NVSS Modernization Projects and Initiatives

The Vital Statistics Modernization Community of Practice (VSMCOP) is an expanded effort to modernize the natality and mortality data flow using FHIR standards. FHIR, pronounced “fire,” is a framework developed by Health Level Seven (HL7) to improve the exchange, integration, sharing, and retrieval of health information.

FHIR has opened doors to innovation that will strengthen the entire health data ecosystem. The community of practice includes state vital records offices; medical examiners and coroners (ME/C); hospitals and healthcare organizations; IT vendors and informatics consultants working with electronic health records, electronic death registration systems, and ME/C case management systems; and state and national organizations of ME/Cs, vital records, and public health.

• Community of Practice Home Page

This collaborative effort is developing standards that will enable interoperable electronic data exchange among electronic health record systems, U.S. vital records systems, and potentially other public information systems for birth, death, and fetal death events.

• e-Vital Standards Home Page

Mortality workflows for As-is and To-be death data [PDF – 494 KB]

NCHS is focused on development of national standards for the automatic transfer of medical and health birth certificate data directly from hospital electronic records to state electronic birth registration systems. The change aims to reduce, if not eliminate, problems caused by missing or out-of-date prenatal care records and user error related to locating complete and updated prenatal care information.

The linked birth and infant death data set is a valuable tool for monitoring and exploring the complex inter-relationships between infant death and risk factors present at birth. Historically, NCHS released these data in two completely separate file formats:

• Period data files, which included all infants who died in a given year, whether they were born in that year or the previous year.
• Cohort data files, which included all infants who were born in a given year, whether they died in that year or the following year.

Starting in 2017, NCHS released first-ever combined 2017 period/2016 cohort linked birth/infant death file. This new file includes sequence numbers incorporated into the period linked files so users can create their own cohort files. Enabling users to create their own cohorts from the single file has greatly improved the timeliness of the cohort file availability.

In 2016, NCHS released a report presenting, for the first time, data on cause of fetal death by selected characteristics such as maternal age, Hispanic origin and race, fetal sex, period of gestation, and birthweight. These data had never before been released on public-use files or published, partly due to resource constraints and quality concerns. Because understanding fetal death is critical to preventing it, NCHS committed resources and made changes to improve data quality.

For example, the cause-of-death item on the fetal death report was redesigned for the 2003 U.S. Standard Report of Fetal Death to improve the quality and specificity of information reported for cause of death. NCHS also revised instructions on coding cause of fetal death in 2012, developed a system for processing cause, and centralized coding for cause of death within NCHS in 2010. Beginning with 2015 data, a new system reduced reducing manual interventions during coding and improved how cause of death data flows within NCHS.

NCHS is working with jurisdictions to achieve more comprehensive death information and quicker transmission of death data to NCHS and state surveillance systems. NCHS received initial funding through the Patient Centered Outcomes Research Trust Fund (PCORT) to improve the quality and timeliness of data on drug overdose deaths. The resulting project, Modernizing the Infrastructure for Capturing Drug Death Data and Enhancing Research on Opioid Poisoning using Death Certificates, brings together a broad Implementers’ Community to develop, test, pilot, and track new approaches to exchanging mortality information, with the goal of having 90% of drug-related death records made available for public health surveillance and decision-making within 90 days of death.

• Implementers’ Community Home Page
• Link to Project Page on PCORT website: Strengthening the Data Infrastructure for Outcomes Research on Mortality Associated with Opioid Poisonings: Modernizing the Infrastructure for Capturing Drug Death Data and Enhancing Research on Opioid Poisoning Using Death Certificates

Medical examiners and coroners (ME/Cs) play a critical role in fatal drug overdose surveillance; however, the systems and standards ME/Cs use vary greatly by state. NCHS has partnered with the National Association of Medical Examiners (NAME) to develop and publish standards that will result in consistent methods for opioid-related death investigations.

NCHS is developing a new system to automatically code the cause of death on death records, which is expected to increase the proportion of causes being auto-coded (compared to the system currently in production) from 75% to 90%.

NCHS is working with CDC’s Center for Preparedness and Response (CPR) and CDC’s National Center for Environmental Health (NCEH) to improve the timeliness and accuracy of disaster-related death reporting:

• CPR led efforts to develop a disaster-related Death Scene Investigation (DSI) Toolkit for collecting data at death scenes during and after natural disasters.
• The Public Health Emergency Preparedness (PHEP) cooperative agreement incorporated language encouraging jurisdictions to strengthen their EDRS for better reporting of disaster-related mortality.
• NCEH and NCHS developed and published the 2017 disaster-related death certification reference guide to help certifiers report direct and indirect deaths from disasters.
• NCEH and NCHS are currently supporting Puerto Rico, Texas, and U.S. Virgin Islands in their efforts to strengthen disaster-related death certification and registration processes.
  • These jurisdictions are receiving training using the NCHS death certification reference guide.
  • The project in Puerto Rico also includes designing and implementing their first EDRS.

An ongoing two-year study at the National Academy of Sciences is also bringing together national experts on death data and emergency response, including leaders from NCHS, NCEH, and CPR, to explore how can we do better at counting the casualties from large-scale natural disasters.

The Validations and Interactive Edits Web Service (VIEWS) is an online service developed by NCHS that can be used when data is entered into Electronic Death Registration Systems (EDRS). VIEWS checks entries and sends an alert when a piece of information is incorrect or unusual. VIEWS contains an “intelligent” mortality-focused spellchecker and also checks records for rare words, ambiguous abbreviations, rare causes of death, ill-defined terms, as well as cross-checking age and sex information with cause of death. VIEWS can also consult a surveillance list to identify and flag additional conditions of interest. By providing improved and consistent validations immediately at data entry, VIEWS:

• Improves data quality at the outset, increasing its value for surveillance
• Improves efficiency by reducing the number of “rejects” to be coded and late stage “cleanups”
• Reduces training demands for jurisdictions by providing smarter tools