Open banking vs. open health

Let me start by saying, this is about open data and the question of who owns the data: the customer (patient) or the vendor.

In banking, regulators around the world have become involved in various degrees and declared: the customer owns their data.

In healthcare, it’s much less clear. Why? More importantly, what should care providers (and in the US payors) do to deliver better care?

Open banking

Please go listen to Mr. Open Banking’s Open Banking podcast. If you care about open banking, listen to each episode. If you care about Open Health, just listen to “Episodes One: What is open banking?” and “Episode Three: Following the Market.”

At the end of episode one, the interviewee says something along the lines of, “Customers don’t want open banking, they want the outcomes that result from open banking.” They want a cool app with their data from their bank. (And they want it securely.)

Open health

As you listen to the podcast, if you “squint” you’ll hear that the issues are the same across industries. Customers (patients) want better outcomes.

Banks are notorious for making it hard to transfer accounts. Care providers are even more nefarious because, at least ideally, they’re trying to care for their patients (where banks are simply holding onto your money).

Why open?

I love to follow this anecdotal thread. It’s anecdotal because it’s not a rigorous data analysis. Though it illustrates the point.

It’s useful to track cholesterol over time. Ever since my 20s, I’ve been doing cholesterol tests. I know that’s a long time, but imagine if I could chart my cholesterol over time? I’d have a sense of what high cholesterol means based on my personal history.

Instead, each of those results is locked into the provider who took it. Tests done at my annual checkup are with my family doctor. Tests done by specialists are at different hospitals. And so on.

If you’ve been to a lot of doctors like me, you’ve probably had tests done repeatedly because it’s easier to just draw a little blood and run a test (and have the insurance company pay for it) than it is it track down a recent test and use that.

Hospitals make a lot of money on running simple blood tests. Hospital tests are much more expensive than those done at a regular lab (US-specific data point). Of course, they want to run the test again. It’s simple — your money (the insurance company’s money) vs their time. They’ll spend your money all day long.

If you use Apple Health, you’ll see what I mean. I’ve hooked up a couple of different care systems here in NYC and I can chart my test results over time, regardless of what doctor ordered the test. I can easily share those results as well, making my care more cost-effective.

There’s one major difference between banking and health

The main difference is that banks have a lot of different software that runs their banking systems. Software vendors will continue to sell banks lots of software, regardless of their business model. And they’ll sell software to those using the bank’s data. So, software companies don’t have skin in this game.

The banks want to lock their customers in. I take a decidedly more cynical approach than Mr. Open Banking does on his podcast.

I think there needs to be a strong financial regulation to force the banks to open up. And those that opened up without regulation did so to influence the regulators, not for the good of the customer.

In healthcare, it’s different. There are two main healthcare patient record systems and they are walled gardens. Now, it’s not just the healthcare providers who want to lock customers in but they are in alignment with the software vendors who want to own all the patient data and be the gatekeepers for added-value (to keep selling even more software).

In a similar vein, banks refer to themselves as “software companies with banking licenses.” One has never heard a hospital call itself a “software company with a medical degree.” It’s about priorities and the willingness to innovate.

I’ve presented at FHIR® conferences, and audience questions always bring up this point — these software vendors make it hard to get data in and out, and they’re connected at the highest levels of the organization, so that will not change. What do I suggest?

What should care providers do?

The drive towards open data provides an opportunity and is a threat to incumbents. For both banking and healthcare, I believe data owners need to create a platform where data ownership becomes a competitive advantage, enabling them to build better capabilities that solve for customer outcomes (instead of bank/care-provider processes).

• First, and I’m focused on healthcare here. Care providers need to separate security and privacy capabilities from the patient record system. That way hospitals gain more flexibility while managing risk. This is one area where healthcare’s conservatism is well warranted, especially relative to personal finance.

I can always get a new credit card number if it’s compromised by fraud. There’s no way to reset my DNA (or whatever health identifier is relevant).

• Next, care providers need to align with the jobs customers hire them for, not with their process. Meaning, patients hire care providers to stay healthy, not get a blood test. Doctors hire the hospital because of their expertise, not because they provide a room for an exam that allows them to search google to explain something to the patient.
• Finally, they need to use the focus on the customer (patient, doctor, nurse) outcome to expand the opportunity for service. Today, patients visit the doctor for a checkup, and the doctor says, “eat healthier to reduce your cholesterol” and then leave the patients alone while they’re dealing with eating. With mobile and other technologies, care providers can take their process and put it in the customer experience (of eating, cooking, shopping) to enable better care outcomes.