Glaser on Health Care IT Perspectives from the Decade that
Defined Health Care Information Technology (HIMSS Book
Series) 1st Edition
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Contents
Foreword xv
Preface xvii
Acknowledgments xxi
About the Author xxiii
Section One
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HIT Applications and Analytics Challenges 1
How the Internet of Things Will Affect Health Care 3
Health Care Applications 4
Need for Oversight 5
Interoperability: A Promise Unfulfilled 7
Why We Need Interoperability 8
The Challenges of Interoperability 9
A Nationwide Effort to Advance Interoperability 9
Where Do We Go from Here? 10
Solving Big Problems with Big Data 13
The Scope of Big Data 14
Final Thoughts 17
The Role of IT in Understanding and Managing Cost 19
When “Good Enough” Just Isn’t 20
Retooling for the Future 20
The Age of Transparency 23
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vi Glaser on Health Care IT
Heeding the Call for Health Information Exchange 25
Improving Care across the Continuum 26
Key Considerations 27
A Critical Linchpin for Better Care 29
The Growing Role of Analytics and Business Intelligence 31
The Focus and Nature of Business Intelligence and Analytics 32
Ramifications for the BI and Analytics Management Ecosystem 33
The Learning Years 35
From the Transaction-Based EHR to the Intelligence-Based EHR 37
The Transaction-Based EHR 38
Tackling the Accountable Care Challenge 38
Toward the Intelligence-Based EHR 40
Smarter Tools to Manage Big Data 41
Surviving a Revenue Cycle System Conversion 43
Preparing for the Unknown 44
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Charting a Course for Success 44
Six Key Technologies to Support Accountable Care 49
Shifting Perspectives and New Competencies 50
IT Building Blocks to Support Accountable Care 51
Aligned, Focused and Moving Forward 54
Accountability and the Revenue Cycle 55
Ramifications of Accountability on Revenue Cycle Systems 56
Focus on the Fundamentals 58
RCS Checklist 59
The Next IT Revolution: Nearly Ubiquitous Computing 61
The Four Waves of IT Revolution 61
The Fifth Wave 62
The Potential of the Fifth Wave 63
Ramifications of the Fifth Wave 63
Accountable Care Organizations and Health Information Exchange 65
The Need for a Health Information Exchange 66
Targeted Interoperability 66
A Foundation for Targeted Interoperability 66
Differing Levels of Information Exchange 67
Contents vii
Information Technology for Accountable Care Organizations 69
The Accountable Care Organization 69
Health Information Technology Ramifications 70
It’s All about the Data 72
The Variability of Patient Care 73
Iterative and Sequential Care 73
A Need for Agility 75
Managing Clinical Decision Support 77
Leverage Existing Committees 78
Examine Committee Composition 78
Ensure IT Review and Assessment 79
Define Oversight Group 79
The Service-Oriented Solution for Health IT 81
Applications as Foundations: Laying the Groundwork for Evolution 85
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Advanced Interoperability: Beyond the Exchange of Data 89
Section Two
Improving Organizational Performance Through HIT 93
Telemedicine Hits Its Stride 95
Another Access Point to Care 96
Making the Case for Online Care 97
Overcoming the Barriers 98
A Good Prognosis 99
From the Electronic Health Record to the Electronic Health Plan 101
Transformation of the Care Delivery Business Model 102
The Care Plan 102
The Plan-centric EHR 103
The Evolution of the EHR 104
Business Models in Other Industries 105
The New Business Model 105
The Evolution of Accountability and Collaboration 107
Five Key Areas to Explore 108
Where Do We Go from Here? 111
viii Glaser on Health Care IT
Ensuring IT-Enabled Gains in Organizational Performance 113
Two Studies Worth Noting 114
Ramifications for Health Care 115
Managing Complexity with Health Care Information Technology 117
The Primary Value Proposition 118
Mastering Three Sources of Complexity 118
Architecture Is Fundamental 121
A Caveat for Leaders 121
Expanding Patients’ Role in Their Care 123
Getting There from Here 124
Little Things Can Make a Big Impact 125
Portal Power 126
Technology Is Only Part of the Equation 126
Ready, Set, Go: Performance-Based Reimbursement 129
Money on the Line 129
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Game On 130
Key Considerations 131
Providing Ideal Patient Care 133
Information Technology for Community Hospitals 135
Help for Smaller Hospitals 136
The Necessity of Information Technology 137
HIT Options 137
Nursing in the New Era of Accountability 141
HITECH Requirements 142
Nursing at Center Stage 142
The Road Ahead 143
Providing Consistency Amid the Chaos 145
A New Era in IT’s Strategic Importance 147
Impact on Providers 148
Looking Forward 149
IT Strategies for Process Improvement 151
Focus on Core Processes 151
Contents ix
Define the Scope of the Work 152
Adopt an Incremental Approach 152
Enhance Processes with Intelligence 153
What Happens After EHR Implementation Is Done? 155
The Myth of IT’s Competitive Advantage 159
The Fundamentals of Sustained Collaboration 163
Individual Gain Is Apparent 163
High Degrees of Interdependency in Achieving Gain 164
Clinical Data Exchange as a Commodity 164
Collaboration Efficiencies 164
Minimally Invasive Approach 165
Summary 165
Success Factors for Clinical Information System Implementation 167
Managing Threats to Large IT Projects 171
The Board’s Role in the IT Discussion 175
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Board Roles 176
Committees and Members 176
What Should Board Members Look For? 176
Summary 178
The Challenge of IT Value 179
The Nature of IT Value 179
The IT Value Context 180
The Dissipation of Value 181
Summary 182
Section Three
IT Management Challenges 183
The Risky Business of Information Security 185
Numbers Don’t Lie 186
Warding Off Danger 187
Not If but When 189
Hitting the Restart Button: We’ve All Been There 191
Doomed from the Start? 192
x Glaser on Health Care IT
Failure to Launch 192
No Guarantees 194
Always a Lesson to Be Learned 195
Organizational Effectiveness in Implementing IT 197
Critical Factors 198
Managing Change 198
IT Governance 199
Strategy Considerations 199
Bringing It All Together 200
The Scope of an IT Strategy 203
The IT Asset 203
IT Strategy Elements 204
IT-Centric Organizational Attributes 205
IT Strategy Considerations 205
More Than a List 206
Thinking Strategically about New Information Technology 207
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Five Questions to Evaluate Technology 207
Why Answer These Questions? 209
Data Challenges on the EHR Agenda 211
New Considerations 212
The Years Ahead 213
Are They Using IT? Effectively? 215
Necessary Downtime 219
The Legacy of Leadership 221
IT Effectiveness, Part 1—The Fundamentals 223
IT Effectiveness, Part 2—Evaluating the IT Department 227
Linkage of the IT Agenda to the Organization’s Agenda 227
Governance 228
System Implementation 228
IT Service Levels 229
IT Staff 229
Summary 229
Contents xi
Section Four
HIT Industry Observations 231
Why We Do What We Do 233
My Father 233
The Foundation of Medical Care 234
Health Care IT Innovation: The Best Is Yet to Come 237
An Era of Accelerated Innovation 237
A Societal Shift 238
Playing to Win 239
Living in Harmony 241
Of Guns and EHRs 243
An Odd Parallel 244
In Praise of Revenue Cycle Systems 244
The Best Laid Plans 246
More Time Needed for Meaningful Use 249
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Reason for Concern 250
Fundamental Risks 250
Time for a Time Out? 251
Seeing Health Care from Both the Provider’s and the
Vendor’s Viewpoints 253
The More Things Change, the More They Stay the Same 254
Yet, Some Things Are Different 255
We All Play a Part 256
Getting Ready for the Big Dance 259
Early Adopters Set the Stage 260
Winning at CPOE 260
The Federal Electronic Health Record Strategy 263
Meaningful Use 263
Incentives 264
The Changing Meaning of EHR 265
The Complexity and Scope of the Federal Strategy 265
Bumps in the Road to Universal Adoption 266
xii Glaser on Health Care IT
Boundary Erosion in Information Technology 267
Value and Risk 267
Consumer-Oriented Technologies’ Impact 268
Finding Balance 269
Taking Care in EHR Adoption 271
EHRs Are a Tool 272
Adoption Will Be Difficult to Predict 272
The Future Must Be Assessed 273
The Impact of EHRs Will Be More Extensive Than Care Improvements 273
Manage the Change 274
Health Care’s Progressive Transformation 275
Large Numbers of Small Organizations 276
Incentive Misalignment 276
Fragmented Care 276
Process of Care 277
Health and Medical Data 277
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The Nature of Provider Organizations 277
The Path Ahead 278
Health Care IT Progress Report 279
Hard Work Pays Off 279
Hurdles on the Horizon 280
Four Challenges in Personalized Medicine 283
The Tiering of EHR Adoption 287
Tier 1—Non-adoption 287
Tier 2—Adoption but Little Value 288
Tier 3—High Value Achievement 288
Tier 4—Sustained Value Achievement 289
Observations 289
The Four Cornerstones of Innovation 291
Innovation Is a Property of an Organization 291
Innovation Happens When People Try to Solve Real Problems 292
Innovation Can Be Managed 292
Contents xiii
Information Technology Can Be an Important Contributor
to Innovation 293
Conclusion 293
Information Technology Is Not an Intervention 295
When Information Hurts 299
Importance 299
Difficulty 300
Worth It 301
Index 303
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Foreword
The year was 1997, the place was a Marriott just outside Ann Arbor, Michigan, and the
reason was my attendance at the Information Management Executive (IME) Program
sponsored by the College of Healthcare Information Management Executives (CHIME)
and the University of Michigan. The military sent me to this program as part of my
Information Management Fellowship and Internship. This is a where I first met John
Glaser. He was serving as a faculty member, helping new and young health care execu-
tives understand health care information technology (IT).
John was far more than an excellent instructor guiding and shaping the minds of the
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future leaders of our country’s health care IT transformation journey. He was and still
is the Godfather of the role of the health care CIO—and much of what we understand
about the adoption of IT to change health care can be credited to John.
He served as the Founder and initial Chairperson of CHIME. Though starting
small, CHIME now represents over 1,700 CIOs and other health care IT executives
in every state in the nation and 20+ countries worldwide. His vision at the time was to
connect, engage, and empower these budding new leaders.
John is stricken with the same affliction that many of us in this crazy, but fun,
profession have: “I Can’t Say No (ICSN) disease.” After successfully completing the
IME program in 1998, I asked John, along with another great CIO (Ed Kopetsky), to
consider mentoring and guiding me through my career. Of course, both, succumbing
to ICSN, agreed. Now, nearly 20 years later, I have the privilege and honor to serve as
the President/CEO of CHIME. I am pleased to report that John’s vision for CHIME
and the role of CIOs has remained true. In fact, we just launched our new vision state-
ment, “Exceptional Leaders Transforming Healthcare.” These four words describe John
Glaser perfectly: An exceptional leader transforming our industry.
If you know John at all, you know he openly and willingly shares his thoughts,
knowledge, and often strong opinions through writing and speaking. I am not sure that
even John knows how many articles, blogs, presentations, and interviews he has con-
ducted and produced over his career. Although the volume is surely impressive, it is his
profound impact that truly can’t be measured. As CHIME now teaches more than 100
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xvi Glaser on Health Care IT
students a year in the CHIME CIO Bootcamp program and graduates 1,000+ students
per year, it is important to point out that in every single class, most, if not all, faculty
reference John’s work, knowledge, and the impact he has made on the next generation
of HIT leaders.
This book is a collection of John’s finest and most challenging work. These writ-
ings represent over a decade of self- and industry introspection and critique. Some will
explore the current challenges and potential solutions we face during these transitional
years; some will dissect the current policy, exploring weaknesses and errors; but all will
educate and inform in a witty and thought-provoking style.
Today’s challenges, just like those of the past several decades, require shared learn-
ing and understanding. These writings represent an amazing opportunity to learn and
understand from one of the best. He not only helped to start us on this journey but also
blazed a path of discovery and innovation.
John has always endeavored to help create great and revolutionary leaders. As we
strive to enable an industry full of HIT revolutionary leaders, we are guided by several
key principles learned and reinforced by John’s teachings:
1. Do Not Accept the Status Quo: Revolutionary leaders learn from the past and
present to create a new and innovative (often disruptive) future.
2. Be Flexible: Challenging the present for a new future often results in failure
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that helps guide future success. Being flexible allows us to rebound quickly and
continue to move forward.
3. Plagiarism Is a Skill, Not a Crime: Although we do not mean this from a theft
of IP or someone else’s thought, we do encourage rapid sharing of best practice
and knowledge in such a way that we create exponential learning and change.
4. Revolve (revolt), Not Evolve: The pace of change must help create a new and
different environment of care that truly leads to improved quality and safety, and
reduced cost for our country and the patients we serve.
5. Make Somebody Mad Today: If we do all of the above, we will make some (and
often many) mad. So, our collective challenge is to make somebody mad today
by creating a new and different environment of care through the revolutionary
application of technology and process change.
John has always challenged us to be our best, question what is in front of us, and
create a better future. Please enjoy these amazing writings with that mind-set. Then,
use the knowledge to improve your revolutionary leadership skills and create a brighter
and better tomorrow.
I am sincerely a man blessed to call John Glaser mentor, teacher, and friend.
– Russ Branzell
President and CEO
College of Healthcare Information Management Executives (CHIME)
Preface
We are in the early stages of remarkable changes in health care and the ever-evolving
foundation of information technology (IT) that supports it. Indeed, a new era of health
care is upon us:
An era that has seen the enactment of the Patient Protection and Affordable
Care Act (commonly called the Affordable Care Act or ACA), which brought about
sweeping legislation intended to reduce the numbers of uninsured and make health
care accessible to all Americans. An era in which changing reimbursement models
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are driving care providers from a care volume to an outcomes orientation, wherein
evidence-based medicine—and the ability to manage volumes of clinical evidence
through sophisticated health IT systems—will mean that providers can tailor treat-
ment for the individual and intervene earlier to keep patients well. And an era in which
patient engagement will become a critical component in the care process, particularly
in population health management.
Perhaps most notably, from a health care IT standpoint, this era has added two
inescapable words to the health care IT lexicon, permanently shifting the industry’s
focus from adoption to “meaningful use” of electronic health records (EHRs). This
has been a good shift—a much needed shift—and a very worthy endeavor by the fed-
eral government.
As I look in the rear view mirror of a career that has provided me with multiple
vantage points from which to see the industry—including that of a provider CIO, an
advisor to the national coordinator for health IT, a vendor executive and CEO, a con-
sultant, and an academic—it’s clear to me that this transformation has been building
for over a decade. During this time, I have had the privilege of contributing thoughts,
opinions, advice, and observations about everything from preparing for meaningful use
to innovation to why it is we do what we do in this noble profession in which technol-
ogy strategically intersects the practice of medicine and the business of health care.
This past decade has taught us a great deal about spurring both the adoption and
the meaningful use of EHRs and the systems that surround them. It has taught us
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