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Healthcare Informatics System Proposal (Excerpt)

System proposal to delivering nutrition information in grocery stores using barcode scanners.

Introduction and Background

Recent decades have seen unprecedented increases in obesity in the United States, among both adults and children. Today, 17% of children ages 2-19 are overweight or obese (National Institutes of Health). The large increases in the incidence of childhood obesity are an especially pressing public health concern because of health and social consequences that often persist into adulthood (American Obesity Association). The US Preventive Services Task Force reports that the "number of children and adolescents who are overweight has more than doubled in the last 25 years" carrying with it increased risk of diseases which had traditionally been limited to older adults, including diabetes, elevated blood lipids, and increased blood pressure" (2005).

It is important to note that childhood obesity does not occur in a vacuum, and the family environment often contributes to its development. For example, the risk that an obese adolescent will become an overweight or obese adult increases from 70% to 80% if one or more parent is overweight or obese (US Health & Human Services). In addition, research has shown that interventions for obese children/adolescents which target the whole family rather than the individual are more likely to be successful (Epstein, Valoski, Wing, McCurley, 1994; Flodmark, Ohlsson, Ryden, and Sveger T, 1993; Golan, Fainaru & Weizman, 1998). Consequently, guidelines for treatment of obesity in children and adolescents recommend the evaluation and involvement of the parents, and focus on healthy eating and activity (Barlow & Dietz, 1998).

This paper will propose the design of a system whose goal is to change eating habits by focusing on an intervention which targets the parents of overweight and obese children. The key purpose of the proposed information system is to effect changes in eating behaviors by providing nutrition information at the point of purchase using barcode scanner/touch screen interfaces. An additional component will be a grocery-shopping tracking mechanism (implemented using a supermarket savings card), with an associated web-based interface that will aggregate and analyze the data. Although education provided during office visits and/or online can be used to supplement and manage the information provided by the system, the major benefit is to provide information when purchasing decisions are being made, when it is likely to be most effective. The system will also work as a conduit for two-way communication between the parents and the child's providers.

Although grocery-shopping behavior does not fully reflect the eating patterns of the child and family, it is probably a good starting point for estimating general eating habits for the family. Its major purpose is to serve as a learning opportunity that may carry to eating behaviors elsewhere. One option to supplementing this information would be to use a similar system in the child's school cafeteria to obtain a fuller picture of actual consumption.

System Design

The major feature of the information solution is to deliver nutrition information through kiosks and nutrition check scanners in the supermarket. These scanners would be similar to currently existing price check barcode scanners that have recently become popular in department stores, and therefore probably familiar to the target users. Another option for the scanner location might be the shopping cart itself. This would further reduce the effort required to obtain the information, but would be more costly in terms of the number of scanners that would need to be installed. The functionality of this part of the system would be implemented as follows:

The advantage of this part of the system is that is reduces the burden on the user to enter information manually. It also does not require users to remember information learnt elsewhere, or to remember to bring shopping lists or other shopping aids with them to the supermarket. The presumption is that users' reliance on the system would decrease as they learn to make better shopping choices over time.

Although providing nutritional information at the point of purchase is a key component of the system, for it to be fully effective, it needs to include the ability to track users' purchases and provide reports to both the user and the providers. In order to take advantage of these benefits, the users would need to sign up for the nutritional program online, in the doctor's office, or even in the supermarket itself. The simplest way to track the users' purchasing behavior would be to tie this information to the existing system of supermarket savings cards. Grocery shopping information is already being tracked by supermarkets for marketing purposes, and can probably be easily adapted to the purpose of nutritional information analysis. Because potential users of the system are likely to be existing users of supermarket savings cards, they would be more likely to adopt the system, as it does not include additional effort on their part. It would also present the opportunity to reward positive behavior by offering coupons and other rewards for making positive nutritional choices. The final component of the system would be an online reporting functionality that would analyze user shopping data over time and provide feedback to the user and providers. This information could also be delivered at supermarket kiosks, or through simplified printed reports at checkout.

The process steps for this part of the system would be as follows:

The reporting engine of the system would include analysis that is targeted toward providers, that is more technical in nature, but also more focused on information that is of key concern to the provider (that is data that relates to trends in the patient's health status as well as key problems which should be addressed during the office visit).

Because the major component of the system involves delivering information in the moment, the system has to be designed with several constraints in mind. The first of these is the fact that the time to deliver the information in the store is likely to be very limited. A user cannot be expected to spend a long time looking up information while grocery-shopping. In addition, it is unlikely that the user will be willing to check the nutritional content of every item he or she is about to purchase. This means that the information provided in the supermarket will need to be packaged in manageable and easily understandable chunks, and why the supplementary functionality will be essential in delivering more extensive information and making sense of long-term trends.

The other limitation is the fact that the system will not account for restaurant-eating behavior, or the child's eating behaviors while away from the home. It would be virtually impossible to implement a system that could automatically track all eating behavior. Again, here the online functionality might be used to obtain fuller data by providing the option to enter information about restaurant-eating behavior. As already mentioned, school systems might be a good place to set up a complementary system. It is also presumed that users will be able to apply the nutritional education that will take place while using the system to eating decisions elsewhere, and to in turn pass this information and healthier eating habits onto their children.