With Coca-Cola announcing the release of its new cane-sugar soda, food aid at the center of federal budget discussions, and the “Make Our Children Healthy Again” strategy, food’s role as one of the most important cornerstones of health is back in the limelight. For all ages, food is a powerful intervention that supports preventive care, addresses or reduces the symptoms of chronic care, and can be a powerful tool for healing. Yet its impact is hindered by differing definitions, inconsistent standards, and murky criteria for accessing critical clinical information. Together, these barriers prevent food-related interventions from achieving measurable impact at scale for those in need. Support for technology, data, and standards could be the key to harnessing food’s ability to make demonstrable change in health care.
Current challenges to measuring Food Is Medicine
Food is Medicine (FIM) interventions differ widely. The number of meals per week, length of the intervention, inclusion of nutrition counseling, and even the types of customization available all factor into outcomes. These inputs are critical to understanding the types of interventions that are most effective for different populations and medical scenarios.
While medical practice has benefited from rich data on inputs through standardized codesets, FIM interventions do not benefit from the same set of standards. While a distinct set of Current Procedural Terminology (CPT) codes exists for medical nutrition therapy, they fail to capture critical details on the intervention, limiting insight into which approaches deliver the best outcomes.
To accurately measure the effectiveness of interventions and understand best practices, FIM providers need clear data on patient outcomes, such as hospitalization records and lab results. Unfortunately, access to these types of data is far from a guarantee for FIM providers. While 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 can 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. Furthering this challenge is the reality that access to aggregated, usable data is far from universal. While some states have robust frameworks for data exchange between providers and health plans, these frameworks are not universal, and their infrastructures vary widely.
Measuring the future of Food is Medicine
There is a clear opportunity to standardize how data on FIM interventions is captured. The American Academy of Nutrition and Dietetics has already mapped out its Nutrition Care Process Terminology (NCPT), a long-standing best practice for clinical documentation by registered dietitians, to SNOMED-CT standards, which support much of the clinical data exchange across electronic health records and health information networks. As FIM providers adopt and update systems of record, incorporating NCPT can be the first step in enabling seamless data sharing with health care providers. Vendors serving FIM providers who invest in this codeset could evolve into valuable data sources for quality improvement and care coordination. At the same time, electronic health record vendors and health information networks can also deepen their understanding of the nutrition care process and the application of SNOMED codes to capture these key inputs.
Federal and state frameworks for interoperability offer several clear avenues for FIM providers to access data consistently while preserving patient privacy. The Trusted Exchange Framework and Common Agreement (TEFCA) now includes a vetting process for Qualified Health Information Networks to ensure that new participants exchange data in accordance with the framework’s terms and HIPAA requirements. At the state level, California’s Data Exchange Framework allows any provider addressing 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 required steps to protect patient privacy and security. Directly engaging clients in their care can also be an effective way to obtain clinical and claims data crucial for care coordination. The 21st Century Cures Act requires the availability of this data from health plans and certified EHRs 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 care system’s efforts to prioritize a powerful tool for keeping people healthy. To make sure that Food is Medicine interventions are delivered the right way, we must be deliberate and proactive in how we collect and share data. We already have the tools. Now it’s time to use them.
Photo: flickr user JP
Paul Norton is a Director at BluePath Health, where he leads a portfolio of technology focused client engagements across a variety of organization types, ranging from early stage technology companies and community based nonprofits to statewide government agencies. Before joining BluePath Health, Paul was technology lead for B2B partnerships and joint ventures at Oscar Health. Paul was also Director of Policy at Manifest MedEx, California’s largest nonprofit health information exchange, where he helped spearhead efforts to pass California’s data exchange framework.
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