainly has broader application so whether you're located in california have operations or employees in california or even if you have no california connections whatsoever today's content is really designed to share learning that is likely to impact you so leading off for us today is dean freeders and again dean is general counsel at mobile med work health solutions which is based in california and and dean is going to talk a little bit about some of the legal uh implications of what is happening uh both nationally and and in his home state okay go ahead thanks for that thanks for that great introduction jeff and we're very pleased to be here today we always enjoy partnerships with enterprise health i can tell our attendees if you're attending from outside california i'm a transplant from illinois i'm currently in california but rest assured we are running antivirus on the presentation today so there's no chance of transmission through the webinar you should be safe so if you're outside of california or if you're within california why are we concerned about the topics that are coming out of california the regulations that are coming out of california well if you look at the regulatory web of requirements that are being imposed across this country what's happening in california is emblematic of what we see in many states or what we're starting to see in many states there are some states that when you have a covet outbreak there's one state that has 32 mandatory notifications that have to made to five different public agencies anytime you have a single coveted outbreak in certain types of employment facilities coveted related leave workers compensation presumptions additional notices triggered by covet infections or even possible covet infections these are becoming commonplace across the country separately even if it's not yet mandated where you're working there are reasons why some of the requirements that are being mandated in california should be considered as best practices to stop the flow and spread of covet so if you're not regulatory uh if you're not subject to regulations yet that mandate you comply with these some of them should be evaluated for implementation unilaterally so that you can adapt some practices that will help keep your workplace safer so why are we talking about this today well if you're in california there are several regulations and requirements that are actions that require immediate compliance that took effect upon passage and require you to start taking action today there are if you're outside of california or within california regardless of the effective date of these regulations several of them are things that you should consider implementing right away if you're not already doing them a rapid reporting of infections at any of your work sites getting that out to your employees and also to contractors working at the sites that's something you should be considering implementing if you haven't already reporting covet 19 infections to workers comp carriers we'll talk more about that in a couple minutes but there are some reasons why early reporting makes sense even potentially before you're aware of a causal connection between the work site and a cove infection documenting your coveted response policies your leave and your notices having a good set of forms in place to respond to any potential infection or any employee request for leave relating to kovid in just about every state there are a myriad of different types of leave whether it's federal leave state leave a local law or even just basic sick leave or workers compensation law that are all intersecting here and understanding how they intersect and making sure your policies are compliant and you're telling your employees what they can and can't do these are critical steps to take these are actions that are going to help protect your enterprise so we wanted to start by talking a little bit about osha guidance this is something that's applicable nationwide even in states that have statewide like california has our own cal osha these are factors that you should consider with respect to the intersection between coveted and recordable workplace illnesses or injuries we're accustomed to thinking about workplace injuries that are recordable as you know an employee falls off a ladder an employee is shocked an employee is injured by a piece of equipment the the concept of infectious disease being a recordable workplace illness or injury is not something we customarily deal with at least outside of the healthcare setting but osha has come out and provided some guidance to us on when we should consider kovid to be recordable so first for moshe's standard you have to have a confirmed positive test diagnosis that's a critical step based on the standards that they've put out if you don't have a confirmed test there is not a requirement to report it so if you have an employee who calls in and says i have symptoms i called my doctor i'm not getting tested but they said i have to quarantine that's not a recordable illness according to the last standards from osha if you do have a positive test the employee was tested and tested positive then you have to proceed into the rest of the osha elements is it work related how do we know if covet is work related well there's not a objective standard that says yes this clearly is or no this isn't so we have to consider the nature and duration of the exposure is the employee an employee who's in a public facing position or not if it's someone who's isolated back in a private office or if they're isolated in an office trailer working by themselves and they don't have exposure to the public or other employees incredibly unlikely that their exposure is going to be work related if they're an employee who is working at front desk and engaging in extensive customer service particularly in areas that aren't as compliant or aren't as regulatory with regard to requiring masks and sanitization more likely it could be work related we also look at other employees in that immediate area if if you have seven employees working in an area five of them contracts coved more likely that's going to be work related if it's a single employee working in a group and only one employee contracts it well that's a factor that makes us think this may not be work related so what's the spread of the disease in the workplace and then finally you're going to look at there's alternate explanation for the exposure if the employee contracts coved and you speak with them and they say yeah my son got it last week and then my wife got it my daughter got it and now i got it that seems like an alternate explanation for the exposure that could reduce the likelihood that it's a workplace exposure so you're going to evaluate those factors to determine if it's work related finally according to osha you'll look at if there are any reporting criteria that are triggered and these are the standard osha recordable unless or injury workplace criteria so death missed work restricted work and so on if you look at those anytime you have a coveted exposure you're going to have missed work someone that is exposed to covet is going to be required to stay home to isolate to quarantine to remain out of work for a period of time unless they are working from home teleworking remotely and 100 able to continue working you will always have some missed work medical treatment beyond first aid that's another one that covet almost always triggers there's almost always going to be follow-up with a primary care doctor there's almost always going to be these days there will almost always be testing completed so that is another one that you're very likely to see and then third a physician diagnosis of significant illness so we're not talking about loss of consciousness or transfer those kind of issues they could apply but these are the most likely ones if you have a physician diagnosis that an employee has coveted that by itself is almost certain to trigger uh that that criteria so if you have an employee who has a positive test and if they they miss work they get any medical treatment they're diagnosed with covet you're really focusing on is it work related what was the nature of their exposure at work and that's something that we're looking at nationally so we'll transition to some of the more specific california regulations assembly bill 1867 was recently passed it takes effect it took effect about a month ago on september 19th if you're familiar with the family's coronavirus relief act the federal law ffcra ffcra typically applies to employers with 500 or fewer employees this california state law triggers leave for employers with 500 or more employees so this is trying to impose another layer of leave for larger employers who are exempt under ffcra and what does it offer it offers supplemental paid sick leave for covet the provisions are somewhat similar to ffcra you get up to two weeks of leave up to 80 hours so if you're a full-time employee 80 hours if you're a part-time employee it's a calculation based on the number of hours that you normally work within a given work period it is triggered by more than just a covet diagnosis it can be triggered by a quarantine or isolation order an order from your health care provider or an employee prohibition on working so if you prohibit employees from coming in due to a covered 19 exposure that can trigger the supplemental paid leave again this is another layer of leave to supplement the federal law it's something that we're starting to see in a number of other states this applies not only to employers with 500 or more employees but also to employers that have first responders or healthcare workers so the the concept of supplemental state legislation that's creating additional paid sick leave for persons who are suffering from covet that's a trend that we're seeing nationwide senate bill 1159 is another california law this took effect immediately it affects all california employers but this is one that i really think is going to be applicable nationwide as well in the coming months this creates a rebuttable presumption that certain covet 19 infections are workers compensation compensable if they occur within 14 days of you working so if you work and have a positive pcr test so the the statute is specific aaron is going to talk in just a couple minutes about the difference between pcr and antigen and antibody and all the various types of testing this is based on pcr testing which is really considered the gold standard for reliability if you can track the covet infection and have a positive pcr test and that occurs within 14 days of when you worked for certain circumstances there's a presumption that that's going to be a compensable injury um this changes the timeline for when you're going to be eligible for temporary disability payments now under this law if you have any paid cove leave for example if you get the covet leave we talked about in the previous statute you have to take that before you're eligible for temporary total disability payments but this gives you a broader window to use ttd it also requires that you as the employer report any coveted infections to your workers claims administrator now there's a retroactive reporting period if the infection occurred before this bill took effect and there's a current reporting period so we're in that retro window right now if you have coveted infections that have occurred since about june to today's date you should look at the statute if you're in california and report those to your workers compensation administrator if you have infections occurring in the future you're required to report them within three business days there are some unique rules in the statute about the type of information that you share they restrict sharing protectable health information there are some kind of interesting uh nuances to how the report works but definitely especially to take a look at when i say it's going to be applicable across the country right now we don't have a standard for how workers compensation claims are going to be evaluated i believe the standard that we're seeing in here with a presumption that that exposures are work related is something we're going to start seeing across more states ab685 also a california law this is one of our central considerations here it takes effect january 1st it applies in california but should be considered by all employers if you have an employee or a contractor at one of your job sites who gives you notification of a potential covet exposure and it's based on either a lab confirmed diagnosis a doctor's diagnosis with or without a test a covert isolation order from a public health official again with or without a test or a death due to covet as determined by the county we say county here because it's the county health department in california that would make that determination so if you get that notice from an employer or contractor you are required to notify all employees as well as the employer of any contractors who are at the same work site during the infectious period we have some details up on the screen there about what that means but in essence you're thinking the place the employee worked if they're in a hundred story building and they work on the seventh floor you're going to look at the seventh floor if they're working out on a field harvesting almonds you're going to look at the other employees that were in that field so you're looking at the site the employee was at not necessarily every employee who was within a mile of of the the infected person you're looking during the infectious period which is determined by the department of public health and aaron will give us some clinical data on that momentarily if you get that notice from the infected person you're required to notify the employers and contractors in writing you have to give it by personal service email or text you have to send it within one business day you have to also notify the bargaining unit if there is one if you have a collective bargaining unit you have to notify the representative in that notice you have to give them notice of the available leave the benefits they have you have to tell them that they're protected against retaliation or discrimination for using their coveted leave and you're required to advise them of your safety plan for covid control so we're thinking aerosol transmissible disease protection plans injury and illness protection plans you're required to give them notice if you have three or more cases within two weeks you have to notify the department of public health and you have to keep your records of these notices for at least three years there will be auditing of this coming in the future if you have a worksite that presents an imminent covet hazard cal osha has the authority to go in and shut down that work site unilaterally something that all oshas have in theory but this makes it express with respect to covet so summarizing the trends that we saw more covet leave supplementing the federal leave rebuttable presumption on workers compensation compensability and notifying your comp carriers so they can be prepared to deal with the potential influx of claims that will be coming and notice to employees and contractors of potential exposure as an employer you have an obligation to minimize the spread of covet 19 and maintain your covenant safety plan you have an obligation to track where your employees and your contractors are working and track exposures over a longer period of time over the infectious period if i say the infectious period is 14 days and you have to think about demonstrating where your employees were or were not working 14 days ago are you going to be able to do that you have an obligation to engage in some rudimentary worksite contact tracing if you get notice of an infection you have to go back and look where an employee was or wasn't and give notice to everyone who is around them you have to maintain records and implement a system that allows you to give notifications and that allows you to maintain those records in a secure and safe fashion complying with the laws so what are the hurdles to implementing that as an employer we have to generate and track data relating to covet exposure in the workplace as well as employee diagnosis coming from outside the workplace we have to track employee assignments we have to implement infection control best practices we have to provide data we have to provide notifications so there's a clinical aspect here and there's a technical aspect during the process of this we need to understand how covert works from a clinical perspective so we can prevent it so we know what the infectious period is and we have to track all of that data somehow even when covet is over when there's a vaccine that comes out and everyone's vaccine vaccinated we have herd immunity this is a thing of the past we're going to have to have excellent health records retention to show that we complied with the osha retention requirements the calos requirements if you're in california to show you're complying with hipaa with cmia which is a california medical records confidentiality act or your state version of that as well as managing and responding to workers comp claims and other potential regulatory or legal liabilities that are going to be in the pipeline we have to think about if our employees are infected and we adversely impact another contractor at the work site what's our liability going to be there and how are we going to document what our response was what efforts we took in order to mitigate potential harm to other persons so we have some regulatory standards being implemented we have some hurdles to overcome much of those hurdles involve understanding the clinical aspects and understanding how we manage data in order to effectively protect ourselves and our employees and that's where my other two speakers come in today so i will turn it back over to jeff to introduce our next speaker and we can learn more about the clinical implications of covet 19. thank you very much dean that was great next up is aaron davis and aaron is a nurse practitioner and manages uh clinic operations at the stanford university occupational health center uh so aaron take it away thank you jeff and thank you for the opportunity to let me speak today so initially from a clinical perspective how do we prepare we need to understand coping 19 from a clinical perspective and that's going to guide best practices for management so initially we're going to talk about testing and as being mentioned there's a myriad of different tests and we're hearing about a bunch of different tests that are coming out but the gold standard for diagnostic testing which diagnostic testing is um will show you if you have an active infection or a recent infection the gold standard is the pcr test so there are other molecular tests that are sort of similar like a lamp test but basically these tests detect genetic material or the rna of a virus um they can take about one to seven days for the results to return the the one caveat is that it's it while it detects a piece of the virus it doesn't necessarily mean that that piece of the virus is actively replicating so there are new tests that are coming out that are fda approved we have one now at stanford and now stanford for negative strand testing that actually when you get the pcr test coming back positive uh you can then run a negative strand test to see is this an actively replicating virus and so we're getting closer to being able to tell whether people are actively infectious or if they've had affection in the past and they just have sort of pieces of the viral rna left over the other diagnostic test that we're hearing a lot about now is the anagen test and anagen testing detects specific proteins on the surface of the virus they can be used they may be less specific and a little less sensitive but they can be used for screening screening testing in high risk congregate settings in which repeat testing so routine testing daily or every other day could quickly identify people with asar's cole2 infection to help with infection prevention and control measures and help prevent transmission and because these are a little bit less sensitive or specific you would want to confirm it with a reverse transcriptase pcr test but the testing itself can be helpful in terms of um of rapid testing as dean mentioned the the california law does specifically say that you have to be positive with a pcr test so even if somebody has positive with an antigen you'd want to repeat it with a pcr anyways to confirm the antibody testing looks for antibodies made by the immune system after viral exposure antibodies take days to weeks to develop by the body after an infection and they can last for weeks to months right now we really can't use antibodies for any kind of diagnostic purposes or to indicate if we have immunity to stars kobe 2 because we really just don't know enough about um how much antibody the body has to make to be immune and we also don't know how long that immunity lasts for so you really shouldn't use it at this point to determine absence or presence of infection so how do we test and by how do we test we mean how frequently or how regularly and when do we test so types of testing in the workplace baseline testing which means initial screening for individual individuals returning to the work site so people who are new hires uh people who are safer california after the shelter in place return to work or people coming from uh returning from travel outside of uh for us our immediate area domestically or internationally we do sort of a baseline test to see where they are at that point in time there's also surveillance testing which is ongoing systematic collection and interpretation of data that is a large like public health concept that's intended to monitor the community or population level infection and disease for incidence and prevalence so this is something the cdc would do or county public health and a lot of this is the identified information but to kind of see what's going on at a bird's eye level what we're doing more frequently now in the workplace is screening testing which is essentially a combination of baseline and surveillance testing because we're doing routine testing but we're doing it to detect the presence of an active infection in somebody who's either symptomatic or early on in their course of infection maybe has vague or little symptoms so we can identify those folks and prevent further transmission of disease and then there's also surge testing which is a large deployment of testing in response to an outbreak detected through surveillance testing so say you have a group of 20 people and three of them are positive based on surveillance testing you can quickly test an entire group of 20 people so we can determine the scope of the outbreak and then also it helps with contact racing to see who those people were in contact with and if there's other groups that you need to test so that you can start isolating people and removing them from the workforce to help mitigate the spread of infection and then as dean mentioned we need to talk about the infectious period because that's the period in which um somebody can give an infection to someone else and as part of the the new california law if somebody is you know onsite during that infectious period um and um we want to mitigate any other risk to other employees so if reporting is required based on this infection period what's the current definition for a long time we were saying 14 days right now the cdc and the department of public health says that people with mild moderate symptoms remain infectious for no more than 10 days after symptom onset so most of the current regulations are based around that 10-day infectious period now not to say that people with moderate to severe symptoms could potentially have a longer infectious period 20 days or more but those people are are likely going to be seeking um further medical treatment they're likely going to be seen either by their primary care or even hospitalized and so they'd be monitored further and um and and their course of infection uh and return to work based on a course of infection would be largely more symptom-based than just that 10-day infectious period so our current stanford protocol which tends to be a little bit maybe a little more uh stringent than some others also based on the county that uh stanford is in santa clara county is on the more stringent side of things but our current return to work policy after self-isolation is that you have to have be fever-free for at least seven days without medications and if you have respiratory symptoms shortness of breath it will be breathing um persistent coughs they need to be significantly improved and it has to be at least 14 days after the symptoms first appeared or in the event of somebody who's asymptomatic the date of the positive test and they have to be cleared by us now again if somebody is very ill and they're hospitalized their primary care would actually be the and in general their primary care is a treating provider and can and would give the the return to work if somebody has a very severe case um and we would go by their their primary care and guidance on that so after we talk about testing and return to work we talk about how we mitigate so but how do we how do we prevent spread and so obviously hand washing with either soap and water or alcohol-based hand sanitizers frequently um you know getting the message across to stay home or self-isolate if you're ill or if you've been recently exposed to a confirmed case or somebody with uh highly suspect symptoms of probit 19 until those are confirmed or they're that person is confirmed to have some other condition that may not be infectious to you to properly wear an appropriate mask and to regularly clean and sanitize high touch surfaces we know that this virus is actually fairly weak outside the body so using appropriate cleaners on countertops doorknobs those kinds of things significantly significantly decreases the ability to spread infections just by touching surfaces so then we talk about screening and intake um screening should be done daily and symptoms should or and and those questions should start to circle around symptoms within the past 14 days that are covered like including fever cough shortness of breath nausea vomiting loss of sense of loss of taste or smell also including recent travel outside the area we've been monitoring that a lot particularly in people who travel to areas where infection rates are high and also any close contact with confirmed or suspected cases we also ask questions that may assess what contact taking in future if needed so particular buildings or rooms that the person has entered within the last 72 hours any co-workers that they may have been in close contact with um you can do temperature checks as well as a component of the screening process particularly for points of entry and exits into indoor areas and those areas specifically where people may or may not be wearing maps such as dining areas but they should not be done temperature check should not be the sole screening tool for for daily screening and you can also use telethermography so using cameras video cameras connected to infrared screening devices that can stand for surface temperature on an individual and these can automate these can be automated into medical records or other electronic record keeping systems that can flag folks for uh aberrant results and and maybe consolidate the the information that um is going back to employers as well and i believe that yes that's it thank you so much okay great thank you aaron uh our final panelist is emily mccomb and emily is director of account management and enterprise at health and while emily is currently an indiana resident she hails from california and manages relationships with a number of our west coast clients so emily over to you thank you jeff i switched places with dean he hailed from illinois and came to california i am now in the midwest and came from california so we'll have to switch back dean i would like a swap i'd like a swap box all right jeff if you want to thumb through the slides for me that would be great so we're going to give you a bit a bit of a highlight reel this evening for um some of the setup and configuration we've done around the channel 19 offering which is sort of a limited offering based on enterprise health which is a full occupational health tracking system we had fortunately worked with some customers a couple of years ago during their enterprise health implementation who had the need to build a pandemic tracking system and then put it on a shelf they didn't have a need for it at that moment but they had had to use for it in the past and it was a very painful thing to track in spreadsheets and on paper so as a part of our implementation they said hey let's develop something that we can pull off the shelf if we were to unfortunately need it in the future and unfortunately here we are with covet and they did need it so we were able to spin up a lot of these features really really quickly with our customers which is great so i'll keep it to a highlight reel this afternoon and give you an overview starting with employee symptom monitoring so at the frequency that your organization needs we can send out sms and email messages to remind your employees to submit their symptom monitoring um this can be done just once a day at a predictable time which is what a lot of organizations are doing now just to get people kind of in the habit of you know each day at six a. m or whatever it might be going through and doing their symptom monitoring we are starting to work with more employers so who are wanting to do this on a shift by shift basis so if your shift starts at say you know 10 am we would want them to receive that reminder maybe at 8am so that we have a little bit of lead time there especially with some states now mandating that if you work double shifts like we so often see in healthcare you may need to report twice you may need to do your symptom monitoring more than once per shift and so with those intricacies we're starting to work with customers to receive data from systems like chronos and other time management systems so that we can actually target those communications based on when they're scheduled um so that's a that's a new a new thing that we're doing with a lot of our customers um and it's going quite well um so jeff if you advance to the next slide you can see a quick example of what the sample or i'm sorry what the sms messages look like just very simple reminder to complete your symptom monitoring and you can see the blue link there would actually take the employee to the secure employee portal where they could submit their symptoms online i'll show you what that looks like here in a second we do have a lot of customers who are using sms more so than ever covid has been the impetus for change around organizations allowing employees to use their personal devices for work related purposes companies who i've worked with for years who have staunchly said absolutely not we will not send messages uh to sms you know to personal devices we will not allow people to get email on personal devices now have come back and said you know hey we really need to do that we need to lighten the restrictions there and allow people to use their cell phones because more people are working remote than ever and we need to be able to get in touch with these people just as quickly as possible so that's been an interesting and great trend for employee engagement the next slide is just a quick example of what the email might look like if you are not leveraging sms or if you historically have not collected your employees mobile phone numbers in the past again that's something actually that we saw over the last couple of months i have um had several customers run you know big communication campaigns with their employees to get their cell phone numbers updated in their central registry so if you have not done that yet then we're still leveraging email quite a bit for those reminders as well and on the next slide jeff we'll take just a quick overview of access because security you know we're hearing about hipaa sort of setting aside penalties for now for a lot of coveted related issues that may spring up but we know that certainly will not be around forever and regardless of those penalties you know we all feel a stewardship towards our employees data privacy and we want to be good stewards of that privacy so we have set up single sign-on with our customers so that they are the employees are accessing that employee portal in a very secure way and still making those security folks happy and that's been a great way to help to with um getting buy-in to use um personal devices you know if we're still if we're still asking employees to use single sign-on a lot of our employers are still working to install vpn access on their employee cell phones which they never thought they would do in the past now big organizations are doing that in math and it's going very well but doing that access through single sign-on means you're not dealing with password management and all the headaches and nightmares that come along with that so when an employee does click on those links from the sms or from the email they're taken to an employee portal that looks very similar to this and they can click on the little blue label here that you see that says covid19 symptom monitoring they can click on that link and they can submit their symptoms for the day i do this every time i have to go into our office and i usually do it while i'm fumbling for my badge at the door because we have a qr code at the door is a reminder that says hey if you have not submitted your symptoms yet today do that before you walk in and in about the time it takes me to find my keys and my my building badge i can get my symptom monitoring done it's really really quick and you can see on the screen here we're providing some immediate feedback on those symptom monitoring questionnaires at the bottom you know if they answer no to everything they're not symptomatic they haven't had a fever um the system gives them a quick point of feedback to say your answers indicate that you're cleared for work today if they mark yes to anything that message would change and it would vary answers indicate you should not come to work please call to schedule a telehealth visit um the nice thing about the platform is that these questionnaires are really in the customer's hands to control the text that you're seeing conditionally at the bottom of the screen can say anything you'd like some say you know please call your supervisor others say call the employee health hotline at xyz other customers have you know opened entire call centers because they just have such an influx unfortunately with you know seasonal allergies even and things going on in their area where people are just calling in in droves because they have the sniffles and needing to kind of sort through that and weed through those folks who need to quarantine or need to come to work so you're in control of the questions that are being asked on the page and then conditionally also the statements are being made at the bottom of the screen as well as a follow-up when they submit that page depending on how they answered they would also receive an email with a big colorful message in that email this image just displays right in the body of the email and it either says you are clear to go to work today or you are not it has the date and nice big numbers as well and what's nice about this is that when they walk into the building if you do have um officers security officers monitoring your employee entrances they can just hold up their phone with this email from you know even 10 feet away and you can still read that date really clearly and you can see if they are cleared or not cleared and it's a real easy way to manage access to the building because you're able to just visually see this really quickly or if this is something you're acquiring that they show their supervisor there's a level of accountability when an employee knows they're going to have to show proof of having submitted their symptom monitoring before they come to work it's not a passive thing if you're doing that proactively we've seen that that really does increase adoption significantly if you're using the enterprise health platform and you are using a supervisor portal to communicate with the leadership staff as well you can use the supervisor portal actually we have a report that can be published out here where your supervisors see their staff roster and they see who has and has not monitored their assumptions or submitted their symptom monitoring and it will um i think it has like a date time stamp on there so that they can see exactly when that was done so if they are being empowered to proactively check before those shifts start they can see who's done it and who has not and they can get in touch with that staff to say hey you haven't done your symptom monitoring you can't come to work until you do can you please get that done and that's really helped to drive compliance and adoption with our customers as well so once an employee maybe reports that they are symptomatic or reports that they they did go to a wedding this weekend where they found out that their you know their uncle their aunt or whoever had coveted um and now we need to look at taking them out of work our clinicians have um encounters in the system visits where they can start to track what is going on with that employee's case so why are we monitoring them you know was it a work related exposure um to dean's point that's critically important for your osha logs we need to know if that was determined to be a work exposure or if there was a community exposure to aaron's point where we're starting to see a bit of a resurgence and customers who are wanting to know about their employees business travel frankly for the last several months most employers have said just don't travel and no one was tracking it anymore but now that people are loosening those restrictions a little bit we're starting to see that people are kind of tracking those hot spots a bit more and within the screens the clinicians can track um approximately when they were exposed if they believe they were exposed are they referring them from testing and then when the test results come back from the lab which we'll talk about more here in a minute they can track those results as well to start to kind of build out those statistics and just understand the status of their employees if it's appropriate to take them out of work on the next slide we're going to see that we can build a restriction out and you can see here it says lost time covet 19 from 10 13 to 10 i think it says 22 small text sorry um and when we do um code in that we're going to have a restriction it can actually fire up emails then to their supervisor to automatically notify the supervisor that hey jeff dennell is going to be out of work for a couple of days and that way that supervisor can start covering those shifts right away without the employee health staff or the hr staff having to pick up the phone to get in touch with the supervisor to coordinate that they're getting sort of real-time communications as soon as that information is put into the encounter and now you are also getting to track the volume of time and productivity that your organization is losing because of coven when you do put an employee on restriction and when you do begin to monitor them for either an exposure or symptoms that they're having their information is placed on a work list and you can assign employees to specific case managers um and so they can filter their work list by only the employees and the cases that they are managing and you can see on this screen here just gives you a quick picture of people who've been referred for testing if their test results have come back if they were positive or negative and if they are on restriction uh what those dates are and certainly they can navigate to the employee's chart and see that in a very granular way within their encounter and within their chart but this just gives a quick picture um for that case manager so that they can just you know quickly understand what is going on with the employees that they're helping to manage so let's look a little bit at um lab testing and tracking of results it's been um a firestorm of activity in lab integrations these days we've had an integration with lab core and quest certified integrations with those partners for a long long time we've worked with tons of hospital labs to do epic and server integration but we have seen a pretty significant uptick in just even smaller lab groups who have started to do covid testing and so we've done a lot of lab integrations recently most of which are bi-directional if at all possible we really want to set you up to be able to order the lab test directly out of the system so if you are if you've noted that somebody needs testing and you're you know you're putting them out of work for a while right from that encounter you can create that order and it transmits electronically right over to lab core or whoever you have an integration with um so that you aren't um you know managing a separate system and the clinician can just order that right out um of the system and also um by doing that then you're able to when the result comes back you really get to kind of link those results up so you can tell um just at a glance through some quick system reports um which results are outstanding and and which you've received back so when you do get the results back um they will come back this is an example of a just a sample lab core test that comes back you can see it's kind of small text i'm sorry it there's a column that says normal and it says not detected meaning the test essentially is negative and these are all discrete encoded values so again you can you can trend with your organization to see bash our infection rates up or down and you can also place some automated business rules around these for notifications so if you see that a positive test result or a negative test result in this case was um sent back into the system you can trigger an email that would automatically go to that employee to let them know hey your test was negative you can you know return to work or um you know get in touch with us at ehs for next steps and jeff if you had to answer that next slide i think i put an example of what that email might look like yeah alternatively you might um have an email that just says um you're your test your test results has been received please click here to view the results and then that would take them into the employee portal which is completely secure and that's a great way to um to communicate positive results as well if there was sensitive information you didn't want to sign via email that's a great benefit of the employee portal you can put that sensitive information out there and the automated notification to the employee based on that lab test coming back would go again write out the email and it really helps to eliminate kind of the manual effort that it takes to communicate with those teams if an employee is positive of course now we're all doing the very fun task of contact tracing and we have built out the ability to link employee records together so in this example this is my test chart d.

c beck and william hart were both close contacts of mine during the time periods that you see here on the screen and again the benefit of this is understanding who we need to be in touch with um dean shared some interesting regulations that they're dealing with now in california that you have one day to notify these people that they've had a potential close contact so by linking these charts together by linking these employee records together again you can run those automated notifications to let's say in this example daisy we can fire off an email automatically to her once she's linked as a close contact and it would simply say something to the effect of you've had a potential exposure please call us for more information or you've had a potential exposure please don't return to the building until further notice or whatever it might be appropriate to communicate at that time but you can really satisfy that burden of notification pretty quickly just with some really simple automated rules there and the last item i want to take us through this evening is reporting on coveted statistics executives are you know needing meeting information in nearly real time to make a lot of tough decisions about the business and our employee health professionals are needing that information very quickly as well so that they can respond to hot spots and all the good things that are going on with um covet these days so a couple of examples of the reporting dashboard that's in the channel 19 build testing outcomes understanding what percentage of your tests were positive negative and how many pending results you still have yet to come back worker monitoring volumes we've seen um we've had some employee partners who they've had to add 50 60 employees to call centers just to manage the volume of employees that they're monitoring and being able to show those trends over time to see how many employees you're monitoring i think is really helpful when you're you know certainly budgeting for staff but just also kind of helping the organization to understand um really the volume of effort that it takes to to monitor the people that need monitoring on the next slide we have some additional statistics about lost time and days away so i think this is just a quick average of how how many employees you have out of work at a given month and seeing what those trends are doing very important something that we did not show today but that we do have in the whole enterprise health build is a full osha log module so as you would enter that time away and you would designate a case as osha recordable it will build all of those all of that lost time on your osha log and allow you to report out on that at the beginning of next year and then the last slide is just a quick overview of recovery outcomes so how many people have just recovered and come back to work um how many people ended up you know being negative and just not affected and and then also you know how many are just unknown they've either quit and left the organization or we just we don't know the outcome of that case and that is it for me jeff so i think we are ready for q a so i will turn it back to you okay great thank you emily and thanks to all of our panelists for sharing with us today we do have plenty of time for q a so remember that you can pose questions using the chat feature in webex uh so we'll get to as many of those as we can and i'll go ahead and kick it off with it with a question or two and then we'll uh we'll monitor the chat um hey dean let's start with you you know california is often often painted with kind of a broad brush as being as being let's call it regulation rich in in your experience how does regulation that starts in california kind of make its way to other geographies well i think one of the things that we've seen in california interestingly is the legislature has been be consistent there hasn't been a lot of divisiveness in the in the state legislature at least about the need for covet-related regulations and so they've been able to pass laws pretty quickly some other states have had more challenges with that so in essence california is us able to move a little bit faster in this space there are some areas where we have very extensive regulations in california that that significantly impact business operations but i think as we tried to show many of the things that are being put into regulation here are really best practices so there are things that you have to do if you're in california but if you're in in my home state of illinois not all of them are laws yet but they're things that you really need to look at so they're things that whether they become a law in a given update or not a lot of businesses are going to be doing them because they're best practices or other companies that are multi-state and they do some business in california and some in other locations and they tend to look to the most rigorous set of regulations and follow those universally but you may not want to give your employees additional leave that they're not otherwise entitled to but you really should take a look at giving the notifications when you have an infection in the workplace you should think about how you're handling workers comp or how you're going to and how you're interacting with your comp carrier so we are leading the nation in many ways in the regulations right now and that spread is going to be because a lot of it seems like the right thing to do from a conservative business approach gotcha great thank you um aaron uh you know certainly colleges and universities have received quite a bit of press coverage lately you know tied to the return of students to campus to classes to athletic programs and and certainly most employers have their hands full as they're focusing on their employee populations but you know i would think a an institution like stanford has kind of an added layer of complexity as you're as you're you're managing the health of the workforce that is in turn supporting the academic mission of the university um you know how does that kind of factor into your approach to managing cobit 19 with your faculty and staff yeah it's a it's a good question because you know we do have a number of faculty and staff that interact with students on a daily basis but it's it's an added layer to even what you said because you know students in high schools or or elementary schools will then go home at the end of the day we also have students and grad students who live on campus so you know it's it's another layer of not just where people work or go to school it's also where people live and so we have had to do uh work with some of the departments uh that particularly work with the residential areas the dining areas to go over more training in terms of how to mitigate spread but also for the folks that have to enter people's residences like what kind of ppe they need to use which is usually above and beyond what they're used to wearing and we've done a lot of training with those departments um this is one of the reasons why we encourage surveillance testing or weekly testing with the faculty and staff that particularly interact with students or are very public facing because we can help to decrease the risk of spread by kind of surveillance testing and if anyone comes test positive we can remove them uh from you know the public facing view and do some more testing and test the start contact facing immediately um so it definitely is uh has its challenges and and you mentioned athletics and you know the pac-12 we are one of the last uh conferences to decide we're going to try to do some varsity sports in the fall and so athletic programs are now being required by the ncaa to do the antigen testing that i mentioned on a daily basis and then our county has um which is santa clara county has added the regulation of doing three times a week pcr testing on top of the daily antigen testing so that does apply to the athletes it all applies to all of the coaches athletic staff folks that are working with the athletes on a daily basis but we also have basically added faculty supervision of athletes in their residential areas as well so it's it's definitely a lot of moving pieces and a lot to keep track of oh yeah that's that that's amazing thank you yeah um you know emily um you know you you demonstrated how technology is being used to manage things like symptom monitoring and case management and reporting and contact tracing but i know now we that we've entered the fall there's a lot of concern about layering layering flue uh on top of cobin 19. week