HIT makes satisfying progress, but enters period of uncertainty

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John Glaser, MD, remains one of the driving forces in the healthcare IT industry today, with a long list of accomplishments.

As CIO at Partners HealthCare, he led the way in implementing digital clinical care systems, often in pioneering fashion for the rest of the healthcare industry. He left that role to become CEO of Siemens Health Services, and is now vice president of population health and global strategy at Cerner Corp. after it acquired the Siemens HIT division.

Glaser also has been a voice for increased professionalism within the HIT industry. He helped to form the College for Healthcare Information Management Executives in the early 1990s, and through his consistent writing of books and influential magazine articles, he provides thought leadership for where those in the HIT profession should be aiming their sights.

Glaser recently shared his latest thoughts on the HIT industry with HDM Editor Fred Bazzoli, particularly in light of the release of his latest book, “Glaser on Health Care IT: Perspectives from the Decade that Defined Health Care Information Technology,” a collection of some of his most widely read articles of the past 10 years.

Your book reflects your observations of the industry over the last 10 years. What are the major trends you’ve seen over this time?

A couple things have happened, and none of these are in rank order. Adoption of clinical systems is way up; we’re in a very different place than we were 10 years ago. The portfolio of applications has been broadened, and now we’re talking about interoperability, a new generation of analytics and population health. Another thing is that we’re getting much better at managing deployments. While implementations still go south, they go south less frequently. Organizations are beginning to use these systems for their competitive advantage. The wireless infrastructure is ubiquitous. The current generation of IT is more potent, and its ability to accomplish things is much higher. The goals of federal initiatives are changing, and they really will drive the design of the electronic record going forward. Granted, there’s still a lot of work yet to do with interoperability and more. We’ve got our work cut out for us, but technology has taken a material leap forward.

Of the four broad themes in your book, which is the most important one, in your estimation? Where do executives need to “step up their game” the most?
The most important one is increasing their ability to manage and leverage the technology. One of the more interesting studies I’ve ever seen is one that looked at public companies and their gross margins, and it noted that the gap widened between winners and losers. The difference was their ability to manage technology. Technology is available to every one of those companies; those who were skilled were able to apply the technology to their company’s benefit. It shows the incredible importance of leadership in managing technology. One of the most important skills is working with the leadership of the organization to help them come up the proficiency ladder. That’s going to be the next generation of the CIO.

With uncertainty surrounding the meaningful use program, where does that leave the healthcare IT movement? Are potential changes in meaningful use a good or bad thing?
I think the core point is that we will see the end of the needs-based program. It will continue to go on as portions of the payment scheme will be tied to it. CMS has latched onto the fact that it can dictate the levels of use through policy, and they’ll hang onto the enforcement approach of certification. The federal government has achieved an understanding of how to leverage its payment mechanisms to force the issue.

Has meaningful use has primarily achieved its objective, and what is its legacy? What needs to be the next step for IT use beyond the MU program?
On the one hand, if you wanted adoption to happen, it certainly did. Has there been progress on interoperability? That’s happened, too. If you go down the list of what ONC walked into when it came into being, a lot of good things got done. While interoperability has made some progress, it’s not as much as we would have liked. Meaningful Use solved some problems, and it has made real strides in adoption but exposed other issues. While there is a MU “hangover,” you’d have to declare the MU program a success.

Security has been headline news, not only in the industry, but in the general press. The ransomware incident in California gained a lot of attention. Where does the industry stand in its security stance, and how can it improve to do a better job of blocking threats?
The industry is in a very different place than it was a year ago. With the hacks of organizations like Sony and Anthem, there’s a growing understanding that these incidents were not just done by a lonely teenager hacking in a garage. It’s clearly the work of nation-states trying to get data. This has a whole lot more visibility than it did a year ago. We have to be sober about the fact that it’s a hostile world and these threats won’t go away. At the end of the day, there’s a bigger industry commitment to making information more secure than it was a year ago.

In which areas are you expecting to biggest changes over the next 10 years in health IT? What capabilities need to grow—both in providers and vendors—to meet those changes?
Healthcare is going through a material change in the business model. Any time you get material change in the business model, through regulation or deregulation or other forces, you will enter a period of extraordinary uncertainty. The extent is just not known. How many Americans will be covered by ACOs in 2020? There’s a tremendous range of estimates. While it’s hard to predict what exactly will happen, it will be an exciting time. We want to make sure that it turns out well and that what we do now guides the ship in the right direction.

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