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What if there was an EMR built on Wikipedia?

WikiEMRI’ve been thinking about EMRs, electronic medical records, lately. It’s a subject, despite some professional experience, I don’t feel particularly close to. In fact, if anything, they are a source of consternation. As an industry insider, I see them as an expensive albatross around our collective neck. As a human centered design advisor, I see them as an encumbrance for both providers and patients. And, as a patient I see them largely as an opaque blob of data about me with a placating window in the form of a portal.

Which makes me wonder, am I obsessed with EMRs lately?

One of the reasons is certainly my personal interest in technology. And, while I don’t work in health IT, it’s natural to draw some connections. For instance, Wikipedia is consistently in among the top 10 most visited internet sites ( it is currently number 6 ). And, say what you will about citing Wikipedia, but a 2010 study found it as accurate as Britanica. Google trusts Wikipedia enough to use it as the primary source for its knowledge graph cards; and we’ve all settled a bar bet by finding some fact where a Wikipedia article is the canonical answer.

The secret sauce for Wikipedia is in it’s roots. Literally, the root of its name, wiki, describes the underlying structure. Wikis were the internet’a solution to knowledge bases – large repositories of information about a process or thing. Companies had been using knowledge base software for years. Traditionally, a central maintainer, often a sort of corporate librarian, curated information, such as common answers to customer questions, so customer service reps could find it quickly.

Wikis democratize the knowledge base by allowing anyone to edit an entry. If you work for a company which sells widgets and you discover a new way to service the widget, you simply amend or append to the record in the corporate wiki. But what about the corporate librarian, they all cried. Except, no body cried.

It turns out, the network effect and the wisdom of crowds produce richer, more accurate databases of knowledge when the literal barrier to entity is removed. Make it easy for anyone to input knowledge, and the database and its accuracy grow. And so it came to be, since anyone can edit almost any entry in the largest encyclopedia the world has ever known, Wikipedia is remarkably current and accurate.

So I wonder…what if medical records worked like Wikipedia?

What if, my record lived on some commonly accessible platform; not open to anyone, but accessible by my providers and I? Maybe we have to do some kind of online handshake to mutually access it.

What if we could both edit the record, at the same time? My doctors could put in their notes and I could add my own. Or I could edit theirs. And they could edit mine.

Some readers may have concerns about the records’ integrity but as patient advocacy expert Trisha Torrey points out reviewing our own medical records can help spot and fix errors. And, as we know from Wikipedia, more eyes and contributors on a record increase its accuracy and reliability.

Another important lesson from Wikipedia is the idea of revision log, which Wikipedia calls page history. Any registered user can make edits to almost any record in Wikipedia’s vast online encyclopedia. Every time an edit is made the changes are logged, including the name of the user who made them. Anyone can review the changes and roll back some or all of them, or make additional changes of their own.

Imagine a medical record platform where patients can review the entries made by a doctor, and if appropriate make additions at it or even changes. For instance, after reviewing notes from my last physical, I discovered a small unimportant inaccuracy in my record. I take Vitamin D supplements, and in the record, it was noted that I take Vitamin E. Big deal? Probably not, but what if it was related to a prescription medicine? Providers are human and, as we know, to err is human, but by allowing patients to review and edit their own records, they would be able to fix errors.

A Wikipedia-style EMR would also better allow for patient-contributed data. There are often symptoms, observations or measurements which patients observe outside of the timeframe of a visit with their doctor: a week of poor sleep, a month of improving blood pressure measurements, an off-again, on-again skin rash. These kinds of things may not even warrant a phone call, but wouldn’t it be nice to log them directly?

Finally, and this may perhaps be my strongest argument for a Wikipedia-style EMR, we’ve got to do something about data exchange. Color me cynical, but I’m not convinced the health information exchanges (HIEs), offered by the major EMR vendors as well as technology giants such as Oracle, are the answer. Each EMR vendor has a financial incentive to keep their data in a proprietary format. Further, their customers are, by definition, the providers, not patients.

No, what we need instead is a common, centrally accessible platform where patients and providers have parity, equal footing. No one party’s observations, notes, measurements, or data trumps the other. A common platform would make it easier for different providers to openly collaborate, in front of the patient, virtually, in a common record. Your specialist could be literally updating the same records which you, the patient, are adding to while your primary care doctor is also reviewing and making edits. Dogs and cats, living together. Mass hysteria!

GB

And there’s an extra credit reason we need a Wikipedia-style EMR. It doesn’t just promote or enable patient empowerment, it demands it. Owning our own data requires responsibility. It becomes the patient’s garden to tend. And its our right to tend those gardens.  Stephen Ross and Chen-Tan Lin, writing in JAMIA, concur:

Overall, studies suggest the potential for modest benefits (for instance, in enhancing doctor-patient communication). Risks (for instance, increasing patient worry or confusion) appear to be minimal in medical patients.

This doesn’t have to be a pie-in-the-sky dream either. Someone could build a WikiEMR today. The platform which runs Wikipedia is called Wikimedia. In fact, it would likely meet all of the Meaingful Use Stage 1 requirements…except one, and could be regarded as HITECH-compliant:

  • Anyone can download it, or install it on a hosted server. It can use the same strong SSL encryption which protects Epic, Allscripts, Athena and McKesson platforms.
  • It is free (a substantial discount off the price tags stuck to the EMR giants).
  • It provides user access audits and record edit history.
  • It is accessible via mobile and desktop
  • It can use multi-factor authentication
  • Wikimarkup, the simple language used on Wikimedia sites, supports mathmatical calculations so a WikiEMR could do unit conversions, Boolean checks, and data aggregation and reporting (including graphing).
  • It can generate reports for the MU core measures including abstracting 14 core objectives, 5 out of 10 of the menu objectives, etc.

What one, small, requirement is missing? As far as I know, Wikimedia is not a certified EMR. Anyone want to start a fund drive?

Evernote Is My EMR And Its Better Than The Rest

EvernoteEMRSpoiler alert: I’m not dying and there doesn’t appear to be anything major wrong with me.

I know, you hate spoilers. But I thought I’d get that one out of there way. It makes the rest of this considerably more pleasant for us both.

I’ve got a new personal electronic medical record. I’m able to store and track my health history. I can add and edit my own notes. I can pull in data from external sources like my quantified self gadgets. I can share data with my provider, or family members. It’s secure, it’s cloud-based, it’s mobile and it’s on all major platforms.

Evernote is my personal EMR.

For the uninitiated, Evernote is a cloud-based, free service with apps on every major desktop and mobile platform. It’s general purpose is to store, sort and help you find anything you throw at it. You can upload a PDF, email a note, clip an image from a website. You name it, and Evernote can probably store it. Take a picture of a wine label, and Evernote will transcribe the text in the image using optical character recognition, so when you search for Zinfendel, you’ll find the image of the wine bottle. But wait there’s more. Since you took the picture with your phone, Evernote also has the gps data, time and date attached to the image. You can add some tags such as “California”, “zin”, and “jammy” to make the note even more specic and personal.

Evernote has a widely supported API (applications programmers’ interface), so many other apps can read and write data into Evernote. For instance, the web-based automation service if this then that, IFTT as it’s known, will, for instance, append a line to an Evernote note every time you get a tweet; creating an effective backup solution.

I personally throw everything I can into Evernote. When I book travel, and the print window pops up over the itenary confirmation, it select PDF to evernote rather than print. When an online store emails me a receipt, I forward the email into Evernote. I have more IFTT rules logging things to Evernote than I can feasibly recount, but a few stand out. When I step on my Withings wifi-enabled scale, IFTT adds a line to an Evernote note with the date, time, my weight and body mass data. I can do the same thing with my Withings blood pressure cuff. And, it turns out, Evernote is pretty much perfect as a personal EMR.

In short, I get a lot of meaningful use out of Evernote.

Recently I was asked to get an MRI (see above re spoiler). I had the MRI done at a health system an hour away from my home. The system uses Epic and has the MyChart patient portal available. My primary care doctor also works for a system which uses Epic and has MyChart. But these two Epic installations might as well be separated by led walls. My PCP ordered some labs, that the other doctor needed and my PCP, in turn, wanted a copy of my MRI results. So one doctor calls me and says can you please print a fax to us the lab results. Mummmm, ok. It’s 2014 and I, the patient, am transmitting my own clinical data between two systems via analogue fax? Then my PCP wants a copy of the MRI results. Same problem. I am again reduced to data mule. I am Jacks health information edchange

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So now we have two identical multi-million dollar EMR installations, each with some data about me, but neither having a complete picture or seamless interchange. Again, I’ll point out that this is 2014 and I can FaceTime someone around the world on my phone. And we’re using faxes?!?

But there is one place where I have a complete record of my health and health-related behavior. You guessed it, Evernote. Everytime I have a test done, I get an email from which ever isolated multi-million dollar Epic system at which I’m seen. I log in, and click a button on my web browser tool bar which instantly clips the entire page as both text and image and stores it in an Evernote notebook called Health.

The images from my MRI? They are in Evernote.

Last year, before my annual physical, I decided to eat my own dog food. I started a new note in my Health notebook called health observations. I captured the little things I wanted to remember throughout the year: an ache here, a reminder that I saw a physical therapist, a picture of the vitamin D supplement I started taking… Before my physical, I typed out an agenda in an Evernote note:

  • Review observations note
  • show picture of all supplements and capture into med reconciliation list
  • review journal article on psoriasis and glycerine and why I’m not using prescription steroids anymore
  • ask for opinions on nutritionalists

When I went into the physical, I let my physician do his HPI and med rec and then mentioned my agenda. He knows me well enough to find the humor in my proposal - hey, it’s pretty nerdy - but he graciously went along with it. He did his physical exam and then tuned control of the visit over to me. I asked if I could record the audio and did so using Evernote’s built in audio recording feature.

I also scan, or import PDFs of all my insurance data including EOBs (explanation of benefits). I scan medical receipts and co-pays. So I effective also have a rudimentary revenue cycle system.

I am nearly certain, today, Evernote has a more complete, more personalized view of my health and medical history than any other system on the planet. I can share entire notes, or their contents, via secure links to anyone I chose. I can automate data intake, or enter it manually. I can capture fitness and behavior data. I can trend, search, snapshot, and review my own medical records. I can add to them any time I want, from any device.

Please tell me why a multi-million dollar system is more patient-centered?

Book review: Thinking, Fast and Slow

I heard about Daniel Kahneman’s Thinking, Fast and Slow from friend and ePatient superstar e-Patient Dave. It’s the first, what I’ll call, real book I’ve dug into since finishing my MHA in January.

And, it has blown me away!

In Thinking, Kahneman outlines our brains’ two basic modes of thinking: system 1 and system 2. System 1 deals with instincts, gut reactions and heuristics. System 2 is the slower (Kahneman says lazy) part of our mind which is capable of more complicated reasoning.

We read, most often, through system 1 which recognizes words quickly, as patterns. System 1 is why we are open to suggestion (your left leg feels a little numb right now, doesn’t it?….see!).

System 2 is the part of our brain which can reason through fact and fiction. But only when we engage it. Kahneman demonstrates system 2 early in the book by having readers write a three digit number and mentally begin adding 1 to each digit. According to Kahneman we actually have a physiological response —our pupils dilate as we engage system 2 to work through the basic math.

Here’s what I’ve found most interesting:

System 1 works best with absolutes. Kahneman refers to this is WYSIATI, what you see is all there is. For example, we see a label reading 90% fat free as positive and forget there is also 10% which is fat. We see 90% fat free, that must be all that matters.

System 2 is more conscious and can hold multiple options at the same time.

This ties in to my growing understanding of pluralism —the concept of two or more truths coexisting. For instance, a patient can be both hopeful and scared at the same time. The challenge is, according to Kahneman, only system 2, the more lazy part of the mind, is capable of understanding that both emotions can coexist. Our tendency is to rely on system 1 which focuses on what is in front of us. In the case of the patient above, it may be a look of fear on their face. Boom, that’s it. System 1 identifies fear and that’s what we go with. The patient is scared and that’s what I’ll deal with.

Without engaging system 2, we might not also identify hopefulness, or optimism, or doubt, or any other coexisting emotions.

These two systems are not limited to how we process perceptions about emotions. We face the same challenges in examining facts, causation and data in general. In fact, that is what much of the book deals with.

Kahneman has a gifted ability, much like Malcolm Gladwell, to distill complex science into what almost feels like common sense. Despite its length, it is a quick, enjoyable read.

You can get it on Amazon here: Thinking, Fast and Slow

From elsewhere: Tracking health indicators hints towards disruptive innovation in doctor patient relationship

Pew Internet’s Susannah Fox, today, released the official report behind her amazing Stanford Medicine X talk. The report is a great read for data geeks, health wonks and ePatients alike. But there’s one part in particular I find especially indicative of an impending disruption in how we approach medical care as patients.

According to Pew:

Seven in ten (69%) U.S. adults track a health indicator for themselves or a loved one and many say this activity has changed their overall approach to health, according to a new survey by the Pew Research Center’s Internet & American Life Project.

This is the first national survey measuring health data tracking, which has been shown in clinical studies to be a tool for improving outcomes, particularly among people trying to lose weight or manage a chronic condition.

Of all the results, I find one in particular compelling:

40% of trackers say it has led them to ask a doctor new questions or to get a second opinion from another doctor.

I’m predicting 2013 and 2014 as the years we see a sea-change towards true consumer-driven health. In the past, wonks have spoken about high deductible plans and health spending accounts as the economic vehicle to compelling consumer behavior. The problem with that version is it assumes people will consume less healthcare services if they are footing the bill.

There is some truth regarding spending usage. But, largely sick people will seek care and people without access —via insurance or a government program —will delay care until the need is chronic and more costly.

What I’m excited about, based on the Pew results, is the potential of true consumer driven healthcare. Today, it’s increasingly easier to wear a gadget and get direct access to cutting edge lab tests. For $99, 23andMe will examine your DNA an report back some pretty amazing data.

So, if 40% of people report asking new questions based on following their own health indicators, how long before patients become the initiators of a care plan? Rather than rely on doctors to discover whats wrong with us, we’re moving a world where we might know more about ourselves before we seek a doctor than after seeing one.

That idea might challenge some people, including doctors. Rest assured, it doesn’t eliminate the need for doctors. We’re simply looking at a period of disruptive innovation which will change the role of physicians (in some circumstances). It’s a bit like coming to an architect with your own rough draft of blueprints.

For more about Susannah Fox, Pew and the report, check out the video interview from Medicine X:

Susannah Fox - Medicine X Conversation from Larry Chu on Vimeo.

Socioeconomic factors and health outcomes in Virginia

  The quality of healthcare matters and it is one of the more difficult things for a consumer/patient to gauge. We can tell if a consumer product is cheaply made, or if a dining experience is sub par. It is harder to observe, research, quantify and compair the quality of healthcare. For most Americans, unless it is a major procedure, or requires services offered at a specialty location, we probably stick close to home. But what if the quality of care close to home is vastly different than even a few hours away?

Another very interesting angle is to consider is if variations in outcomes and quality are not simply in the hands of the provider, but also influenced by socioeconomic factors. Do you have access to high quality food and can you afford it? Do you have access to health education and do you have the means to follow the recommendations? Do work conditions in manufacturing-dominated areas contribute to health issues that aren't as prevalent in professional areas?

This week, the Robert Wood Johnson Foundation released an interactive tool for exploring health outcomes by geographic area. In Virginia, there are some pretty clear relationships between positive health outcomes and medican household income. I've not reviewed enough data to suggest any causalities. For instance, are better care facilities found in more populated areas and therefor those areas have better outcomes? Regardless, the relationship between low income and poor health outcomes is worthy of discussion; particularly as our country continues the debate over national health reform.

RWJF Map:

New York Times Economic Samples from 2005-2009:

In this case, the colors are inverse. The upper map shows positive health outcomes in white and light green. For instance, Nelson (NE) and Albemarle  (AE) counties. The lower map shows higher household incomes in dark green. For instance: Fredricksburg and Charlottesville metropolitan areas.

The relationship is a little more clear if we look at county by county:

Rank Health Income
1 Fairfax City of Calls Church
2 Arlington Arlington
3 Loudoun City of Alexandria
4 Albemarle Fairfax
5 York Loudoun
6 Alexandria City of Fairfax
7 James City James City County
8 Clarke Goochland County
9 Powhatan Albemarle
10 Mathews Fauquier

source: Health - RWJF, Income - Wikipedia

To be absolutely clear, this is not a scientific study. There are likely many other factors which should be considered including population density, density of qualified healthcare providers, etc. We need to also think about other things that go hand-in-hand with economic disparity. For instance, areas of low income are traditionally associated with fewer healthy options for food and are sometimes classified as food deserts. Areas of high income tend to also have better education, which has a well studied cause and effect relationship to positive health outcomes.

My point in sharing this comparison is simply to call attention to the large variation in health outcomes, even in a single state and to raise the question of socioeconomic factors, as well as variations in clinical quality, as a contributing factor. What do you think?

Quant Self gaining popularity in other circles

I'm continuing to see references to self quantification appear outside of the niche world of quantified self devotees. This week on the TWiT podcast network, two of Leo Laporte's shows featured conversations about capturing, measuring and analyzing data about our own health. Now, certainly these two shows represent niche communities and interests of their own. TWiG focuses on cloud computer, social networking and Google. Security Now is about, you guessed it, security. What I find particularly exciting is both shows feature discussions about using personal health devices without knowing the term quantified self, suggesting the ideas of self quantification are creeping into other areas; the long tail is beginning to widen.

On Episode 138 of This Week in Google, the hosts discussed the Nike Fuelband device. Nike's Fuelband wrist-worn gadget made a splashy debute at this year South By South West, selling out via their pop-up store. The Fuelband, which is often compaired to the defunct Jawbone Up, is very similar to the FitBit (which I still think is the best device in the space - love mine!).

Here is a link to the exact position of the discussion on the Fuelband.

Host Jeff Jarvis describes, these devices as "the internet of things, and things tend to be you..."  At last year's Stanford Med 2.0 event, Dr. Bryan Vartabedian  described personal health devices as "An API into the patient." An API - application programmer's interface - is a term in computer programming and hardware which references a programmer's ability to connect with another program or device. The point Dr. V and Mr. Jarvis are marking is that quantified self devices give users and providers access to retime data about health and actives, without needing a lagging lab test or resource-intensive diagnostic study.

On episode 344 of the wonderfully nerdy Security Now podcast, host Steve Gibson discusses his penchant for "conducting experiments on [himself]." In 2009, Mr. Gibson, usually focused on technology security, released a special hour long discussion on his studies of vitamin D. This week, he briefly mentions an expriment he conducted on eliminating most carbohydrates from his diet.

Editorial note - I've discovered in my own move to a mostly vegan diet, there many differing opinions on what constitutes the perfect diet and just as many studies to back them up. That said, I'm not sure I completely agree every part of his food-related discussion with host Leo Laporte. Nevertheless, Mr. Gibson has an almost obsessive habit of regular blood draws and lab tests.

You and watch their discussion on dietary changes and how they affected his lab results here.

Security Now 344: Your Questions, Steve's Answers #139 - YouTube.

Wolfram Alpha and big data for healthcare, or why I really hate my alarm clock

  The quality of my sleep doesn't determine how long I sleep. You'd think it would, right? I mean, if I don't don't sleep well, shouldn't I sleep longer to compensate? On 68% of nights, I sleep between 5.7 hours and about 3 hours. I wake up about 9 times a night. 

There's a good reason quality doesn't affect duration. It is small, mostly black with a glowing red face. Every morning it jars me out of  my peaceful slumber with an auditory slap to the senses. I kinda hate my alarm clock.

I learned all of this, and more, about my sleep habits in about 30 seconds. First, I downloaded a month of sleep data in Excel format from Fitbit. Then I uploaded the Excel file into Wolfram Alpha's new Pro site. The site spun around, did a little animation and boom - graphs!

Unless you are a data geek or survived college calculus, you may not know about Wolfram (the makers of Mathmatica, often used in academic settings). But, if you are an Apple iPhone 4s user, then you likely use Wolfram Alpha every day. Just ask Siri to convert your 10k training route to miles. Wolfram Alpha is the backend for a lot of Siris mathematical and data based answers.

Last week, Stephen Wolfram and team announced a new Pro feature for $4.99 per month ($2.99/month for students). With Pro, you can upload your own data sets in a verity of formats, including:

  • tabular
  • CSV and Excel
  • audio files
  • pictures
  • PDF and CDF (for interactive graphs)
Once you throw some data at Wolfram Alpha, it quickly goes to work like a million little digital ninjas, slicing and dicing the results. In a basic query, Wolfram will attempt to develop graphs, statical analytics, and interpretive results. You can go further by specifically asking for variance (ANOVA) or regression tests, for example. There's a lot you can do which I don't claim to understand.
Why am I, a guy who bombed out of Calc 301 in college, so excited about math and data? There is tremendous potential in healthcare.
As the old expression goes, we are data rich and analysis poor. Healthcare providers create a lot of data. With the growth in adoption of electronic medical records, it is only getting deeper. We have piles of metrics on health, weight, clinical measures, time, money, outcomes, quality, infection rates, payments, demographics, and usage. Do people who get annual physicals have lower cholesterol than those who don't? I'm sure we can find a study in the New England Journal of Medicine. But now with tools like Wolfram Alpha Pro, we can throw our own data sets against the big metal in the cloud and see for ourselves.
From a patient's perspective, this has big implications for the quantified self movement. I have a Withings scale, which outputs weight data over time in Excel format. My Withings blood pressure cuff does the same for my BP. My Fitbit knows about my food consumption, activity levels, caloric burn and sleep patterns. My Digifit tracks and exports my cardio response to exertion, along with resting and recovery heart rates. If I can bundle all that data and have a site like Wolfram Alpha analise it, do I need an expensive sleep study? Is there a correlation between my diet and sleep quality? Maybe I'd learn that nights when I eat fewer carbs, I sleep better but preform less well in the gym the next day.
If you think all those sensors, gadgets and data files sound nerdy...well..you are probably right. But just wait. Personal health devices are popping up everywhere. It is only a matter of time before we are dripping in data about ourselves, our health and our bodies. Will we need an expensive health system to understand the data, or will sites like Wolfram Alpha put the understanding within our own reach? How does that change the role of the doctor, and provider organization?
One thing is already clear, I really do sleep longer on weekends:
 

By the way, on an average night, while peacefully dreaming of healthcare for all, I'm bombarded with 372 times the amount of radiation I'd get from eating one banana. Data!

Wolfram|Alpha Pro: Experience the Next Big Step in Computational Knowledge.

Creepy, Malicious or Helpful - Google and Health related searches

Leo: "You search [Google] for psoriasis and you are telling the world..." Jeff: "So what if you have psoriasis.... what's the harm to [a patient who has type 2 diabetes] and google gives you ads.... we have to get down to [what is the real harm] and not have this discussion up here about creepyland"

That's the start of the conversation at towards the end of episode 132 of This Week in Google. Jeff Jarvis goes on to suggest Google has a vested interest in protecting people's data. He makes the point, if Google were to cross a line from what is perceived as creepy into actual malicious harm, their goose would be cooked. People would never use Google again. Jeff thinks the benefit we get from Google knowing more about us, coupled with their business interest, outweigh the risks.

Is he right? Do you think search engines know too much about us based on our search habits? What about this conversation in particular, around health related searches - a topic many hold as close to the vest as financial records?

I see both sides of the coin. I recognize the concern many have about not wishing to disclose sensitive health data for a various number of reasons - secrecy, perceived fear of insurance or employer reaction, data ownership, etc. I also see the value in a site like google knowing enough about me to return relevant results, based on a holistic picture of me. So what if they serve me related ads at the same time?

Curious what you think...

Here's a direct link to the conversation, starting at 1:03:30

This Week In Google 132: The Google Father - YouTube.

Vail's EpicMix, an innovative model for healthcare data

I'm not a huge fan of what I call blatant marketing. You know it when you see it, particularly with interactive campaigns online. You want me to do what? Like this page, give you my home address, and retweet your link for a chance to win an iPad? No thanks. I avoid frequent shopper cards at the grocery store for the same reason. When Vail Resorts launched Epic Mix last year, I was skeptical. Vail wants to track every move you make, literally, on their mountains. Vail installed RF chip readers in every lift line and started putting RFID chips in their lift tickets. You go through a line, and they know it. They also know your age, gender, address, family members and travel dates. With the tracking and demographic data, they have a pretty good idea about your habits at their resorts. You can even tie your credit card to your ticket for on-mountain purchases. I imagine the database thinking something like this (you know, if databases could think):

The Jones family starts skiing at 10am most days. Not surprising since they are from the East coast and have the time change. The kids are both in ski school today ... cha-ching! Oh look, mom and dad just stopped for lunch at the high end restaurant and the kids are eating pizza at the casual on-mountain restaurant. Mom skis black diamonds mostly and is logging 2x as much vertical as dad. They seem to come out every year around the same two weeks. Judging from their address, I bet they make about $110,000 a year and take two major vacations. We should email them a month before, I'll make a note of it. I wonder if they'd want a time share....

Pretty spooky huh?

So what did Vail do to change the value proposition of their data capturing? They launched EpicMix, a customer facing portal into the data. You sign up and register the ID number from your lift ticket. From there, things get social very fast. There is a FourSquare like game component where you earn pins - just like the real pins you see on people's hats or jackets - for accomplishments. Ski 26,400 feet and you get the 5 Miler pin. Head into the Northwoods area and you get the Gone Wild pin. The service also tracks your runs and vertical feet per day and season and lets you compete against friends and family. There's even iPhone and Android apps to track your stats in real time. And, of course, it all connects to Facebook and Twitter.

This year, Vail gave professional third party photographers the boot. Now, Vail's own photogs hang out near huge EpicMix Photo placards around the mountain. Ski up, and they scan the RFID tag on your ticket and snap a few pics. That evening, the pictures are uploaded to your EpicMix account and can be shared on Facebook or Twitter for free.

Vail took customer tracking and turned it into a value added service. It's a draw, something Vail's resorts have which other ski areas don't have.

It will come as no surprise I see a healthcare analogue in all of this. Rather than capture data about customers and keep it to themselves, Vail turned it into a customer-facing service. Does your doctor treat your medical records the same way? Can you go online and look at them? Do you get rewarded, even virtually, for losing those 10 pounds or controlling your asthma? Can you chose to share parts of your record with family or friends?  Can you chart your A1C scores over time?

Even with the rise of patient access into electronic medical records,  we've still got a ways to go before we reach the same level of understanding about personal data. I continue to see consumer devices and services leading the trend, which tells me two things: 1) people do want to own, collect, monitor and selectively share aspects of their health and 2) the consumer oriented companies can do it for cheaper. The later is likely owed to less red tape, regulations, research, etc. To be fair, there are iPhone apps which will graph your weight. And there are iPhone apps which will track your skied vertical feet. But the value of that data changes when it's shared with your provider (not that it has to originate with them, mind you).

Any thoughts? Are you aware of any provider organizations who are going beyond MyChart (an example of a patient EMR portal) and offering value added analysis and services on top of YOUR health data? What kinds of things would you want to see, beyond direct, unfettered access to the record?

By the way, according to my EpicMix dashboard, in the last 12 months, I've skied 121,453 vertical feet at Vail resorts... not too shabby for busted knees!

Since I've basically given Vail a free ad, I might as well embed their EpicMix video, it explains the service pretty well: