Public Health Data Standards Consortium http://phdatastandards.info

1. Public Health Data Standards Consortium http://phdatastandards.info

2. Connecting Communities for Better Health PHDSC / eHealth Initiative Annual Conference Vital Statistics as an Assessment Tool for Population Health Outcomes Marjorie S. Greenberg, MA Chief, Classifications and Public Health Data Standards Staff National Center for Health Statistics, CDC May 2005, Washington, D.C.

3. Vital Statistics – A decentralized system • Individual record data for births, deaths, fetal deaths • 4 million births, 2.4 million deaths, 25,000 fetal deaths • Counts for marriages and divorces • 57 reporting areas • Registration responsibility based on state law • Responsibility for reporting lies with provider of services (hospitals, physicians, funeral directors, coroners) • National standards developed by NCHS and states • Model laws • Standard certificates

4. Vital Statistics – Making People Count • Core of our population health information systems • Base for public health, social science, economic planning and program development • Key indicators of health status world-wide and at the local, state and national levels • Track progress to goals (e.g., Healthy People 2010) • Identify disparities (racial, ethnic, socioeconomic position, geographic) • Alert to emerging problems

6. Vital Statistics – Health Outcomes • Leading Causes of death • Heart disease, cancer, stroke, chronic lower respiratory diseases, accidents, diabetes, influenza/pneumonia, Alzheimer’s disease, nephritis, septicemia (top ten) • Birth indicators • Birth rates by age, multiple births, teenage pregnancy, childbearing, fertility, timing and adequacy of prenatal care, cesarean delivery, preterm birth and low birthweight, birth defects, maternal risk factors (e.g., hypertension, diabetes) • Linked birth and infant deaths • Used to explain the 2001-2002 infant mortality increase • National Death Index • Resource to aid epidemiologists and other investigators

7. Vital Statistics – Major Users • Governmental agencies – federal, state, local • International organizations (WHO, United Nations) • Researchers • Advocacy groups, think tanks, professional groups • e.g., March of Dimes, National Campaign to Prevent Teen Pregnancy, Child Trends, SIDS Alliance, ACOG, National Partnership to help Pregnant Smokers Quit, American Cancer Association, American College of Surgeons • Commercial organizations • e.g., Nestles, Fisher-Price, Pfizer, Novartis

8. Why Re-engineer Vital Registration Systems? • Death registration currently is a paper-based system • Birth reporting is automated at hospitals; however systems are inflexible, non-standardized and antiquated • Automation of records at the source • Flexibility to revise rapidly, address new data needs • Speed the flow of data • Potential for linking with other health data systems • e.g., electronic health/pre-natal records • Protocols and standards for Intelligence Reform Act • Contains authorization for grant programs to strengthen state registration and certification for identity/security purposes

9. How will Re-engineering improve Data Quality? • More accessible instructions – help screens • Real-time querying • Spelling and clarification of terms • Abbreviations • Prompts to include more specific information • Ill-defined causes of death and modes of dying • Inconsistent information • Prompts to avoid certain terms or certification practices • Built-in edits • Linkages with longitudinal health records, health screening systems • Sharing of common data elements

10. Key challenges • Dealing with multiple outmoded legacy systems • Re-engineering is costly, complicated undertaking, particularly when done on a state-by-state basis • States often focus on differences between systems rather than commonalities • The need for re-engineering has slowed implementation of revised birth certificate • Death registration must integrate provider systems and funeral director systems • Budgetary limitations have eroded systems • Variable budgets among states • Need to migrate to national IT standards

11. Strategies to address challenges • NCHS/CDC is collaborating with National Association of Public Health Statistics and Information Systems (NAPHSIS) and Social Security Administration to facilitate development of enhanced, standardized cost-efficient systems • Formed oversight committee • Developed national functional requirements for re-engineered birth and death registration systems; Phase I was released January 2004 • Consensus data standards and edits specifications • Work in progress … align standards with Health Level 7 and Public Health Information Network (PHIN)

12. Proposal to develop an HL7 V3 Vital Statistics Birth Messaging Standard • Leverage information technologies used within the healthcare industry • Develop a set of message specifications to support data interchange between state vital record systems and other public and private entities using V3 format • CDC PHIN MS messaging system recommended for facilitating transmission of vital events between systems; PHIN and vital events data elements aligned • Proof of concept: Pilot Project with state of Colorado • Colorado has successfully configured PHIN MS to transmit XML files to NCHS • Consider using this as prototype for future testing and implementation with other state partners

13. Summary • Vital statistics are the foundation of population health information • Standard certificates for birth and death are among the original health data standards • Vital statistics systems now need to be brought into the electronic age and aligned with healthcare information technology standards • The Public Health Data Standards Consortium is supporting NCHS/CDC, NAPHSIS, SSA and the states to develop HL-7-compliant vital event messages in support of the National Health Information Network

14. Where to find the latest information • Visit the NAPHSIS website to keep up to date with re-engineering: http://www.naphsis.org/projects/index.asp?bid=584 • the NCHS revision website for the latest on certificate implementation: http://www.cdc.gov/nchs/vital_certs_rev.htm • the Birth website: http://www.cdc.gov/nchs/births.htm • And the Mortality website: http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm