The Vermont Department of Health (VDH) has been planning the development of electronic systems for vital events for several years as the older, paper driven processes are inefficient and time consuming. Prior to EDRS, the Vermont EBRS (Electronic Birth Registration System) was implemented in 2005. Nationally, electronic death registries are currently in use or development in over 40 states as well as the District of Columbia and New York City.
This move to electronic reporting presents an opportunity to address two important concerns in death reporting, timeliness and quality of information. Prior to EDRS, it took an average of 38 days from the date of death for a completed death certificate to arrive at VDH. With the initial roll out of the EDRS to funeral directors and town clerks we have already reduced this to an average of 4 days from date of death to registration of a certificate. However, with the medical certification of deaths submitted on paper, the need to verify unclear or incomplete information continues to cause delays.
When physicians and funeral directors are enrolled as EDRS users, the information they certify is available to the Vermont Department of Health immediately. Equally important, with the EDRS physicians will receive feedback regarding information they have provided about the cause of death at the time they are actually completing the certification. Edits in the system prompt users to provide all appropriate details and assure items such as dates are consistent and complete. Edits also help identify cases that should be referred to a Medical Examiner for review.
Additional Factors Driving Implementation
Need for more timely termination of SSA benefits and fraud prevention
The Social Security Administration (SSA) seeks to reduce costs and the chance of fraud by canceling benefits as soon as possible after the event of a death. The EDRS is seen as an important tool in accomplishing this and VDH received funding from SSA in 2005 to develop and implement an EDRS. In return, VDH must transmit deaths to SSA within 5 days of the event and within 24 hours of receipt.
Federal legislation requires an EDRS to be in place.
The Real I.D. Act of 2005 included minimum standards for state-issued driver’s licenses or personal identification cards, including requirements for verification of an applicant’s identity. As a result, state Vital Records’ Offices are required to have the following items in place by the end of 2010:
- Centralized database at the state level which contains all birth and death certificates dated back to 1935 with the most up-to-date (within five days of event or modification) information, including corrections and amendments.
- All deaths matched to corresponding births.
- Electronic messaging system integrated with the database to allow for state and federal agencies to conduct electronic (automated) verification of a birth or death.
Includes features that improve quality of death data
Clear and accurate reporting of death is important for providing families with an accurate account of their loved one’s death. It is also important because this information is used for local, national and even international public health planning and research. Unfortunately, in the past, the information provided on certificates has often been incomplete or inappropriate.
The EDRS includes edits that assure all required fields have been addressed. The application also prompts users to confirm all available information has been provided when a cause of death appears incomplete or unlikely. Finally, the electronic record eliminates the issue of illegible handwriting and prompts users to spell out abbreviations.
Supports proper reporting and review of “unnatural” deaths
Failure to report cases that require review or certification by a medical examiner has been a concern with the paper process. At times this is due to physicians who are uninformed about Vermont’s reporting requirements; other cases have resulted from a failure to adequately state an underlying cause. Prior to the EDRS, these cases were often caught upon review of certificates by the Chief Medical Examiner after disposition. While the OCME will continue to monitor certificates to assure reporting requirements are met, edits in the EDRS will also alert physicians at the time of reporting if the cause indicates a case that likely requires review or certification by a medical examiner.
Allows real-time monitoring of deaths
The EDRS provides an opportunity to immediately flag deaths from rare causes and monitor early indications of pandemic or bioterrorism events.
- A death can be certified any time of day or night from any place the user has internet access.
- Funeral Director and Physician no longer need to sign the same paper form. This reduces the need for travel and results in more timely transfer of necessary documentation among parties involved in certifying a death and facilitating disposition.
- Data entry directly by the physicians will eliminate the need for Vital Records staff to follow up regarding incomplete or illegible information. Physicians will receive feedback at the time they complete the certification.
- Users can print documentation from the system at any point in the process including a Preliminary Report of Death or Informational Copy of the Death Certificate that can be used for record keeping or to obtain permits necessary for facilitating disposition. .
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