1. North Dakota’s In-House Development of EVER Darin J. Meschke, State Registrar Director, Division of Vital Records June 6, 2006 NAPHSIS 2006 San Diego, California

2. Birth Registration Our “old” way We register about 9,400 births each year (635,000 pop.) Prior to 2006, we were still registering births on paper certificates Facilities manually typed up the birth certificates and sent them through the mail to our office. One staff person would audit and verify the information on the certificate and the paternity acknowledgment Office data entry staff would enter, then a second would re-enter the data for verification Paper copy would then be scanned for issuance

3. Road Blocks Funding –State general funded office –Extra state funds hard to come by Interest/Support –Department/Divisional support was lacking –Processing times were never really bad doing it manually –Received the NCHS Award in 2004

4. Whose going to pay? In March 2005, we applied for some carryover BT funding as part of the PHIN/NEDSS initiative to enhance our Master Population Index (MPI). –We made the argument that the faster we receive birth data from the hospitals, the faster we can populate our MPI so we will be better prepared for a mass prophylaxis if there is ever a need.

5. Can we even do this? In anticipation of receiving funding, we began the planning process with our state’s Information Technology Department to develop the system. –No time for formal RFP process Did not have time to write/review an RFP ITD was already our “vendor” for Vital Records systems Initial estimate was around $150K –We used the Use Case specifications off the NAPHSIS website EBRS and MoVERS –NAPHSIS staff traveled to ND to assist with preliminary use case discussions (A Big Thanks!!!!) Rose Trasatti was extremely helpful Kathi Mueller, SD also a tremendous help

6. EBRS – The real work begins… In late May 2005, we received the approval from the CDC for our carry-over request –$160K from our Focus Area B funding was redirected to develop a web based EBRS –The planning process then got into full gear and ITD began developing in July 2005 We already had an Oracle infrastructure in place Our back-office software was still going to be used ITD was creating a front-end web application for the hospitals to enter birth data

7. Use the Use Cases ITD found the use cases to be extremely valuable during development –Gave them a resource to use when they didn’t completely understand what we wanted –They modeled their documentation from the use cases VR staff also benefited –Didn’t have to explain every last little detail –Allowed us to concentrate on the look and feel of the system and the major functionality, instead of the detailed programming questions.

8. Working with hospitals As part of the development process, we formed a working group (VR, ITD and Hospitals) In our case, users very excited about EBRS –To this point in the process, no negative criticism Local Bismarck (2) hospitals came in during development for some testing –Very beneficial in understanding the differences between how each hospital conducts their business

9. EBRS - User Acceptance Testing In late November 2005, we began our initial user-acceptance testing. –Again, we used the use cases to make sure the primary functionality was working. –Made sure that all of the required edits we being enforced. –Local hospitals came in again to let us know what they liked and disliked (some problems found and changes made)

10. EBRS - User Training In mid-December 2005, we began our hospital user training at four regional locations. North Dakota has a very small population but it does take a while to get across it. –The “Big Four”, as we like to call our 4 largest cities (towns) were selected for this training. Fargo, Bismarck, Grand Forks and Minot I conducted all of the training personally at local hospitals I had the training schedule all planned out and during the first session, my wife called to inform me that my father had passed away. So I had to scrap the rest of that trip and do the training the week between Christmas and New Year’s. (But it all worked) Some additional development changes were made as a result of training and further testing, but ITD would make the corrections almost as fast as I could report them

11. EBRS in North Dakota On January 3, 2006, we began accepting 2006 birth certificate information from all of the states birthing hospitals. 2003 U.S. Standard changes will also implemented 21 hospitals with approx. 125 users –Hospital staff very appreciative of new system –Complaints are very minimal and very positive –One data entry/One Submitter per record User accounts maintained by the our office –Passwords were a minor problem, but we made a system change to make changing them much easier.

17. EBRS – Lessons Learned It’s not bad to be last –Jumping from paper to Web-based –A whole lot of help exists out there NAPHSIS Other states (plagiarism is a good thing) –No need to reinvent the wheel on everything Get done what you can with the money you have –EBRS only one part of EVER –Ongoing process to get to Death and Fetal Death

18. EBRS – Lessons Learned System just needs to work, doesn’t need to be absolute perfection. –Start with a base and then expand Make use of the Use Cases –Invaluable to our success –Saves time for programmers and VR staff Don’t be afraid to ask for help –Other states –NAPHSIS

19. EBRS – Lessons Learned Project Manager must stay on course –ITD provided an exceptional PM ND has outstanding hospital staff –Eager, willing to accept change –Happy about electronic registration –Make documents/worksheets available for download Small hospitals doesn’t need to print 1000s

20. Questions Darin J. Meschke, State Registrar Director, Division of Vital Records North Dakota Department of Health Phone: (701) 328-2494 dmeschke@nd.gov www.ndhealth.gov/vital