Field Report: UCLA Health with Michael Pfeffer, MD

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Bill Russell / Michael Pfeffer, MD

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June 12, 2020: The one silver-lining of the COVID-19 pandemic is that it’s accelerated our use of tech in healthcare — a process that many health IT specialists have been working towards since long before the pandemic. In this episode, Bill talks with Dr. Michael Pfeffer, Assistant Vice-Chancellor and CIO for UCLA Health who provides insights into how his organization has dealt with the pandemic. Michael discusses the efforts that UCLA underwent to prepare for the pandemic and how they scaled their telehealth offerings to cater not only for COVID-19 inpatients but also for those with chronic conditions and patients needing preventative care. While health systems are faced with decreased revenue and uncertainty about the future, Michael shares his thoughts on why health IT is needed now more than ever. Michael talks about what health IT should prioritize within this context, especially as we move from the COVID-19 crisis into a potential financial crisis — a landscape in which health IT will be even more critical in ensuring an organization’s success. Michael and Bill then talk about the future of remote work, the need for a vaccine to create a proper roadmap of the future and how UCLA is preparing for a second surge of coronavirus patients. Finally, Michael shares his greatest learning from the pandemic which emphasizes how a relaxation of rules has resulted in an expansion of telehealth. 

Key Points From This Episode:

  • How medical schools are implementing a number of online features in light of the pandemic.
  • To address the pandemic, UCLA first prepared for patient surges.  
  • UCLA’s use of telehealth to cater for patients. 
  • Michael talks about how organizations had been scaling towards telehealth pre-COVID-19.
  • From chatbots to remote patient monitoring, why COVID-19 accelerated tech in medicine. 
  • How UCLA adapted their remote-work model; now all IT work is done remotely. 
  • Why a COVID-19 vaccine is critical to determining future plans. 
  • Michael’s view on health IT’s focus; consolidate and eliminate redundancy and costs. 
  • The increased importance of health IT in enabling a health system’s success. 
  • UCLA’s efforts to keep their patients and caregivers safe. 
  • How Michael has prepared UCLA to deal with a second surge of COVID-19 patients. 
  • Michael shares the lessons that he learned from the pandemic. 
  • The importance of providing both telehealth and in-person services. 

Field Report: UCLA Medical Center

Episode 265: Transcript – June 12, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:04] BR: Welcome to This Week in Health It News where we amplify great thinking to propel heath care forward. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT, a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. 

Well, we have a special request here. The programming team at This Week in Health IT would like to highlight solutions that deliver hard dollar savings to healthcare in under 12 months. This is in direct response to comments we’re hearing on the show, as well as comments I’m hearing in my consulting practice. We want to see what kind of response we get from you guys and then we will determine how we’re going to get this integrated into our programming and get it out there. Send in your responses, [email protected]. Love to hear from you. Love to hear what you guys are doing that is showing hard dollar savings, real money savings for healthcare. 

This episode and every episode since we started the COVID-19 series has been sponsored by Sirius Healthcare. They reached out to me to see how we might partner during this time, and that’s how we’ve been able to produce daily shows. It’s just a special thanks to Sirius for supporting the show’s efforts during the crisis. Now, on to today’s show. 

[0:01:35] BR: All right. This morning, we are joined by Dr. Mike Pfeffer, the CIO for UCLA Medical Center. Good morning, Mike. Welcome to the show. 

[0:01:46] MP: Thank you so much, Bill. It’s great being back since our last discussion. 

[0:01:51] BR: Our last discussion and face-to-face, in person at a conference. I look forward to doing that again sometime. I’m not sure when that’s going to happen. By the way, thank you for taking the time. I know this is a extremely busy time for everybody. So thanks for taking the time to join me. 

[0:02:11] MP: Yeah, my pleasure. This is an exciting day actually at UCLA because it’s our medical school graduation and it will be all virtual. So first time ever virtually and a big shout out to the IT organization, especially in the AV department and our content team for being able to put this together. Yeah, it’s a new world when you’re doing medical school graduations virtually. 

[0:02:41] BR: Yeah. How are you making it special? I mean, what does it look – I’m just more curious than anything. 

[0:02:48] MP: Yeah. Well, it’s really about making sure the graduates feel that this is a special time for them and a lot of work has gone into graphics and how we’re going to present the different speakers and then acknowledging each one of the graduates, having their names read. Then kind of taking that and taking the graduates’ kind of responses to the graduation and putting all that together. Yes, it’s different. We’ll see how it goes. But overall, I’m really excited that we’re able to provide something for them because it’s truly an extraordinary achievement to graduate medical school. 

[0:03:34] BR: Yeah. I mean, to graduate from UCLA Medical School, that’s an amazing deal. I know that my daughter goes to Baylor. She’s a freshman at Baylor and she got a survey and she was telling us about it last night. Then I as a parent got a survey today, and it’s really extensive. I mean, because they’re talking about coming back to campus in the fall and they talk about do you want to or how do you feel about a 14-day quarantine when you come in, how do you feel about staying the whole semester instead of coming home for Thanksgiving and those kind of things. If you do go home at Thanksgiving, how do you feel about taking the remainder of your course online? How do you feel about taking classes on a Saturday?

I mean, this is really a new world we’re living in where you have to think through a lot of things that we didn’t think about before. It’s amazing, isn’t it?

[0:04:23] MP: It is amazing. It really is. 

[0:04:25] BR: All right. Well, let’s jump into – I’d love to hear what’s going on there. Give us an idea of how the health system experienced the pandemic thus far. 

[0:04:34] MP: Sure. UCLA Health basically did what a lot of other organizations like ours did, and that was get ready for a potential surge. That means making sure we have capacity in our facilities. Making sure we have the appropriate equipment for our providers like protective equipment, ventilators for patients that need it, and then all the ability for us to provide care to people virtually. Because COVID doesn’t negate everybody’s chronic medical conditions that need care or preventative care measures, so we need to make sure that we can provide all that the best we can. So really ramping up a virtual video visits. We went from 400 a month to 80,000 in the month of April. That’s somewhat of a significant increase but it really allows our physicians to connect with our patients, and that’s really, really important. A lot of work on just ensuring that we’re ready, we’re prepared, that we’re doing research on the topic. All that’s kind of still going on. 

[0:05:50] BR: That’s amazing. I want to focus on a handful of those topics that you just brought up, because we’ve seen amazing gains as you noted in telehealth and a lot of different modalities in really other digital tools as well. Remote patient monitoring, chat bots, and other things have been sort of inserted into the process. How do you think that stuff is going to be integrated into our post-pandemic work models?

[0:06:19] MP: Yeah. I think all of this was going to happen, and the pandemic accelerated it completely. People asked me, “Well, how could you go from 400 video visits to 80,000 video visits? How do you have that ability to do that?” I usually say that we’ve been preparing for this as an IT organization for years, right? We’ve put in all the infrastructure. We’ve put in all the processes. We’ve tested. We were ready to scale. Obviously, we weren’t prepared, thinking maybe scaling at that rate but we were really ready for this. Sure enough, we were able to scale at that rate. 

Again, I think all of these things that we’ve put in place is real expansion of telehealth, chatbots on websites, online scheduling, all of those things were coming if not already here in some aspects. I think it’s just an acceleration of the digital patient experience and I’m very, very excited about where it’s going to go. 

[0:07:32] BR: Yeah. It’s interesting that you say we’ve been preparing for this for a long time. We really have. I mean, it’s – We’ve been talking about telehealth and its ability to really improve access, quality satisfaction for a long time. Talk about work from home a little bit. How have you experienced work from home and what do you anticipate the future will be for your specific health system?

[0:08:01] MP: Yeah. The IT organization actually began a remote work or telework about five years ago, and that really had to do with the fact that traffic in Los Angeles could make a five-mile commute into an hour and a half. So to have a balance for the employees in IT to be able to do the detailed work they need to do, as well as maintain relationships, we had a hybrid model. You would either – Depending on your role in our organization, you would work three days a week from home and two days a week in the office work or four and one or – Yeah, four and one. We did have some parts of our organization that didn’t, so desktop support, for example. Our call center actually was all in house as well. We call that customer care. 

We’ve been doing a lot of this for a while and we really came up with a model. I think that worked pretty well. It’s not perfect, but the idea that you would schedule for your week, not your day. I think a lot of people look at their daily schedule and they say, “Okay, this is what I have to do today. I’m going to go do it.” But we’ve really tried to encourage. Look at your week and the reason why that’s important is the days that you are at home are the days that you’re really kind of have the ability to dive deep into technical or complex tasks. The days you’re in the office are really for relationship building, key meetings with your business owners. Thinking about it as a week instead of a day I think has been really instrumental.

Now, in COVID, we’ve gone to kind of what we’re referring to as fully remote with on-premise as needed. If you need to come in and do something, whether it’s in the hospital or in one of the clinics, something is broken, we need to be on site for something, there’s a key area, then you come in for that particular thing. But otherwise right now, the IT organization is working fully remote. 

[0:10:19] BR: Post-pandemic, do you think you’ll go back to the four and one or the three and two model? Or do you think that will change at all or do you think you’ll just go back to that? 

[0:10:34] MP: Yeah. That’s a good question. We’re working through that and actually kind of the way we’ve been thinking through this is getting everybody in the IT organization to weigh in. We actually had a work stream. We asked about 10 people to get together and think through what is it going to look like in the future. Then taking that product of work, we’ve been allowed, the entire IT organization, to comment, read it, and give us their suggestions. Our plan is we’re working through that. We’re coordinating with UCLA Health as a whole because we need to also comply with what the organization is going to do. Then we’re looking at what’s going on in LA County with the virus as well. So kind of bringing all those things together will determine what we look like. In the meantime, we’re going to be staying remote until mid-September and then we’ll see what happens. 

I think a vaccine is going to be critical to really understanding what the future is going to look like. I was just reading a recent study that suggested that immunity may not be as long as we think, and so that’s another challenge when you’re looking at if you get COVID, are you immune to it forever or for a while, and the answer may be no. That’s going to significantly change how we think about this as well. 

[0:12:07] BR: Yeah, we’re figuring things out really as we go and we’re getting new information all the time. It’s really interesting. We’ll blow the illusion of the podcast here. Today is May 29th, and the reason I give you the date is I sort of want to snapshot in time of your priorities. What are the priorities of health IT today and have they changed significantly since January 1st or do you think they’ll change significantly towards the end of this year?

[0:12:36] MP: Well, I think there’s going to be some change. I won’t necessarily say significantly in terms of what we need to provide to the organization; always stability, reliability, outstanding customer service, and support. Those things are just paramount to what we do. I think we’re really going to have to look at our portfolios and see what is really necessary, what can be consolidated, what different platforms we can bring together, are we duplicating things, and really look to as best as we can reduce some of our costs around our purchase services, at the same time providing what the organization needs. 

In this challenging time, I think all health systems are grappling with decreased revenue and uncertainty into the future. But at the same time, needs IT more than ever, right? So health IT is even more critical than it’s ever been I think in enabling the organization to be successful. It’s going to be that balance. We want to be good stewards of the resources that we are really blessed to have. But at the same time, every dollar that’s spent on health IT is a dollar not spent on medical education, medical research, and patient care, right? It’s really focused on – I’ll call it strategic finance in health IT. 

[0:14:13] BR: It’s interesting. We have interviewed a bunch people. A former CFO for UPMC was on, and we did talk about this that we’re really exiting one crisis, which is the pandemic, and we’re entering for some health systems, which is another crisis, which is a financial one. Nothing is more important at that point than the automation and the capabilities that IT really brings to bear, and I think that’s what you’re speaking to. 

We are seeing signs that [inaudible 0:14:43] is growing, which means volumes are starting to pick up. That seems be across the country. What kinds of things is your health system doing as you expand procedures maybe from a safety standpoint or new systems that you’ve put in place from an IT perspective around safety?

[0:15:05] MP: Yes. I can’t prove this but I will say that going to a hospital or having a procedure is probably safer than going to your grocery store, because we do everything we can to ensure that our people are safe. We’ve have an automated symptom tracker that we built that every day prompts our employees to see if they have any symptoms. We have temperature checking for all employees and visitors and patients coming into our facilities. But I really think our main message and goal is really to encourage people who need to have medical care to come in.

As an example, for elective surgeries, the word elective is always a challenge because people need their surgeries. Maybe it’s not an emergency but you can only put these things off for so long. We’re doing COVID testing two days prior to the surgery for all of our patients, so we can ensure that our patients are not concerned that they have it and they’re asymptomatic or our providers that are taking care of them. 

That I think has been really successful. But all in all, UCLA Health is practicing state-of-the-art hygiene and cleaning and use of protective equipment to make sure that we are as safe as possible for our patients. 

[0:16:45] BR: Yeah, absolutely. From a health IT standpoint, how are you planning for a second surge? Have you implemented any technologies that will help you to respond quicker if there happens to be a surge [inaudible 0:17:04]?

[0:17:06] MP: Yes. I’ll break it into three areas. One is analytics. We built out an incredible amount of analytics on COVID-19 patient flow. All the things that we need to very closely track, how things are going on in our health system and the community as we do all of our testing, so we can see all this information. In fact, the UCLA Health COVID testing is actually – We have a dashboard that’s public off the UCLA Health website, so you can see how many tests we’ve done. We actually had that pretty much in the very beginning, but you can see how many patients are currently hospitalized at our facilities and positive and negative in total testing. It’s actually really interesting. So really robust analytics that are helping us determine kind of where we’re going and being able to predict. 

The second is our structural kind of design of our electronic health record to enable what we call shadow beds, so we can quickly expand the amount of beds we have in our facilities if we need to. A lot of work went into building out that infrastructure beyond what we already have. We had some of it in place but we went really beyond that. 

Then the third thing is really about continuing to ramp up our telehealth capabilities. One thing we’ve done which I think is really amazing for our patients is we have inpatient iPads for basically every patient. On those are not only access to the electronic health record, but also they have a Zoom platform and an account assigned to the room, so they can actually video with their families, as well as providers. So providers can actually video into the rooms and allows us to check in much more frequently as needed. 

Kind of all of those technologies in terms of telehealth and expanding our digital patient experiences is what we’re doing to ensure we’re ready for any future surge. 

[0:19:19] BR: Sort of the silver lining of this is that all the digital health initiatives we’ve been talking about the last five years were so accelerated with the times. It’s really amazing to hear all the places you guys have integrated. What do you consider the greatest learning at this point from the experience thus far?

[0:19:39] MP: I think one is and maybe it’s not learning but I knew this kind of all along that how amazing my team is here at UCLA, both the organization and operations and financing. All of our groups coming together in a line around this pandemic, as well as, of course, the health IT organization and the dedication. It’s truly incredible. So maybe not a learning but just a reaffirmation of that. 

I think one of the things that is interesting to me about all of this is how impactful rules that are imposed upon health systems can limit technological growth. For example, take telehealth. One of the struggles that all of us have been having is how do you interpret all the different rules across all the different insurers, all the different states, CMS on who can have telehealth visits, video visits, who can’t? With the relaxation of some of those rules and the movement that telehealth or video visits are equally reimbursed compared to an in-person visit has been game-changing and has allowed us to expand this in a really rapid way.

My hope is that we continue to learn from that and not put these rules in place that really limit how we can take care of our patients in the best way. Had none of those rules been relaxed, I think a lot of organizations would have been in a very difficult situation in terms of expanding their kind of video visit capability and most importantly caring for patients that needed it during this pandemic. To me, that was I think really, really interesting and just seem like how quickly everybody was able to expand when these rules went away. 

[0:21:43] BR: Yeah. I think that’s really true. I mean, the stories are amazing, right? I mean, you gave your numbers, and we hear people say we went from a hundred to a thousand or now it’s like tenfold, like a hundred to 10,000. This time last year, we did this many. This year, we’re doing 10,000 and we’ve seen that across the board. It really is amazing. It’s the funding and then it’s the rules. Those are the two things that really just really blew open the doors for telehealth that’s been interesting to watch. 

[0:22:16] MP: I think the next steps are really going to be going back to our researchers to look at what is truly the best use of telehealth. There are absolutely needs for in-person visits, whether it’s from a relationship standpoint and getting to know your primary care physician to having the primary care physician or other specialists be able to do an exam, to procedural. There’s reasons why you need to come in and there are great reasons why you don’t, and that a video visit would be a great way to perform the visit. 

One physician commented to me that you can learn so much about a patient when they let you into their home, right? Other family members can be there that normally wouldn’t have been there. I mean, there’s really incredible benefits, and we need to have a very evidence-based approach on when is the best time to use video visits and when is the best time to come in person. But I think the synergy of those things is really going to be defined healthcare going forward, and I’m really, really excited about that.

[0:23:23] BR: Well, Mike, thanks for your time. I really appreciate you coming in. By the way, you win the award for the best background. Unbelievable. 

[0:23:29] MP: Thank you. 

[0:23:30] BR: I will get that.  

[0:23:30] MP: I appreciate that. 

[0:23:32] BR: [inaudible 0:23:32]. All right, we’ll catch up again in the fall. Take care. 

[0:23:37] BR: That’s all for this week. Special thanks to our sponsors, VMware, Starbridge Advisors, Galen Healthcare, Health Lyrics, Sirius Healthcare, and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders. If you want to support the fastest growing podcast in the health IT spaces, most of you can see this now without me even finishing it. The best way to do that is to share it with a peer. Stop right now. Send an email. Tell somebody, “Hey, this is a great show. I’m getting a lot out of it. You’re going to want to check out these interviews and conversations.”

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Please check back often as we’re going to continue to drop shows on a daily basis through the end of June or until we get through this pandemic together. Thanks for listening. That’s all for now.