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Secure Transactions for Electronic Medical Records

Just after hearing a great, if quick and concise, discussion “Toward Health Care Reform Through Electronic Medical Records” featuring Jonathan Oberlander, Tim Carey and Deniese Chaney at the UNC Gillings School of Global Public Health this evening. Louise Winstanly turned to me and said “Why not let banks to it?” This was not only a good insight but one in keeping with the class discussion that I had been planning for tomorrow in the School of Information and Library Science. Not about banks nor about health records, but about the sources of disruptive innovations as described by Clayton Christensen (for my class in this video from this past summer).

Banks, Louise had realized, have been experts at secure, reliable, authoritative transactions between institutions as well as delivering money and records to the correct individuals anywhere in the world. If an individual and the country of Qatar can trust the fiscal transactions handled by banking systems, then surely UNC Hospitals, Duke Medical, Medicare and you and me could trust them with health information.

In fact, if banks concentrated on what they did well — that is not the content so much as the secure transfer and reliable delivery — you could have access to your health records by just a card swipe from an ATM-like machine or on your phone or a computer display. Authorized entities could update the records much like direct deposit is done. They could download appropriate parts of the records much like drafting your checking account or receiving an electronic transfer.

Banks could err bank the records. The bank of your choice holding all or part of your records as you deemed appropriate.

The network and the controls and the security are already in place. The banks need not, let me say again, be concerned with the content, nor with the format of the records. Those are separate issues that could be decided by other entities be they medical groups, government, insurance or even individuals. Standard formats would make sense but banks need not even be aware of those standards to perform much of the work of interchange and transactions.

What does this have to do with disruptive innovation? Banks have a proven and transferable competency with technical infrastructure in support of secure transactions. Medical organizations do not. Yet we see medical organizations, governments and insurance attempting to create new networks right beside the world’s best networks for secure transactions. If banking networks were to conceive of themselves not as financial exchange networks bit instead as secure information exchange networks, then they would already be in the business and would by now own it. Less replication, less useless reinvention, less time to build trust (you may not trust banks as investors and makers of loans but you do trust the ATM), there is already a culture of cooperative exchange that is well understood. All of this is under very long term construction in the medical area and in fact may not be accomplished in my life time. Banks and banking networks would have to do more than turn the switch, but not much more.


  1. For some reason, we think we have to reinvent the wheel rather than looking for simpler, if not always obvious, solutions like this one. Nice idea, but I fear it’s too sensible.

  2. Interesting concept. I think the evil is the decentralization of electronic medical record keeping. Every medical provider has his or her own system regardless of the technology used as the backbone of said system. To borrow a term from IT, some form of cloud computing would be ideal. That takes the technical administration out of the hands of the thousands of health care providers across the nation and places it in the hands of a few experts. The problem with that approach is market power that could be abused by private corporations. I’d personally rather see a nationalized system perhaps run by a non-profit like the Red Cross. As Paul states, we have models in the banking industry for secure access to records. I like the idea of a medical ATM card. Go to your doctor, swipe your card and the doctor immediately gains access to your complete medical history.

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