"Health begins where we live, work, play, pray"

Welcome to the big unlock podcast where we discuss digital transformation and emerging technologies in healthcare. Here are some of the most innovative thinkers and leaders in healthcare and technology talking about how they are driving change in their organizations.

Paddy: Hello again, everyone, and welcome back to my podcast. This is Paddy and it is my great privilege and honor to introduce my special guest today, John Glasser, Former CIO of Partners Healthcare, and now an Executive Adviser at the Cerner Corporation. John, thank you so much for joining us and welcome to the show.

John Glaser: Thanks, Paddy. It’s a pleasure to be here.

Paddy: Thank you. So, John, you’ve been a CIO at one of the leading health systems in the country. And now, you’ve been working with one of the big EHR providers. So, you must have a unique perspective on all the discussions that have gone on about the cost of EHR implementations, the burden on physicians, and of course, all the benefits of digitizing patient medical records. So, can you talk to us a little bit about how your views on EHRs have been shaped by your experience?

John Glaser: Yes, sure enough, Paddy. And I think, I mean, there are a couple of parts to the question you’re asking me. So, I’ll start with the one on the burden, which is one of the more pressing issues today. Clinicians concerned about the usability systems or when you look at it, you see a couple of things. You know, why there are some legitimate concerns that people are raising. Well, sometimes the design isn’t very good or could be made better. So, it’s not as intuitive it needs to be. There are too many clicks, it takes too long, etc. At times, as long as they are just bad designs, we can fix that. But there are also some ways, for example, using a lot of dimensions of voice recognition and the ability of AI to empower a voice and so other ways of interacting with the system. So anyway, one topic is ongoing work improving the design, using new technologies where possible. The second area that we could spend a lot more time or better ideas is changing the workflow. At times you see provider organizations and also their partners, and I see this at Cerner, where they just go live to turn it on, but they really didn’t go through a workflow changes or how best to distribute who does what in the clinic, et cetera. So, you can actually change a lot of work by moving the work around to better suited people to do this, that or the other. So that’s workflow can be improved a lot in some of these cases. The third of the times we ask the doctor to do stuff which is just kind of overwhelming. I mean, documentation can be onerous, and CMS has been recently working on just reducing the documentation burden. Also, you think when I was a partner, we always called the tyranny of large numbers of good ideas. Where we just say, the committee said, golly, we should have the docs ask about smoking. You know, that’s a great idea. We should ask them to ask about whether you’re safe at home. Yeah, it’s a great idea. One by each. All these are great idea, but you add them all up and they’re just crushing in terms of time. So part of it is sort of going through the record in finding out what do we really need the clinician to do here? And maybe sometimes we can use new techniques such as AI to sort of construct documentation that goes on here. And then the fourth thing is sometimes it just takes long. So, if I gave you, Paddy, a prescription pad to write me a prescription, how long would that take you? Three seconds, tops. I said, well, now I want you to sign on. Pick the patient, pick the dose, pick the drug, all that other stuff. Really good. How long would that take you? Well, 30 to 40 seconds. And so you’d take these tasks that happened all the time and you make them longer and there is probably no way to really make them shorter. We don’t know what that is. And the problem with that is the doctors. Well, what’s in it for me? Why am I spending all this extra? How do I gain here? We don’t have a very good answer for that. You know, we suck up time. They don’t really deliver much to you. So, the other part is you are moving the value-based care where you really do get rewarded for quality, so that you’ll say, all right, I’ll spend the extra time because I can see what’s in it for me. Anyway, there’s a multifaceted approach to dealing with the usability issue. Unfortunately, none of them are simple. It’s this progressive, you know, operating on lots of different fronts. So, I think that’s going to be part of it. I think there’s value here. I mean, and sometimes the value you can express numerically, you know, there’s fewer errors or there is turnaround times or things like that. But at times the value is really intangibles. If you have better communication with the care team. I’m sure if we do, around the world you measure communication in better decision making. At times you can measure and at times you can’t. But that’s true of IT in general. So, I think there is a, you know, what you see is we still have challenges and usability will always have this complicated, multifaceted value proposition. But nonetheless, I expect all of this is very foundational to say we really want to change the health care system, get into value-based care, engage consumers, etc. Can’t imagine that we can successfully do that based on a pile of paper.

Paddy: Yes. So, it is fair to say that it’s all a work in progress. And it’s just going to get better over time. But we know it’s going to hurt a little bit while we get there?

John Glaser: I think it’s fair Paddy. There’s no silver bullet here.

Paddy: Yes. So, one of the things that has been criticism against technology vendors as well as health systems, in all fairness, is the question of interoperability. Do you have experience in data interoperability challenges acutely as a CIO of Partners, but you also have seen it from the point of view of a major electronic health record provider. How long do you think it’s going to take before we get to a place which is similar to, well, let’s say, the banking sector is?

John Glaser: Well, I think a couple of things. One is, you recently did an article in Harvard Business Review on kind of what can we learn from banking and, you know, not only in banking but also travel. The travel industry is pretty well advanced in interoperability. Did you see a couple of things? One, in both industries the interoperability is partial. And the reason it’s not complete is two-fold. You know, sometimes there are no real reasons for the industry to cooperate. So, for example, in banking, as you know, and I know we can go anywhere and use our get access to our account or withdraw money through the ATM infrastructure shared by lots of different banks and financial institutions all over the world. On the other hand, Paddy, if you go into your account, and want to withdraw 20 bucks in the wealth part of it, you don’t have it. You only have 10. What it doesn’t do is say, I’m going to reach into your Bank of America account, see if I can find 10 bucks, transfer it and serve it up to you. That interoperability doesn’t exist. Why? Because the banks don’t want it to exist because they view it as a competitor problem. You know, you might reach it, and holy smokes! Paddy has got a lot of money here. Maybe I’m going to entice him to join my bank.

John Glaser: We’ve bank American join Wells Fargo. We know banks have no interest in that. So sometimes it’s incomplete because there’s no rationale business case for it to be present. The second is technology. Dances are always happening in interoperability of life. So, for example, you know, a lot of these are kids do this. They use these micropayments, where they sort of send a payment to their iPhone for 20 bucks for share of dinner together? Well, between MIT and others, there’s no interoperability here. Why? Because it’s too new in lots of ways. So anyway, the point is you look at other shoes and you see a partial, I think said, is it where? Yeah. But they’ve been successful. They’ve done some stuff. Sure. And how do you know what were the conditions that led them to that? Well, there are three things, one of which is they really zero in on particular transaction or try to connect everything to everything. They say, well, we’re gonna go after the A.T.M. sharing of the infrastructure or in our case in healthcare, we might say we’re going to go after authorizations and referrals. We’re going to try to connect everywhere, very targeted transactions. Second, those targeted transactions, there really is a business case. And sometimes in healthcare, we confuse use cases with business cases. Use cases – here’s how it works but doesn’t mean anybody will pay for it to work. But here’s how it would work. In business cases, there’s a real strategic, compelling revenue cost service rationale for this kind of stuff. So, they’re very good at that and getting agreement. The third is they have an industry body that pulls everything together. So, in swift or in banking, it’s a swift alliance. Ten thousand members. The banks get together and talk about how to settle at the end of the day. Debits and credits deposited against each other. They need to streamline that, so they know what your account is and what my account is the following morning. So, switching gears, in travel, the open travel lines exist to sort of help the travel guys. So, for example, if you go from here to there and you use two airlines in the process, your bags have to go from one airline to the other. Well, how did that happen? You know, it’s not only an interoperability thing, but it’s also a process. You know, what is the baggage person do when they take these bags off your United flight and move it on to an American Airlines flight? So anyway, they have these industry groups that bring everybody together, sort through priorities, business cases better. We may have that in the recognized coordinating entity that Oh, and to just suit up with a Sequoia project, et cetera. So, I think Paddy, what we’ve got to sort of take the playbook from those and to look at these three. And I guess the last comment I’ll make that just goes back to my days as CIO. You go into the board meeting. So, you know, we got 50 different requests for IT projects, grand total of One hundred million bucks. But we don’t have a hundred million bucks. We’re going to give you 30 million bucks. If you are all okay, Well, then of the 50, I can do 20. And so, we have to prioritize just because of bandwidth and because of money, et cetera. So invariably, a lot of the interoperability stuff never made the cut. You know, it never was a top contender with stuff you want to do for nursing or improve the revenues cycle or to improve security on the infrastructure. So, it wasn’t as if there were bad people making data blocking decisions. It’s just that the rationale was not as compelling as other rationales, et cetera. That may change as we do value-based care and there’s a greater reward for continuum. But it’s a classic example of a business case in a particular instance of a health system. The business case often just wasn’t strong enough to sort of rival effectively with other propositions.

Paddy: Yeah. So, you mentioned the CMS and the coordinating entity that they announced. Of course, the CMS and the whole industry, they are kind of into the middle of this. And they had this for the last couple of years. But there’s a lot of confusion, at least to me and maybe even to some of my listeners here. So, you know, we have the FHIR API standards of the CMS and ONC are working with HL7 organizations. Now it is the 21st Century Cures Act, there’s something called TEFCA that’s out there. How do my listeners unpack all these? Is it a simple way to unpack all these and understand what’s going on at a high level?

John Glaser: Oh, I think it’s a tough thing, Paddy. And you’re not like you mean you can read about Hollywood as the recognized court and what’s really behind tapped. But some of these is new. And so, you don’t really know how effective all of it is. And will it get tuned or altered along the way? And sometimes you go in and you say, golly, there’s this bill in front of Congress, that bill in front of Congress. And a lot of bills get put on it, put out there, but never make it anywhere and never give out a committee and never get voted out. And so, there’s a swirl of bills that come through. And even when a bill passes and it goes into committee and gets to an increase, their golly, it’s pretty fluid and the expert aren’t sure, etc. So, I think it’s really hard to do that. My best advice on that is one is if you’re with a large enough organization, a health system or a health plan or whatever. Usually, there’s a government relations person or a person whose job it is to be on top of what’s going on in government. Sometimes the IT stuff during the health system there probably also pay attention to Medicare rates or state level activity on Medicaid and other things like that. They’re paying attention to privacy laws that are so large. One of the things you do, you turn to say what seems to have such a person in my organization and I’m going to then talk to him or her periodically about kind of what’s going on. You know, on a regular basis, the best channel. So that’s one way to do it. The second way to do it is to, you know, you’ve got to go to conferences. I’m going to go to a Chime conference or HIMSS conference or whatever. And, you know, there’s usually a government discussion there, and I want to listen to that. The third way that people have is, sometimes they sort of have to subscribe to or have relations with lobbyists or firms in the D.C. area whose job it is to keep tabs on all this kind of stuff. So, you often see a health system with a connection to a set of folks in D.C. whose Job it is to monitor their rules and regulations that are going on, etc. And then you can finally join organizations such as the E-health Initiative or the Electronic Health Record Association. Many of them or D.C. based. You do preview a pretty darn good job of keeping on top of what’s going on here, etc. And then obviously you, Paddy, and I’m sure you do this from time to time. But I think it’s hard and there’s lots of other ways you can do it because there’s sort of this cottage industry that has emergencies as too hard for people to really keep on top of it. So, I will be a lobbyist in DC or an association or whatever it was design it is to make sure that you get the scoop on what’s happening and how it’s changing.

Paddy: Yeah, I read a recent report I think that was done by one of the big consulting firms, Accenture, which said that, look, this information blocking rules that the CMS proposed earlier in the year and was announced during HIMSS, actually. It’s coming. It’s coming down the pipe, may be down the road. Well, health systems need to get prepared for that, and their survey seems to indicate that people are not prepared, are not aware or don’t care or any combination of the above. So, John, just in light of your comments, is this even a big deal, should health systems be doing something in anticipation of all these things going into effect?

John Glaser: Well, I think it’s really hard for a health system to prepare for this because there’s this language in their Paddy and its fuzzy language. So, it says your health system has to make sure that patients can get their data with no additional effort. So, what does that mean? Or if you’re a vendor that you can’t you know, this can’t be _________costing or I mean, there are obviously costs that are way out of line. But we know what point you cross the line with your costings on this kind of stuff here. And that if, you know, someone says, hey, I want to have access to my data, you have to serve up everybody. Yeah, but I can get overwhelmed by this thing. Aren’t there ways I can part it? So, there’s a lot of fuzziness in the language about what do you really mean? I think the part of regulation is getting clarity over again. I spent a year ago and see where meaningful use is coming out and know the legislation said we’re going to give you money, you know, an incentive to adopt in the meaningful use of interoperable electronic health records. And that’s all it said. what is meaningful use me. Well, it took regulations to really say it means this. And we have all this very complicated set of certifications and this that the others come out of that. So, you take all these data blocking stuff and that specificity that we now see around these, doesn’t exist yet. And they’re still working on the rules to sort of create it. I think this could be really complicated. So, in a way your health practitioner says, I can’t prepare because I don’t know specifically what you mean. What do I tell my troops to do in the IT department or medical records department, etc.? So, I think all you can really do is do a couple of things.

John Glaser: One is to your point; you can pay attention and talk to your colleagues at consulting firms. What’s going on? The threat of the other. The other is to make sure that you are a part of and aware of what your lobbying or professional societies are doing, such as what is the American Hospital Association doing about this and they’re working out their hearts.

John Glaser: What is the AMA doing about this, the Medical group management association? Anyway, Organizations that represent providers are trying to work with Congress. We got to get clarity here and only clarity, the clarity that’s practical not just clarity that’s going to be awful. You know that we go through think you can do some basic stuff that goes through. But I think it’s really hard to get this until we get this clarity and all you can really do. And it’s worth doing this to work with, you know, organizations like the AHA to make sure that your opinions are known to them and that you’re hearing from them kind of where the conversations are in terms of creating the real rules and regulations that will give us all clarity.

Paddy: So, watch and wait, basically.

John Glaser: And but also stay connected to the organizations that are in D.C. trying to work with him and to get clarity.

Paddy: Yes. So switching topics here a little, so today the big buzz is all about digital health innovation, digital transformation, and you see a lot of announcements, almost on a daily basis, the big tech comes to the act in a big way, the Microsoft and the Googles of the World. We see a slew of partnerships that are being announced. You know Cleveland Clinic just announced one with Amwell. And the bunch of these partnerships are happening. And you have all these nontraditional players, a Walgreens, Wal-Mart and CBS. So, what do you make of all of this? Where is the industry headed at a very high level in terms of its competitiveness, in terms of a fundamental shift in primary care relationships and so on?

John Glaser: Well, it’s a fair question. And I think it’s remarkable time that this industry saw it. I think, you know, when you step back in Hollywood, the industry is going through this amazing change in business model, and business models basically says, I’m an organization. Here’s what I’m going to do. Here’s how I’m going to do it. And you are going to be like what I do and how I do it so much. You’re going to pay me and you’re going to pay me enough to make profit and maybe I’ll become rich and all that other stuff. Example is Uber, the business model is I’m going to get you from point A to point and say, well, yeah, that’s not all that walking does that fighting does that, etc. But who says, yeah, but how I do it is really different.

John Glaser: So that is for sure. And it’s pretty neat to all use Uber it better. So anyway, in healthcare we’re going from this shift of business model from volume to value-based care, from fragmented care to integrated care, from reactive secure you shop or fix you to proactive management of health. And from one which is really centered on the clinician to one that is more centered on the consumer or the patient. And as a profound business model ship, anytime you have a business model ship like that and it can be induced by the technology like the web or mobile device or by an arcade, a lot of payment mechanism people see opportunity. So, it’s not surprising that you see several tech giants and other organizations, retail, pharmacy, retail, that CBS is the Walgreens, Walmart, etc. saying, hey, we can do a whole bunch of these people stepping in. So, there’s business model shift, there’s opportunity when that happens. And I see how I can leverage some of my strengths to go off and to do this kind of stuff. So, I think we’re seeing this flood because of that going on. Now, what I think is happening is sort of the traditional boundaries between providers and health plans between the pharmacies and the providers are that these crucial boundaries are getting blurry. We are ________ whether it’s provider sponsored health plans that kind of are gone or Optum has a massive, you know, delivery arm, probably the largest delivery arm in the country, frankly. And, you know, as you see this, you know, in fact, I just got my flu shot at my local Walgreens this morning. And so, they’re increasingly getting into some basic types of care, let alone going on the Internet. And you can get prescriptions for E.D., drug or eye medicine, all kinds of stuff. What we’re seeing anybody records the stuff. Those are really fluid times. It’s going to go under. Now, how it will turn out, I’m not really sure. I mean, I see the tech giants, you know, the Microsoft, Google, AWS of the world. Well, they’re really doing sort of two things here, one of which is providing infrastructure. And so, Apple, for example, with healthcare and research kit, is providing infrastructure for you to develop new and cool stuff, whether you’re Cerner or an Epic or whether you’re a health system or whatever. And they benefit because they sell more iPhones and watches and stuff like that. So, they’re all doing infrastructure. Sometimes it’s cloud, sometimes it’s Apple creating healthcare set up. And now, the infrastructure of case of hosting, but also tooling, which is AI tool or voice recognition tools, you know, Siri things along those lines or so. Anyway, the tech giants are saying I’m going to deliver infrastructure so that as you guys go through, this is a model change. You can do all kinds of pretty cool stuff that’s going to go on. The other part is if you look at particularly Google and Amazon in particular, say increasingly they want to surround you and I as consumers with all facets of our lives. So, on Amazon, if you order something, Paddy, I want you to order ninety-five, maybe 100 percent of everything you ever buy through Amazon. And it’s not only books and electronics and this and the other, but now it’s groceries. And increasingly, you’ll be durable medical equipment, your health care stuff. So, I just want to surround you and make it really easy for you to order everything. Now, there’s a lot of value for me in that I want to sell advertising I can so, you know, I can charge money for a little bit of extra kicker for all these proposals that are putting. And also, I get to know you. So, you’ll see the sort of personalization coming in here and calling people like you bought X. So, I’m going to use all that knowledge and all fancy and sophisticated intelligence and great supply chain, et cetera, to surround you and be much more effective at making money off your daily activity. Google, on the other hand, which is also trying to surround you. You’re trying to surround you based on searches that you do. So, is Paddy interested in looking at locations, is he looking at what it’s got a chronic disease, what does he look at? And I want to surround you. And not only do this search improve Dr. Google, for example, but also in your home, you know, we know a lot more about you in your home or to make it ___________ So I think above and beyond the infrastructure, in particular the case of Google, Amazon they surround you in an ecosystem which we actually benefit from and use a lot, which they increasingly understand us and health care becomes a critical adjunct to understanding hobbies and understanding financial status and understanding, you know, whether you have a big family or a little family and all this kind of stuff, anyway, they’re getting into health care just to round out their understanding of you and surround you with support based on things you buy or questions that you ask. So, what all this mean to the, you know, the Corners and Epics and _________ all those folks? I really don’t know. You know, you see the Cerner AWS announcement. I suspect increasingly there will be this effort to put another layer on top of the EHR. a layer that’s kind of like the population health, but, you know, essentially, it’s a platform that sits on top, pulls in data from devices and pulls the data from claims, engines and charts and provides a series of additional services to you and me as individuals, and the health systems and also the life sciences. So anyway, that is going to a remarkable time to see how this battle settles out.

Paddy: Yeah. And this is obviously the whole competitive landscape is shifting. So EHR vendor is kind of moving upstream and they’re getting into more of the value-added world. And of course, the big tech firms are trying to move into more of, I don’t think they’ll ever become EHR vendors. I could be wrong. So, they need, the emerging needs are all about analytics and user experience and so on and so forth. Now, one thing that I hear a lot is that the health care, the relationship between the health care consumer and her primary care physician is a unique one, which is built on trust. And, you know, no matter what you may say about the brand value that Amazon e-commerce platform or a Walmart or Walgreens, there are certain things for which, you know, the trusted relationship between the physician and the patient that’s kind of unbreakable in some ways. Now, there are generational differences. Millennials have a whole different approach. They don’t even have a PCP in the first place. And, you know, the boomers, on the other hand, are used to a certain way of consuming health care. Does a shift in demographics play a role? Is it going to play a role in how healthcare is going to be served and consumed in future?

John Glaser: Well, yes and no. I think a couple of things. One is you and I and everybody don’t care whether you’re 22 or 82. You have two different types of relationships with the health care system. One is what I call truly transactional, like today. I want to get a flu shot. You know, I could I did it. A Walgreens is nearby. But it didn’t matter to me whether it’s CVS, you know, and, you know, the nice lady who gave me the flu shot. I mean, I don’t know who she is. I don’t really care if I renew who she is. It’s better if it’s a transaction. It’s like buying groceries. You know, we want that. We want good grocery. You want to pay the amount. But, you know, I don’t really care whether the person is checking me out and I ever have a personal relation. To that aspect of health care, we’re just transactional, pure and simple. And again, you could be twenty-two and it’s transactional. You can be 80 to it is transaction. So, there I think, you know, the retail guys will do just fine because at the end of day, we want good, convenient, high quality, relatively inexpensive service. There’s another category relationship, called agency, which is why it is different. You know, my relation to you is based on trust, based on the fact that you have knowledge that I don’t that you have experience that I don’t, and I never will. Frankly, I trust you will be smart and thoughtful, care about me, et cetera. Know an agency relationship can exist with your doctor and if you have cancer or, you know, weird or scary and neurological disease. I don’t know you. I trust you as an agency. It also exists with a financial planner. Most of us, you know all these options ________ Paddy, maybe you’re all over this stuff. You Know, I trust the financial planners. Listen, John, you want to retire. You want to send a kid to college. Here’s what we got to do here. And if I had a complicated legal situation, I would trust an attorney. I don’t know. You help me. So anyway, the point is we have agency relations to several different types of people, including our doctors, etc. that we will always have. Now, it’s interesting, me, Paddy, I have three daughters. Thirty-six, thirty-three and thirty. And the 33-year-old and a 30-year-old are new moms. You know, within the last year, both had grandkids. That’s how I view them. So, it’s very clear to me that those my daughters value enormously the personal relationship with the pediatrician and value when they were pregnant. The personal relationship with their obstetrician. Now they’re millennials. But, you know, they want a healthy kid and they want a pregnancy without complications in the sight of the other. So, they might be millennials and they’ll willing to do certain they’re more comfortable with the technology than I am. But when it came to stuff that really mattered to them and when it came to stuff where they said, golly, you know, the stakes are high and there’s an imbalance of knowledge here, I trust and need that data. So anyway, I look at that and say why on one hand, millennials will try to do more of this. But on the other hand, all of us have, you know, retail transactions and health care in my daughters, as young as they are, you still have the value trust relationship as parents.

Paddy: And I think that’s very well put actually it’s pretty nuanced. So just to round out our discussion today, John, you talked about a bunch of the emerging technology. You talked about voice enablement. And I think that this fantastic scope for increasing productivity and reducing the burden on physicians just to voice enablement. And I think there’s already progress being made in that. You talked about cloud, how Cerner in particular is driving relationships with AWS and all the other cloud lenders are getting it. I just want to talk with quickly about AI, what you think of AI’s potential.

John Glaser: Oh, I think, Paddy, I think it’s massive. And I think, you know, it’s interesting, if you go back over the history of business use of IT, every decade, there’s a class of technology IT technology would just change the world. The world’s different as a result. So, in the 60s, it was the mainframe computer. In the 70s, it was the minicomputer. In fact, you know, the Cerner – Epic ________ they were all born of the mini computer. In the 80s, it was a network personal computer. When I came on the scene, I saw it.

John Glaser: And you could really do your own computing power, connect the printer stuff and use Ethernet, all that stuff. In the 90s, it was the web that debuted. So, you know, Amazon founded 1990 for Google in 1998. The world’s a different place because of the Web. In the 2000s, there was the mobile device and, you know, high speed wireless network. You know, the iPhone debuted 2006. So, and also and you look in a very short period of time, 15 years, how much the world is changed because of the mobile device. Is it in the current decade? What does it say? You know, the world will change because of that. Now, sometimes these changes play out over a long period of time, decades. For example, in this country, we are all sort of concerned about the web being used to influence elections will shoot. You know, this is 20 years into this revolution. Now we’re still learning about both the pros and the cons of the technology. Anyway, AI will play for a long period of time. I do ________ or are sort of focused on calling what we remove the need for doctors and, you know, and wheel cars really be driverless in all circumstances. And we get, you know, a little too ahead of ourselves. But it’s here now. Least, you know, Siri, for example, Alexa has remarkable A.I. capabilities. My wife has a Volvo XE night and you couldn’t crash that car if you wanted to. You know, the A.I. that keeps you from drifting in the lane and getting too close and parking and all those kinds of other stuff. So, there’s A.I. everywhere across us. And, you know, I see the same in the machine. You know, the logic will look at machine say the performance of part sixty-two is getting a little erratic here. I think it’s going to fail in four hours. So, let’s I’m going to dispatch a message to a technician to get out here with a new part Sixty two before it goes down. Paddy, we will see profound change. It’ll be multifaceted. It’ll be all over the place. It’s not like it’ll be here or not there, et cetera, in our professional lives, our personal lives, et cetera. You will take decades to play out. But nonetheless, you and I will have this conversation 20 years from now and we’ll say, golly, look at the change that A.I. It’s happened. And I guess part of the cool thing is, if that’s really true, that every decade is something changed the world. What’s next? That’s good question. It’s usually hard to see the decade that is going to come, but it invariably comes.

Paddy: Well, John, it’s been such a pleasure speaking with you. Thank you so much for sharing your thoughts. And thank you for being on the show.

John Glaser: My pleasure, Paddy. Thanks for inviting me.

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