Where We Began: Early Steps Toward Modernizing the National Vital Statistics System
Much has changed since we began tracking the nation’s vital statistics more than a century ago. Even recently, vital statistics collection used to be a slow process that involved a combination of paper-based files and electronic information stored on mainframe computers. We needed to move away from these outdated methods toward 100% electronic systems that are connected and can “speak the same language.”
The National Vital Statistics System is built from a multitude of different systems extending across 57 jurisdictions in the United States
By the early 2000s, the National Vital Statistics System had begun shifting from paper-based reporting to primarily electronic systems. However, these electronic systems were mostly individual and remained separated by differences in processes and technologies.
NCHS made a commitment to resolving these differences and building a national system that could answer the changing needs of our nation. Below are the initial steps that were taken as we began to envision a newer, faster, smarter National Vital Statistics System.
Step 1: Identifying the Issues Confronting Vital Statistics
In examining the issues, NCHS and its partners recognized that there were inefficiencies throughout the vital statistics system. For example:
- In jurisdictions, many of the steps for processing records relied on paper, or else on manually entering data into multiple different electronic systems. Labor-intensive processes limit how quickly data can move between systems and create opportunities for error.
Inefficient systems can impact:
- Access and Usability
- At NCHS, the mortality coding system for assigning cause of death had been built in the 1980s and relied on flat-file techniques for processing and storing data, rather than transactional submissions of data to states. It also lacked mechanisms to improve error rates and assess the quality of automatic coding.
- Medical examiners’ and coroners’ offices had many redundancies in their reporting processes. Data systems containing key information (e.g., systems at toxicology labs) were not interoperable with the medical examiners’ and coroners’ systems and were burdensome to access.
- Vital records systems faced a lack of interoperability overall, especially between systems in the mortality data flow.
Step 2: Creating a shared vision
The mission to solve these issues and transform the NVSS began in earnest in 2011-2012, with the formation of the Good to Great Committee. This joint committee between NCHS, the National Association for Public Health Statistics and Information Systems (NAPHSIS), and states set out to define a new vision for vital statistics that would both take advantage of new technologies and better equip us for the future.
Based on the committee’s vision, NCHS and its partners began projects to advance the vital statistics system. The initial focus was on improving mortality data— specifically, creating an “enhanced” state-based network of electronic death registration systems (EDRS). The basic elements of this network would center on:
- Improved timeliness
- Quality cause-of-death information
- Statewide coverage
- Participation from physicians, medical examiners, and coroners
Step 3: Getting everyone on the same (electronic) page
In the first half of the decade, NCHS began supporting major mortality initiatives focused on timeliness and data quality. Specifically, many projects focused on improving the exchange of information between states and NCHS. The concept of Special Projects – projects testing new and improved methods for collecting and transmitting information – was incorporated into the contract NCHS has with each state for collecting vital records data.
Major Mortality Initiatives for States
- Funding Statewide development of Electronic Death Registration Systems
- Physician and Medical Examiner/Coroner participation in vital records special projects
- Making system changes to remove of manual steps in the process
- Technical assistance to lowest performing states
- Funded 19 states for timeliness
- eVitals Standards and system interoperability
- Draft HL7 FHIR standardsexternal icon approved by HL7 standard organization
- Demonstration projects for interoperability across the mortality data ecosystem, to include electronic medical records, medical examiner/coroner systems, electronic death registration systems, state-based surveillance systems, and NCHS
- Evaluating the quality of cause-of-death information in two states
- E-Learning for training physicians on certifying the cause of death
- Funding 10 states to improve the quality of cause-of-death information
In September 2016, NCHS launched a wider initiative focused on mortality data and statistics. The project aimed at improving the ability of users from across the mortality data ecosystem to access timely and accurate mortality data. We began to explore financing models for mortality data services; pilot new electronic death registration (EDRS) capabilities; and engage with stakeholders from local, state, territorial and national levels, including collaborating with other federal agencies and programs to enable needed interoperability changes.
in May 2018, a State Vital Statistics/Records Offices and Medical Examiner/Coroner Implementer’s Workgroup was first convened by NCHS using funds from the Patient Centered Outcomes Research Trust Fundexternal icon. The workgroup brought together a community of people who work with mortality data, including medical examiners and coroners who certify drug overdose deaths, personnel from state vital records offices that register the deaths, NCHS staff who produce official national statistics, IT experts, mortality data users, and other stakeholders. This group has today evolved into the NCHS Implementers’ Community to modernize death data.
Step 4: Measuring Success
Through these initial projects, the NVSS has begun evolving into a more capable resource for public health surveillance – something that had never before been possible.
These early efforts yielded notable accomplishments, including:
- Significantly improved transmission rates of mortality records being received by NCHS within 10 days of the date of event (from just 7% in 2010 to over 60% in 2019)
- Commencement of the Vital Statistics Rapid Release program, demonstrating the ability to provide provisional, rapid estimates on select causes of death
- Better data exchange capacity, specifically through state quality projects to improve electronic death registration systems
- An increased ability to leverage literal text from the death certificate to maximize the ability to capture specific-drug information
Our work to modernize the NVSS continues. Learn more about where we are and where we’re headed today: