title: Using electronic health records to conduct children's health insurance surveillance.
abstract: OBJECTIVE
  Health insurance options are changing. Electronic health record (EHR) databases present new opportunities for providers to track the insurance coverage status of their patients. This study demonstrates the use of EHR data for this purpose.
  
  
  METHODS
  Using EHR data from the OCHIN Network of community health centers, we conducted a retrospective cohort study of data from children presenting to a community health center in 2010-2011 (N = 185,959). We described coverage patterns for children, used generalized estimating equation logistic regression to compare uninsured children with those with insurance, and assessed insurance status at subsequent visits.
  
  
  RESULTS
  At their first visit during the study period, 21% of children had no insurance. Among children uninsured at a first visit, 30% were uninsured at all subsequent visits. In multivariable analyses (including gender, age, race, ethnicity, language, income, location, and type of clinic), we observed significant differences in the characteristics of children who were uninsured as compared with those with insurance coverage. For example, compared with white, non-Hispanic children, nonwhite and/or Hispanic children had lower odds of being uninsured than having Medicaid/Medicare (adjusted odds ratio, 0.73; 95% confidence interval: 0.71-0.75) but had higher odds of being uninsured than having commercial insurance (adjusted odds ratio, 1.50; 95% confidence interval: 1.44-1.56).
  
  
  CONCLUSIONS
  Nearly one-third of children uninsured at their first visit remained uninsured at all subsequent visits, which suggests a need for clinics to conduct insurance surveillance and develop mechanisms to assist patients with obtaining coverage. EHRs can facilitate insurance surveillance and inform interventions aimed at helping patients obtain and retain coverage.
authors.affiliation: Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, FM, Portland, Oregon 97239. angierh@ohsu.edu.
authors.forename: Brigit
authors.initials: B
authors.lastname: Hatch
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.forename: John
authors.initials: J
authors.lastname: Heintzman
authors.forename: Christine
authors.initials: C
authors.lastname: Nelson
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.forename: Trisha
authors.initials: T
authors.lastname: Vakarcs
authors.forename: Jennifer
authors.initials: J
authors.lastname: Devoe
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D015331:Cohort Studies; D003151:Community Health Centers / Q000458:organization & administration*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data / Q000639:trends*; D007348:Insurance, Health / Q000706:statistics & numerical data / Q000639:trends*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data / Q000639:trends; D006278:Medicare / Q000706:statistics & numerical data / Q000639:trends; D015999:Multivariate Analysis; D009922:Oregon; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States
keywords: children; electronic health records; health; insurance