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Fighting for a 21st Century Vital Statistics System

For nearly a decade, NAPHSIS has worked alongside our partners in the data user community to convince lawmakers of the need to modernize the vital statistics system. Despite the overall fiscal and political toxicity in Washington, lawmakers from both parties have recognized the value of more, better, and faster data for both public health and administrative purposes. The budget of the National Center for Health Statistics (NCHS) has slowly and steadily increased, and in each year, we've seen Congress prioritize funding for the vital statistics infrastructure. Most recently, Congress appropriated $5 million to help NCHS help jurisdictions continue to modernize the National Vital Statistics System—moving from paper-based to electronic filing of death records. Because Congress and the administration have prioritized electronic death registration systems (EDRS), states have been able to speed the release of birth and death statistics of public health importance, including infant mortality and prescription drug overdose deaths. In fact, the percentage of mortality records reported to NCHS within 10 days has increased from 14 percent in 2012 to 40 percent in 2015.

But we're not done yet! For death registration, we are close to having an EDRS in all jurisdictions. Nevertheless, even in states with an EDRS, many systems continue to rely to some extent on hybrid drop to paper records, a practice that compromises the accuracy, timeliness, interoperability, and security of these data and the records themselves. Within states with electronic systems, many haven't the resources to expand technical assistance to, and maximize electronic death reporting by, medical certifiers (i.e., physicians, coroners, and medical examiners). Some early adopters lack the resources to modernize their systems to keep pace with new technology. Improving the uptake of EDRS among death data providers will be essential if the vital statistics system is ever to be fully electronic. In addition, greater outreach, professional development, and technical assistance to physicians, coroners, and medical examiners is necessary to improve the quality of cause of death data reported. Timely data are important, but if they are not of high quality, we will continue to fall short in our ability to understand and improve public health.

It's also time to update how we share vital statistics amongst the states and with our federal partners. Americans rarely live and die where they are born, so sharing of such information across state lines is essential for monitoring leading causes of death and preterm births, developing programs to improve public health, and evaluating the effectiveness of those interventions. Cross-jurisdictional sharing is also essential for reducing fraud that allows erroneous federal and state benefit payments to be made to deceased persons. The STEVE (State and Territorial Exchange of Vital Events) system is the cornerstone of such data sharing, facilitating fast and secure transmission of complete vital records data across state lines and with other critical data partners, including NCHS. After nearly ten years, STEVE's antiquated architecture cannot keep pace with technological advances and user needs. Because the system's technology obsolescence poses security vulnerabilities, STEVE is no longer viable and must be replaced. Funding is needed to support the development of "STEVE 2.0."

As part of our ongoing advocacy efforts, NAPHSIS recently joined the "Friends of NCHS" in seeking a funding increase for the agency so it may help jurisdictions improve the quality and specificity of cause of death data reported by physicians, coroners, and medical examiners. We also urged lawmakers to provide new funding to help rebuild the architecture of STEVE to better monitor our nation's health and reduce waste, fraud, and abuse in federal benefits programs (see letter here). As in any presidential election year, the path forward for spending legislation is far from certain, but based on our success to date we feel confident that lawmakers will continue to prioritize vital statistics.

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