When the COVID-19 pandemic hit, Michael Pfeffer, MD, assistant vice chancellor and CIO of UCLA Health, and his team developed data reports and EHR updates for testing, workflow changes and remote work support. Now, they are focused on the technologies to succeed in the digital health world.
For example, the health system is developing new ways to engage with patients digitally through the patient portal and improving telehealth visits.
"One of the most important things is to make sure our patients feel comfortable and continue to seek care for chronic conditions or other issues that can't be put off during the pandemic," said Dr. Pfeffer. "All health systems saw a significant decrease in patient visits when the pandemic began but that doesn't mean ongoing medical conditions went away. We want to use technology to connect providers and patients so they can continue to care for patients' chronic conditions in a combination of telehealth and in-person visits."
The IT team must be agile and align with the rest of the organization to remove technology-related roadblocks and streamline processes. UCLA Health changed the approvals, workflow design, testing and implementation process for new ideas to accelerate execution. The IT team aligned with the rest of the organization to make that happen.
"We went from 400 telehealth visits per month to more than 60,000. To enable that many new providers and workflows, and engage our patients as quickly as we did, we needed everyone in the entire organization working together," said Dr. Pfeffer. "The IT organization has been preparing for the telehealth transition, knowing virtual care would be a significant part of healthcare in the future. All of the infrastructure, workflows and training were in place, enabling us to scale the technologies in close partnership with our operations colleagues to roll it out."
The health system is working to define the appropriate balance between in-person and virtual visits, and Dr. Pfeffer sees the need for both going forward. The health system is collecting information to identify when it's appropriate to conduct video versus in-person visits and anticipates there will be additional research on where telehealth is most beneficial for patients.
There are also advantages for physicians and nurses in the telehealth interactions because they can develop a deeper relationship with patients. During virtual visits, the clinicians can see the patient's home and environment; they can build trust with that person and learn about their different family members and pets.
"You get a privileged window inside their home and can see a different side of the patient’s life," said Dr. Pfeffer. "We know that social determinants of health play a critical role in health outcomes, but often are hard to capture fully with in-office visits. But now I have a lot of physicians commenting to me about how they are able to connect with patients on a different level with video visits and better obtain this key information."
With the increased investment in telehealth and remote care, there is also a need to pay more attention to the digital patient experience. Dr. Pfeffer and his team are working to give patients a 360-degree view of the health system with digital offerings. They are now able to schedule visits for themselves, communicate with care teams and providers, and engage in both telehealth and in-person visits. In addition, the expansion of inpatient video visits and the digital needs for hospitalized patients are critical in light of the pandemic, allowing patients to connect with care team members, family, and friends virtually. UCLA Health is marketing these capabilities to attract more patients.
"We want to provide a seamless patient experience and continue to elevate that experience," said Dr. Pfeffer.
The IT team is also focused on supporting a large remote workforce. When the pandemic began, the health system rolled out Microsoft Teams enterprise wide to give employees more ways to communicate, and now the system is refining those tools to make remote work even better and safer. Additional investments in productivity and automation tools will continue to improve remote work efficiencies. However, the health system is also looking for ways to reduce technology costs, potentially including further advancement to the cloud and eliminating IT portfolio redundancies.
"Fundamentally, our IT investments come down to value," said Dr. Pfeffer. "For every project that we are asked to do for the organization, we try to figure out what the value proposition is and we figure out whether we can achieve the same goals with the tools we already have. Can we get 90 percent there? Is that good enough? Does the project really push all of our capabilities to the next level?
"We are also investing in the IT team, and growing their knowledge will be critical. It's less about having to cut projects and more about re-thinking our priorities and seeing how we can use current technologies. We are working creatively with our vendors on that as well."
UCLA Health has a robust IT governance system that is unique because none of the groups are chaired by IT; they are all chaired by leaders from key departments in the organization, which allows the IT team to listen and understand where they can improve.
"We look at data from our IT service management tools and that allows us to understand how we are doing with solving issues and fulfilling requests," said Dr. Pfeffer. "We survey every person afterwards to see how we did. Anyone who feels we didn't deliver receives a call from a manager to see how we can do better and solve the problem. We also look at re-opened tickets as a measure of our quality service."
The IT team also rounds within the hospital and clinics with other administrative team members to see how the technology is used and asks questions about how things are going. Clinicians are prevalent in the IT team as well, bringing first-hand clinical experience to the team. Many are part-time informaticists who also see patients, or have a clinical background so they have the perspective of the end-users in mind. Dr. Pfeffer recently spent a week of attending on the medicine ward at the hospital and he used the systems his team implemented.
"I'm constantly on the lookout for feedback from people within the organization, and being able to still put on my scrubs, mask and face shield and see patients is really important to me. I can teach residents and medical students during the pandemic and use the technologies that are provided by the IT organization to care for patients," he said. "It gives me another lens to look through when I have my monthly IT town halls."
Prior to the pandemic, Dr. Pfeffer's IT town halls were quarterly, but he began doing them monthly when everyone went remote over the past few months. The town halls can include guest speakers or IT professionals presenting key project successes; the past few have been more focused on Q&As to make sure everyone has the opportunity to ask questions.
Finally, Dr. Pfeffer and his team are providing platforms for researchers, clinicians and quality teams to access and visualize multi-dimensional data safely and quickly. These platforms also enable machine learning-based artificial intelligence that can then integrate into the health system's processes and EHR. UCLA Health, as a leading academic medical center, is focused on learning from data to develop new diagnostics and therapeutics and improve health outcomes. Dr. Pfeffer and his team want to make sure that this can be done faster and easier by increasing automation and focusing on the user experiences of faculty and staff.
"I'm incredibly proud of the IT organization for what they've been able to do to enable the organization to care for our patients," he said. "The front-line workers are fueling our response, but those behind the scenes in IT are critical. They have the dedication and passion to work long hours and deliver on what the organization needs during the pandemic; it's a testament to the dedication that they have to improving peoples' lives and supporting UCLA Health’s mission and vision."