The US Vital Statistics System: Challenges for the Future from a State Perspective

1. The US Vital Statistics System: Challenges for the Future from a State Perspective By Garland Land Executive Director of NAPHSIS Presented at the 2007 MCH Epidemiology Conference

2. Plans and Challenges for the Vital Statistics System Importance of Vital Statistics for MCH • Low birth weight • Prenatal care • Smoking during pregnancy • Key birth defects • Birth spacing • WIC participation • Race and ethnicity • Infant mortality • Perinatal mortality • SIDS • Etc.

3. Plans and Challenges for the Vital Statistics System What we (NCHS, NAPHSIS and the vital statistics offices) are doing or not doing to improve the vital statistics system has direct impact on your work.

4. Plans and Challenges for the Vital Statistics System State and National Initiatives Affecting Vital Statistics • Re-engineering vital statistics information systems • 2003 U. S national standard certificates • Accessing new 2003 standard certificate data • Automating inter-jurisdictional exchange of vital records • Coordination with other programs • Training and technical assistance • Standards • Data quality • Web-based data dissemination query systems (WDQS) • Funding the Vital Statistics System

5. Plans and Challenges for the Vital Statistics System Re-engineering the Vital Statistics System • In past, most states have used client-based electronic systems to collect birth records • The NCHS and NAPHSIS jointly sponsored a re-engineering effort that has led to: • National use cases that represent about 80% of business functions of all the states • National edits • States either purchasing vendor web applications or developing own applications based on re-engineering specifications • NAPHSIS has two staff that provide technical support for states implementing re-engineered systems

6. Electronic Death Registration Systems, by Jurisdiction, With SSA Funding Indicator, July 2007 Washington * Maine Montana North Dakota Minnesota * * Oregon * VT * * * Alaska Wisconsin NH * Idaho * South Dakota MA * * New York Michigan CT Wyoming RI * Pennsylvania Iowa NYC * Nebraska NJ Nevada * Ohio Indiana * DE Utah * * Illinois * MD WV Colorado Missouri * Virginia * Kansas DC California Kentucky N. Carolina Tennessee Arizona Oklahoma Arkansas New Mexico S. Carolina * * * * * Georgia MS Alabama * * Received SSA Funding LA Texas * * * * Florida * Hawaii Status Up and Running In Development Planning/Requirements Stage

7. Electronic Birth Registration Systems Updated August 2007 WA ME MT* ND MN OR VT AK WI NH ID MA SD NY MI WY CT RI PA IA NYC NE NJ NV OH IL IN DE UT MD WV CO MO VA KS DC CA KY NC TN AZ OK AR NM SC GA MS* AL* * Re-engineered without 2003 certificate LA TX FL HI* Re-engineered In Development Planning/Requirements Early Planning

8. Plans and Challenges for the Vital Statistics System Some of New 2003 Birth Data Items:

9. 2003 U.S. Certificate of Birth Use Updated October 2007 WA ME MT ND MN OR VT AK WI NH MA ID SD NY MI WY CT RI PA IA NYC NE NJ NV OH IL IN DE UT WV CO MD MO VA KS DC CA KY NC TN AZ OK AR NM SC GA MS AL LA TX FL HI Implemented 2003 revision In Development Planning No Current Plans

10. Plans and Challenges for the Vital Statistics System Accessing New 2003 Data • Data available directly from the states that have implemented the new standard certificate • In 2006, the states passed a motion that restricted access to the data at the national level • In 2007, the states passed a motion to collaborate with the NCHS on the analysis, dissemination and publication of 2003 data items

11. Plans and Challenges for the Vital Statistics System Automating Inter-jurisdictional Exchange of Vital Records • For several decades, states have agreed to send copies of records that have occurred in one state to the state of residence • Most records exchanged are hard copies or computer listings • Some states have such limited resources that they: • Do not send all their records to the residence states • Do not key the resident records into their data base • States have endorsed the concept of electronic record exchange: • State and Territorial Exchange of Vital Events (STEVE) • Messaging system that allows the sending state to define the rules regarding what agency/program can receive which records and which data elements • Expect to start implementing STEVE system in the states by 2008

12. Plans and Challenges for the Vital Statistics System Coordination with Other Programs--EHDI • Vital records jurisdictions are encouraged to coordinate with their state EHDI program to ensure use of the most efficient and effective system of collecting necessary data that measures EHDI performance indicators using birth data where appropriate • As efforts are made to re-engineer their birth systems, NAPHSIS members are encouraged to consult with appropriate EHDI staff throughout the project development process with regard to accommodating EHDI data requirements • Consistent with federal and jurisdictional statutes and vital statistics procedures, NAPHSIS members are encouraged to provide data requested by the jurisdiction’s EHDI program in order to report on progress towards achieving the national EHDI goals • Motion passed 6/06/07

13. Plans and Challenges for the Vital Statistics System Coordination with Other Programs—EPHTN • Cooperative agreement with CDC • Provides education and awareness to NAPHSIS members regarding the EPHTN and to EPHTN members regarding vital records

14. Plans and Challenges for the Vital Statistics System Training and Technical Assistance • ASTI courses have been eliminated • NCHS only able to provide two training courses • Registration Methods • Basic Course on Vital Statistics Analysis • NAPHSIS is developing a training program • Birth clerk training • Other • NAPHSIS is developing a Technical Assistance Program

15. Plans and Challenges for the Vital Statistics System Standards • Statistical • Security • Metrics • Accreditation

16. Plans and Challenges for the Vital Statistics System Data Quality • Data quality varies across vital records jurisdictions • Some states have lower than expected infant mortality rates because not all deaths are reported on some very low birth weight babies • Some states have unknown rates for some variables that are 3 to 10 times higher than other states • The true data quality is not known for most states • NCHS and NAPHSIS have recently formed a data quality workgroup

17. Plans and Challenges for the Vital Statistics System Data Access • About half of the states have Web-based data query systems (WDQS) • Expensive to develop and maintain • NAPHSIS is assessing our ability to partner with a current system and make it more widely available

18. Plans and Challenges for the Vital Statistics System Financing the Vital Statistics Cooperative Program (VSCP) • NCHS purchases vital statistics data from the states to create the national vital statistics databases • For the last several years, NCHS has insufficient funds to purchase 12 months of data based upon the funding formula agreed to by the NCHS and states • Has led to purchasing a partial year of data from one year’s appropriation, and purchasing the remaining data from the next year’s appropriation • While rejected, consideration was given to skipping a year of birth or death data to solve the budget problem

19. Plans and Challenges for the Vital Statistics System Financing the Vital Statistics Cooperative Program (VSCP) ….continued • No funding to develop electronic birth systems and implement the 2003 standard certificates • SSA has provided partial funding to about 30 states to develop electronic death systems • The President’s Budget for FY 08 is flat for the VSCP • Fewer months of data can be collected because of cost of living index built into purchasing formula • The “Friends of NCHS” have been able to get Congress to increase funding for the NCHS and VSCP for FY 08 • However, the President may veto the final bill

20. Plans and Challenges for the Vital Statistics System The Vital Statistics System • Has been around for over a hundred years • Is taken for granted • Is appreciated but not supported • We think we know what needs to be done to improve it • Several good things are happening • We welcome your suggestions and support