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.Discussion: 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. (J Am Board Fam Med 2014;27:804 -810.)

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Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained.

BackgroundThe relative ease of movement of physicians across the Canada/US border has led to what is sometimes referred to as a ‘brain drain’ and previous analysis estimated that the equivalent of two graduating classes from Canadian medical schools were leaving to practice in the US each year. Both countries fill gaps in physician supply with international medical graduates (IMGs) so the movement of Canadian trained physicians to the US has international ramifications. Medical school enrolments have been increased on both sides of the border, yet there continues to be concerns about adequacy of physician human resources. This analysis was undertaken to re-examine the issue of Canadian physician migration to the US.MethodsWe conducted a cross-sectional analysis of the 2015 American Medical Association (AMA) Masterfile to identify and locate any graduates of Canadian schools of medicine (CMGs) working in the United States in direct patient care. We reviewed annual reports of the Canadian Resident Matching Service (CaRMS); the Canadian Post-MD Education Registry (CAPER); and the Canadian Collaborative Centre for Physician Resources (C3PR).ResultsBeginning in the early 1990s the number of CMGs locating in the U.S. reached an all-time high and then abruptly dropped off in 1995. CMGs are going to the US for post-graduate training in smaller numbers and, are less likely to remain than at any time since the 1970’s.ConclusionsThis four decade retrospective found considerable variation in the migration pattern of CMGs to the US. CMGs’ decision to emigrate to the U.S. may be influenced by both ‘push’ and ‘pull’ factors. The relative strength of these factors changed and by 2004, more CMGs were returning from abroad than were leaving and the current outflow is negligible. This study supports the need for medical human resource planning to assume a long-term view taking into account national and international trends to avoid the rapid changes that were observed. These results are of importance to medical resource planning.