MORTUARY SCIENCE PROGRAM
P.O. Box 64882, St. Paul, MN 55164-0882
Telephone: 651-201-3829
Email: [email protected]
Mortuary Science Ad-Hoc Meeting Agenda
April 12, 2016
1:00 PM – 3:00 PM
Hiway Federal Credit Union
840 Westminster Street St. Paul, MN 55130
IN ATTENDANCE:
Present Members
Alexa Goetsch
Tim Hoff
Jody Bystrom
Carrie McGhee
Joe Sellwood
Robert Ryan
Mike Carroll
MDH Staff Members
Marguerite Slonine
Laurie Studer
Carlena Weiland
Erika Fulgern
Molly Crawford
Guests
None
Absent Members
Mark Arnold
Anne Kukowski
Dr. Michael LuBrant
Mark Ballard
Peter Lind
AGENDA ITEMS:
1. Introductions
2. Announcements
a. Agenda change - Move preceptor‘s responsibility to June meeting.
b. Mortuary Science website now has a practitioner section which includes
announcements and links.
c. Currently under announcement dashboard “No CE waivers accepted as of Jan. 1,
2016”.
d. Individual links include CE, Forms, Military exemption, pre-need, and FTC vs. State
Regulation.
e. Legislation: Couple constituents from St. Cloud area, Representative Knoblach
initiated language for prep room, MDH is neutral on this subject as well as MFDA.
Bill is currently moving through the House Committees.
To obtain this information in a different format, call
651-201-3731. Printed on recycled paper.
www.health.state.mn.us
MORT SCI AD-HOC MEETING MINUTES
3. Current Topics
A. What kind of supervision should interns have?
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Question: What are the requirements for interns? Complete an accredited program
in Mortuary Science, pass both state and national board exams, complete an
internship (clinical hours factored in), completing 25 case reports in each of the
following areas: arrangements, services, and embalming’s.
What are interns allowed to do?
Discussed 149A.01 Purpose and Scope and 149A.71 Funeral Industry Practices.
Contract must be reviewed and signed by a licensed mortician.
Licensee liable for what goes on the contract.
What supervision is required?
In past years has been somewhat of an ongoing question for our office, MDH
recently approached.
Discussed 149A.20- Interns must be under direct supervision of a person holding a
license.
In 2009 a definition for direct supervision was added to statute.
“Direct Supervision”-means overseeing the performance of an individual and that
the supervisor is available to observe and correct.
Question: How does that work for a large funeral home vs. smaller funeral homes?
Discussed the challenges of smaller rural funeral homes and number of staff
available.
Discussed challenges of owners being preceptors.
Suggestion was made to have two preceptors.
Suggested members bring ideas to June meeting for preceptor guidelines.
Question: Asked if Interns have to identify themselves in any way- identified by
having their intern registration cards posted at the establishment.
Interns are not mandated to tell consumers they are interns.
Remark added: generally we mention they are in training.
B. MN Office of Vital Records:
1.
2.
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5.
M.R.&C Changes
M.R.&C is a state wide system. 100% of funeral homes are using this to record fact of
death, almost 100% use by medical examiners for referrals and final cause of deaths.
Funeral homes enter death into system. 20% are not filed electronically. Staff
assistants designated by physicians entered 81% of death records, 19% were
entered by vital records staff. Ramsey County on starts on Feb. 22 one request at a
time that they will not accept paper and explained they need to get the physician
signed up and send the paperwork electronically. Last month we signed up over 100
physicians to use M.R.&C. Tripled from last year.
Coming in May:
Eliminating some email’s received from M.R.&C
Can set default on location, set a primary location
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MORT SCI AD-HOC MEETING MINUTES
6.
7.
Processing Times
110 offices in MN process birth/death certificates. State office does not have walk-in
service. Our processing times are increasing. Paper worksheets coming in to register
deaths takes up a lot time. Processing time usually takes a few days. People are
calling to ask if we received their fax or mail which takes more time which leads us
to the paper project.
8. MN Paper Cut Project
9. GovDelivery helps report any changes or updates if you are a subscriber.
10. Death registration added a question regarding embalming to help track.
11. CDC may help fund additional upgrades and positions to help move things along
faster. To help get the final push of everyone going electronic.
4. Question asked: Certificate ordering. Any issues? The only issue stated was some funeral
establishments do not like the $40 amendment fee. Sometimes family reports wrong
information and the death certificate needs to be changed funeral homes feel bad charging
the $40 so they may cover cost.
5. Topic Requests: Please email [email protected] or [email protected]
6. Adjourned: Meeting Adjourned at: 2:50
7. Next Meeting:
June 7, 2016,
1:00 p.m. – 3:00 p.m.
Hiway Federal Credit Union
840 Westminster Street, St. Paul, MN 55130
3
Hennepin County
Medical Examiner
612-215-6300
530 Chicago Avenue
www.hennepln.us/me
Minneapolis, MN 55415
Fax-Administration: 612-466-9970
Fax-BIDing: 612-466'9980
Fax-Investigations: 612-466-9990
Andrew M. Baker, M.O., ChiefMedical ExaminerofHennepin, Dakota and Scott counties.
December 21,.2015
Dear Funeral Directors,
We are quickly approaching the beginning of a new year. Aswe reflect on 2015, the year brought
several improvements in the area of customer service, including the addition of a full time Morgue
Operations Attendant to assist Funeral Home staff, and updating internal processes to decrease
turnaround times on cremations and death certificates.
In addition, we were fortunate for the opportunity to provide MDH Office ofVital Records with a
· liaison to help improve Death Certificate and Cremation processes in the MR&C system. Several of
those enhancements have already been implemented.
As we look ahead to 2016, we want to continue this momentum and incorporate existing
technology to improve our collective partnership.
·
' · · ··
Beginning Monday; Januacy 4,.2016 the Hennepin County Medical Examiner's Office wiUno
longer accept paper or faxed cremation approvals on cases that we have assumed jurisdiction
and will sign the death certificate. This includes deaths in Hennepin, Dakota and Scott comities.
Cremation approvals on MedicalBxaminer cases must be entered and approved in the MR&C
system:
We will continue to accept paper and fax cremations only on deaths certified by a private
physician, or occurring outside of the Hennepin, Dakota and Scott county jurisdiction.
Thank you for your patience and continued support as we implement this new process. I firmly
believe this change wiUbenefit both ofus.
Cheers,
ShawnJ Wilson Oper,itions Manager .. . .· ·.•· .·.·•.. Himnepi11 County fyledicalEx~min~r · Midwest Medical Examiner's Office
Accredited by
14341 Rhinestone Street NW, Ramsey, MN 55303
Phone:
763-323-6400 + Fax:
763-323-64 79
A. Quinn Strobl M.D. Chief Medical Examiner
Anne Bracey M.D. + Michael Madsen M.D.
March 31, 2016
Dear Funeral Directors:
In cooperation with Minnesota Department of Health and in support of efforts to transition to online
only/electronic death certification, the Midwest Medical Examiner's Office will no longer accept
paper/faxed cremations for cases failing under the Medical Examiner's jurisdiction (i.e. the Medical
Examiner is responsible for signing the death certificate), as of April 15, 2016. This will streamline the
process and prevent reduplication of efforts (currenUy the Medical Examiner has to authorize both
paper and oniine cremation approvals for every decedent).
Our goal is to have all cremation approvals completed online and we will be working with our
communities' physicians, in collaboration with the Minnesota Department of Health, to achieve this
goal. We are aware many physicians are already registered, yet are still asked to fill out paper
cremation approvals. We encourage you to start utilizing electronic cremations whenever possible.
It is clear online certification and cremation approvals will benefrt all by improving turnaround time,
preventing errors due to legibility, and helping physicians by prompting them to contact the medical
examiner when invoking injury to prevent unnecessary delays in filing.
We greatly appreciate your cooperation and assistance in this transition.
Sincerely,
~ ~ - - ­
A. Quinn Strobt MD
Chief Medical Examiner
AQS
---------
-·~----­
OFFICE OF VITAL RECORDS
Improving the Timeliness and Quality of
Minnesota’s Electronic Death Registration System
TASK ORDER REQUEST FOR PROPOSAL NO: 2016-Q-93751
TECHNICAL PROPOSAL
Request
The Minnesota Department of Health (MDH), Office of Vital Records (OVR) wants to improve the
timeliness and quality of death records and to maximize use of its electronic death registration
system (EDRS). OVR’s strategic plan, program goals, and practice of continuous improvement align
with the goals of the National Center for Health Statistics (NCHS) as described in the Task Order
Request for Proposal No: 2016-Q-93751. In addition to improving performance within its own
jurisdiction, Minnesota aims to strengthen the National Vital Statistics System, enhance the Vital
Statistics Cooperative Program (VSCP), and improve the quality of death data and timely reporting
and availability of death data.
OVR is responding to the task order with this proposal because Minnesota has been unable to
achieve the goals identified in the five-year road map launched by NCHS in 2013. OVR fears that
without the funds awarded through the task order contract, Minnesota will not have the necessary
resources to achieve and sustain the targeted results within the road map timeframe. OVR requests
the maximum award of $210,000 and a 24-month project period to accomplish the work, meet
objectives, and achieve the project goals.
Readiness
Minnesota meets the requirements, shares the vision, and can benefit from task order resources.
OVR is ready to perform. If awarded, a formal project plan and contractual agreement would provide
OVR an operational framework to propel the program forward assuring continuous improvement
activities. It would also focus OVR to achieve the project goals by assigning a high priority to
improving death registration and maximizing use of its electronic system, the Minnesota Registration
and Certification (MR&C) System.
OVR meets the minimum threshold to respond this Task Order Request for Proposal No: 2016-Q93751. Minnesota has:
1. A signed VSCP contract
A. OVR’s current VSCP contract no: 200-2012-50824, was issued on June 11, 2012.
a. The VSCP Contracting Officer is listed as Christine Godfrey and multiple authorized
representatives signed on MDH’s behalf
b. Minnesota has delivered on time and is in good standing with NCHS.
2. A functional EDRS.
Minnesota’s EDRS is the MR&C System. MR&C is a real-time, electronic web-based system used
statewide. It was developed under contract specifically for Minnesota. MR&C is owned and
operated by OVR and maintained by technical staff employed by the state. MR&C was introduced
in 2011 and is the third EDRS in Minnesota. MR&C:
A. Operates in all geographical units in Minnesota. It is used in all 87 counties and is accessed by
physicians throughout the state
B. Uses the 2003 U.S. standard certificate for deaths
C. Uses the NCHS edit specifications to improve the quality of death information.
In addition, should OVR be awarded funds, the framework for success is in place for immediate
implementation. MDH (DUNS 804887321) is registered in SAM and is active; the CAGE code, it is
1YBC4. If awarded, OVR will comply with all of the contract terms including performance reporting,
timely deliverables, CDC37.0001 Non-personal services; clear identification on communications and
correspondence, receipt of payment through electronic funds transfer, timely and correctly
submitted invoices, and abstinence from lobbying activities. Furthermore, OVR will comply with all
special contract requirements, participation in the Contractor Performance Assessment Reporting
System (CPARS), evaluation of performance using CPARS, and all other requirements.
Goals
OVR will identify its strategies to reach the national timeliness goals as outlined in the task order
Scope of Work so that within two years of the award, Minnesota will achieve the following:
• Receive at least 80% of its mortality records electronically through its EDRS
• Transmit death information collected through MR&C to NCHS within 10 days of the
date of death for at least 80% of death events occurring within its jurisdiction
• Transmit data about deaths related to state-specified causes of deaths to the State
Epidemiologists within one day of the registration or receipt of the specified cause
Need
Data is an important part of helping federal, state and local health departments achieve better health
outcomes for their constituencies. Currently gaps exist in the timeliness, accuracy, and usability of
vital record death data which hampers effectiveness in its use. Additionally, this data and its timely
availability on individual certificates are important to the families of the subjects of the records.
Because local public health agencies may be compromised in their ability to do surveillance activities
by the length of time it takes to receive death data, they have requested death data sooner than
what has regularly been available to them. Local public health agencies from multiple jurisdictions
want death data in real-time to intervene and take preventative actions sooner so that the health of
Minnesotans is better protected, maintained, and improved. OVR has made significant improvements
to meet this need, but more can be done.
Families are sometimes forced to wait for long periods of time before a death record is finalized with
both the fact and cause of death. The availability of a complete death record affects access to death
certificates that satisfy estate settlement needs and emotional closure.
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Minnesota Department of Health, Office of Vital Records
Within MDH, multiple programs rely on accurate and timely reporting of death events. Some
programs require death data containing the literal cause of death information and others require
coded information. OVR authorizes data users, manages multiple agreements and adjusts resources
to meet the increasing demand for death data to be shared in near real-time so that programs can
carry out their duties and obligations.
Background
MDH, OVR oversees and maintains a reliable statewide system to register, certify, and report vital
events. About 42,000 deaths occur annually in Minnesota. The majority of these deaths, nearly 80%,
are registered completely electronically through the MR&C system. Minnesota statute requires the
fact of death to be reported within five days of the event while cause of death reporting has no
similar statutory requirement. Furthermore, statute allows only physicians, medical examiners, and
coroners to provide the cause of death.
Minnesota has had an EDRS in place since 1997. When OVR introduced MR&C in 2011, OVR adopted
the 2003 U.S. standard certificate and employed many new technological features. OVR also pushed
to transition users from one system to another and recruit new users. In the five years since, paper
cause of death registration continues.
As a third generation EDRS, OVR was confident that MR&C would streamline the death registration
process, improving both timeliness and data quality through automation, systematic triggers, and
programming to error-proof data entries. Currently, 100% of funeral professionals use MR&C to
register the fact of death. Many physicians have user accounts for the system; however, a large
number of physicians have never established a user account or have an inactive account. OVR has
been unable to maximize electronic system efficiencies.
Although physicians must provide the cause of death, OVR allows physicians to designate staff to
enter the cause of death into MR&C on their behalf and under the physician’s direction. With this
arrangement, OVR requires physicians and their designated staff to document their process and
cooperate with any audits in addition to signing an MR&C user agreement that details the
designation and authority. Designated staff provide the cause of death information for about 65% of
the electronically filed records. Together these designees and physicians electronically file cause of
death consistently above 75% of the records.
Thus, about 25% of death records filed in Minnesota require OVR intervention and resources to
manually enter the cause of death information provided on paper. OVR staff must review cause of
death worksheets for completeness and many worksheets must be rejected due to missing or illegible
information—both of which could have been eliminated had the MR&C System been used. About a
quarter of the paper worksheets that OVR receives involve records that have the cause of death
provided by a physician with an MR&C account, but who failed to register the cause of death online.
Furthermore, a fair number of worksheets that OVR staff attempt to complete have already had the
cause of death registered online in MR&C. Thus, sometimes a physician provides the cause of death
for a decedent as many as three times: on a paper disposition authorization, on a paper cause of
death worksheet, and online in MR&C. Because OVR staff do not know which paper worksheets may
already have the cause of death registered online, they must look at each record in MR&C regardless.
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Minnesota Department of Health, Office of Vital Records
Statutory requirements for disposition authorization and ingrained paper processes waste valuable
time and consume limited resources resulting in redundant activities to provide cause of death
information. Paper complicates, competes with, and prevents full use of the MR&C System.
Barriers
Despite a long history of electronic death registration and these successes, OVR has not achieved full
participation of the physician communities. The perpetuation of paper among members of the
funeral industry and stagnant growth of online registration limits Minnesota in improving timeliness
of death reporting and for near real-time public health surveillance.
The reasons for Minnesota’s limited participation are many. They involve a complex interaction of a
lack of funding, split reporting responsibilities between funeral staff and physicians combined with a
traditionally linear flow for death record completion, changes in OVR leadership, competing priorities,
prioritizing the needs and expectations for birth registration over death registration improvements,
inability to attract and keep physician participation, inconsistent messaging at the federal and state
levels, and lack of clear communication to professionals involved in death registration. These barriers
have not only precluded the use of Minnesota’s mortality systems for public health surveillance
purposes, but also have limited the timely reporting of national mortality statistics and the inclusion
of records in the National Death Index.
Strategies to overcome Barriers
OVR is proposing specific strategies necessary for Minnesota to reach these goals. Minnesota shares
some of the same barriers that other jurisdictions face and some barriers are unique to Minnesota’s
system, culture, laws, and system. OVR’s approach identifies specific barriers to timeliness and quality
and the project proposal outlines specific strategies to overcome them. OVR plans to follow strategies
identified in the NCHS Road Map. OVR proposes to actively solicit and recruit physicians, medical
examiners, and coroners to fully participate in online death registration through MR&C; implement
“lean” processes to overcome process barriers such as obtaining documentation for disposition and
manual data entry for exceptions; implementing VIEWS II or similar programming in MR&C to achieve
the same results; automating even more components of MR&C to remove manual steps; eliminating
paper documentation when electronic notices and records meet the need; and improving
performance management and the reporting back to data providers.
Experience
OVR has a reputation for of taking action to improve the National Vital Statistics System. In 1997,
Minnesota was among the early jurisdictions to implement an EDRS. Since that first system, OVR has
employed continuous improvement at all levels. OVR performs well and usually maintains data that is
rich and below NCHS’s tolerance levels for unknown data. OVR monitors its performance acting on
NCHS feedback and regularly-issued performance data; self-monitoring, analysis, and examination;
customer and partner input and feedback; and use of available technology.
OVR embraced innovation when it replaced its second EDRS in 2011 with a more responsive, realtime web-based system, the Minnesota Registration and Certification (MR&C) system. MR&C is an allpurpose system to register, certify, and report vital records statewide. MR&C automated many
manual responsibilities, integrated disposition functions, standardized activities and service, and
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Minnesota Department of Health, Office of Vital Records
changed vital records forever in Minnesota. MR&C was built in-house under contract with Sogeti, and
continues to be upgraded, enhanced, and maintained by State of Minnesota IT staff who work
directly with the OVR program staff.
Together with its local agents and partners, federal programs, and state staff, OVR oversees a highly
functional system that values and employs continuous quality improvement. OVR’s past efforts have
succeeded in moving the dial on increasing the use of MR&C for cause of death registration and for
improving death data timeliness, accuracy and availability.
With the advent of MR&C in 2011, OVR invested resources to carry out an ambitious Field Services
plan to identify, recruit, and support physicians in using the new system. This one record and one
physician at a time approach resulted in physicians who maintain active accounts and routinely use
MR&C with success and a significant number of physicians who transitioned from the previous
system only to let their user accounts become dormant.
OVR will gather a strong and effective project team to accomplish goals and objectives. Including the
Education Coordinator who will be hired from the proposed project budget, the 17-member team
brings knowledge, abilities, skills, and years of professional experience in their areas of expertise.
Resumes are included in the proposal attachments. The proposed team includes:
OVR Leadership:
• Molly Crawford, State Registrar—Project Sponsor
• Heidi Granlund, Deputy State Registrar—Project Manager
• Krista Bauer, Registration and Amendments Supervisor—Team Member
OVR Staff:
• Cheri Denardo, Data Quality, Nosologist—Project Team Leader
• Neeti Sethi, Data Quality, Nosologist—Team Member
• Gloria Haluptzok, Data Quality—Team Member
• Sally Almond, Field Representative—Team Member
• Kirsti Taipale, Communications Specialist Field Representative—Team Member
• Maria Schaff, Health Educator Field Representative—Team Member
• Ann Porwoll, Fiscal Analyst—Team Member
• Cindy Coleman, IT Liaison Field Services—Team Member
• NEW HIRE, Health Educator—Education Coordinator
IT Staff
• Ping Li, IT Supervisor—Team Lead
• Otto Hiller, Developer—Team Member
• Larry Winship, IT Lead, Developer—Team Member
• Arifun Chowdhury, System Tester—Team Member
• Cindy Joanning, Developer, Tester—Team Member
Many of the OVR staff have similar experience that uniquely qualifies them for the project. For
example, OVR employs two nosologists who monitor death registration and with team members
focused on data quality, react to NCHS’s performance reports. They inform Field Services and help to
prepare targeted approaches to embrace opportunities for improvement, prevent problems, and
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Minnesota Department of Health, Office of Vital Records
convert reluctant partners and problematic users. Various efforts have resulted in Minnesota
improving the literal cause of death reporting, receiving specific and meaningful ICD-10 coded
records, and eliminating delays. Some OVR staff participate on NCHS/NAPHSIS committees and
special projects within MDH.
Team members will have active roles throughout the project. In addition to these core members, OVR
expects to engage participation from internal agency programs such as the Public Health Practice
Section which employs MDH staff who specialize in quality improvement, strategic planning,
community engagement, and meeting facilitation. OVR expects to seek input from the MDH Center
for Health Equity to consider opportunities to promote health equity and eliminate disparities. OVR
will seek new partnerships in the licensing and compliance area at MDH. The proposed project
requires engaging health care organizations and facilities. OVR will need regular data about licensed
facilities. In addition, OVR will request access to data about licensed physicians from the Minnesota
Board of Medical Practice that is being received and used by other MDH programs. OVR also plans to
seek support for the proposed project from programs that rely on death data.
Engaging external partners representing key audiences and Minnesota vital record voices will be
essential. OVR will target participation from physicians, medical examiners, funeral directors,
morticians, funeral staff, and other professionals important to vital records. These auxiliary members
will play roles at critical times during the project. Their expertise and support will lend credibility to
the project and will assist OVR in obtaining buy-in and compliance.
Past Performance
OVR has historically performed well on contracts and projects. Past performance can be indicative of
future performance. OVR recently completed two high-profile projects involving cross-jurisdictional
partners involved in vital records. OVR has a history of continuous improvement and delivering on
contracts and agreements.
VSCP Contract Ongoing
OVR consistently performs well on all deliverables associated with the VSCP contract. References
include Christine Godfrey and Connie Gentry from NCHS.
E-Vitals Project 2012-2014
Enhancing Electronic Health Records Systems to Generate and Exchange Data with Electronic Vital
Records Systems. Supported through a cooperative agreement U38OT000216-2 from CDC. This work
was funded by the CDC, NCHS through the VSCP – Special Projects #200-2012-50824 Task Order 0002.
The amount of the contract was $345,000.
The Minnesota E-Vitals Project evaluated the readiness of MDH and Minnesota birth hospitals for
secure standards-based exchange of birth records information using the Integrating the Healthcare
Enterprise (IHE) Birth and Fetal Death Reporting (BFDR) Profile and Health Level Seven International
(HL7) standard message and document specifications (e-birth records standard). This project revealed
support for adoption and use of e-birth records standards. It also found that addressing the
contributing factors to the lack of readiness and implementing the recommendations will require the
effort of the entire vital records community and its partners. Continued support of e-birth records
standards will strengthen the vital records system.
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Minnesota Department of Health, Office of Vital Records
OVR continues to provide information about the project and technical assistance to health care
organizations, vital records programs, electronic health record vendors, informaticians, and others
who are interested in meaningful use, interoperability and the electronic exchange of information.
OVR staff are currently collaborating with NCHS, the State of Utah, and others to co-author a
textbook endorsed by the Health Information Management Systems Society. The book will highlight
success stories and challenges to implementing health IT standards.
References for this project include Michelle Williamson and Hetty Kahn from the CDC, and Johanna
Goderre Jones from the U.S. Department of Health and Human Services, Office of Population Affairs.
MN Death Data Delivery March 1, 2015-November 30, 2015
In 2014, Minnesota local public health agency representatives collectively approached MDH
leadership to voice their needs for vital records death data sooner. Local public health expressed a
need to have access to death data sooner than the release of the annual statistical file which was as
many as 22 months after the death events. Local public health wanted preliminary death data to
enable a more timely response to emerging issues such as drug overdose deaths so that public health
surveillance and prevention activities could be accomplished in near real-time.
Shortly after this, the OVR was invited by the Robert Wood Johnson Foundation to replicate a quality
improvement project involving death registration in North Carolina. The Robert Wood Johnson
Foundation created this project as part of their Quality Improvement Forum and offered consultants
to improve performance across federal, state, and local public health agencies. OVR received
resources but no financial award. OVR accepted the invitation and used project resources to renew
its focus on death registration and to create a solution to satisfy Minnesota's local public health
needs. The effort was named the Minnesota Death Data Delivery Project.
In the short duration of this celebrated 6-month project, OVR achieved its primary objective of
getting death data to local public health sooner in just three weeks. OVR improved coding through
analysis, testing and consultation with NCHS. OVR was able to increase the number of death records
being auto-coded achieving and surpassing its goal of an 80% return. Investing time and resources in
small improvements to MR&C such as triggers to refer records to medical examiners, error-proofing
data entry, and implementing system-generated email notifications to speed the registration process
provided a huge return. OVR also achieved success in speeding the completion of cause of death on
death records so that more than 50% are finalized within the first three days of fact of death being
registered—a significant shift that is important to families and their choices for disposition. By getting
preliminary death data, representatives from the local public health community report that they feel
the ”pulse" of the mortality landscape and that the substantial reduction in wait time for data
enables a more timely response to emerging issues. In fact, some believe that the leveraging effect
may improve upon persistent public health issues such as traffic fatalities, infant mortality, sudden
unexpected infant death, and other efforts.
On January 14, 2016, OVR received the Minnesota Governor’s Continuous Improvement Award for
improving the quality and availability of Minnesota vital records death data accomplished through
Minnesota’s Death Data Delivery Project.
References for this project include Pamela Russo from the Robert Wood Johnson Foundation, Donna
Marshal from the Association of State and Territorial Health Officials, Karen Knight and Matthew
Rowe from the CDC, NCHS, Patricia Potrzebowski from the National Association of Public Health
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Minnesota Department of Health, Office of Vital Records
Statistics and Information Systems (NAPHSIS) , and Chris Bujak and Pam Vecellio from Continual
Impact.
Approach
OVR partners with Minnesota funeral directors, morticians and their staff, physicians and health care
organizations, medical examiners and coroners, as well as federal, state, and local programs involved
in death records, certificate issuance, and data sharing to improve public health. The proposal and
funding will not require legislation, new rules, or changes to existing rules. The work involved in
meeting the goals can be accomplished within the current legal framework.
If awarded, MDH, OVR would fulfill its purpose and conduct activities already required by statute,
rule, and contract with NCHS. The award would allow OVR to focus resources on improving death
registration and specifically on increasing physician use of the electronic vital records system. Shortterm commitments would involve devoting existing resources toward these goals while supporting
and maintaining operations and the statewide vital records program. The award would provide a
source of funding to allow for technical enhancements and programming to improve the timeliness
and quality of mortality data. The project would help OVR recruit physicians to use the electronic
system for reporting death data and put in place tools to provide ongoing technical support and
stakeholder service while sustaining maximum use and efficiency.
This competitive task order award would supplement the ongoing VSCP contract between MDH, OVR
and NCHS to electronically transmit birth and mortality data to the National Vital Statistics System
and to receive coded death data back.
The task order provides an opportunity to improve the timeliness and quality of mortality records so
that the National Vital Statistics System is strengthened. OVR proposes a 24-month project beginning
in April 2016. Minnesota’s goal is to improve death registration timeliness and data quality within two
years by both increasing the use of online registration and reducing paper. By March 31, 2018, this
project will help Minnesota consistently receive more than 80% of its mortality records electronically
through MR&C; transmit 80% or more of records containing death information to NCHS within 10
days of the death event; and share data about state-specified causes of death with the State
Epidemiologist within one day of death records having the cause of death completed and filed.
Within the framework of the project, OVR has its own objectives to reduce paper involved in the
death registration process, disposition, and records management related to vital records.
OVR recognizes that the project will not be accomplished in a vacuum. The statewide vital records
system, which involves many partners, customers, activities and responsibilities will continue to
operate requiring OVR to balance new initiatives with day-to-day operations. OVR is planning for
these challenges. OVR will leverage existing staff, IT resources, and MR&C system improvements
already identified to jump start the project. OVR accepts that internal and external forces may impact
vital records work while ongoing and new business needs will require attention as the team advances
the project and meets milestones on time. The project will be a proactive priority within OVR’s
traditionally reactive culture and environment. OVR staff have the training, tools, authority and
support to take action and implement change. The project would be a catalyst to change and would
provide the resources for long-term sustained improvement and increased performance.
8
Minnesota Department of Health, Office of Vital Records
OVR will use multi-phased approach during the project to assure that the infrastructure is in place to
support and sustain improved performance resulting in shorter timeframes and better quality for
death records. Although the project mostly requires a linear progression of activities from start to
finish, some work will occur simultaneously, and some phases will have soft transitions.
Others recognize the need for death registration improvement and are sensitive to the burden that
paper registrations outside of MR&C place on all partners. OVR welcomes quality improvement
efforts initiated by external partners and will support them as they are presented. Precious resources
are pushed to the limit when business practices perpetuate paper when a fully functional EDRS exists.
Several weeks ago the Ramsey County Chief Medical Examiner set a no-paper policy refusing to act
on any paper requests to authorize cremation. His refusal got the attention of funeral directors and
created a commotion to get physicians signed up to use MR&C. The move has had a cascading effect
among clinics in the Chief Medical Examiner’s jurisdiction. OVR rose to the occasion and supported
the effort in spite of little preparation. This experience reinforced OVR’s plan for a thoughtful phased
approach. Having a solid foundation in place to support the push for online use and inviting change
will be important. Managing the phases will assure that resources are allocated appropriately to meet
partners’ needs and industry demands as the project progresses.
OVR proposes the Minnesota Paper Cut Project—a five-phased approach to improving the timeliness
and quality of death registration.
Phase One—Internal focus, April-September 2016
The initial phase of the project involves internally-focused improvements and activities. Phase one
examines policies, procedures, and the programming of the MR&C System. Phase one identifies
barriers to improvement and breaks them down. Activities include:
• Strengthening the foundation of Minnesota’s vital records system
o Revise and create new policy and procedure manuals
o Revise and create new MR&C user documentation
• Building a sturdy framework to support the many important professionals involved in the vital
records system
o MR&C application enhancements
 Improve programming to support cause of death registration before fact of
death registration
 Update data tables for accurate lists of physicians and their contact information
 Integrate tools to error-proof cause of death registration and data entry
including a spell-check feature such as VIEWS II and other tools.
 Further improve automated emails and system-generated communication
 Create new and improve existing work queues within MR&C to better manage
record flow to completion
 Program MR&C to accomplish the purpose of existing paper documentation
replacing it with electronic data transfer, automated communications, and
electronic data and record repositories
o Centralizing OVR communication
 Revise website to add new information and improve existing information
 Publish resource materials, user support information, forms online
9
Minnesota Department of Health, Office of Vital Records
Create a help desk, call center to provide customer and stakeholder support via
telephone and email—create new positions, hire, train, staff (this requires a
one-time IT purchase detailed in the budget)
Creating educational materials and resources
o Improve and expand the Field Services training tool box
 Create onboarding materials to assist physicians new to MR&C
 Develop a system to address regional training needs, requests and needs
 Build relationships with health care organizations to support their in-house
training and integrate vital records training as part of employee development
 Employ technology to meet the training needs of professionals involved in
death registration
• Online training
• Webinars
• Opportunities to practice MR&C in a hands-on training environment
Gathering data and stakeholder input
o Conduct Informal and formal discussions with physicians to understand and explore
their needs, challenges, and ideas for improved death registration
o Test ideas, new MR&C features, training materials with users of the system and key
audiences
o Recruit and recognize champions external to OVR who push the project forward

•
•
Phase Two—External focus, September 2016-September 2017
This second phase of the project involves externally-focused improvements and activities. With the
OVR infrastructure in place, phase two builds on setting expectations, building awareness, informing,
and preparing the way for improved death registration fully online. Phase two continues elements of
Phase One and encourages early adoption, readying the system and the players within the system for
change. Activities include:
• Building awareness, communicating, and informing
o Perform active outreach through workshops, presentations, event exhibits with
primary audiences of physicians, health care organization risk/quality assurance
professionals, funeral directors, and others including members of the public
o Publish articles and updates acknowledging change, introducing new policies and
procedures, highlighting champions
o Support physicians and their organizations who need help in moving the project
forward
• Managing performance
o Monitor data quality and communicate information about performance
o Focus on targeted improvement areas and publish performance reports—breaking
down the project goals into incremental process improvement measures
• Sharing information
o Develop talking points for OVR leadership and staff to share consistent and on-target
messages
o Post information about the project and improved performance of Minnesota’s death
registration process online—keeping information current and fresh
• Active recruiting
10
Minnesota Department of Health, Office of Vital Records
•
•
o Identify physicians and funeral establishments that perpetuate paper unnecessarily
and reach out one at time to encourage online registration
o Approach health care organizations and facilities to encourage internal adoption
(facility/organization-wide) use of the MR&C
o Support physicians and funeral establishments that contact OVR with questions and
take the opportunity to market online registration
Onboarding new users
o Create easy process to establish MR&C user accounts
o Implement an easy password reset for MR&C
o Provide immediate instruction for new users, hands on experience
o Introduce early training and encourage/require participation
Establishing a no-paper deadline
o Set a deadline for online use for death registration—proposed deadline is September
30, 2017
o Publish the deadline, integrate deadline in communications, outreach, customer
contact
o Encourage early adoption of MR&C use before the deadline
o Strategically target health care organizations and facilities to require physicians to use
MR&C
o Prepare OVR to enforce deadline
Phase Three—Change, October-December 2017
This third phase of the project is short and direct. It involves a hard approach to make online death
registration a reality. OVR will have eliminated barriers to using MR&C and will have a solid
foundation in place to support users and overcome objections to use. OVR will stand firm. OVR will
prepare for this third phase by redirecting existing resources and staff to support late adopters and
minimize impact to customers. Activities include:
• Enforcing a no-paper process
• Expediting new user accounts and training
• Posting results, sharing performance information
Phase Four—Stabilization and Sustainability, January-March 2018
Phase four of the project involves stabilization activities with a focus on sustaining improvements and
use of MR&C. Phase four begins a process of transitioning the project into a maintenance status. This
phase also involves celebrating success, acknowledging the efforts of external partners, users of
MR&C, and other change agents. During this phase OVR will create a solid process to manage
exceptions to the new no-paper approach and resource the process for maximum efficiency.
Activities include:
• Reinforcing expectations
• Redirecting resources
• Cheering progress
• Converting late adopters
• Managing exceptions and establishing process
• Reporting back, reporting progress
• Managing performance
11
Minnesota Department of Health, Office of Vital Records
Phase Five—Manage the New Normal, March 2018-ongoing
The final phase of the project acknowledges the “new normal” and completes the deliverables. In its
journey following the NCHS Road Map to the destination goal, Minnesota will have found its new
home. This phase settles in. It documents the project, tells its story, and assures that the performance
improvements accomplished have ongoing support. Tools developed during the project as well as
activities required to sustain the new normal are operationalized. Activities include:
• Closing the project
• Shifting activities to routine maintenance
• Assuring ongoing support for operations
• Sharing information
• Reporting back to partners regularly
• Performance monitoring and reporting
• Seeking continuous improvement
OVR will use the proposed project as a springboard to recruit new and support existing physicians in
their duties and activities to register cause of death electronically. Project resources will help OVR
focus energy and effort to achieving success maximizing online registration beyond its long-stagnant
plateau. The project will allow OVR to “get over the hump” of increasing MR&C use. Strategies
included in the proposed project plan will reap short and long-term rewards. Setting new
expectations and shifting the culture will foster an environment that expects and rewards online use.
Phase five also contains an element of future focus. Deliverables accomplished in the course of the
project will sustain performance levels. Specifically:
• Equipment such as the call center/help desk will remain in place long after the project ends.
The staff hired for the call center/help desk will centralize OVR’s point of contact and triage
physician and other partners’ needs so that technical support and customer service are
immediate and seamless.
• Training and education materials as well as new training tools will be operationalized during
the project. OVR will continue to maintain these deliverables within the ongoing Field Services
work.
• Performance reporting and the mechanisms created to share data and report back to
professionals involved in vital records will gain momentum in the project and continue to fill
future demands for information and provide data for continuous improvements beyond those
achieved in the project.
• MR&C System enhancements and application innovations will remain. The project will assure
they are given priority and that they advance Minnesota’s vital records system with improved
performance. Once tested and released, they will not be undone. Furthermore, OVR’s inhouse IT professionals will continue to support the MR&C system as part of their established
duties.
Because OVR is using the funds as a catalyst for change and is integrating operational duties with the
project, it will build capacity. Current resources devoted to processing paper registrations and data
entry will be redirected. Staff will be repurposed. And OVR will sustain the improvements to
timeliness and data quality.
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Minnesota Department of Health, Office of Vital Records
By April 2018, OVR will have completed this task order project. The National Vital Statistics System
will have been improved and OVR will have accomplished much, including: 1. improving the
electronic vital records system to eliminate barriers to online registration; 2. creating user
documentation for the electronic vital records system and online documentation of policies,
procedures, and laws governing Minnesota vital records program; 3. creating education materials and
training to onboard and support physicians and other users of the system; 4. creating a single point of
contact to provide technical support and service to vital records partners in carrying out their
responsibilities for death registration; 5. building awareness of the MR&C system; 6. recruiting
physicians and others involved in death registration to voluntarily use the system for maximum
efficiency and effectiveness; 7. directing resources to sustaining use of the system and continuous
improvement beyond the goals of the project so that Minnesotans are better served with timely and
accurate death records and data.
Potential Challenges
With any project and effort for continual improvement, OVR expects challenges. Integrated in the
project planning are steps to identify challenges to incremental and full success. The skilled project
team will work together to discuss concerns, historic challenges, and possible impediments to the
proposed effort.
Potential challenges already identified include the lack of statutory requirements to register the
cause of death timely. Minnesota’s vital records system relies on physicians to respond quickly to
death registration requests in order to meet customer demands for complete and accurate death
certificates. OVR has no intention to propose legislation. Instead, it plans to work within the existing
legal framework to recognize and reward responsiveness, efficient processes to handle cause of
death registration, and facilitate timely filing.
Along the same lines, OVR plans to achieve voluntary compliance among all professionals who have a
role in vital record registration to maximize online registration. Although no mandate exists to
specifically require electronic death registration, Minnesota law gives authority to the State Registrar
to maintain a statewide system of vital records. Under the Minnesota Vital Statistics Act, the State
Registrar is responsible for the administration and enforcement of the activities of all persons
engaged in the operation of the system of vital records; is responsible to develop and conduct
training programs to promote uniformity of policy and procedures throughout the state in matters
pertaining to the system of vital records; and has the authority to prescribe, furnish, and distribute all
forms required by the Act and any rules adopted under these sections, and prescribe other means for
the transmission of data, including electronic submission, that will accomplish the purpose of
complete, accurate, and timely reporting and registration.
OVR intends to use the authority of the State Registrar to its full extent. OVR will discontinue
administrative support to process paper cause of death registrations and cease manual data entry
activities. Exercising this authority will require determination and strength by OVR staff. The project
team will need to prepare the office, the partners and professionals involved in the vital records
system, and members of the public so that expectations are set, advance notice given, and pain
associated with change is minimized.
Assessing the quality of the cause of death data occurs at many levels. OVR will work closely with
NCHS to monitor performance and compare Minnesota’s data with other jurisdictions. OVR will also
13
Minnesota Department of Health, Office of Vital Records
integrate MR&C enhancements to build on existing programming to further error-proof data entry.
Preventing problems such as misspelled medical terms, eliminating skipped data fields, and
integrating other similar straightforward programming fixes is within the project’s scope. Beyond
these quick-wins, however, OVR anticipates challenges. Data validation involving medical record
audits can be complicated and access to records and cooperation among members of the medical
community may present challenges. These higher level activities will likely be out of scope.
OVR also expects challenges to investigative efforts for continuous improvement. Sometimes asking
why in order to get to the real need is met with resistance. The project team will examine the reasons
and requirements for certain processes in order to improve them. Getting to the root of an issue and
meeting the authentic need are critical to success. To arrive at NCHS’s final destination on the
national Road Map to improving timeliness and quality in death registration, OVR must change how
business is done. OVR will not improve without approaching the work differently. Some partners
involved in death registration will push back and resist change. OVR expects some to fight to maintain
the status quo, relying on a paper process and trail for death registration. Pushing change and giving
permission to be uncomfortable is important. OVR will direct resources and effort into building trust,
engaging the community early and often, sharing ownership, and supporting the change. OVR will
work with MDH communication experts to assist in navigating these challenges. Clear messaging at all
stages and phases of the project is key.
Tasks
Task #1: Development of Project Plan
OVR will immediately begin developing a Project Plan and submit the plan within the first 30 days if
awarded the project. OVR will present the proposed plan and review it with NCHS to reach consensus
on the performance baseline timeliness reporting of death records to NCHS.
OVR’s plan will describe barriers to timely transmission of mortality records to NCHS and will propose
specific strategies to overcome those barriers. The Plan will describe how these strategies will be
executed, monitored, and controlled. The Plan will detail staff who will contribute effort to the
project as part of their continuing role in the Minnesota vital records program. OVR expects the
project team to comprise existing program and IT staff and the full-time Education Coordinator who
will be hired under the project. The Plan will summarize aspects of the project and provide detailed
information about management and activities. OVR’s plan will outline project objectives, specific
actions steps, and major milestones over the course of the 24-month project. OVR will document
assumptions and decisions about how the project is to be managed; and document the scope, cost
and time sequencing of the tasks it will undertake. This proposal provides high level information that
will provide the basis for the plan. OVR will map the major milestones on timeliness of submission of
records to NCHS and will use this data as the primary basis to measure progress.
Task #2: Implement the strategies in the Project Plan
OVR will implement the strategies outlined in its Project Plan using an array of activities to improve
timeliness and quality. OVR’s Project Plan will describe what Minnesota perceives to be the best
approaches to timeliness and improved data quality. OVR will implement those approaches meeting
timelines and the schedule negotiated between NCHS and OVR. OVR will direct award resources to
this endeavor and set priorities within OVR to leverage existing resources to supplement the award.
14
Minnesota Department of Health, Office of Vital Records
Task #3: Performance reporting
OVR will report regularly and on time each month to NCHS the status of the project activities as
defined in the approved project and compare the accomplishments with the approved schedule. In
these reports OVR will acknowledge accomplishments; describe any risks or barriers that arise that
may impede the successful completion of the project; list steps to minimize those risks or to
overcome any identified barriers; and report any other issues affecting the outcome of the project.
In addition to regular monthly reporting, OVR will provide an electronic quarterly report via the
NCHS/DVS PCOR Quarterly Report Template which will be provided by NCHS/DVS upon awarding of
the contract. OVR understands that this report will be used to monitor progress related to both the
timely electronic registration of death records and the swift transmission of the records to NCHS.
OVR agrees to meet with the NCHS EDR Project Officer at least once a year to discuss the status of
the State’s project and any contract issues at a time and location prescribed by NCHS. To conserve
resources and accomplish multiple goals, OVR will suggest that the OVR Project Manager meet with
the national Project Officer at the annual joint conference convened by NCHS and NAPHSIS.
At the close of the project when the deliverables are met, OVR will furnish a final report outlining
what was accomplished over the life of the project including information about Minnesota’s
improvements in timeliness and death data quality. OVR understands that 20% of the total contract
award will be held until OVR makes its final report.
Support
OVR’s proposal is supported by MDH leadership and partners involved in the Minnesota vital records
community. MDH is accredited by the Public Health Accreditation Board (PHAB). The department
invested much to earn its PHAB designation and continues to invest in and encourage activities,
including quality improvement, to retain its accreditation. This proposed project not only presents an
opportunity to improve the National Vital Statistics System, it will contribute to the ongoing
improvement activities required for the agency’s PHAB status. In addition, OVR works in collaboration
with other agency programs critical to the success of the proposed project. Executive leadership,
financial management officers, directors of the division, and technical staff share OVR’s vision and
support this project proposal. OVR’s goals are authentic. The program has aspired to improving death
registration timeliness and quality long before the task order was announced. OVR is ready and
hungry for results. Finally, this proposed project aligns with the mission and vision in Minnesota. It
will help MDH improve the health of all Minnesotans while OVR achieves its vision of informing Public
Health and improving lives, one record at a time.
To obtain this proposal in a different format, call: 651-201-5972.
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Minnesota Department of Health, Office of Vital Records
POINT OF VIEW
COMMENTARY
We need to end the paper trail
Why all physicians need to use the state’s electronic system for registering births and deaths.
BY MOLLY MULCAHY CRAWFORD
E
very day, more than 300 births, deaths
and fetal deaths occur in Minnesota.
Physicians play a critical role in documenting these vital events quickly and
precisely. Records of these events contain
demographic and legal information, and
important health and medical information
as determined by a physician. This information is used to monitor mortality trends
and identify public health concerns that
need to be addressed.
Registering births and deaths
Registering a birth with the state is
straightforward. One reason is that nearly
99 percent of the 69,000 births that occur
in Minnesota each year take place in hospital birthing centers, where systems are
in place for gathering and reporting such
information.
Physicians have an indirect role in birth
registration, as they are responsible for
maintaining the mother and child’s medical record. In almost all cases, a designated
representative from the hospital (usually
a health unit coordinator or a member of
the medical records staff) manually enters
information from those records into the
Minnesota Registration and Certification
(MR&C) system, the state’s electronic vital
records system. (Currently, electronic
health record systems in hospitals and
clinics are unable to exchange information
with the state’s vital records system.) Some
of the information they enter includes
the mother’s hepatitis B status, abnormal
conditions and congenital anomalies in the
newborn, breast-feeding status and maternal morbidity. According to law, a birth,
including the required medical information, must be registered with the state
within five days.
Registering a death is more complicated.
Unlike birth records, death records have
two parts. One deals with facts, such as
suicide, homicide, accidental), whether
the decedent was pregnant at the time of
death, whether tobacco use contributed
to the death and more (Minnesota Rule
4601.1800).
There is no statutory deadline for medical certifiers to register the cause of death.
According to data from the state Office of
Vital Records, the cause of death was provided within three days for more than half
of deaths registered between January 1 and
October 31, 2015 (Figure). It was provided
more than 10 days after death in 19 percent of cases, often because the record was
referred to a medical examiner or coroner
or because the physician was waiting for
toxicology findings or autopsy results.
demographic and legal information about
the decedent. The other delineates the
cause of death and includes relevant medical information. Although a death certificate can be issued with only the facts, both
parts are required for a death record to be
complete, and both parts are often needed
to settle an estate.
Funeral establishments record the facts
of a death, and Minnesota law requires
that this information be filed with the state
within five days of the event.
State law requires medical certifiers,
including treating physicians, coroners
and medical examiners, to document
the cause of death and answer questions
about it, including whether an autopsy was
performed, the manner of death (natural,
FIGURE
Length of time after death during which medical information was
filed by physicians in Minnesota, January 1 – October 31, 2015.
19%
Filed in more than
10 days
7
6
51%
Filed in 3 or fewer days
5
1 4 days (6%)
2 5 days (5%)
4
3 6 days (5%)
4 7 days (5%)
5 8 days (3%)
6 9 days (3%)
7 10 days (2%)
N = 33,775 deaths.
3
2
1
Source: Minnesota Office of Vital Records
JANUARY/FEBRUARY 2016 |
MINNESOTA MEDICINE | 33
COMMENTARY
POINT OF VIEW
More than half of the 41,500 people
who die each year in Minnesota are cremated. State law requires a body to be
preserved if final disposition will take
place more than 72 hours after death. To
save costs, families often want cremation
to take place within that period. Because
Minnesota law requires that the cause of
death be known and authorizations be
obtained before final disposition, the onus
is on the physician to file the necessary
information about the cause of death in
a timely manner. As more people choose
cremation, prompt filing of the medical
information about the cause of death will
become even more important.
The paper problem
All births and deaths are registered electronically through the MR&C system.
This system is used by all hospital birth
registrars, funeral establishments, medical examiners and coroners, and issuance
offices. Yet, only 81 percent of the records
filed by physicians are done so electronically. Further, of the records that come
to the Office of Vital Records for manual
entry of cause of death information,
27 percent come from physicians who are
signed up to use the MR&C system, but
send paper. This perpetuation of paper is
a problem for everyone involved in vital
records activities.
If a physician doesn’t use the MR&C
system or if they use it but don’t tend to
emails notifying them that there is a death
record needing their attention or check
their MR&C work queue, it’s up to the funeral establishment to make sure they submit the necessary information. More often
than not, funeral staff end up faxing the
physician a worksheet to use to complete
the cause of death. Sometimes the physician will fax that to the state, only to get an
email notification from the MR&C system
telling them to provide the cause of death
electronically. This can result in confusion
and extra work for the funeral staff and
the physician.
Continuing to provide cause-of-death
information on paper also leaves room
for error and can result in different reasons being recorded on the disposition
34 | MINNESOTA MEDICINE | JANUARY/FEBRUARY 2016
documentation and the death record. For
example, functionality within the MR&C
alerts physicians when data they provide
seem unlikely, such as uterine cancer
being the cause of death of a male or natural death being categorized as an overdose.
These scenarios can go unchecked if the
information is entered manually.
One way to maximize the use of the
MR&C system is for physicians to designate a representative who can enter data
on their behalf. Practices whose physicians
want their partners to be able to register cause-of-death information in their
absence were among the first to do this.
Now, some large health systems including
Mayo Clinic and Essentia Health have staff
who act as death registrars and shepherd
records through completion within their
facilities. Internally, physicians provide the
cause of death information to their designees who then document the information
and assure that complete and accurate
health and medical data are filed without
delay.
In fact, of the death records that have
cause of death filed directly into the
MR&C system, only 25 percent are filed
by physicians who log in with their user
account and password. The other 75 percent are completed by their designated
staff. Physicians need to work with the Office of Vital Records to appoint a designee
to submit cause-of-death information on
their behalf.
The importance of electronic data
Registering deaths electronically has
public health benefits. Because of the
improved timeliness for filing death records when people use the MR&C system,
Minnesota now sends daily files to the
Centers for Disease Control and Prevention’s National Center for Health Statistics
(NCHS). The NCHS automatically provides numerical codes from the International Classification of Diseases, 10 Revision (IDC-10) and returns the files to the
Office of Vital Records. The quick turnaround allows the Minnesota Department
of Health to share nearly real-time death
data unlike ever before.
Local public health agencies are now
using this information to conduct surveillance and plan prevention activities.
Having real-time death data allows them
to respond to emerging issues (eg, drug
overdose deaths) in a more timely manner. It also helps them address persistent
public health concerns such as traffic
fatalities, infant mortality and sudden,
unexpected infant deaths. In addition,
the City of Minneapolis is incorporating
2014 death data into the Big Cities Health
Inventory, a project designed to illustrate
the major health issues that affect urban
communities. The Metro Public Health
Analysts Network, which consists of nine
city and county public health agencies in
the Minneapolis/St. Paul metro area, is
exploring opportunities to use this data to
conduct surveillance around 18 mortality
indicators.
Less paper, greater benefit
Information about births, deaths and fetal
deaths is important to families, public
health agencies, health care organizations
that monitor performance and conduct
quality assurance activities, life insurance
companies, and other entities. Physicians’
commitment to recording health and
medical information related to vital events
is crucial to the success of the state’s vital
record system. With their voluntary compliance, we can work smarter and faster
and with fewer resources, informing public health, serving families and improving
lives one record at a time. MM
Molly Mulcahy Crawford is State Registrar in
the Minnesota Department of Health’s Office
of Vital Records.
For more information about physician
responsibilities and requirements
when registering a death or to register
a designee to submit medical data,
contact the Office of Vital Records
at 651-201-5993, 888-692-2733 or
[email protected]. The
Minnesota Department of Health also
maintains information on its website
specifically for medical certifiers at
www.health.state.mn.us/divs/chs/osr/
physician-me/.