The Digital Healthcare Revolution

On this episode, Tom talks with Dr. Michael Pfeffer, Chief Information Officer and Associate Dean for Stanford Health Care and Stanford University School of Medicine. Dr. Pfeffer is unique as a CIO because he is also a clinical professor and actively practicing Hospitalist Physician. 

Together they discuss Dr. Pfeffer’s unique role, the increasing reliance and incorporation of technology in healthcare, and the possibilities of what technology can offer to healthcare providers, as tools to allow them to offer more personalized, people-centered care.

Transcript

Tom Andriola 0:00
Dr. Michael Pfeffer serves as Chief Information Officer and Associate Dean for Stanford Health Care and Stanford University School of Medicine. He is also a Clinical Professor in the Department of Medicine and Division of Hospital Medicine with a joint appointment in the center for Biomedical Research (BMIR) in Stanford University School of Medicine. 

I refer to Michael as a unique breed of CIO, where he is bringing his expertise as a doctor into the technology sector, to offer unique IT solutions for the medical community. Together we discuss the changes that are currently being driven by an increasingly digital era in healthcare, especially post-pandemic, where patient care looks much different than before. We also talk about the possibilities of what technology can offer to healthcare providers, as tools to allow them to offer more personalized, people-centered care.

Tom Andriola 01:25
Welcome Dr. Pfeffer.

Michael Pfeffer 01:27
Thank you, Tom. It's good to see you.

Tom Andriola 01:29
Absolutely wonderful. Thanks so much for being with us today. So I'm gonna jump right into the first question, Mike. So you are part of what I like to refer to as the “new breed of CIO”, one that's been clinically trained. Can you tell our audience how your career journey took you to where you are? And the advantages that you see being clinically trained as the Chief Information Officer? 

Michael Pfeffer 01:49
Yeah, thanks, Tom. It's a great question. Because it wasn't what I envisioned when I was doing medical school. I actually really wanted to be a program director for a residency program, internal medicine, that's what I was thinking about. And you know, I love teaching, and I love seeing medical students and residents really grow throughout the training process. But I also kind of fell in love with informatics. And it really happened because I wanted to make things better for the way workflows were happening in the hospital. And I studied chemical engineering, so I love to make things work better and engineer them so it's more efficient and more streamlined. And I saw an opportunity when I was at UCLA, and the decision was made to move from the current state, which was mostly paper, and some best-of-breed systems to an enterprise-wide electronic health record, and decided, “Oh, this is a great opportunity to kind of see how I can help.” And I joke, because they posted three part-time physician informaticist positions. I applied, two other people applied, so my chances were pretty good that I was going to get one of those slots, and began my journey in informatics and haven't looked back, it's been really life changing. I've learned so much through the process, and have met incredible people from every aspect of healthcare that are truly passionate about what health care means to the world.

Tom Andriola 03:29
So you and I met when you stepped into the CIO job at UCLA, you had already been done with the primary implementation of Epic there. And when I met you, one of the big things that you talked about from day one was, you've always been a huge champion of the EMR concept. But you talked a lot very passionately about physician burnout. Where do you see that going, right? Because physicians now may be more burned out than ever, given what they've been through in the last two-and-a-half years, but physician burnout and what you're trying to do at Stanford, what do you see for the future?

Michael Pfeffer 04:02
I mean, it's a really great point. I do really believe in the power of electronic health records and what it brings to the table. But all of it isn't good. And the other piece about how this relates to physician burnout is, it's one piece of the pie, but for every single physician or clinician, nurse, I mean, this is for all of health care, really, it's really personal. It's really unique to that person, in terms of what are the factors that are really contributing to it, so the best we can do is try to eliminate as much burden with technology solutions across the board. So I really like to think about usability and simplicity. How do we make things easier? How do we make things more usable? How do we reduce everything from alert fatigue to the number of clicks you need to do? But really, bigger than that, we're going to have to tackle things like “how do you disconnect?” How do you cover people's inbox, for example, so they can have a rest? How do we engage with what has become a new way of working with patients, which I think is phenomenal, but we've seen engagement digitally go through the roof, starting with video visits, the patient portal usages have significantly increased, which means more messages, which means a new way of really taking care of patients. And so how do we figure out how to make this work better for our clinicians and give them more space to do the things they love, and then really help figure out what are the things that are contributing most to burnout, but that's very individual. I really don't think there's a one-size-fits-all but I do really want to emphasize the disconnecting piece, I think that's really, really critical. And it's not just disconnecting from the EHR, but email and picking up your phone, and all of those things. It's really a problem. 

Tom Andriola 06:05
You know, I was sitting a few months ago with the head of a primary physician group, and they were talking about a 500% increase in email, plus texting, that is just overloading the primary care physicians. As patients have gotten more comfortable interacting through electronic means, there's just this overload of communication. And to your point, right, it's everything from all that extra work, to outside of normal hours of their shift, to “Hey, is that a protected exchange of information and what liability gets created?” So it's so it is a huge, huge paradigm shift in so many ways, that technology will be part of it. But culturally, is that something that you're talking about with the doctors that come up in the physician practice? You know, when when you talk about with docs–

Michael Pfeffer 06:58
Yeah, all the time, and we put together an in-basket, kind of war room, that's been meeting for a little less than a year now to see what can we do technically, across the board, to try to make things better for clinicians on the messaging front. But part of it also has to do with, access is a challenge across many health systems. And so if you can't get to see your physician, what else do you do? You message them. And so that is also playing into this, and I think that's only going to increase, especially as we head into the winter months, as we're seeing, hopefully not too much of a surge, but definitely flu and RSV. So I think we have to figure out, okay, if this is the new way of how we're going to work, and then how do we build that into the way we think. And part of it is putting ourselves in the shoes of the patient and the shoes of the provider. Both have to be satisfied or enjoy the digital patient and digital employee experiences in order to make it work. You can't have an imbalance, otherwise I think it contributes to burnout and dissatisfaction.

Tom Andriola 08:11 
Agree, okay, so it's been a little more than a year for you at Stanford, and you know that I'm a huge studier and observer of leadership. So tell me, how did you spend your time in your first year? And what aspects of your leadership or challenge or opportunities for growth did you find, as you were jumping into a new organization, both of which are amazing, by the way. But, you know, new organization, I'm sure a different culture. So what kind of leadership challenges and how did you spend your time?

Michael Pfeffer 08:39
Both amazing places, you're right. I mean, I'm very fortunate to have the UCLA opportunity and this opportunity at Stanford Healthcare. One of the most interesting things is transitioning during a pandemic, and how that changes interaction. You know, better than anybody, the role of the CIO is a “people role”. It's a relationship role. It's a “bringing teams together to do highly complex things with little room for error”. And so that's all about relationships and trust and collaboration. And it's harder to do over Zoom. And so I've had to learn how to do that, how to connect over Zoom, how to encourage in-person meetings where they need to be, and really work very, very hard on that and building the team. So my leadership team were phenomenal. You know, we met every day, every week in-person, pretty much, for two hours, and then one-on-ones to really try to build relationships, both within the team and with me, so that we know we can trust each other, we can challenge each other. That's really, really critical. And then across all of my peers, the faculty, really trying to build those relationships as best as I can. It's slower. It's a slower process, I think than when everybody was in person, so I think that's been eye opening for me, but it still boils down to people and relationships and trust and, and really championing the missions, patient care, education, research, why we're here. I mean, that really does bring everybody together. And it is an incredible mission. I mean it's the difference between working at an IT or a tech company and working in health IT. You there's that health part of it which is really magical and such an important impact on people's lives so kind of knitting all that together I think is really critical. 

Tom Andriola 10:40
That's great. So this past year, Becker's recognized you as one of the top chief digital executives, it's always great to be recognized by Becker's for sure. I'm curious, as being someone who's clinically trained, having a strong technical background, being a champion for technology's potential impact, how do you talk about the digital revolution in healthcare, both inside and outside the organization? And I know you're going to talk about AI here, because you have some strong views on AI. 

Michael Pfeffer 11:07
Well there's a lot of big words that have been tossed around. And there's a lot of hype, and there's a lot of, I think, exciting things. I think people are really excited about the potential of digital in healthcare. I think the word even digital is overused. What does that even mean? But when we look at what the potentials are, it's going back to usability and simplicity, which is, I think, kind of the bedrock of how we can make things better. So when it comes to thinking about the interaction with a clinician and a patient, ambient voice technology doing a lot of the work of writing notes, for example, is a good example of improve usability and simplicity. When we think about AI, and the potential for this, and there's a huge chasm between the algorithms sitting on the shelves, and then bringing them into clinical use. But again, it's it's trying to help clinicians make decisions, perhaps, or operational efficiencies, simplifying those things. And if we make it usable again, then there's a real opportunity for these things. One of the things I'm really excited about here is we launched the inaugural chief data scientist for Stanford Healthcare, Dr. Nick Grimshaw, and he is embedded in the IT organization. Instead of having it siloed off, by bringing it all together, and educating my team on artificial intelligence, machine learning, how do you make it work, how do you assess for fairness, usability, reliability, all of these things, and then, the AI algorithm itself is just such a small piece of the puzzle. In fact, that's probably the smallest piece of the puzzle, right? And I look across the whole thing, from governance, to machine learning operations, to deploying it in workflows, I mean, you need the you need a whole army of people who get this. And so I'm really excited about what we're building here in that, in terms of a true data science team in the IT organization that collaborates throughout the IT organization through all the pieces, and then a governance that really thinks about fairness and value and, and really driving us to the next level. So I think that's going to be key. And then precision medicine has gotten a lot of airplay. I think there are going to be some really neat opportunities around that. When you think about pharmacogenomic drug interactions and new ways to think about how we incorporate that information and genomic information in the EHR. So I think we're gonna see some pretty amazing things in the next five years on this. 

Tom Andriola 13:38
One of the things that I think of environments, like you're at UCLA, Stanford has this way, we're gonna hear UCI, we have this, but you have both a strong academic, medicine research environment, but then you have the rest of the university, right, a strong interdisciplinary, many schools be able to tap into, the School of Engineering, the School of Business. How do you think about having all of those chess pieces at your disposal. Not under your control, but the ability to build bridges to them, and then to design care and what care will look like for patients in 2030? Tell me a little bit about what goes through Dr. Pfeffer’s head as he thinks about pulling all those pieces potentially together.

Michael Pfeffer 14:25
I mean, that's one of the amazing things, like you said, about working at a university like this. I mean, there are a ton of great ideas and new ways to think about things that live both within and outside of the School of Medicine in the various schools here. I mean, from the design school, to the business school to the new earth school, and we could talk about sustainability because that's probably our biggest challenge in health coming up. And leveraging that, we actually have this really amazing program at Stanford called the Catalyst program. And what it does is it basically is an incubator of sorts, bringing incredible talent from across different parts of the organization together to apply for not only resources, but project management with the idea of taking something that's an amazing idea and then scaling it, implementing it, and then potentially spinning it out with the idea that it's really going to help humanity. So that's one example of a program here that really does aim to bring together different disciplines to really get to a better place.

Tom Andriola 15:35
And so what does this mean for the patient? When you look out five years, or we look all the way to the next decade of 2030, what's going to change for the patient and the type of care that they will receive from a place like Stanford Health?

Michael Pfeffer 15:49
I want to say more personalized, an easier experience, almost maybe an enjoyable experience. You know, I think that's important. I mean, how you think about even going to the physician's office can be stressful. And so how do we make the experience even better, how do we offload a lot of the work that doesn't need to be done by clinicians, so there's more time for those in-person interactions. Obviously, we're going to have amazing care. But more personalized, more attention to the experience, there's a ton of work being done on the patient experience-side here, which is really amazing, and bringing that kind of information together about, not only the clinical piece of it, but the experiential piece of it to really help define the patient journey in new ways. 

Tom Andriola 16:41
So when you were thinking about taking the job and asked me some of my thoughts, one of the things – because I lived in the bay area for many years, as part of some of the roles I had in my career – like one of the benefits of this job that makes it truly unique, over other great jobs is your proximity to the Silicon Valley ecosystem. And that is a real benefit that there's companies that come visit you all the time, but more importantly, you're standing in line, getting a cup of coffee, and somebody is pitching something, and it is applicable to you. And you're like, “Hey, do you mind if I join your conversation?” So tell me, I know you're only a year in but, how has the Silicon Valley ecosystem interacted with you? Or how has it shaped some of your strategic thinking for the future?

Michael Pfeffer 17:29
It's been really fascinating. Just like you said, you can be standing in line for coffee, and you hear an amazing conversation going on. I'm learning a ton. I think I'm in my learning mode, more than anything else, at this point. Not only the incredible interest of health and healthcare by tech companies, but also the need for them to partner and learn from healthcare organizations, because it can't be one or the other, it has to be both. And so really getting to understand more how these tech companies are thinking, how they view health as a really key part of their portfolio or will be a key part of their portfolio has been really interesting. Obviously, there's significant venture capital up here, and how they think about startup companies, how they want to invest. And then from my standpoint, do we want to take a risk on a startup company, when the potential could be that it's acquired, or the goal is to just exit and then leave the organization hanging with something that they've been providing for patients. So, it's really been a fascinating opportunity to be up here, listen, learn and grow from it. And so I think it's really exciting. We mentioned a little bit about sustainability, but that's another big topic we're hearing more and more from tech companies and partly because we're demanding that we purchase and partner with sustainable companies, but I think people are really starting to understand the risk to health if we don't figure out how to be more sustainable.

Tom Andriola 19:18
Yeah no, and for our audience members that don’t know, Stanford has a very, very big gift that was given to the university. I don't remember the number, exactly, Mike, but it was a big number to potentially establish a new initiative that's bringing together the entire Stanford community around sustainability. It's really one of the landmark moves on sustainability in the country in the in the academic setting, so it'd be really interesting. In addition to having Silicon Valley right there outside your back door, and the Sand Hill Road crowd, as they're called, do you also have a strong incubator culture inside of Stanford? I would imagine there's some type of strong incubator, and is that a pipeline of things that ultimately come into a “Let's introduce this in an AB test in the clinical environment?”

Michael Pfeffer 20:07
Absolutely. I'm blown away by the faculty here. I mean, it's just incredible, the accomplishments, the passion. There's lots of different incubators here. I mentioned one, Catalyst. And one of the things that I'm really excited about is how do we, as an IT organization, move even faster? And I think creating frameworks about how you interact with us, what are the things that are needed for security? What are the things that are needed for privacy? What platforms do we use? How would you integrate this fairly quickly? What API's are available to interact with the datasets? The more we can create those frameworks and environment for our faculty and incubators, I think the faster we're going to be able to move. And so that's something that I've been working on with my teams here, and it's a work in progress, but I think it's going to be really powerful.

Tom Andriola 21:02
Great. Well Mike, thank you, I really appreciate you taking the time again, you know, we were colleagues for several years, and I was both excited and also felt a great loss when you left us from the University of California system. But Stanford does provide just for an amazing opportunity, and I know how much you care about both the patients, and then how what we do in the technology field benefits the patient. I can think of no better place for you to go to continue making contributions to our industry and to our patient community. So I want to thank you for joining us today, sharing a little bit about what's been going on with you and Stanford and we look forward to great things to come. 

Michael Pfeffer 21:43
Thanks, Tom. It's always a pleasure. And you know, I've learned a ton from your leadership and thinking throughout the many years and it's really helped me grow and so I really appreciate that. And I would be remiss to say we're nothing without our teams, right? And there's just such incredible people that I get to work with every day that make this all possible and that to me is really the magic of it all: getting to work with people who are truly dedicated to the missions and choose to do that in health IT, so my hat's off to all health IT organizations out there because they're working really hard for an amazing mission. 

Tom Andriola 22:17
Great. Thanks, Mike.