Using electronic health records to conduct children's health insurance surveillance

Brigit Hatch, Heather Angier, Miguel Marino, John Heintzman, Christine Nelson, Rachel Gold, Trisha Vakarcs, Jennifer Devoe

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


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. Pediatrics 2013;132: E1584-e1591.

Original languageEnglish (US)
Pages (from-to)e1584-e1591
Issue number6
StatePublished - Dec 2013


  • Children
  • Electronic health records
  • Health
  • Insurance

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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