Why you'll never use CurrentC (and why this matters to healthcare)

Oh! You've never heard of CurrentC? That's ok, you're not missing anything. With Apple Pay making news recently as a frictionless and secure payment system, the spotlight has been shone on businesses who have opted out of the new service. In fact, the biggest complaint with Apple Pay is that not enough businesses are accepting it.

It has also come to light that the reason why many large retailers have opted out of Apple Pay is because of a consortium called the Merchant Customer Exchange (MCX), which is an effort spearheaded by Walmart to encourage customers to replace credit cards (with fees that the retailers loathe) with their checking accounts.

Here is how CurrentC works (according to those who have used the currently invite-only service):

• Download the CurrentC app (Apple App Store or Google Play)
• Register for an account
• Add a PIN to the app
• Add a checking account to the app
• NOTE: this requires giving CurrentC your SSN and drivers license number, which, in their own words, "is not stored in your phone."  As if it makes us more comfortable to know that critical information commonly used in identity theft will be stored in the cloud of an organization that has already been hacked.
• Add any rewards programs you would like to use with the app

Alright! Now you're ready to pay! To do that, just perform the following steps:

• Take your phone out of your pocket/purse
• Unlock your phone (if you have a PIN/passcode)
• Find the CurrentC app on your phone
• Type in the CurrentC app PIN/passcode
• Navigate to the payments section of the app
• Hold the phone steady to scan a QR code near the cash register

Credit: TechCrunch

Finally, rest comfortably knowing that this data resides in the cloud and that your purchase history could be shared among all participating MCX retailers so they can use that information to send you targeted ads and loyalty offers.

Sounds consumer-friendly, no?

That's exactly the problem - this is a solution that primarily benefits retailers, not consumers. CurrentC is trying to use the thin veil of loyalty rewards to mask their true intentions. Some consumers will see right through this ruse, while others will simply balk at how cumbersome the service is to use. I understand the desire for retailers to bypass the 2-3% processing fees that come with credit card transactions, but until they find a solution that gives consumers a substantially better experience than the current status quo, they will fail.

While the 2-3% processing fees might hurt retailers, credit cards provide significant benefit to consumers through:

• Convenience in grouping transactions together in one monthly payment
• Robust fraud protection
• I've been automatically mailed a new credit card twice in the last year due to the Target and Home Depot breaches. Any fraudulent purchases (where were none) would have been reimbursed, no questions asked.
• Compelling rewards programs
• Cards now offer up to 2% cash back on all purchases, assuming they are paid off on time
• Last but not least, the ability to purchase something using credit, and pay it off over time

This is where Apple Pay succeeds in providing additional value to consumers. In addition to retaining all the benefits of credit cards noted above, Apple Pay:

• Simplifies the checkout process to a single motion involving moving your phone close to the checkout kiosk while holding a finger on the TouchID button. Because phones are usually immediately accessible to most people, this will be more convenient than pulling out a credit card.
• Dramatically increases security. Your credit card number is not stored on your device or anywhere else. Transactions are made via a dynamically-generated single-use number at the point-of-sale. In the event of a credit card breach, your number is safe, and no new card needs to be issued.
• Automatically works with your credit card issuer to update expired cards without any user intervention.
• Keeps your purchase history private. The credit card issuer will still know, but Apple does not have access to this information; it will not be shared with anyone else.

So what does this have to do with healthcare?

I've previously discussed the importance of creating mobile apps that start with the problem and integrate into users' workflows. These concepts are not unique to healthcare, but we happen to be at the beginning of a movement to take healthcare mobile in the hope that we can fully realize the benefits these emerging technologies may provide to healthcare quality and efficiency.

Ensuring that these technologies are useful and usable will be key to our success, and the contrast between initiatives like CurrentC and Apple Pay is instructive.

Even so, the financial world is relatively simple compared to healthcare (which includes the financial aspects plus much, much more). Integrating into a consumer's workflow is far easier than integrating a new intervention into a provider's workflow, and then attempting to scale that intervention across multiple hospitals and EHR vendors.

Yet this is exactly what we need to do. Standards-based frameworks such as the SMART platform show promise that this is achievable. I will have more to say on this topic in the near future. Until then, keep your eyes open for other examples where usability is sacrificed for secondary gains. CurrentC is not alone.

Why solving healthcare problems is so hard

In my mHealth discussions I often meet budding entrepreneurs who are frustrated that finding solutions to healthcare problems just isn't as easy as it is out in the broader tech world.  They're right.

The reasons for this are many.  I won't get into the complicated reimbursement models or ACOs or proper alignment of incentives.  For the purpose of this discussion I'll focus on just one thing - arguably the most important - the human body.

Leonardo da Vinci's famous Vitrivian Man.  Studying the outside is the easy part ... (no disrespect to da Vinci, of course)

But first, let's discuss physics.  The laws of Newtonian physics (i.e., classical mechanics) have been well understood for hundreds of years.  The understanding and application of Newton's three, simple laws eventually gave rise to the industrial revolution, and, by extension, modern society as we know it.  In just a blink of cosmic time, humanity progressed from horse-drawn carriages to landing a man on the moon, 238,900 miles away.

Even more impressive is that we have successfully sent something the size of a small dog from our dear planet Earth to another planet hundreds of millions of miles away, causing it to land (without damage!) in a very specific location on that planet.  Of course I'm talking about the Mars Pathfinder mission and Sojourner rover (and other successful missions to Mars).  For a little perspective, this would be very roughly equivalent to hitting a golf ball from earth and getting a hole-in-one on the moon.  On the first try.  And don't forget that the moon is moving, so by the time the ball arrives, the moon will be in a totally different place than when it left the end of your club.*

This is a picture taken from another planet (let that sink in).

So if we understand the basic laws governing our universe so well that we can accomplish incredible feats such as this, why is it so hard in healthcare?

To put it simply, because each living organism might as well be its own universe with its own laws.

The human body is an incredible, complex universe, governed by laws that we still know relatively little about.  Yet unlike classical mechanics, once we learn a new law or association about the human body, it's not guaranteed to hold true for each unique organism.  That's because we're all different owing to our personalized genetic makeup, something we're just beginning to understand.  Although DNA was discovered in 1869 and its double-helix structure identified in 1953, the function of each gene in our intricate genomes is still largely a mystery.

And then, even if we knew the function of each gene, it wouldn't necessarily explain the complex interplay of proteins and carbohydrates and receptors and positive/negative feedback loops ... the list goes on.  There could never be a set of simple laws to govern these unbelievably elaborate interactions.  Despite numerous advances and tremendous knowledge, we still can't eliminate pain without side effects, completely eradicate cancer, or even cure the common cold.

Wanna know a secret?

For those of you outside the field of medicine, this is why we're always speaking in the language of statistics and probability - why we say things like "maybe" and "likely" or "unlikely."  Because we can't precisely define an outcome based on predefined laws (i.e., no Mars landings here ...), we must observe the outcome in lots of human beings so that we can then make an educated guess about what will happen to you.

That's right!  That's our big secret!  As physicians, we're just guessing most of the time when it comes to how we treat you!

Now before you get too excited (or worried), sometimes those are really, really good guesses ... like, we're 99.99% sure.  For example, we know vaccines save lives (and don't cause Autism).

But it's that last 0.01%, or 0.1%, or sometimes 20%, where there remain lingering doubts and inconsistencies.  This is why healthcare innovation is hard, and will ever remain so.

BUT, this is also why it's essential that we take advantage of the latest technology advances - including mobile technology - to solve these problems.  Despite the inherent difficulties in healthcare innovation, the promise has never been greater, and the tools have never been more accessible.  Let's go heal the world together!



*And even this pales in comparison with the Rosetta mission currently underway by the European Space Agency, where they are in the final stages of landing a craft on a comet (named Churyumov-Gerasimenko) just several kilometers long, a process that involved the spacecraft orbiting the sun several times, slingshotting itself around the Earth thrice and Mars once in order to take advantage of those planets' gravity to attain the proper speed and trajectory.  I'm not kidding.  I didn't mention this one because the landing hasn't happened, yet.  That will take place on November 12th, 2014.