New Hyde Park, N.Y.-based Northwell Health spent years proving that firearm injury risk screening could become a routine part of clinical care before its approach was integrated into Epic and made available to health systems nationwide.
The firearm safety screening tool was included in Epic’s May 2026 software release, allowing health systems using the EHR platform to incorporate Northwell’s firearm injury risk screening approach and prevention interventions into existing clinical workflows.
But the work began years earlier.
“It all started in 2019 when we, as a large health system, decided to prioritize taking on gun violence as a public health issue,” Chethan Sathya, MD, director of Northwell’s Center for Gun Violence Prevention and a pediatric trauma surgeon, told Becker’s.
Northwell launched its NIH-funded “We Ask Everyone” research initiative in 2020 to study how firearm injury prevention screening could be implemented at scale. Since then, the health system has screened more than 200,000 patients across its network, according to Dr. Sathya.
While evidence supporting firearm injury prevention interventions has existed for decades, healthcare adoption has lagged, he said.
“We’ve known for decades that screening for firearm injury risk, whether I’m talking about asking about access to a gun and then providing safe storage counseling and gun locks, or providing violence intervention resources, has a lot of evidence backing it up,” Dr. Sathya said. “The only problem is that a minority of healthcare workers in the country ever talk to patients about gun injury risk.”
Northwell’s focus became less about creating new screening questions and more about figuring out how to operationalize them within clinical workflows.
“A big part of this was actually just implementing questions that we already know work — implementation science,” Dr. Sathya said.
Over the last several years, Northwell studied how to integrate firearm injury risk questions into routine care alongside other screenings for mental health, substance use and social determinants of health. The research found clinicians could successfully incorporate the conversations into patient encounters when supported by training and workflow design.
“We were able to demonstrate that if you do this the right way, and it’s integrated in the EHR, it can become part of our routine practice,” Dr. Sathya said. “We can move the needle forward on actually having physicians, social workers and others understand that this is like any other question that you would ask.”
The health system also found concerns about patient pushback were largely unfounded.
“More than 99% of our conversations with families are very positive,” Dr. Sathya said. “Patients not wanting to answer the questions is rare.”
One of the biggest lessons from the initiative was the importance of EHR integration.
“One of the key barriers to hospitals and clinicians using screening tools is EHR integration,” Dr. Sathya said. “Time is precious. You don’t want another screening question, so things have to be highly efficient.”
Without EHR integration, screening programs can be difficult to implement, document and scale, he said.
“If you don’t have screening questions already working through the EHR, it’s very difficult to implement new programs around screening,” Dr. Sathya said. “If you can streamline that process, like what Epic has done, it just makes that lift 10 times easier.”
The partnership with Epic emerged after Dr. Sathya connected with Epic founder and CEO Judy Faulkner during a panel discussion focused on firearm injury prevention.
“That’s where the Epic concept came from,” he said. “I was introduced to Judy Faulkner on a panel that I had participated in on this topic, and it’s been wonderful working on this along with a number of other hospitals.”
The screening tool evaluates both firearm access and community violence risk. Depending on responses, clinicians can provide firearm safety counseling, distribute gun locks, connect patients to violence intervention programs and document interventions within the EHR.
Epic has also published a white paper outlining Northwell’s screening methodology and implementation guidance for health systems interested in launching firearm injury prevention programs.
Now that the tool is available through Epic, which serves a large share of U.S. hospitals and health systems, Dr. Sathya sees an opportunity to expand adoption nationally.
“One day I would hope that asking questions about gun violence risk and offering preventive interventions becomes no different than how everyone asks questions about mental health risk now,” Dr. Sathya said. “That used to be stigmatized. Substance use used to be stigmatized. But now it’s part of a routine visit. I think this is a big step forward in making this a routine part of annual care.”
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