Continuing our series of discussion from CHIME/HIMSS 2019 we hear from John Glaser where we discuss a wide range of topics from population health to the future of computational models to see patterns and inform better care.
Bill Russell: 00:11 Welcome to this week of health it where we discussed the news, information and immerging thought with leaders from across the healthcare industry. This is Bill Russell. Recovering healthcare CIO and creator of this week in health it a set of podcasts and videos dedicated to training the next generation of health it leaders. This podcast is brought to you by health lyrics, helping you build agile, efficient, and effective health it. Let's talk visit health lyrics.com to schedule your free consultation. We were recording a series of discussions with industry influencers at the Chime Himss 2019 conference. Here's another of these great conversations. Hope you enjoy.
Bill Russell: 00:46 Why don't you introduce yourself and we'll just go in.
John Glasser: 00:48 You want me to talk to the camera here. All right. I'm John Glasser. I'm a senior vice president at Cerner
Bill Russell: 00:54 John, you're so you're a former CIO of the year as well.
John Glasser: 00:57 I was the CIO, uh, gollies back in 1994 at the chief information officer at Brigham and women's Hospital at the time.
Bill Russell: 01:04 And now you're with a Cerner? Cerner, right. Wow. It's been a while. You've been with Cerner?
John Glasser: 01:10 Well, I was the CIO at the Brigham and then partners healthcare, uh, when they merged with the mass general and between the two 22 years and then left in 2010 to run the health care it business for Siemens. And then we were acquired in a, uh, in 2015 by Cerner. So I've been with Cerner about four years ago.
Bill Russell: 01:26 Wow. So, um, so you know, just what some of the questions we're asking if people, are there trends you're looking at right now? Trends you're trying to keep an eye on that you're going to, I dunno, take a look at it. The show this year.
John Glasser: 01:38 Well there's these broad trends that continue year in and year out in the sort of broader landscape changing the payment system that has progressively moving to more value based care and it will take decades to play through. But nonetheless it moves. And so every year it's going to, where is it, where people trying, etc. So that's one on the technical side. I think the AI sort of broadly speaking intelligence and analytics continues to be, it will be quite profound, you know, over time. And so we'll see kind of what progress we've made last year. Engaging consumers remains important but challenging. And we'll look at that. A plus is the, you've probably seen the federal government issued some of their interoperability rules this morning, so I'm sure there'll be a lot of discussion about those and the whole topic of interoperability.
Bill Russell: 02:16 Yeah. So now we finally have a definition around what data blocking.
John Glasser: 02:20 Well, I'll haven't seen and you will see as will I these various, uh, you know, interpretations of this 700 page proposed rule. And I think the best I can understand what it will be primarily is what blocking is not. Uh, and so from there on out, you begin to, you will feel if you're the federal government complaints and through sort of case law, you're going to do sort of refine that.
Bill Russell: 02:41 Well, and there's seven exemption. So it's like, here's the definition, here's the penalty and here's seven exempts. So we'll see. Um, and I'll be honest, I read it about an hour ago, so I have,
John Glasser: 02:51 oh, you've got an hour on me. I haven't, I'll wait for the two based on, yeah, that's exactly,
Bill Russell: 02:56 I read the, a couple of the article side so it'll be interesting.
Bill Russell: 02:59 Yeah. Um, so uh, social determinants, population health, value based care continued to be drivers. How is technology going to play? I mean, what, what technologies do you think are going to play in and how will technology play in that?
John Glasser: 03:13 Well, I think there's a number of ways. If we take the area of population health, it says, all right, if I needed to take care of you in a group of people like you, I need to characterize it. You, I need to understand you and I need to understand clinically which are what's going on. I also need to understand is socially, whether you're poor or not poor, et Cetera, I need to understand your genetics. I need to understand a range of things. So we'll use a technology to gather the data to characterize you in, to characterize me and the point of characterization and say, well now I know that the plan, here's what I had to do. And the plants are different depending on whether you've got means you don't have means or a diabetes or you don't, so that will it be a lot of collecting of data to help formulate strategies. And then a lot of the technology will be a follow, well are the strategies working? Plus you have to introduce it into the workflow, both the patient and the clinician. Here's what should happen next.
Bill Russell: 03:55 That's interesting cause we, um, another one of those cases where the job is becoming less and less about technology and more and more about integrating with the business. We're not even asking some of this, what we heard in the last talk. We're not even asking some of those questions yet to build out a whole person profile, if you will.
John Glasser: 04:12 Yeah. I mean we, you know, we talked to clinicians and say, all right, I'm happy and I get the need to catch will determined about food insecurity. Okay, but what do you want me to do? You know, if someone says I have a tough time finding, getting a meal or I live in, uh, you know, the only thing that's close to me as a convenience store, uh, and so it is, you know, we are having to work with, well what do you do once that, so actually the technology part will be the easiest part. It's finding out this food. It's now note what it will be. The more challenging part.
Bill Russell: 04:38 I mean technology plays a role, you know, we can, we can Uber people around and actually get them where they need to get to. A, we can address loneliness, which we heard this morning is a major issue through, uh, you know, video visits, down chats and certain technology. But the whole idea of, hey, I live in a place without an air conditioner. I mean, is the health system supposed to start buying air conditioners.
John Glasser: 05:02 Well I thnk, you know, one of the, our, our clients we work with, they were encouraging all the elderly people that get out and do their 10,000 steps. And it wasn't happening. Question is why? Because the leash laws weren't enforced. They were afraid of the dogs. I said, well, son of a gun, how do you fix that? And is that the job of the health system? To fix the leash law. A couple of, about a year ago, he's talking to the guy who was the head of Medicaid for the state of Arizona, said what are the two largest social determinants? And he said, homelessness and incarceration, you know, you'll come out of jail and you can't get a job. So if you're a banner or dignity or any health system in it, what do you want us to do about the incarceration problem? So we as a society and it helps, I have to sort through what does it we expect out of all the various players.
Bill Russell: 05:41 So, um, one of the interesting things in the last talk she was describing data silos. Now when we talk about data silos, typically we're talking, you know, our Ehr data and write whatever. When she was talking about data silos, she was saying, Hey, we need, uh, we need housing data. We need the education data, all that. All those kinds of things. Are we going to start creating? Is that going to be part of our repositories? I think it sorta what she was pointing to that if you really want to address the complete person, you know you're going to have to start looking at all this stuff. And it's not just, and sometimes when we talk about, you know, the interoperabilities exchanging clinical data, but if I refer you to a place for food security, there's an interoperability loop presumably. So there's a referral coming out and whether you took advantage of me went back. So I think it will cause us to look at a broader, more multifaceted, more complex meaning of interoperability and what we have to do and the collecting of data to go with that.
Bill Russell: 06:32 So like a, like a homeless shelter, we would, we would have a record of this person coming to a home or a food bank.
John Glasser: 06:39 I mean that's part of the theory. So if you showed up next appointment, I'd be in a position to say, how come you didn't take advantage of the food pantry? You know, what's going on here? And do you need, you know, their health, et cetera?
Bill Russell: 06:49 Is that the physician or is that going to be,
John Glasser: 06:51 I think your point of all these things, see, I, you know, you, you can argue probably appropriately so, but it's someone in the office who's prescreening us is, by the way, I know you're going to see Dr. Smith, but let's cover these kinds of things here. And if you're, the practice person says, yeah, but that's an expense. You know, I've got to hire somebody to go off and do that. Uh, you know, who's covering all that?
Bill Russell: 07:08 I remember back in 2010 when they showed me the plan for the health system, was we're going to create this continuum of care. And I'm like, okay, well our medical group data is still not talking to our client data. And now you're adding in, you know, longterm acute, I mean, just all these different clinics and whatnot around the thing. And now what we're saying is that, could, that continuum of care is now expanded, correct. Well beyond that, y
John Glasser: 07:33 ou know, our knowledge of what it takes to be healthy, you know, and we get into this stuff that says, are you lonely? And what do you want me to do about you being lonely in a variety of things like that. So it is not just the, weather I can get food or feel safe at home. It's just kind of am I part of a community. Am I engaged them and I feeling valued?
Bill Russell: 07:50 So if you were a CIO today, what would you be focusing in on?
John Glasser: 07:53 Well, I think, you know, and that's part of, I think where we could have done a little bit more than the prior talk. You said, Golly, it's overwhelming. Where do I even start? You want me to solve incarceration? How do I do that? I said, well, I don't think you've got to do that. I think there are tools that allow you to do a social determinant assessment. Prepare tool is one of them. So why don't you start doing that, uh, and gathering data about who's coming in, et cetera. And there are companies that have resourcing in your community. Here's where you go for domestic violence help. Here's where you go for financial assistance. Here's how to get a ride to the practice. And I start putting those into the Ehr such as the tool says we've got a food security issue. Here's who to refer you to basic stuff. Uh, and not, you know, worry right off the bat about how in the world am I going to connect to this silo or that style, et cetera. We may need to do that. You don't have to wait for that to get going on this stuff,
Bill Russell: 08:38 but is it going into the EHR? We're going down to very specific or, or is there, is there a layer above that, but you're bringing all this data into condition, better interoperable platforms than it?
John Glasser: 08:49 Well, I think it's one of the sort of broader challenge is in a lot of ways you say this is this population health layer that sits on top. Because we look at, for example, in our case, our average customer health system has in their catchman areas, 16 different Ehr, you know, and they don't, they're not in full control. So they're going to have some interoperability issue. So by almost as a matter of course you will do this layer on top, brings it all in and cleans it up, associates you, you know, across multiple medical record numbers and you could argue that's where not to go, et cetera. Now that being said, we need to get, if you're in front of your doctor, we want your doctor to be aware of certain things. So there's this, how do I fit it into the workflow? But it may very well be that the right a home for this as a pop health layer or extended HIE layer of some form.
Bill Russell: 09:33 Interesting. Yeah. Um, I mean, what are you gonna what are you excited about at the conference?
John Glasser: 09:39 Oh, I think, you know, I, in some ways I've seen your friend, oh, I guess, you know, being haven't been in this industry for a hundred years. Uh, no. In some ways I wish I were 20 years younger. Uh, because it is a remarkable time in terms of the potency of the technology. So part of it is just to see where things are and what are people learning about, you know, it's a classic Gartner curve, but a lot of the stuff the way up at the height. Yup. You say, well let's cut through the noise and see the reality of a lot of this and that's always just kinda cool to see.
Bill Russell: 10:07 It will be a, it will be interesting as I continue to say it's going to be, it's a great time to be. Sure. And uh, it feels to me like the patient's increasing you, but you've been at this longer than I have. Is the pace increasing?
John Glasser: 10:19 Well I think in a couple of, yes And in a couple of ways, one is the, the business model shifts are occurring finally to the value based care. So that sort of picking up an urgency. The second is that the pace of technology is accelerating and accelerating a more potent way. Um, you know, if you look at, I remember, you know, if you take every decade and say there's a technology that occurred in that decade that changed the world, and you say, well, what does that, well, in the 70s is the mini computer eighties, it was in network, personal computers, his nineties, it was the web and the 20s it was the mobile device. And in this decade it's Ai and all those pickup and they all gang up on each other. It's not like we're done with a web or done with mobile, isn't golly, this sort of compounding effect. Uh, plus you get these new entrance in here, like Google and Amazon and everybody, and all of sudden people said, holy smokes, there's an urgency in an anxiety here. Uh, because they're very potent organizations that can move fast with vigor and effectively, and will that change the game? So I think there's a, there's a pace. Changes in anxiety changed. It's different. Uh, and that's kind of remarkable.
Bill Russell: 11:18 Yeah. And all the, all the players that are getting in have different objectives. Yeah. I mean, Google's objective is very different than Amazon's, uh, apples. And what are they all and they're all taking a piece. Yeah. Cvs. Aetna though. That's a little bit close.
John Glasser: 11:30 I have a, I teach this course in e-health at Wharton at the second year, Mbas. And so our course, our class and about a month, Is we're going to look at the strategies of Google, Amazon and apple and talking about, well, what do you think is going on here? class and do you think there'll be successful? And what's in their way of being successful? It'd be interesting to see, you know, with these young bright people, uh, come up with,
Bill Russell: 11:51 and it's, it's not, it's not a foregone conclusion that they will be successful because they have failed in the past.
John Glasser: 11:56 You know what I mean? You're right. They, and you could on one hand say, well, they failed. They don't know nothing and they're going to get their fingers burned, et cetera. But they're smarter. They have more reason to be in here that the times are playing more to their strengths. So you could say, look, the mobility, so it's quite real. Everybody's real. So Apple's got a real strength here. Plus the, you say, well, the date in the analytics is much more real now. So Google has got an asset to play, right, et cetera. So I think there are needs in this industry which play much more to their strengths. They have greater reason to be here, et cetera. And they're hiring some good people. It's not like there's devoid of talent.
Bill Russell: 12:25 My last question, is there a technology that is going to help us to clean up the data? Right? Yes. I mean that's, that seems to be, you know, to take advantage of machine learning and AI. Uh, I, I heard of Mayo presentation and they said, look, we're going to be in better position to take advantage of machine learning and AI because they did all the very difficult yeah. Uh, work as they went to epic to really clean it up. All the processes and what not. But most health systems have 60 EHR, whatever. Is there a technology that's gonna really help us or is that just going to be,
John Glasser: 12:59 there's a class, I think the class of machine and pattern learning, will do that. So the machine, you know, for example, in the healthy intent, which is a Cerner population health and bring in data from lots of different sources. Um, 95% of the cleanup is done by the machine. This is, this is the pattern that's going on here. This Mr. Smith is a diabetic. I know it's not in the problem was, but this is what's going on. And in a lot of ways you borrow a technologies and new insight from other industries. So if you look at, um, the intelligence and national security people, they look at patterns of data coming in and said, golly, there's a elevated terrorists threat here. Uh, and they're looking at radio and TV and all kinds of stuff. So we're getting as a broadly speaking across multiple industries, which are much better at picking up patterns and say, this is what's going on with a pretty degree, reasonable degree of certainty self that will, it doesn't solve everything. And it doesn't mean there aren't kick outs of the machine will get it wrong from time to time, but it's, it's actually quite impressive what can be done.
Bill Russell: 13:50 It's exciting. Yeah. John, always a pleasure.
John Glasser: 13:54 Pleasure. Thank you for your pleasure to be here and, uh, look forward to hearing all the rest of these interviews that you have gathered. It should be fun. I'm looking forward. Great.
Speaker 1: 14:01 I hope you enjoyed this conversation. This shows a production of this week in health it. For more great content, you can check out our website at www.thisweekinhealthit.com or the youtube channel. At thisweekinhealthit.com/video thanks for listening. That's all for now.