The slow flow of birth data is one of the great frustrations of State and local health officials. Its high error rate requires many back-and-forth queries among hospitals, local registrars, and State agencies.
Recent changes in public policy and technology offer the opportunity to re-engineer the system. These new information systems could provide real-time feedback on at-risk infants and guide immunization efforts.
Birth Certificates
In almost all States, a child’s birth is documented on a paper certificate that records the primary legal data and confidential demographic and clinical information. The document then serves as a primary means for a family to obtain essential services, such as social security benefits and health insurance coverage.
The Federal Government is looking to electronics to streamline the system by reducing the time a month’s worth of birth information takes to reach the State level and, ultimately, families. Instead of receiving tapes from the States that batch and transmit a month’s data, the Federal Agency hopes to send a continuous stream of electronic information directly to local registrars and hospitals.
Hospitals are eager to improve the quality and timeliness of their data and are rethinking their processes. The furthest advanced form of reengineering is to integrate the production of a birth certificate into a hospital’s clinical information system. This approach would allow most information to be filled in automatically, with parents and clinical personnel verifying only the essentials.
Such systems have yet to be widely adopted, partly because standardized data definitions and communication protocols are needed. However, the timeliness of vital event data can be significantly improved. In that case, it may also be possible to reconceptualize birth certificates public record as a component of a broader perinatal information system, routing data via a secure network to the appropriate authorities for various purposes.
Birth Records
Despite the emergence of electronic point-of-service information systems, much data with significant public health value is still being bottled up in paper forms. In addition to the State-standard certificate of live birth, obstetric and medical records contain the following:
- Labor and delivery logs and Apgar scores
- Social and demographic information
- Prenatal care
- Maternal medical and obstetric complications
- Congenital disabilities
Some of this information is abstracted by hospitals for use in other reporting systems, such as hospital discharge abstracts and uniform bills, or is sent to local health departments as part of State-wide child immunization tracking systems or hepatitis B screening programs.
Hospitals have traditionally been the principal record-keeping organizations involved in births. Increasingly, however, HMOs and other managed care plans are building enterprise-wide information systems that can generate birth certificate data as a byproduct of their regular operation. Moreover, many of these systems now include built-in edits to prevent the keying of duplicate or seemingly incorrect data.
A survey of states using an EBC found that most reported improved timeliness in transmitting data to the State from their hospitals. Improvements in this area will require fundamental changes in institutional arrangements and policies and a reconceptualization of the birth certificate as one element of a unified perinatal information system.
Vital Records
The data we see as vital national statistics start as local information in the 57 jurisdictions that register births, deaths, terminations of pregnancy, and marriages. They rely on their local resources and demand for customer service to meet national standards of quality, timeliness, and security (as defined in the contracts with NCHS under the Vital Statistics Cooperative Program).
Jurisdictional staff oversees the registration process. They also interact with people who request certified copies of birth records, file corrections and amendments to those records or submit allegations that the data recorded by the local office have errors.
As a result, there are numerous opportunities for reengineering processes to improve the quality and scope of the information they produce. In addition, welfare policy and healthcare changes have increased demands for more policy-relevant details on perinatal events.
In this context, new technology offers significant opportunities to improve the capacity of jurisdictions to respond to these demands. At the same time, the technology also provides new possibilities for rethinking the entire system of collecting, recording, and disseminating public birth records. This would involve a radical reconceptualization of the birth certificate as the foundation of a broader perinatal information system that would route individual identifiers through an electronic network to the various agencies authorized to receive it: vital statistics, health statistics, Medicaid and the Women’s, Infants, and Children’s Program of the Department of Health and Human Services, metabolic disease screening, immunization registries, and child support enforcement.
Birth Registration
The full implementation of the right to be registered at birth, recognized in many international instruments, depends on a well-functioning civil registration system. Ideally, it should be free and universal, enabling all individuals to acquire a legal identity. Birth registration is a vital part of this system, and its complete coverage, accuracy, and timeliness are crucial for fulfilling many other rights, including those related to health and education.
Traditionally, hospitals have been the principal data collectors for State birth records systems. Within obstetric units, nurses and medical record or unit clerks interview mothers, collect demographic information, and abstract hospital discharge data, all of which go into the state birth certificate form. In addition, the same information is usually sent to health departments as a hospital discharge abstract or uniform bill and to other information systems for maternal or fetal deaths, inborn errors of metabolism screening, and immunization registries. This results in duplication of data collection and redundant communication among hospital personnel, local registrars, and State agencies.
Achieving improved timeliness of birth data will require changes in organization and policy at both State and Federal levels. States could reconceptualize the birth certificate as a foundation of a perinatal information system and route data electronically in a secure network to authorized health and welfare agencies, such as State vital statistics offices, Medicaid, WIC, the women’s and children’s programs of the Department of Agriculture, metabolic disease screening, immunization registries, and welfare and child support enforcement.
