Food is medicine that needs data to thrive

With Coca-Cola announcing the launch of its new cane sugar soda, food aid at the center of federal budget discussions and the Make Our Kids Healthy strategy, the role of food as one of the most important cornerstones of health is once again in the spotlight. At any age, diet is a powerful intervention that supports preventative care, treats or reduces symptoms of chronic care, and can be a powerful healing tool. Yet its impact is hampered by differing definitions, inconsistent standards, and unclear criteria for accessing critical clinical information. Together, these barriers prevent food-related interventions from having measurable impact at scale for those who need them. Supporting technology, data and standards could be the key to harnessing food’s ability to drive demonstrable change in healthcare.

Current challenges in measuring Food Is Medicine

Food is Medicine (FIM) interventions differ significantly. The number of meals per week, the duration of the intervention, the inclusion of nutritional advice, and even the types of customization available are all factored into the results. These contributions are essential to understanding the types of interventions that are most effective for different populations and medical scenarios.

While medical practice has benefited from rich input data through standardized code sets, FIM interventions do not benefit from the same set of standards. Although there is a separate set of Current Procedural Terminology (CPT) codes for medical nutrition therapy, they fail to capture critical details of the intervention, limiting understanding of which approaches provide the best results.

To accurately measure the effectiveness of interventions and understand best practices, FIM providers need clear patient outcomes data, such as hospitalization records and laboratory results. Unfortunately, access to this type of data is far from a guarantee for FIM providers. Although there are general industry practices for sharing data with medical providers and health plans under the Health Insurance Portability and Accountability Act (HIPAA), the status of FIM organizations under HIPAA may vary based on the structure of their programs and partnerships, and even based on whether or not they are set up to electronically bill claims. Added to this challenge is the fact that access to aggregated and usable data is far from universal. Although some states have robust frameworks for data exchange between providers and health plans, these frameworks are not universal and their infrastructure varies widely.

Measuring the future of food is medicine

There is a real opportunity to standardize the way FIM intervention data is captured. The American Academy of Nutrition and Dietetics has already mapped its Nutrition Care Process Terminology (NCPT), a long-standing best practice for clinical documentation by registered dietitians, to the SNOMED-CT standards, which support much of the exchange of clinical data across electronic health records and health information networks. As FIM providers adopt and update their systems of record, integrating NCPT can be the first step in enabling seamless data sharing with healthcare providers. Vendors serving FIM providers who invest in this set of codes could become valuable data sources for quality improvement and care coordination. At the same time, electronic health record providers and health information networks can also deepen their understanding of the nutrition care process and the application of SNOMED codes to capture this key information.

Federal and state interoperability frameworks provide several clear pathways for FIM providers to access data consistently while maintaining patient privacy. The Trusted Exchange Framework and Common Agreement (TEFCA) now includes a verification process for qualified health information networks to ensure that new participants exchange data in accordance with the terms of the framework and HIPAA requirements. At the state level, California’s data exchange framework allows any provider meeting health-related social needs under the state’s Section 1115 waiver to sign the state’s data sharing agreement. This gives them a clear path to the data they need to measure patient outcomes and coordinate care, as well as a set of steps required to protect patient privacy and safety. Directly involving clients in their care can also be an effective way to obtain critical clinical and claims data for care coordination. The 21st Century Cures Act requires this data from health plans and certified EHRs to be available to applications when patients request it through an application programming interface (API), and a number of companies have built the technical infrastructure to enable this access at scale. The CMS health technology ecosystem will only make this type of access more valuable in the future.

Putting the tools to work

We are at a critical juncture in our health system’s efforts to prioritize a powerful tool to keep people healthy. To ensure that Food is Medicine interventions are implemented in the right way, we need to be deliberate and proactive in how we collect and share data. We already have the tools. Now is the time to use them.

Photo: Flickr user JP

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