# Presentation: 280347

## Vital Statistics as a Digital Public Health Surveillance System

**Centers**** ****for Disease Control and Prevention**
**National Center for Health Statistics**

-      Delton Atkinson, MPH, MPH, PMP
- Deputy Director, Division of Vital Statistics

## Background 

- 57 registration jurisdictions
- Complete census registration system
- Primarily for the registration of the event for legal purposes
- Secondarily for the collection of health outcomes
- All are state-based registries, meaning that.....
- Governed by state laws and regulations, not Federal
- Records owned by the state of occurrence
- States have a choice of participation in the National Vital Statistics System
- Must share records or information with a cadre of entities
- Lacks nationally-approved standards

## Without standards, how do we then influence this decentralized, state-based system?

- Models and Guidelines
- U.S. Standard Certificates for birth and death
- U.S. Standard Report of Fetal Death
- Model Law and Regulations
- Facility and Mothers Worksheets
- Guidelines for Electronic Death Registration System
- Vital Statistics Contract
- NCHS guidelines on the data elements and edit specifications
- Procedures for collecting, coding, and editing the data
- Guidelines on data capture at the source (e.g., worksheets)
- Defined transmission formats of data to NCHS
- Training and instructional materials
- Automated coding systems (e.g., mortality medical data system)

## To what extent are these state-based vital statistics registries electronic?  	Critical question when thinking about the state-based vital statistics system as a surveillance system

## AK

**AK**

**CA**

**ID**

**OR**

**WA**

**MT**

**WY**

**UT**

**CO**

**AZ**

**NM**

**TX**

**OK**

**KS**

**NE**

**SD**

**ND**

**MN**

**WI**

**IA**

**IL**

**OH**

**IN**

**KY**

**WV**

**VA**

**NC**

**GA**

**FL**

**AL***

**MS***

**MO**

**AR**

**LA**

**NV**

**HI***

**MI**

**PA**

**NJ**

**NY**

**CT**

**MA**

**VT**

**NH**

**ME**

**TN**

**MD**

**DE**

**RI**

**DC**

**SC**

- Electronic Birth Registration Systems
- Updated January 2008

**NYC**

- Re-engineered
- *without 2003 certificate

- In Development
- 2009 Target

- Planning/Requirements
- 2010-2011 Target

- Early Planning
- 2012 > Target

*** RFP Released**

## Alaska

**Alaska**

**California**

**Idaho**

**Oregon**

**Washington**

**Montana**

**Wyoming**

**Utah**

**Colorado**

**Arizona**

**New Mexico**

**Texas**

**Oklahoma**

**Kansas**

**Nebraska**

**South Dakota**

**North Dakota**

**Minnesota**

**Wisconsin**

**Iowa**

**Illinois**

**Ohio**

**Indiana**

**Kentucky**

**WV**

**Virginia**

**N. Carolina**

**Georgia**

**Florida**

**Alabama**

**MS**

**Missouri**

**Arkansas**

**LA**

**Nevada**

**Hawaii**

**Michigan**

**Pennsylvania**

**NJ**

**New York**

**CT**

**MA**

**VT**

**NH**

**Maine**

**Tennessee**

**MD**

**DE**

**RI**

**DC**

**S. Carolina**

- Electronic Death Registration Systems, by Jurisdiction,
- With SSA Funding Indicator, January 2008

**New York City**

- Up and Running

- In Development

- Planning/Requirements Stage

- Received SSA Funding

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- Up and Running/Back Office

## Characteristics of these state-based electronic systems

- Principally web-based systems that are not yet integrated with data provider systems
- Developed to meet current state laws, rules, and/or practices
- Specifically produced by contractors in response to a jurisdiction’s RFP
- Only a small cadre of vendors developing these types of systems
- Not yet able to easily transfer information between jurisdictions for birth and death matching, surveillance, or other purposes
- Follow general specifications developed by NCHS and NAPHSIS

## Given the current status and our  challenges, can vital statistics be an effective surveillance system, and if so, what is required? 

- Action on 3 levels
- Addressing each level concurrently

## Level #1: Implementing statewide electronic systems in each jurisdiction

- Electronic vital statistics systems:
- Foundation for national public health surveillance
- Major goal for the past 5 years
- Not yet accomplished----*Funding is the major issue*
- Associated goals:
- Implementing 2003 U.S. standard certificates
- Using the NCHS edit specifications with their new systems

## Level #2: Capacity to exchange needed informationwith other systems

- Improving the capability of birth, death and fetal death systems to provide record-based and response-based information to an array of health and administrative systems
- Other States
- Other Registries
- Birth defects
- Newborn screening
- Early Hearing Detection & Intervention
- Cancer
- Etc.
- Voter Registration
- Drivers License
- Federal Systems such as SSA and DHS

## How are we doing this?

- Current data integration practices
- Electronic extracts on some regular basis
- Facilitating linkages using these extracts by
- Collecting programmatic data on the vital certificate to be used for matching, and/or
- Collecting sufficient identifying information on both the birth and program file
- Initiatives on exchanging ***response-based*** information for administrative purposes:
- Electronic Verification of Vital Events System  (EVVE)
- Online System for the Verification of Social Security Numbers
- Initiatives on exchange of ***record-based*** information for administrative and statistical purposes
- State and Territorial Electronic Vital Events System  (STEVE)
- STEVE to be used to transfer statistical and surveillance information to NCHS
- Transmission of NCHS statistical records through CDC Secure Data Network

## How are we doing this? (cont.)

- Initiatives on the timeliness of death reporting for surveillance purposes:
- Goals
- Fact of death within 5 days
- Cause of death within 10 days
- Recently released CDC-funded State Cooperative Agreement for Pandemic Flu Surveillance, with electronic death reporting as one of the projects
- Pilot Project between NCHS, CSTE, and 4 states to demonstrate the use of electronic death systems for timely surveillance of influenza

## Level #3: Systems Integration

- System integration comes through nationally-approved standards
- Just beginning at this level
- Standards development initiative
- Project: Develop HL-7 approved standards for the transmission of birth and death information between systems
- Being led by our Data Policy staff
- Federal/state/private development effort

## Challenges with Systems Integration

- Increasing the education of states about the importance of:
- The integration of electronic vital systems w/ electronic health & medical records
- Linkage of the collection of the medical portions of the birth and death certificates and fetal death reports to the electronic health records
- Enhancing the participation of the medical community in reporting of medical information electronically
- Implementing minimum performance standards for vital statistics programs, either voluntary or through regulations such as the Intelligence Reform and Terrorism Prevention Act
- Funding vital statistics programs adequately, both ongoing funding and pilot funding to develop and test new integration and surveillance concepts
- Complete statewide coverage is mandatory
- Enhance ability of NCHS to collect, process and analyze data for surveillance purposes

## Key Contacts at the CDC/NCHS Division of Vital Statistics:Charles Rothwell (CRothwell@cdc.gov)Delton Atkinson (DAtkinson@cdc.gov)Dr. Robert Anderson (RNAnderson@cdc.gov)Stephanie Ventura (SVentura@cdc.gov)