Friday, June 27, 2008

Healthcare Gets a (Digital) Backbone

Posted by Mark Brousseau

The digital backbone that connects health providers, payers and vendors is expanding, according to Behind the Numbers: Healthcare Cost Trends for 2008, a new report from Pricewaterhouse Coopers’ Health Research Institute (

Connecting the health system electronically will aid payers in better managing both performance and compliance throughout the continuum of care, the report concludes. Clinicians and business offices are increasingly using technologies such as personal computers, electronic health records, wireless systems, biometric devices, and imaging software to coordinate and improve care. For example, widespread adoption of electronic medical records and other health information technology is estimated to save $162 billion a year by improving care management, reducing preventable medical errors, lowering death rates from chronic disease, and reducing the number of employee sick days, the report finds.

Providers are beginning to invest substantially in their own health information technology (IT) systems. During the past few years, most hospital systems have been allocating an average of 25 percent of their capital spending on health IT, according to Fitch Ratings, a New York ratings agency. While initial spending on IT has been shown to add to costs, the longer-term effect is one of reduction in costs. Health IT investment typically reaches a tipping point in terms of cost, according to Pricewaterhouse Coopers’ research released in 2007. That tipping point tends to reflect continued investment after which hospital operating costs are reduced. Building the digital backbone requires connecting to physicians, and an increasing percentage of physicians themselves are going business electronically as well, Pricewaterhouse Coopers found.

What do you think? Post your comments below.

Friday, June 20, 2008

Weak EHR Adoption Called Troubling and Sobbering

Posted by Mark Brousseau

An interesting article from Government Health IT on the slow adoption of electronic health records (EHRs):

4 percent of U.S. doctors use EHRs, new study finds
Nancy Ferris

A milestone study of the adoption of health information technology has produced findings that one of the study’s authors calls troubling and the other calls very sobering.

The survey of 2,758 U.S. doctors, sponsored by the Office of the National Coordinator for Health IT (ONC), found that only 4 percent had a fully functional electronic health record system. Another 13 percent had a basic or partially functional EHR system.

A 2006 study, also sponsored by ONC, found that as many as 9 percent of doctors had fully functional EHR systems. However, Dr. Karen Bell, director of ONC’s Office of Health IT Adoption, said the survey parameters were different.

“There is an increase,” Bell said at a press conference to discuss the results, which were reported in an online edition of the New England Journal of Medicine.

The earlier survey, undertaken by the same team, found that 24 percent of doctors had some sort of computerized record system, but the question allowed them to count billing systems and other kinds of systems not directly related to health care.

Dr. David Blumenthal, director of the Institute of Health Policy at Massachusetts General Hospital and a co-author of the study, said, “We need to get moving a lot faster than we have been if we are going to take full advantage of this technology and realize its promise for medicine."

His colleague, Massachusetts General researcher Catherine DesRoches, said she found reason for hope in the findings. Forty-two percent of the doctors surveyed said their practice had bought an EHR system but had not yet implemented it or they were planning to buy one in the next two years.

“Physicians who use these systems like them,” she said, and they reported that the technology supported better patient care.

But, DesRoches said, doctors are uncertain whether they will get a financial return on their investment in EHRs, and they are fearful of new legal liabilities that could arise. Cost, she said, is the No. 1 barrier to doctors’ adoption of the technology.

Although ONC had touted the previous survey as a benchmark from which to measure future EHR adoption, Bell said the more recent one is “a true benchmark.” She said an agency of the Centers for Disease Control and Prevention will repeat the survey using the same survey instrument in the future.

Thursday, June 19, 2008

Federal Reserve Seeks Tenants

Posted by Mark Brousseau

An interesting article from the Associated Press on the Federal Reserve's extra office space:

Fed leases more space as people write fewer checks
The Associated Press
Tuesday, June 17, 2008; 3:45 AM

HELENA, Mont. -- The shift to fewer paper checks and greater electronic movement of money in the United States has left the Federal Reserve with some empty office space.

Processing of checks by the Fed, a service commercial banks purchase, is down as more Americans pay their expenses electronically with debit cards, automatic deductions from checking accounts or other options.

More than two-thirds of the noncash payments in the U.S. are electronic, according to the Fed. Locations where the nation's central bank clears checks have fallen from 45 to 18 within the last few years, and the number of Fed check employees is down to 2,800 from 4,600 in 2003.

Check work previously at the Helena Branch of the Federal Reserve Bank of Minneapolis has been consolidated with Denver operations. Branch manager Paul Drake says about one-third of roughly 100 Helena jobs ended last year, freeing up space in the brick building near the city's historic Last Chance Gulch. Now a construction crew is remodeling part of the building for a tenant set to arrive this summer.

Some Fed locations were leasing offices long before changes in the check business but now may be seeking more tenants because of reductions in check processing.

Leasing is among options being considered for Fed space that will become vacant in Cincinnati when its check operations move to Cleveland by year's end, and in Charlotte, N.C., and Baltimore when check work moves to Atlanta and Philadelphia. The Federal Reserve Bank of San Francisco has a couple of established tenants and expects to lease additional space this year as check processing operations are removed, spokeswoman Carol Eckert said.

The Fed expects that as its check processing is scaled back, eventually only the Atlanta, Cleveland, Philadelphia and Dallas locations will perform a full range of check work.

In Montana, Silicon Valley-based SRI International will move its Helena operations and staff of 10 into 3,300 square feet of the Federal Reserve building next month, SRI spokeswoman Ellie Javadi said. The relocation will provide expansion room for the research-and-development nonprofit founded in 1946 as Stanford Research Institute.

With distribution of cash to financial institutions one of the Fed's functions, and its banks housing millions of dollars, managers don't want just any business to move in.

"There are certain tenants that would make a good fit for a facility such as this, and there are some that wouldn't," said Helena's Drake, declining to elaborate.

Talk between representatives of the Federal Reserve and SRI occurred during an economic-development conference last year in Butte and ultimately led to the SRI lease.

Electronic payments first surpassed checks in 2003, when 36.7 billion checks were written and electronic payments surged to 44.5 billion, according to the Fed. Further reducing paper handling is Check 21, a federal law that allows banks to send digital images of the checks people do write, rather than moving those slips of paper from place to place for processing.

Although "wringing the paper out of the system" boosts efficiency and checks are receding dramatically, don't expect a checkless society anytime soon, said Doug Johnson of the American Bankers Association, an industry group in Washington, D.C. "For the foreseeable future, there will be people who are accustomed to sending their payments by check," said Johnson, vice president of risk management policy.

Three in 10 bank customers say checks remain their preferred method of payment, said Wendy Feller of IBM's Institute for Business Value, a research unit in San Francisco. Security is consumers' leading concern about electronic transfer, Feller said.

But that is not the issue for Brian Johnson, whose bill payments keeps checks moving into the Federal Reserve or other clearinghouses.

The 25-year-old assistant at a Helena retirement complex finds that paying electronically "feels like another step in losing control of my budget."

"I send checks every month," Johnson said. "I want them to send me a bill, and I want to look at the bill, and I want to budget the bill, and then I'll send them a check."

Wednesday, June 18, 2008

Technology Influences Profits

By Mark Brousseau

Sixty-seven percent of respondents to a recent McKinsey Quarterly survey said a faster pace of technological innovation would have a very or somewhat positive impact on the profitability of their company over the next five years – topping the list of key trends that influence profits.

The increasing availability of knowledge and the ability to exploit it was predicted as having the next biggest influence on profits, cited by 60 percent of respondents as having a very or somewhat positive impact.

The development of technology that empowers consumers and communities, and the adoption of increasingly scientific data-driven management techniques, also were among the trends cited as influencing profits over the next five years.

What do you think will be the top trends that influence profits? Post your comment.

Credit Steers Bank Relationships

By Mark Brousseau

The 2008 Treasury Survey by Treasolution Inc. confirms what lockbox providers have long suspected: corporate bank relationships are influenced by credit facilities.

Sixty percent of all respondents to the survey said their bank relationships are influenced by their credit facility, while 24 percent of respondents said their credit facility didn’t influence their bank relationships. Sixteen percent of respondents to the survey said their company didn’t have a credit facility.

Among respondents that had credit facilities, a whopping 72 percent of companies said they influenced their bank relationships, while 28 percent said they didn’t.

Does your corporate credit facility influence your bank relationships? Post your comment.

Tuesday, June 17, 2008

Prototyping to Success

This article describes how to IT can provide sucessful solutions when IT and end-users have trouble communicating requirements and proposals via traditional written specifications.

It was posted by Paul Murphy, on ZDNet's blog (

June 16th, 2008
Continuous prototyping

I’ve been involved with hundreds of mid range business application development projects plus a few big ones and my universal experience with all of them is first that process blocks progress; and secondly that the more formal the specifications process, the less realistic the usage specification and therefore the less successful the eventual application.
A big part of the problem is that users and analysts simply don’t understand the same words in the same ways. At the obvious level this has the consequence that data dictionary definitions don’t apply either to all users of the data or consistently over time -and at the more subtle level it means that users will describe their jobs in terms of the official procedure manual while expecting you to understand that they don’t actually follow it.
In a work to rule strike, union members explicitly follow every rule or procedure laid down by management - and thus bring the organization to a grinding halt. Sit down with users within any kind of formal setting or process and what they tell you will reflect the rule book - and if you implement it in your code you’ll be enforcing a work to rule process: meaning that your application will bring the organization to a grinding halt.
The better answer is continuous prototyping - a process which starts by establishing long term user relationships within which you do initial development and then continues as you revise your prototype after it goes into production.
In the initial development stage for continuous prototyping you work in the user environment, build your initial screens and attach actions interactively under user direction - then, just as you’re beginning to think you might have a clue, you’ll run into a roadblock showing that you’ve got it wrong.
Getting the first few wrong that way is normal - because users don’t understand the bigger context any more than you do and so they’ll applaud your efforts, and then find niggling little maybes, how abouts, and surprises that cumulatively cause you to throw away what you’ve done and start over. Two or three starts later, you’ll have a first screen or set of screens along with some appreciation of the complexities and overall flow of the work - and the rest of the thing will start to fall into place.
My favorite tool for this has long been Unify’s Vision/U2K combination - because the on screen create and drag was both fast and highly intuitive for the users watching me work; because the source files produced were text (meaning, among other things, that a simple script could extract the data references and build the schema); because search by example worked across everything; because you could make large, complex, screens accessing as many tables (and databases) as you wanted to; because you could cheerfully mix system generated data with user generated data; because a host of external variables let you customize almost everything for the specific end user; and, because you could tie in any Unix process you wanted to from anywhere in the operational process.
Now if you haven’t seen or used one of these toolsets this will all seem rather foreign to you and there’s not much I can do to help. You might, however, want to consider these two factoids and then use your imagination a bit:
Microsoft Access is a limited volume, single user, single data set, single screen, single language copy of the typical 1980s 4GL/RDBMS application builders without the multi-processing, language linkages, and user specific customization capabilities that come with Unix - think of it as a kind of thumbnail demo for a true 4GL/RDBMS combination and you’ll get the idea.
The Microsoft small screen pop-up and click routine is an outgrowth of graphics limitations on the 386/486 based PCs Windows 3.X was aimed at - because, on those, small pop-ups inside rectangles drawn in primary colors gave the impression of speed and thus validated the purchase decision. That worked because the bright pop-up window frame itself registered with the viewer - while the switch to pastels or other light colors on putting something inside that window hid the delay in getting the text and data in place.
One consequence of the interactive, user driven, design approach is that you find yourself making bigger and bigger screens with increasing levels of apparent complexity - because users simualtaneously demand that you add just one more thing, and decry “computer hassles” like having to click a mouse as time and concentration killers. As a result, you’ll typically find yourself pushed to the limits of your hardware - the screen below, for example, illustrates this because it’s designed for NCD’s 21″, 1280 x 1640, 1990s HMX screens as an absolute functional minimum.
This kind of thing is counter-intuitive for people raised on the Microsoft desktop, but real users (i.e. people who care about their jobs, and not the PC) don’t care that it’s big, ugly, and intimidating: they care that it’s hassle free, menu free, and fast -things which, at least according to the users in the pilot group this was tried with, would have made the time and billings manager it fronted for extremely effective in large scale use.

Screens like this are a consequence of how active prototyping works - users always want both more functionality and less computer hassle, so you end up finding ways to make the computer function as a tool for them to get their work done - something that reverses the traditional developer’s view of the user as the computer program’s input device.
To make the process work you define the screens and actions interactively with users; giving them things they can see and react to as you talk - something that requires you to fake in the back-end stuff until you get time to do it off-line. That gives them a continuously evolving view of what they’ll get - and, of course, that process makes them think: meaning that while you’re off filling in those back end holes they’ll change their minds about some things, add a few things you’ve never dreamt of, and invite a couple of new players into the game - thus quite possibly forcing you to start over on either the whole thing or parts of it.
As a result the process is often extremely frustrating; but when you’re done you usually have a prototype that works - one users already trust, one that reflects the actual work flow; one that has been tested for the overwhelming majority of usage cases, and one that’s really fundamentally ready for production - provided you remember that today’s production system is just a prototype for tomorrow’s because neither their workload nor your application is ever static for long.

Saturday, June 14, 2008

BOC Picking Up Momentum

By Mark Brousseau

Although retailers were hesitant to adopt back office conversion (BOC) in its inaugural year, Barry J. Nordstrand (, president and CEO of Solutran, thinks the momentum for BOC is building as retailers are becoming more aware and better educated on the benefits that BOC can provide.

“Approximately 2 percent of US businesses have adopted BOC,” Nordstrand told me, adding that Celent projects the number of businesses utilizing BOC will reach the one million mark by 2009 and 5 million by 2012. “One reason for this projected growth is the fact that general awareness of BOC is increasing in the market.”

As an example, Nordstrand points to a case study recently presented at NACHA’s Payments 2008 conference in Las Vegas. Walgreen’s spoke about its success in implementing a Solutran deferred capture model and discussed its successes thus far. “As additional large retailers continue to deploy BOC as a check conversion alternative, others will be looking to follow,” Nordstrand explained.

“There are many reasons why retailers are considering implementing a BOC solution,” Nordstrand added. “BOC allows retailers to reduce costs without making any changes to the existing POS process. The checkout process is not impacted allowing consumers to get through the lane in an expedited manner. BOC also eliminates the need to provide additional training for a position that experiences high turnover.”

Nordstrand said these are all important issues for large retailers who understand that changes to the checkout process create unnecessary operational risks.

By converting check transactions to ACH debits, retailers are able to reduce their banking fees and processing costs, extend their deposit cutoff time frame, and eliminate trips to the bank while improving speed of returns and funds availability, he added. It also enables them to consolidate their banking relationships and establish a centralized account for checks.

“Having gotten off to a slow start, the increased market awareness and ability for retailers to study the success of early adopters will have BOC rolling in no time,” Nordstrand said.

Wednesday, June 11, 2008

Social Security Checks Going Debit

Posted by Mark Brousseau

The move toward electronic payments has now impacted Social Security checks:

Social Security checks now offer debit card option
By Kathy Chu, USA TODAY

For millions of Americans, accessing their Social Security benefits is now just a card swipe away.

A new debit card being offered by the Treasury Department gives nearly 4 million recipients who have no bank accounts an alternative to paper checks that they must cash, usually at a price.

The new debit card, issued by Comerica Bank, was quietly marketed to nearly 3.5 million recipients of Social Security and Supplemental Security Income this spring. It's now available to any benefit recipient via

States already load child support payments and unemployment benefits onto debit cards. The federal government has used prepaid debit cards, too, for disaster relief aid. But the Social Security debit card is the largest push to date to switch from costly paper checks to electronic payments.

"Our goal is to move to 100% electronic payments," says Judy Tillman, commissioner of Treasury's Financial Management Service. "It's safer and more reliable for delivery" of funds.

The new debit card will eliminate the need for consumers without bank accounts to use costly check-cashing services, the Treasury Department says. It will also save the government money. The Treasury estimates that if all 4 million recipients without bank accounts signed up for the card, it would save $42 million a year.

As with any other debit card, using it won't always be free. For instance, holders typically will get one free ATM withdrawal per month. After that, they'll be charged 90 cents for each withdrawal. A fee of 75 cents per month also applies if card holders want paper statements mailed to them.

Still, the fees are among the lowest in the industry for such services, says Nora Arpin, director of government electronic solutions for Comerica.

About 80% of the 57.3 million Social Security and SSI recipients already have their benefits directly deposited into their bank accounts. The challenge will be to get the remaining consumers to switch from checks to electronic payments such as direct deposit or the new debit card.

The card "might be confusing if they're not savvy about electronic payments and don't have (experience with) a bank account," says Chris Allen, a director for Hitachi Consulting.

EHRs Go Beyond Treatment

Posted by Mark Brousseau

An interesting article from Government Health IT on electronic health records:

EHRs go beyond treatment
Health IT promises to streamline agency requests for copies of clients’ medical records

BY Nancy Ferris Published on June 9, 2008

Americans are often asked to supply medical records when they enroll at a school, seek to obtain disability benefits or apply for certain jobs.

Having those records available electronically would make it easier for patients to access them, as long as there is a process in place for authorizing their release from various health care providers’ systems.

The Social Security Administration is leading a project to automate the process for obtaining authorized information from electronic health records. As officials struggle to deal with a growing workload of applications for disability benefits, they say they hope the initiative will make the agency’s job easier and improve service to the public.

SSA receives more than 2 million claims for disability benefits each year, a number that is expected to grow steadily. In each case, the agency obtains names and addresses of the applicant’s doctors and his or her authorization for the providers to release medical records to SSA. The agency then contacts the doctors and waits for the records to arrive by mail — a process that can take months and costs more than $500 million a year.

SSA officials say they envision being able to use the Nationwide Health Information Network (NHIN) to send authorizations to providers electronically and automatically receive the records in return. They are launching a pilot project that involves Beth Israel Deaconess Medical Center in Boston, and they are participating in trial implementations of the NHIN this year.

Not coincidentally, Dr. John Halamka, chairman of the Healthcare Information Technology Standards Panel and a prominent health IT advocate, is Beth Israel Deaconess Medical Center’s chief information officer.

As part of the project, officials will identify HITSP-approved standards that could be used in the process of obtaining medical records, said Debbie Somers, senior adviser at SSA’s Office of Disability Systems.

The agency’s officials know the standards will not completely meet their needs, Somers said, but they are determined to use them whenever possible. They are especially interested in adopting the Continuity of Care Document (CCD) standard, which summarizes the patient’s health conditions, medications and allergies.

At the same time, SSA officials will choose a standard format for electronic medical records used by disability examiners, who spend hours searching through files for specific pieces of information.

“With every hospital and doctor, the record is in a different order and it looks different,” Somers said. With CCD, examiners could pull data into SSA’s system. To make it even easier for them, the agency will highlight certain diagnoses and procedure codes that amount to evidence of disability.

“By the end of August or September, we will actually be requesting real data from [Beth Israel Deaconess] and receiving real live data back, which we can use to [fold] into the medical record,” Somers said.

For the NHIN trial implementations, SSA will work with other project participants to test the system’s ability to send requests and receive electronic medical records from the Military Health System, Veterans Health Administration, Indian Health Service and other providers.

“We hope to still have the same back end on our side but to be able to use the NHIN as a transport,” Somers said.

“It’s really amazing what these first steps are accomplishing,” she said, adding that SSA is on track to have a production infrastructure for retrieving EMRs in place next year.

As a result of the project, SSA could free millions of dollars, people with disabilities could get their benefits faster, and health care providers could be free of dealing manually with records requests from SSA. Halamka has said the resulting cost savings could pay for implementing the technology at hospitals.

Other providers of disability benefits, such as insurance companies, could also find the technology beneficial — along with schools, camps and other organizations that need copies of medical records.

“We may be the largest medical record requester, but we are only one,” Somers said. “People need to be able to provide the authorization and have their medical record go wherever it needs to go.”

Monday, June 9, 2008

Suit: Comcast Publishes Check

Posted by Mark Brousseau

Pa. woman is doubly furious at Comcast

By JOE MANDAK Associated Press Writer
06/06/2008 01:03:16 PM EDT

PITTSBURGH—A western Pennsylvania woman who sent Comcast Corp. a check made out for "My Right Arm and Zero Dollars" is up in arms because she says someone from the cable TV company published a copy of the check on the Internet.

Krista Cooney and her husband Chad filed a lawsuit in U.S. District Court in Pittsburgh alleging Philadelphia-based Comcast invaded their privacy when the check she wrote last summer showed up on the Internet.

Cooney sent the check because she was unhappy with a large bill she received for her cable television, Internet and telephone service, the lawsuit said.

The Allegheny County couple contend an unknown Comcast employee circulated an e-mailed copy of the check—containing their personal banking information, address and phone number—along with a snide comment. A Colorado man saw the image and alerted the Cooneys because he had been a victim of identity theft and realized the couple was at risk.

Comcast declined to address the lawsuit specifically in a statement Friday, but said the company has apologized to Krista Cooney and is working to address her concerns.

"The individuals involved in this incident are no longer with the company," the statement said. "Comcast holds our customers privacy and security in the highest regard."

The lawsuit filed Tuesday comes just weeks after customer satisfaction ratings for Comcast fell to an all-time low. The survey by the University of Michigan's American Customer Satisfaction Index ranked Comcast below other cable and satellite TV providers.

The eight-page suit said the incident began when the Cooneys subscribed last year to Comcast's $99-a-month "Triple Play" package of bundled services. The first bill the couple received was for nearly $297. The lawsuit said Krista Cooney could only afford to send the company about $268, intending to pay the balance and a late fee the following month. A Comcast spokeswoman could not immediately explain its billing policies.

When Comcast sent a letter threatening to cut off the service, Cooney sent two checks: one to cover the balance and next month's bill, and the "My Right Arm" check meant to register her displeasure.

Cooney wrote "Robbing Customers Blind" in the memo section of that check and sent along a short note, saying, "Some people do have a budget ya know," the lawsuit said.

Thursday, June 5, 2008

Thoughts on TAWPI and Catch Phrases

Thoughts on TAWPI and Catch Phrases
by Paul Traite

I was thinking about the upcoming (and seemingly non-stop) crop of trade shows and expos. I was looking forward to a game I play with a few of my associates – amusing ourselves with the various catch phrases we see on the big headline marketing booth banners.

To try to maintain plausible neutrality, I won’t name any myself. But what we find amusing are catch phrases with at least a few of the following attributes:

  • Terms that only other people deeply immersed in the industry know the meaning of.

  • Catch phrases that seem to mean nothing at all, or are so ambiguous as to be about as useful.

  • Superlatives or other descriptive side-fodder used by almost everyone, which reminds me most of what the guys at small time carnivals call out to get you to come see the bearded lady inside the tent.

It seems to me that all this gobbledygook must, at the least, be useless to the prospective customers. I would venture to say that it even keeps many from striking up a conversation at an expo booth, because they feel embarrassed that they don’t know what in the world the marquee booth products and services are.

TAWPI to the Rescue?

TAWPI’s membership consists of a large number of both industry “vendor-side” experts, as well as both long-time and newly arrived customers of industry services.

Collectively, we have both a large amount of real knowledge on what many of these catch phrases and terms mean, as well as also having a well honed sense of humor.

How you can help

I ask anyone to submit your favorite catch phrases, along with what you seriously believe it means, a humorous alternate definition, or just a question if you don’t know what it means. TAWPI will build up a glossary of these terms and provide it to its members.

You can make submissions either as a comment/response to this blog entry, or use the blog comment/email response.

As an incentive, there is a contest for the best “alternative” definition.

If enough participate, we can build a meaningful glossary for our newer members, and maybe through humor help retire some of the catch phrases that have no real business in this real business.

Monday, June 2, 2008

Banks Frustrating Customers

Posted by Mark Brousseau

An interesting article from Reuters:

Customers grow dissatisfied with retail banks
Wed May 28, 2008 12:07pm EDT

NEW YORK (Reuters) - A rise in fees has led to growing dissatisfaction with retail banks, J.D. Power and Associates said in a study released on Wednesday, adding that banks may be sacrificing long term growth in favor of short-term gains.

Customer satisfaction with retail banks dropped 26 points on a 1,000-point scale to 737 from the year before, according to the survey of nearly 20,000 households, conducted by the consumer study arm of McGraw-Hill Cos Inc.

While the current financial crisis has bruised the image of retail banks, it is cost-cutting and increased fees that have largely contributed to falling consumer sentiment, the study found.

"Some of the key drivers of customer satisfaction, such as the percent of transaction problems, fees, and wait time for tellers and phone service are going the wrong direction," Rockwell Clancy, executive director of financial services at J.D. Power and Associates, said in an interview.

Faced with the collapse of home values and the credit crisis, banks have cut personnel and increased transaction charges to meet shareholder demands.

"Typically when financial institutions are under a crunch, with loan volumes going down and charge-offs going up, banks raise fees and reduce staff to make their numbers," Clancy said.

Among the highest rated retail bankers, Commerce Bank received the top spot in the Mid-Atlantic and Midwest regions, while BancorpSouth Inc was rated highest in the Southeast.

Wachovia Bank was ranked first in the Southwest, and Bank of the West led the Western region of the country.

Banks that resist the urge to cut costs and retain a high level of customer service could reap financial rewards in the future, J.D. Power said.

According to the study, a bank that increased the number of highly committed customers -- people with a strong emotional attachment to the brand -- by 5 percent saw overall deposits grow as much as 3 percent annually.

"The focus on customer satisfaction can sometimes be considered as a discretionary expense when in fact it's the real differentiator in financial performance," Clancy said.

(Reporting by Steven Bertoni, editing by Dave Zimmerman)

What Happens in Vegas ...

By Mark Brousseau

While what happens in Vegas is supposed to stay in Vegas, Nancy Atkinson (, senior analyst at Aite Group, shared her thoughts with me on the big stories at NACHA’s Payments 2008 conference held a few weeks ago in Sin City.

And, contrary to the city’s marketing slogan, Atkinson says many of these topics will continue well beyond Vegas.

... The introduction of the new standard entry class code, IAT (International ACH Transactions) in March 2009 makes international transactions easy to identify and automates compliance reviews, Atkinson said. Significant changes are being made to ACH systems for bank originators and receivers, she noted. Since these changes interface with anti-money laundering and Office of Foreign Assets Control’s (OFAC) specially designated nationals list, testing of the systems changes is particularly important. But banks need to test with their end users as well.

... Check imaging is maturing and reaching broad acceptance. The next frontier for check image clearing is to standardize the resolution of exception items to approach 100 percent automation for clearing and settlement, Atkinson said. The Federal Reserve is coordinating efforts with all key participants on this initiative, she noted.

... Remote deposit capture (RDC) for corporations, bank branches and ATMs is being embraced like few new products. Banks enhance their revenue generation and relationship building by offering RDC to commercial clients, Atkinson said. Considerable cost savings are realized by banks that implement RDC in their branch offices and through their ATMs, she noted. It’s for this reason, that Atkinson expects significant growth on both fronts will continue through the next few years.

... The concept of payments hubs is gaining traction with financial institutions. The hub provides common functionality, such as fraud prevention, regulatory compliance and capturing fundamental payments initiation data in a single system regardless of the ultimate payments system used. Atkinson said this approach streamlines processes, centralizes compliance and fraud prevention updates, and improves customer interfaces. Clarification of the benefits and iterative and flexible implementation options for a hub lead more financial institutions to consider adoption, she said.

... Remittance data remains an important concern. Financial institutions and their clients want more data that is actionable, Atkinson explained. Initiatives that address current shortcomings in the provision of remittance information with regard to their respective payments processes include full-page image capture in RDC and the Federal Reserve and CHIPS (The Clearing House Interbank Payments System) effort to standardize remittance information for wire transfers based on ISO 20022.

“Payments 2008 initiatives focus on more than operational efficiencies.” Atkinson concluded. “There is lots of momentum around the improvement of payments processing and that momentum carries far beyond the boundaries of Las Vegas.”