Challenges and Unfinished Business for NCHS and States in Vital Registration and Statistics

1. Challenges and Unfinished Business for NCHS and States in Vital Registration and Statistics Charles J. Rothwell Director, NCHS crothwell@cdc.gov National Center for Health Statistics

2. Welcome and thanks … but • I want to share with you how after many years I see the future of vitals • This is not going to be the usual presentation by a visiting NCHS Director • I want to spark conversations and spur future actions by those in this audience

3. Yes we have much to be proud of • Vital registration through improved business practices and automation is more responsive than ever • Vital statistics content is more extensive and is quicker and easier to access for policy makers, researchers and the public • Vital statistics is the foundation for measuring the health of our nation, states and communities

4. “Good to Great” – Are we there yet? • A few states are getting close to “Great” • A few more are “Good +” • However too many in my opinion remain “good” to “good –” • For vitals to remain vital … NCHS and all states have to soon be at the “good +” level … “good” won’t do.

5. Two alternate futures • Vital statistics based on vital registration systems will remain the foundation of measuring the health status of our communities, states and the nation , or • Back to the Past …Vital registration will become your primary responsibility and “vital” statistics will come from elsewhere

6. Surprisingly the problem is we are NOT in a crisis ! • We are improving but not fast enough • The health data world outside of vital statistics is changing faster • Vitals through vital registration will no longer have a monopoly … there will be competition • That competition can be easily beaten if we recognize we are soon to be in a race.

7. So what are some of the general challenges we face? • Overly restrictive or conflicting data release policies in states • Protecting the status quo without the means to do so • Willingness to look for new partners to fund our activities • Willingness to take calculated risks

8. What am I talking about? What are some specific changes that should be made or challenges to overcome?

9. Issue 1- Timely Data Transmission • What needs to be done for states to send NCHS data as soon as it arrives at their electronic “door step”… or at least twice a week? • If it does not cost states additional to do so why should NCHS pay extra for the information to be sent as soon as it is received? If it does cost more what is that incremental cost?

10. Issue 2 – NCHS specific problem • NCHS has to stabilize its medical coding system. What happened with 2011 and 2012 mortality data should not happen again!

11. Issue 3- ME/Coroner events • In order to improve timeliness for mortality, what can be done to improve follow-back to ME’s and coroners on pending records?

12. Issue 4 - Births • Although we are doing data quality studies, can we reduce the natality data set now to make it less onerous? • Are there items better collected by sampling after the fact from EMRs? • Should we make the natality data from birth certificate “lean and fast” and let PRAMS do the rest?

13. Issue 5 – Data transmission and matching systems • Are states now sharing data on out of state events through STEVE … if not why not? • Are all states sending data through STEVE to NCHS … if not why not? • What has been done with the NDI data we sent to you for matching to birth records?

14. Issue 6 - EDRs • What can be done to encourage states to expand EDRs? • Have states followed up with their state public health preparedness folks to get funding … if not why not? • When NCHS finally got funding, what kept states from applying to NCHS for funds to expand their EDR coverage?

15. Issue 7- EMR’s • How can EMR’s be used to add to the robustness of mortality data and reduce data collection for births? • Example … what would it take for states to populate the statistical portion of death record with morbidity information from the electronic medical record … to build a passive longitudinal record of morbidity of decedents?

16. Issue 8 -Cost of EBRs and EDRs • Cost of maintaining and building EDRs and EBRs … is our current approach affordable? If not • Do we now know enough to begin building a core EBR and EDR system for states to use? • If so … who should do this … NCHS, NAPHSIS … some third party?

17. Issue 9 – Joint activities • Could an EIS program for vitals help? • Are joint reports with state analysts possible, practical or useful? • Should NCHS try to fund a State Center’s program to build new statistical capacity or keep our activities focused on EBRs and EDRs? • Good to Great

18. Issue 10 – Timeliness • NCHS must move away from just annual reporting of vitals but be able to provide year to date reports • NCHS must expand its mortality surveillance programs with CDC-Atlanta programs • NCHS and States should be able to report on 90% of all vital events within 3 months of the date of the event.

19. So where will the competition come from? • Electronic medical records as they become ubiquitous will allow for: • Sampling at the national and state level to measure health status including births and deaths • EMR’s could include a simple cause of death module perhaps a drop down selection menu or automated medical coding systems could be applied and made required reporting

20. So what will it be? • Vital statistics based on vital registration systems will remain the foundation of measuring the health status of our communities, states and the nation, or • Back to the Past …Vital registration will become your primary responsibility and “vital” statistics will come from elsewhere

21. Questions? crothwell@cdc.gov