December 9, 2022: It started with a doodle on a napkin and has grown into a movement that’s helping to transform healthcare. John Glaser, Executive in Residence at Harvard Medical School is the man who helped found CHIME and envisioned the formal role of CIO. How has CHIME evolved over the years? How does it help CIOs to network, share ideas and support each other? What is the CIO of the Past? The CIO of the Present? The CIO of the Future? How did the CIO role transform from the sole authority on IT to team player? How can CIO's pay it forward to the next generation of leaders?
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Today on This Week Health.
Back in the day as it were you looked at the C-suite, they didn't understand IT, they didn't really want to talk about it, et cetera. Board. Same thing here. Now they actually understand, they've been through EHR implementations. They grew up with this stuff. So they're actually quite capable of handling the conversation with you in terms of change management. So you're much less the sole authority. You're much more the team player and the orchestrator of the conversation.
thanks for joining us on this week health keynote. Today we have a special episode, a conversation with John Glaser of Harvard Medical School, also former CIO of the year, part of the Founding Fathers of Chime, and we talk about a bunch of things at the Chime Fall forum. This was actually one of the interviews in action that we did. And we talk about how Chime has evolved over the years. We talk about the CIO of the past, the present, and the future, and we cover just a ton of different things. Great conversation. Always love catching up with John, and I really hope you enjoy. My name is Bill Russell. I'm a former cio. For a 16 hospital system and creator of this week, health instead of channels dedicated to keeping Health IT staff current and engaged. Special thanks to our keynote show sponsors, Sirius Healthcare, a CDW Company, VMware Transparent Press, Gainy and Seus and Veritas for choosing to invest in our mission of developing the next generation of health leaders now onto 📍 the show.
All right, here we are, another interview in action from the CHIME fall forum and we're here with John Glaser and you know at least four people we've interviewed so far, John have had John Glasser's stories. .
Well, so you've been around long enough, you're gonna generate some stories, that's for sure. So
you had the panel discussion this morning? Yeah. And you represented. The CIO of the past. Right. Does that hurt in any way?
Well, no, but one is, I was around in the past, so people want to know how did it get started and what was some of the why's and who was involved, et cetera. So I happened to have been there when all that occurred.
Well, let's give some of that because for our listeners who aren't here, that was really fascinating to me, the whole chime and chin. Yeah. And at first it sounded like a joke, but there was a chi and there wasn't, there was a chime. Yeah. Talk about the, early days its formation and how it.
Yeah, I mean there was the, sort of, the backdrop was is that you were beginning to see in the late eighties, early nineties companies that were beginning to use it competitively to really advance their products and services. So American Airlines Saber System Frito Lay was an example USA and claims filing, et cetera.
So all of a sudden said, wow we're gonna be on back office automation here. We're in this series here. And you could see there's a lot of Harvard Business Review and other discussions, books that came out about the topics was clearly coming, this use of it competitively. And the conversation at the time was, well, it's not here in healthcare, but it's coming in healthcare.
And if you looked around the room at your current CIOs and it say, man, we gotta upscale them. If they're gonna be in a position to really handle this conversation, lead it, et. So that was a discussion. How do we help them do that? And can we create an organization that will bring them together, educate them, teach them, et cetera.
So at the time, I was the board chair of hys and hymns was in a lot of trouble. At the time it was still part of the American Hospital Association of Losing money, had some staffing issues, et cetera. So we thought, well, we'll stand it up and the electrical would've been, we'll make it part of hs. Well, hymns needed other things to do. Well, the next thing to do is we'll make it part of the American Hospital Association, which hymns was part of. But Aha said, we don't want anything to do with you guys. So you're on your own. You're on your own. Go get 'em, tiger. Let's see how you do. So it was in this backroom of a hymns board retreat that I, along board chair Rich Rde, who was the Simons, the CIO of Baystate in Worcester.
And he was the past. And then Rich Corll, who was part of Chi, and I'll get back to Jim in a second said, let's go stand it up and who should we have on the board and all the usual things you would do to go off and do that. And as mentioned as all here, it was Ryde who said, Hey, let's put the word college in there cause that'll show we're really here. Educating and high level. And Rich Corre wrote down the acronym CHI or Chime. I'd never seen it before.
You know what? It's interesting. I mean, you put collage in there, there's something in a name. Yeah. Because 30 years later that's. Core function of what China continues to do?
Well, in some ways the model is pretty simple. You say, look, we're gonna take a set of folks who have a common profession, a common set of interests, and we're gonna bring 'em together and we're gonna do two things. One is we're gonna educate 'em, so we'll put stuff out there, speakers and this and the other, but the more important, perhaps we're gonna create relationships so that they learn from each other and teach each other and have someone to talk to, et cetera.
So we, we did that. And at the same time, in parallel had been this group called, Center for Healthcare Information Management, which was vendors and consultants who had come together, they could see the same thing coming and they thought, boy, our business prospects will be better off if we help move the field into a more strategic sense.
So Rich Carrell was the CEO of that. And he said, well, let's bring those people together with the CIOs and recognizing the importance of the partnership. And that's in a way how chime got started, how the Chime Foundation is CHI sort of morphed into the Chime Foundation
and that's how it. It's interesting cuz great concept by the way, CIO of the past, CIO of the Present CIO of the future in that it's interesting to me cuz the CIO of the past, you don't even represent the CIO of the past. Cause the CIO of the past was the person who was technical enough to sorta make sense of some things and make things happen. But the CIO role changed pretty dramatically over the last 30 years, hasn't it?
I think if you look at the archetype of the CIO at. the time First of all, they weren't called that, they were director of it Maybe data processing manager. Actually, the title was not as common as it is now. And their job was to make sure the system stayed up.
We didn't have quite the same security issues in, but nonetheless there was some, and they was going through these departmental systems. So how do I go with an rfp? How do I choose between pharmacy vendors, et cetera, and how do I. quote install it In a different way. So it was much more it's important work, but it certainly wasn't the strategic executive that you see today.
And now you had there Meadows and Andrea, Andreas fantastic. And I joked with Andrea. I was interviewing you yesterday. It's like it, it used to be you were brought into the room to be the technology person. Yeah. now you're leading projects. That are around clinical workflow and communication and supply chain. I mean the cio really has to be, I, I don't want to jack of all trades, but also be able to participate in all those conversations.
Yeah. And you know, and cuz your board will say, golly, when I do this in banking, it's a great consumer experience. What are you doing? And so you have to know what are they doing at banking and what are we doing here too?
So you have to be able to have that strategy conversation. You have to be able to technically make it robust cuz the auditors come in and say you're secure or you're not. On this kind of stuff, you have to deal with docs who say the system stinks, what are you going to do about it? And I think the other thing Bill is kind of interesting is back in the day as it were you looked at the C-suite, they didn't understand IT, they didn't really want to talk about it, et cetera.
Board, same thing here. Now they actually understand, they've been through EHR implementations. They grew up with this stuff. So they're actually quite capable of handling the conversation with you in terms of change management. So you're much less the sole authority. You're much more the team player and the orchestrator of the conversation.
we're talking about some fundamental changes that are going on in the industry Yeah. That have really leveled the, the industry. You have the pandemic, then you have the financial challenges. Yeah. Then you have cybersecurity.
Yeah. And it's interesting to me that it used to be I bring CIOs in here. Yeah. And. They were fundamentally working on different things. Yeah. If you're a large academic medical center, you're looking at some different things and that's still the case. Yeah. But there's commonality now between the critical access hospital and the academic medical center where they could, they could actually sit in a room and go, yeah, yeah let's talk about these three things. Cause we're having financial challenges. We're having cyber security. I mean, we're working in cyber security and the pandemic has led to. Employee unrest, I guess is what we'll call it.
Well, you see the organization, the American College of Healthcare executive every year do this survey of CEO and their top issues in the health systems, et cetera. And typically, if you go back over the years there's probably six to eight issues and there's some ranking, but there at golly, we're gonna worry about quality, we're gonna worry about medical staff, relationship, et cetera. And they were all kind of narrowly bunched together.
And so depending on where you were, number three could have been your top one, and number two was the top one, et. Here, it's, what's really different now is there are two which dwarf everything else, and that is, what do I do about workforce burnout? All this and virtual, et cetera. The second is my, I'm getting crushed on an operating margin here.
The costs are way up. I'm doing per diem work and nurses, I wasn't doing that before. Plus my volume never really did recover from the pandemic, et cetera. So anything that can save me. Or cut costs or improve revenue. Boy, boy, it's unusual to have two issues that it just cut across the board.
So I'm gonna put you back in the role We'll have some fun. So, I put you back in the CIO role. Yeah. I'm gonna come to you and say 7% cut across the board in it. Yeah. How do you approach that? Because to a certain. Don't you want to change the conversation to be more strategic rather than tactical?
Yeah, yeah. Sure. And having been through that kind of drill before, there is no way politically that you're gonna dodge that bullet. There's nothing that you will say, this is, I'm immune. Yeah. You might get it down to four or three, whatever. You ain't dodging that bullet cuz everybody's got their reason why I'm strategic everybody.
And so to see this is enough of you guys. All right. Cut your darn budget and get it. Okay. So you're gonna take it on the chin in some way, shape or form. So what you also realize is say, look, I'm a corporate citizen. I will do what I've gotta do here whatever. That being said, what I wanna make sure is in front of you is initiatives in which we, sometimes we just have to do them because of regulation or the auditors say et cetera.
But I'm gonna make sure that I front stuff that's got clear ROIs and a track record, okay? And if I get stuff that's a little fuzzy around the edges, then I'm gonna know I'm out on a limb here and it may not survive here. So I want, I'm gonna take it on the. But I'm also gonna make sure that what, that I clear to me, I am listening to you and understand what's needed here.
It's stuff that saves money. Let's not get all cosmic on me at this point here, cetera. So you've got, anyway, you just have to recalibrate. It doesn't mean they won't do cosmic stuff, but you just gotta be careful with that and make sure you're not over your portfolios ladled up with that stuff. Cause it looked like you don't get it, you don't get where we are at this point.
So was there a straight path from like computer science in high school to CIO role?
No, no, no. Well, I mean, like, I think you probably you talked to lots of people I think most careers are like brownie in motion. You're going this way, you hit something, you go that way. You sort of zigzag every now and then you'll get someone who says like, golly, I want to be CEO ge by the time I'm 45. And God love 'em. They get it. Yeah. They're that direct that ain't, that's not common here. So I was I was expelled from high school my junior year, so that was, and.
Went off to college and went to Duke. Got a degree in math, but largely I didn't know what else to do. And then I worked in a salmon cannery, and then I hitchhike from the salmon cannery and Fairbanks, Alaska. The Panama Canal took me six months and just all over kingdom come and I got down there and I said, I'm tired of hitchhiking after six.
I'm just tired of it. Plus, I'm madly in love with this woman who I met at Duke, you knows 48 years ago. We're still together. I said, I'm gonna go back and be in Durham, North Carolina while she finished the school, and I'll just take whatever job. And that kind of started this meandering path bill into the cio. It was, it was certainly not a straight shot by any magic stretch.
I'm sorry. Got kicked outta high. I'm still, I got caught up on that, but what was, what's the story behind you getting kicked outta high school?
I wrote an underground newspaper in an all male Catholic Jesuit high school. So freedom of the press, well, worse than that it was all of it was four. Three of us, four of us wrote it and each had. Mimeograph. And so you may remember the old dresser graph back in the day, and it's all about drinking beer and sort of taking advantage of 60 year old girls. And we knew all about drinking beer. We had no knowledge whatsoever. Just hopes about the latter.
We made the mistake bill of publishing it on the afternoon of parents night. Okay? So mom and dad came down to meet with the priests and laying blew. So the following morning we were in front of a tribunal. And one by each. And I was the last one. My three buddies went in there and they did, I don't know if you're a Catholic or not.
Did the Maya coup at Latin for Father? I'm so sorry. Yeah, I got in there and there they are. Nine Jesuit father Laia in the middle looking down at me and saying, Mr. Glass, are you aware of the damage done to the school and how this has countered everything we're trying to teach you as a fine, upstanding human man?
And I said, cause I got mad at him. I'm not sorry at all. As far as I'm concerned, the Catholic Church is a criminal organization, , and I said for thousands of years the church has suppressed signs conducted on just Wars. And I think frankly positioned on birth control is doing millions of women and children. And I was actually proud of what I'd done and I hoped it would be the first and a long series of criminal activities in my part of keeping their tradition of Catholic church so I could, my buddies got. I got kicked out cuz I just crossed the line cuz I got mad at 'em. And now that's mistake number two. Don't get mad in a situation like that. So that's what happened with the junior year. There you go.
Well the good thing is you found that out in your junior year because how many times have you been in meetings as a cio where you're like, you could feel it coming and you're going, no, that gets me kicked out.
Yeah. No, no, no. I mean, you learn how to sort of either ignore certain things Cuz you know, there you are and some Barb is coming at you about your systems and why you're schmuck and your people don't know what they're doing, et cetera. And on the one hand you want defend your people. On the other hand, you can't overly defend cuz the person may have a point.
📍 📍 Conference season is upon us and our this week, health team and I will be at the Chime Fall forum celebrating their 30th year in San Antonio. And we're also gonna be at the HLTH conference, HLTH in Las Vegas the following week. While at these events, we're gonna be recording our favorite show on the road, which is interviews in action. And as you know, what we do is we grab leaders from health systems, healthcare leaders from across the country. And we capture 10 to 15 minute conversations with them to hear what's going on, what they're excited about, what are their priorities, and those kinds of things. It's a great way for you to catch up very quickly on what other health systems are thinking and doing across the industry. We actually air this on the community channel this week, Health Community. It's the green one. So if you go out onto your podcast listener of choice and do a search. This channel is also where community members like yourselves have been invited to do interviews of their peers. So check those out as well. You can subscribe wherever you listen to podcasts. Look forward to catching you on our interviews and action. 📍 📍
All right, last question Cause we have a line here at this point. Yeah, sure. The giving back to the next generation. I always tell the story of I called you and John Halamka And you guys both gave me your time. Yeah. You had no idea who I was at the time.
I'm like, Hey, I'm a new cio, I don't know what I'm doing. And you're like, I appreciate that. Oh, sure, sure. And you gave me your time. How, how can people pay it forward? I mean, you clearly have done that. A lot of people have those stories. How can the people who are listening to this who are in the role, be it in a federally qualified health clinic CIO or a IDN or academic, how can they pay forward
Well, I think a couple ways. Bill like conversation with you and I get it here. too People will say, I just want to thank you cuz we had this brief conversation. It was really important to me is one is when somebody wants a piece of your time, you give it they don't want much of your time and by and large and you can have an extraordinary impact on them.
By, well I'll call this person on your behalf or let me tell you what I think of that, etc. So one is you give pieces of your time and again, so do that. The second way that you get is by acting with integrity and conviction, et cetera, cuz people will watch you your staff watches you And they wanna see how you behave, how you handle certain situations when incoming comes.
How do you react to this kind of stuff here? And you wanna show strength, you want show courage, you wanna show honesty, you wanna show all that stuff. They may not say it, but that has had an impact on them about how they want to lead and how they want. So by being a role model and being authentic is a way that you sort of pay it forward.
Because you mentioned in this talk, I think your leadership style is a combination of who you are natively what do you like? Just like. etc But also you see others and you see that was really cool how he or she did that. I want to do that too. Or that was appalling what he or she did, and I don't ever want to do that.
So any leadership style is a composite of the styles of people you've interacted with. So be one of those things. Who adds to that style? And that will have an amazing impact,
John. Always a pleasure. Thank you for starting Chime all those years ago.
It was a pleasure. It's cool to see what's come on it really cool.
It's fantastic picture of just a handful of you and down the staircase. Yeah, yeah. It's amazing. Something like this can start from just a handful of conversations.
Yeah, no, no. It's like a lot of things, you'll look at the Cerner conversation. Three guys having a conversation over a picnic table. That's how soon got started. Absolutely. Anyway, it was a pleasure. Thank you. All right. Thank you.you could tell from the Chime: