About a month ago, I posted a review of Safeway Foodflex , which intrigued me as a novel health management tool that uses data that is far more significant than that generated in medical care – what we eat. You can read the review here.  

I noted in the review that the site was down when I wrote my post – it was confirmed for me that this is because the site was in the midst of a major overhaul to improve its usability and focus. With that in mind I wanted to revisit to see what was different. I did get a little help understanding some of the features, but I have not spoken with the team at Safeway yet. They are of course welcome to comment/add information to what I write here!

The impact of transparent sharing

As the title of the post says, there is a really nice evolution happening here. First, its important to point out that the revolutionary concept that started with the last version is carried forward here – that your grocery will provide you (me) with the data we generate with our purchases and help us (me) leverage it for our health. Think about this for a minute – how much purchasing data do we generate in our daily lives, and how transparently is that shared with us?

A note about sharing personal data

In this blog review I struggled a bit regarding whether to share screenshots from my own account. Even though it’s perfectly legal, I have a rule in my professional life that I never demo my own medical record. My rationale behind this is that it’s poor form to use my account as a demo because it may unintentionally create an expectation for other employees/leaders that their personal medical information is sharable in public forums, even though there is no such expectation – my employer vigorously protects the privacy of its members/patients information. The better course is for organizations to create demonstration systems.

In this case, I decided that since I am a customer of Safeway and not an employee, that it’s okay since I’m not creating expectations for other customers or employees of Safeway. The application of the above is that I would not expect to see a Safeway employee demo this system using their own personal data.

I have blurred out my purchase details in any event.

Goal oriented: The case of sodium

I decided to focus on my intake of sodium, because I happen to dislike a lot of it in my diet, and as you can see from the screenshots below, I was able to go to household trend for sodium, zero in on a hidden source of it (fat free salad dressing, I really had no idea), find an alternative, and then see the impact on my trend. Slick.

What an improvement over conventional medical care today – in the doctor’s office we just don’t have time to review a person’s diet history, and usually just a few screening questions are possible, like “do you salt your food?” or “do you drink whole or nonfat milk?” I could imagine a nutritionist or a physician prescribing the use of this site with a goal to get sodium below a certain amount.

I think the site does a good job of not being prescriptive since it is not run by a health system – the focus is on USDA requirements without any valuation about whether there is “too much” of any nutrient. A health system involvement could make this a bit more relevant, by tying the results to clinical goals, however.

Future expansion

The site is not currently linked to Safeway.com for ordering of food. In addition, there still isn’t linkage to product images or food labels. I understand that this is a bit similar to the challenge in health care of putting drug labels and medication images together. It’s not an easy task.

Even more possibilities through integration of community and the health system

The site is a great example of Health 1.0 (and that’s a compliment, the competition is Health 0.0), through its liberation and simple management of the data. The power of this information included in a patient’s health record could be significant.

For example, in the future people could compare food choices with other patients who identify themselves with certain chronic conditions and maybe the quality of the management. You could ask, “Show me the shopping list of people with hemoglobin A1c’s under 7.0″

Or as Susannah Fox noted in a comment on the last post, “show me the shopping list of other families managing severe food allergies,” and “allow me to send a list of products (or evan a full shopping order) to family who we are visiting in preparation for a visit.”

In interactions with the health system, in a future world, maybe there could be a print format co-designed with a health system for reporting nutrient intake, and setting goals. In a world of HIT interoperability, I’d also be interested in standards for electronically conveying nutritional information into a personal health record, and ultimately into an electronic health record for use in medical care.

And of course let’s not forget even farther ranging applications, like Twitter integration (“Mother, I noticed on your Twitterfeed that your caloric intake is down over the past 2 weeks, are you feeling okay?”) and mobility.

A PHR for Food

I think Safeway’s work in this area should be watched and supported – I can imagine so many exam room conversations that could be impacted by a good discussion of what we eat. The foundation for those discussions is information – perhaps a discussion of Food 2.0 might be worthwhile at the upcoming Health 2.0 conference…..

Images: Click on any to see larger

After using Safeway’s Foodflex (and I think that’s the link, the site is down during this writing for scheduled maintenance. I think http://www.foodflex.com works as well) I realized that there’s an organization that has as much if not more data relevant to my health as my health system does – the grocery store.

It’s a good thing that Safeway is making this data available to consumers, I hope there are plans to support this data in achieving its potential as a powerful part of a personal health record system.

I learned about Safeway’s innovative work in health and health care from Scott Shreeve’s blog and some of the writing of Jen McCabe Gorman (more relevant links to Safeway-related work are here) so I decided to give Foodflex a try.

The sign-up was a little rocky, and my belief is that I was starting to use the site while it was having a series of outages. However, the customer service support team was very helpful, and the site appears to have stabilized since I began using it. It does take a few days to a week after signup for a nutrition report to be available after your first shopping trip.

Just like the first time seeing my own medical record on a personal health record, it was impressive to see a list of all the groceries I have purchased. The reality is this data is being collected on anyone who uses a food-club card, I think we forget that this is happening, so it is nice to get some return. The graphs are somewhat helpful, and there is an opportunity to look at alternatives to food items that I’ve purchased which have a different nutritional profile.

I think the power of this data is in the ability to self reflect on what we are actually buying – the occasional jar of peanut butter is sometimes more occasional than we think, for example. Before I get into some of the drawbacks of the site, I don’t want to underestimate this point. It’s a big deal to be presented with food choices in an automated system like this. Imagine the possibilities that could come from sharing this information with your family or other professionals that you might work with. They are big.

The challenges of Foodflex come from the navigation of the data, and the inability to do more than a few basic things with it. There is the ability to separate or remove certain food items from the calculations that do not belong to a specific person, but the controls are fairly crude. The site isn’t very AJAX-y and requires some paging around to see all of the information.

Before I would criticize the site, though, I would remember my own experience supporting patient access to their health care data – it’s not as easy as one would think, and relative to one’s peers, it’s incredibly innovative. Based on that idea, I think this is good work that should be encouraged.

And, this data should be made available as part of a personal health record (which would require a beefing up of security, since you only need to provide a phone number at a store to add data to an account).

As my colleague Paulanne Balch, MD, from Kaiser Permanente Colorado, informs me, the #1 thing a patient wants to know after a a doctor visit is, “What should I eat?” Our food record is as important and maybe more important than our biomedical record. In the future, an API could be made available for this data to be securely delivered to applications that could assist patients with specific dietary needs or goals. Just as with the personal health record, availability of data is a great first step. And the beginning of a revolution of rising expectations, which is good.

With thanks to Safeway for their innovation and for demonstrating the possibilities of this part of our health record. By the way, I did contact the very nice customer service folks and offered to talk to a program manager about the product and its plans, but did not get a response. If anyone out there wants to comment, or show me more in depth parts of the program, feel free to contact me or post in the comments, I’m available…..