Perspective: Leveraging Electronic Health Record Data Within Food Is Medicine Program Evaluation: Considerations and Potential Paths Forward

Abstract

Perspective: Leveraging Electronic Health Record Data Within Food Is Medicine Program Evaluation: Considerations and Potential Paths Forward Christopher R Long 1,*, Amy L Yaroch 1, Carmen Byker Shanks 1, Eliza Short 1, Elise Mitchell 1, Sarah A Stotz 2, Hilary K Seligman 3 1 Gretchen Swanson Center for Nutrition, Omaha, NE, USA; 2 Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA; 3 Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA A B S T R A C T Government, health care systems and payers, philanthropic entities, advocacy groups, nonprofit organizations, community groups, and forprofit companies are presently making the case for Food is Medicine (FIM) nutrition programs to become reimbursable within health care services. FIM researchers are working urgently to build evidence for FIM programs’ cost-effectiveness by showing improvements in health outcomes and health care utilization. However, primary collection of this data is costly, difficult to implement, and burdensome to participants. Electronic health records (EHRs) offer a promising alternative to primary data collection because they provide already-collected information from existing clinical care. A few FIM studies have leveraged EHRs to demonstrate positive impacts on biomarkers or health care utilization, but many FIM studies run into insurmountable difficulties in their attempts to use EHRs. The authors of this commentary serve as evaluators and/or technical assistance providers with the United States Department of Agriculture’s Gus Schumacher Nutrition Incentive Program National Training, Technical Assistance, Evaluation, and Information Center. They work closely with over 100 Gus Schumacher Nutrition Incentive Program Produce Prescription FIM projects, which, as of 2023, span 34 US states and territories. In this commentary, we describe recurring challenges related to using EHRs in FIM evaluation, particularly in relation to biomarkers and health care utilization. We also outline potential opportunities and reasonable expectations for what can be learned from EHR data and describe other (non-EHR) data sources to consider for evaluation of long-term health outcomes and health care utilization. Large integrated health systems may be best positioned to use their own data to examine outcomes of interest to the broader field. Keywords: Food is Medicine, electronic health records, food insecurity, program evaluation, health care utilization, produce prescriptions