Northwell Health, New York's largest health system, was frustrated with the limited capabilities of its existing occupational and employee health IT, and was forced to develop work-around processes to overcome technology deficits.

THE PROBLEM

In order to manage both employee health and the provision of services to other employer clients, the health system was using a combination of different vendor and homegrown technologies. There was little integration between these applications and approaches. Information was in silos, and significant manual effort was required.

"We conducted a comprehensive vendor evaluation including demos, an RFP, reference checks and a review of proposals," said Dimitry Trembitsky, senior director of product services and management for information services.

"As we completed the evaluation process and selected the Enterprise Health technology, the COVID pandemic struck and we had to immediately pivot our focus to COVID response – both for our own employees and in support of our employer clients."

PROPOSAL

Northwell Health turned to Enterprise Health and asked if it could set deployment of the vendor's full technology to the side and instead deploy COVID-specific functionality. With more than 78,000 associates along with volunteers, contractors and other stakeholders, Northwell needed a technology that could scale to its large footprint, could be configured and deployed at lightning speed, and would be flexible enough to support the organization during a rapidly changing and uncertain period of time.

This was mission critical, as the occupational health team was responsible for taking care of the Northwell employees who were in turn taking care of COVID patients.

"Enterprise Health spent the first few months of the pandemic working with their client base to rapidly configure existing functionality to support COVID-specific use cases and workflows," Trembitsky recalled. 

"Fortunately, they had an existing pandemic response module, which they were able to quickly adapt, and they also modified existing functionality, including employee portals, case management, reporting, lab ordering and results, and mass immunizations.

"They packaged this COVID-specific functionality up as an offering called Channel-19, and enabled us to start with this as an initial phase," he continued. "Initially, our primary need was around employee symptom-monitoring. We needed to rapidly set up an employee portal enabling employees to report on COVID symptom status prior to starting each shift, and to clear employees for work based on responses."

"We were able to set up feeds from not only the Northwell PeopleSoft HR system, but from multiple other systems we use to track volunteers, students and other nontraditional populations common to health systems."

Dimitry Trembitsky, Northwell Health

For clients with symptoms, Northwell needed to be able to restrict them from work and trigger case management protocols to track them until clearance could be granted for return to work.

MEETING THE CHALLENGE

Enterprise Health was able to work with Northwell Health to quickly set up an employee portal for symptom monitoring, as well as a clinical application that enabled the employee health team to conduct case management for symptomatic or exposed employees.

"As part of this effort, we were able to set up feeds from not only the Northwell PeopleSoft HR system, but from multiple other systems we use to track volunteers, students and other nontraditional populations common to health systems," Trembitsky explained. 

"We also were able to integrate with Northwell's Kronos system so that employees were notified to complete symptom monitoring only before their scheduled shifts."

The health system also set up single sign-on to enable the employee population to log into the employee portal easily.

"Early on, we threw Enterprise Health a curveball, and asked if they could also help us manage our annual flu program," Trembitsky noted. "The solution we were using was not up to the task and would have required significant custom development in the midst of a pandemic – and our preference was to manage both COVID and flu vaccinations out of one system. Enterprise Health was very accommodating, and we added this as a second, parallel phase to our COVID project.

"In addition, it quickly became apparent that the COVID pandemic was fast-moving, constantly evolving, and would last far longer than initially hoped for," he added. 

"We quickly moved from symptom monitoring and case management, and worked with the vendor to configure their solution to support new COVID testing modalities, the emergence of variants, the availability of vaccines and vaccine mandates."

The pandemic and the guidelines imposed by various government agencies created an ever-changing set of requirements, and Northwell needed the vendor to remain agile and adept as it navigated this new territory.

"For example, when COVID vaccines became available, Northwell and Enterprise Health collaborated to rapidly reconfigure their existing mass-immunization capability to support employee COVID vaccinations – including the management of multiple vaccines with differing dosage requirements and establishing interfaces with state and city immunization registries," Trembitsky said.

"Northwell was an early leader in getting this set up, and we have been able to continue to modify workflows to support boosters, vaccine mandates, and the various regulatory and policy twists and turns we have faced," he added.

The employee vaccination program was so successful the health system was able to modify the workflow to support the administration of COVID vaccines to non-employee populations like first responders and other emergency workers. Northwell was designated as a site to support these populations, in large part based on its early success with employee populations and its ability to integrate with and collaborate with immunization registries.

RESULTS

Northwell was able to manage employee symptom-monitoring very effectively over the course of the pandemic. Employees are notified prior to reporting to work that they need to complete a symptom-monitoring questionnaire, and they immediately receive a cleared/not cleared electronic badge after they submit their response.

The employee health team is notified of employees who are not cleared, and they are able to case-manage symptomatic or positive employees out of the Enterprise Health technology. This saved us from an unmanageable mountain of manual effort. In addition, Northwell was able to generate reports showing compliance and symptom status, giving it real-time visibility into the status of the workforce.

"When it became apparent that COVID vaccines were in development, Northwell began collaborating early with Enterprise Health to be ready for vaccine administration," Trembitsky recalled.

"Due to this advance preparation and our combined ability to anticipate vaccine complexity – multiple manufacturers, varying dose requirements, etc. – and to quickly establish interfaces with both the New York City and New York state immunization registries, we were able to administer the first vaccine in the U.S. to a Northwell nurse," he said.

This generated significant national and international press coverage, and the image of a Northwell Health employee in front of the Northwell logo was ubiquitous. This reinforced Northwell's position as a leader in the health system space. It also demonstrated the commitment to the health and wellbeing of the employee population.

"We also collaborated with the vendor on developing and launching a mobile app to handle employee symptom-monitoring," Trembitsky said. "This mobile app replicates the functionality in our employee portal, and works on iOS and Android platforms.

"The vendor's technology automatically generated email and text reminders to our employee population before each shift," he continued. "However, we realized that sending text message reminders to tens of thousands of employees each day was cost prohibitive."

Even given volume discounts given the size of Northwell's population, it would cost the health system more than a half million dollars annually in text-message fees. With the mobile app in place, Enterprise Health can generate app push notifications. This all but eliminates texting fees for Northwell and for its employees.

The vendor's technology also gives Northwell the ability to confidently manage vaccine mandate compliance. Northwell can document vaccine administration in the vendor system and capture proof of vaccination for employees who have been vaccinated elsewhere.

The health system also can generate reports that show vaccine mandate compliance, enabling it to stay in line with the mandate for healthcare workers.

"Based on the results achieved, we were able to cement the business case to Northwell management that we needed to invest in deploying the full Enterprise Health solution," Trembitsky said. "The pandemic underscored the critical importance of a present, productive and healthy workforce and the need for a strong underlying digital infrastructure to support occupational and employee health initiatives.

"Our collaboration with the vendor and our ability to navigate the pandemic aided us in justifying the investment in a more comprehensive solution," he added.

ADVICE FOR OTHERS

"While I would not recommend waiting for another pandemic before you consider investing in this kind of technology, my thoughts on what to consider when making decisions about occupational and employee health solutions is informed by our experience over the last two years," Trembitsky said.

"I would advise my colleagues at other health systems to consider the following when evaluating potential partners:

"Agility. COVID made it abundantly clear that health systems need technology partners who can respond rapidly and creatively to support client requirements, use cases and workflows. While the feverish pace imposed by COVID will subside, agility has become a business imperative.

"Collaboration. This pandemic has been stressful for anyone involved in occupational/employee health. It has been especially trying for health systems, as the occupational health team is responsible for managing the health of those who take care of patients with COVID. Northwell now fully appreciates the importance of working with technology vendors who can demonstrate empathy, flexibility and understanding, and are willing to roll up their sleeves and work with the health system side by side. Be on the lookout for partners who can help you figure out what to do when faced with an ambiguous and ever-changing situation.

"Comprehensive functionality. Health systems need technology with occupational and employee health depth and breadth. It is not practical to manage employee health using multiple commercial applications, spreadsheets, homegrown databases and even paper. Health systems need technology that can handle a wide range of occupational and employee health needs on a single platform, including the ability to manage both your own employees and third-party client programs with one system.

"Interoperability. A strong solution will be able to integrate with HR systems, timekeeping applications, labs, immunization registries, email applications, medical devices and patient-facing electronic health record systems. In order to improve employee health, it is important to eliminate data silos and harmonize all employee health data on one platform.

"Employee engagement. One of the unanticipated outcomes of the COVID pandemic is the 'great resignation,' which has been felt acutely in the health system space. It is more important than ever to build workforce trust, and technology that engages employees and makes it easy for them to share and access information helps to demonstrate commitment.

"Future investment. When evaluating technologies, consider more than the initial price, and account for downstream benefits, such as the ability to retire multiple applications [and] approaches, the aggregation of employee health data on one platform, expected productivity [and] efficiency gains, and the value of improved employee engagement."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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