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July, 2017
Adjudication Project an Innovative Model for Other
Jurisdictions
At the National Association of Public Health Statistics and
Information Systems Annual Meeting in Memphis in June, Krista Bauer,
Registration and Amendments Supervisor for the Office of Vital Records (OVR)
presented, “Adjudication Trifecta—Collaboration Across Agencies to Improve the
Completeness and Accuracy of Birth Records.” The national audience of more than
300 vital statistics professionals was eager to hear how Minnesota is working
to assure that legal parents are listed on their children’s birth records.
Krista’s presentation emphasized the significance of three
separate and very different state agencies coming together to strengthen
families—a trifecta that provides a win for everyone. Krista explained how OVR,
the Minnesota Department of Human Services, Child Support Division, and the
Minnesota Courts initiated a pilot project in 2015, to improve data on birth
records.
Each year in Minnesota, about 22,440 (33%) infants are born
to unmarried mothers. A large percentage of unmarried parents establish
paternity at the hospital at the time of birth registration by voluntarily
signing the Minnesota
Recognition of Parentage Form (PDF). When this happens, both the mother who gave
birth and the man who is the biological father are recorded on the child’s
birth certificate. For families who wait to establish paternity, only one
parent, the woman who gave birth, is on the birth record.
Later, some parents establish parentage in court through a
paternity adjudication. Annually about 4,500 petitions are heard and determined
in Minnesota courts. Some of these actions are through family court, but most
are initiated through the child support system. The problem is that birth
records aren’t automatically updated when this happens. Someone has to file the
court order with the vital record office in the state where the child was born,
request that the record be updated, and pay a fee. When no one takes these
steps, both legal parents do not show on their child’s birth record. Confidence
in the accuracy of vital records is important. Unreliable records can lead to
other problems and frustration felt by the public, child support, vital
records, the legal system and others.
Two years ago, Minnesota initiated a pilot project to solve
this problem. OVR proposed a simple solution to eliminate barriers and
streamline the process. OVR introduced a “Certificate
of Adjudication” (PDF) form similar to a form used for adoptions, to provide
information to vital records. The three state agencies worked together to
develop a process to complete and file the form so that birth records would be
updated.
Initially five counties piloted the form which requires the
court administrator to complete sections and forward it to OVR. OVR updates the
child’s birth record and bills the county child support office for the fee. Immediately
the agencies saw improvements. More birth records were updated by OVR, fewer
requests were rejected (from nearly 50% to 1%) because OVR had all the
information it needed, and the processing time to file these and update the
birth record was reduced from about four months to a few days.
Last fall OVR, Child Support, and the courts agreed to
expand the pilot project statewide. Today 34 counties and tribes are
participating with others expected to join soon. Further, because of the
success of the pilot project and the importance of having complete birth
records, the Minnesota Department of Human Services proposed legislation last
session to cover the fee for all court-ordered adjudications for Minnesota born
children even when the actions were initiated outside of child support.
The pilot project continues and the agencies hope that it
expands to all 87 counties. The early process improvements have been sustained
and continuous improvements are sought. It’s likely that similar legislation
will be put forward next session establishing the certificate of adjudication
in law.
Accuracy is
a priority for the Office of Vital Records (OVR). Having data tables in the
MR&C System that are complete and up-to-date is important for timely vital
records registration. When registering the fact of death, funeral staff need to
select the name of the medical certifier who agrees to provide cause of death from
the search results drop-down menu. If you cannot find the medical certifier by
entering the first few letters of each name, OVR prefers that you contact the OVR
Help Desk at 651-201-5970 or health.MRCAdmin@state.mn.us to request addition of the medical
certifier’s name. Provide OVR with the medical certifier’s full name,
credentials (MD, DO, CNP etc.), license number, and medical facility name if
they are associated with one. The Help Desk will confirm that the medical
certifier is not in the table and get the table updated, or will help you find
the medical certifier in MR&C.
Your request
notifies OVR to add the medical certifier to the MR&C medical certifier table
and prompts OVR to recruit the medical certifier as an MR&C user to
register cause of death electronically. Adding the medical certifier’s name to
the drop down list alone does not create a medical certifier MR&C user account.
If funeral
staff “free-form” the entry of medical certifiers:
- OVR is unaware that a medical certifier is not in the medical certifier table.
- Depending on your browser, may save your entry for re-selection.
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Medical certifier will not receive the “Pending cause of death” email.
Contacting
OVR to request that we add a medical certifier assures that the entry will be
complete and that OVR staff will contact the medical certifier to sign up to
become an MR&C user. When a medical certifier completes the user agreement and
OVR creates the user account, the medical certifier gets notifications through
MR&C prompting them to complete their part of the death record.
The names of
many Physician Assistants and Advanced Practice Registered Nurses are not yet
in the medical certifier table. Please collaborate with OVR to recruit these
new medical certifiers and assure that they have access to electronic death
registration. Email medical certifiers the Medical Certifier and Designated Staff User Agreement (PDF) instead of perpetuating inefficient
paper death registrations. Help us help you.
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The Midwest Medical Examiner’s Office started processing all
cremation authorizations electronically using Minnesota Registration and
Certification (MR&C) on July 1, 2017. The Midwest Medical Examiner’s Office
joins the Hennepin, Ramsey, and Southern Minnesota Regional Medical Examiner offices
(representing 53 of 87 Minnesota counties) in reviewing cause of death
information and approving cremation authorization requests electronically in
MR&C. Paper/faxed cremation authorization requests are no longer accepted
at these ME offices for many reasons.
In recent letters to funeral directors and medical
certifiers, Dr. Strobl, Chief Medical Examiner at the Midwest ME Office,
affirmed that “Online death certification and cremation approvals will benefit
all by improving turnaround time, preventing errors due to [il]legibility, and
helping providers by prompting contact with the medical examiner when invoking
injury to prevent unnecessary delays in filing. Using the electronic process
has many benefits for everyone involved.”
Dr. Strobl, Chief Medical Examiner for Midwest, recounted
the story of an avoidable problem of a faxed paper cremation authorization that
demonstrates why paper is not an efficient process in today’s electronic
world. Not only was it frustrating for
the funeral home and ME’s office, but the paper process delayed the death
registration for the family. Read more about Dr.
Strobel’s commentary here.
The transition from paper to electronic death certification
aligns well with the Minnesota Paper Cut Project, a two-year project to improve
the timeliness and quality of death registration. As part of the Paper Cut
project, the Office of Vital Records (OVR) is implementing a no paper policy on
October 1, 2017. The no paper policy means that medical certifiers (or their
designated staff) enter the cause of death information into MR&C. OVR will
no longer enter cause of death information from paper worksheets faxed to OVR. Tell
your colleagues who may not receive Vital Records News.
OVR invites medical certifiers not yet participating in
electronic cause of death filing to come on board with the rest of our
partners. Learn how to become an MR&C user and designate staff to enter
cause of death on your behalf by visiting the Death
Registration for Medical Certifiers page. By completing and submitting the Medical Certifier and Designated Staff User Agreement (PDF) , you
will be ready to comply with electronic only filing on October 1, 2017.
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