Interview with John Glaser, ABCs of Evaluating Technologies Worth Your Investment
Barry Jacobs: With all of the discussion about innovative technologies,
what is the difference between ideas about transformation versus actual implementation?
John
Glaser: One certainly encounters fuzzy, jargon-disguised concepts.
Perhaps the most brilliant example was the Internet transforming business — e-business, cyberspace, disintermediation, etc. — new jargon, new concepts. Suddenly, there was a brand new way of thinking. The old economy and ways of managing were dead. Well, dot-coms and market valuation went south.
In his book, Good to Great, Jim Collins talks about how good companies become great companies and stay great over very long time periods.
One thing he points out, is that this move from good to great, is not a single event. It was persistent, smart, focused attention to what you're good at that led to transformation. At times we forget that often the most effective transformations are the result of smart folks who work well as teams, and who stay very focused on some core ideas and go after them doggedly year in, year out; challenge in, challenge out; problem in, problem out.
At times, we make it look as if it's quick and easy — slap a browser on or redesign care — and all of a sudden, you're two standards of deviation away from where you were. Maybe there are occasions where that's worked; but as a fundamental idea, it's not sound.
BJ: What are some of the critical factors that you look for when you are making a decision about what old and new technology to invest in?
JG: The computerized record is an idea that's been around for decades. But it's very clear to me that it is an extraordinarily powerful tool. Though there's new technology surrounding it — browser-based or wireless — it's still an old idea.
We have some new ideas that may not require much new technology at all, such as progressively integrating our systems with the payers' systems to synchronize our master patient index with their subscriber database to reduce the number of claims rejections because of name misspellings, for example. In many cases, we find a mixture of old and new ideas can be done with a facility's existing technology, but sometimes newer technology really is required to make the next step.
Regardless of the mix, there are important fundamentals. One is, make sure that you're clear on what the value is. If it's going to improve revenue capture, extend the reach of specialists, or reduce medication errors, that's good value.
You might need to pilot or experiment. It always means that you scour the planet to see who else is doing it and what they've learned. If they're having a rough time, does that mean it's a bad idea or they just didn't do a great job of implementing it?
Particularly if it's new, find out if it's ready to scale, reliable, and that if you introduce it at a larger scale, it would work efficiently. For example, if we're going to do second opinions over the Internet, have we figured out the workflow whereby the material gets to the specialist, an opinion is rendered, and that opinion gets back to the patient?
We tend to be technology agnostic. At the end of the day, if you can't describe the payoff, then the technology's irrelevant.
BJ: Once you are focused on a particular innovative technology, is there a problem with political fiefdoms within a hospital organization that can make implementation difficult?
JG: An example for us is technology that supports patients communicating with their doctors, requesting refills and scheduling appointments through the Internet. Often you pitch a new IT idea, and the board says, we've already got more IT ideas than we know what to do with, and we don't have enough capital to do them all. Why are we adding to this pile? There's always an entrenched agenda, and it may even be an excellent agenda. You have to know why this idea should be in the top 10.
You have to help people understand the consequences. For example, if I'm the doctor, will I get overwhelmed by email? Is there a risk that care will be practiced over email that I should see in person? Will I lose revenue? They're worried, and in the absence of any other data, can imagine some bad scenarios.
Any set of ideas, proven or otherwise, will have some folks who think it's a bad idea. We can describe them as "political fiefdoms." We can cast aspersions to make people seem nefarious, underhanded, or narrow-minded. Occasionally that's the case. But more often, it's simply that people don't have a clear understanding of why something is useful. Other times they feel threatened, since, if you insert this new goal into the top 10, something has to go because the capital pool is finite, and that something might be their pet project. All organizations are political. It doesn't matter whether you're a hospital, GE, or the Red Cross; there are always constituencies and differences of opinion, honestly held and otherwise.
One should be honest and communicate with people. I try to rely on high-integrity people who are trying to make good judgments. I don't have a magic answer other than to groom and place people who are good, honest, and who are also skilled political actors.
BJ: There's so much information to be aware of. How do you stay in touch, and how do you decide what's fluff and what's important?
JG: I read what I can, attend conferences, identify people who have smart things to say, and I listen. I identify sources I trust and respect. In an IS department, you delegate. We have a CIO. I'm not as on top of the technology breakthroughs as he is, so I ask him to keep me educated. We have people who are responsible for monitoring and evaluating new ideas. They act as filters. They're not going to be free of mistakes, but our people do a pretty darn good job.
Sometimes you have to pay attention to what's politically hot. If something, whatever it is, goes south, and there's going to be debris; you've got to pay attention because of the organizational and political consequences.
There are situations where you pay attention because the idea at play appears to have great power. For example, provider order entry. The notion is that doctors are being asked to be aware of too many things. The computer can be very good at pointing out things that are overlooked, like contraindication or allergy.
So the notion of an intelligent agent passing judgment on a transaction in which the stakes are quite high — people can get hurt, or resources can get misused — is a very powerful idea. The idea that you can do a better job of managing chronic disease by connecting with people in their homes is a very powerful idea. The idea that you can take data from payers and providers and combine it to get a more holistic picture of a patient is a very powerful idea. Certain architectural ideas like Web service are very powerful.
I form judgments of an idea's potency. That doesn't mean that it's actually been implemented well, or that any implementation of that idea has achieved its full potency. But if it is, or appears, potent, then you want to make sure that you and your organization understand it.
There's also a third class — the first being political, the second being potency of idea — the third, is a situation where the idea isn't that radical, but if we make it work well, the payoff is big. The notion of insurance EDI — eligibility query to the payer and back — is an important idea, but it's not radically potent. Nonetheless, if you can make it work, you can make enormous gains on improved revenue capture and reduced insurance transaction error. There are ideas that require a lot of blocking and tackling, just hard work — training hundreds of people, integrating systems, etc. But we've got to do it, because it's a serious improvement.
BJ: What advice would you give CXOs as far as adopting some of these best-of-breed ideas?
JG: I have three messages for CXOs. One is to be careful about new, sexy ideas. There may be power in the idea, and people at conferences, the trade press, and vendors get all worked up. But, there's nothing like being cynical; it's good for you. Don't be overly cynical, or unwarrantedly cynical, but be reasonably cynical.
The second point is, you don't have to be the first adopter of a new technology. History shows many casualties with the first adopter. Who first came out with the PC? It was Sinclair, Osborn, and Radio Shack. It wasn't Dell. Who's in charge of the world now? It's Dell and HP. It's people who were second or third order.
Point number three, is that you ought to feel quite willing to say no to an IT proposal. If you're going to go with the computerized record, wireless, or docs talking to their patients through the Internet, be sure to understand where the value is. The value is not always in dollars; it can be in service or quality of care. Make sure there's enough data and explanation to support it.
Ask yourself, is it in the interests of my broad strategy or my pursuit of clinical and operational excellence to do this? If the answer is yes, do I have a good, strong, trust-worthy team to implement it? Have I well-resourced and well-organized them? Do I have faith in my CIO or CNO?
People want to treat IT as if it's a separate, distinct conversation; it ain't. It's no different than a division chief asking for a new clinical service. You'd want to understand why you need new facilities, equipment, physicians, or whatever. What's the upside? What are the risks?
So, be cynical; it's okay to be the fourth adopter; and use the same set of skilled training, instincts, experience, and seasoning in dealing with IS as you would elsewhere.
