1. Best Practice Scenario Web-based EBRS at birthing facilities Validates NCHS edits at time of data entry If record passes all validations, jurisdiction allows auto registration EBRS automatically generates IJE natality file and loads in STEVE STEVE transmits IJE file to NCHS in real time

2. Hospital Completes Birth Record Passes all NCHS edits? Submit Record to VR Jurisdiction Via Web Correct Errors and Resubmit for Validation System Automatically Performs NCHS Validations YN Local Registration Required? System Auto Registers Record Go To 2.0 Y N Paternity Acknowledgement Required? N LIVE BIRTH Go To 3.0 VR Database Generate Routine Submissions to NCHS using STEVE END 1.0 Best Practice Y QA Before Registration? Go To 4.0 Y N

3. Potential Reporting Delays: Local Registration Often a paper process Longer filing deadlines due to geographic or staffing issues Manual record delivery Keyed into local systems Electronic record sent to central office on hold Central office must match, log, stamp and key in local registration info

4. Hospital Completes Birth Record Passes all NCHS edits? Submit Record to VR Jurisdiction Via Web Correct Errors and Resubmit for Validation System Automatically Performs NCHS Validations N LIVE BIRTH VR Database END 2.0 Local Registration Print and Send Paper Record to Local Registrar Y Manually Logs, Reviews and Files Record Hold for X Days Record Received From Local Registrar? N Mail or Deliver Record to VR Jurisdiction END Match Records, Manually Stamp, Log, Key Local File Number Generate Routine Submissions to NCHS Register Record Y Timeliness Metrics: A.Number of days from date of birth to when paper record is received from local registrar (A1 to A2). B.Number of days from when record is received from local registrar to when record is registered (B1 to B2). C.Number of days from when record is registered to when it is submitted to NCHS (C1 to C2). C2C2 C1C1 B2B2 B1B1 A2A2 A1A1

5. Potential Reporting Delays: Paternity Affidavits Delay registration pending PA from birth hospital If not established in hospital, awaiting parental paper work or court order Jurisdiction can usually proceed to register record without father’s information if paternity documents not received within specified time frame Subsequent inclusion of the father’s information on the birth certificate after registration must be by court order

6. Hospital Completes Birth Record Passes all NCHS edits? Submit Record to VR Jurisdiction Via Web Correct Errors and Resubmit for Validation System Automatically Performs NCHS Validations YN Register Record 3.0 Paternity Affidavit LIVE BIRTH VR Database Generate Routine Submissions to NCHS END Mother Married To Father? Y Hospital Provides Paternity Documents to Parents Hospital Records Husband’s Info as Father Paternity Affidavit Signed in Hospital? Hospital Submits Record with Father’s Info Y N Hospital Submits Record without Father’s Info N Paternity Affidavit Needed? Signed/notarized Paternity Affidavit Received? Y Hold for X Days N Y Verify Father’s Info Correct and Complete N Timeliness Metrics: D.Number of days from date of birth to when paternity affidavit is received (D1 to D2). E.Number of days from when paternity affidavit is received to when record is registered (E1 to E2). E2E2 E1E1 D2D2 D1D1

7. Potential Reporting Delays: Pre-registration Quality Assurance Jurisdiction does QA prior to registration Request corrections from birth hospital Wait until corrections received from hospital Key corrections into record Re-do QA steps Register and submit

8. Hospital Completes Birth Record Passes all NCHS edits? Submit Record to VR Jurisdiction Via Web Correct Errors and Resubmit for Validation System Automatically Performs NCHS Validations N LIVE BIRTH VR Database END 4.0 QA before Registration Y Hold for X Days Generate Routine Submissions to NCHS Perform QA On Record Record Fails QA? Request Hospital Correction of Errors Y Hospital Corrections Received? N Y Register Record N Timeliness Metrics: F.Number of days from when record is received until QA is performed (F1 to F2). G.Number of days from when record fails edits until request submitted to hospital to correct errors (G1 to G2). H.Number of days from when hospital is requested to correct errors until errors are corrected. (H1 to H2) I.Number of days from when errors are corrected until record is registered (I1 to I2 ). I2I2 H1H1 G2G2 G1G1 F2F2 F1F1 I1I1 H2H2 Update Record With Corrections

9. Best Practice Recommendations To Improve Timeliness Eliminate local registration where possible Allow local registrar access to central VR database for online local registration Don’t hold up processing of electronic record pending receipt of paper record Do not delay birth registration when paternity documents not received Do not delay birth registration to conduct QA; perform QA after records have been submitted to NCHS; provide corrected records subsequently if needed

10. Take the Time to Improve Conduct analysis of your own business practices Check your system’s performance reports Use the flow diagrams or make your own Measure your timeliness performance Identify areas for improvement and set tangible targets Ask NAPHSIS for help with business process improvement