By creating food and nutrition insecurity screening within Tufts Medicine’s Epic electronic health record and patient engagement system, the new Tufts University Food is Medicine Institute in Boston and its team of medical, science, technology and health policy collaborators hope to further food-is-medicine science with their data.

They also aim to figure out how to address food and nutrition accessibility within the healthcare system.

Proponents of food is medicine say food-based interventions could address one aspect of social determinants of health and improve health equity while they support the nutritional needs of patients with chronic diseases.

At the international level, the World Health Organization focuses on food security and other challenges to address global health equity. As part of the National Center for Chronic Disease Prevention and Health Promotion the Division of Nutrition, Physical Activity and Obesity within the U.S., the Centers for Disease Control and Prevention also focuses on food and nutrition security as one of five social determinants of health. 

Dr. Dariush Mozaffarian, a cardiologist and the Jean Mayer Professor of Nutrition at the university's Friedman School of Nutrition Science and Policy and a driving force behind the study of food is medicine at Tufts, said at the launch of the Food is Medicine Institute earlier this month that researchers seek to support "food-based nutritional interventions integrated into healthcare to treat disease and advance health equity with supportive policies and programs at the population level." 

"But really the core focus is, how do we actually get food into healthcare?"

In addition to working with the team embedding nutrition security screening tools into the EHR at Tufts Medical Center, Ronit Ridberg, research assistant professor at the Friedman School, said she is also studying how food and nutrition can support maternal and child health equity and is looking at how these groups use produce prescription programs.

"We want to test strategies on how to increase participation, engagement and benefits utilization, really the way that people want to be using these programs," she said before introducing a panel on cross-sector collaboration.

When asked why Tufts created a food institute as the panel started, Mike Dandorf, president and CEO of Tufts Medicine, explained that to include food as part of care at the point of care, a series of things have to happen.

"What I'm trying to do is set the stage to set a different trajectory for healthcare," he said.

"And at Tufts Medicine, what we're really trying to do is be a protagonist in what we need the healthcare industry to look like." 

Dandorf acknowledged that, as a medical enterprise, Tufts and others provide great medical care in the U.S., "but we really do fall short when it comes to healthcare."

According to the Implementing Food and Nutrition Security Screening in EPIC and Clinical Care at Tufts project website, its pathways will be based on:

• Identifying best practices for streamlining clinical workflow to include screeners.
• Expanding those successful screening practices across departments and practices, like family medicine, maternal and infant health, pediatrics, and cardiology.
• Gathering reliable data for research that can explore associations between positive screens and health outcomes, healthcare utilization and cost.
• Improving nutritional status and patient health through resource referral and related research.
• Identifying departments within Tufts Medicine to replicate these efforts.

While screening could add to a provider's digital burdens during appointments, point-of-care tools that effectively capture and use SDOH data could also help providers advance health equity, according to Mohamed Humaidi, senior vice president of data and analytics at the New York and Florida-based health coordinator CareAbout.

EHRs "often lack the capability to easily integrate or exchange data with diverse sources, even among EHRs from the same vendor," Humaidi told Healthcare IT News in June.

Healthcare's SDOH interventions require multiple partners

There are many moving parts and partners needed to address food-insecure and nutrition-insecure patients in the healthcare system, beyond the need for SDOH technologies that integrate well with EHRs.

The speakers list at the Tufts Food is Medicine Institute's launch included healthcare leaders, medical scientists, policymakers, food-security organization founders and patients, as well as tech and life insurance industry partners who have worked to advance food-based interventions in healthcare. 

Many joined the event virtually – including World Central Kitchen Founder Jose Andres, Senators Cory Booker (D-N.J.) and Ed Markey (D-Mass.), U.S. Department of Agriculture Secretary Tom Vilsack, Congressman Jim McGovern (D-Mass.), and others.

Mozaffarian noted in his introduction and overview that food insecurity – "which is not exactly the same as poor nutrition" – has the highest rates of diet-related diseases. A map he shared showed an overlap of food insecurity and diabetes.

The policymakers echoed the lack of access to food and nutrition as a barrier to advancing health equity, and also noted that the cost of food insecurity adds billions annually to healthcare costs.

"Right now, we live in a world where providers are writing more and more prescriptions, while researchers are telling us that a lot of the time, prescribing fresh fruits or vegetables might also be able to help," said McGovern, who serves on the House Rules Committee and is a senior member of the House Agriculture Committee.

"We need a paradigm change," he said.

In previous years, the USDA has funded food equity programs through Medicare and Medicaid. Vilsack talked about a number of initiatives, and noted that the Gus Schumacher Nutrition Incentive Program, which ends in 2023, funds fruit and vegetable purchases by SNAP participants and has a produce prescription program.

Pam Schwartz, executive director of community health for Kaiser Permanente, discussed four medically tailored meal studies supporting disease management and wellbeing that are based on the presence of both a specific health condition and social needs.

She reported positive results for diabetes sufferers from a study involving Instacart delivery of curated boxes of produce prescriptions to Medicaid-population diabetic or prediabetic individuals for six months. 

The work will soon be presented, said Schwartz, who leads the organization's national food security strategy and ensures that social health interventions are integrated into Kaiser's care and services provided to Medicaid members. 

Kaiser researchers are "seeing lower rates of A1C in a really hard-to-serve, high-risk population," she said.

"Our clinicians are really excited about this. Our patients are really excited about this."

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.