title: Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?
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.
  
  
  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.
  
  
  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.
authors.affiliation: Oregon Health and Science University, Department of Family Medicine, Portland, OR 97239, USA heintzma@ohsu.edu.
authors.forename: John
authors.initials: J
authors.lastname: Heintzman
authors.affiliation: Oregon Health and Science University, Department of Family Medicine, Portland, OR 97239, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: OCHIN, Inc., Portland, OR, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Hoopes
authors.affiliation: Oregon Health and Science University, Department of Family Medicine, Portland, OR 97239, USA.
authors.forename: Steffani R
authors.initials: SR
authors.lastname: Bailey
authors.affiliation: Kaiser Center For Health Research Northwest, Portland, OR, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.affiliation: Oregon Health and Science University, Department of Family Medicine, Portland, OR 97239, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: O'Malley
authors.affiliation: Oregon Health and Science University, Department of Family Medicine, Portland, OR 97239, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.affiliation: OCHIN, Inc., Portland, OR, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Nelson
authors.affiliation: OCHIN, Inc., Portland, OR, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Cottrell
authors.affiliation: Oregon Health and Science University, Department of Family Medicine, Portland, OR 97239, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Devoe
mesh_terms: D002648:Child; D003151:Community Health Centers; D057286:Electronic Health Records; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data; D009922:Oregon; D010372:Pediatrics; D014481:United States
keywords: Medicaid expansion; children; community health centers; electronic health records; health insurance; health insurance claims