Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers

Abstract

PURPOSE Electronic Health Record (EHR) databases in community health centers (CHCs) present new opportunities for quality improvement, comparative effectiveness, and health policy research. We aimed (1) to create individual-level linkages between EHR data from a network of CHCs and Medicaid claims from 2005 through 2007; (2) to examine congruence between these data sources; and (3) to identify sociodemographic characteristics associated with documentation of services in one data set vs the other. METHODSWe studied receipt of preventive services among established diabetic patients in 50 Oregon CHCs who had ever been enrolled in Medicaid (N = 2,103). We determined which services were documented in EHR data vs in Medicaid claims data, and we described the sociodemographic characteristics associated with these documentation patterns. RESULTSIn 2007, the following services were documented in Medicaid claims but not the EHR: 11.6% of total cholesterol screenings received, 7.0% of total infl uenza vaccinations, 10.5% of nephropathy screenings, and 8.8% of tests for glycated hemoglobin (HbA 1c ). In contrast, the following services were documented in the EHR but not in Medicaid claims: 49.3% of cholesterol screenings, 50.4% of infl uenza vaccinations, 50.1% of nephropathy screenings, and 48.4% of HbA 1c tests. Patients who were older, male, Spanish-speaking, above the federal poverty level, or who had discontinuous insurance were more likely to have services documented in the EHR but not in the Medicaid claims data.CONCLUSIONS Networked EHRs provide new opportunities for obtaining more comprehensive data regarding health services received, especially among populations who are discontinuously insured. Relying solely on Medicaid claims data is likely to substantially underestimate the quality of care.

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“…A study particularly highlighted the benefit of electronic medical record (EMR) data over claims data [13]. This resulted in the recent development of databases that combine both claims data and EMR data for health care analysis.…”

In This Issue: Technology and Primary Care

“…DeVoe et al have found that, in a network of Community Health Centers, EHR data provide a more comprehensive picture of preventive services delivery than Medicaid claims data. 4 These fi ndings add to the argument that EHRs can be important tools for research, policy, and reimbursement, particularly when pertaining to the under-and uninsured.…”

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“…Devoe, et al [7] compared the entries in EHRs with the same data in the Medicaid claims data set for a group of 50 community health centers in Oregon. They found gaps in data congruence across the study group, with some services documented in the Medicaid data set but not the EHRs, and others documented in the EHRs but not in the Medicaid data set.…”

“…The primary effort was the development of a set of data governance and data life cycle processes that focused on the awareness of data quality. 7 The studies in other industries point to the processes deployed and potential for change relevant to the health care industry, while the studies of health services data frame some of the known challenges and complexities that remain in the health care industry. For many community health centers, which serve especially vulnerable populations, and tend to be less well-resourced than hospital providers, understanding the complexities related to data collection and use, and developing appropriate strategies to improve data collection and use information more effectively, remain challenging.…”