Surf the Next Set of COVID-19 Waves

well good afternoon everyone thank you for joining us my name is jeff dinell and i'm president of enterprise health and i'd like to welcome you to the get ready for the next set of waves webinar focused on actions that several innovative organizations are taking to respond to the kovid 19 pandemic and to anticipate what may be coming next and this is actually the sixth in a series of webinars that we initiated earlier this year in response to cobit 19. and we're excited to report that we have more than 450 individuals who've registered for today's session which is outstanding uh we want to thank all of you for taking the time to attend today and we want to thank our friends at the bri network who helped us to promote the event just a couple of housekeeping items we've muted everyone except our moderators and panelists on entry uh to minimize background noise but we are recording this session so we will email everyone who registered early next week with a link so that you can access the recording and share it with others we're using webex today and that's been a successful platform for us hopefully we won't see any glitches given the uh the large numbers that we're expecting but hopefully everything will go well for us and we've got a really really outstanding panel today we put together a group of occupational and employee health experts who include enterprise health clients and partners and we've asked each panelist to make some initial remarks about their observations on today's topic and then we'll have a q a session you can submit questions via the chat feature in webex and then we'll get to as many of those as we as we possibly can after each of our presenters shares some of their material with us joining me today to help moderate is ashley ross with bri network and bri is a leading organizer of conferences and events in healthcare pharma biotech finance and other industries so thank you ashley for joining us today and before we turn it over to the panelists i'm going to quickly provide some context on our organization and today's topic so if you had the misfortune to ride on an elevator with me and of course in this day and age we'd we'd be wearing masks and standing in opposite corners of the elevator but if you ask me who is enterprise health this is what i would say we're the only cloud-based health it solution that combines occupational health and compliance clinical care and employee engagement on a single interoperable certified electronic health record platform and our focus is on helping our enterprise clients and their employees have a healthier future we work with a a nice roster of blue chip global corporations government agencies hospitals and health systems and universities who operate their own on-site employee health clinics and provide employee health services to other organizations as well and when it became apparent early this year that kovid posed a very serious threat we started to work very collaboratively with our existing client community to respond and fortunately the enterprise health solution already included a really important set of building blocks to help our clients react so we already had pandemic response case management medical surveillance encounter documentation you know lab ordering and lab results delivery employee engagement so we were able to work as a community to rapidly configure this functionality to help our employer clients manage workforce health and safety in response to what was happening with covid19 and our clients began using our application to manage things like employee travel to monitor employee symptoms to handle testing programs to document things like work from home accommodations and after working and refining this with our existing client base over a couple of months we realized that that a lot of this capability would be really valuable to people who were not our clients so we acted actually packaged all of this up uh and launched channel 19 as a standalone application to help really any employer organization you know manage and monitor employees for cobit 19 systems and we've since developed channel 19 and deployed it in corporate university health system and government settings all across the united states and we're continuing to to you know refine and improve the application uh we continue to layer on new capabilities like telehealth and contact tracing and our clients have been able to successfully manage uh return to work uh and we're also uh using this application ourselves for our own employees when they work on site at our offices and what's happened most recently here just in the last couple of weeks is we started discussions with several of our clients to prepare for covid19 vaccination programs which is something that's certainly in the news a lot these days and again we're going to be able to modify our existing mass immunization functionality that that most of our clients use very frequently to manage uh employee flu vaccination programs but we're adjusting that existing functionality uh in support of covid 19 requirements i'm sure that um you know many of us feel like we've been hit by a covid19 tsunami over the last several months as this pandemic has really had an outsized impact on our lives on our organizations on the health and safety of our employee populations since early this year and we've rapidly figured out you know how to shut down how to dial back how to work remotely we've ramped up testing we've developed different strategies to return essential employees to work and keep them there and we've invested in technology to support all of these efforts and as many predicted uh what we've seen is sort of a shark teeth pattern of outbreaks followed by lulls followed by more outbreaks with different regions experiencing a different set of troughs and valleys and things are happening certainly in waves you know we see people embrace wearing masks then people stop wearing them then people start wearing them again we see people who have been really diligent early on about social distancing then they kind of let their guard down then they start to get diligent again you know we're seeing things like outbreaks that are tied to events ranging from you know big motorcycle rallies in sturgis to the resumption of classes at schools and universities and the impact of all these different waves can certainly be a challenge to wrap one's head around and changes that many of us thought would be temporary have been extended and in some cases are going to become permanent for example many organizations who were reluctant to consider remote work as an option are now really embracing it as a new way to operate and they recognize that in at least in some industry sectors that the benefits far outweigh the the drawbacks we're seeing that traditional colleges and universities where the educational mix you know usually favored in-person learning over online instruction uh that many of them are now conducting almost all of their classes online even for on-campus students and we've also seen hospitals and health systems have migrated in mass and very rapidly to telehealth as a viable care option and many expect that that will continue long after this pandemic ends so as all of this unfolds uh employers have implemented a wide variety of measures to protect their employee populations and most have continued to refine their approaches to deal with not only what's happening today but to anticipate that next set of waves that's coming our way and today we're fortunate to have a great panel that's going to share some of the innovative work that they've been doing in response to covid19 and in preparation for what might come next uh so so these surfers if you will have been riding some pretty gnarly waves and we're really excited to uh to hear what they have to say so leading off for us today is dr charles williams and dr williams is senior director for corporate health services at eli lilly and company and lily has been a long time client of ours they've been a great partner we've been collaborating closely with them since the start of this pandemic and lilly has been at the forefront of coven 19 testing efforts and now they're working on a new clinic concept that's really really exciting so uh let me turn it over to uh to dr williams and i will uh pull up your slides and advance them for you uh thanks jeff and at the mercy of everybody's eyes i'll go ahead and turn my video on for just a few moments while i go through the slides just to kind of make a little additional connection first of all thanks for enterprise to enterprise health for having us and asking us to participate in this uh it's it's uh an incredible opportunity really to kind of share some of the things that that we've been doing and i'm happy to be able to bring at least one of the unique kind of response initiatives that that we've we've put forward here at lilly indianapolis and our at our corporate headquarters and just for a summary for the the group on the call today um lilly in business for over 140 years um we've got as as jeff said we have a long-standing relationship with enterprise health with web chart um as our platform for documentation for our occupational and our non-occupational services that we provide our corporate headquarters is in indianapolis indiana we probably have a physical presence of about 75 different countries across the globe but the largest presence in one concerted location is in indianapolis indiana where we have a corporate headquarters and the main u. s manufacturing facility we have about 15 000 employees in the greater indianapolis area so when um covid19 hit um it was uh pretty significant and we've been uh really from uh the from day one we've been we've been uh earnestly engaged and what can we do to manage this uh pandemic that we knew was really coming we have about 4 000 employees in our china operations alone so we were really in it from the from the front i've been with the organization i'll be four years in november uh and uh tell people it's the best job i've ever had so um jeff if you'll go to the next slide when i when i joined lily um actually if if you can believe we actually had a life that existed before um uh the covid 19 and the sars cov2 virus you know we have two on-site medical clinics one in our corporate headquarters and then uh one in in indianapolis and then one in our main u.

s manufacturing facility that's about five miles away from the main corporate headquarters one of the things that i brought to senior leadership pretty early on was the risk that actually influenza brought to our population you know you can see some of the statistics this is actually 2018 2019 data that u. s employees missed over 17 million work days a year just due to influenza and it really had a impact of over 7 billion dollars in six sick days and lost labor not only that but um and that's just u. s numbers not only that but whenever a employee or a patient came into one of our clinics that was infected with influenza there was a potential exposure of my health care staff and the facility to that virus that could be potentially transmitted so i actually had conversations with our senior leadership very early on in my in my tenure here to talk about how can we enhance the infection control measures actually of the facility itself while we were doing the infection control measures from our employee and health care staff and really didn't get a whole lot of interest peaked because we dealt with influenza all the time well lo and behold then come the ends of december and january february march and and we've all been introduced to source cov2 and then the illness covered 19 the results from that and lo and behold there was a a new and refreshed interest and what can we do not only to protect our employees but to protect our facilities including our facilities that had to provide medical care for occupational and non-occupational needs for our on-site employees so a lot more interest in that and we were able to really kind of put forward a unique response initiative that i want to talk to you about so so so if you think about some of the kind of core problems that we addressed really because lily has the essential function really to produce and deliver life-saving medication kind of across the globe there was really the inability like many if not all of the people your operations in your organizations to really stop the operations we very early on moved a large majority of our non-essential people off campus in order to get appropriate social distancing and to follow a lot of the guidelines that were coming forward but we had to keep essential manufacturing operations open as well as we transitioned our clinical diagnostics laboratory into an infectious disease laboratory so that we could do primary reverse transcriptase pcr testing not only for lilly employees and contractors but for the general public and we were one of the first locations and we were the first location in the state of indiana to actually do a mass coveted collection drive-through that we maintained still to today and that actually ended up being a key facilitator for what we're going to talk about next so we really had the inability to stop those operations we had to keep people here at all times 24 7 in order to keep our operations going and we knew that because the illness would be come and has become endemic that we would have employees and contractors who would be presenting would be on campus asymptomatic but infected as well as those that would become symptomatic whenever they uh while they're on campus and at work and we knew that the process that we have is that those individuals would come to our employee health services clinics to seek care so we knew that there was an existing risk of exposing our facility itself the medical clinics we had itself to potential secondary contamination and we knew that there was uh a tremendous amount of limitations and early testing capability and that um there are continued uh limitations on access and then really turn around times for the tests that are being obtained so since our facility developed our own reverse transcriptase pcr testing and our own drive-through facility we were able to turn around samples that we collected in less than 24 hours which was a tremendous opportunity for us within employee health services to use our own capability to help evaluate our employees and contractors that were symptomatic and or at risk of potentially being exposed through testing the key was how do we do it we had really our two priorities really were employee safety and our ability to continue to produce and deliver life-saving medication and then really our third priority was to do the most we could for the general population as a whole so one of the things that any of you if you've had opportunities to be associated with a hospital system or you may have heard quite a bit about this especially early on is the hospitals that had the highest level of capability in the early response of the pandemic were those that had the ability to really isolate to identify and isolate individuals that had that a contagious disease that was spread through respiratory droplets and the use of their airborne infection isolation rooms this is actually kind of the adaptation of the link that you see below the cdc's website for the explanation of what an airborne isolation room is and that really you can think about that facility is an area where there's negative pressure that basically draws all the exhaust from from the exhalation of patients and takes that out and either disperses it out uh widely disperses out into the to the air ambient air outside or passes it through a hepa filtration a high efficiency particulate filtration system before it's recirculated back into the back into the building itself or into the room the key component is you want to keep someone that has a infectious disease that is transmitted through airborne particles you want to keep those particles get them out of the room and away from others so that they don't infect really anyone else so this is really a common mainstay and primarily developed with tuberculosis and one of the mitigation measures for tuberculosis most tertiary healthcare systems that are out there have facilities that are equipped with one or several airborne isolation infection rooms a lot of intensive care units will have those some hospitals have wards that each room is their own airborne isolation room itself some emergency departments will have one room that staff like that some may have several rooms but that really is the key to help do good infection control for somebody that may be infectious from a disease that's being spread from a respiratory path so what we did one of the things that we did at lily was to look and see is there ability for us to do essentially the same take and translate what how hospital systems maximize their ability to manage somebody with an airborne a transmitted infectious disease and incorporate that into our medical operations could we develop a facility or an area where there's negative pressure clinical space that's going to allow us to with the most certainty as possible pull that air out from that others are exhaling in that negative pressure environment and increase the level of kind of operational safety for our medical providers that would be an area where we could do all of our diagnostic testing as well as any other aerosol producing procedures like if we're doing pulmonary function testing and so forth we wanted the system to be part of our employee health services system so we wanted it to be tied into our enterprise health web chart so we could actually schedule patients in and those individuals really for our purposes would be individuals that were asymptomatic and they needed to be tested for one reason or another for instance our process that we have here at the corporate headquarters because we have easy access to testing our employees or contractors that have tested positive or are required to retest negative prior to returning to work so we're testing some individuals that will be asymptomatic by the atomic test as well as we're testing individuals that have mild to moderate symptoms obviously those people with more moderately and severe symptoms we're directing those to health care facilities the others are still using our drive-through testing we wanted a facility obviously that would be able to do all and continue to practice all of our other infectious disease control measures social distancing barrier precautions for droplets hand washing hand sanitization and all those other things we wanted that to be to be incorporated into it engineer facility that's as little touch as possible so you have very few handrails or door knobs and so forth that you have to manage and then we wanted to cite a facility that could be staffed easily by our staff and with the highest level of safety for them so we wanted an area that would have a clean side and then a side that was kind of an isolation site as well and so i'm happy to say we're able to kind of put all those principles together into one facility so i brought just a few photos of of what we've been able to develop at lilly we were able to identify a freestanding building that's a little over 2000 square feet that was being used for contractor training for new contractors coming on train them how to access the facility the facility is standalone and at ample parking uh we've uh and and we've taken this facility through a series of modifications to actually turn it into an airborne isolation testing facility uh exclusive for lilly employees and for for our needs so what you see here is kind of the front the front of the building itself in the parking lot itself where individuals will park there will be telephone numbers at the telephone number for the back desk that you can see kind of to the through the windows on the right hand side where individuals that will that if they're scheduled they'll they'll drive in they'll park they'll have in front of them the telephone number to call that rings to the front desk they verify their appointment their time and the car actually serves as their waiting room they do not there's no waiting area in the building itself so they'll receive directions on when to come in and how to access the facility from the front desk itself there's an intercom system in the lock the front doors are locked and so they where they'll do um verification um of who they are and what their time is and then whenever they enter the enter the building they go into this vestibule that you see here in the right hand side of the picture that door obviously the silver door and the in the in the distance will be closed but that is the kind of the beginning of their negative pressure isolation there there's another intercom system that's on the class wall that you see on the right and what you see the right is uh through the glass is kind of a clean area where the staff is once they're verified that they have the appointment we understand why they're there they'll be buzzed in and the door to the that's in the direct foreground will open and then you'll see in the left-hand side they would pass through the door you see on the left and then there's two airborne isolation rooms we don't have our um office equipment in there yet or the exam room equipment but we're gonna have two we're gonna have an exam chair in there that's gonna be appropriate for them to be evaluated for them to have um a code collection or sample testing or being given a vaccination perhaps all of those are negative pressure rooms and then and you see a kind of an image of one of those on the right hand side and then the outside of those rooms we have a bench top laboratory space area they have a designated restroom that's actually been converted into a restroom that we can do drug screens through so if we want to use this facility for for cause reasonable suspicion or pre-employment drug screens we can use it for that area for that purpose as well the picture below the one on the left is you you turn you're looking into kind of the clean area and what you see is you see that's the area where the staff will be that door again will be locked badge accessed by staff only there will be a donning and doffing station just to the immediate left of that door where personal protective equipment will be taken off after the interaction with the patient before the person before the staff member goes into the clean area in the side and then the picture on the right you can see is is the the staff area and then on the the glass door as you can see is that looking out kind of in the vestibule so this facility will be able to manage kind of three staff members comfortably at any time while maintaining social distancing with a clean side that is for the staff normal operations and the isolation side that has full visibility to the clean side um for patient care and so this is just a kind of a quick cause i thought it was kind of neat these are actually the the with the topic of the wave topic that uh enterprise health has for this this is actually the sensor controller that we have for opening and closing the doors is actually the wave sensor so i brought this slide just to kind of finish up well thank you dr williams a really interesting concept and i know you guys are uh at least as far as i know the the only client we have that is kind of you know this link to create a you know a space like this for your employees which is fantastic okay next up uh we have uh scott tucker and scott is the co-president of maple leaf farms and maple leaf farms is actually the largest producer of duck in north america and you can find their duck and chicken products and restaurants and retail operations all over the world now unlike most of our kovid 19 webinar presenters scott's actually not an occupational health expert but he's been thrust into kind of a unique position as he leads operations for his family-owned poultry company and i think most of us have probably seen a lot of news reports talking about how protecting workers from covet 19 and food processing has certainly been a challenge and i know that maple leaf moved very quickly and aggressively to invest in workplace health and safety and they're using our channel 19 application to track employee symptoms and to start to manage contact tracing full disclosure i will say i am a member of the maple leaf farms board of directors so in the last couple of meetings i've learned about how the company is responding to the pandemic and so i really wanted to to get scott an opportunity on one of our webinars to share what they're doing uh with a with a wider audience so with that i will turn it over to scott and scott let me bring up your slides here super jeff thank you very much and good afternoon everyone really appreciate this opportunity to uh talk to you about maple leaf farms and our response to uh this horrific pandemic that we've uh we find ourselves in um just a little quick overview of maple leaf jeff was nice enough to mention a number of these points who are a fourth generation family-owned poultry processor again we're the largest fully integrated processor of duct in north america as well as we further process chicken into a number of delicious products one of the other benefits of growing duck is you get some wonderful by-products off of that mainly down and feathers that we use in the manufacture of bedding products uh that you might find at places like uh crate barrel or in the comforter you buy from casper we are also one of four primary breeders of duck in the world which essentially means that uh we've developed our duck genetics and we sell it to other gut processors uh value its performance we have a thousand employees worldwide and we are headquartered in northern indiana so just to share a little bit about our uh code 19 journey you know in march and april we certainly were in a discovery mode you know as a critical infrastructure business we would designated that along with obviously lots of other food processing uh companies we're very fortunate to remain in operation uh but given that um you know we we just continued our operations we had to move very very quickly in terms of understanding uh what this virus was about um we certainly didn't know a lot about it obviously cdc guidelines were changing rapidly we attended webinars and industry meetings uh pretty much ad nauseam to learn as much as possible and all of that was first and foremost trying to protect our workforce um as we learned more about cobia 19 we began to establish written policies and procedures as well as a coven 19 playbook which established written guidance for mitigation and compliance one of the other things that we did very early on which i think really helped our entity and certainly our relationships in the community is cultivating a relationship with our local health department officials this helped with the perception of maple leaf with that health department i think especially early on when there were a lot of questions about the impact of the virus within the poultry industry there were a lot of reports and certainly at processors much larger than maple leaf farms of you know hundreds of people succumbing to the virus we wanted to get out in front of that you know share what we were doing with health officials to protect uh our workers and i think that really helped develop a lot of confidence in the systems that we were working on also helped provide us with ongoing updates and information that were really vital to establishing and updating our ongoing protocols so the protocols that we establish follow cdc and osha guidelines and have from the outset really fall into four categories engineering controls sanitizing and disinfecting cobia 19 controls and administrative control so let me describe a little bit what we instituted within each of those categories um as as jeff mentioned i'm in charge of our operations areas so i'm really focusing really on on all of those areas in this presentation where we have the vast majority of our employee base [Music] and the first thing we did from an engineering control standpoint is establish physical barriers in all of our operations areas and and given the integrated nature of our business we really had to look at a lot of different areas we have a number of operations including hatcheries feed mills but the area that really required the most diligent work was in our processing plan and the pictures you see here on the screen are really highlighting what we did in those processes as you can kind of see our processing lines were really never set up to provide the six foot distance between employees as has been suggested by the cdc so in the areas where that six-foot threshold could not be met we had to develop and erect physical barriers such as strip curtains you'll see that kind of in the uh the lower left hand picture as well as disposable barriers which you'll see in the other two pictures that were really critical to ensuring social distancing between employee physicians as well we had to ensure that employees were protected through their break periods they obviously spend a significant amount of time at lunch or on breaks and we need to make sure they were safe during those times so we had to erect physical barriers in a variety of places in those types of common areas including at lunch tables and hand washing stations as you'll see pictured here we also had to look at all the touch points within those commons areas for potential cross-contamination which led to us installing touch-free dispensers for a lot of common items things such as coffee and water of all things things that you might not think of otherwise but uh could be a vector for the virus at the absolute outset of of this pandemic we quickly moved to try to add hand sanitizing stations which at first were in very very short supply as you see pictured here we initially had to just put jug dispensers seemingly everywhere until more you know touch-free dispensers were more readily available which we now utilize we also had to physically think about how employees clock in and clock out um you know during their shifts and if that could be a vector for uh spreading the virus and this resulted in the installation of additional time clocks in a variety of places finally we had to take a really hard look at our hvac and ventilation systems and while we've not gone the route of hepa filtration yet in the case of what lily has done we certainly increase the velocity of air exchange within our facilities we have to be very careful in terms of that velocity and in terms of the differences in negative and positive pressure as it could impact the actual uh product itself and so we have to absolutely make make sure that it doesn't impact food safety or quality of that product so in terms of sanitizing and disinfecting and while we continue to perform mandated cleaning and sanitizing on our plant boards daily by usda requirements we have significantly increase the frequency of cleaning in commons and welfare areas we actually have employees assigned within all of our facilities provide sanitizing of frequently touched surfaces they do it every two hours and before in between breaks for our employees we also are performing deeper disinfecting and misting of commons areas between shifts daily with usda approved sanitized so in terms of cobed 19 controls uh we have had to quickly install areas for employee screening and additional break room space um because we essentially did not have enough break room space to begin with to ensure that six feet of social distancing um so while as you see in these pictures the screening and the break rooms are in the same space they are physically separated now the screening that we do every day includes temperature taking as well as a system assessment questionnaire for every employee of our processing campus and every single employee whether they work in the process and facility or not goes through these particular screening areas now there's a lot of debate and question about the efficacy of temperature taking uh that certainly can be questioned and as we found out can be very difficult when you have colder weather conditions outside and as we had to get started very quickly inside of a tent as you see there on the left-hand side picture thermometers don't always work very well when it's cold outside and you don't have the tech heated enough so we had to do a lot of scrambling to make sure that was adequate so that we had adequate assessments of people coming into our facility but we really felt very strong it was one more line of defense we could take to prevent a facility spread of this horrible virus um you know to conduct this screening obviously right now we're utilizing these rented tents but we hope to eliminate these colder weather issues uh in in our screening by moving to modular units that will be installed here before the colder weather sets in additional cova 19 controls next we implemented an employee training program which we developed in-house was specific to mapley farms there's a powerpoint with voiceovers in english spanish and burmese we have populations of all of those speakers in our operations and through that we've provided facts related to cova 19 how to protect yourself and others and certainly what maple leaf is doing to protect its team members to try to uh give them a sense of the things we're trying to do to protect and support all importance we also developed control program audits to ensure that we continue in compliance with cdc and osha guidelines the cdc facilities checklist audits are done monthly and we utilize the guidance that's issued by cdc and osha specific to meat and poultry processing facilities and is specific to the following controls the ability to maintain social distancing promote hand hygiene identifying and excluding sick workers from working providing education training and communication as i just mentioned cleaning sanitation disinfection providing ppe and face appropriate and evaluating and maintaining appropriate ventilation internal as well we also do random uh verification audits um to ensure that that six foot spacing is being maintained where people are passed uh properly physical barriers and face shields are in place signage and floor marketing are being maintained and uh certainly hand sanitized very important it's in place and being used consistently as well as the common areas being sanitized on a regular basis finally in terms of the administrative controls as i've already mentioned we perform screening prior to entry we also provide visual cues as reminders to maintain social discipline on floors of time clocks in a variety of other areas uh you know it can get congested within some of these break room areas and it's important to maintain those cues as well as we're also forced to adjust our start and break times reduce density within our break room and commons area also as no surprise we implemented a mandatory base covering policy and maple leaf certainly provides mass as needed to all employees as well as in jobs that are not stationary on the production floor and the six foot social distance room cannot instantly maintain maple it provides face shields to those positioned in addition to the wearing of the mask obviously part of our controls involves continually discussing personal hygiene among our workers unfortunately we've had several of our workforce contract the cobed virus and although none have had serious consequences from the illness we're very fortunate for that and given that we have had no traceable spread of the virus within our facilities unfortunately our employees have contracted the virus outside of the workspace so in trying to understand the spread and do the contact tracing most of the employees that have been exposed were either living in communal living arrangements or been participating in car pools to get to work so as you can see it's been really critical for us to educate our employees about the dangers of whether it's communal living or particularly the carpooling aspect of it um finally we we've certainly maintained a very liberal policy of asking employees to stay home if they exhibit any symptoms of coved whatsoever we are strictly following cdc guidelines in this regard and typically seeing poise out 10 to 14 days when they're symptomatic or in some cases asymptomatic on paid leave so from an employee tracking and tracing perspective we are evolving as a company early on we participated in in several webinars including the channel 19 wanted to understand how best to manage tracking and tracing at the time in april uh that we did some of those we weren't having a lot of cases and keeping track of everything on a spreadsheet really seemed to be working unfortunately later we understood how overwhelming spreadsheet tracking could be and begin the implementation process channel 19 with enterprise health we now have a streamlined system that only tracks encounters but provides much needed reporting and we are now working with the team at enterprise health to establish contact tracing contact tracing through the system as well now we were really impressed with enterprise health's system and giving their strong systems background in the health care field with patient care their software is making it much easier to track employee issues for occupational nurses as well and their contract tracing module will eliminate another spreadsheet or form based process for us also and it's a lot going to allow us to quickly see if we have workplace exposure or spread of the virus this is something that we've had to manually track today and it's very very time consuming it'll be very nice to provide a more automated documentation to support the fact that we haven't experienced workplace or exposure or spread here at maple leaf so we're appreciate appreciative of enterprise health and their partnership and the support they're bringing to our operations uh during what has been a very very challenging time so thank you very much uh jeff i'll end it back to you okay great thank you scott and last but certainly not least uh is um leticia hesh matt and leticia is director of employee and occupational health at a company called mobilemed and we first started working with leticia many many years ago when she was managing the occupational health program at stanford university and while she was doing that she actually led the selection of enterprise health as their employee health electronic medical records solution and after a few years as a client leticia actually joined our firm in a sales role uh on the west coast of the united states and after doing that for about three years just a few months ago leticia decided to leave our firm and she joined mobilemed and they're an innovative company that provides occupational and employee health services to other employers on an outsourced basis so uh is is once again a client and in the last few months we've worked together to deploy channel 19 to help uh several california state agencies uh manage covet 19 symptom monitoring and testing efforts so latisha i will turn it over to you and let me pull your slides up thank you and i know i need to be cognizant of time as well so i'll try and keep things brief good morning everyone on the west coast and good afternoon to everyone on the east coast um pleasure to be having a conversation with you here this morning and talking to you a little bit about what enterprise health asked me to share this morning which is what we're seeing in the workplace what employers what steps employers are taking um and kind of what trends are that we're seeing what employers are doing with regards to their covid response and how they're riding the wave so just to share a little bit with you about mobilemed and what our core competencies are we're an on-site occupational health provider we specialize in employee health programs for employers of all sizes we're currently working with a large array of institutions and sizes of employers we have some manufacturing uh food manufacturing companies as well as some larger product manufacturing companies we're working with software companies um some construction as well on site we've been working with some of the largest amusement parks in the united states we're on site at several international airports and we're working with some government agencies as well so you can imagine what the varied number of employers that we're working with the needs are very different as well originally we were a west coast-based company that quickly gained a national presence with covin and we're actually opening some of our software companies have a global presence that we work with and have asked and incorporated our services to the reopening of all of their sites as they look to reopen at the end of 2020 here and the beginning of 2021 so we actually are opening um our first clinic in estonia next month which is very exciting and employers are making both national and international introductions as far as clinics go in their reopening process so we create customized programs and they can be delivered everything from intense which is some ways that we had to deploy very quickly for employers who needed to have rapid testing done via mobile vans we work within employers buildings we do on-site and nearsight clinics as well so not all employers have a place for a large on-site elaborate clinic and so we're able to meet the needs and pivot with the employee to see what types of services they may need and provide that so um to highlight some of the measures that employers are taking um for covid safety in the workplace you know a self-attestation at home before coming to work is definitely something that employers are looking at they've implemented either through their hr solution or through their clinical ehr and so doing a screening at work at home before coming to work is something that a lot of employers will do we also very commonly see questionnaires upon site entry so we are actually placed on at some locations um that where they need to do attendance screening and make sure that there have been questionnaires answered prior to entering the building and some do that and actually monitor and others will just go ahead and do a verbal or an oral questionnaire before entering the site here we are at one of our construction sites actually and that's the one of our attendance screenings at one of the major international airports um so temperature monitoring programs as you've heard from our previous panelists temperature monitoring programs are something that a lot of employers are implementing and if you have multiple entry points to your building if you have a large volume of employees some employers are opting to utilize their services for thermographic imaging and you see a picture of one of our thermographic imaging cameras here you can actually incorporate questionnaires or have someone asking the questions while they utilize the thermographic imaging cameras to see if they post a temperature prior to entry as well so we have a lot of employers that are doing that as an additional layer so here's a few of our employees at a local hospital california depending on the region that you're at mandates are very different as well as what industry you're in california in particular for all health care workers as well as skilled nursing facilities needed mandated antibody testing or mandated pcr testing we also offer antibody testing depending on what the employer would like but there's a wide variety of employers that are doing either baseline testing for surveillance whether that be weekly monthly post exposure testing and some employers that are offering to do it as a wellness screening for return to work or just a nicety for employees to feel more comfortable if they'd like to have testing they can have testing available on site so we see pcr is the most common is the gold standard but there are employers that prefer the rapid antibody testing on site as well and surface testing something that we also have employers that are asking for and we've partnered with a surface testing company um to see if their janitorial is doing the um the cleaning up to par like they'd like to have it done making sure their sanitization practices are working and they do randomize surface testing to see if they're having any cross contamination or if there's any surfaces that may be um contaminated in the workplace so that they can up or better their cleaning protocols in the workplace one thing that we very commonly see are employers that implement a temperature monitoring program or work with their hr system and implement screening questions and they feel like they're they're taking this layered approach and they're doing the parts that they need to but early on while implementing all of these screening protocols or safety layers in the workplace um some forget to really have a protocol in place and handle what what do we do when they're an employee test positive so we have this temperature screening protocol we haven't had a positive now all of a sudden we do and how are we going to handle that so while employers are definitely getting ahead of that being that we work with employers of all sizes and not everyone has a robust program like for example um dr williams in the lilly program some employers put in these safety measures and didn't have an established protocol for really what they're going to do when they do have a positive and how that positive may present itself and what the various options are that can protect them so having established protocols in place are really important have those protocols reviewed by an occupational health provider an infectious disease provider using the cdc and osha has guidelines as well and making sure you have all of the preparation that you need for when you do have a positive what's going to happen typically if we have temperature monitors on site testers or screeners on site will provide ppe immediately if someone just post the temperature and assist them in escorting them out of the building or out of the tented area that we may be working in so definitely making sure you have a protocol how to handle it making sure you have ppe on hand and making sure they're wearing that ppe if they're around anyone and they do post a positive for whatever that screening measure may be and then making sure you have return to work best practices as well so we have them leave the building we have them off work but are you following a symptomatic approach to return to work are you following a testing approach to return to work and how you can help with those return to work clearances or things that we're helping employers with as well and then the last part that employers also will kind of believe as kind of a last resort is now we're getting these data similar to what um mr tucker said we were on you know spreadsheets for a while and that's something that we hear very often a lot of employers will try to manage it through their hr system or with spreadsheets and very quickly realize as this is didn't go away in a month or two and is not going away for the foreseeable future we need a way that's sustainable that we can record and report this data some of our international airports are having audits done by the various counties and cities that they're located in how are you able to really record all of that data in an organized manner and have these audits be in compliance for these audits and have an organized reporting measure for you so that's really important and as maple leaf farms did and my with my previous experience at stanford and working with enterprise health we also chose to utilize the channel 19 platform for all of our data for employers that we're working with and we've utilized channel 19 to make sure that we have all of that data in one place so how do we do so you can include your symptom monitoring and self-attestation through the solution and then i'll just check you can screen through quite quickly here on this last one you can put your testing results so really important that your results are not only kept but that you're able to communicate them and you're able to pull reporting from them as well so we have a interface with our national lab all of our test results are through that lab the patients can see their data on the patient portal they're able to actually access their their test results through the portal were able to communicate a work status to the supervisor to hr with regards to their testing and their return to work dates and anticipated dates around that and also do contact tracing and any follow up with the employees so the most important is to have a plan have a team it really does take a village and if you don't have an on-site occupational health clinic per se have resources and professionals that can help you with that and help you organize the solution so those are some of the things that we're seeing in the workplace currently it's definitely i've been quoted in saying it's a layered approach it's like a day in san francisco and needing to layer your clothes on you have to do depending on the region depending on your industry your volume you're going to have to take a layered approach to safety in the workplace that's going to work for your for your exposure in the workplace and luckily with enterprise health and the group here you've got a lot of resources to pull from so thanks for allowing me to speak today great thank you very much letitia and yeah thanks to thanks to all of our presenters uh this is this has been fantastic some um you know really interesting things that you're you're doing and and dealing with um so what we'd like to do now is uh and and i'm going to ask ashley ross from uh from bri to to help me out here too uh what we want to do is facilitate some q a with the group uh and and i would remind you that uh you can pose questions using the chat feature uh in webex uh and we'll you know we'll get to as many of your of your questions as we can and i know we prepared some questions as well um so uh you know ashley do you want to maybe maybe start us off with a couple of questions absolutely jeff thank you so much and thank you again to our speakers i think we're going to go back to uh dr williams so lily is not only a pharma company but it has a long standing reputation for an employee-focused culture can you comment on how your involvement in life sciences and health care as well as that culture has influenced your response to this pandemic well that's a great question you know it's been it's been huge you know so lily has had employed health services not only does um you know lily as a pharmaceutical company that i mean we really see ourselves as a healthcare company and organization so really you know at the core of our foundation is care custody and service to others in the health care field so that translates also to the caring company that we take for our for our own employees lily has had employed health care providers on staff since 1916.

so we have a long storied history of providing care and services so coming in as the the medical director for our corporate health services has really kind of been a huge opportunity to to not only translate you know what we can do from an occupational health perspective and uh in a you know acute care and minor primary care health perspective for our employee population but really to invest in what the company's mission is as far as helping to care for others external to lilly so one of the things in my role in my organization has been able to do is we are touching essentially every other organization in the company that have had involvement in helping with the pandemic response plan from consultation with our group and provision of supplies and services to the pyd which is the new monoclonal antibody that is finishing its phase 3 trial work now to delivering the you know my organization does contact tracing and uh positive notification as well as symptom surveillance for all of our employee and contractor personnel so really you know it's been an incredible opportunity to focus internally on our employees as well as to participate in early as a component to the covid19 response initiative that the company has globally um and it really is just been an incredible opportunity great thank you dr williams we do have a question from janet that just came in how are companies leveraging their eap suppliers as part of the overall strategy i i would be happy to kind of go first with that so we've seen a so we have a corporate contract for domestically and i'll talk about in the u. s we have um for our u. you