1. Oregon Mortuary and Cemetery Board November 18, 2014 Jennifer A. Woodward, State Registrar Public Health Division Center for Public Health Practice Center for Health Statistics 1

2.  Overview of the Center for Health Statistics  Changes in new law  Electronic Death Registration  Communication  Questions and Discussion

4. Analyze What do we do? Vital records CollectRegisterAmendStoreSellAnalyze 4

5.  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 5

6. 6 Social Security Administration

7.  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

8. 190319151927193919511963197519871999 Registered domestic partnership records 2008 Divorce records 1925 Fetal death records 1919 Marriage records 1906 Birth and death records 1903 6 million vital records in Oregon Overview of the Center for Health Statistics 8 1999

9. Number Births45,582 Deaths33,888 Marriages24,871 Divorces14,198 ORDP538 Diss. of Dom Part109 Fetal Deaths265 ITOPS8,186 Total Records127,637

10. Vital records issued168,642 Amendments to records36,771 Average # certificates issued/day682 % orders processed as rush69% Highest number of certificates issued in a month (March 2013) 16,566

12.  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

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

14. Increase use of Electronic Death Registration Law requires hospitals with more than ten deaths to have records certified in OVERS

15. No 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

16. Order form required  New law requires written application for every order for certified copies of death certificates.

19. Two ways to submit records……. Paper Electronic

20.  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.

21. All paperSplitOVERSTotal Funeral directors1629224269 Funeral homes10*32149181 *5 of the 10 funeral homes not using OVERS are out of state.

22. September 2014 ElectronicHybridPaper Doctors20.9%70.5%8.7% NP39.5%54.8%5.7% PA21.6%70.3%8.1% ME88.9%8.1%3.0% 793 distinct medical certifiers have used EDRS to date during 2014. 4,393 medical certifiers signed death certificates.

23.  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.

25.  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

27.  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

28.  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

29.  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

30.  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

31.  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

32. Method death record filed for facility deaths by month (non-Medical Examiner) Facility where death occurred September Electronic% Harney District Hospital3100.0% Lake District Hospital1100.0% Tillamook Regional Medical Center1100.0% Doernbecher Children's Hospital1100.0% Blue Mountain Hospital1100.0% OHSU Hospitals and Clinics5498.2% Sacred Heart Medical Center - RiverBend3981.3% Legacy Emanuel Medical Center1071.4% Legacy Good Samaritan Medical Center866.7% St Charles - Madras266.7% Kaiser Foundation Hospital - Westside562.5% Tuality Community Hospital660.0% Adventist Medical Center1257.1% Sky Lakes Medical Center555.6% Legacy Mount Hood Medical Center654.5%

33.  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)

34.  OVERS help desk  One-one with CHS staff  Newsletters  Emailed notices and alerts  Information on the web  Training on the web  Webinars  Reports 34

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36. Contact information Jennifer Woodward Jennifer.A.Woodward@state.or.us 971-673-1185