1. Violent Death Supplements: Extending CA-EDRS Michael Hogarth, University of California, Davis (UCD) Jason Van Court, Injury Prevention Branch, CDHS Rod Palmieri, California Dept. of Health Services (CDHS)

2. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Background The California Violent Death Reporting System Managed by the California Epidemiology and Prevention for Injury Control (EPIC) Branch of CHDS Funded by CDC as part of its National Violent Death Reporting System (NVDRS)

3. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 CalVDRS 2003 - 6,336 violent deaths in California California has 58 counties No statewide coroner system All records must be accessed at the county level Counties use different systems to store their information Requires abstracting from the death certificate, coroner report, police reports, and supplemental homicide reports

4. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 CalVDRS CalVDRS circa 2004 Manual abstraction at the local level CDC NVDRS software Installed on laptops used in the field Application submits data to a central location, then to CDC Problems Incompatibilities between local network firewalls and the encryption/VPN client used on the laptops Uses a manual process to collect information that may be available electronically

5. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 NVDRS Software

6. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 CalVDRS and CA-EDRS Since Jan 1, 2005 California has had a running Electronic Death Registration System (EDRS) Could EDRS be extended to make the CalVDRS data collection an easier process?

7. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 About CA-EDRS Built by UC Davis BIRCS in 13 months (11/03 - 12/04) & $1.8m Hybrid - supports paper and electronic workflows DCs, Amendments, Disposition Permits Includes remote attestation by voice/fax [http://www.edrs.us]http://www.edrs.us All death certificates since Jan 1, 2005 have been entered in CA-EDRS (243,000+) County-level implementations since Jan 1, 2005 Participation is voluntary Began with planned pilot implementations in Yolo and Riverside (1/05 - 7/05) Started statewide county level rollout in Jan 1, 2006 - present

8. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 CA-EDRS Status - June 06 1,200 active user accounts 243,334 Death Certificates & 3,579 Amendments in CA-EDRS (query - 06/03/06) 38,000 DCs by funeral directors/medical facilities 11,000 DCs attested remotely by fax or voice (service introduced Nov 1 2005) 6.5 million ‘logged system actions’ since Jan 1 2005

9. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 San Diego Implemented 3/1/2006 5,312 records since implementation Over 96% of records started by funeral homes Over 98% of these are “attested” by Fax or Voice signature by certifiers

10. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 CA-EDRS Implementation 1/062/063/064/065/066/0610/064/07 Imperial, Sacramento Monterey San Diego, San Benito Kern, Ventura San Mateo San Francisco 9/06 Kings Stanislaus, Sutter 34,000 (15%) 30,000 (13%) Riverside, Yolo20,000 (9%) 55,000 (24%) 57,000 (25%) 225,000 (100%) 61,000 (27%) 67,000 (29%) 68,000 (30%) 72,000 (32%) Los Angeles150,000 (66%) SL Obispo, San Bern.86,000 (38%) 2/07 Sonoma90,000 (40%) 11/06

11. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Extending CA-EDRS Could EDRS be leveraged to help collect CalVDRS data? Partnership between CDHS Office of Vital Records and Epidemiology and Prevention for Injury Control (EPIC) Branch Funded through private grants (Packard Foundation) secured by EPIC - $48,000

12. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Requirements Integrate functionality into CA-EDRS Retain NVDRS information model Incident, Person, Weapon Provide value to the user - entice coroners to use it Keep it simple - visually

13. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Approach Created the notion of a death certificate “supplement” in CA-EDRS Built supplements as a generic ‘plug-play’ functionality Many supplement types Data is separate from Death Certificate data but linked through internal identifier Coroner Supplement First supplement Collects CalVDRS data EDRS DECEDENT FOLDER Death Certificate Disposition Permits Attestations supplements Coroner Supplement (VDR Suppl.) Incidents Child Death Review Supplement

14. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 NVDRS - Incident

15. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 NVDRS - Person

16. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 NVDRS - Weapon

17. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Coroner Supplement Provides Coroners with the ability to store/extract supplemental information for: Homicide Suicide Unintentional Gun Dean Child Violent Death Etc… Also - collects valuable information for the California Violent Death Reporting System (CalVDRS)

18. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 The Coroner Supplement Incident-based Incident information: number of victims, description, police case report number Permission-based access Allows only coroners or their staff to view/update supplement information Ability for Coroner to export supplement data in a format compatible with MS Access

19. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Violent death supplement

20. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 incident information

21. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Create a supplement for this incident

22. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Manner of death Toxicology General information

23. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Circumstances (homicide)

24. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Weapon information

25. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Timeline Available with EDRS v2.2 mid-June, 2006 Functionality Violent Death Supplement VDRS Core Data Collection Set data entry Export of Violent Death supplement for Coroners Implementation Strategy Collaborate closely with Calif. Coroner’s Association Seek EDRS coroners to use it and evolve the functionality through coroner feedback Provide functionality and training along with CA-EDRS rollout in each county

26. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 Concluding remarks Consider “extending” the functionality of your EDR to collect death-related epidemiological information not on the standard Death Certificate An example of a successful public- private partnership (DHS-EPIC, DHS-OVR, Packard Foundation, UC Davis)

27. Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006 CA-EDRS - CalVDRS Project Acknowledgments Packard Foundation Office of Vital Records, CDHS Epidemiology and Prevention for Injury Control (EPIC) Branch, CDHS