Violent Death Supplements: Extending CA-EDRS

1. Violent Death Supplements: Extending CA-EDRS Michael Hogarth, University of California, Davis (UCD)Jason Van Court, Injury Prevention Branch, CDHS Rod Palmieri, California Dept. of Health Services (CDHS)

2. Background • The California Violent Death Reporting System • Managed by the California Epidemiology and Prevention for Injury Control (EPIC) Branch of CHDS • Funded by CDC as part of its National Violent Death Reporting System (NVDRS)

3. CalVDRS • 2003 - 6,336 violent deaths in California • California has 58 counties • No statewide coroner system • All records must be accessed at the county level • Counties use different systems to store their information • Requires abstracting from the death certificate, coroner report, police reports, and supplemental homicide reports

4. CalVDRS • CalVDRS circa 2004 • Manual abstraction at the local level • CDC NVDRS software • Installed on laptops used in the field • Application submits data to a central location, then to CDC • Problems • Incompatibilities between local network firewalls and the encryption/VPN client used on the laptops • Uses a manual process to collect information that may be available electronically

5. NVDRS Software

6. CalVDRS and CA-EDRS • Since Jan 1, 2005 California has had a running Electronic Death Registration System (EDRS) • Could EDRS be extended to make the CalVDRS data collection an easier process?

7. About CA-EDRS • Built by UC Davis BIRCS in 13 months (11/03 - 12/04) & $1.8m • Hybrid - supports paper and electronic workflows • DCs, Amendments, Disposition Permits • Includes remote attestation by voice/fax[http://www.edrs.us] • All death certificates since Jan 1, 2005 have been entered in CA-EDRS (243,000+) • County-level implementations since Jan 1, 2005 • Participation is voluntary • Began with planned pilot implementations in Yolo and Riverside (1/05 - 7/05) • Started statewide county level rollout in Jan 1, 2006 - present

8. CA-EDRS Status - June 06 • 1,200 active user accounts • 243,334 Death Certificates & 3,579 Amendments in CA-EDRS (query - 06/03/06) • 38,000 DCs by funeral directors/medical facilities • 11,000 DCs attested remotely by fax or voice (service introduced Nov 1 2005) • 6.5 million ‘logged system actions’ • since Jan 1 2005

9. San Diego • Implemented 3/1/2006 • 5,312 records since implementation • Over 96% of records started by funeral homes • Over 98% of these are “attested” by Fax or Voice signature by certifiers

10. CA-EDRS Implementation 1/06 2/06 3/06 4/06 5/06 6/06 9/06 10/06 11/06 2/07 4/07 225,000 (100%) Los Angeles 150,000 (66%) Sonoma 90,000 (40%) SL Obispo, San Bern. 86,000 (38%) Stanislaus, Sutter 72,000 (32%) Kings 68,000 (30%) San Francisco 67,000 (29%) San Mateo 61,000 (27%) Kern, Ventura 57,000 (25%) 55,000 (24%) San Diego, San Benito Monterey 34,000 (15%) Imperial, Sacramento 30,000 (13%) Riverside, Yolo 20,000 (9%)

11. Extending CA-EDRS • Could EDRS be leveraged to help collect CalVDRS data? • Partnership between CDHS Office of Vital Records and Epidemiology and Prevention for Injury Control (EPIC) Branch • Funded through private grants (Packard Foundation) secured by EPIC - $48,000

12. Requirements • Integrate functionality into CA-EDRS • Retain NVDRS information model • Incident, Person, Weapon • Provide value to the user - entice coroners to use it • Keep it simple - visually

13. Approach EDRS DECEDENT FOLDER • Created the notion of a death certificate “supplement” in CA-EDRS • Built supplements as a generic ‘plug-play’ functionality • Many supplement types • Data is separate from Death Certificate data but linked through internal identifier • Coroner Supplement • First supplement • Collects CalVDRS data Death Certificate Incidents DispositionPermits supplements Attestations CoronerSupplement(VDR Suppl.) ChildDeathReviewSupplement

14. NVDRS - Incident

15. NVDRS - Person

16. NVDRS - Weapon

17. Coroner Supplement • Provides Coroners with the ability to store/extract supplemental information for: • Homicide • Suicide • Unintentional Gun Dean • Child Violent Death • Etc… • Also - collects valuable information for the California Violent Death Reporting System (CalVDRS)

18. The Coroner Supplement • Incident-based • Incident information: number of victims, description, police case report number • Permission-based access • Allows only coroners or their staff to view/update supplement information • Ability for Coroner to export supplement data in a format compatible with MS Access

19. Violent death supplement

20. incident information

21. Create a supplement for this incident

22. General information Toxicology Manner of death

23. Circumstances (homicide)

24. Weapon information

25. Timeline • Available with EDRS v2.2 • mid-June, 2006 • Functionality • Violent Death Supplement • VDRS Core Data Collection Set data entry • Export of Violent Death supplement for Coroners • Implementation Strategy • Collaborate closely with Calif. Coroner’s Association • Seek EDRS coroners to use it and evolve the functionality through coroner feedback • Provide functionality and training along with CA-EDRS rollout in each county

26. Concluding remarks • Consider “extending” the functionality of your EDR to collect death-related epidemiological information not on the standard Death Certificate • An example of a successful public-private partnership (DHS-EPIC, DHS-OVR, Packard Foundation, UC Davis)

27. CA-EDRS - CalVDRS Project • Acknowledgments • Packard Foundation • Office of Vital Records, CDHS • Epidemiology and Prevention for Injury Control (EPIC) Branch, CDHS