Screening
Require that food insecurity screening be completed at least once annually as part of a routine primary care visit.
Process
Administer intake forms through an online patient portal before the visit or at check-in or through paper forms at appointment check-in or in rooming. Benefits and challenges of different intake forms are described here.
Technology
Build food insecurity screening into online patient workflows as part of appointment check-in to enable electronic capture. Enable a means for care team data entry when paper-based screening is deployed.
Personnel
At patient check-in, clinical support staff (e.g. front desk personnel, medical assistants, nurses, social workers) confirm that food insecurity screening has been completed. If not complete, collect screening data in clinic during rooming and input result into the EHR.
Conduct anti-bias trainings as it related to food and nutrition insecurity so that team members can address patient concerns appropriately.
Eligibility
Flag patients who meet FIM program eligibility criteria.
Process
With additional technology resources available, health systems can develop BPAs that appear in the EHR based on a patient’s food insecurity status and diabetes diagnosis. Flags indicate the program for which a patient is eligible, along with information on whether that program is available to clinic patients.
When additional technology resources are not available, clinical care teams can use information collected by the patient in self-assessments and/or through specific prompts collected during the clinical visit.
Technology
Code BPAs indicating when a patient is eligible for a FIM program based on food security status, diabetes diagnosis, and FIM programs available to the clinic. BPAs that appear based on a patient’s food insecurity status alone should prompt clinicians with a list of resources to refer patients to local food assistance programs and prompt a referral to a community health worker or social worker.
Personnel
Train clinical care teams to recognize and respond to EHR BPAs that necessitate a referral to another clinical team, in-house program, or external vendor.
A Case for Screening for Food and Nutrition Insecurity
Food insecurity is a household-level economic and social condition of limited or uncertain access to adequate food.
Screening for food insecurity and other social determinants of health (SDOH) is recommended for all individuals in primary health care settings and is increasingly being integrated into EHR tools and clinical care pathways.
While food insecurity has historically been used in clinical screening and research, a growing recognition of the distinction between access to food generally and access to healthy foods specifically has spurred an evolution in healthcare, public health, and policy toward a new, complementary concept to food security—nutrition security.
Nutrition security is defined as consistent access, availability, and affordability of foods and beverages that promote well-being and prevent and if needed, treat disease.
Nutrition security complements, not replaces, measures of food security. For example, a patient may have enough money to purchase healthy foods but lacks reliable transportation to get to a grocery store or has a disability that makes it challenging to shop and cook independently.
Patients with diet-sensitive conditions and experiencing either food or nutrition insecurity can be considered for FIM services.
Best Practice Alerts
Within the EHR, a Best Practice Alert (BPA) is set to appear when:
- A patient has a relevant diagnosis for diabetes (ICD-10 code – E11)
- AND screens positive for food insecurity or limited access to healthy food.
The BPA displays:
“This patient may be eligible for Food Is Medicine support. Would you like to place a referral to [Program Name]?”
Options include:
- “Yes – auto-generate referral order”
- “No – not eligible/decline”
- “Remind me at next visit”
This ensures that the screening and eligibility checks are embedded within routine care while minimizing additional workload for providers.