The National Vital Statistics System
“Moving Forward……….”
Delton Atkinson, MPH, MPH, PMPDivision Director
Centers for Disease Control and Prevention (CDC)National Center for Health Statistics (NCHS)
Division of Vital Statistics (DVS)
NAPHSIS ConferenceJune 11, 2014
Change Is…..
I
“…..the law of life,
and those who look only to the past or
the present,
are certain to miss the future. “
(John F. Kennedy)
Presentation Agenda
Changes in the staff
Where have we been?
Where are we going?
Challenges and Opportunities
Staff New to DVS
Mrs. Laci Banks, MS (Survey Statistician)
Mr. Matt Rowe, MBA (Supervisor , Medical
Classification and
Evaluation Team)
Internal Staffing Actions
Holly Lambert (Senior Medical Classification
Specialist)
Mia Jones (Senior Medical Technician)
Adrienne Rouse (Statistician—Medical Cause
of Death)
Recruitment Actions or Internal Changes
Vital Statistics Specialist (NC)
Medical Classification Specialist (NC)
Senior Nosologist (NC)
2 Computer Scientists (NC)
Chief, D.A.C.E. Branch (NC)
Deputy Director, Division of Vital Statistics
(Md.)
National Vital Statistics System
National Vital Statistics System
Over 6 million vital events reported annually
NVSS Performance ---Births and Fetal Deaths
Improved release of data 2012 final data released w/n 12 months of end of data
year
2013 preliminary data released w/n 5 months of end of
data year
Released 6 years of Fetal deaths (2006 – 2012) in 10
months
Implemented new reports Released “new birth” data for 2009-2012 and
accompanying report
Source of Payment of the delivery which will be useful for
ACA
NVSS Performance ---Births
180 180 180 180 180
105 90 75
426
554
435 411
334
260210
180
939
698663
579538
360300
270
0
100
200
300
400
500
600
700
800
900
1000
1100
2007 2008 2009 2010 2011 2012 2013* 2014*
Da
ys A
fte
r E
nd
of
Da
ta Y
ea
r
Data Year (*Estimated Closing/Report)
Birth File
VSCP Contract Due Date NCHS File Closing
NCHS Final Report Publication
NVSS Performance ---Deaths
180 180 180 180 180 165 150 135
660
788
614
462
349
540
330270
860
1057
719
848
930
630
418360
0
100
200
300
400
500
600
700
800
900
1000
1100
2007 2008 2009 2010 2011* 2012* 2013* 2014*
Da
ys A
fte
r E
nd
of
Da
ta Y
ea
r
Data Year (*Estimated Closing/Report)
Death File
VSCP Contract Due Date NCHS File Closing
NCHS Final Report Publication
Category of Issues
• DVS IT System Issues
• Internal business processes and practices
• State file issues
State Issues Affecting 2011 Medical Data
• Duplicate file names
• Duplicate records within a file
• Incorrectly numbered records where age-gender mismatches
occurred
• Records with incorrect data year
• Transmissions submitted out-of-sequence
Federal Issues with 2011 Medical Data
ACME Editor Bug--injury literal invisible to coderBug in Transax Table Creation Program
File Tracker file repository did not support files with duplicate filenames. Franken-records
ICD Codes not synchronized between applications Incorrect auto-coding where records were coded to generic codes by default Lack of quality control Manner of death and other data not being persisted through the MMDS application
MMDS could not code certain literals to ERN; however it was not rejecting them Redactor bug caused missing data due to truncation Miscoding of 2011 records using MMDS applications meant only for 2009 or 2010 State/internal updates/corrections sometimes blocked by the activation log WebMMDS/Micar200 bug -- blank line mishandled
NVSS Performance ---Deaths
Proportion of Mortality Records Received Within 10 days of the Date of the Event in 2013 and in First Quarter of 2014
Percent of Records received Jurisdictions in Jurisdictions in w/n 10 days of date of event CY 2013 1st QTR. 2014
80% or more 2 2
60 to 79 0 2
30 to 59 9 13
5 to 29 19 18
0.1 to 4 9 4
None 18 18
U.S. Average (%) 17.69% 27.92%
Publishing 2011, 2012, and 2013 death data in 2014
Building a State-based network of EDRS Funding of states this summer to enhance timeliness Possible PCOR for more substantial enhancements;
• 12 states using FY14 funds and 10 states using FY15 funds Monitor/evaluate the 7 states already funded. Lessons
learned? Building our EDRS partner network
Designing and implementing VIEWS II System Plan/develop/pilot new system in 2014/2015 Can rare cause verifications be done with VIEWS II? Can VIEWS II improve the quality of submitted COD
information? Retooling our Automated Coding System
Evaluation of IRIS. Possible pilot in 2015. Implement in 2016?
Re-engineering of the MMDS? Is this feasible?
Priorities for 2014, 2015 and 2016
Planning the next generation collection/analysis tools Electronic reporting of deaths (HHS Entrepreneurs
Award) Electronic reporting of fetals Data visualization and surveillance tools
Enhancing the National Death Index Implementing NDI Early Release Addition of military records. Maybe State department? Linking NDI with state records for fraud purposes?
Enhancing Medical Quality Assurance Implementing statistical reviews on current flow basis Feasibility of joint federal/state quality control reviews? Implementing system and manual quality reviews Nosological training and training of state staffs?
Priorities for 2014, 2015 and 2016 (cont.)
Using electronic health records Finalizing national birth and death standards and
implementing nationally Piloting HL-7 EHR and EDRS systems (Possible funding in
Fall 2014) Piloting/implementing HL-7 electronic health records and
electronic birth systems Expanding Mortality Surveillance
Pneumonia and influenza surveillance. Collaboration w/ Influenza
Rare Vaccine Preventable. Collaboration with NCIRD RSV. Collaboration with NCIRD Drug-related mortality. Collaboration w/ FDA Suicide. Collaboration with NIMH Others?
Priorities for 2014, 2015 and 2016 (cont.)
Improving vital statistics data and its utility E-Learning for medical/health data for births Completion/analysis of data quality studies Revising birth and fetal death data elements Expanded statistical/research studies, incl. Federal/state
studies Mortality Indicators Project (CDC Award)
Improving the VSCP Program Achieving the VSCP timeliness and quality standards Increasing state awareness & education about the
contract Negotiating the 2017-2021 VSCP contract; Enhancing
contract IQ. Rethinking “joint-ness” in the Joint NAPHSIS/NCHS
Annual Meeting Marketing vital statistics.
Developing a strategic plan for the Division
Priorities for 2014, 2015 and 2016 (cont.)
Embracing timelines and quality ---- why
can’t we?
Building “lean” vital records/statistics
agencies---local, state & Federal
Developing an informatics-savvy workforce
Effectively marketing our worth to others
Establishing/Coalescing in new and non-
traditional partnerships
Embracing “controlled” innovation
Challenges/Opportunities for “Greatness”
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