Supporting Health Insurance Expansion: Do Electronic Health Records Have Valid Insurance Verification and Enrollment Data?

Overview

Journal J Am Med Inform Assoc

Publisher Oxford University Press

Specialty Medical Informatics

Date 2015 Apr 19

PMID 25888586

Citations 15

Authors

John Heintzman

Miguel Marino

Megan Hoopes

Steffani R Bailey

Rachel Gold

Jean OMalley

Heather Angier

Christine Nelson

Erika Cottrell

Jennifer DeVoe

Affiliations

Soon will be listed here.

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.

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