Vital Statistics Re-engineering Project

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

2. Problems faced by Vital Records Offices • Timeliness of data • 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 alert federal agencies within 24 hours of registering these events? • Quality and accuracy of data • Can a state provide assurances regarding the quality, correctness and completeness of the data? • Reduced funding

3. Who is NAPHSIS? • National Association for Public Health Statistics and Information Systems • Members include 57 vital event registration jurisdictions (states, cities, territories) • 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 • An affiliate of the Association of State and Territorial Health Officials (ASTHO) • Partners include: CDC, NCHS, SSA, AAMVA

4. Re-engineering • Use of new technology and re-engineering of vital records processes • Re-engineering • Fundamental re-thinking and radical re-design of business processes to bring about improvement • 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.

5. Steps toward a re-engineered system • 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

6. Re-engineering background • 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 • Separate costly re-engineering projects in various jurisdictions • Need for a standards-based uniform, systematic approach • Electronic access to and dissemination of vital records data • Linkage/integration of vital records data with other systems • Use of vital records data to reduce fraud and improve administrative services • Response to changing technology

7. Current status of the jurisdictions • Using older technology • 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 • A growing interest among jurisdictions in integrating birth records with newborn hearing and metabolic screening, birth defects, immunization and other federal systems

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

9. Recap of jurisdictions projects (cont.) • 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 • 49% of the jurisdictions are looking at new legislation to help with re-engineering, primarily on electronic signatures

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

11. NAPHSIS re-engineering effort • 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 • Includes representatives from NAPHSIS, NCHS, and SSA • Sub-committees established for: • Electronic Birth Registration • Electronic Death Registration • Reports/Files/Outputs • Customer Service and Certification • Information Technology • Data Modeling

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

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

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

15. Meeting Growing Expectations • Better technology at the jurisdictions’ disposal to allow ease of use, modification and maintenance • Significantly improved timeliness and quality • Improved customer service through the use of electronic records and integrated databases • More efficient office operations through automated work-flow management and performance monitoring • 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

16. Benefits to Partners • Improved quality and timeliness of reporting jurisdictions • Less time spent on data correction and iterative records gathering • Timely production of nationwide vital statistics • 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. • Significantly better customer service • Congruence with the e-Vitals initiative of the Office of Management and Budget

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

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 • Nineteen additional EHDI data items could be collected through a re-engineered birth system

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