Over 20% of U.S. children live in a household without consistent access to food.
To promote food security among all children and families, the Academy supports screening
families using the validated two-item Hunger Vital Sign (HVS) and including results
in the electronic health record (EHR).
A positive screen requires a response of “often true” or “sometimes true” to either
or both of the following statements:
“Within the past 12 months we worried whether our food would run out before we got
money to buy more.”
“Within the past 12 months the food we bought just didn’t last and we didn’t have
money to get more.”
The Centers for Medicare & Medicaid Services Accountable Health Communities Screening
Tool has incorporated the HVS, and individual institutions have brought the HVS into
their EHRs in a variety of ways.
In October 2017, Boston Medical Center primary care clinics rolled out the THRIVE
Screening & Referral Program, which includes the HVS. Patients complete a paper screener
in the waiting room, and it is entered into the EHR. A medical assistant scores the
screener and can enter orders like referrals to social work or therapeutic food pantries.
The provider then can sign pending orders and add them to the problem list.
Hennepin County Medical Center in Minneapolis aims to have screeners standardized
in all outpatient clinics by this spring. Clinic patients complete the screeners verbally.
Patients with positive screens are offered a bag of groceries, a sheet of community
resources and an EHR-based referral to Supplemental Nutrition Assistance Program outreach
via a Feeding America Partner.
Providers who screen for social determinants of health are still learning the best
ways to administer screeners and respond to positive screens. Some practitioners do
not have the resources to support families, and many families already are connected
to resources. In addition, there are concerns that asking these types of questions
(particularly in front of a child) may be traumatic.
Providers also may have questions about how to document food insecurity screening
in the EHR and code for screening. An Overview of Food Insecurity Coding in Health Care Settings: Existing and Emerging
Opportunities from the Hunger Vital Sign National Community of Practice addresses coding concerns,
Clinicians can use International Classification of Diseases, Tenth Revision, Clinical
Modification (ICD-10-CM) code Z59.4 (lack of adequate food and safe drinking water)
and the newly developed Systematized Nomenclature of Medicine – Clinical Terms (SNOMED
CT) code 733423003 (food insecurity) in the EMR/EHR for food insecurity diagnosis.
The SNOMED food insecurity code is automatically mapped to ICD-10 code Z59.4.
With common language and appropriate coding, food security data can be shared across
multiple platforms and with health departments and other community partners.
Logical Observation Identifiers Names and Codes (LOINC) offer practitioners an opportunity
to code answers of the HVS in interoperable ways. The LOINC database creates a universal
system of describing clinical variables like lab values, nursing diagnoses and patient
care datasets. LOINC can encode valid instruments like the HVS to give each question
a numeric code that can be shared across all EHRs just as lab values can be shared.
As of December 2017, LOINC codes correlating with the HVS were approved and can be
viewed at http://bit.ly/2t6YJz5.
Incorporating coding language to document food insecurity screening and interventions
is a crucial part of providing individual patient care and transforming data into
an interoperable language that can be shared. Pediatricians should communicate with
their information technology departments to identify the best method to incorporate
food insecurity screening as well as the appropriate coding systems. Such proactive
approaches help provide a foundation to eliminate food insecurity in individual families
and the community.
Katherine Joyce is a medical student and member of the AAP Council on Clinical Information