Episode 39

Healthcare's Digital Foundation

with John Glaser, Ph.D.

December 9, 2021

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John Glaser, Ph.D.
Executive-in-Residence, Harvard Medical School

John is an Executive-in-Residence at the Harvard Medical School Executive Education. He is a former senior vice president of population health, at Cerner Corporation. Previously he was chief executive officer of Siemens Heath Services. Prior to Siemens, John was chief information officer at Partners HealthCare.

 

John was the founding chair of the College of Healthcare Information Management Executives (CHIME) and the past-president of the Healthcare Information and Management Systems Society (HIMSS). He is the former Chair of the Global Agenda Council on Digital Health, World Economic Forum. He is former Senior Advisor to the US Office of the National Coordinator for Health Information Technology.

John serves on the boards of the Scottsdale Institute, National Committee for Quality Assurance, Wellsheet, and Relatient.

John has received numerous industry awards including the John P. Glaser Innovation Award (established by the School of Biomedical Informatics, University of Texas Health Sciences Center), William B. Stead Thought Leadership Award (American Medical Informatics Association) and the Lifetime Achievement Award (CHIME).

John received his Ph.D. from the University of Minnesota. He has written over 200 articles and three books on the strategic application of IT in health care. He is on the faculty of the Wharton School at the University of Pennsylvania, the UTHealth School of Biomedical Informatics and the Harvard School of Public Health.

 

Being a member of multiple boards allows me to see the industry from multiple vantage points and hear different perspectives.

Transcript

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Gary Bisbee, Jr.  00:48

He was expelled from high school, backpacked across Panama, and he’s an industry leader in healthcare IT. Today we are featuring Dr. John Glaser, an executive in residence at the Harvard Medical School. John served as the CIO for Partners HealthCare, now known as Mass General Brigham, for 22 years until he accepted the CEO position at Siemens Health Services. We discuss why he made the jump and the differences in similarities between leading an academic health system and a commercial company, and between the CEO and CIO roles. We dive deep into the continuing evolution of health IT, such as limitations of interoperability, challenges of usability, and the future of AI and machine learning. John serves on multiple boards of directors and provided insights into governance. We touched on what makes exceptional board members and how to strike the balance between governance and management. For up and coming leaders, John advises that you understand who you are, what you believe in, and follow your instincts. Let that approach guide your career and your life.

 

Gary Bisbee, Jr.  02:03

Well, good morning, John, and welcome.

 

John Glaser  02:06

Thank you Gary, it’s a pleasure to be here.

 

Gary Bisbee, Jr.  02:07

We’re pleased to have you at this microphone. You’ve been a prominent and very successful leader throughout your career. Couple of highlights were being the CIO at Partners, now known as Mass General Brigham, and being the CEO at Siemens Health Services. So from the standpoint of the audience, we’d like to get to know you better and understand what’s behind some of the decisions you’ve made. Why don’t we kind of kick off at the beginning? So what was life like growing up for you, John?

 

John Glaser  02:39

Oh, I think Gary, my sort of youth who is probably pretty typical of a whole lot of folks. I grew up in suburban San Francisco Bay Area, the town of San Mateo, and I went to Catholic grammar school, Catholic high school, was a Boy Scout, an altar boy, Junior Achievement, you know, all the typical things you might see. Probably only two real unusual items, I spent a freshman year at a British boarding school. My father was a consultant in McKinsey, he was sent to Germany. My brother and I were dispatched to British boarding school for a year. I still have a cricket bat in the attic for reasons that are unclear to me. And the second was I was expelled from high school in the middle of my junior year. Other than that, it was a pretty typical upbringing of someone born in 1955.

 

Gary Bisbee, Jr.  03:20

I have to jump in and ask the obvious question. So what happened to cause you to be expelled, John?

 

John Glaser  03:27

Well, I went to a Catholic High School. Three colleagues and I wrote an underground newspaper, which was a little raunchy. It was well written, frankly, I still have a copy of it. It was well written. But we made the mistake of distributing on the afternoon of Parents Night. So mom and dad came down to the school and this, holy goodness, the roof blew off. And my buddies and I were in front of a tribunal of priests the following morning, and one by each went through. My three friends did the mea culpa, if you’re Catholic, the sort of Latin for “my father, I’m sorry”. But I got mad and I accused him of being sanctimonious and hypocritical. And I said the Catholic Church was a criminal organization. I just got mad. And so I didn’t realize that I had crossed a line in there. So I was decapitated as a result of that conversation and there you go. So, lessons learned about timing and lessons learned about, I probably could have handled that discussion a little bit better in retrospect.

 

Gary Bisbee, Jr.  04:16

Well, I guess lessons learned is the key. So what did the young John think about leadership?

 

John Glaser  04:22

Well, I don’t know that the young John really thought about that. I mean, the young John sort of had purpose, but didn’t have purpose for lots of things here. And I think a couple things, you know, just to give you an example, Gary, you know, I wound up my first job out of college, I was a math major at Duke, was at Pizza Hut. And my next job was in a salmon cannery in Alaska. And then from Alaska, I hitchhiked from Fairbanks, Alaska to the Panama Canal through North Carolina. It took me six months. That is not a focused human being on a linear path to medical school or being a lawyer or whatever. So I don’t really think I thought about it. I kind of, you know, accidental leadership is perhaps a better way to put it. I also think, you know, frankly, snd you know more about this than I do, that leadership in a way is a, you know, people get into it almost secondarily. They may have a desire to start a company or a desire to solve global warming, etc. And they’re aggressive in their focus, and they become leaders along the way. But that’s not what they started out to do. They started to start a company, And or leaders, you go into a job, you happen to run a team, you do pretty well, you get moved up the ladder, and you say, son of a gun, I really like this. And I’m actually pretty good at this. And you learn along the way. I think leadership is just this never ending series of experiences and things that shape you.

 

Gary Bisbee, Jr.  05:32

Well, that’s well said for sure. What about your parents? Do you think your leadership style mirrors at all that of your parents?

 

John Glaser  05:40

Yeah, I think directly and indirectly. I was lucky to have good genes. So you know, reasonably intelligent. I was raised well, and educated, and fed, and avoided some of the horrific situations that people sometimes encounter in their home, et cetera. My father was a very successful consultant and very active professionally in sort of the professional societies. And I, you know, mimmicked that a lot in my own upbringing. My mother was very eccentric. So she taught you to challenge and try to be unorthodox. So, to give you an example Gary, she spent the last 20 years of her life in a camper truck roaming around the southwest. We actually never knew where she was at any moment in time. And that was just her style. And she, you know, passed on some of that to us. But so, they shaped you along the way, perhaps not as intentionally or as directly as you might imagine, but they shape you nonetheless.

 

Gary Bisbee, Jr.  06:23

So what about healthcare, John? At what point did you either fall into healthcare or think that healthcare would be a good place for you?

 

John Glaser  06:32

Well, I think following is probably the better way to, the better verb here. As I mentioned, hitchhiked, and got to Panama, and realized two things. One is, I’m tired of hitchhiking, you know, six months is a long time to be sleeping on pieces of cardboard, the back of Shell stations. And the other is I was actually madly in love. It occurred to me, I’m actually madly in love with this woman who I had met in college. And I don’t know what I’m going to do. But I’m going to go back to Durham, she was still at Duke. And I’m going to be with her. And we’ve been together for 47 years as a result of that. So I went back there for no other reason than to be with her, took the first job I was offered, which was as a programmer analyst at Research Triangle Institute. At the time, they were doing the first federal study of healthcare quality and utilization. It hadn’t really been studied comprehensively before. And I was a programmer designed to do Fortran based analysis of the work they’re doing. And I thought, Gary, this is pretty darn cool. You know, healthcare is really interesting. And you know, I didn’t want to be a Fortran programmer for the rest of my life. But this IT stuff is kind of interesting, too. So it was kind of wandering in, you know, based on seeing her and based on the first job I was offered.

 

Gary Bisbee, Jr.  07:36

So you ended up at the University of Minnesota in a medical informatics program to get your Ph.D., which, in those days, I was pretty early on to think about medical informatics and get a graduate degree, wasn’t it? So you were blazing a path there to some degree.

 

John Glaser  07:54

Well, I was early, that’s for sure. At Research Triangle Institute, after three years I realized that healthcare I wanted to stay in, but I didn’t want to write Fortran code for the rest of my life. My stepmother actually had a Ph.D. in epidemiology. And she said, why don’t you go get a Ph.D. in biomedical informatics or medical informatics at the time. And I thought, well, shoot, why not? I’m not sure what I do with a Ph.D. or why I’d get one, but it certainly seemed, you know, better than writing Fortran code. And at the time, Gary, there were three programs where you could actually get a title, you know, your degree read “health informatics” or something like that. One was at Stanford, one was at UCSF, and one was at the University of Minnesota. And I said, well, I’ve lived in the Bay Area, it’s time to go try a different part of the world. And so I wound up at the University of Minnesota, which had a great program and a variety of other things, plus the, you know, I got my expenses, tuition, and some nominal room and board coveredby them, courtesy of the National Library of Medicine. So anyway, that’s why I wound up in Minnesota. There weren’t many programs at the time.

 

Gary Bisbee, Jr.  08:50

Right. Well, you traded down on the weather, going from Duke to Minnesota.

 

John Glaser  08:57

Gary, after growing up in California, and then eight years in North Carolina, between college, this, and I got there, I couldn’t believe the settlers stopped. I said, you got to be kidding me. This is so cold. After one night, we’re off to Salt Lake City or off to Palm Springs or whatever. And then I look in the white pages, which we don’t use these days anymore, but at the time you did, and there were 11 pages of Olsons and I thought, no wonder, the Scandinavians, this is just like home. No wonder that people stayed.

 

Gary Bisbee, Jr.  09:22

That’s true. And I can talk about Minnesota because I grew up in Duluth, Minnesota. So, I understand that. Well, what led to accepting the CIO position at Brigham and Women’s?

 

John Glaser  09:35

Well, I got out of graduate school. And you know, when I got to graduate school, you know, a number of my colleagues were doing IT, sort of designing the next generation of electronic health record offering on how to represent medical knowledge. And so that’s important, but not nearly as important as making organizations adopt it well, you know, doing great things, and how organizational change was hard, and management was hard. So I wound up going to a lot of classes at the Carlson School of Business while I was at the University of Minnesota, very management centric. I came out of there wanting a interesting quasi academic environment without being an academic and wound up at Arthur D. Little, a big consulting firm in Cambridge, which brought us out to the Boston area. And after a year, I was asked to run their healthcare IT consulting practice, which I did and really loved it. I mean, great people, smart people, etc. However, a long way to respond to your question. But you know, a couple years into that, my wife said, look, we got two little kids, and we want a third, and this is the wrong time in our family’s life for you to be gone three days a week, or five days a week, and she was absolutely right. So I gotta get off the road. The second, Gary, is I’ve been dispensing lots of wisdom. You know, I’d walk in a room and I was this wise, 31 year old consultant here, you know, still umbilical cord attached. And I’ve actually never lived this wisdom. It’s like the difference between raising a kid and reading about raising a kid. There’s a world of difference, you know. So I said, well, I’ll go try it, you know, maybe I’ll take this job. It’s local, you know, it’s a great organization, it’ll get me off the road, and it’ll give me a chance to take the wisdom. So that’s how I took the job early 1988, as the CIO at the Brigham.

 

Gary Bisbee, Jr.  11:06

Well, you were a CIO, and then of course, Brigham and Women’s joined with Mass General to be called Partners, which is now Mass General Brigham. But you were there, ultimately, as CIO for roughly, what, 22 years?

 

John Glaser  11:20

Yeah, yeah.

 

Gary Bisbee, Jr.  11:21

So what were the major changes during that time? I mean, IT really almost developed completely in healthcare during that time. How do you look back on that, John? And what do you think the major changes were during your time as CIO?

 

John Glaser  11:35

Well, there were multiple, Gary, as you can imagine. One is this extraordinary change in the technology. So, when I first got there, the personal computer was still new and the network PC was new, and we used to have committees looking at PC purchases, made sure they were astute, etc. So you move from the personal computer, to the web, to the mobile device, to now AI. They say, golly, there’s been extraordinary changes in the technology. Similarly, you know, IT in the early 80s was still pretty much the back office, you know, throw coal in the boilers every morning, make sure that payroll gets done, and the lab works, and all that other stuff. And by the time I was done, it was pretty much a strategic asset, where you really begin to think about how to leverage it competitively and further very important strategic initiatives. And along the line, the clinical systems, the electronic health record, and decision support, etc. took leaps and bounds. So there’s just been incredible progress in doing that. And I think taking a complicated organization like the Mass General, you marry it to another complicated organization, and you get an even more complicated organization. So a lot of changes about how you manage very complex organizations and, along the way here, it was this move into value based care, which, you’ve seen a lot of, this sort of slow moving glacier through the valley, but it’s moving through the valley, and you began to see the real advent of measuring care quality, and worrying about errors, and how we’re doing with populations. And probably last but not least, Gary is, you know, professionally became quite active, you know, with HIMSS, and CHiME, and writing, and things like that, plus having three daughters who went from infants to outstanding young women along the way here.  So a lot of changes you can imagine in that 22 year period of time.

 

Gary Bisbee, Jr.  13:14

Well John, it started out, as you point out, back office, we’re talking health IT, particularly in a health system, back office. You ended up really working with the CEO, the Board of Directors, CFOs. I mean, it became a very strategic kind of position. How did you handle that just professionally, and personally, that growth and different focus over the course of the 22 years?

 

John Glaser  13:38

Well, I think it was fortunate. Like perhaps most folks that you talk to, I had some people along the way, who shaped me. Dick Nesson was my first CEO at the Brigham and he was phenomenal at making sure we always remembered why we were here. And that’s the care of patients etc. He was also phenomenal at taking extraordinary talent, giving them a long leash, and if they stepped in crap, getting them out of there. Jim Meaghan was an exceptional listener. So anyway, along the line are people who shaped you, and who wanted you to succeed, and wanted to understand, and were willing to take the time to go off and do that. And I think that plus, you know, developing a terrific network of colleagues in the industry, so you’re learning all the time from the consultants, and from the other CIOs, and from other practitioners. So it’s a grooming experience. Over the period of time, you become ready, and quite facile, and quite comfortable, frankly, at operating at fairly high levels with some pretty high stakes undertakings.

 

Gary Bisbee, Jr.  14:29

You may have seen, yesterday, there was an article in the Wall Street Journal about, let’s break up the IT department and move it out to the various business units. As you pointed out in a previous discussion, that kind of thought comes up from time to time, but what’s really behind that and what’s the value of thinking about moving more of the IT function to the business units?

 

John Glaser  14:52

It’s kind of a blunt object response to a performance problem. And I think there’s clearly no question, and people study, that when you get an IT group and a business group that really work well together, they teach each other, they collaborate on plans, they hold each other mutually accountable for, this is what you’re going to do, this is what I’m going to do, etc., that you can really do remarkable things when that collaboration happens. And it’s between a business unit and finance, or s business unit and HR, you can get this to happen, etc. When it doesn’t happen, you can have real problems along the way. So I think sometimes those articles are written because somebody says, golly, we’re having a bear of a time with our IT group. They’re unresponsive, they speak in weird language, we don’t get them, and all this kind of stuff. And so the performance problem is, let’s disband them all, show them how to run it. It may or may not work, it’s got a high risk proposition. IT people don’t necessarily to work for business people. They want to work for IT people and it does take a certain set of management understandings that you may or may not have. So I think you got to be careful with that kind of a blunt response to a performance issue.

 

Gary Bisbee, Jr.  15:53

Well then, after 22 years, you accepted the appointment as CEO of Siemens Health Services, which I think, and one thing, was a real credit to you and the prominence and success of your career that you’d be offered that job. Looking at it from your standpoint, what were the decision points about your accepting that position, John?

 

John Glaser  16:15

Well, Gary, you know, 22 years, I sometimes would ask, you know, why did you stay that long? I said, well one day at a time was interesting. You know, just I enjoyed it one day at a time and, all of a sudden, it adds up to 22 years just like that. It’s like life in general. But, I also began to become bored, and antsy, and said, I could do this in my sleep to a degree. And that’s not fair to me. And it’s not fair to them. So I remember actually going to my boss, who was the Chief Operating Officer. I said I’m bored. He said, take a sabbatical. I said, to do what? He said, I don’t really care. Just get this out of your system. You know, at the time, and this was late 2008, I knew the HITECH Act and meaningful use was going to pass and I reached out to some colleagues who were at the federal government and Health and Human Services, who were going to create the regulations behind that, you know, what does meaningful use mean? What does it look like? And I said, hey, if you had me for a year, would that be of interest? He says, oh, come on down, we need all the help we can get. So I spent a year in the government working on the meaningful use rules and regulations, and helping to distribute $37 billion worth of money. It was just really cool, a very exciting time to be in the middle of all that. Anyway, my time with that was over, the rules were done, the money distributed, etc. I came back to Partners and it was even worse. By dint of timing, two weeks after I got back, a gentleman from Siemens called and said the CEO of the Health Services Group has left. Do you want the job? And 48 hours later, I called and said, sure, I gotta do something because, you know, I’m going nuts. And I thought, what’s the worst that could happen? You know, the worst is I get fired. Or I don’t like it, you know, big deal. You know, those are quite recoverable, actually, you know, in people’s life, etc. So I took the job because, one, I had to do something. Second, it looked very interesting. It might be fun.

 

Gary Bisbee, Jr.  17:49

The obvious question is, compared your time at Siemens, versus your time in a health system, what were the major differences other than the obvious, the purpose of the organization was different.

 

John Glaser  18:01

I sometimes would get asked, what do you miss about Partners? I said, well, I miss three things. I missed the mission. I really believed in the mission of research, and education, and community. And it’s not like Siemens was ignorant of that. It just wasn’t front and center, you know, what they were doing like it was at Partners. So I believed in the mission.. The second is, I remember taking the elevator at the Dana-Farber and, in the elevator with me was an elderly woman with an IV pole who probably weighed 50 pounds, she was dying. And I thought, I’m reminded of why I’m here.  This is why I’m here. You know, I’m not a doctor. But this is what we are all about. So you get reminded by being proximal to care why you are here. The third is you get in these meetings with rocket scientists. And that’s just really neat. Now, you know, there are smart people at Siemens and very smart people at Cerner. I’ll give you this example, Gary. I write a letter to my family every week and I have for 35 years, you know, usually three to four pages long, covering a range of things. And a couple of weeks ago, I wrote about the fact that diphtheria, which was deadly for young kids, and can you imagine as a parent holding an infant who’s suffocating in your arms, and there’s nothing you can do. Between the time diphtheria was named and the vaccine was developed was 92 years. How long did it take Moderna to design its vaccine? Two days. Two days. Wow. And so you’re sitting with people and that’s what they’re doing. And so this is just really cool. I mean, they’re smarter than I will ever be by factor 10. But it’s just really neat to go out and do. So I miss that, even though, again, there are smart people, and etc. On the other hand, what I don’t miss is the urgency. You know, we’ve got to get things done. There’s competitive pressure, we got to move. I like the urgency. I like the clarity of decision making. It’s pretty clear, you know, how to get things done. And we didn’t waste a lot of time on a lot of committees doing this. And I also liked at Siemens, and the cases certainly the global perspective, you had to think about systems in Australia, systems in the Middle East, and systems in Europe, and that was just a very interesting perspective to happen, let alone the difference between an American academic health center and a German industrial giant.  There are all of these cultural differences that go with that. Both sides had some features that were exceptionally attractive. Both had sides that were annoying. But nonetheless, I enjoyed the change.

 

John Glaser  18:31

What about the difference between being a CEO and a CIO? How did you kind of react to all of that? Then, looking back on it, which did you like best?

 

John Glaser  20:18

The roles wee more similar than different, that’s for sure. I mean, at the end of the day, in both, you have to say, what is our strategy? What are we trying to get done here? And strategies are hard, there’s uncertainty in the environment, you don’t know how your competitors will react to this, that, and the other. So what’s the strategy? What’s the plan to get there? Are we resourced well enough? Do we have the right fannies in the right seats to make this thing happen and are we executing well enough along the way? Sooner or later, the trains gonna leave the tracks and run down the gully, and so we got to dig our way out of a ditch that we’ve, you know, done ourselves for. You’ve got people who are really talented, really good, but every now and then, they stumble or they have aspirations of… anyway, that’s all the same, you know, at a level. The same set of instincts that make you good at one make you good at the other. And in both cases, you’re accountable to somebody else. You know, you’re accountable as the CEO to a board, and to shareholders, and etc. And as a CIO, you’re accountable to a C-suite, and the medical staff and, you know, your community, things like that. So you still have that you’re not a unilateral agent, you know, so to speak here. Remember, Gary, one of the things we would say at Partners, and you can see this in other academic health centers. A 19-1 vote is a tie. Oh, for God’s sakes, you know, just a consensus based model. I’d love to be back in the mission stuff. On the other hand, I wouldn’t mind importing the urgency. I wouldn’t mind importing the clarity of decision making, etc. So, in a way, it’s like asking which of your children do you love the best? You know, I love them all for different reasons. And in some ways, like your kids, if I could just fuse you two. boy we’d have the perfect human being. But there you go. Anyway, I can’t pick one. I’d like to fuse the two if I could.

 

Gary Bisbee, Jr.  21:49

Yeah. Well, that’s wisdom speaking, John. What was the toughest decision you made while you were the CEO at Siemens, do you think?

 

John Glaser  21:58

Well, I think the hardest decision, and there were, you know, complicated decisions about, you know, do we fund a new product and will it do well in the market? And how do you sunset a product when people still depend on it, etc. The hardest decision and perhaps the one that was the biggest disappointment is I really wanted us to make a go at it at Siemens. It had struggled over the years, some bad decisions were made. And not that we were flawless, because we had our own share of decisions that weren’t so smart, but I thought, golly, we’re going to show them how to do it within the seams, big industrial giant, make MRIs and power plants, etc. And at the end of the day, that wasn’t going to work. You know, that’s not who they were. We weren’t moving fast enough in a meaningful use era. And so it was time to find, as we called it, a better owner. And as you know, Cerner became the better owner. And on the one hand, that’s absolutely the right thing to have done for the customers, and for the business, and for the industry. On the other hand, golly, I wanted to make it work. And we didn’t, we just weren’t able to do that.

 

Gary Bisbee, Jr.  22:52

And the whole Siemens operation built on shared med originally, right, the financial model that was just an awesome, awesome financial product that was, I’m sure, hard later on the clinical side, and then finding a better option as a solid business. So that was a tough one. Let’s go to data, healthcare data. The importance of it and the magnitude of it has changed a lot over the last 20 or 30 years. You were at the HITECH Act, you were right there at the beginning as the regulations were being developed. How do you view the importance of the HITECH Act to digitizing medicine?

 

John Glaser  23:33

Well, I think it was exceptionally important. I remember sitting in the halls of the Health and Human Services, and you could see they had a board with one big S curve, which was, at their time, the thought of, here’s the accountable care. Value based care is going to have an S curve that looks like this. You say, well, if that’s the case, it’s impossible to do value based care really without a digital foundation. That’s correct. So we actually have to precede this S curve of value based care with an S curve of adoption. And that’s why meaningful use came to be and you say, did it in fact give the two year, what it was supposed to do, headstart, three year headstart, on laying the foundations? Absolutely. You know, we went from 10% of hospitals are numbers like that of using sophisticated clinical systems to 90%, of physician practices too. So it really laid the foundation in lots of ways. So, thumbs up. Accomplished. It also elevated the role of the federal government and the healthcare IT landscape immensely. Largely before that, the insurer would deal with HIPAA and a variety of other things. But now it was the biggest gorilla at the table, in terms of what was going on there, etc. Now, it created or left some what I call hangover issues. So, you know, usability is still an issue. Interoperability is still an issue across the board. And I think, Gary, frankly, a lot of organizations said this is a mandate. I’m going to install it and check the box, you know, just get my check, and I don’t lose conditions of participation in Medicare programs. But what they never really did was to optimize use of it to improve care. They just, quote, installed it, like installing new fixtures in your toilet, etc. So I think there’s some untapped potential in there. But nonetheless, the federal government laid the foundation exposed, some secondary issues, and elevated its role in the conversation.

 

Gary Bisbee, Jr.  25:14

Interoperability is obviously a big issue. I’m sure you all knew it. There are just a bunch of barriers there. What’s the timeframe, John, do you think to kind of resolve this interoperability gap, if you want to call it that? Will we see, at the end of this decade, will we be through this or what’s your thinking?

 

John Glaser  25:32

Well, I think, as we’ve all seen in the 21st Century Cures Act, there are some provisions there that made it really, if you were, quote, engaged in information blocking, you got beat up a little more severely than you might have in the past, and laying out certainly application programming interface standards, etc. The other thing, Gary, is I think we have to be a little bit more thoughtful and real about this topic. In no industry is there broad interoperability, end of statement. So sometimes we get into this conversation, golly, you can go anywhere in the world, use my ATM, and get some money. That’s true. On the other hand, if you were to go to your bank tomorrow, say Bank of America, whatever it is, and say, I want 20 bucks. And then Bank of America says to you, Gary, you don’t have it, you only got 10. Tell you what I’m gonna do, I’m going to reach into your other bank accounts, the one you have at Citizens and Wells Fargo, see what I could find. And if I find 10 bucks, I’m going to bring it back and give it to you. That does not happen. Why does it not happen? Because the banks don’t want it to happen. Why do they not want it to happen? Because they don’t want somebody to say, holy smokes, Gary’s got a lot of money. Maybe if I send him some, you know, inducements, he’ll leave Wells Fargo and come to Bank of America. So in all industries, there are real limits to interoperability. Hilton’s best deals don’t show up in Expedia, they show up on Hilton.com. In financial services and travel, it is more advanced than in other industries, you see three things. One of which is focused on a limited targeted set of transactions, you know, restricting cash, or, in our case, prior authorizations, perhaps, or insurance claims, etc. So very targeted set of transactions. Second, very clear business cases when there’s a case. So people say, I’m willing to pay for that, you know, I do want to see that happen.  It’s different from a use case, which is, that’s cool, but you know, don’t ask me to cough up money for that. And the third is a body which brings all the players together that says, let’s hammer out the details of standards, of capital investments, etc. In banking, Swift is one of the organizations that does that. The Open Travel Alliance does it in travel. So will we ever see it in healthcare? We’ll see it better. Will we have this sort of nirvana of free flowing data everywhere? Not a chance that that will happen. It’s never happened anywhere.

 

Gary Bisbee, Jr.  27:30

Yeah, that’s a well reasoned point. You mentioned usability. What about usability relative to doctors using the EHR? How will that unfold over the rest of this decade?

 

John Glaser  27:42

Oh, I think it’s a tough one, Gary. I think there are multiple levers you can pull and are being pulled. Sometimes the design is crummy. So you know, no wonder because it’s confusing, etc. I do think there’s some technology that can help, like we’re making a lot of progress in voice recognition. So rather than type, you just talk. And it is really real progress in sort of allieving some of the the interaction burden. So we’ll make technology advances. Sometimes, it’s because these things are poorly implemented. I mean, KLAS, you know KLAS, did a study once and found that, for Epic and Cerner customers, there are organizations that are happier than happy and organizations that matter that helps about the whole thing. And same system, you know, same Cerner system on both, same Epic system in both. Why? Well, it’s, you know, training was good at one, not so good in the other, workflow design, you know, all the stuff that goes in implementation. So, the designs, did we implement it correctly? Did we train people correctly, and this, that, and the other. I think the third thing that we can do is be sanguine about the fact that, how long would it take you to write a prescription on a pad? Two seconds. How long is it going to take you on a computer, no matter how well you do it? 30 seconds. So some things will just take longer. We’re asking you to take a burden because we want clarity and decision support, etc. And then last but not least, Gary, I remember, you know, sitting in these meetings at Partners doing a design of our electronic health record. We wrote our own for, you know, several different reasons. I always remember listening to this committee of doctors saying, while we have them, why don’t we have them do this? Let’s ask. They should ask about smoking. They should ask, are they safe at home. They should ask about this. And they should ask about this. All these are really good things to do. In aggregate, they’re lethal. And they just sort of, you know, overwhelm the doctors, what I call the tyranny of large numbers of good ideas. It’s just crushing. So part of it is, let’s take some burden off their plates, you know, some of the documentation is crazy, and why are you doing it when we could have someone else in the practice do it, etc. So part of it is just distributing the work. All of those have to play out to address the usability issue. None of those are quick fixes.

 

Gary Bisbee, Jr.  29:40

Right, for sure. Well, we’ve seen a lot about AI, machine learning, and how that is being used or will be used in healthcare. What’s your view, John, how will that unfold over the rest of the decade? How important is that? Will they be used both for clinical and administrative purposes?

 

John Glaser  30:00

I’m actually finishing up a book with two colleagues on AI in healthcare. And so it’s actually due to the publisher within 30 days here. So anyway, we’ve talked a lot about this.

 

Gary Bisbee, Jr.  30:09

Well, John, you’ll have to come back and we’ll talk about the book

 

John Glaser  30:13

Special deal for you guys, hot off the press. I think, Gary, a couple things. One is it’s kind of interesting when you look at the history of IT use by industry. About every 10 years, a technology arrives that just changes the world dramatically. The mainframe in the 60s, the mini computer in the 70s, the network personal computers in the 80s. In the 90s, it was the web. You know, Amazon, founded in 1994, Google in 1998, the connected mobile device in the decade 2000, and the iPhone debuted in 2007. And you say, well, what’s it now? And it’s AI. And you say, but it’s really early. You’ve probably seen, and maybe most people listening, have seen the Gartner Hype curve, you know, the peak of inflated expectations, trough of disillusionment, and path of productivity. When they place various AI technologies on that curve, it’s all to the left. It’s all in inflated expectations. It’s all a trough of disillusionment. There’s very little in mature use. So we are early. And so it’s really hard to work your way through all the issues, like bias, and black box, and, you know, this kind of stuff here. We’ll get through it just as we got through the Sinclair and the Osborne, all these rinky dink little personal computers way back when. So I think where we’ll see it, Gary, we will see it fairly soon on the administrative side, doing prior authorizations, helping with coding, helping with scheduling, etc. Why? Because there’s not a whole lot of regulatory oversight needed here. The ROI’s a little clearer. The AI machine learning is a little easier to get done, etc. The rollout on the clinical side of helping a doctor make a better decision, or you and I make, that’ll take longer because the regulatory and the complexity of it all. So nonetheless, these things take time to play out. This takes years to play out. And so, you and I will have this conversation a decade from now and say, wow, look at what’s happened in the intervening 10 years. But we might have a conversation in a month and say not much has changed in the intervening month.

 

Gary Bisbee, Jr.  32:00

Well, you published recently an article in the Harvard Business Review, something about the five principles of consumer experience. Share with us, John, if you would, the themes of that article.

 

John Glaser  32:12

I was at CHiME, which is the healthcare CIO meetings, and being a former CIO listening to a number of my colleagues talk about what they call the digital front door in their organizations. And basically, it says we want to give a digital setup whereby patients can find a doctor, schedule an appointment, look at the results, pay their bills, etc., sort of ease the experience, the consumer patient experience and, you know, perhaps catch up with what you have in other parts of our lives, like banking and checking into flights, etc. So they were talking about the digital front door, and it’s a smart thing to do. And I thought about that, I said that’s a smart thing to do. However, you ought to think about five things, you know, as you go about this type of stuff. And that’s what the article is about. Here are the five things I think you got to consider as your plans evolve here. One of which, Gary, and you’ve probably seen this too. In healthcare, there patients and there are consumers. People receiving care. People like you and me making decisions about breakfast or, you know, what kind of car we bought. And we keep the two separate. And they’re not separate at all. In fact, patients are always consumers and consumers are always patients. So as a patient, you make a decision. Do I take my meds? You know, do I do my rehab? Do I stay with a doctor? I’m making consumer-type decisions. And as a consumer, you’re making decisions about your health all the time. Do I get up and go running or not? What do I eat for dinner? All this stuff here. So I think, you know, one of things you got to be careful about in healthcare is treating them as separate individuals, separate personas.  They’re actually the same, so just be careful about that. So that’s number one. Number two is, you’ve got to be careful about the term, digital front door, because often in the first wave of IT digitization, you take a physical thing and you make a digital equivalent, but you preserve the name. Automated teller machines. Well, it’s an automated teller is what that is. The electronic medical record, well, it’s paper medical record, but it’s electronic, etc. And we’ve done the same with a digital front door. You walk into the hospital, you walk into the doctor’s office, and so you got to be careful with the label because it can imply that there’s a physical structure. That may not be the case, you know, it may be at home, it may be walking around with a device on you. It implies that we will care for you once you ring the doorbell, we’ll react. Well, you’ll always have to do that. But you might want to think about, proactively, all the time, reaching out. Plus, you and I know this. It is more than the technology. It’s the process change. You know, I really want the appointment with the doctor, not just the electronic equivalent. And a lot of this stuff is directed to the ambulatory practice, but it covers all experiences across the healthcare system that have got to go on. So basically, Gary, these are the things I would encourage us to think about as we go into the next stage of whatever it is these organizations are planning to do in the digital front door.

 

Gary Bisbee, Jr.  34:52

Yeah, it was a terrific article easily readable. So congratulations on that. Definitely a good one for all of us. John, let’s turn to governance for a moment, if we could. You’ve sat on a number of boards and sit on a number of boards. What do you enjoy most about being a board member?

 

John Glaser  35:10

Well, I think there’s a lot of things, you know, one of which is, you’re working with some pretty talented people, you know, fellow board members, the leadership team of an organization, who are trying to do pretty impressive things, you know, in overcoming some non-trivial obstacles, and that’s just the sort of the team sport of working on complicated meritorious challenges. That’s always fun, you know, and it’s been part of my career, your career, etc. And that’s sort of a way to go off and do that. So I really enjoy that part of it. The second is, because you can be on several, is you have different lenses into the industry. There’s, for me, a telemedicine lens into the industry. There’s a measurement of quality lens into the industry. And so you can see this industry from multiple vantage points, which is just kind of interesting to go off and to see. And the other is, you know, unlike the sort of nine to five day job, there’s a lot more flexibility in terms of time. So, you and I were talking before this about being grandfathers and so just time with grandkids, which is always fun to do, or visit places on this planet that I haven’t seen yet. I’m not sure I will, given however long this pandemic lasts. But nonetheless, I wouldn’t mind seeing more of it. So I enjoy the same team element that has been part of my career, yours too. But, also the advantages of seeing lots of different perspectives.

 

Gary Bisbee, Jr.  36:21

John, you’ve been both management and obviously a board member. One of the big issues that I’ve always found when I’ve been on boards is that balance between management, governance. Management and governance each have swimlanes. How do you handle that situation, John?

 

John Glaser  36:40

Well, it can be tricky. I mean, at the end of the day, I think you have to remember as a board member, that you represent some constituency. You know, your job is to represent the shareholders in a for profit board. In Partners Healthcare and others, your job is to represent the community. So your job is not to represent management or be their shill. Your job is to represent and make sure the interests of the shareholder, or the interest of the investors, or the community are there. Part of is just remember that, you know, keep that in the back of your mind. That being said, you want to make sure, if management is acting in accordance with that, that you were supportive as you can be. Your job is not to get it done. It’s their job to get it done. Your job is, first of all, given this, what are the legal things you have to do about compliance and make sure those things are happening so that you’re protecting the interests legally and regulatorily of the community you’re serving. But it’s to support those things and help as needed to help, with guidance, with opening your Rolodex, whatever it might happen to be. You know, in some ways, it reminds me of raising children, particularly adolescent females, because there were times in the discussion with a daughter who’s 15 or 16, you say I’m not so sure I would do that. Now, there’s a fine line between where you step in and say, I’m your father, no, because I just think that’s asking for huge trouble, versus, you’ve got to learn, kiddo. You know, you’ve got to go off and do your thing and I’ll support you, and I’ll love you madly, etc. So there’s always that kind of fine line at times where you say, you know, jeez management, your call, you’re on the hook, you know, whatever, versus 100%. So anyway, there’s a bit of a challenge, and at times you want to get in and run it yourself. That’s not your job. That’s their job to go off and run it. But that being said, and I think good board chairs can sort of slap your hand when it’s inappropriate, and good board chairs can sit down with CEOs and other members of the board later on and say, let’s talk about how we sort of get the balance back, if we, you know, wandered off a little bit.

 

Gary Bisbee, Jr.  38:26

What are the characteristics of an exceptionally good board member, John?

 

John Glaser  38:30

Oh, I think, Gary, a number of things. There’s the usual of any senior leadership person, that they’re bright, they’re honest, they’re direct, they communicate, all the things you’d want to see, you know, just regardless of whether a board member, or a C-suite person, or the management level, you’d want to see that and things like that. I think they bring something to the table that is clear to them, and clear to the others. And that can be because they know a whole lot about a particular topic that’s really important to us, or they’re about as well connected as anybody could possibly be in the industry, or they bring a brand and a legitimacy, frankly, because they’re on the board, this board must be-, whatever it is, it’s clear why there’s an asset that you bring to the table across the board. You know, other things if you keep going down the list is they take the time to understand the company and what it does, and its customers. You say I’m really gonna learn a lot and I got to do more than surface learning, I gotta learn. It doesn’t mean I’m making widgets with the rest of them, but I’m in there learning. And the other is you’re prepared when you walk in and deal with issues, and you’re responsive, etc. So your job is to coach and support as needed, which means you know, you got to be prepared, understand the industry, understand the players, etc., and know when and how to respond across the board. In some ways, that’s kind of a lot of what management does, you know, depending on your management style, is the, you know, all of the above.

 

Gary Bisbee, Jr.  39:51

John, this has been a terrific interview. I have one last question if I could, and that is, in our audience, there’s a number of of earlier stage or up and coming leaders. What advice do you give to up and coming leaders?

 

John Glaser  40:07

Gary, I think there’s probably three things to do. And these will sound a little entanged. One is, always trust your instincts about this, that, and the other. I’ve mentioned before, when I got out of college, I didn’t know what to do. I didn’t want to go to med school, didn’t want to go to law school, and I thought, I don’t know what to do. What the hell, I’m going to go hitchhike for a while, etc. So in retrospect, at the time, I thought, golly, everybody else is so certain. And I’m going to be the one who winds up in the trash heap here. But my instincts were that that was not me. And I followed that. And similarly, I got down to Panama. And I said, you know, I’m madly in love with this woman. What the hell am I doing down here in Panama? I’m gonna go be with her, it’ll work out. So trust these instincts that you have. It goes with the second thing, which is understand who you are and what you believe to be true. And so there are certain things that you value and, like, part of our earlier conversation, I value the mission, you know, and I value this and I value-. Understand that, and understand how you learn, and understand what you like and don’t like. And so don’t do things you don’t like. Last thing, Gary, is, you know, at the end of the day, all of us pass away, and you say, well, if I had five minutes left, and I wanted to look back on my life, what would I want to say about it? And so you ought to have that list. What do you want to say? And to make sure that any given day, you’re doing the things that help you say what you want to be able to say when that time comes? And sometimes I get asked, well, John, what would you want to say? I said I want to say five things. I want to say that I’m as madly in love with my wife then as I am now. The second is that my three daughters will have led lives as blessed as mine. They’ve taken their own paths and God love them, etc. But they will be as fortunate as I’ve been. The third is that I’ve been spared crushing pain, and poverty, and bigotry, etc., and all the crappy things that can happen to people. And if I’m not spared, at least I dealt with it with courage. And then the fourth is that the people who I work with will say I inspired them, taught them, and lead them well. And then the fifth is that the industry I served and the organizations that I served are better because I was here. There’s never going to be a plaque to me in some, you know, monument somewhere, that’s okay. And if you can say those five things, or whatever your list is, then you will die with a smile, etc. So those are the three things. Trust your instincts, know who you are, and, you know, you can’t really develop that list when you’re 16. When you’re 36, you’d better be able to do that. And so that’s what I would pass on to the folks who are listening and who have terrific and brilliant careers ahead of them.

 

Gary Bisbee, Jr.  42:26

John, great advice. We appreciate your time today. Well done.

 

John Glaser  42:31

Thank you, Gary. It was a pleasure and it’s always good to see you, and thanks for taking the time. I enjoyed it.

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