Electronic Death Registration

1. Electronic Death Registration “Never Sign a Death Certificate Again” Presented by Texas Department of State Health Services Texas Vital Statistics www.texasvsu.org

2. Electronic Death Registration is Required By Law Health and Safety Code §193.002 requires the person in charge of interment or in charge of removal of a body from a registration district for disposition to file death certificates electronically as specified by the State Registrar. Likewise, Health and Safety Code §193.005 requires that medical certifiers on a death certificate submit the medical certification and attest to its validity using an electronic process (currently Texas Electronic Registrar) approved by the State Registrar.

3. Fast Facts As of October 10, 2009: • There are 1,364 funeral homes registered to use TER • There are 8,114 physicians registered to use TER • There are 319 local registrars registered to use TER • All 13 County Medical Examiner’s offices registered to use TER • 44.67% of all death certificates are fully electronic. • 92% of all Social Security numbers are successfully validated using TER

4. Texas Electronic Registrar Is: • Internet Application • Accommodates all levels of participation • Initiates social security verification process • Edits, cross-checks, SSN verification – all reduce potential errors • Result – a faster, more efficient, more accurate process

5. What about my Signature? • When Funeral Directors and Medical Certifiers (Physicians, JP’s, ME’s) are entered as users in TER, they are assigned a temporary PIN (Personal Identification Number). • The first time each Funeral Director or Medical Certifier verifies/certifies a record, they will be required to change the PIN to a number only they will know. • This PIN must be kept confidential; therefore, each Funeral Director and each Medical Certifier MUST verify/certify their own records (in other words, the signature process cannot be delegated to office staff). • The PIN holds the same legal standing on the electronic death certificate as a signature has traditionally held on the paper certificate.

6. Computer Specifications • 1.0 gigabyte processor speed or faster with 512MB of RAM or more • Adobe Acrobat Reader • Pentium 4 or equivalent • Windows XP Operating System • Web browser with Flash Player (7.0 or greater) • Internet access at 56K or better • 1024 x 768 resolution color monitor

7. How can do I register to use TER? • Go Texas Electronic Registration Page: www.requestTER.texasvsu.org • Complete the online Registration Form

8. Enroll By Going Here

10. Once Enrolled You Will Receive an Email from help-ter@dshs.state.tx.usthat will include: • Welcome to Texas Electronic Registrar Death Registration • Computer specifications • Resources and website information • Service Level Agreement • Confidential and Non-disclosure Agreement • User ID, Password and PIN number • help-ter@dshs.state.tx.us or help-ter@texasvsu.org • Password Guidance document • Remote Access Security Policies document

11. Example of the Start up email from help-ter@dshs.state.tx.us

12. User Setup VSU will set up one Local Administrator who will Add, Remove, and Modify Users in TEDR, Medical Certifiers and other staff. *see back of TER brochure

13. Let’s get started.

14. The notification prompt will be in the form of an email, or can be sent to any other electronic device that uses an email address (pager, PDA, etc). The email contains the name of the funeral home The basic information about the deceased And the unique EDR #

15. Accessing The Record • Access the Internet by clicking on the icon. • Copyhttps://ter2.dshs.state.tx.us/edeathto the address bar. • Select ‘Enter’ or icon. https://ter2.dshs.state.tx.us/edeath

16. This is Called The Portal Page. Click on ‘Thin Client Application’

17. Logging into TER Enter User Name Password Click Login Dr. Kilgore Select Location Click OK

18. Under ‘Functions’, click Medical Data Entry or click on icon This screen is called the Main Menu

19. From the Medical Data Entry screen, click the ‘Search Record’ icon This is the Medical Data Entry screen Let’s retrieve the record.

20. or, select ‘Search’ from the registration menu

21. This is the Search Recordscreen You can search with any combination of items

22. Enter your search information or EDR # Click ‘Find’

23. The system will retrieve all records matching the search criteria

24. Click on the desired record or records – the row(s) will become highlighted Click ‘Select Records’

25. The selected record will be displayed

26. or, click to choose Filter Option

27. Choose desired filter option

28. Click to access records in queue

29. Select record to complete

30. The Demographic Information that has been entered by the Funeral Home will pre-populate in the corresponding fields in Medical Tab 1 The selected record will be displayed

31. Start entering data on Medical 1 tab

32. If you do not wish to enter a Medical Record number, tab, with your ‘Tab’ button. When the Soft-Check Alert’ Appears, select ‘No’ if you do not wish to complete this item at a later time or ‘Yes’ if you do. The ‘Medrec’ field and the ‘MECase Number’ Field are optional. However you still have to tab through the fields to resolve them.

33. MEs and JPs: If your information is different from the Demographic your can add, edit, or delete the information that is different. If there is no middle name, press ‘TAB’ to skip to the next field.

34. A box will appear that will indicate that your information is different from what the Funeral Home has put in the System.

35. Medical Certifiers will have to indicate the date of death type.

36. If there is more than one Medical Certifier with your particular facility, you can select another physician if the physician that was assigned is unable to sign the death certificate. i.e. Attending Physician is out and an Associate Physician Has Approval by the Attending Physician in Accordance to HSC §193.005(c) to complete the medical certification.

37. Review the time of death and make that it is accurate in accordance to your records. You may edit this if you need to. 24 hour clock (military time) is acceptable.

38. We are now on the Medical 2 Tab

39. Complete each item by selecting the appropriate response from the pull-down lists

40. Quick tip – TER Death will not allow a physician to certify a manner of death other than ‘Natural’. A message will be displayed notifying the physician, who should then ‘DECLINE’ the record. The funeral home can re-designate the record to the appropriate JP or ME for certification.

41. Why Can’t A Doctor Put the Manner of Death as Accident? Code of Criminal Procedure Art. 49.04. DEATHS REQUIRING AN INQUEST.  • (a) A justice of the peace shall conduct an inquest into the death of a person who dies in the county served by the justice if: • (1) the person dies in prison under circumstances other than those described by Section 501.055(b), Government Code, or in jail; • (2) the person dies an unnatural death from a cause other than a legal execution; • (3) the body or a body part of a person is found, the cause or circumstances of death are unknown, and: • (A) the person is identified; or • (B) the person is unidentified;

42. Why Can’t A Doctor Put the Manner of Death as Accident? • Art. 49.04. DEATHS REQUIRING AN INQUEST (cont.).   • (4) the circumstances of the death indicate that the death may have been caused by unlawful means; • (5) the person commits suicide or the circumstances of the death indicate that the death may have been caused by suicide; • (6) the person dies without having been attended by a physician; • (7) the person dies while attended by a physician who is unable to certify the cause of death and who requests the justice of the peace to conduct an inquest; or • (8) the person is a child younger than six years of age and an inquest is required by Chapter 264, Family Code.

43. Why Can’t A Doctor Put the Manner of Death as Accident? • Art. 49.04. DEATHS REQUIRING AN INQUEST (cont.).  • (b) Except as provided by Subsection (c) of this section, a physician who attends the death of a person and who is unable to certify the cause of death shall report the death to the justice of the peace of the precinct where the death occurred and request that the justice conduct an inquest. • (c) If a person dies in a hospital or other institution and an attending physician is unable to certify the cause of death, the superintendent or general manager of the hospital or institution shall report the death to the justice of the peace of the precinct where the hospital or institution is located.

44. Why Can’t A Doctor Put the Manner of Death as Accident? • Art. 49.16. ORDERS AND DEATH CERTIFICATES.   • The justice of the peace or other person who conducts an inquest under this subchapter shall sign the death certificate and all orders made as a necessary part of the inquest.

45. NO Responding ‘NO’ to the Injury question will “disable” the rest of the injury questions and not allow entry

46. The Manner of Death implies that an injury did occur This is an example of a cross-check

47. Changing the response to Yes will resolve the conflict Click ‘OK’ to continue

48. Complete each item by entering information requested or selecting responses from pull-downs

49. We are now on the Medical 3 Tab

50. If the cause of death has not yet been determined, check the “Cause of Death Pending” box You must also type “PENDING” on Line A