Records that were processed through Super-MICAR or were manually coded are then processed through the remaining components (MICAR200, ACME and TRANSAX) of MMDS. In 1999, MICAR200 had a throughput rate of 95-97%, while ACME rate was 98 percent. Moreover, based on a reliability study, ACME error rate for selecting the underlying cause is at onehalf percent, while TRANSAX, the multiple cause codes had a one-half percent error rate [26] . Due to the high processing rates and low error rates, MMDS is considered by practitioners as the gold standard for the processing and coding of death certificates in the US and other countries (such as Canada, the United Kingdom (UK) and Australia). Therefore, we used the codes produced by this system as the "gold standard" when comparing with the methods developed here.