gateway to the future: improving the national vital statistics system st. louis, mo june 6 th –...

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



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



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



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



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



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



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



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



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



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)



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?



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”



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



Issuance

Our challenge is to anticipatetechnological changes

and business needs for the next twenty years



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.)



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



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



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



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 …



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”?



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



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.



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



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



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

gateway to the future: improving the national vital statistics system st. louis, mo june 6 th –...

Documents

health statistics

division of vital statistics

birth slide

state vital statistics

registration clarification

registration practices

registration topics

prevention national