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Monday, March 14, 2011

A Doctor is Not a Bank

All too often I've heard the comparison between the financial industry and its efforts to make transactions electronic, and the healthcare industry.  But health is not something that I can make deposits on and withdraw later.  We aren't talking about a case where there are only two organizations completing business transactions on behalf of their customers.

There's a lot more going on here.  A better comparison would be to automation supporting electronic commerce between multiple businesses.  I'll use electronic publishing as an example, since I have some history in that space.
Imagine that you had a customer needing a new web page.  You have to understand what the customer is trying to accomplish, and then design a page to meet their needs. Along the way, you have to obtain assets:  Text content, media (pictures or video), put it together, get approvals, and publish the content.  Obtaining the assets might involve negotiating access to content from others, paying someone to provide it, or simply assigning the job of creating it to someone on your staff.  Afterwards, you need to put all those pieces together into a coherent whole, possibly get someone to review and approve it, and then it gets pushed out to the web.  Anywhere along the way you may learn that there are other tasks to perform.  Some of the content may need to be coded in Flash, in which case, you might need to put a flash player download button on the site (which means you need another piece of content), et cetera. Oh, and if you are providing full service, you might also evaluate how people respond to the page, and make any adjustments necessary to improve their response.  Now, consider making that whole process electronic, and you begin to understand the complexity of healthcare. BTW:  There are systems that support this process electronically, but they are proprietary.

You have a patient, with a specific complaint or symptom. After spending a bit of time getting to know that patient, a healthcare provider has to make some objective assessments (findings), or get others to provide them (e.g., referrals or testing).  Some information may need to be generated by specialists.  Once you've determined what is wrong, you need to pick a treatment.  Oh, that might need approval (from the patient's insurer), and then you need to follow up to see that the treatment worked, and adjust as needed.

I wish I could earn excess health, deposit it with my Doctor, earn interest and come back and make a withdrawal of it from him as needed.  If that sounds ridiculous to you, then please join me in efforts to stop comparing healthcare IT interoperability to banking.


  1. Great points, Keith. In the article I wrote about EHR, I used the banking industry as an example of computerized records. However, as you point out, the comparison falls flat on its face when it comes to interoperability, and more current analogies are needed. I guess what I was trying to illustrate was that the technology to document patient's medical history has existed for a while, but is only now being seriously developed in the US.

    The complexities involved in healthcare are immense. In addition to what you've already mentioned above, there are charges for reviewing labs, beds, meals, even lighting that get factored into hospital stays. Creating systems that can keep track of all these complex transactions is quite a challenging task, and I'm glad we have people keeping us honest about just how tough it can be.

  2. Keith, I am with you up to the last point... The Google-Health, HealthVault, and 23andMe(We) do have models for 'interest'. It is not necessarily money, but by offering your health information up for medical research one will be a part of creating knowledge. The hope of all offering data is that the new knowledge is offered to the public and that the original individual or their friends or relatives benefit.