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How Can Vital Statistics Remain Vital for Measuring
Health Status in the U.S.?Charles J. Rothwell
Centers for Disease Control and PreventionNational Center for Health Statistics
Vital Statistics Attributes
• Core of our health data systems• Basic data for public health, social
science, economic planning and program development
• Monitors key indicators of health world-wide and at the local, state and national level
• Tracks progress to national health goals
• Identifies health disparities• Alerts us to emerging health problems
However Vital Statisticsis becoming a chronicle
of the past
How can this be changed?
Computerization in U.S. Vital Registration & Statistics in
2004
• In general computerization in health care in the U.S. lacking except for claims processing
• Birth record – Perinatal record of mother and child
• Death record – demographic/registration – Funeral Directors; Medical – certifying physicians
Computerization in U.S. Vital Registration & Statistics in
2004• Vital Registration at the State
level was automated but with old systems
• Most states had automated birth registration systems in hospitals but standalone, antiquated and not easy to modify – no use of the internet
• Death registration was paper based
• No electronic linkage between states
Computerization in U.S. Vital Registration & Statistics in
2004
• No linkage to automated medical records
• National systems – mainframe/batch
• National systems: annual reporting
• Preliminary reporting when 90 +% complete – still late
• Final reporting - very delayed – getting worse
2004: Much Needed to be Done!
• States needed to re-engineer vital registration systems at the source using the internet
• data transmission standards needed to be developed - linkage to emerging electronic medical records
• data transfer system needed to allow states to transfer to other states, NCHS and other Federal agencies
2004: Much Needed to be Done!
• States needed to change vital registration law to support electronic collection and issuance of vital records
• NCHS needed to improve automated mortality coding system & provide other internet based software seamlessly through state automated registration systems
2004: Much Needed to be Done!
• NCHS needed to re-engineer its internal systems to edit at time of data receipt
• NCHS needed to move away from annual processing and reporting to year-to-date.
Status 2011
• re-engineering the internal NCHS systems has been completed and is now accepting data transmission from the states
• In an SQL Server environment processes vital records from the 57 jurisdictions
• easy access of data for analytical and dissemination purposes at any stage in processing the records – but much remains to be done
Status 2011
• Record exchange system between states complete – 16 states using STEVE – 6 on the way
• EBR’s and EDR’s re-engineered based on consensus standards
• 35 states with EBR’s
• 31 states with EDR’s – but not complete coverage
Status 2011
• NCHS developed systems for improving the quality and timeliness of mortality statistics
• Views – Web-based service with EDR’s – improve input to automated medical coding systems
• Web-based tutorial for physicians developed
Status 2011
• HL7 standards for data sharing between EBR’s, EDR’s and electronic medical records developed – much work remains
• Automated and manual medical coding now done at NCHS
• Draft Model Law for 2011 developed supporting electronic registration and security
On the Horizon
• Question-based cause of death input in the making – but only in beginning stage
• Pilot data sharing between electronic medical records and vitals
• If data sharing successful – determining responsibility for collecting data items
On the Horizon: Mortality Surveillance
• What’s the vision?• Near real-time identification of
deaths due to rare or other specified causes
• Continuous monitoring for emerging temporal and/or spatial clusters
• Automated (daily/weekly/monthly) reporting on select causes of death
• Effective paths for communicating with partners (federal, state, and local)
On the Horizon: Mortality Surveillance
• What’s being done to get there?• New staff position with primary
focus on surveillance activities
• Dedicated federal programmers & support by contract technical staff
• Funding selected states for more current data
Future Challenges
• Data availability vs. confidentiality
• Electronic health records standards – will they be followed?
• Is surveillance possible and is it a responsibility of a statistical agency?
• Does it makes sense to go to a single EBR and EDR for use by all states?