To Make Death Data Faster, Just Listen

By Judy Moulder, Director, Office of Vital Records & Health Statistics, Mississippi State Department of Health

Information from death certificates can lead us toward more effective disease prevention, better cures, and healthier lives. When crisis strikes, timely and high-quality death information becomes even more critical. Mississippi has had a lot of experience with crises – from Hurricane Katrina to the opioid epidemic to COVID-19.

Because we’ve seen firsthand how much it matters, we’re always working to improve the systems that report deaths in our state. What we’ve learned is that our best results often come from the simple act of talking – and listening – to people.

Learning from others’ experiences

Over the past two years, Mississippi has been part of a nationwide community focused on modernizing death reporting systems at every level. That community, which is led by the National Center for Health Statistics, has been a place where we can connect to other states doing the same work we’re doing.

When we first joined the NCHS community, our electronic death reporting system (EDRS) was pretty new, and we were able to talk with others who had been down this road before us. By listening, we learned some unexpected things they hadn’t planned for. One state told us that they hadn’t anticipated the number of help desk calls they would get after they switched to an electronic system. We took that to heart and planned right off the bat to have enough trained staff to answer any questions that came in.

Other states told us they were so busy with the rollout of their new systems that they hadn’t thought ahead about tracking progress in the timeliness of the data. Because of this, we developed and ran standard reports from the beginning.

Building a community around change

As we worked through the different steps of making our new death reporting system more interoperable, we reached out to everyone whose systems we needed to connect with. Sometimes, we were met with a sense of panic: What does this change really mean?

We had a lot of in-depth conversations about interoperability and what that meant for all of us. We worked closely with our electronic system vendor and with other programs that handle death data – from cancer registries to national systems that track violent deaths – to see what was feasible and who was ready to receive real-time information. Interoperability only works if everyone is in it together.

Removing the roadblocks

We also listened to our state medical examiners, coroners, hospitals, and funeral homes. We hired a third-party expert to learn about their processes and how they interacted with us. The expert identified barriers: what was slowing down the transmission of data within our state?

Among other things, we learned that our medical examiners were critically short-staffed, and their caseload was too high. They told us about their workflows, and we helped them understand ours. They saw how important they were to the timeliness of the data and we worked with them to eliminate unnecessary steps in the reporting process. We also sought advice from our counterparts in other states and, based on their input, we rolled out a state medical examiner component for our EDRS in April 2019.

We discovered that we needed to make better connections with funeral homes, so we met with their associations to set up symposiums across the state. For the first time, they began to fully understand how the death certificate flow works, and we offered them hands-on EDRS training. We also talked with them about the importance of interviewing families to collect demographic data. Many of them had felt embarrassed to ask the family about the education of the deceased; once they understood why we needed it, they felt more comfortable asking for the information.

With COVID-19, we’ve been reaching out to a lot of physicians individually to help them understand how to report the cause of death. They may not have time in their frantic schedules for formal training, so reaching out personally helps.

Small moments get big results

All these small advancements and conversations have added up over time to a much, much bigger accomplishment: measurable improvements in the timeliness of our death reporting. All but a very few facilities are now electronically reporting deaths to the state. When we first started on this project, Mississippi was only reporting 46% of its deaths electronically. Today, that number is up to 98%. We’re also improving the number of deaths reported to NCHS within 10 days, and every quarter we get better and better.

Now that we’re facing a pandemic, the power of connection is really becoming evident. We didn’t do anything fancy. We just listened, and we learned, and those lessons are serving our state today, right when we need it the most.