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Snippets from the Google Groups Cloud Computing Listserv As They Awaken to Medical Banking in the Cloud

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The Medical Banking Project agrees on the "cloudy" future of healthcare but argues banks (or their 3rd party suppliers) are the vendors with the greater exposure to security concerns, have the greatest history with online data delivery, etc.

Hopefully on this one occasion these resource pointers will not be considered "too spammy" for this listserv:

MBlog - Medical Banking Blogging - http://mblog.mbproject.org
International Journal of Medical Banking - http://www.mbproject.org/journal
Medical banking Project site - http://www.mbproject.org
LinkedIn Group - http://www.linkedin.com/e/gis/74285/183D9F20CD6D
7th National Medical Banking Institute ADVANCING HEALTH CARE REFORM BY CREATING A FEDERAL HEALTH BOARD - http://www.mbproject.org/stream.php

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Jeanne Morain:

With the due date for Electronic Medical Records provision of HIPAA coming in 2014 - The Healthcare Industry needs more innovative solutions around the implementation  that is easier for those less technical to use.  It will be very tempting for all of us technologist to jump on the opportunity - but we need to proceed with caution.

One of the biggest burdens faced by medical care professionals are the very systems we put in place to help make their jobs easier.  The number one complaint I have heard when talking to the users in the medical industry is the amount of time needed for the electronic charting, syncing, loss of data etc taking away from continuity of care for their patients.

Centralizing this data is a HUGE savings for physicians.  Universal Client computing came from understanding the impact of not applying the right technology for the right use case but also understanding the need that there has to offline capabilities as well as online to avoid negative outcomes.  Tying together offline and online with solutions like application virtualization that can leverage local compute power by do bidirectional updates of data to the cloud over HTTP/HTTPs - or other hybrid based uses cases will go much farther then just espousing one technology over another.

We need to think both In and Out of the Cloud to have solutions that will work in the real world.....

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Jeanne Morain:

There are many uses in the healthcare industry where the Cloud can help but when implementing for those systems a bit of care needs to be taken.  From the major hospitals I have worked with in the US and discussions in EMEA the following uses cases fair very well in the cloud:

1) Medical Billing - particularly when billing is done either in a foreign country or by a third party.  Privacy laws in Europe around health information require the data to be kept in the country of origin.  I have seen medical billing done successfully with VDI implementations for larger institutions but believe a CLoud implementation with EC2 (following proper SAS70 guidelines) would also be a viable solution.

2) Transcription services make sense as well - similar to medical billing.

 Edge Cases Not Recommended 3) I am a large proponent of the Cloud and Virtual Desktops but there are edge cases that should wait until the technology is more mature like Critical applications required for 3D or 4D imaging used in diagnosis, in Emergency Medical areas like ER, Nurses Stations, ICU, etc that require access to vitals and charts, Pill dispensing stations that are locked.  As someone that has provided technology for infrastructure for over a decade - I know too well how lives can be lost due to accidental patch or reboot on an individual basis now multiply that by 40 or a 100.  The technology is not ready yet.

For the Optic Digital imaging diagnosis below - can you tell us where the graphics processing was done?  Also did anyone chart the malpractice or misdiagnosis ratio of those films over traditional methods?  At first blush the costs savings look great - but we are talking about eyesight and lives when we are talking about medical.

I have heard of issues with hospitals trying to implement Cloud based solutions in Emergency rooms. In one case the wireless network connection failed while a physician was trying to review films to remove a bullet from a patient.  Although IT tried they could not fix it in enough time to save the patient.

The next example is a personal one - My family was impacted by a significant misdiagnosis of EchoCardiogram films for my husband's heart.  The EchoCardiograms were misread by a Physician in India collaborating with the Physician in Phoenix.  We were told that my husband's condition was graver then it was, asked if we wanted to participate in an experimental study for the greater good of man kind because his condition was not reparable (Supra Cristal VSD, Pulmonary Stenosis and a Patent Ductus Arterosis).  At the time our childre were 6 and 11.  We spent two days of hell planning for the worse.   The second physician we spoke to the following week had a different opinion and referred us to Stanford.  Stanford concurred with the second physician.  He did have the VSD but did not have the other issues.  Apparently the resolution on the remote display protocol was not clear enough for the Physician in India that read the Physician in Phoenix's file to get an accurate discern that what she was seeing was not a PDA but additional movement on the echo from the higher pressure shunting of the blood when the valves opened and closed.  We never sued the doctors because it was a technology issue.

Had we have listened to the first doctor mentioned - chances are my husband would be dead given the morbidity rates of the experimental surgery or at best would have another 2 or so years left.  Instead - he has a good prognosis.

Now I ask you - if that is your spouse, parent, child or YOU would you want the films processed at the server and streamed?  I for one am glad we sought a second and third opinion from someone that used a local PC with high end video graphics cards.

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Khazret Sapenov :

I also know, that doctors use Amazon Mechanical Turk to process transcripts, thus reducing their HR burden.

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Sachin Duggal:

Yes - in fact you can use the cloud for making the supply and demand equalise. We did this for a diabetic retinopathy project where we connect doctors within certain regions to do diagnosis of eye images of patients who have been to clinics in different city or country. Thereby reducing the waiting time and giving dr's additional revenue streams.

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Jason Meiers:

Medical expenses are increasing everyday although the same medical processes have been around for a while with cloud computing do your think there is an opportunity to overhaul and simplfy high cost medical processes leverging infrastruture-as-a-service?

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Rajeev Gupta:

In healthcare its important to learn first and foremost the HIPAA regulations. Some of the clauses from what I understand require in simplified terms that the patient sensitive data be separated and/or encrypted from others and the machines be in a “cage”.

Having said that once you have the patient identifiable data separated from the actual data, you could use the cloud. I can see specially in claim processing, image processing or data mining that the cloud could be very useful.

Also since the “cloud” sits on the internet and a down internet can bring in a lot of liability to the end provider – I feel EMR would be a long shot.


March 27, 2009 in A Bank-Driven eHealth Ecosystem | Permalink | Comments (2) | TrackBack

John Casillas on A Vision for eHealth Using Banks

Intro: Thank you Maureen and the entire team at the President’s Council, they deserve so much credit; Members and Sponsors.

Once a person visiting a restaurant in France was so taken by the entrée that she asked the Chef for the recipe. The following year she visited the same restaurant, ordered the same dish and asked for the Chef again. “I’ve tried it over and over again and its not coming out. What’s the missing ingredient?” The Chef replied, “madamme, after you follow the directions you must throw yourself into it”.

Today, during an unprecedented global crisis in banking and as our domestic healthcare systems strain under the weight of a growing underserved population, it may seem counter intuitive to link two ailing systems. But for those in banking and healthcare who have thrown themselves into the prospect of improving healthcare, a new vision of the future is emerging that is powerful, energizing and compelling! They have stumbled upon a missing ingredient in our national dialogue to improve healthcare – medical banking. And they realize there is simply too much at stake for banks not to be sitting at the table as we fix our healthcare system.

The recipe for economic disaster is a broken healthcare system. This was the central message of the President at last week’s healthcare summit. Thus all the things that drive the banking and financial services engine rely on healthy individuals and communities and a productive labor force. Dr. David Mirvis, who will be on our Federal Health Board panel today, researched this linkage and found that economies rise and fall based on the health of people in an article published in JAMA. Dr. Stephen Parente, who will also be on our panel today, wrote in our Dr. HSA Column that an economic stimulus pathway could be distributing using cards credited with $500 to be used for prescription drugs, adding that while he’s not very excited to see so much money being spent, if its going to happen anyway, let’s spend it smartly. Many see a clear link between healthcare and economic vitality so the real question is why wouldn’t banks be fully engaged, why wouldn’t banks use their resources in the national quest to fix healthcare.

We’ve all heard a common ingredient for success: “necessity is the mother of invention.” Perhaps it will be of necessity that we find healthcare using the rails of our banking complex to finally realize the national dream of real time data exchange between all the industry actors. When the dish is ready, we believe that banks can ramp healthcare onto a digital platform. Banking processes were at one time mired in paper too, and there is no question that the lessons they bring to the table, and in some cases their very systems and processes, in which they are highly invested, can fast forward our national eHealth strategy. Yet we don’t hear very much about this paradigm shift in the national process. We hear about spending billions of dollars to create a new digital system, but what about the digital system lying right under our nose?

Ultimately, our challenge is to forge a health-wealth view of the future, where banks join with fellow healthcare stakeholders to develop common solutions to help the uninsured and unbanked, to socialize better tools and information that families can use for their medical treatments, to help individuals get real time access to their healthcare records through online banking used by 55 million households in America and growing, and to enable community centers that President Obama is investing in with eligibility, funds and data transfer platforms that support far greater coordination of the finite healthcare assets in the community. Oh yes, we have a vital ingredient and a critical role in the national dialogue and don’t let anyone tell you otherwise.

Banks and financial services firms are teaming with health technology companies and others to create a new paradigm, starting with vastly improved administrative processes and moving up the value paradigm in phase 1, to automating workflows that remove the paper chase, leveraging the unique market position of the bank to process and capture payment data that improves revenue cycle decisioning through denial management or contract management routines that take up so much time in the business office, and finally moving to the top of the pyramid of value, to address the enterprise needs of the healthcare community. Different banks are evolving at different rates along this pyramid. As you do, know that the top contenders have found compelling prospects for profitability. As success stories come in, medical banking groups are following this strategic pathway, creating one of the nation’s most compelling “Green Tech” engines – another tie into the goals of the Obama Administration. Yes, we have a critical ingredient for the national dialogue to improve healthcare.

Moving to phase 2, we should align the immense annual investments in privacy and security in online banking with the unique data needs of each stakeholder. This calls for electronic integration of assets to liberate data so it can travel securely in real time. We’re all stirring this pot together – our own build-out of specialized banking platforms, NGA’s recent summit where former HHS Sec Leavitt called on leaders to “remember Argentina” and to invest in healthcare to stimulate the economy, John Halamka’s HISPC 11-state collaborative to normalize state laws that impede the flow of health data across state boundaries, WEDI’s leadership to move us toward the 5010, EHNACs program for clearinghouses, ABA’s HSA Council, TAWPIs new HPAS, HIMSS’ annual summit and much more – all of these efforts, in my view, are moving us towards greater data liquidity that at the end of the day will, and must, empower the consumer.

In phase 2, banks are embracing the power of their market position, reving up eHealth strategy, creating real time gateways with health IT partners, specializing card platforms to automate payment processing across stakeholders, leveraging online banking to support single-sign on for the consumer, giving families private access to health-wealth tools, and although Track 1 is a primary focus for many today, the recipes of the future belong to Track 2: innovations in medical consumerism.

So we ask you to apply yourselves diligently to the task of exploring how financial systems can align with the national process to improve healthcare; and this moves us to phase 3, examining how governance models, like the Federal Reserve, can spearhead common standards banks can use to empower business and consumers with mission-critical and family-critical tools…tools that hospitals can use to automate the routines in Phase 1, tools that health plans can use to reduce disbursement costs, tools that community care centers can use to access healthcare assets in real time, tools that will allow you and I to use a “healthcare ATM” just like we use the regular ATM, so if we travel abroad as a medical tourist or just across the country and we get ill, we have secure and private on demand access to our healthcare records and our financing resources at the swipe of a card. We can get this done!

Building an electronic medical banking community, the theme of our event, moves the President’s “Green Tech” agenda forward. Rationalizing the extreme paper chase in healthcare is core to modernizing our healthcare system. We’ve done good work digitizing the front door, sending the claim from the provider to the payor but the back door was left wide open and today, whenever you visit a care giver, a steady stream of paper follows you – almost all payment related. This mountain of paper invades our healthcare system, creating enormous barriers to efficiency, siloing data that needs to be securely liberated to improve healthcare at every point along the process and especially at point of service, where adverse drug events cause avoidable pain and loss.

Who will liberate this data? How will it happen? If you follow the trail, it leads through the banking world – a service is rendered, payments are processed. In this country, payments only move through banking systems. Thus banks can use their tremendous investments in information technology to ramp healthcare onto the on-demand paradigm that leads to better health programs for all the stakeholders. That is in large part what our educational program here is about. And what we need to do is understand how to add value to that data so it can address the unprecedented cash flow pressures our health care system is experiencing, not just from the economic downturn but because of the very complexity of our healthcare payment system. Today, I’m very proud to report success stories coming in from our members – one provider saving $4 million in 12 months after implementing a medical banking platform, another saving $660,000 and other stories that are catapulting medical banking into best practices. Yes, we have a Green Tech Message that is delivering compelling ROI and we need to spice up the national debate by making our voices heard. And I’m proud to say that that is what we can do at this Institute.

Sometimes when agonizing over problems you wake up to find solutions right under your nose. I want to suggest to you today that the medical banking build-out is inevitable. As banks linked with airline systems removed layers of inefficiency, enabling consumers with online tools, so medical banking is following a similar pathway, pushing paper out of the system, liberating data, fueling revenue cycles and decisioning; helping banks and their healthcare clients to gain a better view of the intrinsic value of the fundamental financial unit in healthcare, so taxed with myriad codes, and potentially unleashing $200 billion in credit from receivables that are wasting away on the books and records of our nation’s healthcare systems. Other industries have liquidated this asset. This is a mainstream practice except for healthcare, where the value of receivables is too often locked in a deep freeze. This will change in the new medical banking paradigm.

Now, do you remember how when growing up, Mom made you eat the peas? Some of you still don’t like peas because of that. Value should drive progress not legislative fiat. It may make sense to engage a legislative agenda at some point, but for now we’ve chosen to take our ideas to the marketplace and let the market decide. And they have. The 1100 employer strong Automotive Industry Action Group embraced medical banking as a strategy, helping us to create a new Tool Kit for Employers to diffuse medical banking practices in the marketplace, and we’re excited that LeapFrog and others are taking notice of our efforts. MBProject just aligned with NCPDP, the only group that is doing real time processing on a general basis, to cross-pollinate ideas with our banking members. The HFMA is here, a powerful healthcare group, and this is testimony to the power of our ideas. I look forward to hearing Bob Broadway tell us how we can help hospitals navigate one of the toughest times in the history of healthcare. As Obama said, we’re at that Thelma and Louise flashpoint in healthcare, where the car could go over the cliff. The medical banking community will not stand by idly and watch banking and healthcare crash burn. We’re in the game. Its Game On for Medical Banking!

We reached out to consumer groups too. Greg Scandlen, founder of Consumers for Health Care Choices, will share his ideas and I’m going to listen to him carefully. We need to listen to consumers, because our quest to build platforms that serve business will ultimately find critical mass in service to families. Banks know the power of scaling services for the masses, which they do everyday. As we collectively fine tune the vision in medical banking, new concepts will emerge of how to marry online banking, credit terminals, ATMs, branch systems, to personalized healthcare platforms that promote better lifestyles and better healthcare. Not only will this improve customer retention but banks may add three times more to the bottom line by creating a health-wealth portal, linked to online banking, based on an extrapolation of research done by Dr. Paul Whitman, here from California Lutheran University in Simi Valley.

We need to gather other chefs into the kitchen who don’t mind the heat. So we reached out to national leadership like the Mayo Clinic Health Policy Center. Bob Schmoldt, a leading national figure from Mayo, recently concluded a high level meeting in DC to fine tune the concept of a US Health Board. We’ll explore this area today and gain your valuable input. So you better plan on throwing yourself into this discussion, which we will document and provide to the White House Office for Health Reform.

Healthcare and banking groups are sharing ingredients, they are finding common ground to improve healthcare in increasingly powerful ways. When I first started talking about this in 1996, I was met with a field of bank stares. Yet convergence is vital to the national dialogue to improve healthcare. The Medical Banking Project has pioneered new ground; we’ve thrown ourselves into the healthcare dialogue with a critical ingredient and with our members, we are making great strides. All of you, top executives in your domains, must know that you are an integral part of the process, not a bystander. You should not accept the fact that everyone in healthcare is sitting around a table and leaving you out. You must be in the process, you must, if necessary, throw yourself into the process to fuel an electronic medical banking community that provides powerful and relevant services for our ailing healthcare system.

This is not a time sit back. I know there are groups that are struggling. I know that you are coming here trying to find your footing in this dynamic and complex area. I know its not easy. But I exhort you to move forward. Hold on and invest. Your ideas are far too compelling and you have a very good chance of being rewarded well for your efforts. You must not give up! Your participation is vital to the healthcare interests of our nation.

To help you, MBProject has created new tools:

Our Gold Seal program, is the essential underpinning of our movement. Its not just a technology platform that we need; we must build a platform of trust for business and consumers and bankers know that all too well. One slip up, and 58% of your customers will change banks. Your margin for error is almost non-existent. I encourage you, because even though today’s climate of low confidence is tough, consumers are still depositing funds into your accounts, using ATMs, credit cards and more. Let’s not throw the baby out with the bath water. Banks will continue to provide a central driving force in the evolution of healthcare solutions.

Our Dispute Resolution Initiative is a key tool that Sheila Schweitzer will discuss at our National Roundtable during lunchtime.

Our Medical Banking Tool Kit for Employers will be unveiled tomorrow where we’ll hear from Scott Sharland, Executive Director of the Automotive Industry Action Group; about their initiatives to manage fiscal stress, and how medical banking offers a key ingredient for their long term viability.

Our International Journal of Medical Banking, as Maureen discussed, provides a peer reviewed tool that helps to get the mental juices flowing to spur creative strategies linking banking and healthcare systems.

Our Executive Training Program, as announced by John English, a professor at Vanderbilt University, will address a growing need to train new medical banking talent and to foster critical leadership standards in this emerging area.

And there are more exciting programs being developed our Tool Shed. Tools that are being honed by an awesome cast of executives – our members – who are building common standards for creating a Green Economy, A Digital Economy, A Lean Economy; (a lean, green, stimulus machine)…they are building an electronic medical banking community. We urge you to become part of the process! Don’t sit aside when we need you to come to the table. We can’t educate you in medical banking in three days! This is much like drinking water from a fire hydrant. To get the recipe right, you need to be involved 12 months out of the year, you need to join MBProject and help us to make a difference!

In closing, I want to emphasize again that necessity is the mother of invention. What if one of the most important and critical ingredients for fixing our banking and healthcare crisis was to find common ways to help each other? What if two broken, elephantine systems, prodded by a dancing mouse, discovered new ways to heal themselves? Cleary, a healthy community supports a productive workforce that ultimately results in healthy deposits. Healthcare and banking leaders truly have much in common. There is good reason to invest in healthcare to energize the bottom line, and get the economy moving forward again. I believe we have an historic opportunity to influence the progress of our nation by throw ourselves into the creation of an electronic medical banking community. Towards this end, we offer this Institute to inform the national process, so that we can collectively build a healthy-wealthy future for our families and communities. Thank-you.

Presentation of awards

Medical Banking Project is driven by a mission: to convert digital savings into charitable resources. We do this by optimizing banking resources for healthcare. What gives life to our mission are the executives that have come into our process as members and leaders of our workgroups and councils. We want to acknowledge each of these leaders for their hard work. Each year, one or two people rise to the surface.

March 24, 2009 in A Bank-Driven eHealth Ecosystem, Medical Banking Institute | Permalink | Comments (0) | TrackBack

John Halamka on IT Spending: When Less Is More

Financial-services providers outspend the health-care industry on information technology, but they haven't made good use of all that data

When it comes to information technology spending, I've often been told companies in the health-care industry should behave more like banks.

During the decade I've been a chief information officer, IT operating budgets have been 2% of my organization's total budget. That proportion is typical for health care. During the same period, IT budgets for the financial-services industry have averaged 10% or higher.

Given the recent troubles of AIG (AIG), Lehman Brothers, Merrill Lynch, Washington Mutual, and others, you have to wonder whether those IT budgets represent money well spent.

Of course, financial-services firms have had great systems for handling such tasks as share trading, disaster recovery, and data storage. But did they have the business-intelligence tools and dashboards that could have alerted decision makers about the looming collapse of the industry?

Too Much Data

Did the financial-services industry have controls, risk analysis, or a memory of previous crises ranging from the Depression to the Japanese banking debacle to the collapse of Enron and WorldCom? Was it greed, irrational expectations, or too much data and not enough wisdom that brought down these institutions?

We in the health-care profession naturally take no delight in the financial industry's descent. At the same time, we're trying to make the most of our IT spending and make wise choices with the data we've amassed.

One of the challenges of being a doctor in the 21st century is information overload. More medical literature is published every year than a doctor can read in a lifetime. As electronic health records become more common, doctors can be overwhelmed with data gathered about each patient. They do not want to review hundreds of normal findings; they want to know the information that can be acted on to keep patients healthy. More

John Halamka to John Casillas
: The purpose of my article was unrelated to banking or medical banking - it was to point out that we all need less data and more wisdom.  I was asked the question yesterday - what is the advantage of medical banking as compared to a fully functional PHR like Google Health?

John Casillas to John Halamka: John,Touche. Yet people arent stuffing their money under the matress, they're depositing it. They are still using ATMs, credit cards and according to the last ABA report, online banking continues to grow. For all the hazards that we've encountered in investment banking, the commercial banking side of the house is operating as its always been, 24x7. Today, people still trust their banks to access the money instantaneously all over the world. We should not throw the baby out with the bath water. Most people, even and especially the uninsured, seek the ER when they are sick. Is the health care system broken? Yes. Do people still rely on it when they get sick. Yes. In medical banking, we find ourselves linking two broken systems - systems that represent the health and wealth of peoples and nations. Both have the potential to fundamentally transform our lives for the better. Linking tremendous investments in IT in banking to optimize healthcare isnt only good thinking, its actively being persued by mutiple muti-nationals and other companies - even governments. Needless to say, I wouldnt be too quick to erase the high levels of automation acheived in banking from my website or resume. Those levels of automation have produced outstanding improvements in how we manage our money today. And they will continue to do so as medical banking, mobile banking and even micro-banking evolve in the marketplace. Bottom line: our message is still the same. Banking systems have enormous potential to improve healthcare. And we have an historic opportunity to make this happen for our world, for our families. -from vacation in sunny California

Ed Dodds to John Casillas and John Halamka
: Diebold ATMs infected with credit card skimming malware at ZDNet

March 20, 2009 in A Bank-Driven eHealth Ecosystem | Permalink | Comments (0) | TrackBack

Tools For Building An Electronic Medical Banking Community


The theme of our 2009 Medical Banking Institute, "Building An Electronic Medical Banking Community", wasn't an empty promise! Our Members have been very busy!

We are pleased to announce the creation of a new series of digital and educational tools for the growing medical banking community! These tools will do things like help assure the marketplace that medical banking organizations are meeting the highest standards of privacy, confidentiality and security, rationalizing costs in the healthcare revenue cycle, implementing medical banking programs that save time and money for groups that purchase healthcare and much more!

Make sure to check back often! More MBTools are being developed to increase the efficacy and efficiency of your operations! Send comments and suggestions to: [email protected]. We wish you every continued success engaging and developing medical banking programs!

Panel: Driving Medical Banking Into Everyday Practice - A New Tool Kit for Employers


John Casillas, Chair, Medical Banking Institute


J. Scot Sharland, Executive Director, Automotive Industry Action Group (AIAG), Southfield, MI

June St. John, Chair, Education and Programming, Medical Banking Institute; Wells Fargo

Eric Booth, COO, The Leapfrog Group, Washington, DC

The role of an educational video



Data-driven performance

March 13, 2009 in A Bank-Driven eHealth Ecosystem, Medical Banking Institute | Permalink | Comments (0) | TrackBack

Capitalizing A Whole New Industry


Kevin Lavender, Senior Vice President, Healthcare Finance, Firth Third Bank, Nashville, TN


Harriett Flowers, Managing Director, Converge Capital, Dallas, TX

Raymond Falci, Managing Director, Cain Brothers & Company LLC, New York, NY

March 13, 2009 in Medical Banking Institute, Venture Capital | Permalink | Comments (0) | TrackBack

Keynote Panel - Banking on Better Healthcare


John Casillas, Chair, Medical Banking Institute


Al Briand, Division Head, BNY Mellon Treasury Services Product Management and Strategic Development, New York, NY

Making the case for standards allowing for economies of scale and will determine the success of medical banking

Mentioned SWIFT and messages moving capabilities; they should be studied to see how they produced their standards

Paula Fryland, Senior Vice President and managing Director- Corporate Banking, PNC Bank, Louisville, KY

Local level:

Community involvement, community development

Boards members at community hospitals

Charitable giving - building facilities, fundraising


Health NPOs liquidity markets have collapsed, banks have stepped up

New solutions:

Extending and/or customizing current products or services

Point of Sale technologies

Whole new solutions

Pete Wheeler, Wells Fargo

Leading by example to create knowledge dissemination

WF 281,000 employees; HSAs, wellness program

Huge deposit base, huge lending base, huge brokerage presence, huge mutual fund presence, huge geographic reach

As employees go to other companies they bring their knowledge of the medical banking options to others firms


Global angst re: banks

PNC: Virtual wallet, healthcare 10s of millions of dollars in business investment, incredible opportunities in administrative transactions of hc, including noncredit products to build relationships

BNY Mellon: Can't count on certain aspects of traditional business so discovery of new opportunities must be explored; there must be a business case for them; friction (not seemlessness in transactions) means opportunity; consumer-centered healthcare; health custodians

WF: Opportunities coming from the synergies of combining 2 banks

Question from floor: quality rating on bonds

How will existing clearinghouse and transaction engines be tied together; current "RAILS" in place

How will XBRL and international standards impact -- bring as many players to the table to create and apply the standards

Economy of scale is THE DRIVER

Super-regional and community banks: Smaller banks have many healthcare related account; train a couple of SMEs first, build portfolios over time; attend conferences and be involved in groups active in the space

Will banks repeat their earlier investment in automation to accounts receivables

Health Wealth Portals? Convenience for either business or retail banks is important; cell phone convergence metaphor

How does hc impact your strategy? PHRs??? Wealthy individuals request new services; back office accounting of wealth management tools

How does the money saved by more efficient transaction being targeted to indigent care by hc orgs impact your banks? Banks have not recognized indirect benefits of their efficiencies investment in the communities they serve

TAKE AWAY: Economy of scale is THE DRIVER, standards are THE ENABLERS

March 13, 2009 in A Bank-Driven eHealth Ecosystem, Community Care Platform, Medical Banking Institute, Medical Consumerism | Permalink | Comments (0) | TrackBack

Next Steps for Moving the Industry Forward

Maureen Turo, President, National Medical Banking Institute, VP, Healthcare Strategy, The Bank of New York Mellon Treasury Services Division, Pittsburgh, PA


Comments from many on how many different constituencies are represented at the Institute and in MBProject

There needs to be a voice for Washington, DC

1) Task Force, Richard Mobley, Lead - 18 volunteers to climb the Hill

2) Ideas collected by the Mayo Clinic at the Institute will be compiled and emailed to attendees

Medical Banking Report provided on a quarterly basis at the MBP Portal

March 13, 2009 in Medical Banking Institute | Permalink | Comments (0) | TrackBack

Deven McGraw on the Great Privacy Debate: Impact of ARRA 2009

[email protected]

Health Privacy Resources

Health Privacy Project at Center for Democracy and Technology

  • Health IT and electronic health information exchange have tremendous potential to improve health care quality, reduce costs, and empower consumers
  • The public wants health IT – but also has significant privacy concerns
  • Failure to build foundation of trust is an obstacle to achieving greater health information exchange

Health Privacy Project at CDT

  • For years there was no progress on resolving the privacy and security issues raised by e-health
  • Project’s aim: Develop and promote workable privacy and security policy solutions for personal health information

Evolution of Federal Privacy Protections

    1996 – Enactment of Health Insurance Portability and Accountability Act (HIPAA)
  • Congress gives itself 3 years to enact privacy legislation
  • 1999 – Proposed rules
  • 2000 – Final rule
  • 2002 – Regulatory changes
  • 2003 – Effective for most

Era of Health Information Technology

    Health IT bills stalled in 108th &109th
  • Privacy was framed as the obstacle – but it wasn’t the only issue
    Legislation moved furthest in 110th – but economic woes stalled progress


  • Broke the privacy "logjam"
  • Most significant change to the healthcare privacy and security environment since the original HIPAA privacy rule
  • Not a change to everything about HIPAA – but some significant changes that will need to be addressed by many entities handling health care information
  • Most provisions require further regulatory clarification

Privacy and Security Provisions – Overview

  • Substantive changes to HIPAA statutory provisions and privacy and security regulations
  • Enhanced enforcement of HIPAA
  • Provisions to address health information held by some entities not covered by HIPAA
  • Misc: Administration/Studies/Reports/Educational Initiatives

Substantive HIPAA Changes

    Breach notification requirement
  • Definition of breach
  • Safe harbor for “protected” data
  • Detailed requirements re: timing and content of notice; how provided to individual and HHS
  • Business Associates must notify covered entities
  • Strengthened individual right to restrict disclosures to health plans for payment and operations
  • Secretary guidance on minimum necessary
  • Use of limited data set where possible in interim
  • Discloser determines minimum necessary
  • Minimum necessary still does not apply to treatment
    Accounting for disclosure requirements for entities using electronic health records
  • Requirement applies after standard and regulations are developed
  • Phased in over time
  • Covers only 3 years
  • Change with respect to how business associates comply
    Patient right of electronic access
  • Can direct record to another entity or individual (PHR)
  • Changes to definition of marketing
  • Limited right to use information for marketing if the communication is paid for by an outside entity
  • Exceptions for treatment communications and communications about current drugs and biologics
  • Opt-out for fundraising communications
    BA contracts required for RHIOs – and PHRs in some instances
    Prohibition on “sale” of health records or protected health information
  • Public health
  • Research
  • Treatment of an individual
  • Sale of a facility/business
  • Payments to business associates
  • Copies to individuals
  • Designated by Secretary in regulations

HIPAA Enforcement

Business Associates accountable to authorities for compliance with some HIPAA privacy and security rules (+ new provisions)
Application of HIPAA criminal provisions to individuals
Ability to civilly enforce where violation qualifies as criminal but no criminal penalties pursued
Requirement to impose civil penalties in cases of willful neglect
  • Corrective action may still be pursued for lesser offenses
Tiered increase in civil monetary penalties
Distribution of % of civil penalties to individuals (penalties also go to OCR)
State AG civil enforcement
Secretary required to do periodic audits

Provisions for Entities not Covered by HIPAA

Temporary breach notification provisions for PHR vendors and internet applications
  • Breach definition
  • Same safe harbor for protected information
  • Enforced by FTC
Study by HHS & FTC with report to Congress on privacy and security recommendations for PHRs
  • Which agency should regulate?
  • Timeframe for regulations (no specific authority to regulate)

Misc. (Administration/Studies/Reports/Educational Initiatives)

  • Strengthened authority for ONC
  • New advisory committees on policy and standards
  • OCR public education initiative on uses of PHI and individual rights under HIPAA
  • Privacy Officers in each HHS region
  • Chief Privacy Officer within ONC - Not charged with HIPAA enforcement/oversight

Misc. (Studies/Reports/Educational Initiatives)

    Studies/Reports by HHS Secretary
  • Annual report on enforcement
  • Study on implementation of the de-identification requirements
  • Study of HIPAA definition of psychotherapy notes with respect to inclusion of test data and materials used for evaluative purposes
    GAO Studies:
  • Methodology for providing individuals with a % of civil monetary penalties
  • Report on best practices for disclosure of PHI for treatment purposes
  • Report on Impact of ARRA provisions on health care costs and adoption of EHRs

March 12, 2009 in A Bank-Driven eHealth Ecosystem, Medical Banking Institute, Medical Consumerism | Permalink | Comments (1) | TrackBack

National Rountable: Medical Banking & The Health Data Ecosystem - Engineering A Revolution in Revenue Cycle Management


Sheila Schweitzer, Chairperson & CEO, CareMedic Systems, St. Petersburg, FL


Robert Nay, Director, BlueCross/Blue Shield of Florida, Health Options, Jacksonville, FL

Charlie Myers, Director of Operations, Special Programs and Support, Johns Hopkins Hospital and Health System, Baltimore, MD

Russell Taylor, Strategic Systems and Processes, Aetna, Inc. Middleton, CT

Laurie Holtsford, Director, Business Office Support, Community Health Systems, Brentwood, TN

Scott Hawig, Divisional CFO-Patient Revenue Management Organization, Duke University Health System, Durham, NC

March 12, 2009 in A Bank-Driven eHealth Ecosystem, Medical Banking Institute | Permalink | Comments (0) | TrackBack

Mayo Clinic Health Policy Center - Advancing Health Care Reform By Creating A Federal Health Board


Ceci Connolly, National Staff Writer, Washington Post, Washington, DC

Keynote Panel:

Robert K. Smoldt, Chief Administrative Officer Emeritus, Mayo Clinic, Rochester, MN

David M. Mirvis, MD, University of Tennessee Health Science Center, Memphis, TN

Murray N. Ross, Ph.D., Vice President, Kaiser Foundation Health Plan, Inc., Oakland, CA

Roy Ranthun, HSA Consulting Services, Silver Spring, MD

Stephen Parente, Ph.D., Associate Professor Finance, Carlson School of Management, University of Minnesota, MN

Study Documents:

US Health Board Proposal (PDF) | Enabling Legislation (PDF) | 2009 International Journal of Medical Banking

March 12, 2009 in A Bank-Driven eHealth Ecosystem, Medical Banking Institute | Permalink | Comments (0) | TrackBack