John Glaser, Boston’s Top Hospital Geek, Talks About Obama’s Health IT Plan and Getting Booted from Catholic School

John Glaser, chief information officer of Partners HealthCare, sits atop one of the largest health IT organizations in New England. Yet beneath his corporate shell lives a scorching wit and perhaps a somewhat reformed hell-raiser. He was kicked out of his Jesuit high school in the Bay Area during his junior year for his part in an underground newspaper that, in his words, was “all about drinking beer and [dating] 16-year-old girls.” (Read on for his stories about answering to a Jesuit tribunal at his school and hitchhiking to the Panama Canal.)

Glaser, 55, has been part of the brain trust of hospital IT experts that has advised President Barack Obama’s administration on its plan to pump $19 billion over the next several years to speed the country’s transition from paper-based health records to electronic health records (EHRs). But Glaser is not afraid to point out the failings as well as the merits of the President’s plan.

Glaser (pronounced Glass-er) understands the huge challenges of Obama’s health IT plan. Only about 6 percent of U.S. doctors actually use electronic health records for their practices today, he says. And the President has set a very bold goal of having full electronic health record adoption in this country by 2014. The vision is to eventually have networks in place so that hospitals and physician practices can access and share every American’s electronic health record.

People listen to Glaser about these big topics in health IT because he’s been thinking about them at a high level for a long time. He took over as chief information officer of Partners in 1995. The health information systems group he leads includes seven CIOs who report to him, a total of 1,500 people, and an annual budget of about $270 million, according to Glaser. (To put the size of that organization in perspective, consider that one of the largest public health IT companies in Massachusetts, Phase Forward (NASDAQ: PFWD), had a total of 939 employees at the end of last year.)

So I was thrilled to listen to Glaser’s views on the torrent of change across the health IT landscape during our brief interview at the Convergence Forum on Cape Cod earlier this month. Here are some excerpts from that interview:

Xconomy: What are the big business opportunities in health IT, in your opinion?

John Glaser: I don’t know how well they are being exploited. There are a couple of threads here. One is that there is incentive federal money that will be amplified by other money for EHR adoption, particularly in the small- and medium-sized physician practices and hospitals. The bigger places like Kaiser Permanente, Partners, and Boston Medical Center have already made lots of investments doing very well. The second one is people who do [health information] exchange activities and interoperability stuff. The third will be secondary use of data; people beginning to look at EHR data to do post-market surveys or to support clinical research or do comparative effectiveness (which measures how well treatments for an ailment work alongside others). I think the fourth is uneven but, given the chronic disease problem, different ways to engage patients, whether in the workplace or through personal health records.

X: Glen Tullman, CEO of the medical software powerhouse Allscripts, recently said: “We are at the beginning of what we believe will be the single fastest transformation of any industry in U.S. history.” That sounds a bit audacious. Do you agree with that?

JG: I don’t know about a transformation of “any” industry in U.S. history. One thing is that the pace of transformation in many industries has picked up over the past couple of decades. Telecommunications has gone through amazing change. Retail has gone through amazing change. Financial services have gone through amazing changes, etcetera. So, I don’t know how to compare the economic and historical accuracy of that statement, but I do think we’re going to go through a hell of a lot of change in healthcare IT in a relatively short period of time. The pressures [to reduce costs in health care] are reaching breaking points. The funds are flowing in to do a variety of things. Increasingly, if you’re a doc or a hospital, it’s hard to avoid doing this electronic health records stuff, because it’s strategically and operationally perilous to not do it.

X: Watertown, MA-based Athenahealth (NASDAQ:ATHN) says it’s done surveys with doctors on that show most physicians surveyed think they’re going to lose money from EHR adoption. Do you think doctors will balk at buying electronic health records, despite the incentives available to them?

JG: No, I think they’ll buy. It kind of depends on how many hospitals and doctors’ offices you thought should be able to qualify for the incentives in 2011 and 2012. [Editor’s note: Doctors who qualify under EHR use standards called “Meaningful Use” can begin receiving Medicare and Medicaid incentives in 2011.] I think there was a lot of belief that a majority of them should, but that was never congressional intent. The intent was that a minority, maybe a significant minority, would qualify. Part of it is that expectations are out of line. There are organizations that will qualify, even though the bar is high. I also think it was a smart move on the part of the Office of the National Coordinator to set the bar for qualifying high, and then saying: “I know it’s high. But you tell me where to back off and why. So I’m seeking your guidance and counsel.” It’s better to start high and back off than start low—and nobody’s going to force you to go higher, they’ll just force you lower no matter where you start. So I think it was a smart move despite all the [mess] that was created here. I think the other is that providers are sort of under this belief that the federal government ought to cover the entire cost. The federal government says, “No, I’m here to stimulate, and in a pragmatic business way, I account for maybe half the care in the country, so I’m covering my half.” You will get some gain out of it, operationally, other healthcare payers will follow suit, because of their pay-for-performance or incentive plans. Massachusetts has this conversation that you may need to be a meaningful user of electronic health records in order to be licensed to practice. So the government never was planning to cover all of it, they were planning to cover enough of it to get you to start thinking about it and actually cover enough of it to create a snowball effect, where other forces would converge on this. So I think there will be a backing down in meaningful use, but I don’t think you can dodge this and say that it will all blow away and I’m not playing ball.

X: You’ve written previously that you think adoption of EHRs under Obama’s plan will be “bumpy.” Please explain what you mean by that.

JG: It’s very hard, maybe it’s impossible, to predict with great certainty how this will work and how it will all come together. The definition of “Meaningful Use” is just a very different definition than we’ve used for EHRs in the past. So they are introducing new definitions, new payment, new regional [support] centers for EHRs, and state grants. The private sector response to all this will be thoughtful and diverse. How that will all come together, and what percentage of doctors will be meaningful users two years from now? Nobody really knows. So it’s hard to imagine that you’re going to change it all and it’s going to be this seamless, bump-free evolution, that all physician EHR implementations will go well, that all states will rise to the challenge and have solid, efficient infrastructures. Some states will screw it up. It’s just inherent. That means there will be some percentage of doctors and hospitals in some states that won’t be able to get their health information exchanges to work. There will be some privacy problems that will come along the way. Some people will say, “Holy smokes, what were we thinking when we did all of this?” I don’t see how you can introduce a set of changes to a $2 trillion-plus component of our economy and expect that it will be executed flawlessly. And that’s what I mean by “bumpy.”

X: If one has high expectations for this program to bring swift adoption of EHRs, will they be disappointed?

JG: We’ll find out. The President has said every American by 2014 will have an EHR. That won’t happen. The national adoption rate now is about 6 percent of doctors that are using a well-developed EHR. Do I think that in five years it will be 50 percent? It very well could be at 50 percent. So you could be disappointed or you could say, boy was I pessimistic. It goes back to, it’s hard to change this many moving parts and have any great certainty how it’s going to pan out.

X: What do you think are the greatest weaknesses of the government’s EHR adoption plan?

JG: They didn’t have enough money. [Editor’s note: The plan includes about $17 billion in incentives for physicians to be meaningful users of EHRs and $2 billion to create support health information exchanges and extension centers that help doctors implement EHRs.] When you talk about funding 70 extension centers, you realize that’s not enough money to go around. Two billion dollars seems like a lot of money until you start divvying it up and seeing where it has to go. I might have given them $4 billion or $5 billion for the extension centers.

X: How exactly did you get kicked out of high school?

JG: I ran an underground newspaper at an all-male Catholic school. There were four of us and we each wrote a column. It was all about drinking beer and [dating] 16-year-old girls. We knew all about the former and only dreamt about the latter. I had no working knowledge of the latter. We made the mistake of publishing on the afternoon of parents’ night. So moms and dads came down to this Jesuit school, copies of the newspaper where flying around, and the roof went off. Parents were complaining that their kids were being exposed to this stuff—what the hell is this? So the four of us who wrote it were called in front of a tribunal of Jesuits the following morning. My three buddies all did the mea culpa, which is Latin for “I’m sorry.” When it was my turn, I said I wasn’t sorry at all… and that I was actually proud of what I’d done. I thought Jesuits were cool and would say, “That’s the type of spirit we want, challenging authority.” But I’d crossed the line. So I was kicked out.

X: How’d you end up on the East Coast if you grew up in the Bay Area?

JG: I went to Duke University as a math major and graduated in 1976. I didn’t know what to do with myself, so I went to work in a salmon cannery in Alaska. Then I hitchhiked from Fairbanks to the Panama Canal over a six-month period of time. By the time I got there, I was tired and also realized I was madly in love with this woman I had met in school at Duke. I went back there to be with her, and I’m married to her still. I worked at Research Triangle Institute as a program analyst and did a big survey on healthcare quality and expenditure. I decided that healthcare is cool, so I went out to the University of Minnesota and got a PhD in healthcare information systems. [Editor’s note: Glaser moved from the Midwest to work for Arthur D. Little in Cambridge, MA, in 1984 and has worked in the Boston area ever since.]

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  • Given the number of private practices, one would think that software as a service (Saas) approaches to EHR access would offer considerable potential. Solving the problem of “meaningful use” for doctors in order to allow access to federal incentives and to prevent payment of penalties would seem to be a fertile area in which to build a business.

  • The adoption of electronic medical records is a complicated issue and party due to the new technology that arrives every week for us to mill over and determine if that needs to be incorporated in to the system. I know I wrote one years ago prior to the big movement to the web, same issue though, just more client/server.

    Secondly until the issues of compensation are settled, it’s a slow go. As the old saying goes nothing happens until the bill gets paid and it’s not the stimulus money that puts meals on the table, it’s the claim revenue and right now there’s many MDs up in the air with a lot going on at once.

    I said we should certify payer algorithms before EHR software a long time ago, as why does one area go through the process without the other side? After all we are back to the money side once again. Certification is important I agree, but again we need ethics on both sides of the table here. Payer algorithm certification should come first as that is what helps keep the rest of the issues up in the air almost single handedly.

    Further more on health literacy and with patient involvement, we need role models and everyone has health so we all need to participate and role models at the top can create an atmosphere of trust too, we don’t have that.

    I know I try to speak out pretty plainly as best I can, but when I see the same companies that are paying claims for 15 years of underpayments to doctors and patients being praised and trusted for their analytic, does that not make one wonder how they do business.

    Anyway, if you add this side up to the big nest of non trust and non participants making rules and laws, no wonder so many doctors are skeptical and just seeing what I have from my small corner in life, there’s good reason as nobody appears to be earning any trust around here or making any real efforts to be mentors or role models for anyone else.

    I like technology and what it does and I know electronic medical records are the answer but the other sides of the issues are the obstacles that are holding up the show and prevent real progress.

  • Saumitra

    I agree with Wellescent. May be cloud computing companies could may a foray into EHRs. By the way, I liked this candid interview. Many wouldnt have dared to ask him how he did get kicked out !