Maine Stakeholders Meeting Rose Trasatti Project Manager National Association for Public Health Statistics and Information Systems October 03, 2008

NAPHSIS National Association for Public Health Statistics and Information Systems Represents all 57 vital registration jurisdictions Funded by SSA to support development of EDR systems throughout the U.S.

What is EDR? Electronic filing of death certificates User-friendly death record data entry screens On-line help and built-in instructions Internet accessibility Electronic authentication On-line collaboration among multiple death registration system users

Who benefits from an EDRS? Families Physicians, physician assistants, certified nurse practitioners Medical Examiners Funeral directors Local and state registrars Federal, state and local agencies Public health researchers

Benefits of an EDRS Greater efficiency- participants interact electronically Improved timeliness of death registration Higher quality data via real-time edits Reduces errors in and rejection of death certificates Promotes uniformity in demographic and cause-of- death statistics Increased security and fraud prevention Supports partial electronic/paper death registration

Benefits of an EDRS Electronic referrals to Medical Examiners by Physicians Funeral directors Health departments Printing of the Disposition of Human Remains Permit Electronic trade calls between Funeral Homes Electronic Medical Examiner Release approvals Ordering of certified copies Report and file generation

Online Verification of SSN SSN can be verified during the entry of death data prior to registration Online verification integrated into EDR system SSN electronically verified after key decedent data items entered: Name DOB Gender Social Security Number Receive notification through the EDR system about the accuracy of the SSN

Online Verification of SSN Reduces decedent’s SSN errors on death certificates prior to registration Improves accuracy of SSN reported to SSA Speeds notification of fact of death to SSA Eliminates the need for funeral director to submit an SSA 721 form to SSA

EDRS implementation – it isn ’ t easy An EDRS is a complex system Numerous data items with extensive edit checks Detailed business rules and workflow Multiple users working on the same death record Many users accessing the system from many points Internet application with a need for high-levels of security

EDRS implementation – it isn ’ t easy Because an EDRS is a complex system it is important to have: Well defined requirements Realistic schedule Adequate funding Sufficient technical expertise in developing the system Participation by stakeholders in the full project lifecycle Satisfactory infrastructure and connectivity to the Internet

EDRS experiences – what we learned Important to market and garner EDRS support National level Local level Commonality among jurisdictions related to EDR Standards and guidelines can provide assistance in EDRS development A national model can provide a starting point for EDRS development Jurisdictions can learn from each other Focal point of contact needed to facilitate communication

NAPHSIS EDRS activities Focus on education and marketing at the national level Death data providers State and local government Federal agencies Death data users Developed marketing brochures and training packages

NAPHSIS EDRS activities Exhibit EDR booth and speak at national level conferences National Funeral Director Association National Association of Medical Examiners Alliance for Continuing Medical Education Association for Hospital Medical Education American Medical Association Continuing Medical Education Director’s Taskforce

NAPHSIS EDRS activities Provide consulting services to jurisdictions for implementing EDR systems Meet with vital records agencies/vital records staff Meet with EDR participants Help review state statutes/regulations Facilitate communication with other jurisdictions Developed tools to assist jurisdictions:  EDRS Standards & Guidelines Help review EDRS materials developed either in-house or by a vendor Assist jurisdictions with the tailoring of the EDRS National Model to meet their needs

EDRS National Model - goals Model should meet 80-85% of any jurisdiction ’ s electronic death registration requirements Components should be modular Design should allow customization without changing software Address the needs of the death data providers Include participation from multiple jurisdictions Include a procedure for other jurisdictions and EDRS vendors to review and submit comments

EDRS National Model - process Established an EDRS National Model Team Representatives from six jurisdictions NAPHSIS Social Security Administration National Center for Health Statistics Conducted validation sessions to identify EDRS requirements and develop re-engineering artifacts Use Cases – functionality/workflow System requirements/Business rules Reports, Files, and other EDRS outputs

Published the EDRS National Model for review NAPHSIS did an in-depth review of the model Received comments from jurisdictions Received comments from EDRS vendors Configuration Control Board established Approved recommended changes Re-engineering artifacts revised Jurisdictions can then tailor the EDRS National Model to meet their specific requirements EDRS National Model - process

Examples of Jurisdiction Specific Requirements User Authentication User ID and Password User ID and Password and PIN Biometrics  Fingerprint Check Attestation Process  Fax Attestation  Phone Attestation Secure ID Tokens

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, September 2008 New York City Up and RunningDevelopmentPlanning/Rqmts Received SSA Funding * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Back Office only

Intelligence Reform and Terrorism Prevention Act of 2004 Establish minimum standards for birth certificates Certification and seal by issuing custodian Use of safety paper or an alternative, equally secure medium Other features to prevent tampering, counterfeiting, or duplication for fraudulent purposes Establish requirements for proof and verification of identify of requestor Establish standards for the processing of birth certificate applications Accommodate differences between jurisdictions in manner and form in which birth records are stored and birth certificates issued

Intelligence Reform and Terrorism Prevention Act of 2004 Matching birth and death records Jurisdictions will need to computerize their birth and death records Jurisdictions will need to develop the capability to match birth and death records  within and among each jurisdiction The fact of death will need to be noted on the birth certificate of the deceased Matching must be done in a timely fashion  Electronic birth registration systems  Electronic death registration systems  Interstate exchange of birth and death data

Maximizing the success of your Electronic Death Registration Project Work with your Vital Records Office Participate in the planning process Participate on EDR stakeholders committee Invite Vital Records Office staff to local meetings Invite Vital Records Office staff to write articles for local publications Support legislative changes

Maximizing the success of your Electronic Death Registration Project Participate in validation sessions Define your requirements Review edit rules and design logic Volunteer to be a pilot site Share experiences with other system users Help market the system to garner maximum participation

NAPHSIS contact information Rose Trasatti Project Manager National Association for Public Health Statistics and Information Systems (NAPHSIS) 962 Wayne Avenue Suite 701 Silver Spring, Maryland (301) (phone) (301) (fax)