Oregon’s Electronic Death Registration System:

An UpdateOregon Mortuary and Cemetery Board

November 18, 2014

Jennifer A. Woodward, State Registrar Public Health Division

Center for Public Health PracticeCenter for Health Statistics

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Overview of the Center for Health Statistics

Changes in new law Electronic Death Registration Communication Questions and Discussion

What are we talking about today?

Overview of the Center for Health Statistics

Analyze

What do we do?

Vital records

Collect

Register

Amend

Store

Sell

Analyze

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CHS (Vital Records) is one of a few state programs (below the agency level) that is created in statute.

ORS 432.010 (1) There is established in the Oregon Health Authority the Center for Health Statistics, which shall maintain, operate and advance the system of vital statistics throughout this state . . .

General responsibilities according to law

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National standards set by:

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Social SecurityAdministration

County Vital Records Funeral Directors Hospitals Medical Examiners State Medical Examiner Division of Child Support Department of Human Services Medicaid County Clerks Circuit Courts Secretary of State Department of Revenue

…..to name a few

Our external partners

1903 1915 1927 1939 1951 1963 1975 1987 1999

Registered domestic partnership records

2008

Divorce records1925

Fetal death records1919

Marriage records1906

Birth and death records1903

6 million vital records in Oregon

Overview of the Center for Health Statistics

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1999

Number

Births 45,582Deaths 33,888Marriages 24,871Divorces 14,198ORDP 538Diss. of Dom Part 109Fetal Deaths 265ITOPS 8,186Total Records 127,637

Vital Events in Oregon: 2013Population = 3,919,020

Other work we did in 2013

Vital records issued 168,642Amendments to records 36,771Average # certificates issued/day 682% orders processed as rush 69%Highest number of certificates issued in a month (March 2013)

16,566

Changes in vital records law

House Bill 2093 – Vital Records Modernization- Jan. 1, 2014 Reorganized and updates vital records law.

◦ Last revision 1997 Based on a model state vital statistics law 80% of the law the same - just easier to

understand 20% new requirements

◦ Improve security and confidentiality of vital records and vital statistics

◦ Strengthen death registration ◦ Streamline the law

Major items of new law pertaining to death records

Who can certify the death?Physicians, nurse practitioners and physician assistants licensed in Oregon, Washington, Idaho or California

Major items of new law pertaining to death records

Increase use of Electronic Death Registration

Law requires hospitals with more than ten deaths to have records certified in OVERS

Highlights of new law pertaining to death recordsNo public record Oregon is closed record state No public source of information

◦ Previous years death abstracts at the county were public

◦ No longer public record Report and abstract of death now 24-hour

Notice of Receipt of Body

Highlights of new law pertaining to death records

Order form required New law requires written application for

every order for certified copies of death certificates.

What did not change in law

Electronic Death Registration

Two ways to submit records…….

Paper Electronic

Secure web-based system

Real time

Comprehensive vital records system Electronic Death Records (EDR) (2006)

Electronic Birth Records (EBR) (2008)Electronic Fetal Death Records (2008)

Moves CHS from paper-based to electronic.

Electronic - Oregon Vital Events Registration System (OVERS)

Who using EDR?

All paper Split OVERS Total

Funeral directors 16 29 224 269

Funeral homes 10* 32 149 181

*5 of the 10 funeral homes not using OVERS are out of state.

Who is using EDR?September 2014

Electronic Hybrid PaperDoctors 20.9% 70.5% 8.7%NP 39.5% 54.8% 5.7%PA 21.6% 70.3% 8.1%ME 88.9% 8.1% 3.0%

793 distinct medical certifiers have used EDRS to date during 2014. 4,393 medical certifiers signed death certificates.

Funeral service practitioners generally start records (except OHSU and State ME)

FSP provides to medical certifier or Medical Examiner in OVERS or on paper (hybrid)

After medical certification:◦ If paper or hybrid, goes to county to file and issue,

then forward to state for registration.◦ If electronic, state registers and available at state

and county to issue.

Who is involved in the EDR process?

Moving from paper to electronic death registration

2006 2007 2008 2009 2010 2011 2012 2013 2014 ytd0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ElectronicHybrid Paper

New law

New resources◦ Communicating the importance of EDR◦ Improving partnership with State ME◦ Dedicating staff & resources to focus on

implementation in hospitals◦ Real time public health surveillance

What our we doing to increase the percentage of fully electronic records?

Why is EDR important?

Within 5 days 6 - 10 days 11 - 15 days 16 - 20 days More than 20 days0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%August 2014 deaths -

Timeliness of Registration by method filed

Electronic

Hybrid/Paper

To the family◦ Faster access for financial and legal needs

To the funeral home◦ Faster access for the family◦ Fewer amendments for missing information◦ Accurate social security numbers◦ Less expensive in staff time, delivery costs

Don’t have to track down doctors to get paper signed

Why is EDR important?

To the hospital◦ Reports of death never misplaced◦ More secure◦ Funeral directors don’t come to facility to find

doctors◦ Process is easy, quick, traceable◦ Fewer contacts with vital records for corrections

on missing items◦ Medical certifiers can do electronic amendment◦ Comply with law

Why is EDR important?

To CHS◦ Faster registration and faster amendments◦ Fewer amendments, particularly around

Blank/missing items Social Security numbers Insufficient cause or missing injury information

◦ Comply with law (required for deaths in hospitals)◦ Meet national expectations on timeliness◦ Meet CDC contract for expanded use

Why is EDR important?

To Public Health◦ Information on number of deaths in almost real-

time◦ Information on causes of death more timely◦ Information on rare causes or emerging causes of

death more timely

Why is EDR important?

80% fully electronic by August 2015

Do not anticipate 100% electronic◦ 2013 deaths 33,906 registered deaths◦ 4,928 medical certifiers

14 signed more than 100 records (mostly ME) 36 signed 50 – 100 records 899 signed 10 – 49 records 3,979 signed fewer than 10 records

1,743 signed one record

Goals for adoption

Method death record filed for facility deaths by month (non-Medical Examiner)

Facility where death occurred SeptemberElectronic %

Harney District Hospital 3 100.0%Lake District Hospital 1 100.0%Tillamook Regional Medical Center 1 100.0%Doernbecher Children's Hospital 1 100.0%Blue Mountain Hospital 1 100.0%OHSU Hospitals and Clinics 54 98.2%Sacred Heart Medical Center - RiverBend 39 81.3%Legacy Emanuel Medical Center 10 71.4%Legacy Good Samaritan Medical Center 8 66.7%St Charles - Madras 2 66.7%Kaiser Foundation Hospital - Westside 5 62.5%Tuality Community Hospital 6 60.0%Adventist Medical Center 12 57.1%Sky Lakes Medical Center 5 55.6%Legacy Mount Hood Medical Center 6 54.5%

Getting hospitals on EDR

Signature pads – targeted at medical certifiers

Other functionality for funeral homes◦ Enter time of death in record if no medical owner◦ Change date of death in record if no medical

owner◦ Medical certifier to refer to funeral home

Ordering online 24 hour receipt of body notice (card)

Future plans

OVERS help desk One-one with CHS staff Newsletters Emailed notices and alerts Information on the web Training on the web Webinars Reports

Communication

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Questions or comments?

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Contact informationJennifer WoodwardJennifer.A.Woodward@state.or.us971-673-1185

Thank you