Community
engagement, health equity, and quality improvement intersect in birth
registration project
In early 2016, the Office of Vital Records (OVR) was
wrestling with what to do about birth records with certain incomplete data.
Performance reports from the CDC’s National Center for Health Statistics
showed Minnesota in a three-year quality decline for mother’s self-reported
answers to her race, ethnicity, education level and cigarette use before and
during pregnancy. At the same time, Minnesota Department of Health (MDH)
leadership was pushing OVR and other programs to engage communities—to move
from simply providing outreach and instruction to “communities”, to consulting,
involving, collaborating and possibly even sharing leadership through
bidirectional relationships. OVR embraced the challenge and initiated the
Beginnings and Beyond Engagement (BABE) project.
Vital records activities are essential to public health;
health data collected for the birth record is critical to many MDH programs
such as immunization, birth defects, home visiting, and others. Public health
professionals use health information and other data collected on birth records
to monitor health problems, assess the impact of interventions, and provide
at-risk families the services and resources they need statewide.
These specific self-reported data—race, ethnicity, education
level and cigarette use—are relevant to the determinants of health (including
social, economic and behavioral factors) and are important to advancing health
equity—a priority at MDH.
OVR set out to improve the completeness of data reported by
the mother, but quickly realized that it had a lot to learn. Regions, St.
Joseph’s, St. John’s, and Woodwinds hospitals accepted OVR’s invitation to be
part of the BABE Project. With their help, OVR dove deeper: to gather
information, investigate the current state of hospital birth registration,
expand relationships, question assumptions and explore standard practices. OVR
took the time necessary to understand and approach the problem of birth data
completeness holistically.
OVR met with the facilities, interviewed and shadowed the
committed and dedicated staff, mapped processes, and gleaned information about
each organization's mission, leadership involvement, and own use of data from
vital records for the customers they serve. Together we discussed the birth
registration process and the challenges faced in collecting the data, changes
facilities had made to be more successful, the relationships and collaboration
between birth registrars and nurses. We also talked about the interaction among
departments such as medical records, social services, and the delivery and
post-partum areas, and tools related to data collection and
registration—specifically, the Mother’s Worksheet.
While working with hospitals to answer key questions about
how the need for this data and the importance of the data is conveyed to
mothers, how staff use OVR’s worksheets and mothers’ attitudes towards
providing this data, OVR was also investigating how our public health partners
use the race, ethnicity, education and cigarette use data.
The BABE project expanded its reach to all hospitals by
surveying birth registration staff about their practices, observations, and
experiences. In addition, OVR leveraged the hospital’s direct access to
mothers. After completing the worksheet, mothers were surveyed to capture their
immediate thoughts and reservations. Engaging the source, the partners in
registration, and the users and consumers of data informed the project and
those involved, generating excitement and energy.
OVR applied what it learned to revise and pilot an improved
Mother’s Worksheet. Staff at Woodwinds, St. Joseph’s, St. John’s, and Regions
circulated the pilot worksheet in their birth registration process over a
two-week period in December. No one was afraid to share feedback or was
surprised to see conflicting responses. OVR learned that some data, such as the
child’s date of birth, which was removed from the pilot worksheet (because it
is data available in the health record), was important to the hospital process
when connecting paper documents with health records and entering data into
MR&C.
OVR is drafting a final BABE report to document project
activities and make recommendations for process improvements. OVR will use
findings from the BABE project to revise and launch a new Mother's Worksheet,
highlight best practices, consider going upstream to start the data
conversation at prenatal clinics, inform training and set outreach priorities.
Taking the time to gather information, investigate the
current state, expand relationships, question assumptions and standard
practices before jumping into a fix mode, created a solid foundation to develop
a future quality improvement project with true partner collaboration.
The potentially high cost of online vital records service companies
The fastest and least expensive way to buy a Minnesota birth
or death certificate is to go to a Minnesota county vital records office with
acceptable identification and the appropriate fee. Staff at county vital records
offices can supply the required application, check the customer’s
identification, verify tangible interest and print a certificate within a
matter of minutes. Although certain offices and certain times are busier than
others are, in-person service will probably always be faster than the methods
described below.
For people unable to appear in person, the Minnesota
Department of Health (MDH) Office of Vital Records (OVR) and county vital
records offices offer mail-in service, and many offices can accept certificate
applications by fax. Because everyone must prove they have a right to the
certificate (called tangible interest), requesters must sign their applications
in front of a notary before submitting it. The notary verifies the identity of the person buying the
certificate.
Some county vital records offices have contracted with
VitalChek to process credit card payments and this company offers Minnesota
certificates online for the cost of the certificate plus an additional $7. This
authorized external vital records processor helps county vital records offices
accept credit card payments and directs online certificate orders through
county vital records offices. Certificates purchased through VitalChek avoid
OVR processing times and this may be the least expensive and the quickest way
to get a certificate without appearing in person at the county vital records
office.
Another way to buy a Minnesota birth or death certificate is
through a vital records service company like VitalChek. The internet is full of
offers to “help” customers buy vital records – for an additional cost. And
those additional costs can add up. A quick Google search for Minnesota birth
certificates revealed eight companies that will assist customers in obtaining
Minnesota birth certificates for $33 - $103, with the appeal that their sites
are “faster” or “easier” or even “cheaper” ways to get a certificate. Because a
Minnesota Birth Certificate Application is required, most of these services fax
or email the form to the customer who applies online. The customer fills out
the application, gets their signature notarized, and then returns the
application to the service with the fees. The vendor forwards the application
with $26 to OVR or one of several county vital records offices for fulfillment.
Yes. Vital records service companies buy certificates through
OVR or Minnesota county vital records offices.
Minnesota vital record laws apply whenever and wherever
certificates are issued. Everyone requesting a certificate must complete an
application, show identification, and report their tangible interest. Because
vital records service companies forward everything to OVR or county vital
records offices for certificate issuance, online purchases are usually slower
and more expensive than buying direct from county offices or OVR. The best way
to help customers, patients and families who need birth and death certificates
is to send them to the local county vital records office or to the MDH website.
Required Training for New Birth Registrars
Your role
as a birth registrar is very important for your facility and the families you serve.
With every infant you register in the Minnesota Registration & Certification
system (MR&C), you are entering information that establishes their identity
and follows them throughout their lives.
We thank you for the work you do!
To assure
your success as a birth registrar, the Minnesota Department of Health, Office
of Vital Records expects you to complete both training sessions below within 6
months of becoming a new MR&C user.
Applying Best
Practices for Reporting Medical and Health Information on Birth Certificates
The
National Center for Health Statistics (NCHS) at CDC, collaborating with the
National Association for Public Health Statistics and Information Systems
(NAPHSIS) and several individual jurisdictions developed Applying Best
Practices for Reporting Medical and Health Information on Birth Certificates.
This 45 minute to one-hour eLearning course is for clinical and non-clinical
providers of medical/health information for the birth certificate or the report
of fetal death.
Continuing
education and certificates of completion are available and will provide
documentation of your facility’s participation in this training course and
enable state vital statistics agencies to better understand the training needs
at your facility.
Minnesota
Vital Records Birth Registration 101 training
Birth
Registration 101 will help you build your knowledge, skills and ability to serve
the families and health professionals you work with. You will learn to navigate
MR&C effectively and efficiently, and meet state requirements for MR&C
security and training. Watch Vital Records News and the MDH Birth and
Fetal Death Registration webpages for class sign-up information.
Birth 101 Classes
coming up:
Tuesday
July 11, 2017, 8 a.m. -- Noon, St. Paul
Tuesday
November 7, 2017, 8 a.m. -- Noon, St. Paul
Please
contact the Office of Vital Records with any questions you may have at
651-201-5970
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