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 Welcome to this Week in Health, it influence where we discuss the influence of technology on health with the people who are making it happen. My name is Bill Russell, recovering healthcare, CIO, and creator of this week in Health. it a set of podcasts and videos dedicated to developing the next generation of health IT leaders.

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It's gonna be a discussion on the opportunities, challenges, and promise of leveraging multi-cloud environments for healthcare. If you're there, please stop by. I'd love to see you. We caught up with Dr. Mike Peffer, the CIO for UCLA Medical Center. . And had a great discussion around, uh, physician and clinician burnout, uh, just after he stepped off a panel on that same subject at the Health 2.0 conference, I.

Have a listen. Hope you enjoy. Alright, another session from, uh, health 2.0. We're here with, uh, Mike Peffer, the CIO for, uh, U-C-L-A-C-I-O. Is that still the correct title or did, did you tack on like Chief Digital Officer Innovation? No, luckily still no. Chief Digital Officer. Um, so CIO? Yes. For uh, UCLA Health.

Mm-Hmm. . So you just participated in the panel talking about, uh, physician clinician burnout? Yes. Really? Um, so let's start where this conversation usually starts, which is at the EHR. Right? Um, and you talked about the arch collaborative, which we've had, uh, uh, from class and others on and talked about, uh, the arch collaborative talk.

Um, when we took the survey, uh, we ended up ranking greater than the 90th percentile for both physicians and nurses in terms of satisfaction. Uh, but we still had issues and being at the top of that list wasn't necessarily something you want to jump up and down about, because overall the net promoter score was still in the sixties.

So, um, we still had a lot, we still have a lot of work. You were the 90th percentile, but your, your NPS was in the sixties. What do you attribute that to? Well, I think overall, um. It's doctors. EHR is still a burden. A burden. I'm, I'm, it's a tough, it's, I don't know. I think it's different for every single person.

I, I, I didn't say that. Right. So the burden is really, um, the regulatory environment, the, um, the fact that you can be gotten to at any time of the day, right? So you can't, and you mentioned this, you can't disconnect, right? Can't disconnect. Um. You're, uh, expected to respond at literally all hours of the day.

And, uh, and we haven't really figured out how to document the, the meetings real well. Right, right. So people are staying an extra hour or so, uh, easily. I mean, it, it's definitely a vessel for everything, whether it's regulatory billing. Uh, you know, communications, it's all kind of the place you do everything now, so it, it, you can't disconnect.

And so it, it feels like it's always there, like it's following you around. Um, and while it has lots and lots of benefits, um, it's still that inability I think to, to disconnect. And then the autonomy issues about, you know, . How you have to write your node, kind of all these things. Physicians are creative, uh, people, uh, nurses are very creative and we take, when we take away that creativity, it really takes away kind of autonomy and purpose, which I think are really critical to reducing physician burnout.

It is. Um, and maybe to be fair, I was at the Health Catalyst Summit last week. There's a lot of value in this data that we are collecting. Yes, we are. We are, uh, starting to turn into, uh, real analytics. It's really starting to improve outcomes. Um, but when you talk about the, uh, we're taking away their creativity, in what ways does maybe the.

The, the normal flow now take away their creativity. Well, I think as an example, we'll use the, the billing rules, for example, on how you have to write a note. Um, what that does is it forces people to have to stick to a very particular template. That may or may not apply to the situation at hand. The note is really about, you know, thinking through the patient's care and what you need to do.

Uh, for very simple cases, it may not be that big a deal, but for complex patients, and especially in academic medical center where you're seeing really complex patients, you need to take a step back and really think through the massive amount of data on the patient and, and . How you're gonna put this all together to come up with a treatment plan.

So when you prescribe something to be so specific based on billing rules, which have literally nothing to do with the care of the patient, absolutely zero. Right? It, it, it takes away that autonomy, that creativity, the purpose. Of the note. And the note is viewed as the only purpose is for billing and that's not what it's supposed to be about.

So I think that's maybe how I would, um, describe the, the lack of create or loss of creativity. So you're one of the physician CIOs I. There's a couple of you across the country. Couple of us, yes. And, uh, so talk about, um, what can we do as health IT professionals around this idea of clinician burnout? I mean, the, the surface thing is to really understand, uh, the EHR arch.

I think the arch collaborative is phenomenal. Yeah. In terms of really Mm-Hmm. . Gimme those metrics, but what's, what's the next step? Where do we go? Yeah, I think it's pretty, um, I think it's a lot of, you know, what really good leaders should be doing, and that's just listening. You know, we can't fix everything.

I mean, there's a lot of stuff that's imposed upon us, one by the vendors, one by regulations and everything. But we can still go out and listen. And so we have a physician informatics team at UCLA, a nurse informatics team at UCLA that goes out and listens. And tries our best to really understand the things we can fix, the things we can improve versus the things we can't, and then focus on the things that we can improve.

And that process is just something we, we have to keep doing. Um, I, I, I think physicians want to be heard. Um, and, uh, we, we have to listen. That doesn't mean we can fix everything for, for for certain. We, we can't, but the better we listen. That alone, I think, improves things. And, and one of the things we learned in the arch collaborative when we went through all our data was where we were rated very, very high, was in.

Where the IT department felt like a partner rather than not a partner. So we, I, I, I think we really pride ourselves on listening and we do that through many different mechanisms, but also governance and in our IT governance for example, we don't have any IT people leading any of those meetings. They're all chaired by faculty or administrators or both.

Um, driving kind of the things we do in, in it. I saw a big sign as I was driving. I drove up from Southern California. Oh. And I saw a big sign. UCLA number one. Yes, because it looked like graffiti. 'cause it was painted on the side of a, of a building. But that's the way . Uh, billboards happened in, in la what, what are some things you're doing that you're really excited about, just maybe outside of this topic of burnout?

Wow. I mean, there's so many really exciting things. I, I, I would say, um, precision medicine and, uh. Really thinking about how to actually use artificial intelligence and gearing up for what that's gonna look like. So, you know, it's one thing to sequence someone's genome, it's another thing to say you have an algorithm for whatever, but how do you actually integrate that all together so that it's delivered to the physician in a usable way?

And we've been doing a lot of work thinking through how to do that. So whether it's capturing discrete genomic data in the electronic health record so we can not only . Use that for decision support, but also use that for data mining. Um, combining that with our precision medicine program, which we're calling Atlas.

And then, uh, figuring out how to incorporate more social determinants of health, I think is really, really exciting. We've also, um, really put a lot of work into our cloud analytics platform, which will have the ability to ingest, uh, AI algorithms. To be used, uh, in real time in the electronic health record.

So those are some of the things I'm, I'm really excited about. Um, as we look into the future of where health it can be beneficial. I've, I've joked that it's like signing day E. Every now and then I'll pick up. Well, uh, Mayo just signed with. It's Google. Yes. I saw big announcement. Uh, who's your, your cloud partner at this point?

So we, we have a strategic partnership with Microsoft. Okay. Yeah. So you're moving stuff up into Azure, you're utilizing their Correct. Cloud and, and, and ai. Um, can you give us just a quick, I mean, what kind of tools are available in the cloud that you, you wouldn't ne necessarily have on print? I mean, it's, it, it really revolves around the, uh, ability to scale our compute environment quickly and pay for only what we need to use.

Uh, I, I think one of the things that is really gonna be transformative in health, it is the ability to leverage the cloud for much more than we can right now. So, for example, I have a disaster recovery data center that just basically sits there, but I need it because . You know, we, we can never have a sufficient, you know, a, a, a long downtime, right?

But that's the kind of thing that eventually could be migrated to the cloud. So the more we learn about how to use the cloud and scale in the cloud, the better. And also we need the vendors in health, health IT to be able to support that. So a lot of them don't. Um, and that is limiting our ability to take advantage of that.

And again, anything we can save in terms of the compute, which is gonna continue to grow in need. Uh, we can com put back into some of the more, uh, transformative technologies, uh, in health it to help our providers. Fantastic. Thanks for taking the time, Mike. Yeah, absolutely. Pleasure. Always a pleasure.

Thanks. Thanks. Gosh, I really appreciate Mike's time and I really appreciate his perspective when he said that, uh, clinicians. Are, uh, creative and they need their autonomy restored. That those are two phenomenal, uh, points to make in this physician burnout, uh, conversation and something we need to stay focused on.

Please come back every Friday for more great interviews with influencers. And don't forget, every Tuesday we take a look at the news, which is impacting health. It, uh, keep your feedback coming, bill at this week, at health it.com. It's all really helpful, good, bad or indifferent. It helps us to make a better show for you.

Uh, this show is a production of this week in Health It. For more great content, you can check out our website at this week, health.com or the YouTube channel this week, health.com, and go to the top right, click on, uh, YouTube as the quickest way to get there. Thanks for listening. That's all for now.