Vital records are called "vital" for a reason, providing critical information on important life events including births and deaths. These data are used to monitor and improve public health and support administrative functions that prevent fraud, waste, and abuse. Despite the persistent need for more, better, and faster vital records data, the conversion of paper to electronic records has been slow, particularly in the case of death records.
As is the case with many systems, much of what has caused the delay is not the technology itself but a lack of funding and other resources necessary to implement electronic systems uniformly across the vital records jurisdictions and encourage the consistent use of these systems by data providers (e.g., physicians). Starting in the early 2000s, the National Center for Health Statistics and the Social Security Administration supported the jurisdictions in modernizing birth and death registration systems. More recently, however, states have struggled to raise necessary funding; The Great Recession squeezed state budgets and austerity measures such as sequestration made federal funding even scarcer.
One of the greatest challenges in securing funding for vital records modernization rests in the state houses themselves. In many states, the vital records office is not supported by state appropriated funds. Instead, this core function is either solely or mostly fee-funded through data use agreements with the federal government and other users, and one-time fees paid by individuals at the time of requests for certified copies of birth and death certificates.
Since most vital records offices rely on fees in-part or in-full to support core operations—and the fees associated with data use agreements are generally fixed under contract—the fees for certified copies would need to be raised to support infrastructure enhancements such as electronic systems. Unfortunately such fees are not under the control of the vital statistics office, but the lawmakers in the state legislatures. And since raising fees of any kind is politically tenuous, it is generally a "nonstarter" despite the urgent need for updated vital records systems.
But there is hope. Despite these obstacles, Idaho—generally considered a more fiscally conservative state—has realized the impossible dream and secured a fee increase. In January, Idaho's Senate Health and Welfare Committee approved a rules change that increased the fees for birth and death records from $13 to $16, which is projected to generate about $345,000 more per year for the vital records office. The corresponding House committee soon followed suit, and because the change was a rule change and not a law, the full legislature was not required to vote. The change became official as the Idaho legislature completed their session and will take effect July 1st of this year.
The increase will raise much needed funds to close an operating deficit and update the state's electronic death record system (EDRS). Tom Shanahan, the Department of Health and Welfare's spokesman explained IdahoWatchdog, "Future needs are required for regular database system updates/upgrades to maintain compliance with security and other technical requirements to interface with national systems, as well (as) comply with state law."
NAPHSIS continues to advocate in the nation's capital for federal funding to support states' adoption of EDRS with some success. For example, the administration's budget request once again seeks $5 million from Congress to support EDRS implementation in the remaining states, and an official from the Social Security Administration recently testified before the Senate Homeland Security and Government Affairs Committee that EDRS funding was the single best way to improve death reporting to the agency by states and stop improper payments to deceased individuals. Nevertheless, resources are significantly constrained by sequestration, and funding for new initiatives is hard to come by no matter the level of policymakers' enthusiasm. We can't rely on the federal government exclusively to support our efforts. Idaho's success in securing a fee increase should give hope to vital records jurisdictions that have faced hurdles in procuring state funds for systems updates.
Have experience working with your state legislature to increase your fees? We'd love to hear from you! Please share your successes and failures in the comment box.