North Dakota’s In-House Development of EVER

1. NAPHSIS 2006 San Diego, California North Dakota’s In-House Development of EVER Darin J. Meschke, State Registrar Director, Division of Vital Records June 6, 2006

2. Birth Registration Our “old” way • We register about 9,400 births each year (635,000 pop.) • Prior to 2006, we were still registering births on paper certificates • Facilities manually typed up the birth certificates and sent them through the mail to our office. • One staff person would audit and verify the information on the certificate and the paternity acknowledgment • Office data entry staff would enter, then a second would re-enter the data for verification • Paper copy would then be scanned for issuance

3. Road Blocks • Funding • State general funded office • Extra state funds hard to come by • Interest/Support • Department/Divisional support was lacking • Processing times were never really bad doing it manually • Received the NCHS Award in 2004

4. Whose going to pay? • In March 2005, we applied for some carryover BT funding as part of the PHIN/NEDSS initiative to enhance our Master Population Index (MPI). • We made the argument that the faster we receive birth data from the hospitals, the faster we can populate our MPI so we will be better prepared for a mass prophylaxis if there is ever a need.

5. Can we even do this? • In anticipation of receiving funding, we began the planning process with our state’s Information Technology Department to develop the system. • No time for formal RFP process • Did not have time to write/review an RFP • ITD was already our “vendor” for Vital Records systems • Initial estimate was around $150K • We used the Use Case specifications off the NAPHSIS website • EBRS and MoVERS • NAPHSIS staff traveled to ND to assist with preliminary use case discussions (A Big Thanks!!!!) • Rose Trasatti was extremely helpful • Kathi Mueller, SD also a tremendous help

6. EBRS – The real work begins… • In late May 2005, we received the approval from the CDC for our carry-over request • $160K from our Focus Area B funding was redirected to develop a web based EBRS • The planning process then got into full gear and ITD began developing in July 2005 • We already had an Oracle infrastructure in place • Our back-office software was still going to be used • ITD was creating a front-end web application for the hospitals to enter birth data

7. Use the Use Cases • ITD found the use cases to be extremely valuable during development • Gave them a resource to use when they didn’t completely understand what we wanted • They modeled their documentation from the use cases • VR staff also benefited • Didn’t have to explain every last little detail • Allowed us to concentrate on the look and feel of the system and the major functionality, instead of the detailed programming questions.

8. Working with hospitals • As part of the development process, we formed a working group (VR, ITD and Hospitals) • In our case, users very excited about EBRS • To this point in the process, no negative criticism • Local Bismarck (2) hospitals came in during development for some testing • Very beneficial in understanding the differences between how each hospital conducts their business

9. EBRS - User Acceptance Testing • In late November 2005, we began our initial user-acceptance testing. • Again, we used the use cases to make sure the primary functionality was working. • Made sure that all of the required edits we being enforced. • Local hospitals came in again to let us know what they liked and disliked (some problems found and changes made)

10. EBRS - User Training • In mid-December 2005, we began our hospital user training at four regional locations. • North Dakota has a very small population but it does take a while to get across it. • The “Big Four”, as we like to call our 4 largest cities (towns) were selected for this training. • Fargo, Bismarck, Grand Forks and Minot • I conducted all of the training personally at local hospitals • I had the training schedule all planned out and during the first session, my wife called to inform me that my father had passed away. • So I had to scrap the rest of that trip and do the training the week between Christmas and New Year’s. (But it all worked) • Some additional development changes were made as a result of training and further testing, but ITD would make the corrections almost as fast as I could report them

11. EBRS in North Dakota • On January 3, 2006, we began accepting 2006 birth certificate information from all of the states birthing hospitals. • 2003 U.S. Standard changes will also implemented • 21 hospitals with approx. 125 users • Hospital staff very appreciative of new system • Complaints are very minimal and very positive • One data entry/One Submitter per record • User accounts maintained by the our office • Passwords were a minor problem, but we made a system change to make changing them much easier.

17. EBRS – Lessons Learned • It’s not bad to be last • Jumping from paper to Web-based • A whole lot of help exists out there • NAPHSIS • Other states (plagiarism is a good thing) • No need to reinvent the wheel on everything • Get done what you can with the money you have • EBRS only one part of EVER • Ongoing process to get to Death and Fetal Death

18. EBRS – Lessons Learned • System just needs to work, doesn’t need to be absolute perfection. • Start with a base and then expand • Make use of the Use Cases • Invaluable to our success • Saves time for programmers and VR staff • Don’t be afraid to ask for help • Other states • NAPHSIS

19. EBRS – Lessons Learned • Project Manager must stay on course • ITD provided an exceptional PM • ND has outstanding hospital staff • Eager, willing to accept change • Happy about electronic registration • Make documents/worksheets available for download • Small hospitals doesn’t need to print 1000s

20. Questions Darin J. Meschke, State Registrar Director, Division of Vital Records North Dakota Department of Health Phone: (701) 328-2494 dmeschke@nd.gov www.ndhealth.gov/vital