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Table of Contents

Executive Summary

I. Overview

II. Current process observations

Ill. Recommendations

Detailed Report

1.0 Introduction and Background

2.0 Approach and Methodology

3.0 Detail of Current Situation

3.1 Identification of information needed3.2 Collection of information3.3 Preparation of information3.4 Submission of information

4.0 Observations and Findings

4.1 Cuffent process4.2 Prenatal information and impending changes4.3 Benchmarking study

5.0 Recommendations

. 1 Move the clerk closer to the point of service5.2 Collect information on a portable computer5.3 Provide information during prenatal care5.4 Create legal document for parents who refuse to establish paternity5.5 Authorize clerks to sign birth Certificates5.6 Print business cards for clerks5.7 Cross-train maternity ward and birth certificate clerks5.8 Create a birth certificate form in the WatchChild system

Birth Cci rifìc ate Pt oc’ s Reengmeei ing

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Table of Contents

Executive Summary

I. Overview

II. Current process observations

III. Recommendations

Detailed Report

1.0 Introduction and Background

2.0 Approach and Methodology

3.0 Detail of Current Situation

3.1 Identification of infonnation needed3.2 Collection of information3.3 Preparation of information3.4 Submission of information

4.0 Observations and Findings

4.1 Current process4.2 Prenatal information and impending changes4.3 Benchmarking study

5.0 Recommendations

5.1 Move the clerk closer to the point of service5.2 Collect information on a portable computer -

5.3 Provide information during prenatal care5.4 Create legal document for parents who refuse to establish paternity5.5 Authorize clerks to sign birth Certificates5.6 Print business cards for clerks5.7 Cross-train maternity ward and birth certificate clerks5.8 Create a birth certificate form in the WatchChild system

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I. Overview

The goals of the birth certificate reengineering project are to increase patient satisfaction bystreamlining the capture of birth certificate information, improve the speed and accuracy ofbirth certificate completion, and eliminate unnecessary costs. The project team first studiedthe current process, then identified opportunities for improvement, developed practicalrecommendations, and created an action plan for the implementation of thoserecommendations. In each of these phases the project team considered the birth certificateprocess as a facet of the larger care process in order to identify any opportunities forintegration and to evaluate the impact of proposed process changes.

II.Current process observations

After examining the current process in detail, including an actual walk-through with thebirth certificate clerk, the project team identified the following opportunities forimprovement:

• Multiple visits to patient’s room required to collect information and return forpatient signature

• Three redundant data transfers: 2 handwritten forms, one electronic data entry

• Excessive time spent walking between 4th floor Women’s Hospital and VitalStatistics office in Taubman Center basement

• Excessive time spent delivering birth certificates to practitioners for signatures,waiting for signatures, picking up signed birth certificates.

• Birth certificate clerk often needs to explain the birth certificate process topatients, show them the folder/worksheets that they should have alreadyreceived, and sometimes give them additional copies of the worksheets, etc.

• Patients are unfamiliar with the birth certificate process until after delivery

The project team also benchmarked the UMHS birth certificate.process with other Michiganhospitals to generate further ideas for improvement. Of these hospitals, St. Joseph’sMercy appears to have the most efficient process. St. Joseph’s credited its success to arecent reengineering effort which provided mothers with information during a prenatalvisit, moved clerks closer to the point of service (maternity ward), and empowered theclerks to take responsibility for the process.

UMHS is currently considering implementing WatchChild, a customized commercialsoftware and hardware system for keeping all prenatal and delivery records. The projectteam and MCIT determined that it is technically feasible to design a custom birth certificate -

Birth C ei ti/ic ate Pt oce s s Reengineci ing r2

screen that automatically imports all the data for the birth certificate from records alreadycollected. This birth certificate data could then be printed and uploaded to the State,eliminating most of the current process flow. Implementation of WatchChild is stillpending approval.

III. Recommendations

The project team has considered the costs and benefits of the following recommendationsand worked with involved parties to develop an action plan. This plan is included in thebody of the report.

1. Move birth certificate clerks closer to point of service.

• eliminates travel time between Vital Statistics office and Women’s hopitaI.• facilitates effective communication between clerks, patients, and nurses.• only a small workspace needed.• 109 clerk hour ($958) savings in reduced travel time alone.

2. Supply clerks with laptop computer with EBC software, printer, and modem. Theclerk would take the laptop from room to room to conduct patient interviews and obtain

C parental signatures on the spot.

• eliminates multiple trips to patient’s room.• eliminates redundant handwritten birth certificate forms.• ensures parents’ signatures appear on birth certificate and parents can apply for

social security.• cost of hardware: S1596.• $2,808 estimated annual savings due to error reduction.

3. Provide mothers with birth certificate process information in a pre-natal session.

• educates mothers not to leave hospital before providing information to clerk.• educates unwed mothers about establishing paternity so that it can be

established expediently after birth.

4. Create legal document for mothers who refuse request to esablish paternity.

• protects the hospital from State accusations that it is not trying hard enough toestablish paternity.

5. Certify birth certificate clerk to sign birth certificates.

• eliminates trips to other parts of the hospital and waiting time for signatures.• takes documentation workload off of practitioners.

Birth Certificate Process Reengmeering

-

6. Educate nurses on unit and additjonal hospital staff to answer patient questions aboutbirth certificate process.

7. Cross-train birth certificate and maternity ward clerks.

• provides constant availability of expertise.• allows more flexible staffing to better match workload.

8. Create custom birth certificate form with WatchChild.• wifi eliminate majority of birth certificate workload.• simplified process allows integration of the tasks perfromed by birth certificate

and maternity ward clerks.• Estimated cost of <= $10,000 outweighed by savings in staff

integration.

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1.0 Introduction anth Background

This project seeks to better serve University of Michigan Medical center patients bystreamlining the capture of birth certificate information, improving the speed and accuracyof birth certificate completion, and reducing unnecessary costs. In order to meet thesegoals, the project team first studied the current process and then identified improvementopportunities based on the following client objectives:

1. Complete accurate birth certificate documentation before the mother isdischarged.

2. Eliminate redundant collections of information.

3. Integrate the birth certificate process with the prenatal/perinatal care process.

4. Move data collection and processing as close as possible to the site of care.

5. Provide electronic support for all data.

6. Collect as much information as possible prior to labor/delivery.

2.0 Approach and Methodology

Since achievement of client’s objectives will likely affect the departments and staff of thebirthing center, its affiliated clinics, Medical Information Services (MIS), and MCII’, theproject team interviewed a variety of sources to assess the current situation. The projectteam then involved these sources in developing an action plan. Key contacts include:

• DeNise Crockett, Birth Certificate Clerk, Vital Statistics

• Barbara Dubler, RN, Head Nurse, Women’s Hospital

• Lithe Carter, former Vital Statistics supervisor, MIS

• Carolyn Etzel, Supervisor OB/GYN Outpatient Services

• Sandra Hoffman, Vital Statistics supervisor, MIS

• Margaret Hough, RN, Head Nurse, Outpatient Ob/Gyn Clinics

• Peggy Phillips, OB/GYN information systems manager, MC1T

• Brent Albrecht, MCI]’

In order to understand the current process, the project team reviewed available MISdocumentation on the birth certificate process, including patient forms, volume data, andwork instructions for the birth certificate clerks, and then actually followed a clerk on thejob.

Birth Cern/lcate Process I?eengineering.-4

3

The project team conducted a benchmarking study of the birth certificate processes in threeother Michigan hospitals in order to evaluate the comparative strengths and weaknesses ofthe UMHS process and generat more ideas for lmprovement. This study is included inAppendix B, and its results are• summarized in the Observations and Findings section ofthis report.

In order to identify opportunities for integration and to insure compatibility with anychanges in the OB information system, the project team also contacted MCIT to review thecapabilities and implementation plan of the computerized WatchChild system. MCIT alsoprovided hardware cost figures and recommendations for implementing new hardware toimprove the current process.

3.0 Detail of Current Situation

Currently, the Birth Center at the hospital does not interact with the pre-natal clinics in thecollection of information for a newborn’s birth certificate. The entire process is facilitatedby the hospital’s birth certificate clerk; the hospital employs 2 part-time clerks in thiscapacity. No other hospital employees are cross-trained to perform the duties of the birthcertificate clerks. Therefore, when the clerks are not on duty, work piles up until the nextone begins their shift.

After delivery, the parents are supplied with a folder containing a variety of pamphlets,brochures, and other forms of information regarding the care of their baby. Included inthis folder is a worksheet that the parents are required to complete in order to provide theclerk with basic information for their child’s birth certificate. A copy of the worksheet isincluded in Appendix C. 1. Also included in the packet is a sheet of paper telling theparents how to apply for a copy of the birth certificate at the Washtenaw County Clerk’soffice. The rest of the process is handled by the clerks:

3.1 Identification of information needed

A flowchart of the current process is included in Appendix D. 1. Every morning,the clerk begins the process by logging in to the hospital computer system. Theclerk then prints out a list of the most recent hospital births and identities thepatients that she has not contacted.

At this point, the birth certificate clerk must gather all of her importantdocumentation and carry it from her office in the Taubman Center basement to theBirth Center on the 4th floor of Women’s Hospital, where. she visits both 4 Eastand 4 West. Here, she stops at the nurses station to pick up any birth certificateworksheets that have been completed by parent, and looks at the chart on the wall toidentify the patients’ room numbers.

The clerk then weeds through a pile of papers to determine which patients havegiven her their worksheets, yet still need to be interviewed, what patients have notyet turned in their worksheets, and what patients have left the hospital. Thisprocess can take anywhere from 5 to 20 minutes on each wing, depending on the

Birth Cei rJicate Piocc.s.s Reengineei ing

Cnumber of births. At this point, she is able to identify any parents that have left thehospital without completing the birth certificate worksheet. Later, she will have tocontact these parents via te!ephone at home in order to gather the necessaryinformation. Most of the work for this step takes place in any available inch of thenurses station, which usually ends up being the top of a corner garbage can.

3.2 Collection of information

With the list of patients and their room numbers, the clerk begins to visit eachmother individually. Frequently, however, the mothers are asleep, out of the room,or have not yet completed the initial worksheet. They are often unaware of theprocess or have not yet received the worksheet. At this point, the clerk gives themanother copy and briefly explains the process, telling them that she will return laterto pick it up. If the patient is asleep she leaves a copy on the door. -

If the mother has already turned her worksheet in to the nurse, or has it completedwhen the clerk arrives, the clerk fills out a second worksheet (see appendix C.2) byconducting a brief interview with the mother. The answers to most of the questionsare requested by the State and included in the entry to the EBC system, but are notrequired and do not appear on the fmal birth certificate. The worksheet alsorequires medical data which the clerk collects from the mother’s delivery sheet orrecords at the nurses station.

The clerk sometimes skips or shortens the patient interview if she is short on timeor the patient is unavailable. The clerk occasionally skips the interview because oflanguage barriers with the patient. Sometimes the clerk curtails the interview if shesenses that the patient is uncomfortable answering some of the questions in front ofvisitors in the room.

3.3 Preparation of information

After collecting the patient information, the birth certificate clerk returns to the VitalStatistics office to enter all of the information into the EBC. The clerk reports thisto be the most time consuming aspect of the process and estimates that she typesapproximately 10-12 birth certificates per day.

When the birth certificates are entered, the clerk types out preliminary copies of thebirth certificate, which then goes through several rounds of proofreading. At thispoint, the clerk is supposed to return to the Birth Center for the mothers’signatures. However, as this step is not required before the birth certificates aresubmitted to the County, and since many mothers have already left the hospital atthis point, the clerk often skips this step to save time. This means that the patientslose the option of applying for social security at the same time as the birth certificateis submitted, since this option requires the mother’s signature on the birthcertificate.

Birth Certificate Process Reengineering ,

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The clerk then delivers copies of the birth certificate to the appropriate practitionersfor their signatures. The usual turnaround time to get these signatures is one day,but occasionally it takes Jonger. For the practitioners who are not particular aboutsigning their own birth certificates, the clerk leaves them for her supervisor, SandraHoffman, to sign.

3.4 Submission of information

After all of the necessary signatures have been obtained, the clerk sends theprepared birth certificates to the Washtenaw County Clerk’s office. In order to dothis, she bundles them into an envelope and walks it over to the hospital’s meteredmail room.

Occasionally information sent to the Washtenaw County clerk is incorrect. This isgenerally brought to the attention of the hospital by the parents when they apply fortheir child’s birth certificate at the county clerks office. To correct the mistake, theparents must contact the birth certificate clerk at the hospital, who then brings up thehospital records. If the mistake is the fault of the hospital, the hospital is requiredto pay a correction fee to the county of $26. To correct the error in the countyrecords, the birth certificate clerk fills out a correction form with the rightinformation and sends it into the Washtenaw County Clerk. If the mistake is theparent’s fault, they are required to pay the fee, but the same paperwork is filled outby the birth certificate clerk at the hospital.

Approximately every two weeks, the birth certificate clerk downloads the data fromthe EBC system to the State of Michigan, where it is used for statistical purposes.The hospital also maintains electronic records of this data for their own purposesfor about two years after the birth of the baby.

4.0 Observations and Findings

4 . 1 Current process

The following observations about the current process are targets for improvement.

• The clerks spend a large amount of time &ansferring redundant informationbetween paper records and between those records and Electronic BirthCertificate program.

• If the clerks follow the current work procedure, they may make 2-3 visits toeach patients room.

• The clerks have to spend an excessive amount of time shuffling between theVital Statistics office and Women’s Hospital (14.1 minute round trip.)

Birth Cerrfieate Process f?eengineering

• Although the birth certificate worksheet is given to the parents aiong with otherinformation after delivery, many parents fail to fill it out in time, lose it, or havenever seen it, which greatly slows the process.

• Mothers are often sleeping, out of the room, or entertaining visitors when theclerk stops by to collect information, in which case the clerk must make asecond trip.

• In order to get an authorized practitioner’s signature on the birth certificate, theclerks must drop the certificate at the practitioner’s office and wait up to severaldays before it is signed.

• Due to the remoteness of the Vital Statistics office and part-time schedules of theclerks, they are often inaccessible to patients and Women’s Hospital staff.

• Women’s Hospital staff are generally not educated enough about the birthcertificate process to aid patients or the clerks.

• Due to quick patient turnaround times and an excessive workload, mothersoften leave the hospital before all of the documentation is collected.

• Most parents do not have the opportunity to simultaneously apply for socialsecurity for their baby due to time constraints. Parents often complain aboutthis shortcoming.

4.2 Prenatal information and impending changes

• Although some of the information required for the birth certificates anddemographic data requested by the state is collected as part of the hand writtenob/gyn anteparmm records, this information is incomplete and the clerks do notuse it to compile the birth certificate. Some of the interview questions could beeliminated by examining patient records, but the clerks would still need to visitthe mother’s room. Once there, however, it is faster for them to ask the motherdirectly. The project team recommends further investigation into the possibilityof interviewing the patients on arrival but before deliveiy.

• Mothers are not currently educated about birth certificate, social security orpaternity requirements prior to delivery.

• Ob/gyn and MC1T are currently considering implementing WatchChild, apowerful, customizable UNIX-based commercial software package, to keeptrack of all hospital prenatal and postnatal information from demographics downto fetal monitoring.

• It is technically feasible to design a printable birth certificate form in WatchChildwhich would automatically import from existing records most if not all of therequired birth certificate information and confidential information requested bythe State.

Bii 1/? C c.i rzilcate Pt oces5 I?eeng!new ing .

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Even if the capital expenditure for hardware necessary to implement theWatchChild software is approved, the system may not be fully implementeduntil 1998.

4.3 Benchmarking study

A detailed benchmarking report is included in Appendix B. The study revealed thatwhile each hospital collects identical data, the process for collecting that data variesslightly from hospital to hospital. Because the data collected by this study waspurely qualitative in terms of accuracy and timeliness, it is impossible to rate eachhospital according to these variables. However, from comments made by theindividual supervisors, St. Joseph’s Mercy Hospital is the most satisfied with theirsystem. Their reasons for satisfaction are derived mainly from three key aspects oftheir process:

• Close location of the clerk’s office and EBC system to the delivery unit.

• Information meeting for mother’s held prior to the delivery to explain theprocess and begin information collection.

• Increased responsibility and empowerment of the birth certificate clerks.

It is also interesting to note that St. Joseph’s has the smallest baby to clerk ratio.This shows that the above three variables significantly affect the efficiency of theprocess.

5.0 Recommendations

The project team recommends streamlining the birth certificate process in the followingways, ranked by order of impact. Calculations for any estimates of cost savings areincluded in Appendix F.

5. 1 Move the clerk closer to the point of service

The project team strongly recommends moving the clerk’s office from 31 Taubmanto the 4th floor of the Women’s Hospital. This move would eliminate the timespent walking between the Vital Statistics office and the Birth Center. Moving thebirth certificate clerk closer to the point of service also facilitates bettercommunication between the clerk, mothers, and nurses. The new birth certificateclerk’s workspace would require its own telephone line and minimal space: enoughroom for one desk, a computer, printer, and file cabinets. According to the travelrequirements of the current process, the project team estimates that this move woulddirectly save 109 clerk hours, or $958, annually.

Birth Cei n,/lc ate F; oce s I? c’enginec1 lrzg

(5.2 Collect information on a portable computer

Providing the clerk with..a laptop computer and printer on a pushcart would allowthe clerk to collect information from the parents, verify it, print the birth certificate,obtain the mother’s signature and social security number request all in one step,right in the patient’s room. This eliminates the need for multiple visits to thepatient’s room, along with the time-consuming and error-prone transfer of handwritten data.

Since nearly all mothers would then proofread and sign the birth certificate, thehospital’s error rate should drop considerably. Although some errors may stilloccur, the parents would be responsible for correcting them. In addition to theindirect cost of having a clerk find and correct all documentation, the hospital alsopays a $26 fee to the county per error. Based on past error rates, the project teamestimates a direct annual savings of $2,808 due to a 90% error reduction.

The laptop PC, battery, adapter, modem, and printer models recommended aredetailed in the implementation plan. MC1T quoted the total hardware cost at $1596.This system should be piloted with equipment loaned from MCII’ before makingthe hardware investment.

5.3 Provide information during prenatal care

Currently mothers are not informed about the birth certificate process until afterbirth. The project team recommends providing prenatal patients with a concisepamphlet about the birth certificate process and requirements, especiallyemphasizing the requirements for establishing paternity and its importance to theState. UMHS recently received a letter from the State of Michigan FamilyIndependence Agency criticizing the hospital’s improved, but still below average,rate for establishing paternity in unwed births. A copy of this letter is included asAppendix G. Both prenatal and maternity ward staff should be informed about thebirth certificate and paternity process so that they can assist concerned patients.

5.4 Create legal document for parents who refuse to establishpaternity

This document would protect UM}IS from State accusations (see Appendix G) byproving that the hospital was not able to establish paternity due to the informedchoice of the parents, rather than a lack of effort on the hospital’s part.

5.5 Authorize clerks to sign birth certificates

Currently, the practitioners (doctors and certified nurse midwives) and SandraHoffman, the birth certificate clerks’ supervisor, are authorized to sign the birthcertificates. Except for practitioners who are insistent about signing their own,Sandra Hoffman signs most of the hospital’s birth certificates. By certifying theclerks to sign them, the process would move more quickly and efficiently. Thiswould be an especially advantageous change if the clerks were relocated to the Birth

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Center, as it would eliminate the need for them to return to the Vital Statistics Officefor Sandra Hoffman’s signature.

5 . 6 Print business cards for birth certificate clerks

Attaching business cards with the clerks’ phone number to any birth certificateinformation the mothers receive will increase accessibility and visibility to thepatients.

5 .7 Cross-train maternity ward and birth certificate clerks

In addition to providing a constant availability of expertise for patients and staff, theincreased flexibility of the clerks would allow management to schedule staff tobetter match workload and improve efficiency. -

5. 8 Create a birth certificate form in the WatchChild system

As mentioned before, WatchChild vendors could easily design a printable birthcertificate template that would automatically assimilate all of the data needed.Volume data could then be downloaded directly to the State. If this system isimplemented, the only steps required in the birth certificate process would be tointeiew the mothers ad obtain the parents’ and authorized signer’s signaturesafter birth.

This job and the responsibility of correcting errors could be integrated with the roleof maternity ward clerk. The WatchChild vendor estimates a one-time cost of lessthan S 10,000 to customize the system for birth certificates. As mentioned before,this system will not be implemented for some time, if at alL

6.0 Implementation Action Plan

The project team recommends implementing the suggested process improvements in threechronological phases to ensure a smooth transition. Throughout the implementationprocess, all involved parties should be educated about the process changes. This educationcan be accomplished through e-mail, memos, department meetings, one-on-one training orthrough any other means of effective communication. It is imperative that throughout thisprocess the individuals involved have the opportunity to ask questions, providesuggestions, and voice their opinions. This involvement will minimize confusion andensure that recommendations are implemented to their full potential for improving patientsatisfaction.

Birth Cenificate PrOcess Reengineering

6.1 Phase I Recommendations

6.1.1 Move birtk certificate clerks closer to point of service.

Ownership: contact Mary Anne Bryant, Department Administrator, Pediatrics

Action Plan: • Locate available workspace on 4th Floor Women’s Hospital thatwill accommodate desk, computer, printer, and file storage area

• Obtain appropriate authorization for workspace

• Relocate clerks

Results: • Eliminates unnecessary 14.1 minute trips betweenVital Statistics Office and Women’s Hospital

• Estimated direct annual savings of 109 clerkhours ($958) due to reduced travel time alone

• Facilitates effective communication between clerks,patients, and nurses

6.. 1.2 Provide mothers with birth certificate/paternity informationin a pre-natal session

Ownership: Clinic nurses and clerkscontact Margaret Hugh, Head Nurse, Ob/gyn clinics

Action Plan: • Establish pre-natal visit during which the information will beprovided

• Instruct and train nurses or clerks to deliver the informationto the mothers during their visit

• Provide documentation information includinga.) description of birth certificate process that occurs after the

hospital deliveryb.) need for establishing paternity/associated benefitsc.) means for establishing paternity

Results: • Educates mothers not to leave hospital before providinginformation to clerk

• Educates unwed mothers about establishing paternity inorder to expedite the process and increase paternities, asrequested by the State of Michigan

Birth Cei njicare Pi ocess Reengmeei ing ,rc

6.1.3 Create a form for mothers who wish to decline paternityestablishment

Ownership: Sandra Hoffman, DeNise Crockett, Deshanda Cook

Action Plan: • Create form stating that the mother has been provided withinformation about establishing paternity but wishes to declinefilling out the affidavit of parentage form against the hospital’s

- advice

• Ask mothers to sign

• Provide to State at end of year to verify that a UMHS has madean effort to increase established paternity levels

Results: • Verification of concerted effort to increase levels ofestablished paternity at UMHS despite poor statistics

6. 1.4 Certify clerks to sign birth certificates

Ownership: Sandra Hoffman

Action Plan: • Certify birth certificate clerk through County Clerk’s Office

Results: • Eliminates trips to other hospital locations and waiting timeincurred while obtaining necessary practitioners’ signatures

• Decreases practitioner workload

a Gives clerks greater ownership of process

6.1.5 Print• business cards for clerks

Ownership: Sandra Hoffman, DeNise Crockett, Deshanda Cook

Action Plan: • Send for business cards

• Attach to birth certificate information and correspondencewith patients

Results: • Easily accessible patient contact

Birth Cerri/icate Process Reengineering,1J:’

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6.1.6 Perform a pilot trial using a portable computer and printer

Ownership: Sandra Hoffman, DeNise Crockett, Deshanda Cook, MCIT

Action Plan: • Contact Scott Larsen, MCIT, at 936-5383 to arrange loan oflaptop PC and Deskjet pin-fed printer (outdated)

• Connect hardware and install EBC software onto laptop withMCIT assistance (see Appendix E)

• Collect all information through interviews and eliminateworksheets

• Print out EBC information and have mother validate/signwhile in patient’s room

Results: • Discover and eliminate any unforeseen difficulties beforepurchasing hardware

6.2 Phase II Recommendations

6.2.1 Purchase hardware and implement

Ownership: Sandra Hoffman, DeNise Crockett, Deshanda Cook, MCIT

Action Plan: • Contact Brent Albrecht, MCIT, at 764-5591

• Arrange purchase of IBM 365 ED laptop computer with

Hayes Acura 14.4K internal modem (see Appendix F)

• Arrange for MCIT to configure hardware and install EBC

software (see Appendix E)

• Collect all information through interviews whenever possibleand eliminate worksheets

• Print out EBC birth certificate and have mother sign andlor makeany necessary corrections while in the patient’s roomimmediately after interview

Results: • Eliminates multiple trips to patient’s room

• Eliminates time consuming, redundant, and error-pronehandwritten birth certificate forms

• Ensures that mother’s signature appears on birth certificateand that parents can apply for child’s social security

• Reduces cost of errors by allowing mothers to verify certificates

Birth Cerflfieate Process I? cengineering-

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6.2.2 Cross-train birth certificate and maternity ward clerks

Ownership: SandtaHóffman

Action Plan: • Provide training sessions

• Establish point contact to deal with problems, answer questionsand claim “ownership” of process

Results: • Increased efficiency and flexibility between clerks.

• Constant availability of expertise to collect information andanswer patient questions

6.3 Phase Ill Recommendations

6.3. 1 Integrate birth certificate process into WatchChild system

Ownership: Sandra Hoffman; Joan Robinson, MCIT; Peggy Phillips, MCITOb/gyn and perinatal staff

Action Plan: • Investigate technical and practicaJ feasibility of importing allbirth certificate data from data already collected by WatchChildas part of patient’s record

• Investigate how process and staffing can be radically changed tomaximize cost reduction

• If UMBS decides to implement WatchChild, contract design ofcustom birth certificate screen, capable of printing formattedcertificates and uploading data to the State.

Results: • Elimination of redundant information collection

• Elimination of bothersome patient interviews

• Greatly enhanced speed

• Cross-trained staff will be more efficiently utilized

Birth Cci rfk ate Process Reengmeei inçç

6.3.2 Investigate alternatives for collecting all information prior todelivery if WatchChild is not implemented

Ownership: Pat Warner

Action Plan: • Assemble project team to further analyze process

• Investigate legal aspects of collecting birth certificate data itemsprior to delivery

• Investigate logistical practicality of collecting all patient dataprior to delivery, so as to ensure no patients slip through thecracks

• Further investigate cost-effectiveness of this approach

Results: • May find a way to further reduce patient inconvenience

• May reduce costs further

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Appendix A: Proposed Workplan

Week Beginning:

I. Proposal Development

A. Initial Meeting with Pat Warner

B. Develop Written Project Proposal

C. Proposal Approval/Sign-off

II. Current Workf low

A. Data Collection

B. Staff Interviews

C. Current Process Ftow Development

D. Develop Method to Monitor Process

B. Benchmartcing (phone survey)

F. Assessment of Available IT Resources

G. Observations and Findings

Ill. Recommendations

A. Proposed Process Flow

B. Recommendations

C. Develop Implementation Plan

D. Interim Client Meeting

B. Develop Monitonng Tools

IV. Implementation

A. Compile Project Report and Drafts

B. Begin Implementing Process Changes

C. Report Draft Submitted for Review

D. Final Client Presentation

23.-Sep 30-Seol 7-Oc” j4 21-Oct 28-Oct 4-Noij.±Lgy i No25-Nov 2-Dec 9

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Appendix B: Benchmarking Study

B .1 Purpose

A benchmarking study was perfofmed to aid the project team in assessing and consideringother means of organization for the birth certificate process. From the study, the projectteam obtained and/or generated ideas from processes currently in place in these otherinstitutions.

B .2 Approach

Three Michigan hospitals were contacted to obtain information for this study. Birthcertificate supervisors at St. Joseph’s Mercy Hospital (Ypsilanti), Munson Medical Center(Traverse City), and Beaumont (Royal Oak) were contacted by phone and questioned abouttheir hopital’s current birth certificate process. The following five main questions wereasked in each of these short interviews:

• What was the approximate number of births in 1995?

• Do you utilize the Electronic Birth Certificate system supplied by the state?

• How is the required information for each birth certificate collected?

• What birth certificate information is collected?

• How many clerks do you have employed for the purpose of birth certificatecompletion?

Along with the data from these questions, various other information was collected fromeach interview pertaining to each individual process.

B.3 Findings

Findings to four of the previously stated questions can be found in the following table.Information pertaining to how the Jirth certificate data is collected can be found in the shortsummaries of each hospital’s process that follow.

B .3.1 University of Michigan Hospital Systems

See Current Process Flow

B.3.2 St. Joseph’s Mercy Hospital

Prior to delivery in an educational prenatal visit, the mother’s are given a packet ofpamphlets and forms which contain information about obtaining their baby’s birthcertificate. Contained in this packet is the worksheet that must be prepared in orderfor the clerks to begin processing the birth certificate. The mothers are instructed toread over the information provided and fill out this form if possible prior to theirdue date. The completed information is then to be brought with them on the day ofdelivery and collected by the clerk. If the information is not filled out prior todelivery, a clerk will then drop it off and collect it from the mother before herdeparture from the hospital.

After this information is collected, the mother’s are interviewed by the clerks toverify the data provided. Additional state required questions are also asked of themother. This completed information is then entered into the EBC on a daily basis

U of M St. Joseph’s Munson Beaumont

NumberofBirthsin 2319 4310 1831 5188

1995

Utilize EBC? YES YES YES NO

Number of Clerks 1.5 1.5 1.5 2.5

Baby to Clerk Ratio 1546:1 2874:1 1221:1 2076:1

Data Collected State Required State Required State Required State Required

by the clerks. A copy of the information to appear on the birth certificate is thenproof-read by the clerks and signed and proof-read by the mothers before beingsent out to the county clerk’s office.

The process requires 1.5 clerks to complete efficiently. One full time clerk isalways present along with .another clerk who spends half her day in the file andretrieval area aiding other staff members. Six other individuals are cross-trained inthe birth certificate process to step-in in case of emergency, illness, or vacationtime.

St. Joseph’s recently underwent a reengineering effort to streamline the birthcertificate process. Two new clerks were hired who were empowered to help makeany necessary changes in the implementation process. The office for the clerkscontaining the EBC System was immediately moved to a location in close proximityto the actual delivery rooms to help eliminate time wasted walking back and forthbetween the two areas. Since the new clerks were given full responsibility of theaccuracy and timeliness of the process, the number of mistakes and ensuingcomplaints were significantly reduced. The supervisor of this operation isextremely satisfied with the timeliness and accuracy of this process. -.

B .3.3 Munson Medical Center

Prior to delivery in an on-site educational session titled “Maternity Prepared Stay”,the mother’s are given a packet of pamphlets and forms which contain informationabout obtaining their baby’s birth certificate. The process here on out is verysimilar to that of St. Joseph’s. Currently, 35% of the mother’s come to deliverywith the completed information. A concerted effort is being made to increase thispercentage.

The process currently utilizes 1.5 clerks to complete the required tasks. However,Munson is having some difficulties with their current process and are looking intoreengineering the operation. They are finding that the process is too lengthy due tothe fact that several of the mother’s/father’s are not prepared with the necessaryidentification information needed for the completion of the birth certificate! paternitypapers. (One of the largest difficulties encountered by this department is thesigning of paternity papers.) They are currently looking into better methods to gainthe required information and are interested in any information and orrecommendations the project team may have at the completion of this project.

B .3.4 William Beaumont Hospital

The system at Beaumont is similar to that at the University of Michigan HospitalSystem in that the information and forms are not passed out to the mother until afterthe baby is born. The information is left with the mother along with a note to haveit filled out by the day after delivery at 8:00am in order to be collected by a clerk.The information is then collected and the mothers are interviewed in a similarfashion as at each of the other hospitals. Because of the quick 24 hour dischargetime, the clerks are having a very difficult time interviewing each mother before herdeparture. Many need to be contacted by phone after they have left. This slows theprocess significantly because it is often difficult or even impossible to reach themothers.

Beaumont differs from any or the other hospitals contacted in that they do not utilizethe state provided EBC system. This also slows their process because informationcan not be downloaded directly to the state but rather disks of information fromtheir own system are mailed out.

B.4 Conclusions -

The information collected by each of the hospitals is the same. The process by which tocollect it varies slightly from hospital to hospital. Because the data collected by this studywas purely qualitative in terms of accuracy and timeliness, it is impossible to rate eachhospital according to these variables. However, from comments made by the individualsupervisors, St. Joseph’s Mercy Hospital is the most satisfied with their system. Theirreasons for satisfaction are derived mainly from three key aspects of their proces:

• Close location of the clerk’s office and EBC system to the delivery unit• Information meeting for mother’s held prior to the delivery to explain the process and

begin information collection• Increased responsibility and empowerment of the birth certificate clerks

It is also interesting to note that St. Joseph’s has the smallest baby to clerk ratio. Thismakes it evident that the above three variables significantly affect the efficiency of theprocess.

These three changes should be considered for implementation at UMHS.

C:

Appendix C: Birth Certificate Worksheets

C. 1 Patient Worksheet

iruoi’mauofl reecaa icr i..ompletlngYour Child’s Birth Certificate

—Thank YOU Or

Qi.t.sticns Cail 936—7481

flis worksheet is designed to collect fits information on the parents that wiii Ce needc to prepare thOLeave

certificate of bitW for me cNd. It will be helpful it you would till this form out as completely as possible At

and bring It with you.to the hospital when you come to deliver your baby. NurseDesk

Note that a certificate of bIrth must be filled out completely, Incomplete certificates are not accepted for

tiling. The information will be used to prepare your childs birth certificate which is a legal document. The

law requires the information be suoplied. It is also very important that the informaton supplied Is truthful

as supplying false information is against the law.

I, C).lli.Q.lAME F(P5Ti pOOi.E)

,... ome’a ...—e esi’. ..oou. ,..sri je. cc:A.. stcue,rr ce Sc. ante OF eIRT...’EC0UNTY IF NOT

Sc. k4QTHEA.SURNAI. EFOS Sr. €5(OENC (C.Sw. cc. cc. cc

dM51’ MAMMIEDINSICE C(T’r OR V*I...ZE CF

S. COUNTY

The law soecifically stioulates the orocess for nsmng the father on a child’s certificate of birth. Accordln to the law, the birth

ertilicate for a child must record the mother’s husband as the father whenever the mother was mamed at the time the child was

conceived. If you were not married at the tithe of your Child’S conception Out were married at the time ci birth, the Individuef named

as the lather is your husband at me time of birth, it you were not married at either time, the father’s name may not be entered without

the written Consent from inc indivIdual to be named as the lathe,. €sceQilons to these provisions can occur only throuqh the llndinç

and order of a Court.

9.. FAIIEF( S N*E FIRST, MIOOU. L..sh . SOC1A SECURITY NUM8!fi Sc. STATE OF 3IRTI4.N.Ie 55. OATE OF eiRcouNrwr IF uor USA iMcc. d.,

Additional information that will be kept confidential.

.

- I EDUCATION

It. &IcCStR’r . “..wcc, Pv.no Sccc. C,.C.c C..c,,c cc 12, M*C5 . 4c1.nccc, IcOINc. dcc.. W•IM. lc.

Sc,arn A,w,ca.I, CIvcwc, Qift,. AI4Q. It ASLIfl, 5,.. flNCchtS a CREam. FiJic.a.. (‘OW Sb. p. .‘...—d

01511511, FI.I15ft, RaIIW’, •0. I3cc ccw’l AIlci IncW. cl5. iSSccItr *.wt €lcc,.a,cc,IS.cwIeac, (0.121 CcU.q. (14 cc 5 •1

t ‘4‘‘5.

It. I I‘is’

I 12,

I1211.

w***’*Hote: All birth information must be provided prior to discharge. Leave this

form with birth certificate clerk or at nurse station,

OEPENt oF wust,jc ,si.m’

Aun’r’*a64. PA ins

Owes e’ iSe SuitCcc... icc$

5d. OATEOFSIMTHlMc’ C.y, r..’,

a.sR,r,.i. STATUS s1551•. ,,.cci.e. —.a,.a, ,,,o,vccl IF TMEVIOUSI.y 4AAR(EO, bATE MARRIAGE ENOED

[ Si., STATE

Ii MOT1’IEKS MAIUNG ACDRLSS (STREET iIU’.itER. TY OR V1U.AOE. STATS. P)

Home’ Phone__________

StGNAT1JRE O MCThE O lNORMANT.

N:

C.2 Clerk Worksheet

‘I.

CONFIDENTIAL INFORMATION FOR PUBLIC HEALTH USE ONLY

1_.i1EI ‘1 is..

125. 138.

* EXPSCTEO SOURCE QF PAYMENT I S. MO .t€R5 MAIUNC AOORESS STREET NU4RER CITY OR VII.L,G5. STA YE. ZIP,FOR MEDICAl.. SERa.CE5IPA.et. E.nn.. 8a.Rc.a.d. dAt

SEGNATIJRE O MOTHER OR

AtflTr: ARI 244. P .74

NGAN CE8eTUl’a ‘UEL’D .‘L.’

— \ . Ott..., ire Slat, Cq,rra.\_, Cern.. I.. n...m StaInt.c.

CltIL .

HOSPITAL WORKSHEET

E.RSTI ,IO2LE

ID. 5.%Gi N. TSPtE a •.c E.s.DJ . sr za S r— .Com.. :... •.a..,.._ T.n.t—to a—.s:;— :o os

I ‘II

a.. —OScTAI. tAC.t .0 nOT D.yfla..QNv5EC.5_. a .:t . E....nt : SOT—

ANtE NO IT S Y ‘0’% R 0 .QOZ!0

S.. ::::,02LS ST. 5 5CC nEi

B.. HOTII€R. SIJRN.At.tE SEFORS SI OE5tOENCS C.i.a. a.,. ,.e ;4I 3. CD_nT— 5- STERIRSY MARRIRO : ASIDE CITY OR vIUAGE Ga

TWCC

9.. F.Yn€R5 NAME FIRST ,4100L5. ASTI A DC LSSC AT C — € DATECEBRT’.’CNT° :0 nOT WRote. C.... Y...,

I ANCESTRY. U..... Pa,. Pa.,,. Z....n. Cr.,’,, of IS. RACE. ate..,0., PR4I. IIfl. Na.,. CIA.’ 44.4, IDUCAYIONSa.JtA AteRflcefl 0.e.,.. age.. ..,so...c. Alto.Ateq,ce, 5Oe ,.,ca...y .... CA...,.. ....... A,... no.,,,:. SanS..,.. “.5*nf rae Cat’esCofl,Also. Esw, St..a, F..te,a. etc. :SanWv an... - ;Sanwv or,—, Elnnoat,Secaac .3.2: aa.qe 1.4 of

lB.. MEOICAL RECORD NO. IRE. MEDICAl. RECORD NO. IS. MONIl’t OR PREGNANCT IS TOTAl. PRENATAl. VISITSOR MOTHER GE CHILO P°BNATAl. CARE BEGAN ‘J’SITS

20. l..JVS BIRTHS SOB. OTHER TERMINATIONS 21,. OAOTI’€R TRANSFERRED PRIOR TO DElIVERY’ 22. AiTEVOS.NT AT BIRT14ID..... ... .no CaMEl I$n,,a...o., aa..NRsa.PR a. .. : No

IV 4070 Cflfl CW,Cfl,1 II Vfl. .aICt Canoe RI toGA,, IIWOIRIflC liPRi.

20.. NOW UVING 208. DEAD ‘-‘ , :, I — 0.0.

\J’ : NURSEPA.n Nan.. — N..cnoa — . = MIOWIPE

C o.a.. C C SIN. aAofT TEANEF6PD’ 21. NFANT o”s— NP : CCRTI#EO NURSE MOwOER

C a.. NC ,. r—.. , . :20... DATE 0$ LAST LIVE BIRTh 20.. DATE O LAST OTHER 7 4818 R9 POIIEPRO I. I

IAINJY.ME TERMINATION (Mo.SY..te

2A. BIRTIRWEIGN? 17. DATE LAST NORMAL MENSTRUAl. 25. ESTiMATED w555 29. APOAB SCCR€0t ‘°“ PERICO sec.an lurm. D.y. roan GESTATION I %CIN. I Mel

TOBACCO USE DURING NUMBER CIGARET’TES ALCOtICI. u56 DURING NUMBER ORINC5 - WEIGHT GAINED DURINGP,RIGNAlICY PER DAY PREGNANCY PAM WEEK PREGNAaCY

Or.. ON. DY.. N.

C.2 Clerk Worksheet (cont.)

CHILDS NAME

MEDICAL RISK FACTORSScreen - 1

01. ne(ct. <3OjHgb tIC)

02. Cardiac Disease

Acute or C2ronic Lung Disease

04.LZ Diabetes

054 Genital Heroes

06.[_ Hydmnios/Oligohydr’mnios

07.1 Hernoglobinopathy

o.I Hypertension. Chronic

°E Hypertensioni?regnancy Assoc

lO.L Eciarnpsia

ll.L Incompetent Cervix

Previous Infant 4000 + grants

i3. Previous ?retertn orSGA

14.! Rennl Disease

iS. Rh Sensitizaiion

16. Uterine Bleeding

17. NONE

18. Other

______________________

DATE OF BIRTH:

METHOD OF DELIVERYScreen - 2

lS.1 Vaginal

19. Vaginal After Prey C-Section

20. Primary C-Section

21 Repeat C-Section

22. Forceos23. Vacuum

ABNORMAL CONDITIONS OF NEWBORNScreen - 3

01. Anemia (Hct <39/Hgb <13)

02. Birth Injury

03. Fetal Alcohol Syndrome

04. Hyalirte Membrane Diseasc/RDS

05.L_ Mecoithim Aspiration Syndrome

06.L_ Assisted Ventilation <30 n-in

°-L.._ Assisted Ventilation >= 30 mitt

08.1 Siezures

09. NONE10. Other_______________________

CONG’fITAL ANOMALIES

19 Amniocentesis

20. ectonic Fetal Monitoring

21. Induction of Labor

22. Stimulation of Labor

23. Tocolysis

24. Ultrasound

25. NONE

26. Other____________________

COMPLICATIONS AND METHOD OF DELIVERY

Screcu.2

Cl. Febriie(>lOOFor3SC)

02. Mecomum. ModeraieiHeavy

03. — Preniature Rupture (>12 )trs)

04. — Abruptio Placenta

05. — Placenta Prtvia

06. — Other excessive Bleeding

07. — Siezures During Labor

08. — Precipitous Labor (<3 his)

09. Prolonged labor (>20 his)

10. — Dysfunctional Labor

11. — Breech/Malpresencation

12. Cephalopelvic Disproportion

13. Cord Prolaose

14. Anesthetic Complications

i54_ Fetal Distress16. NONE17. Other____________

11. Anencephalus12. Spina BLfidalMcningoceie

13. Hydrocepbalus

14. Microcephalus

15. Other CNS Anotnalie:

(Specify)

Hent MalformationsOcher Circ.’Reso. Anozaiie:

(Specify)

Recial Acesia/Scenosis

Trach,EsodFistula/Atresia

Ornphalocele/Gastroschisis

Other Gastrointestinal:

(Specify)

Malformed Genitalia

Renal AgenisisOther Urogenital:

(Specify)

01.02.03.

S 04.C 5• —

ES —

N 06.07.

4

08. No Congenital Anomalies

09. Any Other Congenital Anornaliet

(Specify)

OBSTETRIC PROCEDUREScreen - I

Sc 16.R 17.S

N18.

3 19.20.21.

2123.24.

Cleft Lip/Palate

PolydactylyfSyndacryly/Adacryi

Club Foot -

Diaphragmatic Hernia

Other Muscu1oseletal/Inzeg.:

(Specify)

Downs Syndrome

Other Chromosornal:

(Specify)

‘1 C-)

CD C.)

CD 1 CD tIl

C-)

V

L4

C-.)

(J3

m 0 m (I) m 5!

n

Appendix D.1: Current Birth Certificate Process

ND(PavilionIn Medical Information ( D) for births the

(MIS) hours

- I Dupe screen andhighlight

In Labor & Delivery ICheck L&Div1hog and pick uc blue I

(L&D) workss

Note phone and room

In Women’s Hospital number on blueworksheet. Abstract

information from chartonto blue worksheet

J Revisit later or

ilable?telephone/write atIn Patient’s Room

no

a later date Java

yes

Interview and giveinstructions to patient

to fill out forms infolder left by nursing

father to fill outpersformsL__J

no

In Women’s Hospitalor MiS

Print Birth Certificatefrom EBC

rHave certifier (ie CNM,MD, ART) review birthcertificate for accuracy

no

Mail birth certificates toMichigan Department of

Public Health F

Group paternity papers by• county and mail out to

Càunty Clerk

Take blue worksheet toMIS for processingIn MIS

In Patient’s Room

I

Have patient verifyaccuracy of

information on typedbirth certificate

spatieneav1ng

immediately?

Obtain patientsignature

(•.

C

1Make corrections

In MIS

&ppendix D.2: Proposed Birth Certificate Process

Revisit later ortelephone/write at

a later date

Instruct mother andfather to fill out

(Nurses) Explain Birth

Ceritificate process-to mothers

during prenatal visit

Check L&DveryIn Labor & Delivery(L&D)

In Women’s Hospital

In Patient’s Room

Note phone and roomnumbers of mothers.

Abstract information fromchart into EBC.

rno

yes

Interview and enternecessary EBC

information usinglaptop computer

ternipapers

flCSS7

no

yes

V

Print Birth .Certificatefrom EBC

Have patient verifyaccuracy of

informatipn- o typedbirth certificate

+Make corrections

Proof-read printed birthcertificates

yes

Error(s)? Make corrections

no

in OfficeMail birth certificates toMichigan Department of

Public Health

Group paternity papers by

county and mail out toCounty Clerk

Appendix E: EBC Software Description

Features of the Blectronic Sirzh Certificate System

The 2iectronIc Birth Certificate Software (ESC) Is currently instailed in 54 Micnigan hospitals.

These hospitals are or varicus sizes (500 - 10,000 births), he cost to the hospital involves

hardware equipment only (see attached). Software for this program will be purchased by the

State (approximately Si,000) with rio ccst to the hospital. Advantages to the hospitals

include:

- E3C allows the operator to enter and print the lecal portion of the certificate

(top portion) n time to get tne mother s signature. nis is espec:aily nelrul in

larger hospitals with high volumes of births.

- Only the legal portion of the certificate is printed thus ernhasizing

conricentiality. Completec binn cata is tnen transterrea clrectiy to me State via

a mccern.

- Dicttonaries are used to stcre countries, states. Michigan tcwns/c;ties/counties,

anc cemriers’ inrormation cr automatic retrieval into tne Dirtn certincate. I nis

eiim:nates keystrces eric the possio:ii’ or ping errors.

Corrections or additions to certificates (paternity etc.) can be done easily by

retrieving the record and updating information without retyping the wncle

certificate. Certificates can then be reprinted if necessary.

Farms such as hospital bih verifications, paternity, etc. can atso be created

and printed for each child using the report generator.

- Repor can be generated using the stored EC information for each child

through the Custom Report Generator. This can be used for documentation

such as birth logs or for statistical information such as low birth weights.

- Data base developed in reporting births will mirror data held by state and can

be exported to ASCU data files

The system has a method for tracking records sent to the city/coun’ cierks

office.

• By using E3C software, hospitals may be providing a service to some mothers

through the local county health departments. Various local county health

departments have recuested EC birth data from our Registration Unit

County Heatth Departments are then able to follow up on high-risk babies who

are residents of the county.

System can be used for reporting of fetal deaths andor birth defects.

The birth certificate forms come as pin-fed (tractor feed) paper. Only the legal portion of the

certificates will be printed. This means work sheets must be filled out by mother before a

1

Appendix E: EBC Software DescriptionC

certificate can be typed. Once the legal ponion is print9d, you will need to get vo

signatures: Mcther and Physician (or other certifier). The physician must complete the

rnecical portion of the work sneet and other applicacle items in croer for LhC computerrzeo

record to be completed. For some hospitals, this is a total change ;rom their present bih

certificate routine.

Assistance in operating the system is provided by Vital and Health Records staff from

8:00 a.m. to 4:30 p.m., Moncay througn Fricay. When immeaiate aenticn is needed after

working hours, Genesis Systems Corporation in Pennsylvania will assist ycur hospital 24-

hours a day.

Future enhancements being considered for future development incfude:

- Abiii’ to download data to MDPH and have SSA cards de!ivered to the

parents very rapidly with an average delivery time of 30 days.

- Integrated telecommunications to permit more efficient data dcwnloads

- An abiii’ to import irnormation into the system trom other data files such as

aomrng caza

- Possible development of a nevorking capabili to allow for multiple

simultaneous users.

- Addition of a feature to permit the hospital to include additional customized

information in the data set

Appendix E: EBC Software Description

EQUIPMENT AND SOFRIARE REQUIREMENTS

1) IBM XTIAT or compatible computer

Must have one serial and one parallel port

or

Two serial ports

2) 40 Megabytes Minimum Hard Drive. Additional space may be needed.based -

on the following formula:

(# of records per year x 2,047 x 2) + 8,000,000

3) 1 Megabyte of Random Access Memor’ (minimum)

4) One floppy drive (minimum)

May be 5.25” or 3.5’ floppyMay be formatted to 360K, 720K, 1.2, or 1.4M

5) Hercules (compatible) monochrome video card orOptional color monitor and color card

6) Hayes or Hayes compatible 9600 baud modem

7) Carbon Copy Plus telecommunications sofare

8) Letter Quality or Near Letter Quality printer

MUST BE PIN FED (Tractor Feed)Must be 132 columnMust print 12 pitch j12_ <z-Optional Sheet Feede(

if a dot matrix, must be 18 or 24 pin or printemphasized or double strike in 12 pitch.

(Compatible dot matrix printers include Okidata, Epson LQ1OSO,Panasonic KX-i 624, IBM Proprinter.)

9) EBC software and maintenance

10) Available telephone line for telecommunications (direct dial).

11) DOS version 3.t or higher

Software is supplied to each facility by the Department of Public Health, Office of the

State Registrar.

3

Appendix F: Cost Estimates

Medical Information, Vital Statistics Clerk pay rates

bi-weekly pay hours per week hourly pay annual payclerk 1 $ 375.85 20 $ 9.40 $ 9,208clerk2 $ 327.52 20 $ 8.19 $ 8,024

average $ 351.69 20 $ 8.79 $ 17,233

Direct cost of travel timetravel time(round trip) 14.1 minutesbirths/year 2,319travel time/year 109 hoursavg.clerk wage $ 8.79 per hour

annual cost savings $ 958* assuming clerk makes 2 round trips per 10 births

Computer hardwarequisffion costs

Direct cost of errors

births 2,319error rate 5%errors per year 120cost per error $ 26

annual cost of errors $ 3,120

computer IBM Thinkpad 365 ED540MB hard drive10.4” screen

$ 1,500.00

battery/adaptor included with computer $

modem Hayes Accura 14.4 datalfaxinternal modem

$ 95.66

printer

total

used Deskjet tractor fed model $

1,595.6ô*prices quoted by MC1T, available as of 12/9/96

Appendix G: State of Michigan Request to Establish MorePaternities

0- STATE OF MICHiGAN

SEP a ‘19 c ENGLER.

FAMILY INDEPNDNC AGENCYDireC oca ocn SUPPORT

HOSPIt2ls -“ 7109W SAGINAW I.wr, P0 BOX 30478. LANSING MI 48905-797aGERALD H. MILLER, Dfse

September 13, 1996

Mr. John Forsyth, Administrator p •.

University of Michigan Hospital AnbuL5.’ Care1500 E. Medical Center Dr.Ann Arbor, Ml 48106-0001

Dear Mr. Forsyth:

This letter provides information on the progress of your hospitals paternity acknowledgmentprogram as well as outlines some changes in law that will occur beginning July 1, 1997.

You may recall, starting January 1, 1994 all birthing hosoitals were required to offer to unwedparents an opportunity to acknowledge paternity as part of the birth registration process. Prior tothis, a number of hospitals were offering paternity acknowledgment services to unwed parents.Hospital training was provided in the fall/winter of 1993. At that time, hospitals were told that wewould provide feedback once we received data from the Department of Community Health(previously Public Health). Below are the statistics on your hospital’s progress.

Total Unw.d Patarnities % PaternitiesY.ar Births Established stabllshed

1993 2188 541 172 31.79%

1994 2218 594 283 47.64%

1995 2338 528 253 47,52%

During 1995, your hospital had 528 (22.58%) unwed births. We have compared your hospitalwith other hospitals with similar unwed birth rates—ranging from 7 to 25%. On an average, yourgroup of hospitals established paternity for 64.50% of their unwed births. Your hospital is lowerthan the average for hospitals having similar numbers of unwed births. You can see from thestatistics above the changes in your hospitafs effort. More babies are liflked with their biologicalfathers than before because of your hospital’s efforts. Your hospital is in the-best position todetermine what factors prohibit your staff from more fully assisting unwed parents in establishingpaternity.

In the very near future, we will be meeting with various hospitals to determine what does and

does not work in getting unwed parents to establish paternity. We would like any suggestions

you may have where we can be of help in increasing your hospital paternity establishment rate.

The state as a whole has increased paternity establishments from 26.47% in 1993 to 44.89% in

1995. We are hoping to continue to increase hospital paternity establishments statewide through

public outreach efforts. The issue of paternity establishment is a key issue in the philosophy of

personal responsibility. Personal responsibility is a focal point of welfare reform recently passed

Appendix G: State of Michigan Request to Establish MorePaternities (

Page2 -

Hospital Paternity Statistics

by Congress. (Federal Welfare Reform requires every state to establish paternity for 90% of

unwed parents.) We are encouraging hospitals to develop and/or enhance efforts to build

information about establishing paternity into prenatal classes and clinics. This way,

unwed parents are fully informed about the importance and benefits of establishing paternity, and

can discuss the situation during the pregnancy and be prepared to sign paternity papers at birth

in the hospital. We are working with the Michigan Academy of Family Physicians in providing

information in doctor’s offices. We are open to any comments or suggestions your hospital may

have that would be helpful in the effcrt to continue to increase the paternity establishment rate.

We are hopeful that some recent changes in legislation will increase paternity establishments..

The changes include:

The state must establish a central paternity registry that will contain

information on all patemities established. This registry will be housed at the

Department of Community i-iealth.

The acknowledgment must be notarized. (The acknowledgment will no longer

require two witnesses’ stnatures.)

The acknowledgment (original) will be mailed to the Local Registrar who then

forwaros to the Office of Vital Statistics, Department of Community Health.

(The acknowledgment will no longer be mailed to the Probate Courts

The acknowledgment form will contain rights and responsibilities of unwed

parents.

Upon signing the acknowledgment form, custody is granted to the mother unless

otherwise agreed to in writing by the parties or ordered by the court.

The mother and father must be provided with a copy of the acknowledgment form

upon signing.

Your hospital will be provided with the information, revised forms, and brochures prior to July

1997.

This is where the hospital paternity program stands today. You can be proud of your hospital’s

success in providing this valuable service to the population yoU serve. It is service valuable not

only to newborn children and your patients, but also to the community and the taxpayers of

Michigan. Thank you for the involvement and commitment of all stafY involved in this paternity

establishment effort.

If you have any suggestions or questions, please call us at (517) 373-7570.

Sincerely, /— ailace N. Dutkowski, Director

Office of Child Support

cc Medical RecordsOffice of the State Registrar

UNIVERSITY OF MICHIGAN HEALTH SYSTEMOPERATIONS ADMINISTRATION

D-5202 MPB/0718

MEMORANDUM

TO: Barb Dubler / /Sandra Hoffman I ivMargaret Hough I i97

rrj &c•— /

FROM: Pat WarnerJAssociate Hospital Director

DATE: January 8, 1997

SUBJECT: Birth Certificate Process

The Industrial and Operations Engineering Project, “Birth Certificate Process Re-

engineering” was very successful. The final report has been presented and I believe

each of you has a copy. If not, call and we can get you one.

I am very interested in implementing the recommendations. Thus, I ask that Sandra

Hoffman provide overafl leadership for coordinating implementation with the loNowing

responsibilities outlined below:

Barb Dubler:

- Locate a work space on Birth Center floor where the birth certificate clerk can have

access to a computer and some file storage.

- Work with Sandra Hoffman to cross-train birth certificate and maternity ward clerks,

Margaret Hough and Candy Laughlin:

- Create a consistent mechanism to provide mothers with birth certificate/paternity

information in the pre-natal visit process. An evaluation of effectiveness should be

included.

Sandra Hoffman:

- Create a form for mothers who wish to decline paternity establishment.

- Obtain certification for clerks to sign birth certificates.

Memorandum to Barb Dubler, Sandra Hoffman, Margaret HoughJanuary 8, 1997Page2

- Print business cards for the clerks:

- Perform a pilot trial using a portable computer and printer.

- Initiate work with MCIT to purchase hardware and implement system.

- Cross-train birth certificate and maternity ward clerks.

- Coordinate with Peggy Phillips and Joan Robinson to integrate birth certificate

process into WatchChild System.

- Initiate a patient and provider on-going feedback/satisfaction system.

I appreciate all of your work and ask that you implement the pilot by February, 1997.Please let me know if you have questions or need support.

PAW/kis

cc: Richard CoffeyDenise FlemingTim Johnson, M.D.Beverly JonesChrislan ManuelCarol SpenglerRosanne Whitehouse