NCHS Welcome & Updates - National Association for Public Health

Challenges and Unfinished Business
for NCHS and States in Vital
Registration and Statistics
Charles J. Rothwell
Director, NCHS
[email protected]
National Center for
Health Statistics
Welcome and thanks … but
I want to share with you how after
many years I see the future of vitals
This is not going to be the usual
presentation by a visiting NCHS
I want to spark conversations and
spur future actions by those in this
Yes we have much to be proud of
Vital registration through improved
business practices and automation is
more responsive than ever
Vital statistics content is more
extensive and is quicker and easier
to access for policy makers,
researchers and the public
Vital statistics is the foundation for
measuring the health of our nation,
states and communities
“Good to Great” – Are we there
• A few states are getting close to
A few more are “Good +”
For vitals to remain vital … NCHS and
all states have to soon be at the
“good +” level … “good” won’t do.
However too many in my opinion
remain “good” to “good –”
Two alternate futures
Vital statistics based on vital
registration systems will remain the
foundation of measuring the health
status of our communities, states and
the nation , or
Back to the Past …Vital registration
will become your primary
responsibility and “vital” statistics
will come from elsewhere
Surprisingly the problem is we
are NOT in a crisis !
We are improving but not fast enough
Vitals through vital registration will no
longer have a monopoly … there will
be competition
That competition can be easily beaten
if we recognize we are soon to be in a
The health data world outside of vital
statistics is changing faster
So what are some of the general
challenges we face?
Overly restrictive or conflicting data
release policies in states
Protecting the status quo without the
means to do so
Willingness to look for new partners
to fund our activities
Willingness to take calculated risks
What am I talking about? What
are some specific changes that
should be made or challenges to
Issue 1- Timely Data
What needs to be done for states to
send NCHS data as soon as it arrives
at their electronic “door step”… or at
least twice a week?
If it does not cost states additional to
do so why should NCHS pay extra for
the information to be sent as soon as
it is received? If it does cost more
what is that incremental cost?
Issue 2 – NCHS specific problem
NCHS has to stabilize its medical
coding system. What happened with
2011 and 2012 mortality data should
not happen again!
Issue 3- ME/Coroner events
In order to improve timeliness for
mortality, what can be done to
improve follow-back to ME’s and
coroners on pending records?
Issue 4 - Births
Although we are doing data quality
studies, can we reduce the natality
data set now to make it less
Are there items better collected by
sampling after the fact from EMRs?
Should we make the natality data
from birth certificate “lean and fast”
and let PRAMS do the rest?
Issue 5 – Data transmission and
matching systems
• Are states now sharing data on out of
state events through STEVE … if not
why not?
Are all states sending data through
STEVE to NCHS … if not why not?
What has been done with the NDI
data we sent to you for matching to
birth records?
Issue 6 - EDRs
What can be done to encourage
states to expand EDRs?
Have states followed up with their
state public health preparedness folks
to get funding … if not why not?
When NCHS finally got funding, what
kept states from applying to NCHS for
funds to expand their EDR coverage?
Issue 7- EMR’s
How can EMR’s be used to add to the
robustness of mortality data and
reduce data collection for births?
Example … what would it take for
states to populate the statistical
portion of death record with
morbidity information from the
electronic medical record … to build
a passive longitudinal record of
morbidity of decedents?
Issue 8 -Cost of EBRs and EDRs
Cost of maintaining and building
EDRs and EBRs … is our current
approach affordable? If not
Do we now know enough to begin
building a core EBR and EDR system
for states to use?
If so … who should do this … NCHS,
NAPHSIS … some third party?
Issue 9 – Joint activities
Could an EIS program for vitals help?
Should NCHS try to fund a State
Center’s program to build new
statistical capacity or keep our
activities focused on EBRs and EDRs?
Good to Great
Are joint reports with state analysts
possible, practical or useful?
Issue 10 – Timeliness
NCHS must move away from just
annual reporting of vitals but be able
to provide year to date reports
NCHS must expand its mortality
surveillance programs with CDCAtlanta programs
NCHS and States should be able to
report on 90% of all vital events
within 3 months of the date of the
So where will the competition
come from?
Electronic medical records as they
become ubiquitous will allow for:
Sampling at the national and state
level to measure health status
including births and deaths
EMR’s could include a simple cause
of death module perhaps a drop
down selection menu or automated
medical coding systems could be
applied and made required reporting
So what will it be?
Vital statistics based on vital
registration systems will remain the
foundation of measuring the health
status of our communities, states and
the nation, or
Back to the Past …Vital registration
will become your primary
responsibility and “vital” statistics
will come from elsewhere
[email protected]

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