A new group of healthcare industry stakeholders, including the American Hospital Association, HIMSS and the Automotive Industry Action Group, have come together to work on the underpinnings of a future "medical banking" network. Their idea, which is gaining a lot of traction in vendor circles, is that it's important to begin linking up the various elements needed to move money through a consumer-driven healthcare system quickly. Members of the group are developing a reference architecture they're calling the Cooperative Open-source Medical Banking Architecture & Technology (COMBAT). COMBAT is intended to offer real-time healthcare administrative transactions, using open standards-based components that have been tested and deployed elsewhere, including elements of OpenEHR and the Eclipse Open Healthcare Framework. When fully rolled out, the new medical banking grid should coordinate a wide range of healthcare financial functions, connecting providers to health savings accounts, insurance company claims adjudication systems, smart cards and data needed to determine charity-care eligibility on the spot. As these hookups happen, meanwhile, we should see a real tug of war emerge--will bankers, providers, health insurers take de facto control of this financial system?