Is Your 2020 Employee Flu Program Ready?

hello everyone my name is Jeff Donnell and I am president of Enterprise Health and I'd like to welcome you to a dose of reality today's webinar of a managing an employee's flu program in a coated nineteen environment I want to thank all of you for registering and attending and this is actually the fourth webinar that we've conducted since the kovat nineteen pandemic began and the interest in these has been been outstanding so we really appreciate your attendance just a few housekeeping items we've muted everyone except our panelists on entry so that we can minimize background noise I also want to let everyone know that we are recording the session today so we'll email everybody early next week with a link so that you can access the recording and share it with others who maybe we're not able to attend today as always we like to point out that given the uptick in the use of virtual conferencing sometimes we experience a glitch or two with WebEx so hopefully that will not happen today keep our fingers crossed and we're very fortunate today because we've assembled a really tremendous panel of experts who know more than a thing or two about managing a mass immunization program and we've asked each of our panelists to talk a little bit about what they're working on as they prepare for this year's flu season and then we'll open it up for a Q&A session so you can submit questions via the chat feature in WebEx at any time and then we'll we'll get to as many of your questions as we possibly can at the end I also want to point out that we are scheduling another webinar about three weeks on Wednesday June 24th and at that webinar we're going to address the fact that ghovat 19 kind of ironically just really dramatically underscores the critical importance of having strong occupational and employee health programming and the IT infrastructure to support it so in some respects there's really never been a better time to make the business case for increased investments in employee health but that business case has to be made bert during a period of economic uncertainty so during this webinar panelists will talk about the growth outlook for occupational health and provide some practical advice on how to make a case for expansion more information will be coming your way on that one very soon so before we turn it over to our panel I'm just going to quickly provide a little context on our organization and today's topic now if we were stuck on an elevator together and you asked me who Enterprise Help is I would say that we're the only cloud-based health IT 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 enterprise clients and their employees for a healthier future we actually work with a number of blue chip organizations and that includes global corporations government agencies and hospitals and health systems who operate their own on-site employee health clinics and many of them also provide employee health services to other organizations and the logos you see on the screen are just a few of our clients and since February we've been working very very closely with our entire client community as part of a widespread collaborative effort to rapidly respond to the things that are going on with COBIT 19 and what we've done is really modified our existing pandemic response medical surveillance case management encounter documentation employee engagement and reporting capabilities help our clients with their specific use cases and that spans travel employee monitoring testing case management those sorts of things and we've all been working together at a rapid pace we're making refinements on a very regular basis because this is a very dynamic situation things change on a regular basis we've also packaged up that coded 19 functionality and we launched a standalone kovin 19 monitoring application that people are starting to adopt and use we also developed and rolled out new telehealth capability that was something that was already on our development roadmap but we were able to accelerate that and get it launched within a within a matter of days and last week we actually started rolling out contact tracing capability and our plan is to continue to really maintain an agile footing and we're compressing our normal development cycles for months to weeks down to days and not long ago a number of our clients started to come up for air at least little bit from the Kovach crisis and several of them noted that you know flu season is just around the corner so while it's early June people are looking ahead to the fall and and several of these clients recognized that the mass immunization of employees in the fall of 2020 is certainly going to be complicated by koban 19 I think we've all seen in the news that the topic of vaccinations is getting more attention and the popular press is already starting to urge people to get flu shots this year and the CDC is certainly noting that health systems who might see another wave of Kovach patients in the fall really don't want to have to deal with a simultaneous wave of people who are suffering from the flu and we've worked with a number of our clients over the years to really streamline the mass immunization of employee populations but many of the strategies and the technology solutions that we put in place ironically don't necessarily line up all that well with social distancing concepts so once again we're collaborating with our clients to make adjustments for for a new reality so today you're gonna hear from Samantha Lotus who's a client at Wake Forest Baptist Health and she's going to talk about what what they're doing at their health system where flu shots are mandatory and by contrast you'll hear from Tiffany bold at Citgo and she works in a corporate setting where flu shots are completely voluntary and then Emily McComb from enterprise health is going to address some of the things that we're working on to refine our application based on input from Samantha from Tiffany and from several other clients that we work with so our first panelist today is Samantha Lotus Samantha manages the administration and tracking of about 33,000 flu vaccinations each year at Wake Forest Baptist Health Samantha is very passionate about this topic is your visual soon see and her group does some really really creative things to make this effort successful so Samantha let me real quick ask control over to you thank you for the introduction my name is Samantha Lotus I am the administrative manager for Wake Forest Baptist Health for the employee health department and I'm just gonna start out by giving you a little back on our organization for anyone who is not familiar with the hospital we are an integrated clinical and academic health care system in winston-salem North Carolina so we have about 885 bit in our Winston campus alone we have five community hospitals and we have about 300 primary specialty care locations all in all we have about 20,000 employees in addition to that we have 10,000 contract and student workers so the employee health department is open five days a week we have five clinic locations we have 17 total staff members that work across all of them we kind of float our staff around we do acute and work-related visits and we also do matriculation we kind of bring on the med students for the School of Medicine you know we're here to talk about flu campaigns specifically is something that we've been working really hard on to probably last like 15 years it is our only truly mandatory component for the Medical Center it's made its mandatory for every employee contract worker or student who sets foot on to the medical campus we hold it from October 1st through October 31st and it is completely managed by our department and employee health to become compliant employees have four options they can receive their vaccine at an employee health clinic location they can submit a request for a medical exemption they can submit proof of a vaccine from an outside source or they can receive it from an in-network provider so a primary care physician who also works for the Medical Center and that will automatically feed into our enterprise health system for the 2019 2020 flu vaccine season we've ministered just over 10,000 vaccines I'm sorry we administered just over 17,000 vaccines we had about 5,000 that were completed outside of our network and we interfaced over 2,000 that came from our other family practices so we're able to keep our employees they come in to get their vaccines like I said it's mandatory this is because we do have consequences if they don't follow it by November's deadline from this year we had an overall compliance rate of ninety nine point three percent employees who don't comply with us during the designated time frame will be locked out of all electronic systems that they need for their jobs that they won't be able to check their email they won't be able to sign into our PeopleSoft timekeeping or clock in and they won't be able to sign into epic to see any patient care so we manage the flu program and most people think of the flu is just kind of over the winter time but we actually start our planning in June so we actually our first meeting today and we run it through late April usually early May is when we do our final reporting so it's an almost year-round planning and managing that we do for it there is a flu committee which consists of approximately 55 people from different areas of the organization who meet with us and we meet about weekly once we hit August sometimes we'll meet twice a week if we need to we use an electronic record-keeping to maintain all of our data we used to be on a different few Mar that we kind of had to use two different ways to manage our flute campaign and we were using it through PeopleSoft to document our flu vaccines and then we were having to manually print it out and do different types of reporting how to all be done manually so we were doing it on spreadsheets we were doing it on paper as you can assume with 20,000 employees trying to keep track of a mandatory campaign it was very difficult it didn't come without and I'm just kind of skimming through these slides while I paraphrase so bear with me if they come up without a lot of bull error we had a lot of people who were losing access who maybe should have because we were just trying to keep track of everyone and we didn't have an efficient way of doing it so that's one thing that Enterprise Health has really helped us with because now that we are using Enterprise House were able to keep all that data in one and then likewise were able to manage it and report on it from there so bear with me while I go through some of these so I can talk about how we are running the actual program now okay so for the immunization we use the employee portal it's one of the biggest improvements for flute champion in the last year so employees will sign on to their portal they can complete their authorization to become vaccinated from the portal directly they can also submit their proof of vaccine if they got it done someplace else right to their portal and they can also request the medical or religious exemption through the portal as well they automatically get notifications and reminders about the requirement as well as the open clinic times in any location if an employee doesn't complete the form prior to arriving at an employee health clinic like if they don't have their authorization done we use iPads so that they can do it while they're in the waiting area we have also started using QR codes we place them in employee area such as elevators or in break rooms so that employees can scan it with their smartphone it takes them right into their portal and then they're able to fill out their consent easily from there during the open clinic our nurses administer the vaccine we actually run it a little bit differently we have two people who sit at the front of our clinics and they actually handle all the documentation so somebody will come in we'll ask them if they've already concludes our authorization and then we simply document it using iPads that we have sitting there and then we send them over to a vaccinator to be vaccinated if they haven't filled out their consent then we also do their consent for them right there it's really good to mention that specialist coded this year this all requires no signing of paperwork no handing over objects you know it's stuff that we have documentaries were just documenting they hold the iPad they ask the employee the questions that they need to they initial on behalf of the employee if they need to and then they send them over to the vaccinator so Nader's not having to touch the iPads talk to the patient have the patient touch the iPad we kind of have it very separate so that there is no handing off or mixture of those items this is something that we have been doing the last two years so it just so happens and it helps us for this year going into a time when certainly everyone's going to be a little bit more concerned when the nurse begins entering the patients name or skin scanning their ID badges which we haven't done but is a possibility the system automatically pulls the data forwards it from their electronic questionnaire so it tells us that they have any allergies or any reason why we shouldn't be able to get them their vaccine and then we're ready to vaccinate them a key benefit to documenting and managing the flu vaccine within this record system is that we are able to own the whole entire process from start to finish we own it from the point where they filled out their authorization through vaccinating them through the end where we know that our compliance rate and then at the very end when we need to pull any reporting for the NHSN reports that we do at the end of the year it's been a huge benefit to us another thing that I always like to mention is that we use the manager portal as well it allows our managers to be able to go on to the portal check the compliance rate themselves see if their staff have been vaccinated this makes it so that when we turn their access off if they haven't been there is no surprise at the very end of the season when they can't when their staff can't log in I think that pretty much covers how we handle our entire process and I know I speak very fast apologize to anyone and of course we'll be here and open for any questions at the very end Samantha that was great we appreciate that and our next panelist is Tiffany bold and Tiffany is the health services manager and nurse practitioner at Sitka and Tiffany is a self-described employee health nerd and oversees a voluntary flu program at Cisco so with that we'll turn it over you Tiffany I think so a little bit about our company we have about 3,000 employees in four main locations the headquarters location is where I'm at it's myself and two registered nurses our largest refine is in Lake Charles Louisiana and that staffed by a nurse practitioner and three registered nurses we have two smaller locations one in Illinois and the other in Texas those both have about maybe through between 350 500 employees at each and their staff with a nurse practitioner and a registered nurse we have at the headquarters location we also have an additional responsibility for terminals and pipeline locations and that's about 400 employees and then spread out from Florida all the way up to Maine and each one of those terminals have some may have one to two employees and others may have 10 to 12 so those are fairly usually our biggest challenge is managing those locations we also have about 200 employees and three lubricants plants one in Illinois one in Oklahoma and the other in Georgia so we are spread out pretty well between those two groups our employees have the option to receive the flu immunization in two different ways they can either do it through our benefits and can go to the local or community resources and that's provided to them a hundred percent no charge for them we don't get any records if they go out to the community to receive them if they choose to we do provide it on site and at the lubricant facilities we contract for people to go on-site there since they're spread out next slide please so out of the 36 hundred employees we usually give about 1100 flu shots on site so that doesn't count the community the employees that go out in the community our employees typically use the on-site resources just because it saves them time it's very convenient for them because here if they had quarters office they may just have to walk down the hallway to a conference room or so and it's also we have a lot of co-worker pressure they'll grab each other from the offices you know and joke with each other if I'm going get it you're going get it or if you don't get and give me the flu so they have a lot of that going on so that actually is more of a challenge between them and they have fun with it I've already started getting phone calls here at headquarters from people who saying look make sure you have enough flu shots this year because I've never gotten it and I'm getting it this year so we've gone on ahead and we bumped up our order already we usually order our flu shots early like in March or so and here at headquarters we give about between four and five hundred so this year we went on ahead and we bordered six hundred shots expecting more people to receive them we also address a special population and we do it because we have here in the headquarters office 15% of our population or 65 plus and so what I do is I get that list and I email each person individually and offer it as an invitation and I put voting buttons on it and they just respond to the email telling me whether they would like a high dose shot or not like a hot dose I and then I order those specifically for the people to make sure that they have their own reserved for them and then they come in during our normal walk-in hours for to receive that shot so we don't do those when we go out into the locations next slide please so typically what we do is we set flu clinic hours then we send out emails we put it in newsletters we have video screens with all of the happenings in the building and in events and so we get it posted we go out to conference rooms and we go to we have a five story building that we're in and we have large conference rooms on one on the east side and one on the west side and so we go two each for each side over about a two week time period and we stay there for maybe an hour or two and that's where we give the bulk of our immunizations in the plants they are I'm going to venture out to the control rooms to try to get to the population of the operations that can't leave their jobs because they're Manning control boards or that it's going to take too long for them to leave the facility get up to the health services just to get a shot so to take away that barrier with those employees we bring it to them we also offer it during surveillance visits so when they're coming in for mandatory physicals during just regular office visits and we start usually mid September early October when we receive the immunizations and we keep them available all the way through January February as long as we still have stock because people change their minds midway through or they've had a family member who had the flu and they you know decide to get the shot as a reaction to something so we we keep it available and we don't have a cutoff date so our participation is 100% voluntary last year was our first year to go 100% paperless so we were very excited about that using the enterprise health system it saved us probably at least the full workday per nurse because we didn't have all of the paperwork to deal with after we were done with the immunization so that was truly amazing for us this year we're gonna attempt to do the consents ahead of time using the portal we also have an administrative assistant that you set up ahead to deal with the people as they enter and if they don't have the consent done we've got some tablets that are programmed for the portal that they'll be able to access there and then when they get to the nurses the nurses are set up and they give the immunization and document at the same time it one ratio for them since we have a smaller staff and the other thing that we do that employees really look forward to or we do little giveaways it's nothing big but I find that just the smallest giveaway or just some trinket that they like and so we taught these giveaways to flu season so we may get a customized box of Kleenex with a little flu saying on it in the Citgo emblem um we give away hand sanitizers encourage that will give them stickers that says I've got my shot and then they'll go around and show their co-workers that they got their sticker we would do suckers and we'll have sugar free suckers available for people who don't want the sugar so we have a few different things like that and that just makes it more of a fun inviting environment for them to come in and they look forward to that and that is it thank you thank you Thank You Tiffany great presentation and hilarious to hear that suckers work on adults as well as they do for kids so I guess we never stop enjoying those so our last panelist is Emily McComb and Emily is the director of customer success at enterprise health and and Emily and her team have been working with Samantha and Tiffany and several other of our clients to really modify our application in support of the 20/20 flu immunization programs and we're kind of you know we're knee-deep in that process right now and in making those modifications but Emily's going to give you a preview of some of the things that we're working on all right thank you so much yeah we have worked pretty hard to put together a food program that your employees can interact with from a computer a desktop computer a laptop or their cell phone we know that for a lot of you you're really looking for your employees to be able to do your consents online and it's a lot easier sometimes to capture their attention on their self rather than a computer because they may not be sitting at a computer all day to see email notifications that come through so we're excited this year that we can start doing more with SMS messages so invitations to complete their consent or schedule their appointment if you do your flu shots by appointment can all be done on their cell phone through SMS which i think is great news as Samantha mentioned you can also put up posters around the organization with QR codes that are programmed to take your employees straight to that employee portal when they scan that with their cell phone our marketing team put this poster together and we can send this out to you if you'd like and we'll even put the QR code on there for you so that you can post those around break rooms and such to help get that participation driven up a bit we can also target SMS and email notifications based on demographics that you find in the chart so for this example here with mr. Freddie Anderson you can see that he's employed by better Corp he's 37 years old and his job is in transport so based on any number of factors that you see on the screen here we can target communications to him I think it's brilliant that Tiffany is doing this with some of her high-risk population and that's something that you can certainly do out of the system just based on the demographics that come through your HR feed when you send out the notification to fill out the consent paperwork online it's done so on the employee portal so you don't have to exchange paper you don't have to exchange pen previously a lot of these consent forms were captured at the time of the event on a shared iPad we still think a lot of customers are going to choose to go that route but just being more and more conscious of wanting to not you know all touch the same device we think that you know for a lot of our customers they're going to rely more heavily on notifications to go out before the event so that people can fill that out on either there again their personal cell phone or laptop the consent form can also be used to collect acknowledgement of educational information as well so let's say an employee chooses to maybe decline the vaccine you can actually conditionally display some education here and ask them to acknowledge that before they go through and do the declination process which i think is really helpful because we know there is a lot and information and misinformation out there right now about vaccines that were excited to be able to offer those as kind of conditionals on the consent forms you can also ask a series of questions and maybe traditionally collected on paper the day of the event so you can ask them about allergy and medication history and medical history and then based on the information that they share you can actually provide notification that maybe they need to speak with a medical professional before they would reach out for that vaccine or that they need to call you and discuss if that vaccine is a good idea for them based on some risk factors that they would be adding in to their consent form here when it's time to administer the vaccine either at an event or by appointment we really want to make sure that the folks doing the documentation be a clinical or administrative staff that they're working fully off of one screen as Sam outlined with Wake Forest you know they have a couple of administrative folks who are doing the documentation for the nurses who are actually doing the vaccine administration so they can focus solely on that clinical interaction and whoever those administrative folks are we want to make sure that they're just working out of one screen and they're not needing to bounce around from place to place in the chart so the screen you're seeing here is the vaccine administration screen and the only thing they need to change from patient to patient or employee to employee is just really the name if the lot number or something like that changes you know mid event they can update the lot number but all of the information that you're seeing down here is ficky so each time you submit the screen this information stays and all they have to do is put in the employees information we're actually looking to further reduce that data entry using 2d barcodes found on the vials themselves the CC has been a nice job of requiring certain information to be held in those barcodes so that's something that we're looking to launch this year so really all the person who's doing either the documentation or doing the the vaccine administration would need to do is just run a barcode scanner over this it'll work beautifully with just eye cameras or tablet cameras so really you shouldn't need any special hardware either which is certainly very helpful sans it'll lead to the fact too that we can scan employee badges to pull in the name and so you don't even have to type that out either certainly that's dependent on some of that information being contained in your badge and the type of badge that you use but that is certainly an option as well so really our goal is to get this to a point where you're scanning a badge for a patient name and you're scanning a vial for the injection itself and that's it and no one is actually needing to type anything during the event once that information is all collected we can show a blue compliance dashboard out on the supervisor or employer portal certainly this is more appropriate for those of you who require this like in our healthcare customers we wouldn't necessarily want to disclose this information to supervisors where the program is voluntary but we can put this out here so that there is no surprises at the end of the flu season as far as who has completed that vaccine and who is compliant and lastly we know if you are spending the time and their resources to put on these big flu events that someone in your leadership team is going to want to understand the outcome and the success of those events so we're adding some additional dashboard reporting to give your leadership team visualization for the success of the program for that year so they can understand what percentage of people were vaccinated at your organization how many of the vaccines were done off-site as long as we're collecting that information which we actually are with quite a few of our customers which is great how many people may be declined the vaccine and who had a qualified medical or religious waiver on file so you can really give your leadership team and they quick picture of the success of the program throughout the year which we think it's really helpful so we're excited to launch this dashboard this year and just with that I'll turn it back over to you I know you're monitoring the QA and we'll open it up for questions yeah thanks Emily that was great too and yeah we do have certainly plenty of time here left for questions we've already gotten several that I'll start throwing out here but again a reminder that you can pose questions using the chat feature in WebEx so here's a question for Samantha given kovat 19 are you still going to allow walk-ins to your clinics or are you going to require a platelets I probably should have mentioned that too when I was explaining it we actually don't vaccinate inside our clinic locations we on our main Winton campus which houses the majority of our population we actually vaccinate in pods in our cafeteria we section out a large area we have engineering set up partitions and we vaccinate down there so that we can keep the line or reduce any lines and keep them all that commotion out of our clinic so that we can maintain a normal see up in the clinic setting okay great thank you and I guess this is a question for everybody and I know I think you guys have touched on some of this but one of the questions is you know can you talk a little bit more about what changes with your your planned approach for 2020 you know based on based on kovat 19 you know what are some of the adjustments that your that you're planning to make and Emily you might talk about the fact that I know like for example in the past a lot of our clients have used iPads and had you'd have the administrator and at collecting information and then you'd have people actually like you know sign the iPad and give consent or you know right right there which obviously we don't want to do in a Coppa 19 environment absolutely it's been a pretty popular choice in the past to kind of work works aligned so to speak with an attendant who's you know having people sign their forms with her finger on an iPad we were certainly seeing a big push to the employee portal to fill those out electronically instead and so for some of our customers who you know maybe they have pretty significant Network restrictions and don't let their employees traditionally on to that employee portal from a personal cell phone are getting creative with us and figuring out ways that they can accommodate that securely and safely so that's been great and I know that's something a lot of organizations are towards you know putting putting that employee portal really as their employees fingertips on their personal device rather than requiring them to be in front of a computer because for so many of especially it's like the industrial customers that we work with these employees are not sitting at a computer to be able to see that so that's been a been a big trend you know just getting creative with that security and privacy team to understand how we can safely give access to folks from their personal self but Sam and Tiffany I'm interested to hear you know logistical II what you guys are thinking about changing for this year that's a Samantha um you know logistically we obviously in the early stages of our planning but we haven't I don't think that we'll have to make too many changes just on how we usually do it last year we had almost no lines with the new process of having then somebody on documenting and then the vaccinators being able to just vaccinate and have people move on and we also weren't requiring them to touch the iPads at that time either so I am hesitant to say that we won't be changing much but it looks like we won't need to no that's awesome are you are you guys going to do it do anything to kind of account for like the you know six foot social distancing and that kind of thing if people do line up yeah and that kind of helps us with the spaces that we use we do have a little bit more leeway to allow for six feet in between we'll probably mark the ground so that if we do start to have a line we can make sure that individuals are spaced out our Hospital has immense wear a mask initiative happening right now so every single person has to be masked when inside the Medical Center that'll also help them feel more comfortable while they are standing around or congregating to wait for their vaccine and we do run the clinic at most of our locations Monday through Friday so we will likely be ready to ask individuals to come back at a later time at the line to get to be too long this is we've got those same types of things in place for our building and we still have it we've brought just a hundred people back to our building so far we're doing a gradual return so I'm hoping that we can have most people back in the building come September October the our company has been very slow in return so if not I will probably do outside and let people drive through and complete it that way everybody's working from home really successfully and with the portal and with the access we'll use that and still offer it to them so we'll just have to see what the situation is at that time as to how we're going to handle it yeah no that's that's an interesting observation because obviously depending on what happens with kovat if we see if we see more spikes and you know you might have people who come back to work and then all of a sudden are again working from home and yeah how do you handle you know still still taking care of flu shots and that yeah the kind of that the outdoor approach is an interesting one Emily here's one probably for you this is from somebody in a health system setting and they're asking from a security standpoint can nurses at the locations be set up to only see the flu vaccination workflow and not the rest of the employees record yeah yeah that's an important question we go back here what you don't see in this screenshot Cecilia is that this menu there's a little menu icon up here it's collapsed and they're in this role they're locked only to this page to this injection program page so that's really important we do have a limit to access security role for flu administrators because we know sometimes you know they might just be nurses especially in a Health System nurses or volunteering for the event from a completely different Department they don't they don't work in employee health and they should have access to the rest of the record and there's a little again it's not shown in the screenshot but there's like a little pop-up here in the corner that can give you a red flag if someone has a contraindication via a condition that's on their chart or previous bad reaction to the flu they would see those types of pop-ups because it's clinically relevant to the administration but they don't see anything else and they can't get into the employees chart from here and sicker question thank you a question for her for Tiffany and Samantha and that is have you already made plans to purchase needles and alcohol wipes because both seem to be in short supply so now just kind of you know getting more vaccine as Tiffany you mentioned but the the associated supplies hey this is Tiffany um we are when Coby started I made a huge order for all of the Deedat supplies then including needles of alcohol swabs and band-aids anticipating that everything would be in shortage so we did that in February early March and this is Samantha we also already have all of our supplies ordered we actually talked to our flu vaccine rep as well just to make sure that we were going to have those supplies in and we have that order place to another question that just came in is can can you guys expand on this is probably especially for you Samantha can you expand on exemptions and those that decline the vaccine and and and maybe with that too you might you guys might talk a little bit about you know sort of what what you're seeing with anti-vaxxers and and how do you typically handle that so I can come in on that we have two routes an employee can be exempt from obtaining the flu vaccine one is a medical exemption so it has to be a letter from a physician or other provider stating that there is a medical contradiction to receiving the flu vaccine I will note that we no longer accept egg allergies as a reason to not be vaccinated the CDC stopped recognizing that a few years ago so we in turn also don't accept it any longer religious exemption an employee can submit a religious exemption to stating that it's against their religion to be vaccinated we honor all of those requests from our age from an HR standpoint that's kind of the route they decided to go with I will say that last year we had less than 200 medical and religious exemptions total so it's a really small population for us can we just help you brag on your self here for Samantha what's your compliance rating within your organization as of right now we're at we were at a hundred percent we were at ninety nine point three on November first Wow David you say tiffany has had some really fun interactions with some of her team who's been concerned about receiving vaccines I wonder if you wouldn't talk to us a little bit about that because you have a very different perspective Tiffany some share programs voluntary but I know that's something you've you filled it in the past yeah we we've had employees have very extensive conversations we'll sit down with them and pull out the ingredients and let them read the ingredients and so we don't handle those types of situations like in our conference rooms or when were out in the locations we'll ask them to schedule a time and sit down with myself or one of the nurses to go through their concerns let them leave let them think about it so we may have somebody visit two or three times because they're so distraught over making a decision whether or not to get the flu shot last year I've had an employee who had some negative experiences with vaccinations with his children and he you know wrote me some very very detailed emails and he was upset that I was promoting flu shots and so he and I went back and forth and we talked about it and tried to you know get on even ground with it and so it's finding a balance for us and you know and make sure that he also understood that people had the right to receive the vaccines just like he had the right to not receive the vaccine and it's just handling the different personalities Roger and Samantha this is just a clarification question for you when you say compliance that means both those that were vaccinated and includes the people who can show an acceptable exemption right that that all adds up to your hundred-percent okay great and Emily this is one that I don't know if we've encountered or not but the question is can we account for those companies that vaccinate employees family members as well oh yeah yeah absolutely contract dependents in the system we do have some customers who offer several services actually to dependents who are either you know just maybe only on the company sponsored health plan and so we can do some checking against those records to be sure that they're you know qualified to use the clinic services but yeah absolutely we can track those dependents and we can either treat those is just standalone medical records or we can actually link them to the employee's records so you can kind of course the family information together as well so yes that's actually something we have done in the past and can do so pretty easily great and here's one that probably both Emily and and Samantha you may be able to comment on this from in terms of what Wake Forest does on an outsourced Ock health basis but the question is any recommendations for an occupational health provider that goes to 3 or 3 or 400 client companies to do flu clinics you know where each company has different setups and access to electronic devices and those sorts of things I can say sorry go ahead Tiffany no go ahead go ahead I was going to say we found that taking on the iPads we actually go to a couple different locations when we screen taking the iPads has been huge as long as they have Wi-Fi available you can pretty much accessing any of the same systems and do it the same way great Emily were you gonna say anything there nope nope I would just be piggybacking on what's math assessment Creek okay great you know Samantha you you talked about the fact that you kind of separate out you know you have a couple of people who actually you know do do kind of the check-in and the the paperwork electronically on an iPad and then you know different people who administer the flu shot and I know I know a lot of our clients in the past at least they've had they've had a single person kind of do do everything can you talk a little bit about you know how your employees have reacted to to that approach of their bidding any issues and then what are the benefits that you see from doing it that way yeah absolutely so I will say that we again we started doing that about two years ago the benefits have been it has greatly reduced our lines we like I said last year didn't have any lines while people were getting vaccinated it helps to be able to streamline that through the administration administrative process in the beginning and then just go and get your vaccine right in front of you and one of the setup pods the feedback we received from our staff has also our employees of the Medical Center has also improved they like that they have someone they can talk to if they were having any problems filling out their forms or if they have any questions and then when it comes time to get the vaccine they can just go get their vaccine and then leave gotcha great couple of technical questions that just that all that I'll just respond to hear one about can the information from the application download and other applications and the answer is yes absolutely we're Enterprise health solution is is extremely interoperable and you know we've set it up to be able to interface with and integrate with other solutions and applications another question about how does information for demographic graphics and job locations and those sorts of things get into the application and is that done manually in almost every case our clients you know we have to set up a an HR interface so we're interfacing with you know workday or s ap or PeopleSoft or whatever you might have and then we're getting that data in a in a regular feed so that there's no need to enter that data it can be manually entered on a case-by-case basis if you if you need to but you know 99. Jeff