Using geographic information systems (GIS) to identify communities in need of health insurance outreach: An OCHIN practice-based research network (PBRN) report.
BACKGROUND
Our practice-based research network (PBRN) is conducting an outreach intervention to increase health insurance coverage for patients seen in the network. To assist with outreach site selection, we sought an understandable way to use electronic health record (EHR) data to locate uninsured patients.


METHODS
Health insurance information was displayed within a web-based mapping platform to demonstrate the feasibility of using geographic information systems (GIS) to visualize EHR data. This study used EHR data from 52 clinics in the OCHIN PBRN. We included cross-sectional coverage data for patients aged 0 to 64 years with at least 1 visit to a study clinic during 2011 (n = 228,284).


RESULTS
Our PBRN was successful in using GIS to identify intervention sites. Through use of the maps, we found geographic variation in insurance rates of patients seeking care in OCHIN PBRN clinics. Insurance rates also varied by age: The percentage of adults without insurance ranged from 13.2% to 86.8%; rates of children lacking insurance ranged from 1.1% to 71.7%. GIS also showed some areas of households with median incomes that had low insurance rates.


CONCLUSIONS
EHR data can be imported into a web-based GIS mapping tool to visualize patient information. Using EHR data, we were able to observe smaller areas than could be seen using only publicly available data. Using this information, we identified appropriate OCHIN PBRN clinics for dissemination of an EHR-based insurance outreach intervention. GIS could also be used by clinics to visualize other patient-level characteristics to target clinic outreach efforts or interventions.
From the Department of Family Medicine, Oregon Health & Science University, Portland (HA, SL, JED); the Robert Graham Center, Washington, DC (SF, AB); OCHIN, Inc., Portland, OR (TV, CN, JED); and the Health Foundation of Greater Cincinnati, Cincinnati, OH (MC). angierh@ohsu.edu.
Heather
H
Angier
From the Department of Family Medicine, Oregon Health & Science University, Portland (HA, SL, JED); the Robert Graham Center, Washington, DC (SF, AB); OCHIN, Inc., Portland, OR (TV, CN, JED); and the Health Foundation of Greater Cincinnati, Cincinnati, OH (MC).
Sonja
S
Likumahuwa
From the Department of Family Medicine, Oregon Health & Science University, Portland (HA, SL, JED); the Robert Graham Center, Washington, DC (SF, AB); OCHIN, Inc., Portland, OR (TV, CN, JED); and the Health Foundation of Greater Cincinnati, Cincinnati, OH (MC).
Sean
S
Finnegan
From the Department of Family Medicine, Oregon Health & Science University, Portland (HA, SL, JED); the Robert Graham Center, Washington, DC (SF, AB); OCHIN, Inc., Portland, OR (TV, CN, JED); and the Health Foundation of Greater Cincinnati, Cincinnati, OH (MC).
Trisha
T
Vakarcs
From the Department of Family Medicine, Oregon Health & Science University, Portland (HA, SL, JED); the Robert Graham Center, Washington, DC (SF, AB); OCHIN, Inc., Portland, OR (TV, CN, JED); and the Health Foundation of Greater Cincinnati, Cincinnati, OH (MC).
Christine
C
Nelson
From the Department of Family Medicine, Oregon Health & Science University, Portland (HA, SL, JED); the Robert Graham Center, Washington, DC (SF, AB); OCHIN, Inc., Portland, OR (TV, CN, JED); and the Health Foundation of Greater Cincinnati, Cincinnati, OH (MC).
Andrew
A
Bazemore
From the Department of Family Medicine, Oregon Health & Science University, Portland (HA, SL, JED); the Robert Graham Center, Washington, DC (SF, AB); OCHIN, Inc., Portland, OR (TV, CN, JED); and the Health Foundation of Greater Cincinnati, Cincinnati, OH (MC).
Mark
M
Carrozza
From the Department of Family Medicine, Oregon Health & Science University, Portland (HA, SL, JED); the Robert Graham Center, Washington, DC (SF, AB); OCHIN, Inc., Portland, OR (TV, CN, JED); and the Health Foundation of Greater Cincinnati, Cincinnati, OH (MC).
Jennifer E
JE
DeVoe
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003159:Community-Institutional Relations; D057286:Electronic Health Records; D040362:Geographic Information Systems; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D020380:Needs Assessment; D055815:Young Adult
Electronic Medical Records; Geographic Information Systems; Health Insurance; Practice-based Research