1. 1 Vital Statistics Re-engineering Project National Early Hearing Detection and Intervention Meeting February 20 th, 2004 Kenneth M. Beam, Executive Director National Association for Public Health Statistics and Information Systems

2. 2 Problems faced by Vital Records Offices Timeliness of data Timeliness of data Can a state register the birth of a child within 24 hours?Can a state register the birth of a child within 24 hours? Can a state record the death of person within 24 hours of learning about the event?Can a state record the death of person within 24 hours of learning about the event? Can a state alert federal agencies within 24 hours of registering these events?Can a state alert federal agencies within 24 hours of registering these events? Quality and accuracy of data Quality and accuracy of data Can a state provide assurances regarding the quality, correctness and completeness of the data?Can a state provide assurances regarding the quality, correctness and completeness of the data? Reduced funding Reduced funding

3. 3 Who is NAPHSIS? National Association for Public Health Statistics and Information Systems National Association for Public Health Statistics and Information Systems Members include 57 vital event registration jurisdictions (states, cities, territories) Members include 57 vital event registration jurisdictions (states, cities, territories) Formed in 1933 Formed in 1933 Our mission is to provide leadership to improve public health information through strengthening and integrating vital records, health statistics and other health information systems Our mission is to provide leadership to improve public health information through strengthening and integrating vital records, health statistics and other health information systems An affiliate of the Association of State and Territorial Health Officials (ASTHO) An affiliate of the Association of State and Territorial Health Officials (ASTHO) Partners include: CDC, NCHS, SSA, AAMVA Partners include: CDC, NCHS, SSA, AAMVA

4. 4 Re-engineering Use of new technology and re-engineering of vital records processes Use of new technology and re-engineering of vital records processes Re-engineering Re-engineering Fundamental re-thinking and radical re-design of business processes to bring about improvementFundamental re-thinking and radical re-design of business processes to bring about improvement Goal of re-engineering Goal of re-engineering Every jurisdiction maintains an overall vital records (civil registration) system so that integrated current information is readily available to authorized individuals and stakeholders.Every jurisdiction maintains an overall vital records (civil registration) system so that integrated current information is readily available to authorized individuals and stakeholders.

5. 5 Steps toward a re-engineered system Vital records jurisdictions are planning, developing and implementing re-engineered systems Vital records jurisdictions are planning, developing and implementing re-engineered systems NAPHSIS is providing assistance to all jurisdictions by coordinating their efforts, acting as a consultant and communicating re-engineering progress NAPHSIS is providing assistance to all jurisdictions by coordinating their efforts, acting as a consultant and communicating re-engineering progress

6. 6 Re-engineering background NCHS revision of the U.S. standard certificates for birth, death and fetal death NCHS revision of the U.S. standard certificates for birth, death and fetal death Higher expectations of data quality and timeliness by federal agencies, stakeholders and public Higher expectations of data quality and timeliness by federal agencies, stakeholders and public Separate costly re-engineering projects in various jurisdictions Separate costly re-engineering projects in various jurisdictions Need for a standards-based uniform, systematic approach Need for a standards-based uniform, systematic approach Electronic access to and dissemination of vital records data Electronic access to and dissemination of vital records data Linkage/integration of vital records data with other systems Linkage/integration of vital records data with other systems Use of vital records data to reduce fraud and improve administrative services Use of vital records data to reduce fraud and improve administrative services Response to changing technology Response to changing technology

7. 7 Current status of the jurisdictions Using older technology Using older technology Processes and subsystems that cover birth and death registration, certification, back-office not well integrated Processes and subsystems that cover birth and death registration, certification, back-office not well integrated In many cases, every new report requires modification to an existing application and it is costly to make changes to these subsystems In many cases, every new report requires modification to an existing application and it is costly to make changes to these subsystems A growing interest among jurisdictions in integrating birth records with newborn hearing and metabolic screening, birth defects, immunization and other federal systems A growing interest among jurisdictions in integrating birth records with newborn hearing and metabolic screening, birth defects, immunization and other federal systems

8. 8 Recap of jurisdiction projects 70% (36) planning to implement a web-based EBC individually 70% (36) planning to implement a web-based EBC individually 62% (32) planning to implement an EDRS individually 62% (32) planning to implement an EDRS individually Of those planning an EDRS, Of those planning an EDRS, 75% (24) plan to use NCHS edits75% (24) plan to use NCHS edits 87% (28) will use NAPHSIS guidelines87% (28) will use NAPHSIS guidelines 60% (31) planning to implement a certification/POS/accounting system individually 60% (31) planning to implement a certification/POS/accounting system individually

9. 9 Recap of jurisdictions projects (cont.) It is very expensive for jurisdictions to undertake these projects individually It is very expensive for jurisdictions to undertake these projects individually More than 70% of the jurisdictions are looking for help from NAPHSIS and partners to facilitate re- engineering More than 70% of the jurisdictions are looking for help from NAPHSIS and partners to facilitate re- engineering 49% of the jurisdictions are looking at new legislation to help with re-engineering, primarily on electronic signatures 49% of the jurisdictions are looking at new legislation to help with re-engineering, primarily on electronic signatures

10. 10 Current status of federal agencies Federal agencies are providing funds to jurisdictions to integrate data Federal agencies are providing funds to jurisdictions to integrate data It is very expensive for federal agencies to fund individual jurisdiction projects It is very expensive for federal agencies to fund individual jurisdiction projects

11. 11 NAPHSIS re-engineering effort Working with two primary stakeholders (NCHS and SSA) to fund re-engineering activities, including use case analysis Working with two primary stakeholders (NCHS and SSA) to fund re-engineering activities, including use case analysis Re-engineering Oversight Committee co-chaired by NAPHSIS representative and NCHS representative Re-engineering Oversight Committee co-chaired by NAPHSIS representative and NCHS representative Includes representatives from NAPHSIS, NCHS, and SSAIncludes representatives from NAPHSIS, NCHS, and SSA Sub-committees established for: Sub-committees established for: Electronic Birth RegistrationElectronic Birth Registration Electronic Death RegistrationElectronic Death Registration Reports/Files/OutputsReports/Files/Outputs Customer Service and CertificationCustomer Service and Certification Information TechnologyInformation Technology Data ModelingData Modeling

12. 12 NAPHSIS re-engineering process Use Case Analyses to define, analyze and document user-system interactions, determine commonalities, functional requirements Use Case Analyses to define, analyze and document user-system interactions, determine commonalities, functional requirements Requires a high level of commitment from many jurisdictions Requires a high level of commitment from many jurisdictions Technical guidelines to include infrastructure requirements, system performance requirements, scalability, disaster recovery, archival issues, support Technical guidelines to include infrastructure requirements, system performance requirements, scalability, disaster recovery, archival issues, support Defining of business rules and legal concerns Defining of business rules and legal concerns

13. 13 Accomplishments to-date Use Case Analysis sessions conducted Use Case Analysis sessions conducted Electronic Birth Registration Electronic Birth Registration Electronic Death Registration Electronic Death Registration Customer Service and Certification Customer Service and Certification Data Analysis completed for standard certificates Data Analysis completed for standard certificates Reports, Files, and other system outputs (letters, certificates, forms, etc.) identified Reports, Files, and other system outputs (letters, certificates, forms, etc.) identified Model RFP written Model RFP written Estimated that requirements will meet 85% jurisdiction needsEstimated that requirements will meet 85% jurisdiction needs

14. 14 Re-engineering artifacts Artifacts apply to vital records functionality for: Artifacts apply to vital records functionality for: Birth Registration, including Fetal Death ReportingBirth Registration, including Fetal Death Reporting Death RegistrationDeath Registration Customer Service and CertificationCustomer Service and Certification Use Cases Use Cases NarrativesNarratives Diagrams (activity diagrams and controller diagrams)Diagrams (activity diagrams and controller diagrams) Business Rules and System Requirements Business Rules and System Requirements Glossary of Terms Glossary of Terms Reports/Files/Outputs Reports/Files/Outputs IT White Papers IT White Papers AuthenticationAuthentication Birth/Death MatchingBirth/Death Matching

15. 15 Meeting Growing Expectations Better technology at the jurisdictions disposal to allow ease of use, modification and maintenance Better technology at the jurisdictions disposal to allow ease of use, modification and maintenance Significantly improved timeliness and quality Significantly improved timeliness and quality Improved customer service through the use of electronic records and integrated databases Improved customer service through the use of electronic records and integrated databases More efficient office operations through automated work-flow management and performance monitoring More efficient office operations through automated work-flow management and performance monitoring Ability to meet constrained federal reporting requirements Ability to meet constrained federal reporting requirements An integrated civil registration system linked to hearing and metabolic screening, birth defects, immunizations and other jurisdiction & federal systems An integrated civil registration system linked to hearing and metabolic screening, birth defects, immunizations and other jurisdiction & federal systems

16. 16 Benefits to Partners Improved quality and timeliness of reporting jurisdictions Improved quality and timeliness of reporting jurisdictions Less time spent on data correction and iterative records gathering Less time spent on data correction and iterative records gathering Timely production of nationwide vital statistics Timely production of nationwide vital statistics Electronic verification of various attributes of vital events Electronic verification of various attributes of vital events Reduction in fraud through better electronic record matching – SSA claims that it will save $50M per year. Reduction in fraud through better electronic record matching – SSA claims that it will save $50M per year. Significantly better customer service Significantly better customer service Congruence with the e-Vitals initiative of the Office of Management and Budget Congruence with the e-Vitals initiative of the Office of Management and Budget

17. 17 Integrating the Web-based certificate System and the Newborn Hearing System can… Reduce redundant data collection Reduce redundant data collection Standardize the definitions used for EDHI and birth certificates Standardize the definitions used for EDHI and birth certificates Provide the means to quickly determine infants that were missed for a hearing test Provide the means to quickly determine infants that were missed for a hearing test Provide denominators for many of the EDHI performance indicators Provide denominators for many of the EDHI performance indicators

18. 18 How many EHDI data items could be collected through a re-engineered birth system? Twenty-one EHDI data items are on the standard certificate Twenty-one EHDI data items are on the standard certificate Nineteen additional EHDI data items could be collected through a re-engineered birth system Nineteen additional EHDI data items could be collected through a re-engineered birth system

19. 19 Conclusion Re-engineering is essential, but it is not easy Re-engineering is essential, but it is not easy The cost of not re-engineering is very high The cost of not re-engineering is very high The process requires a high level of energy, time and commitment The process requires a high level of energy, time and commitment We have seen results with the development of requirements for a national model We have seen results with the development of requirements for a national model It is a Win-Win Situation! It is a Win-Win Situation! We are looking for your support We are looking for your support