John Glaser, Ph.D. has been a well-known leader in U.S. healthcare for decades, as a consultant (with Arthur D. Little, 1984-1988), a CIO (at Brigham and Women’s Hospital, Boston, 1988-1995, and then with the merged Partners HealthCare, 1995-2010), and more recently, as a vendor executive (with Siemens Health Services (2010-2015; and since February 2015, with the Cerner Corporation, after it had acquired Siemens). At the beginning of this month, he published a book, entitled Glaser on Health Care IT: Perspectives from the Decade that Defined Health Care Information Technology. The 312-page book, published by CRC Press, is a compendium of columns he wrote regularly for Hospitals & Health Networks. Just prior to HIMSS16, Dr. Glaser spoke with HCI Editor-in-Chief Mark Hagland regarding his perspectives on the current evolution of U.S. healthcare and healthcare IT. Below are excerpts from that interview.
So, you’ve written a book. Congratulations—and tell me about it?
Thank you, and yes. Going back a decade, I’ve written maybe five or six columns a year on various topics, for Hospitals & Health Networks, on various topics, from the Internet of things, to assessing the effectiveness of IT organizations, to meaningful use-related topics. So there have been over 50 columns, categorized into four broad categories. [The four categories are “HIT Applications and Analytics Challenges”; “Improving Organizational Performance through HIT”; “IT Management Challenges”; and “HIT Industry Observations.”] So these are some of the topics I’ve thought about. So we took all these things, cleaned them up a bit, and packaged them, and am sharing them.
John Glaser, Ph.D.
When will it be released?
Very soon; there will be a book-signing session at HIMSS.
You’ve been a presence in the industry for a very long time.
Yes, altogether, over 35 years now.
And now is a fascinating moment in healthcare and healthcare IT, wouldn’t you agree?
Yes, I think so. And there’s a lot still to be done. But if you look at the last ten years, with EHR [electronic health record] adoption, driven by meaningful use, and the forward evolution of a broader range of technologies, including for population health, revenue cycle, telehealth, and so on, the technology has obviously continued to be relentless in its innovation. The advent of the web, the emergence of wireless technologies, advances in analytics and in sensors, all those have moved us forward as an industry. And we’re better at implementation now. We’re still not flawless... But we are increasingly able to use this stuff strategically and competitively. And the IT department is more effective than it ever was.
And lastly, the role of the federal government has jumped dramatically. So I think you’re right, we’re in an extraordinary time. I’ve never seen anything like the level of change and of innovation, around helping people with chronic disease managing their health, helping healthy people stay healthy, and so on.
And one of the things happening is a very significant change in the business model; we’re going from reactive to proactive management of health; from niches like pediatric care, to broader care management models. And we’re going through a fundamental shift in payment.
So, I need to ask you the classic “half-full, half-empty glass” question. It would be easy for any of us to pronounce the proverbial glass to be “half-empty” or “half-full” right now in U.S. healthcare. Your thoughts?
You and I could take turns taking each side of that for hours. Interoperability’s still kludgey. Interoperability—that’s still a challenge for docs in practice. You still have implementations that go sideways. You still have security issues… and now with this ransomware, goodness gracious! So there are still a lot of issues. And you could argue, woe is us. But then look at the gains in people using CPOE [computerized physician order entry], and the much greater ability to manage analytics. And the results in managing chronic illness are still mixed. But then, people are using cellphones to do things never done before.
And the reality is that you could go back and forth; and you’re always going to have things that are worrisome. But at the same time, we’re really making progress here. And you and I have been in the industry for a long time. And look at what HIMSS was like 10 years ago. And it will still be the same question of balance 10 years from now.
At a minimum, there’s tremendous policy clarity right now, compared to years ago, would you agree?
Absolutely! We aren’t going back. The dominant mode of payment is becoming a minority—fee-for-service. It’s hard to know what the mature form will look like, but the direction is absolutely clear.
What should CIOs and CMIOs be doing right now, given everything that’s happening?
For CIOs, here are the factors they should understand. One, you have to understand the breadth of the full continuum of care, across ambulatory care, long-term care, etc. Second, you have to get your head around the newer payment models—what bundles contain, what MACRA [the federal Medicare Access and CHIP Reauthorization Act of 2015] requires, all of that will involve. You’ve got to understand this whole healthcare environment, so that you can take action. And third, you’ve got to understand the whole spectrum of technologies that can be applied to the landscape; that’s always been true, being a good technology specialist. And you’ve got to move up in terms of management and leadership capabilities, and team-building capabilities. And you’ve got to both enforce standards but encourage innovation. Build a rock-solid infrastructure, but moving efficiently. Trade-offs. That’s always been around. And frankly, then next, we’re coming to the end of the era of EHR implementation. So what you’ve worried about the past few years was implementation. Now you’ve got to turn to optimization and leveraging. You got some value out of implementation, but now you’ve got to get real value.
And this era of managing populations and taking on risk is coming, or is already here, in some regions. So population health management tools, care management tools, analytics tools, how am I going to engage patients in this? You’ve got to start moving your organization in that direction, through patient registries, care management, interoperability. So you’ve got to approach that to get ready for the next era, while keeping the trains running—security, staffing. So harvesting new technologies and getting ready for the new payment models.
Where are CIOs stumbling, in your opinion?
A lot of them are still early in understanding how to get ready for all the stuff we’ve just talked about. And they’re not alone: their fellow execs in the c-suite are learning about this stuff, too. So the whole c-suite, and a lot of the industry, are all still early in learning about this. So they’re stumbling around a bit still. And some still are not mentally ready to shift from implementing to optimizing a system. So they had two major shifts to make: a skill shift, orientation shift, and knowledge shift… And some are there, and some are getting there, and some really haven’t started to get there yet.
What about the criticism of the vendor community that vendors aren’t future-oriented enough, in terms of developing the solutions, particularly interoperable ones, that providers need right now?
Well, there are a number of examples of vendors that are forward-looking… Cerner is one, of course… some of the recent IBM announcements… Some are preparing for the future, and frankly, I think that Cerner is one of them that are really moving ahead. But then you have much smaller companies that are startups, and just worried about where the next meal will be coming from. And it’s been interesting being a CIO and then a vendor executive—vendors know that tomorrow will show up. And you’ve got to get ready for Stage 3 of meaningful use. But then they walk into their clients, and they’re often pulled by their clients into the now. So I think the vendors do try. But also, it is a shared relationship; and not to let the vendors off the hook by any stretch; but you have to somehow balance things out with the customer CIOs and organizations. So I think it’s a complicated balance—getting the balance between taking care of Stage 3 and so on. At times, it’s a fair criticism, at times it’s not fair, but realize how hard it is to do that.
Any predictions or things to look for at HIMSS?
I’ll be curious, given that things are being talked about... Are we starting to get clearer about how to do things as an industry? I’ll be curious with regard to the understanding about what the technology needs to do.