In May 2022, Healthcare IT News published a story looking at how Northwell Health's pandemic experience made the case for robust occupational health IT. Northwell Health, New York's largest health system, had achieved great success with this form of IT in addressing pandemic-era needs.

In this interview with Dana Flitsch, director of product services and management for human resources technology at Northwell Health, we revisit the massive health system's occupational health IT efforts nine months later to see how it's evolving the technology.

Q. Where were you last May? What did the Enterprise Health technology do for you?

A. Last May, we were beginning to see the light at the end of the COVID pandemic tunnel, but we were not out of the woods yet. Our employee health team is responsible for taking care of the physicians, nurses, and other medical professionals and staff members who in turn take care of our patients.

On September 2, 2022, the COVID Bivalent Booster vaccination was approved for people aged 12 years and older. Challenges were addressed to offer the COVID Bivalent Booster vaccination along with Flu vaccinations to a workforce of greater than 80,000.

Enterprise Health is the occupational and employee health technology that has helped our team manage employee health during the pandemic. Northwell expects our digital infrastructure to support our innovative position.

Enterprise Health helped us be the first health system to administer a COVID vaccine in the United States. They rapidly configured their software to document COVID vaccine injections, and one of our nurses received the first shot.

That same solution enabled us to track vaccine compliance across our entire employee population, and to provide electronic data transmission to both the state and city vaccine registries.

We were also able to use the technology to manage daily symptom monitoring across our employee population. Using an employee portal and a mobile app, employees were prompted to electronically self-report before every shift – enabling us to use technology to quickly identify who was authorized to work and who needed medical intervention.

Also configured was direct transmission of COVID and flu lab test results performed throughout the health system. Team members could be tested at any location, with the results sent back to Employee Health Services for evaluation.

With more than 80,000 associates as well as a large contingent of volunteers, contractors, students and other populations, the technology enabled our employee health team to provide top-notch care and guidance.

I know many hospitals tried to manage their way through COVID using spreadsheets or applications ill-suited to the task, whereas we were able to harness technology to provide best-in-class services.

Q. What have you been doing with the technology since May? How have things been going? Are staff members happy with what they can do?

A. Our work with the vendor started during COVID, and in 2022 we began to layer on the additional occupational and employee health functionality available in its solution. We are taking a phased approach to deployment, and the vendor is working with our team to configure its solution to support our unique use cases and workflows.

This is a delicate balancing act, as we are sticking as close to their standard solution as possible while allowing for Northwell-specific configuration where appropriate. We are proceeding methodically, as in some cases we are adjusting some of our processes to align with best practices Enterprise Health has put in place for other health system clients, and in other cases they are enhancing their standard based on our input.

We are working together extremely well as one extended team, and our “forged in fire” experiences during the intense early days of COVID have helped us develop a collaborative work style that is very effective. We also value the fact that our suggestions for improvement more often than not end up on their product road map, and progress can be measured in weeks and months, rather than years.

We have also been working on an innovative approach to consolidating multiple population data feeds from Northwell to the vendor. When we started working together during COVID, we had to quickly establish interfaces with multiple sources of population data at Northwell – including our primary HR system, as well as applications used to manage volunteers, students, contractors and other populations.

All of these feeds required that we establish complex logic to manage the disparate population information coming into Enterprise Health. We have worked closely to build a single data feed that is consolidated at Northwell, and that feed has been built to a set of specifications best suited to the vendor.

As our technology teams have collaborated for several years now, they are able to explore ways to simplify the inherent complexity found in a large health system like Northwell.

Q. What is an example of a success you've had with the technology between May 2022 and today?

A. One of our successes since we last spoke is the management of tuberculosis screening. For years, Northwell complied with the CDC’s TB screening, testing and treatment guidelines for healthcare personnel by having all of our 80,000-plus staff members present at one of our employee health clinics annually for routine TB testing – an expensive, labor-intensive process that took a significant amount of time for our employees and our employee health team.

While CDC guidelines for TB testing were simplified in 2019, we were finally able to focus on improving our approach last year as COVID subsided to a more manageable level. New guidelines no longer require personnel without a latent TB infection, known TB exposure or evidence of ongoing TB transmission to undergo annual TB testing at any interval after the baseline test.

However, healthcare facilities are still required to educate all personnel annually about TB, assess risk factors, signs and symptoms and encourage personnel to discuss any potential TB exposure with their primary care provider and occupational health clinician.

We worked with Enterprise Health to configure and deploy a workflow that automatically schedules employees to complete a health assessment and TB questionnaire annually.

The solution sends notifications and reminder emails to prompt employees to complete the questionnaire on the employee portal, tasks the appropriate clinic with follow-up to clarify and/or schedule appropriate testing when warranted, and sends automated final panel status emails to employees when the written opinion has been completed.

This new approach has eliminated literally tens of thousands of annual clinic visits by automating the flow of information and helping us easily identify those employees who require further testing and monitoring. The majority of the workforce can now continue focusing on patient care, rather than going through clinical evaluation screening processes that can involve multiple clinic visits.

Q. What is another example of a success you've had with the technology between May 2022 and today?

A. As I pointed out, we pride ourselves on staying ahead of the curve. When we began hearing of a monkeypox (or Mpox) outbreak, it quickly became clear that our area was among the hardest hit geographies in the United States.

We immediately huddled with Enterprise Health and developed a game plan for responding to this emerging crisis in our area. We were able to work together to modify existing vendor workflows, and we were able to go live with an initial solution in a matter of a few weeks.

Exposed Northwell employees are manually enrolled in an Mpox exposure program and notified to take a twice-daily symptom survey on the employee portal. The symptom survey contains logic that will automatically ‘clear’ or ‘not clear’ team members.

Any team members who are not cleared are tasked to the appropriate employee health clinic for further evaluation. The clinic then uses the solution’s case management encounter to track the exposure, document any clinical data and the date the team member can be released from monitoring and un-enrolled from the exposure program.

The technology also can manage vaccine administration.

Q. What are your plans for using the technology this year? What challenges are you going to tackle next?

A. We are continuing to deploy the Enterprise Health solution in phases, and during each phase we are collaborating closely to enhance their standard solution.

One of our major areas of focus currently is the use of technology to improve talent acquisition. In today’s challenging workforce environment, it is critical to streamline the pre-employment medical clearance process and demonstrate to potential employees that Northwell works hard to create a great employee experience.

The vendor's technology includes an applicant portal to automate scheduling and the completion of pre-employment medical questionnaires, and the core solution is designed to enhance and speed up pre-placement exams, testing and clearance.

We are challenging the vendor to configure solutions for both our standard employee population, as well as contractors, students, volunteers and other divergent populations.

We are also working with the vendor to further enhance their approach to the case management of exposures to make it easier to manage not only the source patient, but others who may have been exposed to that source patient.

This is part of a broader initiative to better integrate our employee health and workforce safety operations, with technology integration playing a critical role to minimize repetitive data entry and encourage the appropriate sharing of relevant information to improve our working environment and the health of our employees.

I have no doubt that we will continue to challenge the Enterprise Health team to push the boundaries of their solution, and we have developed a working relationship that supports continual innovation and an agile response to whatever comes our way.

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Email the writer: bsiwicki@himss.org
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