Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Model Law Work GroupProgress Report
Cathy Molchan Donald, MBAKaren Hampton, JDLinette Scott, MD
June 7, 2010
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Model Law Revision
Model State Vital Statistics Act and Regulations: Provides detailed guidance to States that are
considering revision of their own State vital statistics laws and regulations.
Promotes uniformity among states in definitions, registration practices, disclosure and issuance procedures, and in the many other functions that comprise a state system of vital statistics.
Initially established in 1907, has been revised in 1941, 1959, 1977, 1992
http://www.cdc.gov/nchs/nvss/model_law_revision.htm
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Model Law Revision Work GroupChairperson Alvin T. Onaka, Ph.D.
Hawaii Department of Health
Members Catherine Molchan Donald
Alabama Department of Public Health Karen R. Hampton, J.D.
Oregon Department of Human Services Ronald Hyman
Colorado Department of Public Health and Environment
Wilfredo Lopez, J.D.New York City Department of Health and Mental Hygiene
Patricia W. Potrzebowski, Ph.D.Pennsylvania Department of Health
Steven Schwartz, Ph.D.New York City Department of Healthand Mental Hygiene
Linette T. Scott, M.D., M.P.H.California Department of Public Health
Centers for Disease Control and Prevention National Center for Health Statistics, Division of Vital Statistics, Registration Methods Staff
Judy M. Barnes
Julia L. Kowaleski
George C. Tolson
Centers for Disease Control and Prevention
Anthony Moulton, Ph.D.Public Health Law ProgramOffice of the Director/OSI
Deborah Tress, J.D.Office of General Counsel
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Accomplishments To Date Surveys of NAPHSIS Membership developed by
the Workgroup Model Law Survey – 32 states responded
Issuance Survey – 35 states responded
Other Surveys of NAPHSIS Membership used by the Workgroup: Fees Charged
Fee Retention
Levying Fines
Verification Charges
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Accomplishments To Date Solicitation of Comments on NCHS web site
Received feedback from NAPHSIS Members National Archives and Records Administration CSTE Subcommittee on Tribal Epidemiology US Department of Justice, Witness Security Division Vermont Notary Public West VA Funeral Directors Association American College of Nurse Midwives National Funeral Directors Association Lambda Legal ACLU LGBT Rights Project National Center for Lesbian Rights Gay and Lesbian Advocates and Defenders and others
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Accomplishments To Date NAPHSIS Annual Meeting 2009 Inputs
Presentations
Roundtables
Town Hall
Workgroup Meetings began in 2009 April, July, September, November 2009
January, April 2010
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Huge Thank You NAPHSIS Committees have been critical to
the development of the Model Law revision providing reviews and input to the Workgroup Registration Committee
Statistics Committee
Security Committee
Inter-Jurisdictional Exchange Committee
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Registration
• Linda Loftus, MN• Shae Sutton, SC• Melissa Andrews, CA
Relates to 16 of the 29 Sections of the Model Law
NAPHSIS Registration Committee Important role in the process Bi-weekly conference calls
• Gary Thompson, WV• Ken Jones, FL• Stan Nyberg, MA• Colleen Fontana, RI
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Registration Topics
Already Reviewed
Still to Come Delayed Registration of Death Authorization for Final
Disposition Amendment of Vital Records
Death Registration Fetal Deaths Marriage Divorce
Reports of Adoption Birth Certificates
following Adoption Etc.
Birth Registration Delayed Registration of Birth Infants of Unknown Parentage Judicial Procedures to Establish
Birth
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Registration – Clarification Needed
Same-sex marriage as it relates to birth registration Allowing for “parent” labels on the birth certificate or
something more?
Assisted reproductive technology to include surrogacy Asking for clarification of who goes on the birth certificate
and which medical information is gathered? Asking that Model Law indicate Gestational Agreements are
acceptable at hospital to put parents on birth certificate?
Change of parent outside adoption (divorce)
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Registration – Additional Issues
Duplicate registrations and Authority to void records Model Law allows registrar to void a record if fraud or
misrepresentation is found Asking for specific language around duplicates
accidentally filed by institution or something else?
Gender reassignment Model Law allows for the birth certificate to be amended Asking about amending birth certificate or create new
birth certificate; issues about requirement of court order, or other issues?
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Registration – Additional Issues Cont.
Segregation of births to unmarried mothers
Delayed birth certificates More flexibility for older population; Model Law
currently allows for “other evidence acceptable to State Registrar”
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Registration – Additional Issues Cont.
Who can pronounce death? Family Burials
Model Law allows for “other person in charge of disposition”
Do regulations need to clarify procedures when no established facility is involved? (Assistance from Local Registrar?)
Mass Disasters Currently nothing in Model Law about handling of
bodies and death certificates in the event of a mass disaster where there are bodies
Issues around mass graves and temporary disposition
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Issuance
Our challenge is to anticipatetechnological changes
and business needs for the next twenty years
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Issuance Survey Highlights
Eligibility to order records – 35 jurisdictions Four responding jurisdictions reported anyone can
obtain a certified copy of a birth certificate Four additional jurisdictions reported anyone can
obtain a certified copy of a death certificate Relationships that can order had a standard core of
registrant (for birth), parents, spouse, legal representative, then expand by jurisdiction (siblings, children, government agencies, etc.)
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Issuance Survey Highlights – Cont.
Age limit for registrant Father not on the record – can’t get until age 16
Different criteria for identification Some states more restrictive on in person (photo id),
some more restrictive on mail (notarized only) and internet (electronic check of identity)
When identification requirement took effect 16 of the jurisdictions didn’t require ID for birth and
death records until 2000 or later 14 didn’t require identification until 2002 or later
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Establishing identity and confirming relationship
Survey shows: ‘Open’ records –
4 for birth and 8 for death Do not require ID from the applicant –
7 for birth and 9 for death Do not require proof of relationship –
17 for birth and 25 for death
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Issuance – still to come
Apostilles and exemplifications some vital records offices have three steps,
others issue apostilles on their own records History of applicants maintained on a
central database Electronic certifications and verifications Minimum fields for certifications, including
(or not) amendment history
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Security – Is it a myth?
Food for thought: Does your jurisdiction have more breaches
occurring on paper or electronically?
Is there such a thing as tamper-proof (paper or electronic)?
Implications of:HIPAA - Health Insurance Portability and Accountability Act HITECH - Health Information Technology for Economic and Clinical Health ActHCR – Health Care Reform …
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Security
Not a matter of “IF” but “WHEN”
Asking the “right question:” Will I know if there is a breach?
How will I know if there is a breach?
What will / must I do if there is a breach?
What authority (Model Law) would help to accomplish the “right question”?
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Security
For Civil Purposes: Fulfilling vital record role as prima facie evidence
Keeping records unaltered/safe/preserved into perpetuity
Preventing fraud – cross-matching birth and death records
Recording legal signatures: Ink vs. Electronic
For Public Health Purposes: Maintaining confidential data
Ensuring uses are appropriate and conducting follow-up
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Data Flow Terminology A Report is submitted to the Registrar The Registrar accepts the Report and
it becomes a Record The Record is used for:
Certification – subset of the Record necessary for civil purposes
Verification – performed based on matching a Certification against the Registrar’s Records
Data File Provision – subset of the Records used for research, governmental purposes, etc.
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Timeline for 2010-2011
NAPHSIS Annual Meeting Two Round Tables
• Confidentiality and Disclosure
• Registration
Town Hall
Workgroup Meetings July, September, November 2010; March 2011
Draft Model Law Revision for review by NAPHSIS Membership with online comments
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Objectives
Implementation of revised Model Law and Regulations in jurisdictions
Improved uniformity of process
Use as a resource to support justifications for actions in the jurisdictions regarding the vital record system
Gateway to the Future:Improving the National Vital Statistics System
St. Louis, MO June 6th – June 10th, 2010
Acknowledgments
Funding for this effort is supported by the National Center for Health Statistics
Support of Work Group and Committee meetings by the National Association for Public Health Statistics and Information Systems