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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. 

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

 Welcome to this week in Health It where we amplify great thinking to Propel Healthcare 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 some, a special request here, the programming team at this weekend Health.

It would like to highlight solutions that deliver hard dollar savings to healthcare in under 12 months. This is in direct response to, uh, comments we're hearing on the show, as well as comments I'm hearing in my consulting practice. Uh, before you drop me an email, I. I need solutions that have successful client stories.

I receive about 10 emails a week from companies that wanna highlight their product on the show. And my first question is always put me in touch with a reference client. And, uh, amazingly about 90% of those requests fall away, which I find really interesting. Um, we wanna see what kinda response we get from you guys and then we will, uh, determine how we're going to.

You know, get this integrated into our programming and get it out there. So, uh, you know, send in your responses, bill at this week in health Love to hear from you. Love to hear what you guys are doing. That is showing hard dollar savings, uh, real money savings for healthcare. Uh, this episode and every episode since we started the C Ovid 19 series has been sponsored by Sirius Healthcare.

Uh, 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. Uh, and you know, it's just a special thanks to Sirius for supporting the show's efforts during the crisis. Now onto today's show. All right. This morning we are joined by, uh, Mike Effer.

Uh, Dr. Mike Effer, the CIO for UCLA medic, uh, UCLA Medical Center. Good morning, Mike. Welcome to the show. Thank you so much. Uh, bill, it's, uh, great being back. Um, since our last discussion Yeah, our last discussion in, in face-to-face in person at a conference. Um, I, I look forward to doing that again. Uh, sometime.

I'm not sure when that's gonna, when that's gonna happen, but. Um, and, and by the way, thank you for taking the time. I know this is a, uh, extremely busy time for everybody, so thanks. Thanks for taking the time to join me. Yeah, my pleasure. Um, this is an exciting day actually at UCLA because it's our medical school graduation and it will be all virtual.

So first, first time ever, virtually, and, uh, big shout out to. The IT organization, especially the AV department and our, uh, content team, uh, for being able to put this together. Um, so yeah, it's a new, it's a new world when you're doing medical school graduations virtually. Yeah. What, um, how are you making it special?

I mean, what does it, what does it look? I'm just more curious than anything. Yeah. Well, it's, it's, um, 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 gonna present the different, um, speakers and then acknowledging, uh, each one of the graduates having their names read and then kind of.

Taking that and taking the graduates kind of responses to, you know, the graduation and putting all that together. Um, so yeah, it's, it's, it's different. We'll, we'll see how it goes, but overall, I'm really excited that we're. Something for them. 'cause it's truly an extraordinary, uh, achievement to graduate medical school.

Yeah, absolutely. I mean, graduate from UCLA medical school, that's, that's an amazing, uh, deal. I, I know that, uh, you know, my daughter goes to Baylor. She's a freshman at Baylor, and, uh, she got a survey and she was telling us about it last night. And then I as a parent got a survey today. And it's really extensive.

I mean, 'cause they're talking about coming back to campus in the fall and they, they talk about, you know, uh, you know, 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. Uh, you know, 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 Mm-Hmm. think about before. It's amazing.

Mm-Hmm. . It is amazing. It really is. All right. Well, let's, let's, let's jump into, I, I, I'd love to hear what's going on there. Give us an idea of how the health system experienced the pandemic, uh, thus far. Sure. So, uh, UCLA Health, um, basically did what a lot of other organizations, uh, like ours did, and that was get ready for potential surge.

So that means, you know, making sure we have capacity in our facilities, making sure we have the appropriate equipment, uh. For our providers, like, uh, protective equipment ventilators for, for patients that need it. Um, and then all the ability for us to provide care to people virtually because Covid doesn't negate everybody's, uh, chronic medical conditions that need care.

Uh, or preventative care measures. So we need to make sure that we can provide all that the best we can. So really ramping up our virtual, uh, video visits. We went from. 400 a month to 80,000 in the month of April. So that's a somewhat of a significant increase, but it really allows our, our physicians to connect with our patients.

Um, and that's really, really important. So, you know, a lot of work on just ensuring that we're ready, we're prepared that we're doing research on the topic. Um, and so all that's, uh, kind of still going on. That's amazing. So I, I'm gonna, I'm gonna focus in on a handful of those topics that you just brought up.

Um, you know, 'cause we've, we've seen amazing gains as you, as you noted in telehealth, uh, and a lot of different modalities. Um, you know, and, and 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 gonna be integrated, uh, into our post pandemic work models?

Yeah, I think, um, I think all of this, uh, was going to happen and the pandemic accelerated it, uh, completely. And so, you know, people ask me, well, how could you go from four, 400 video visits to 80,000 video visits? So how, how do you. Have that ability to, to do that. And I, and I usually say that, you know, 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. Um, we've tested, we've, we were ready to scale. Obviously we weren't preparing, you know, thinking we'd be scaling at that rate, but we were really ready for this. And, um. Sure enough, we were able to, you know, scale at that rate. And again, I think all of these things that we've put in place, you know, real expansion of telehealth, I.

Chatbots on, on websites, um, online scheduling, all of those things, um, were coming, if not already here in some, some aspects. So I, I think it's just an acceleration of the digital patient experience and I'm very, very excited about where it's gonna go. Yeah. It's interesting that you say, we've been preparing for this for a long time.

We really, we really have. I mean, it's telehealth. To, uh, you know, really improve access, uh, quality satisfaction for a long time. Mm-Hmm, . Mm-Hmm. . Um, talk about, talk about work from home a little bit. So, um, you know, how, how have you experienced work from home and what do you anticipate the future will be for your specific health system?

Yeah, so the IT organization actually began, uh, remote work or, or telework about five years ago and. That really had to do with the fact that, um, traffic in Los Angeles, uh, could make a five mile commute into an hour and a half. And so to have a balance for the employees in it to be able to do the detailed work they need to do, um, as well as maintain relationships.

We had a hybrid model, so 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, or four in one. Um, or, uh, yeah, four or one. Four in one. Um, we did have some parts of our organization that didn't, so desktop support, for example, our, our call center actually was, was all in-house as well.

We call that customer care. Um, so we, 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. You know, I think a lot of people look at their daily schedule and they say, okay, this is what I have to do today and I'm gonna go, 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, uh, technical or, or complex, um, tasks. And the, the days are in the office are really for relationship building, key meetings with your business owners.

Um, and so think of thinking about it as a week instead of a day, I think has been really instrumental. Now in, in Covid, uh, we've gone to kind of what we're referring to as, um. Fully remote with on-premise as needed. So if you need to come in and do something, whether it's in the hospital or in one of the clinics, something's 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, uh, the organization, the IT organization is working, uh, fully remote. So do you think you're post pandemic? You think you're, you're, you'll go back to the, the four and one or the, the three and two model, or uh, do you, do you think that will change at all or do you think you'll uh, just go back to that?

Yeah, it'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. So we actually had a, a, a work stream. So we, we asked about 10 people to get together and think through what is it gonna look like in the future.

And then taking that product of work, we then allowed the entire IT organization to comment. Read it and give us their suggestions. And so our plan is, we are working through that. Um, we're coordinating with, uh, UCLA health as a whole, right? Because we need to also comply with what the organization is gonna do, and then we're looking at what's going on in LA County with the, the virus as well.

So kind of bringing all those things together will determine what we look like. In the meantime, we're gonna be staying remote until, uh, mid-September. Um, and then we'll, we'll, we'll see what happens. I think a vaccine is gonna be critical to really understanding what the future is gonna look like. And I was just reading, uh, a recent, uh, study, um, that suggested that immunity may not be as long as we think.

And so that's another challenge when you're looking at, um, you know. If you get Covid, are you immune to it forever or for a while? And the answer may be no. So that's gonna significantly change how we think about this. We're, we're figuring things out, uh, really as we go and we're getting new information all the time.

It's, it's really interesting. So today is, you know, we'll blow the illusion of the podcast here today is May 29th, and the reason I give you the date is I, I, I sort of wanna snapshot in time of, you know, your, your priorities. So what are the priorities of health it today? And, and, you know, have they, have they changed significantly since January 1st, or do you think they'll change significantly towards the end of this year?

Well, I think there's gonna be some change. I wouldn't necessarily say significantly in terms of, uh, you know, what we need to provide to the organization. You know, always stability, um, reliability, uh, uh, at outstanding customer service and support. Those things are, are just paramount to what we do. I, I think we're really gonna have to look at our portfolios and see what, um, is really necessary, what can be consolidated, what different platforms we can bring together.

Are we duplicating things? Um. Really look to, as best as we can, reduce some of our costs around, uh, our purchase services, um, at the same time providing what the organization needs. So in this challenging time, I think all health systems are grappling with, you know, decreased revenue and uncertainty into the future, um, but at the same time needs it more than ever.

Right. So health, it is even more critical, um, than it's ever been, I think, in, in enabling the organization to be successful. So it's gonna be that balance. We wanna be good stewards of the resources that we are, um, you know, really blessed to have. But at the same time, every dollar that's spent on health it right is a dollar not spent on medical education.

Medical research, and patient care. Right. So, so it's really focused on, you know, I, I, I'll call it strategic finance. In, in health. It, you know, it's interesting. We, we have interviewed a bunch of people and, uh, CFO, former CFO for UPMC was on, and we, we did talk about this, that we're really exiting, you know, one crisis, which is the pandemic and we're entering for some health systems, which, which is another crisis, which is a financial one.

And, and 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. Uh mm-Hmm. We're seeing signs that, you know, claims data is growing, uh, which means volumes are starting to tick up. That seems to be across the, uh, across the country.

Uh, what kinds of things is your health system doing as you procedures? Or, or, or new systems that you've put in place from an IT perspective, uh, around safety. Yeah. So, you know, I, I, you know, and I, 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, right?

Because we do everything we can to ensure that, um, our people are safe. So we, we have an automated symptom tracker that we built. That every day, uh, uh, prompts our employees to, uh, see if they have any symptoms. We have, uh, temperature checking, uh, for all, uh, employees and visitors and patients coming into our facilities.

Um, but I, you know, I, I really think, um, our main message and goal is really to encourage people who need to have medical care to. Um, as an example for, for elective surgeries and, uh, the word elective is always a challenge because, you know, people need their surgeries. Maybe it's not an emergency, but, um, you can only put these things off for so long.

We're doing, uh, test covid testing, uh, two days prior to the surgery. For all of our patients. So, um, we can, uh, ensure that our patients are not, uh, concerned that they have it and they're asymptomatic or, uh, our providers that are taking care of them. So, um, that I, I think, has been really successful. But all in all, I, you know.

UCLA health is practicing state-of-the-art, you know, uh, hygiene and cleaning and, and, uh, use of protective equipment to make sure that we are as safe as possible for our patients. Yeah, absolutely. So how, how has, from a, from a health IT standpoint, um, how are you planning for, uh, a second search? Have you implemented any.

Technologies that will help you to, um, respond quicker if there happens to be a, a late, uh, you know, a surge, uh, analytic. Yeah, so I'll break it into three areas. So one is analytics. So we built out an incredible amount of analytics. On c Ovid 19 Patient Flow, um, all the things that we need to very closely track, uh, how things are going on in our health system and the community as we do all of our testing.

Um, so we can see all this information. In fact, the, uh, UCLA health CO testing, uh, is actually, uh, 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 in pretty much in the very beginning. Uh, but you can see how many patients are currently hospitalized at our facilities and, uh, positive and negative in total testing.

So it's actually really interesting. So really robust analytics that are helping us, uh, determine kind of where we're going and, and being able to predict. The second is, uh, our, uh, structural kind of design of our electronic health record to enable, uh, what we're, what we call shadow beds so we can quickly expand the amount of, uh, beds we have in our facilities to, uh, if we, if we need to.

Um, so that a lot of work went into, uh, building out, uh, that, uh, infrastructure beyond what we already had. We had some of it in place, but we went, um. Uh, really beyond that. And then the third thing is, is, 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, uh, we've have impatient, uh, iPads for basically every patient.

And on those are not only access to the electronic health record, but also, uh, they have, uh, a Zoom platform. And an account assigned to the room so they can actually, uh, video with, uh, their families as well as providers. So providers can actually video into the rooms and allows us to check in, uh, much more frequently as needed.

So kind of all of those technologies in terms of, uh, telehealth and expanding our digital patient experiences is what, uh, we're doing to ensure we're ready for any, uh, future search. Yeah. Sort of the silver lining of this is that all the digital health initiatives we've been talking about for the last five years have were so accelerated over that time.

It's, it's really amazing to hear all the, all the places you guys have integrated. What, what do you consider the, the, the greatest learning at this point? Uh, from the, from the experience thus far,

I think. You know, one is, and maybe it's not learning, but I knew this kind of all along, that how amazing, uh, my team is here at UCLA, um, both the organization, uh, and operations and finance and all of our groups coming together and align around. This pandemic as well as of course, the health it organization, the dedication, it's, it's truly incredible.

So maybe not a learning, but just a reaffirmation of of, of that. Um, 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. So, 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, and with.

The relaxation of some of those rules and the, uh, movement that telehealth or video visits are equally reimbursed compared to an in-person visit has been game changing and has, has allowed us to expand this, um, in, in a really rapid way. And so 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've been in, in a very difficult situation in terms of expanding their, uh, video visit capability and most importantly, caring for patients that needed it, uh, during this pandemic.

So to me, that was, uh, I think really, really interesting. Um, and, and, and just seeing like how, how quickly everybody was able to expand when these rules went away. Yeah, I think that's really true. I mean, the stories are amazing, right? I mean, you gave, you gave your numbers and we hear people say, you know, we went from a hundred to a thousand, or, no, it's like tenfold, like a hundred to 10,000.

In, in, uh, you know, this time last year we did this many in a week. This, this, this year we're doing 10,000, uh, across the.

Just mm-Hmm. really blew open the doors for telehealth. It's been interesting to watch and I think, you know, the next steps are really gonna be going back to our, uh, 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 specialist be able to do an exam.

To procedural, to, you know, there's, 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. Uh, the, the visit one, 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. So I mean, there's, there's really incredible benefits and we need to have a very evidence-based approach on when is the best time to use tele, uh, uh, video visits and when is the best time to come in person. But I think the synergy of those things is really gonna be define.

Healthcare going forward, and I'm really, really excited about that. Well, Mike, thanks for your time. I really appreciate you, uh, coming, by the way, you win the award for the best background. Unbelievable. Thank you. I'm good. I appreciate that . Well done. All right, well, we'll, we'll catch up again in the fall.

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