As a former health system CIO, John Glaser understands the challenges that today’s leaders face. And it’s that experience that has helped guide him in his current role of CEO of Siemens Health Services, as the company works to grow its core products while developing an ambulatory solution to meet the evolving needs of care providers. In this interview, Glaser talks about moving away from a transaction-based model, how vendors can best integrate customer requests into their strategic plans, and the increasing importance of incorporating business intelligence and analytics into the overall strategy. He also discusses how Siemens has handled the healthcare IT workforce shortage, and why leaders need to remember what healthcare IT is all about.
- The state of Soarian Ambulatory
- Getting away from the transaction-based model
- The MobileMD acquisition
- The NextGen relationship
- The customer wish list (when to lead, when to follow)
- Bringing a customer’s perspective to the vendor side
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There is a need to have those two worlds very tightly integrated, very real-time, so that if you see your scores or your performance dipping on managing a population of diabetics and asthmatics, not only can you move quickly on that for clinical reasons, but also for reimbursement reasons.
You have to be careful here. These are substantial investments with a lot of money involved. There’s a lot of work in putting these things in place, and you don’t want to do this every five years. You want to make a series of investments and decisions which have really quite durable value.
What you try to do is to get that balance between here’s what we can do today and here’s what we can do in the future. You need to keep your eye on both. And customers, particularly when you have discussions about what is to come, respond to that.
Ten years ago, you might have been able to tolerate a certain amount of scheduled down time, and increasingly, you can’t tolerate that. In fact, if it gets to be longer than a couple of minutes, it becomes highly problematic. So you realize that the bar is getting raised.
They want to know what you’re going to do, what you’re not going to do, and when you will deliver it. And if you’re going to have trouble, talk to them about that. What drives people up the wall is if they think you’re not telling them everything.
Guerra: Good morning, John. Thanks for joining me in what is turning into our annual pre-HIMSS chat to talk about your work at Siemens and how things are going over there.
Glaser: It’s a pleasure to be joining you, Anthony.
Guerra: All right, let’s start off with what I’d think would be the issue of most interest to current and prospective Siemens customers, which would be the state of development of Soarian ambulatory. So feel free to start where you like, give some background information on what you’re offering now and the timeline for what you may be offering, and you want to frame the overall issue of having that integrated in-patient ambulatory solution — that seems to be what the market wants these days.
Glaser: Fair enough. If we look into the years ahead, and it’s a result of the passage of the Accountable Care Act, but there are all kinds of complementary activity on the part of the private sector and also state governments. It’s clear that we’re going to go through a very significant, very profound change in how providers are paid for the care that they deliver. And so they will, as you know, be incentivized to deliver high quality care and safe care and efficient care. And they’re going to be incentivized to coordinate care across multiple venues and this can be a total hip replacement, which has outpatient work, in-patient work and then rehab, or can be the management of people with chronic diseases.
We all see these coming and the specific forms of it are still fuzzy, and what they will really look in 2020 is unclear, but nonetheless, the basic idea that you have to coordinate and care across venues and you’re going to be incentivized to deliver high quality and efficient care is going to be very much part of our landscape. So when we look at that, we have to take our core products, which have been hospital-based for many years, and continue to grow those and extend those. And so we will be presenting at HIMSS a new version and a very sophisticated version of the Emergency Department application, along with advances and documentation in CPOE and things like that. But it also means that we have to have an ambulatory solution and we’ve talked about having that. We will be demoing portions of that at HIMSS so that people can get a feel for how we’re thinking about it and what the product looks like.
One of the things you have to bear in mind is that it’s not like the industry has not had ambulatory records; it has, for decades. And they’ve largely emphasized the transactions that occur in the course of taking care of someone: writing a prescription, documenting care, retrieving results — very transaction-centric and obviously wanting to be fast and intuitive and all of that stuff. And that will continue to be the case for the years ahead, but we’re adding additional challenges to those who deliver care. We’re going to ask them to manage populations. We’re going to ask them to coordinate care.
The ambulatory record in the years ahead will be the same as the ones we’ve seen in the past, but different. It has to have capabilities which have not been present in the past or certainly not as well developed as they might have been in the past. So we’ll be presenting that and talking to folks about our vision and our thoughts of ambulatory and showing pieces of it. We also informed the sales force back in our annual meeting in November that we expect to be entering into contracts for the ambulatory record by late summer or early fall. And so those customers who are interested in pursuing this will be in a position to sign up for this and be ready for the payment challenges as they come. We expect that about a year from now, the first version will be generally available and it will take care of the Meaningful Use requirements and then the product obviously will evolve from there on out. So that will a big announcement for us; a big set of opportunities to engage with customers about what we’re doing there. But we also couple that; we’re looking at this care coordination accountable care era. And we’ll also be talking about MobileMD, the acquisition, as you know, we made this summer, and how that fits into the exchange of data between applications.
I think one of the things we appreciate, Anthony, is that by and large, most accountable care structures or integrated health systems maybe largely contractually-based in that one provider contracts with three or four others to form an ACO but doesn’t actually own them. And hence, you’ll see a heterogeneous systems that are out there, and that will be more common than not. And so the HIE is a way of sharing data between those heterogeneous systems. They might be ours, they might be Epic’s, they might be Cerner’s, Allscripts’, etc, and the HIE becomes a critical contributor to that. We also think, and this will be part of the discussion at HIMSS, although our plans are still evolving, that there will be forms of electronic health records that sit on top of the HIE and sort of become this interstitial EHR that sits between very heterogeneous types of applications.
So on the one hand, you want to have a Soarian-based ambulatory record, but on the other hand you know that you’re going to be in the heterogeneous world and so you’ll have to co-exist and coordinate care across those platforms. It also means that our Nextgen relationship remains very important to us because some organizations will have reasons to go off and get a system separate from Soarian, and maybe because the clinical relationship is loosely coupled rather than tightly coupled. So we’ll have two prongs—both the Soarian and the NextGen, and leveraging MobileMD across all the boards.
The last piece I will add—or the two last pieces—is that the other thing that we see in this new era is increasing importance of business intelligence and analytics, because increasingly, your clinical performance will have more and more significant revenue performance. There is a need to have those two worlds very tightly integrated, very real-time, so that if you see your scores or your performance dipping on managing a population of diabetics and asthmatics, not only can you move quickly on that for clinical reasons, but also for reimbursement reasons. And that will be coupled by the work we’re doing on predictive analytics so we can target those members of our populations or the providers’ populations who need special attention, and also coupled with algorithms that help one do a better job of making a diagnostic and therapeutic decision so that we get it right the very first time.
And then rounding out, one of the things that came with the MobileMD acquisition was a patient portal, and so we’ll be leveraging that work to provide a lens into both Soarian ambulatory and also the inpatient, the ED, and the range of products and services that we have. So I gave you maybe a lengthier response to your question and the question that you asked, but there you go.
Guerra: Well that’s what makes my job easy. People don’t know that I get to relax while you’re answering, so I appreciate that long answer — just kidding. What I’m thinking is I’m putting myself in a position of one of your Soarian inpatient customers. And what I might hear them say is, ‘John, that’s all great. I want Soarian ambulatory now. I want it as soon as possible. I want it baked. I want it finished.’ People are making huge investments, millions and millions of dollars to get that with other vendors. So I know these things take time and you talked about maybe a year, and I’m just wondering, how do you combat what could be frustration? What do you tell these customers that need it now?
Glaser: Well I think there are a couple of things. One is, when you say an organization says ‘now’, it kind of depends where they are in the process. But now could mean that they’re still in the stages of examining the market and making decisions, engaging their clinical staff, understanding their objectives, etc. And so I’d say if you’re in the early stages of ‘now,’ then you’re timing might work quite well with our timing. And by the time you’ll have closure on this, we’ll be ready for you in lots of ways.
The other thing is they may be on some other EHR which is fine for the time being, but it’s not really the path of the future. They really want a much tighter integrated one, but nonetheless, for the next year or two years, they can stay where they are. They just don’t want to stay there for five years or 10 years. And to that, I’d say you might be in a position to wait for a year or two while we get this thing ready.
And then the other comment we make at times is that you have to be careful here. These are substantial investments with a lot of money involved. There’s a lot of work in putting these things in place, and you don’t really want to do this every five years. You want to make a series of investments and decisions which have really quite durable value—10 years or 20 years. I think we have customers who go back 30-plus years who have been with us for a long period of time.
What you want to do, in addition to taking caring of today’s needs, is position yourself well for that which is to come. So when you look at the challenges placed on the provision of care and the need to not only be efficient in the course of the transactions associated with the encounter, but to be in a really good position to manage a population and a really good position to coordinate care to an effective medical home, to deal with the complex reimbursement environment, and realizing that some of the critical assets that Soarian has — the workflow engine, the rules engine, the analytics — will be incredibly important to you in the years ahead.
I think if you look at the longer term perspective, then you want to make sure that the choice you make today or the path you start on today is something that will be terrific and critical to you and highly supportive of your clinical and administrative and revenue cycle strategies for very long periods of time. So my caution is that I’d be careful about making a move too fast and discovering a couple of years out after you spend a lot of money and put in a lot of effort that in fact, it was suboptimal. There could be reason that you have to turn it on in March of 2012 and we’re not ready in March of 2012—we won’t be ready in July of 2012. But to the degree that a selection time table works with us, or to the degree you can stay where you are a year or two, and to the degree that your vision and sense of what you are acquiring and the relationship you are forming is one that has to last for a very long period of time and you want to be very, very well positioned for the challenges that are coming. And I would say I think it is worth the wait, and the wait, frankly, is not that long.
Guerra: Okay, two things. When you describe the coming year, you talked about coming to the market and showing the market or the potential customers the direction that you’re going. Tell me a little bit more about how you want that dynamic to work and how you make sure you don’t get into a situation where you’re doing what customers want versus giving them what they need.
Glaser: Well, I think there’s always a dynamic of making sure you respond to what customers want, because at the end of the day — and I sat on that side of the table for a couple of decades — there’s a reality that they face. There’s a reality of physicians and nurses having to do more and more with less and less time. There’s a reality of margin pressure. There’s a reality of operational excellence and clinical excellence, and they’re listening and they’re responding to those who deliver care and they’re responding to their administrative leaders. So that voice of what they want — it’s critical to do that. You have to counter-balance that with the times and having sat in hospitals, the time horizon can be quite short — here’s what I need to do in the next year and here’s my current pain points. And people don’t always raise their head to see what’s coming down the pike. They have to be prepared for things that are not here yet but will be. The future, at some point, always becomes today and you want to be ready for the future because it will be today’s reality at some point.
What you try to do — and this is one of the great challenges and a great art, in putting together software for an industry, healthcare or otherwise — is to get that balance between here’s what we can do today and here’s what we can do in the future. You need to keep your eye on both. And customers, particularly when you have discussions about what is to come, respond to that, and in fact, they’re pleased that you’re looking that far down the path and thinking of what they will need, even if that’s not part of the immediate reality. So there’s a balance to that and you constantly check with them about whether you’ve got the right mix, and you also check with people you know in government or people you know in consultancy or academia who are keeping their fingers on the pulse of that which is to come. But anyway, there’s a balance and there is a lot of feedback and a lot of discussion on how to make sure we get that balance correct.
Guerra: You mention the fact that you were a customer and you, I’m sure, had your gripes with vendors from time to time about software that had bugs or things that weren’t delivered on time. So I would imagine you’re taking a lot of that into your role now and saying, ‘I didn’t like it when this was done to me. We’re not going to do this to our customers.’ Tell me how some of that is figuring into the development and release of Soarian ambulatory, either in terms of you having a higher attention to QA than some might. Just talk about that a little bit
Glaser: I think, Anthony, there are a couple of things when you spend time like I have on the customer side, the provider’s side. One is you’re realizing how important blocking and tackling is—that the software works, that the implementation team is skilled, that you have a very secure, reliable, high performance infrastructure. And you so work really, really hard on the blocking and tackling and you also realize that no matter how good you are on the blocking and tackling, you’re never good enough. We’ve seen that over the years. Ten years ago, you might have been able to tolerate a certain amount of scheduled down time, and increasingly, you can’t tolerate that. In fact, if it gets to be longer than a couple of minutes, it becomes highly problematic. So you realize that the bar is getting raised.
It’s getting raised on the performance of the technology; it’s getting raised on how your service is and how well they execute and how efficient they are. There’s this mantra that goes on all the time that we just have to just keep getting better, and there will never be a time when we can rest on our laurels and say, ‘We have arrived, we can be no better than where we currently are.’ So that’s one of the things you bring the table — to realize how critical that becomes.
The other thing that you realize is what customers want more than anything else — well not more than anything else but certainly very high in the list—is transparency. They want to know what you’re going to do, what you’re not going to do, and when you will deliver it. And if you’re going to have trouble, talk to them about that. What drives people up the wall is if they think you’re not telling them everything. They’re going to bank their plans on it and they’re going to go out and set expectations on the words that you tell them. So the other part is to always be transparent. Even if it means we’re screwing it up, you have to tell them that. Tell them what we’re going to do and apologize and help make it right. But the other part is transparency.
And then I think if there’s another thing that customers want to know, it’s that they want to know and believe that the team that they’re working with, the team that they see and the team that they don’t see, is skilled and professional and cares about them as much as they possibly can. They want to say there’s an utmost professionalism in dealing with these folks. And they truly treasure that. It’s professionalism not only on the guy or woman who knows all about the technical stuff and how this works and that works, but also the people who are in the middle of, for example, federal government discussions about Meaningful Use Stage 2 or Stage 3 or the rollout of the Affordable Care Act. So I think one of the things that you learn is that the bar of delivery — blocking and tackling — has got to be high and always getting higher and that you have to be transparent about what is and what isn’t, and that professionalism across all that we do is critical.