ATM comparison is false

I fundamentally agree with the point that putting stimulus money into building a bad system will leave us locked into a bad system, but there are some often-repeated claims about electronic medical records that are disconnected from technical reality. One of these is the ATM example - that health data should flow as easily as ATM data.

Why an ATM is completely different from an EMR

1. ATM Data is much simpler than health data.
ATM data is simple. Account number. Bank (routing) number. Balance. Withdrawal amount. Timestamp.

Health data is complex. Text. Images. Video. Blood pressure. Temperature. Hundreds of blood chemistry values. And more.

To simply wave your hands and say that if we can figure out how to transfer your bank balance information, we can figure out how to transfer images and video and blood pressure is to gloss over one of the fundamental problems: truly standardizing all this is not simple. Every other standard I've been involved with (the TIFF image format, the PDF format, and more) has gone through a difficult growth cycle where everyone found out that implementations of standards are not so standard. (But see my previous post for more on that.)

2. Money is fungible; health data is not.
If someone skims your ATM card info and empties your account, this can be fixed. The bank puts the money back into your account, and you are made whole. You'll want to change your account info to stop the thief from future escapades, but the dollars that are put back into your account are just as good as the dollars that were stolen.
If someone steals your health data, we can't just "put it back". The horse is out of the barn. I've had my credit card data exposed by a newspaper glitch. It was easy to fix, and I don't hesitate to use my new credit card. It would take only one publicized event of health data loss (and we've already seen providers caught peeking at celebrity files) for me to seriously ponder what I tell my doctor, which leads to a point worthy of its own headline:

Health data is more private than any other transaction
If there isn't something in your medical record that you wouldn't want the world to know, then count yourself lucky. Electronic medical records used to be sold as better than paper because access could be audited electronically but not with paper. Then came data interchange, and the multiplying possibilities for improper access might start to outweigh the deterrent value of auditing.

I'm not saying that these problems cannot be addressed, but to think that they will be anywhere near as easy as setting up an ATM network vastly misses the fundamental nature of multiple implementations of standards and the complex, private nature of medical data.