Commentary from Dr. A. Quinn Strobl, Chief Medical Examiner for the Midwest Medical Examiner’s Office
 

As an enthusiastic supporter of electronic death certification, I was asked to write a brief commentary regarding the benefits of electronic death certification and cremation authorization. As I was thinking about what to write, I received a cremation authorization on our fax machine where the entire funeral home section of the cremation form was obliterated by some mechanical error. The time spent attempting to track down the funeral home and approve the cremation was frustrating and delayed the process for the family and funeral home.  

Our office approved almost 5,000 cremations last year, the majority of which were approved through paper process. We understand cremations are needed promptly, and funeral directors often express frustration with how long it takes for some forms to be approved. Let me give the Medical Examiner’s perspective on why this can occur. Faxing a paper form among three agencies (clinic, funeral home, and the ME office) is fraught with potential complications, including: illegibility due to handwriting or transmission issues; busy signals; paper jams or empty paper trays; and, rarely, misplacement of the fax with concurrently transmitted medical records. Our office handles multiple calls every day, attempting to track that piece of paper. To complicate activities further, sometimes we are asked by funeral home personnel to fax a cremation again – to the number where the funeral director is physically located, which was not the same number on the form! Finally, after the death certificate is filed and usually days after we approve the paper form, we log into the Minnesota Registration and Certification System (MR&C) to electronically authorize the disposition for the death record. Many of the challenges, complications, and duplications brought about by the paper approval process could be eliminated with everyone using and checking the same online record.

Like other ME offices, we are collaborating with the Office of Vital Records (OVR) on ways to maximize MR&C. OVR has been receptive to ideas for future improvements and implementing improvements we’ve suggested. We are hopeful that the Paper Cut Project (see May 2016 Vital Records News) will increase efficiency. We think that funeral homes seeing the status of the death record and its cremation approval at all times is an enhancement that will help all of us. Using MR&C for real time status checks will let  the funeral director know whether the approval is in the queue of the ME office or clinic, reducing the time spent tracking the approval process through repeated calls, emails and faxed inquiries. 

Regarding death certificates, electronic death certification is not just about saving time (and trees). The online record also assists the clinician with how to arrange the cause of death statement and advises certifiers not to use uninformative causes such as ‘cardiac arrest’ or confusing abbreviations. Hopefully, future MR&C programing will error proof registration even more by minimizing abbreviations prompting the physician to put a disease or condition in the blank. MR&C already reminds the filer when certain words or selections of manner of death should be referred to the medical examiner or coroner. When the physician follows the cue and lets MR&C refer the record to the medical examiner or coroner, the record can be reviewed and approved or assumed by the medical examiner/ coroner and the cause of death finalized.  

Electronic records are more efficient and accurate. Using MR&C for death registration and disposition authorization saves time and effort on all sides. Let’s all work together to get all coroners, medical examiners, funeral homes, and physicians online.

Since 2009, Dr. Strobl has led the Midwest Medical Examiner’s Office as the Chief Medical Examiner. She has been practicing as a forensic pathologist since completing her fellowship in 2005. Dr. Strobl is board certified in anatomic, clinical, and forensic pathology. The Midwest Medical Examiner’s Office, located in Ramsey, Minnesota, is the official medical examiner/coroner for 20 Minnesota counties, including: Anoka, Benton, Carlton, Carver, Chippewa, Chisago, Douglas, Isanti, McLeod, Meeker County, Mille Lacs, Pine, Renville, Sherburne, Sibley, St. Louis, Swift, Todd, Wright, and Yellow Medicine County. 

The National Center for Health Statistics (NCHS) recently released an updated version of the Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death. This guide is a resource for birth registrars and hospital staff who collect the standard medical and health information for birth certificates that is reported to NCHS at the Centers for Disease Control and Prevention (CDC). 

Some hospital birth registrars may already have an earlier version of the guide from a previous Office of Vital Records (OVR) training, class or conference. The newest version is reorganized, has better and easier-to-understand definitions, lists the preferred source of information in the medical record for each data item, and details keywords, abbreviations, medications that may indicate that an item should be reported for the pregnancy. 

OVR has ordered a supply of printed guidebooks from the National Center for Health Statistics to share at upcoming classes and distribute upon request. The guide is also available online at http://www.cdc.gov/nchs/data/dvs/GuidetoCompleteFacilityWks.pdf.  Birth registrars and interested hospital staff may want to bookmark this link as a handy reference tool. The online text is indexed and searchable, to help users navigate the complex process of birth registration data gathering more quickly.