1. Cincinnati OH June 5 th – 9 th, 2005 Jim Edgar, MPA Supervisor, Montana Office of Vital Statistics EDR and Cause of Death Certification, Montana's Experiences

2. Cincinnati OH June 5 th – 9 th, 2005 Certifiers will directly access the system All data entry will be done directly into the system by the certifier There would be no paper passing it would be all electronic Predevelopment Ideal (What We Wanted)

3. Cincinnati OH June 5 th – 9 th, 2005 The Plan

4. Cincinnati OH June 5 th – 9 th, 2005 How We Planned to Accomplish the Goals 1. Contact all parties who certify cause of death of the certificate. 2. Article published in professional organization newsletters. 3. Direct training.

5. Cincinnati OH June 5 th – 9 th, 2005 Contact All Certifiers Mail Three letters pre-implementation letters announcing training Fax Announcing Training Phone calls to schedule training Confirmation email of training

6. Cincinnati OH June 5 th – 9 th, 2005 First Pre-implementation Mail Out Received a list of 2408 physicians from Board of Medical Examiners 1. No specialties 2. All active license holder 3. Addresses were from all over

7. Cincinnati OH June 5 th – 9 th, 2005 Mail Out Adjustments All addresses outside of Montana were eliminated. 302 Eliminated. A prepaid postcard was enclosed to eliminate anyone who did not certify death certificates. 800 Eliminated.

8. Cincinnati OH June 5 th – 9 th, 2005 Postcard Back

9. Cincinnati OH June 5 th – 9 th, 2005 Article Published in Professional Organization Newsletters. 1.Two articles were published in the Montana Healthcare Provider Association Newsletter 2. One Article in the Montana Medical Association Newsletter There was no response to the articles

10. Cincinnati OH June 5 th – 9 th, 2005 Direct Training 1. Scheduled statewide training 1. Classes were conducted in 12 cities 2. There were 2 four-hour classes per day at each location 2. Each certifier was contacted to schedule the training by 1. Phone 2. Mail 3. Fax

11. Cincinnati OH June 5 th – 9 th, 2005 Pilot Training Pilot Training (April 2003) 4 Sessions over 2 days (Need only to attend one session) 114 Physicians were contacted three weeks before training Result 2 Physicians attended 3 Coroners 4 Admin Staff from 3 Clinics

12. Cincinnati OH June 5 th – 9 th, 2005 Post Pilot Training Adjustments Changed contact focus from Physicians to Office Managers Changed training so it only focused on the data entry not other death certificate issues

13. Cincinnati OH June 5 th – 9 th, 2005 Post Pilot Training Adjustments Change the session organization to train certifier first, this reduced training time to about one hour Created a role in the system so office staff can transcribe for the certifier

14. Cincinnati OH June 5 th – 9 th, 2005 Training Results 122 Coroners have direct access. 76 Physicians have direct access. 85 Medical Admin Staff have direct access. There are Approx 271 physicians in the clinics that have staff transcribe.

15. Cincinnati OH June 5 th – 9 th, 2005 Where We Are Now 1. 75 to 80% of death certificates are being filed electronically. 2. Of those filed electronically 99% include the cause of death certification. 3. Approximately 25% of cause of death information is being entered by the certifier.

16. Cincinnati OH June 5 th – 9 th, 2005 What We Ended Up With (Communication Network) ______Electronic Communication - - - - - Verbal or Paper Communication Hospital Funer al Home Physicia n Hospital Employe e Physician Non- Hospital Employee Coroner Registra r Clerk and Recorder State of MT Vital Records Informan t i.e. Spouse Cause of Death Coder NCHS Social Security Electronic Issuance Physician’s Staff

17. Cincinnati OH June 5 th – 9 th, 2005 How It Is Really Working 1.Some direct entry by certifiers (25%) 1.Physicians 2.Coroners 2.Some entry is by Certifiers Staff (35%) 3. Some entry is by Funeral Home Staff (39%) 4. Some entry is by Vital Statistics Staff (1%)

18. Cincinnati OH June 5 th – 9 th, 2005 Recommendations for Success(1) Educate the Office Administrators and Managers first. 1. They are inside the community. 2. They will figure out the best way for them to use the system. 3. Train the trainer.

19. Cincinnati OH June 5 th – 9 th, 2005 Recommendations for Success (2) Find an advocate Someone who will push and promote the advantages of using the system A.Office Managers B.Coroners C.Funeral Directors

20. Cincinnati OH June 5 th – 9 th, 2005 Recommendations for Success(3) Offer different entry options A. Direct entry B. Medical Staff Transcription C. Funeral Home Transcription

21. Cincinnati OH June 5 th – 9 th, 2005 Recommendations for Success(4) Be flexible with training. 1. Use Scheduled Classes. 2. Add classes off site if needed. 3. One on one, on site. 4. Over the phone.

22. Cincinnati OH June 5 th – 9 th, 2005 I May Not Have Gone Where I Intended to Go, but I Think I Have Ended up Where I Intended to Be. Douglas Adams