Wednesday, May 27, 2009

ATM Healthcare? The way of the future?

Doctors are starting to redesign the way they work to link better with patients and to use the newly available multi-media technologies. This is an important process that will undoubtedly accelerate over the next 20 years. There is a need to substantially redesign many of the traditional processes used to practice medicine - and move to new ways of delivering health services, using what I call ATM Healthcare.

What, then, is ATM Healthcare?

When we think of the term ATM, most of us think of banks. The acronym ATM has entered our language so completely that many people don't even know what the letters stand for - they just know that undertaking an ATM transaction allows money to be drawn direct from their bank account, not from a credit account, and that they can do this at a special ATM machine usually in the street, or at a store checkout. ATM stands for Automated Teller Machine and is simply a direct electronic entry to your bank and your accounts. And it is very simple, convenient and consumer friendly. ATM has made banks and bank accounts much more accessible to customers, wherever and whenever they want. At the same time they have made the work of banks more efficient while dramatically cutting the cost of bank transactions to a few cents from an average of $10-15 per face to face transaction with a teller. This has happened because ATM machines now manage most of the simple bank transactions that used to take up a lot of the time of tellers. This frees up bank staff to spend more time on complicated transactions where human expertise is required. Who can now imagine a bank without widespread ATM facilities? And all this has happened in just a few years.

Computer scientists think of ATM in a very different way. For them ATM is a technical term describing how data can be passed across an electronic network. Here ATM stands for a protocol called Asynchronous Transfer Mode. This protocol was designed as a way of merging old telephone networks with more modern packet-switched computer networks in order to deliver data, voice, and video over the same channel. In other words it allows all sorts of differing data, from varying data sources, to be delivered at the same time.

So what have these two types of ATM have to do with healthcare?

Think of the obvious parallels.

The doctor-patient consultation is in many ways similar to the traditional bank interaction with a teller. It is confidential, about 80% of consultations are relatively simple, and if complications arise, a second person can be called in to give specialist advice. There are also parallels with the computer scientist ATM, because this consultation nowadays involves typically several different types of data - voice, lab results, paper and electronic documents (health records), and increasingly video and digital images. The consultation itself can be described in both computer language and clinical terms as consisting of three information processes – data capture (history and examination), data analysis (diagnosis), and business planning (treatment).
What we in healthcare need to do is start thinking like bankers, and focus on providing our services in a more consumer friendly way. As we do this, doctors need to follow two core principles. The first is the complementarity principle - computers do well, what humans do badly, and vice versa. Computers never forget, and are great at scheduling, remembering and reminding, but humans are much better at data analysis and decision making. So computers should be able to do many simple health transactions, remember and order prescriptions and lab tests, schedule appointments, and provide preventative health information. The second principle is the importance of redesigning business processes before introducing new technologies. There are a lot of similarities between banking and the practice of medicine. And doctors can learn from bankers in this area. There is no reason why we should not introduce ATM Healthcare, in just the same way as bankers have introduced ATM Banking.

What would ATM Healthcare look like?

Firstly, lets assume that, like banking, ATM Healthcare is going to be used for relatively straightforward consultations in many specialities, and will not replace the complicated face to face consultation or intervention that makes up about 20% of overall medical consultations, and will always remain the health "gold standard" consultation. We already have most of the tools of ATM Healthcare at our disposal. Electronic Medical Records, lab results and x-ray images are the health equivalent of bank statements. Telemedicine - video consulting either in real time (synchronous), or delayed time (asynchronous) - is now a proven technology, is already available in some supermarket clinics, and is the equivalent of the teller machine. Email and wireless telephony provide more mobile access to providers, and the whole internet is an amazing educational and clinical communication platform that is already delivering all sorts of ATM Healthcare. We have lots of systems to combine different types of data and present them simultaneously to doctors and patients, just as per the computer scientists version of ATM.

Patients need to encourage doctors to think of ways of redesigning their practice processes to make better use of available multimedia technologies so that they can continue to provide better and more available care. I am sure this will happen, especially as more of the “millennial” generation start receiving care. They will demand that doctors use these technologies, and increasingly change their ways, and hopefully use the example of banking as we move increasingly to ATM Healthcare.

This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at

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