Taking death records digital: The Iowa experience
Connecting state and local government leaders
The Iowa Vital Event System has transformed that state's approach to documenting deaths, but efforts to improve it continue.
As digital death certification becomes standard, states like Iowa -- with an established system in place -- are taking a step back to evaluate what works, what doesn’t and if they are happy with the results.
Iowa’s electronic death certification system (the Iowa Vital Event System, or IVES) has, overall, been a success, according to Melissa Bird, Iowa bureau chief of health statistics. Moving from paper to electronic has cut down on the time it takes for a death certificate to reach the department of public health by 13 days.
And according to the state’s website, the change has also “eliminated the personal delivery of records to physicians for completion and signature, extensive and costly travel by funeral directors to file certifications and labor-intensive processing of paper records at the county recorder's office and by the Bureau of Health Statistics.”
The process starts at the funeral home, explained Bird, with an entry requiring basic demographic information. When the funeral home’s section is complete, it assigns an electronic death certifier. The certifier (usually a physician or medical examiner) completes information about the cause of death and injury information, if that applies. The certifier signs the electronic record, after which it goes back to the funeral director, who then files it.
But IVES, implemented 18 months ago, was “not necessarily popular in the beginning,” Bird said. The state had to deal with significant pushback from some of the more than 8,000 users required to learn a completely new method of death registration. Users that had to enter in only a couple deaths a year found it especially cumbersome.
It took about two months to “iron out” the training process, said Bird. And with users coming in and out of the system all the time, training is ongoing. Iowa uses webinars to help new users navigate the system (provided by vendor Netsmart) and has a full-time, two-person help desk.
IVES users are required to follow Centers for Disease Control and Prevention guidelines when registering a death, and the system is designed around those guidelines to catch errors, although Bird said it doesn’t catch them all, and the team continues to look for ways to improve the system’s functionality.
When something does come up that doesn’t make sense, Bird explained, the public health staff reviews it, follows up on it and corrects it before it’s filed. But those staffers do not have the authority to specify a cause of death. When that is in question, delays can still arise, she said.
“We are currently in discussions to make it more accurate in terms of what the department’s role is,” said Bird. “Cause of death is a certifier’s best medical opinion. So our position is not to tell them what it should be, but we just question what they put down.” Bird said one of the department’s goals is to emphasize cause of death training at the residency level.
Bird is also working on implementing a program that will better troubleshoot how the IVES system itself reads causes of death. “So if an immediate cause of death doesn’t makes sense, the program will question that.”
There's also the challenge or reconciling where an individual died with where he or she officially resides. To move data quickly to other states to prevent crimes including identity theft, and to keep state statistics up to date, Iowa uses a separate system called STEVE (the State and Territorial Exchange of Vital Events), created by the National Association for Public Health Statistics and Information Systems.
“STEVE acts as a secure portal for a state like Iowa to send, for example, information about a person that died in Iowa to Florida, where the person resides,” NAPHISIS Executive Director Dr. Patricia Potrzebowski explained. “It also uses STEVE to send death certification information quickly to a person’s place of birth so the birth certificate can be updated, with less chance of identity theft.”
States also use STEVE to send data to health departments that need to track deaths for reasons such as public safety. “A lot of children die from unintentional injuries, and for public health purposes they want to do prevention,” Potrzebowski said. "They want to know right away when a child dies. It saves time because the state’s office doesn’t have to do a separate data extract every time the state wants to use the data."
Overall, Bird said, she is happy with the way Iowa's system is working, but it could be improved. “We know death info can be better," she said, "and that is one of our goals.”