6 questions with UCLA Health CIO Dr. Michael Pfeffer

While many physicians report frustration with EHRs, Michael Pfeffer, MD, took an interest in the technology — a decision that led him down a new career path.

After earning his medical degree at Cornell University's Weill Cornell Medical College in New York City, Dr. Pfeffer enrolled in the internal medicine residency program at UC Los Angeles' David Geffen School of Medicine. After his graduation from the residency program and chief residency year, UCLA Health leadership decided to move forward with a new EHR system.

"I became involved in the project, and really loved it," Dr. Pfeffer says. "I always loved computers, processes and complex projects and design, and with this project, I got to spend more of my time involved in informatics."

With this experience under his belt, Dr. Pfeffer went on to become chief medical informatics officer at UCLA Health in 2013 and was appointed to CIO one year later. Today, Dr. Pfeffer continues in his position as CIO at UCLA Health, where he also practices as an internal medicine physician.

Dr. Pfeffer spoke with Becker's Hospital Review about his background as a physician, his goals for UCLA Health and why the health system decided to begin the adoption of OpenNotes.

Note: Responses have been lightly edited for length and clarity.

Question: How does your background in informatics and internal medicine inform your work as CIO?

Dr. Michael Pfeffer: I still see patients, so I'm using all of the technology we put in place for our providers. I have the opportunity to see first-hand what kind of products we're delivering, how they can be better and how our clinicians view them. I also get to discuss with patients the use of our electronic patient portal. Working as a physician really gives me an understanding of the business, how we're using technology and what new technologies and efficiencies we should be looking toward in the future to increase the value IT provides.

Q: How has the IT landscape changed for hospitals since you began working in healthcare?

MP: I think IT has become very front-and-center. We use it every day, all the time, by all walks of life in healthcare — including the patients. When I was in medical school and when I was a resident, we used paper. We used some electronic portals for documentation, but they were very primitive and we really had minimal, if any, patient engagement with technology. Now, we have significant interaction with the patient through technology and the electronic health record really permeates the entire clinical enterprise. It's really a fundamental piece of how we do business.

Q: I saw UCLA Health is piloting an OpenNotes project, in which providers share medical notes with their patients. How has UCLA Health rolled out this initiative?

MP: We have a limited adoption of OpenNotes at some of our ambulatory clinics right now. We really wanted this project to be collaborative and not just implemented without hearing from our clinical faculty. We really wanted to take a slower approach that looked at how we benefit both our patients and physicians in this space, by giving our physicians a say in how OpenNotes gets rolled out, as well as taking the time to get some initial pilot data from the project.

What we've learned from our initial pilot with OpenNotes is that the patients really liked it and it had minimal impact on our physicians' workflow. Not zero, but definitely nothing that would be significant from a day-to-day standpoint. Overall, I think it's a great thing, and I think it's worth pursuing. I think it's going to be the standard of how we communicate with patients in the near future.

Q: What advice would you give to other healthcare CIOs looking to adopt OpenNotes?

MP: It's pretty easy to do from a technical standpoint, although it can be a little tricky when you have trainees documenting notes. You want to make sure all documentation is approved by the attending, before releasing it to the patient. But it's really more of a change management issue than a technical issue, in terms of how you're going to roll it out and how you're going to support patients and faculty during the process.

You need to partner with some key clinical leaders as well as your clinical informaticists in order to drive the change necessary to move the project forward. We now have extensive clinical information released to our patients, such as lab, radiology and pathology results, which was a big change. Initially, the thought of releasing these clinical results via the patient portal was a little scary because it was new. But our patients really love it and now our providers really love it, so it's turned out to be a win-win.

Q: Looking toward the next year, what are some of your goals for UCLA Health?

MP: I think it's all about the value proposition. How we can provide increasing value with health IT while also reducing its cost. This is really a major focus next year, for me. I'm also looking at our IT culture and how I can continue to create an environment that attracts the best and brightest in IT. Creating an environment where the people who work in health IT can thrive and innovate is going to be critical to our success as an organization.

We're also continuing to focus on optimizing our electronic health record. We're constantly talking to our providers and trying to figure out how to make things more efficient for them. We really want the experience of working with the electronic health record to be an enjoyable process and one that doesn't interfere with the physician-patient interaction.

Q: For you, as a CIO, what are some health IT trends you want to learn more about?

MP: I think there's a lot of focus on big data and I'd love to learn more around algorithmic medicine and machine learning. I think blockchain is very interesting — what are going to be the use cases for blockchain in healthcare? I'm also very interested in the Internet of Things and how that is going to continue to integrate within health IT. It's more than just 'How can we take a device and integrate it into the electronic health record?' but also 'Where are the improved outcomes going to come from?'. How do we objectively determine the best devices in the Internet of Things and the operational processes to support them that will ultimately improve our patient outcomes?

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