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?