Electronic health records in community health centers: A tool for cervical cancer preventive service surveillance among the uninsured

Background: Increasing use of electronic health records (EHRs) in community health centers (CHCs) offers new opportunities for surveillance among uninsured and underinsured populations. We leveraged a unique EHR database to examine associations between insurance coverage and utilization of cervical cancer preventive services in a network of CHCs. Methods: Data were supplied by OCHIN, a non-profit that provides EHRs to CHCs across the US. Bi-level (individual and clinic) random-intercept logit models were fit to data from 30 clinics in 2 states. Two outcomes were examined: (1) receipt of >= 1 Pap screening test in 3 years (females aged 18-64, n=11,951), and (2) receipt of >=1 dose of human papillomavirus (HPV) vaccine (females age 9-26, n=18,311). The primary predictor was duration of insurance coverage, adjusted for age, race/ethnicity, and income. Results: Compared to the continuously insured, the continuously uninsured had significantly lower odds of receiving a Pap test (OR 0.75; 95%CI .65-.88) and of receiving an HPV vaccination (OR 0.59; 95%CI .51-.67). There was no significant difference in the odds of service receipt between partially insured and continuously insured women. Women from racial/ethnic minority groups were significantly more likely to receive Pap screening than white women, a finding that challenges the results of previous survey-based studies. Conclusions: Insurance coverage among safety net patients is often fluid and may change frequently, potentially impacting utilization of preventive healthcare services. EHR systems in CHCs provide a new