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.

Keith W. Boone is a Standards Geek for GE Healthcare.  He writes at Healthcare Standards and can also be found on twitter as @motorcycle_guy.  His posts are his own opinions and do not represent those of either his employer or the standards organizations that he participates in.

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5 replies »

  1. No, we are a bank. To those who want to rob!!!!

    You see, physicians, until proven otherwise, are an easy target for those who want to rape and pillage the system, because we inherently are considerate and negotiable, because we are in this profession because we care and offer ourselves to aid the community. And that is exactly what sociopaths who work in the financial industry want to access and disrupt. And we foolishly and cluelessly aid and abet this disgusting behavior.

    So, your post intends to set differences, but to those who just want to take advantage of the system for their own selfish and destructive ways, until doctors of a sizeable majority rise and tell the intruders to forget it (ie F Y), health care will not improve and be more effective.

    As I said years ago that was printed, take the F-O-R out of profit in health care!

  2. Welcome to THCB, Keith!

    Alas, it’s even worse than what you describe. Imagine that the CEO of the company MUST be the one typing in the content for your web page, in his spare time no less. And imagine that every content contributor to your site sends you whatever they feel like sending that day, if at all, and each one writes in a slightly different language, not different enough to be blatantly unreadable, but with subtle differences that are difficult to catch. And imagine that what amounts to a funny typo on a web page, translates into a dead person in health care.
    Now, go compare this to ATMs, where addition and subtraction of primary numbers are performed across the wire with great pomp and circumstance.

  3. I like the complex website functionality analogy. A full-featured EHR is like that on steroids, basically a multi-layered/multi-templated GIU atop a complex RDBMS (one that must be able trap perhaps thousands of variables per patient). But I disagree that anyone in the EHR industry is likening this — in particular with respect to “interoperability” — to ATM or checking/savings account transactions.

    A closer (yet still relatively simple) example might be the “bureau pull.” First time I saw an HL7 file example, I thought, ‘well, that’s really no different in concept from a credit bureau file.’

    I use to work in bank risk management. We would routinely get applicants’ and customers’ credit bureau “hard pulls,” which were nothing more and encoded ASCII text files containing demographics info, credit histories and FICO scores, etc, for which you simply needed some import/parsing code (we used SAS “data” statement libraries). You would have great variation from applicant to applicant, from “thin files” to extensive ones. Had I authorized need to get at your “financial health” data, I could do so with little trouble. For quite some time now (yeah, I know, not everyone loves this).

    Again, a simple analogy, given the relative huge breadth of data elements comprising the patient record.

    But, back to your initial comparison, yep.

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