John Glaser, VP & CIO, Partners Healthcare
Over the past year, John Glaser, Ph.D., has been eating and breathing Meaningful Use and Certification even more than his HITECH-focused CIO colleagues. That’s because while Glaser has kept up his role as VP & CIO at Partners HealthCare on a part-time basis, he’s also been winging down to D.C. every week to fulfill his duties as Senior Adviser to ONC and its chief, National Coordinator David Blumenthal, M.D. In this — his first extensive interview since the culmination of that role in March — Glaser talks frankly with healthsystemCIO.com editor Anthony Guerra about working in the federal government, the proposed regulations, and what the future may hold for both the industry and himself.
PODCAST
[audio: One-on-One-W-John-Glaser-Chapter-3.mp3]
BOLD STATEMENTS
… one of the things that will have to be managed is whenever the certification process is in place — and I think there will clearly be a couple of organizations that will be ready to put their stamp on the envelope when the gates are open — they’ll have to be ready for what could be lots of players coming forward.
Regardless of what the Meaningful Use percentages are, 80%, 50% or whatever they happens to be, we’re not there on a lot of these percentages even if they’re lowered a bit.
You have to be careful because the medical staff, the nursing staff may feel like they got run over by a steamroller, and you might cross the finish line, but you’ve left a whole lot of ill will there.
GUERRA: What can you tell us about the comment review process? Technically speaking, is ONC reviewing the certification comments and CMS reviewing the Meaningful Use comments? Are there are a bunch of people in a room taking turns reading the letters out loud (laughing)?
GLASER: The question is how does it really work? Obviously, people submit comments. There were, I guess if I heard correctly, 3,000 on Meaningful Use; I’m not sure what the count was on the standards and certification criteria, but they’re all submitted, and there’s a period of time in which the gates open and then close. After they’re all received, they are all read and there is staff who go through them and compile and summarize the comments. So, for example, you might send in a comment letter, and you have five points you want to make, and staff read those and say, “Well, let’s see. Anthony is making a point about these criteria and he makes another point about that standard, etc.,” and so they keep track of both — they look at what people are commenting on and the nature of those comments, both overall and in specifics.
And so they’re all read and sometimes the people reading them will point out a couple and say, “Listen, you know, John or David or Farzad, you ought to read these comments because they contain some particularly interesting ideas,” and then they’re summarized. So you wind up with a spreadsheet that says we got 3,000 and 500 are from hospitals and 1,000 are on this. The spreadsheet would show who submitted them and a summary, so people can see where the bulk of comments are centered. They can see if there was agreement at least on the vast majority of letters.
And so what you wind up doing is getting a feel for where is it that the industry is focused, what is it particularly worried about, what it is particularly supportive of. You can see if the support is different depending on whether you’re a hospital versus an employer, etc., and what it’s focused on. There are a lot of staff meetings in which people around the room are sitting there and looking at these summaries, trying to resolve where there’s real differences of opinion, what do we want to do about that. If everybody’s on board about A, well, then terrific, we don’t have to spend much time on it. If everybody’s against B, there you go. It’s when we get to C and the people are all over the place that the internal discussion takes place about what’s our position and posture, because what they also have to do is report back and say, “We accept this one, we reject this one, and this is what we’re going to do about this one,” and so there actually has to be a feedback loop that takes those conclusions of internal discussions and ties it back to both the aggregated and specific comments received. It’s a lot of work, an amazing amount of work.
GUERRA: The multi-part temporary certification process seems like it will push the dates well into fall. What’s your best guess as to when the regs are going to drop, and are you concerned about this timeline getting pushed down into the fall?
GLASER: Well, I think they’re hoping to get all three rules out pretty soon and, again, I’ve been out of the loop for about six weeks now. I don’t know if they’re still holding onto that timetable, and I think you’re right. There is an intention of getting at least the interim certification process up fairly quickly, which is also one of the reasons they had both the temporary and permanent certification process in place. I don’t know whether they’re still holding that schedule or not. I think you’re right. The industry can be worried about timing. There’s a big lineup of people — and not just the same people lined up at CCHIT — but all kinds of new players who are going to line up, modular players for example.
The fact that the criteria are focused on Meaningful Use, so it’s not covering the same breadth of terrain that CCHIT covered, means it’s much more targeted. Looking at some of the draft certification tests that have been put out by NIST makes you say those ought to be doable in a (limited) period of time. As they roll forward a lot of people can start looking at their products and asking, “If that’s what it’s going to look like, how would I fair?” So you can do a pretest in a way. I do think that one of the things that will have to be managed is whenever the certification process is in place — and I think there will clearly be a couple of organizations that will be ready to put their stamp on the envelope when the gates are open — they’ll have to be ready for what could be lots of players coming forward.
My own view, and putting on a CIO hat at Partners Healthcare, is that I’m not so worried about the certification process or the timing of it. I’m more worried about whether the system implementations we still need to do — to get the capabilities in place — can be accelerated without being crazy about them. Regardless of what the Meaningful Use percentages are, 80%, 50% or whatever they happens to be, we’re not there on a lot of these percentages even if they’re lowered a bit. So we’ve got some big time work to do with the medical staff and the nursing staff to change the workflow, to understand what to do, etc. So I’m less concerned about the certification process although, obviously, it has to be executed and executed well, and executed as soon as it possibly can. There will be a challenge dealing with this long line out the door. I want to make sure that we here at Partners focus on the work that we have to do to get these systems in place and get the use levels up, and that actually may be harder, at least for me anyway, harder work and more of a gating factor than whether the Meditech we use, the Siemens we use, or even our own internally developed stuff is certified.
GUERRA: You talked about having to move quickly. Do you think there’s an increased risk of introducing HIT-related patient safety errors when the timelines are accelerated?
GLASER: Well, I think anytime you’re in a provider setting, and you have a big system implementation, there can be reasons you want to accelerate, you want to go fast, and whether it’s for Meaningful Use payment or to decrease straddling costs — half paper, half automated and you say, “Geez, can’t I just get it over with, pull the Band-Aid off fast?” — I think you have to be careful about going too fast. You have to be careful because the medical staff, the nursing staff may feel like they got run over by a steamroller, and you might cross the finish line, but you’ve left a whole lot of ill will there. You’ve got to be careful because you think you know how processes ought to work, but you don’t, and you move too fast and you screw things up. Then the operation doesn’t work as well, and I think you could wind up with care situations in which patients are more at risk than they ought to be. So I think there is always this complicated balance about, “Well, let’s move as fast as we can because it’s painful to be in mid flight, but let’s be really thoughtful about how to do this.”
I think that any provider organization that says, “Listen, our job is to get our (Meaningful Use) check as fast as possible, and do whatever the hell we have to do to get it,” that’s wrong. I mean that’s just bad management. It’s also introducing a risk to the organization, which is not helpful in a lot of ways. So you could put on a safety lens. I think that’s an angle of it. It’s not the only angle to it, and you can wind up scaling the technology too fast to the point where (good) performance at a modest scale then turns to garbage at the high end of the scale.
So I think the industry has to say, “Yes, I want to pursue Meaningful Use, but I want to do it as prudently and as efficiently and as quickly as I can. I have to be smart about it, and I have to remember all the things that we have learned over the many years that we’ve all been doing this.” At the end of the day, it’s not whether I get my check in 2012 or 2011, it’s whether I wind up with a more effective organization at the other side that delivers better care, safer care, more efficient care, because that will pay dividends over the long haul that dwarf whatever particular check I might get in any particular year.
I think we’ve got to be careful – and this could be a message through your writing or a message through the AHA to its membership. I say let’s go after the money, that’s what it’s for, and go after it as quickly as you can, because our patients in the healthcare system need it, but let’s be the thoughtful and prudent managers that we know how to be in the course of doing this.
GUERRA: So you’re finished at ONC? Stages Two and Three will not have John Glaser involved in their formation?
GLASER: I am certainly finished with my ONC role and I’m happy, as are you and others, to comment and critique on Stages Two and Three.
GUERRA: You get to be a critic too. (laughing)
GLASER: That’s right.
GUERRA: We talked at a few events during your stint at ONC. Once was at the CHIME Fall Forum. What was it like for you there? I’m sure everybody wanted an inside tip. Everybody wanted to know what’s really going to happen. Was it odd for you to be in that position?
GLASER: First of all, they’re all my buddies and colleagues, and the whole industry, as you know, is just thirsting for insight and still is about what the final rule is going to say, about when will the certification program be stood up and all that other stuff. When you get that much uncertainty, when the stakes are what they are, any nugget that removes some of that uncertainty is really sought after. So I get it.
On the other hand, one of the things they tell you, both as a federal employee and as a contractor (which is what I formally was), is that if you disclose inappropriately, you are risking committing a federal crime, and so I didn’t really have any interest in wandering into that territory, so you just have to keep your mouth shut about this kind of stuff. You may find some broad indication, but you just can’t talk about some of the specifics. So it was kind of odd knowing that there were certain things you’d love to tell them because they’re your colleagues and your buddies, but you just can’t do it without getting in a lot of trouble personally, and also without undermining the process that’s underway. Another problem — if I were to blab to all my CHIME buddies — is that it would have been unfair to those people who weren’t part of that conversation, so you really have to be careful about it, you can’t advantaging one group over another in the course of any one of these things.
GUERRA: So if ONC calls you in a year or two, let’s say David decided to move on to other things, and they say, “Hey John, why don’t you become the national coordinator?”
GLASER: I think he’d be a hard act to follow. I think he’s done, and I’ve known him for awhile, a stunning job. What he’s done in a year is impressive. So I think recognizing that those are big shoes you’d have to fill would cause you to figure out if that was intimidating or stimulating, etc. Who knows? Who knows what will be going on in the country at that point, and whether Partners Healthcare will have said, “We’ve had enough of you. How long are you going to last? Why don’t you go off and do something different?” So it is a remarkable place to be. There are elements of being in the federal government that are maddening, but there are elements that are just incredibly rewarding.
GUERRA: Did you have anything else you want to touch on because I think that’s a great place to conclude things. That was an excellent talk.
GLASER: I’m good, Anthony. I think we all have a lot to talk about when the final rules come out to get our heads around it and see what we can or can’t do, etc. I, frankly, think we’ll be talking about this for a couple of years. There’s the final rules, Stages Two and Three, RECs, HIEs — we’ve got a lot of stuff to come together around as an industry, and help each other understand and guide each other as we go along here. So I suspect you and I will chat more than once in the months and years ahead.
GUERRA: I’m looking forward to it my friend. Thank you so much for your time today.
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