If you've ever seen a dietician, the appointment probably took place in a medical office setting of some sort. There may have been some plastic food replicas involved, but most likely the health care professional didn't follow you around as you purchased real groceries, keeping watch over your choices.

But that kind of real-life assistance could soon be a reality, if a Pittsburgh company's dreams come true.  Connect&CoachImage

The company, called Connect & Coach is attempting to bridge the gap between patients getting in-clinic nutritional advice, and actually helping them achieving their goals in the real world. The tool they've developed to this end is a cloud-based app to help dieticians and CDEs (certified diabetes educators) who work in retail supermarket and pharmacy settings better interact with their clients. This trend has increased in recent years and continues to grow as more and more medical professionals sidestep clinical "office visits" for the no-copay places where PWDs really are.

We've been watching Connect & Coach since they won the Sanofi US 2013 Data Design Diabetes Innovation Challenge earlier this year, so we asked junior team member Amanda Cedrone to connect with Paul Sandberg, CEO of the company creating this app.


Did You Say "Freckle?"

The company behind this Connect & Coach program is called PHRQL, which is pronounced "freckle" and stands for Personal Health Recording for Quality of Life. Much like other tech companies we've written about in the past, PHRQL was started by a group of students -- in this case from Carnegie Mellon University in 2011. Their primary focus was patient-centered solutions for managing chronic illness, most specifically, diabetes.

The company's leaders don't have diabetes themselves, but they wanted to create a program to help PWDs because they've all been touched by diabetes in one way or another -- CEO Paul Sandberg's father and sister both have type 2 diabetes, as just one example. Before designing Connect & Coach, Sandberg's team attended diabetes education classes in order to better see the problems that people were encountering as they were trying topaul_sandberg_CEO_PHRQL understand their disease, and they also interviewed more than 60 diabetics both with type 1 and type 2 and a range of D-experts.

What they came up with is that patients, especially those newly diagnosed, are fed a lot of information in a short period of time and much of it doesn't sink in. Information only extends to the classroom, and as soon as those PWDs leave the classroom, they struggle to apply what they've learned to their own real life. For example, educators may "teach" what bread to eat and the science behind it, but when those PWDs get to the store aisles and are confronted with multiple wheat bread choices, they're just not remembering what they learned. So many PWDs (people with diabetes) are left dealing with blood sugar swings and then later trying to recreate what happened when troubleshooting with a dietician after the fact.

"Both sides are lacking the ability to connect and communicate with real data, so we saw a need to provide technology to help maintain a virtual connection with providers or diabetes educators so (PWDs) an receive feedback when they needed it," Sandberg said.

Into the Real World...

That's where Connect & Coach comes in. It allows a CDE or dietician to track all of a patient's info electronically (basically an E-Medical Record), and the PWD can then download a mobile app called MyFood Coach to view their own information in the cloud and also keep in touch with their dietician. PWDs can post pictures of their food, rate how healthy they think it is, track their weight, and update other relevant personal details. The dietitian can see the information and even send messages through the app.

As envisioned, this app program will allow the dietician to give the PWD more real-world feedback on how to achieve goals — whether that's better blood sugar control, weight loss, lowering their blood pressure, or all three combined.

So, insteadgenie in your phone of the PWD later having to recreate the food-buying experience and what health impact those choices had, the CDE or dietician would have the complete picture on a screen in front of them. Together, they can look at photos of what the PWD's eating, portion sizes and balanced meal issues. Essentially, they can identify whatever disconnect might exist between what the patients think they're eating and what they are actually eating.

This may sound kind of hokey, but not so much if your read the Fast Company coverage, and especially the Rabin Martin coverage (global health strategy firm) on the big potential of this tool:

"The premise is that supermarkets are a better place to try to affect behavior change than doctors' offices because most people go to the supermarket more frequently than they see a clinician and the supermarket is the place where they make decisions about what to eat. The Connect & Coach app pushes personalized nutrition information from the dietitian to the user's phone, which sends an alert when it receives updates, much like the Facebook app. At mealtime, users do not need to manually log what they're eating. Instead, they can upload a photo of their plate, which their dietitian then reviews. In doing so, Connect & Coach helps streamline the process of tracking nutrition, rendering it less onerous for patients.

"The hope is that streamlining the tracking of health indicators — like caloric intake — into things that patients and caretakers are already doing — like buying and eating food— will encourage them to continue tracking, ultimately leading to better health.

However, the most encouraging news on this front may come from Susannah Fox and Maeve Duggin whose recent study with the Pew Internet and American Life Project found that 69% of American adults track at least one health indicator for themselves or a loved one and that 46% of these "trackers" say that tracking a health indicator has changed their overall approach to maintaining their health or the health of a loved one. Maybe the trick is not convincing people to track health indicators but helping them more effectively track those they already care about."

So, there you have it.

Keeping Your Eats Private

The PHRQL team is developing a Point of Sales system that would allow retailers to see how the programs are affecting consumer purchasing -- which naturally raises some privacy concerns.

Sandberg says the entire program is secure, HIPPA-compliant, and nothing is shared without the patient's permission.

He tells us that retailers would not receive specific information about what the individual user "John Smith" is purchasing, but rather grouped information based on what, say, a group of women who are using the store's dietitian to aid in weight loss are purchasing. In the future, they should also be able to see whether their sales are increasing due to customer loyalty programs.

Availability & Pricing (Grrr)

The app is only available on Android devices for now, while the iPhone app remains in development -- but should be available by year's end.

But here's the catch: Individual PWDs can't just go download this app and start using it! That is, you can download the app, but you can't begin using it until you work with your health care provider to set it up. That will most likely go through the patient's insurance, and the cost depends on the services the patient is seeking -- as with most covered medical items. For example, a physician can give you a referral to see an in-store dietitian, and if the retail store has a relationship with your health plan, then both a visit with store's dietitian and use of the supporting Connect & Coach app would be covered. Sandberg says he and his team realize that not all insurance plans cover these services, and that out-of-pocket costs to see a dietitian are roughly $60 per hour, depending on where you live. They are considering looking into ways for people to possibly use the Connect & Coach system without having to go through their HCP.So far, it's been implemented at about 40 Giant Eagle supermarket chains for about eight months and the program has about 6,000 patients in the database. (btw, the company website says the cost for a retail chain wanting to customize the app to their store's offerings ranges from $25 to $152 per month depending on the size of the retailer and how much they want customized, Sandberg says.)

Using the $100,000 prize money from the Sanofi competition, PHRQL is beefing up marketing for the program, and is currently in talks with other major retailers across the country. Sandberg says the team is also focusing on making the product better based on feedback from Giant Eagle users.

"There seems to be good satisfaction with the program," he says. "People are coming back for multiple visits, people are getting engaged. But we haven't been doing this for long enough to have good long-term trends."

With the data so far, Sandberg tells us that in a group of patients trying to lose weight by using Connect & Coach, there's an average loss between a half a pound and three quarters of a pound per week. Not bad!

Not all of those using the program are diabetic, but Sandberg says the database shows a majority of those with diabetes are type 2. They are measuring HbA1c levels of the diabetics participating, but Sandberg said it's too early to have any definitive data on whether the program has helped to lower those numbers.

Diabetes Enthusiasm

Mike Levinson, an RD and strategic sales manager for Connect & Coach, says the program can help both type 1 and type 2 diabetics.

"One of the main benefits for patients with diabetes who use Connect & Coach is the ability to get a customized meal plan and monitor their progress," he said. "Food and nutrition play a crucial role in diabetes and Connect & Coach allows the patients to understand and control their food choices and portion sizes. Most meal plans are hand-written by dietitians and are really just a one-way communication, but with Connect & Coach, the dietitian works closely with the patient and can modify food choices at any moment because of the cloud-based application."

OK, but Levinson works for the company, so we reached out to longtime CDE and dietician Janis Roszler, Janis RoszlerDiabetes Educator of the Year in 2008-2009, for further feedback. She was very enthusiastic.

"Yes and yes!," she said, when asked about whether she'd heard of the program and likes the concept. "At the end of many of the face-to-face sessions I've had with patients, I used to say, 'I wish I could go home with you, but I can't!' This tool enables patients to have a dietitian do just that. It is long overdue and so needed."

Roszler says that if Connect & Coach had been around during her time traveling across the U.S. pitching tips and project ideas to dietitians and CDEs, she would have actively promoted it as a way to reach more PWDs and those with pre-diabetes.

"Currently, that population dramatically outnumbers the amount of diabetes educators and registered dietitians we have in the U.S. We must do whatever we can to reach more people with healthy and reliable advice," she said.


Would you be more willing to work with a dietitian or CDE if you could have their help in real-time while shopping at your local supermarket? Anybody excited about the idea of a 'dietitian genie' in your phone?

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.