Philip Andreae’s Thoughts

Today during a most enlightened networking meeting, beyond what someone in transition normally speaks of, we got into a most interesting and thought provoking conversation.

Electronic Health Care Records

Somehow we got into a discussion of the evolution and problems involved in developing the eletronic patient record.  The gentleman, who will remain nameless, remembered a conversation he had with a man who was involved with the United Kingdom’s work on the exploration of space.  This knighted individual apparently suggested the key issue with developing the electronic health record was the issue of creating the patient’s electronic history from the previous pencil and pen records. 

His approach to solving this problem was to use prisoners as the codifiers.  Of course such an idea immediately causes one to worry about privacy and the threat to the patient and doctors when these prisoners were freed. 

As we talked an interesting thought occurred.  How often is a patient’s history relevant?  How often is the doctor quite happy to meet with a patient and simply focus on the symptoms described during that  persons visit? 

As we reflected, we both realized that often the patient’s history will never be pertinent to a future diagnosis.  In those situations where the history is relevant, let’s say 10%, then there is value to the effort of codifying historic medical records, charts and the like.  The doctor and his office staff can find the time to organize the codification of the relevant data.  Clearly such an approach with the reduction is the cost of establishing the basic health record, is connected with the value a complete electronic health record will have in reducing the cost of long term care, something insurance companies and public health authorities can understand.

For that 90%, after the doctor has become automated and is part of a system designed to capture and retain the Patient Health Record, at the next appointment the doctor in conjunction with the patient can record important facts such as allergies, reactions to drugs, existing conditions and any pertinent operations or procedures the patient can remember. 

Only when this basic profile indicates conditions that will have future implications, is there a need to go through the effort of backtracking through the records and recording any pertinent information.

China and Socialism 

I asked my companion what he was up to.  He talked about the five companies he was working with in China and the various trips he had taken to remote parts of that great country.  He said three things that stuck in my mind. 

1. He remembered a bus trip where he asked about unemployment.  His Chinese companions asked him to look out the window and tell them what he saw.  His response “everyone is working”, “there are no beggars on the street”.  They smiled and he was reminded that in this socialist environment one of the fundamentals is that everyone has work however menial it may be.
    
2. We then spoke of the economic divide that is emerging and like in all countries this is a reality that will always exist unless we can evolve to that social utopia described as the purest form of socialism where every man works to his ability and everyone shares equally. He then reflected on the reality that mobile phones, TVs and other luxuries were everywhere and the age old work ethic that is China, will drive these people to want more therefore work harder to get more.  It is this work ethic that is China’s strength and will be the issue we will have to address as the world moves forward in time.  If we in the west continue to expand our leisure time and the Chinese continue to follow their nature and continue to focus on work.  Who will win?  I think the answer is evident.  Those that work  will be the ones who win.
3. He then spoke of issues within the industrial complex where mine accident occurred or dangerous products are released.  The interesting comment was that those in power, the top three managers, are shot when such things happen.  Of course this form of behaviour is abhorrent and clearly a violation of Christian thinking or western thoughts of punishment. 

Yet what is interesting, assuming they learn to balance the punishment (100 dead in a mine cave do to poor conditions and insufficient safety standards) to the crime, is that those ultimately responsible are ones that are punished. 

I then reflected on what happens in our society.  The executives always seem to go unscathed.  They successfully push the blame down to the supervisors and little people who work and manage the place where the disaster occurred. 

If we were to dig deep enough I am sure we would find that they did all they could do with the tools and budget they were provided.  Budgets and tools authorized by executives sitting in big offices taking down big salaries and only getting worried when shareholders not employees come screaming for justice.

Assuming that China is going to continue to evolve.  That they are going to embrace compassionate forms of punishment.  While at the same time maintaining their work ethic and maintain the premise that responsibility is top down not middle down.  They will become not only an economic power to deal with, but a country with a strong moral sense of responsibility and thus a threat to the soft life that has become the western dream. 

A dream that balances not working more than 40 hours a week with demands for more and more vacation.  China will be a country where hard work is rewarded, pleasures are sought and people have a moral sense of responsibility to each other.

We in the west need to be mindful and learn from those countries that take the goodness of socialism, merge it with the power of capitalism and the forces of the global economy.

Each day I receive a variety of articles on the subject of mobile payments and find countless opinions about the evolution, risks and capabilities of mobile payments.

As is always good form a definition is in order.  I could begin by suggesting a mobile payment is any time that while moving about I can purchase something from someone using some recognised means of payment or currency.  So at the most basic level of understanding carrying cash in our pockets was and still remains a form of mobile payments.  Yet this is not what we mean when we discuss mobile payments.  What we have done is combined two words from two worlds into a new thought.  Mobile emerging from the arena of telephony and the use of the concept of a phone that does not need to be connected with a piece of wire.  Wireless, cellular and mobile all are terms that we associate with the use of radio waves to connect a telephone to a network allowing us to make phone calls from someplace that is in proximity to a receiver or cell tower or satellite.  Now I’m sure all of my readers know these things and are wondering what is the point.

The point is that we also talk about contact-less payments that concept of waving a card in front of an antenna, thus  allowing the card to receive power through induction and then communicate with the device controlling the antenna.  Some people call it that “Tap and Go” feeling others refer to it a PayPass, Visa Wave, Express Pay card and if we travel the world we will find an assortment of other brand names such as Dexit.  In many cities transit agents discovered that by employing contact-less cards interfacing with - terminals they could create efficiencies, improve information about ridership and maybe even reduce fraud. 

So now we have to discuss the application of the technology.  This brings us to the idea of closed loop and open loop systems.  Neither are new thoughts, charge cards issued by department stores are closed loop they only work at that companies stores.  Open loop refers to systems that are widely accepted because someone has gone out and branded a concept, convinced merchants it is convenient and then offered a “Card” to you and I so that we can be identified and employ this “Means of Payment”.  Classic brands that we think of as Open Loop systems include money, MasterCard, Visa, Interac, PIN, eurocheque and an assortment of national brands.

Yet all of these systems have inherent inefficiencies.  Inefficiencies that some see as benefits and others see as highway robbery.  Then there is that class of people who enjoy getting something for “nothing” they like the idea of counterfeiting money, replicating credit and debit cards, capturing our PIN and ultimately stealing our identity and more importantly our hard earned money.  I could also mention merchant discounts, late fees, interest charges, interchange but those are all for another day.

The operators of these systems understand or learn about these various methods of “Stealing” identity and money and have built systems to mitigate the risk, eliminate no minimize yes.  In Europe and throughout the world (except the USA) the members of MasterCard, Visa and the various domestic systems are working to reduce these threats by introducing Smart Cards or Chip Cards all cards employing the EMV specification that have a computer embedded within.  The benefit is that PIN can easily be introduced on credit cards, the cost of telecommunications can be reduced by allowing the computer in the card to make intelligent decisions when ever that card is used to effect a payment.

This movement to secure payment cards with the technology and specifications defined within the EMV specifications began first in France where they went out on their own developed their own specifications and proved to the world that smart cards or chip cards can and will reduce the level of card present fraud and can if employed properly also reduce the cost of telecommunications.  their success can easily be  seen in this chart that tracked their progress and success.

Remarkable success, yet they were now faced with an issue.  First the criminals understood if they disabled the chip (computer) the merchant could still swipe the card and read the magnetic stripe.  This one easily could be solved by eventually not allowing cards that should have a chip to be swiped through the magnetic stripe reader.  But what about when these cards were used in Holland, England or anywhere that had not, and at the time no one had, adopted the same means of defense.  The net result fraud migrated from being a domestic issue to the cards being used in neighboring countries.  Obviously the French became proponents of a global migration to smart cards and convinced Visa, MasterCard and Europay to develop the EMV specifications, recognising that they would have to eventually convert.

I could continue to digress from my main theme and talk about how each country went through its decision making process.  I could then go on and talk about how far along they are in their implementations. Suffice it to say some are finished, others are diligently working towards completion and others are moving at a pace that does not cause undue expense and allowing natural replacement cycles to drive the timescale for implementation.

Here in the country where I live they also have a Chip Migration strategy.  Canada is inpilot or a trial depending on how the lawyers interpret the efforts of banks potentially colluding together.  By the summer cardholders in the Kitchener Waterloo area will be using these chip cards and the media, banks, merchants, processors and associations will be monitoring and learning how the Canadian’s feel about and their willingness to embrace the change.

The following chart outlines Interac’s schedule for deployment.  MasterCard is playing along without committing.  Whereas Visa has stated that they will push the liability for fraudulent transaction not protected by EMV to the Acquirer if their merchants are not compliant by October of 2010. 

So how does all of this affect the introduction of Mobile Payments or Contact-less Cards.  A mobile payment is simply, today, a contact-less payment performed using a mobile phone with the contact-less interface inside as apposed to to using the card as the form factor..  Well some will say not at all, the drivers are different the business case is not the same.  Yet the core technology is a computer in the card.  So why worry, eventually all of this could come together.  Or will the USA decide to take another path all together.

So to end this particular blog I ask a simple question, based on the premise that the mobile and contact-less payments that we see emerging are all about speeding up low value <$25 dollar transactions. What happens when I want to use my contact-less mobile phone for a payment for say a $1,500 hotel bill.  Will I tap my contact-less device “mobile phone”.  Have to find a place to put it while I either enter my PIN or sign the receipt.  Today the clerk typically holds the card for me while I sign the receipt tomorrow what.  Or will they decide to merge contactless and EMV creating a more interesting problem.  I’ll need to keep that phone near the antenna while my PIN is verified and the transaction is authorized.

 Or should we go on and talk about the security concerns that everyone has described in countless articles and numerous logs.  The idea that the criminal will walk down the street reading the content of your purse or wallet with their hidden antenna.

 Or should we talk about who is going to pay the price of adding the contact-less antenna to the merchants point of sale equipment.

 Let me hold those for another day and another flow of thought.

Often as I explore how our culture and our planet evolve I am amazed at how we try to change everything with each succeeding generation.  We, and I remember when I was young, think that our thoughts are original and therefore believe that we were the first to dream it up.  Yet if we explore history we will find that the great and the unknown have probably already put forward the concept.  As an example think of the Helicopter, invented by Da Vinci yet he did not have the tools to make it work.

 The change occurs as we build and create new machines, we suddenly find that we can create and build those things that before were only of our or someone elses imagination.

Yet all this being said we also circle back and adopt patterns that once were in vogue and did not test the passage of time.  The best example is our explicate use of sexual overtones in advertising.  The idea that the spam we receive for male enhancement products is no longer spam but are now commercials on prime time TV is simply an example of how we have lost sight of the value of prudence and morality.  Do we want to learn about feminine products or is that something our mothers will teach us and or doctors and health classes will provide education about.  Do we need to know that your product is more absorbent than theirs or that you can go swimming if you buy this one.

Maybe in a generation or two we will once again realize that by exploiting the art of sex we create and stimulate thoughts that are not biblical and can in some cases harm people.  Yes, a naked body can be a beautiful thing, when an artist exposes it on canvas.  But, is that same naked body art when we use it to advertise cars, shampoo and who knows what else.

As a technology I find that people think I have lost my edge given that I no longer understand the terminology they are using today.  Give me a thesaurus that matches words like a self contained subroutine to an object.  Then we talk about methodologies.  Do they imporve productivity I am sure that people beleive they do and nore importantly then assure us that we are doing a better job of documenting what we are building and mechanisms that assure the original user that he gets what he asked for

As an observer of our times I sometime wonder if we have taken things to an extreme and if our desire to lure people into buying this or that product has turned our world from one where it is all about loving god and your neighbor to one about simply doing anything to earn a dollar, euro, yen of pound.