Supporting health insurance expansion: Do electronic health records have valid insurance verification and enrollment data?

John Heintzman, Miguel Marino, Megan Hoopes, Steffani R. Bailey, Rachel Gold, Jean O'Malley, Heather Angier, Christine Nelson, Erika Cottrell, Jennifer DeVoe

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Objective To validate electronic health record (EHR) insurance information for low-income pediatric patients at Oregon community health centers (CHCs), compared to reimbursement data and Medicaid coverage data. Materials and Methods Subjects Children visiting any of 96 CHCs (N=69 189) from 2011 to 2012. Analysis The authors measured correspondence (whether or not the visit was covered by Medicaid) between EHR coverage data and (i) reimbursement data and (ii) coverage data from Medicaid. Results Compared to reimbursement data and Medicaid coverage data, EHR coverage data had high agreement (87% and 95%, respectively), sensitivity (0.97 and 0.96), positive predictive value (0.88 and 0.98), but lower kappa statistics (0.32 and 0.49), specificity (0.27 and 0.60), and negative predictive value (0.66 and 0.45). These varied among clinics. Discussion/Conclusions EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients. Future work should attempt to replicate these analyses in other settings.

Original languageEnglish (US)
Pages (from-to)909-913
Number of pages5
JournalJournal of the American Medical Informatics Association
Volume22
Issue number4
DOIs
StatePublished - Jul 1 2015

Keywords

  • Children
  • Community health centers
  • Electronic health records
  • Health insurance
  • Health insurance claims
  • Medicaid expansion

ASJC Scopus subject areas

  • Health Informatics

Fingerprint Dive into the research topics of 'Supporting health insurance expansion: Do electronic health records have valid insurance verification and enrollment data?'. Together they form a unique fingerprint.

  • Cite this