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What banking can teach health care about handling customer data

Published on 10/21/2019

This was originally published on on Oct. 14, 2019.

Why can we run our entire financial lives with a few smartphone apps, a couple of plastic cards, and an ATM network, while so many of our interactions with the health care system still rely on phone calls, copiers, fax machines, and even the occasional multi-part form? Why is the routine exchange of health care information still so difficult compared with the routine exchange of financial information?

One reason is that banking has solved some foundational interoperability issues that health care still struggles with. As the longtime CIO at Partners HealthCare in Boston and, more recently, as part of my work at Cerner, a major vendor of electronic health records, I’ve watched this struggle up close for decades. The obstacles are numerous, but they include a lack of agreement on standard methods of information sharing, a habit of regarding patient information as a competitive advantage to be jealously guarded, and a fragmented system of reimbursement that doesn’t encourage interoperability.

The widespread adoption of electronic health records should theoretically mean that we don’t have to repeat our medical history for every new doctor, any emergency room (ER) ought to know we’re allergic to penicillin even if we arrive unconscious, and we’ll automatically get a heads-up if we have a diagnosis that qualifies us to participate in a clinical trial.

Patients who seek their care from a single health care system with advanced information technology, such as Kaiser Permanente or Intermountain Healthcare, may see at least some of these benefits now. But most of us don’t. The records of our checkups and blood test results are with our doctor, the information on our knee surgery or chemotherapy treatment is at the hospital, and only our pharmacy knows if we have actually filled our prescriptions.

What lessons can we learn from banking to help bring health care’s information-handling capabilities into the 21st century?

Lesson 1: Limited interoperability can address a broad range of needs.

Banks move money among themselves with the Society for Worldwide Interbank Financial Telecommunications (SWIFT) messaging system, which was established by 293 banks in the late 1970s and is now used by more than 11,000 banks, brokerage houses, securities dealers, and other institutions. They pay a membership fee and a per-transaction fee based on message volume; in exchange they get a method of quickly and securely transmitting instructions for payments and other transactions using a standardized system of institution codes and structured messages. The system delivers more than 34 million messages every day.

The health care industry has a more complicated information-sharing task than the financial industry. The parties involved may seek information for patient care, billing, clinical research, or public health. And in addition to numerical values and fixed data fields, the information may take other forms such as images, heart monitor tracings, and free-text notes. We become daunted by the magnitude of the task. But like the banking industry, we may be able to accomplish a major part of what we need by concentrating on focused and highly impactful forms of interoperability. Our initial to-do list might include notifying the care team whenever a patient receives any health care services, regardless of provider or location; automating the “prior authorization” exchange between providers and insurers; and ensuring that all providers know about a patient’s history of opioid abuse.

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