Ask the Experts
Q&A on your role in collecting vital statistics
By Patricia J. Brown, MS, RHIA
Manager, HIM Consulting Services
HSS Inc.,
Hamden, CT
Health information management (HIM) professionals will soon see a change in the way vital statistics are collected in hospitals. The National Committee to Revise the Standard Certificates of the National Center of Health Statistics (NCHS) in Hyattsville, MD, has completed its proposed revisions and has issued its recommendations for 2002.
In this Q&A, Brown, who served as the American Health Information Management Association’s (AHIMA) representative on the committee, talks about the changes and how they will affect HIM professionals. Julia Kowaleski of the NCHS assisted Brown in her presentation of the material on this topic at AHIMA’s 72nd National Convention and Exhibit in September.
Q. Why were the changes made and what do they mean for health care providers?
A. The changes were made as part of the ongoing process of revising the vital statistics certificates at least once every 10 years. Each item on the death, birth, and fetal death certificates was discussed in detail for revision. Some items were deleted and others were added. Many of the birth certificate items were expanded.
For example, the item "weight gained during pregnancy," was expanded into "mother’s height," "mother’s pregnancy weight (lbs.) or weight at first prenatal visit," and "mother’s weight at delivery (lbs.) or weight at last prenatal visit."
The proposed changes are very dramatic, in that they address the use of electronic data and not "certificates" and a manual process. For instance, the death certificate group recommended using the hospital abstracting data for some of the information that is used for cause of death — [the information] physicians write on the death certificate at the time of death, knowing that they only have 48 hours in some states to provide the information. This is a major change in the way this information is now collected.
Hospitals have been reporting birth data via computer software systems for the past five to eight years. However, the new recommendations utilize the available technology by, for instance, having the software calculate the age of the parent from the birth date, or the weight gain from the weight at first prenatal visit and just before birth. Help screens will be revised to be more meaningful and contain filters that will not allow erroneous or illogical information to be entered.
Health care providers will need to be ready to submit information in a more timely manner — this is an issue with the current process — and determine if the qualifications of the person(s) submitting the data are appropriate. Can their current information systems provide an interface to the birth registration system that is currently used in the facility? For example, can the registration from the main information system populate the demographics in the birth registry system to eliminate duplicate effort and decrease the probability of keying errors? Is the information that is being provided verified in the medical record, or just from a work sheet that the physician or designee fills out? For the first time, the national group has recommended standard work sheets to be used to gather the data, and it has recommended the source of the different information. For instance, the mother should no longer provide information concerning the "amount of weight gained" or the "number of prenatal visits" from memory — this information will be gathered from documentation in the medical record or prenatal record, if available.
The latest panel felt that the use of technology regarding data storage and retrieval should be used to not only shorten reporting requirements, but also to provide the highest quality data available. The current process for gathering data for birth statistics was sampled by using focus groups and visiting a small sample of hospitals in the Washington, DC, area. It was found that the method for gathering the information varied among the settings and type of hospital staff that was assigned that responsibility. In some hospitals, the mother’s information is relegated to volunteer staff who interview the mothers after birth; some hospitals use nursing staff on the delivery units to obtain the information, and many hospitals give the mother a worksheet to fill out as much information as possible before she leaves with the baby. Not many facilities provide seven-days-a-week coverage for this process.
Q. What role do HIM professionals play in preparing for the changes?
A. The vital statistics information is used for various reasons in the public health arena. In some cases, the outcomes of birth in an area can determine whether a particular public health program is funded in that area. This is frightening for those HIM professionals who know the quality of the data. Some hospitals and states use the cesarean rates from the birth certificates as a "yardstick" for comparison between states and hospitals. HIM’s role is to ensure that quality of the data is the best available and that the data are verified in the documentation.
AHIMA is going to convene a task force to survey hospitals to determine whether the vital statistics staff in hospitals should, at the least, receive specialized training from the National Association of Public Health Statistics and Information Systems. The American Hospital Association, which participated on the panel, also will be asked to help promote the necessary training that will ensure that hospital birth, death, and fetal death information is gathered and reported in a manner that promotes the highest level of quality. The outcome of this survey, as well as any updates regarding the revised certificates, will be presented next year at AHIMA’s annual meeting in Miami. The presentation also will include information concerning death and fetal death reporting.
Q. When will these recommendations be released?
A. The final recommendations are still going through the last stage. The government, as usual, is behind schedule. It is now estimated that the regulations will be released to the states in January 2001, with implementation expected by January 2003. However, it should be noted that part of the delay is due to the field test of the proposed worksheets — another first! The audience at AHIMA asked if the recommendations would be published on-line, but, at this time, the National Center for Health Statistics has no plans to do that. However, the NCHS representative who presented with me, Julia Kowaleski, said that she would take the recommendation back to her supervisor at NCHS.
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