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October 2018
DEATH RECORD STATUS: REFERRED TO M.E.
The Minnesota Registration & Certification (MR&C) System refers death records to the medical examiners/coroners in the county of death when MR&C recognizes certain “trigger” words. Cause of death entries such as hemorrhage, aspiration and fracture are a few examples of the 81 words in the “trigger” list. These terms suggest that a death may not be a natural death. Cause of death information with trigger words require follow up by a medical examiner/coroner before the death record can be filed or a cremation approved.
Why this oversight? A medical examiner/coroner must complete a death record “in cases of likely or suspected accidental, suicidal, homicidal, violent, or mysterious deaths occurring in the county.” (Minnesota Statutes, chapter 390.23) Deaths that fall into these categories “must be promptly reported to the coroner or medical examiner for evaluation.” (Minnesota Statutes, chapter 390.11) However, a referred death record from MR&C is often the first suggestion that a manner of death may not be natural.
While death investigations may vary, there are specific questions that a medical examiner/coroner may ask the medical certifier (physician, physician assistant or advanced practice registered nurse) in follow-up. For example, a cause of death documented as an intracerebral hemorrhage in a patient with a history of hypertension and no recent falls or head strikes is a natural death. An acute subdural hemorrhage in a patient who is anticoagulated and found down with head trauma following a fall, is an accidental death; the medical examiner/coroner must certify the death. Answers to questions related to a patient’s underlying medical history and any recent trauma to the patient are key in determining the manner of death.
Aspiration pneumonia in a patient with a history of dysphagia due to an ischemic stroke is a natural death, while aspiration of a portion of meat resulting in a food bolus asphyxiation is an accidental death; the medical examiner/coroner will certify the death.
Fractures documented on a death record may be the most frequent reason that MR&C refers a death record to the medical examiner/coroner. A patient, who falls, sustains a hip fracture, undergoes surgical repair of the fracture and then dies within days or weeks of the injury, may have died of complications of immobilization due to the injury. The medical examiner/coroner is likely to follow up with an assessment of the patient’s ambulation status before and after the injury, a review the events leading up to the death, and consider whether the patient might still be alive today if the patient had not suffered the injury. Examples:
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Normally active patient, bedridden following a fracture and surgery, develops pneumonia, then dies
- the fracture will likely be implicated in the death
- the manner of death designated as “accident”
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Patient suffered a hip fracture five months ago, returned to baseline ambulation status and then died of underlying natural disease
- the hip fracture is incidental
- the manner of death is natural
If you, as a medical certifier, include an injury in the MR&C cause of death fields, or answer YES to MR&C’s question “Did injury occur?,” pay attention to the MR&C pop up message that suggests a call to the Medical Examiner/Coroner to discuss the role of the injury. That call from a medical certifier to the medical examiner/coroner is important. That call is an opportunity to share information that ensures that the death record is accurate and timely, while it also facilitates final disposition and the delivery of a death certificate to the family.
Mike Burakowski, Investigations Supervisor at the Hennepin County Medical Examiner's Office contributed this article.
U.S. Small-area Life Expectancy Estimates Project – USALEEP
For the first time ever, census tract level life expectancy estimates—based on state death records and population estimates from the U.S. Bureau of the Census—are available. The U.S. Small-area Life Expectancy Estimates Project – USALEEP, computed estimates of life expectancy at birth for most census tracts across the nation. The Office of Vital Records participated by providing to the National Center for Health Statistics (NCHS) public information about the residence addresses of people who died in Minnesota from 2010-2015.
Census tracts, on average, include 4,000 people who typically have similar characteristics such as social and economic status. Previously, county and ZIP code level data have helped researchers to understand the picture of how people live in specific areas, but census tract data helps researchers understand health at the local level—sometimes down to a neighborhood level. This is important because people living just a few miles apart may have vastly different opportunities for a long life.
USALEEP was a joint effort of all states, the National Association for Public Health Statistics and Information Systems (NAPHSIS), NCHS at the Centers for Disease Control and Prevention, and the Robert Wood Johnson Foundation.
NCHS released the estimates last month. More information about the USALEEP Neighborhood Life Expectancy Project, including methodology, data and documentation files, and census tract level life expectancy estimates for the U.S. and for most individual states is available at NCHS’s National Vital Statistics System U.S. Small-area Life Expectancy Estimates Project – USALEEP.
You can also see for yourself. Enter your address on the life expectancy tool at the Robert Wood Johnson Foundation.
Whether we are serving customers, treating patients, or supporting our partners, all aspects of vital records responsibilities require the collection of information. Mothers self-report data that become part of their child’s birth record; funeral staff work with informants to register deaths; people who need certificates complete an application to make their request, and users of the statewide vital records system provide information to get access to Minnesota Registration & Certification (MR&C). Making it easier to collect and report information is a priority for the Office of Vital Records (OVR). OVR is directing resources toward improving data collection by redesigning forms and planning for online processes.
Plain language, accessibility, security, and fraud prevention influence how and why we collect data. In addition, uniform service delivery and standardization influence and inform OVR’s work to improve data collection. Over the last 18 months, OVR has targeted several documents used by the public and by professionals for updates. In the process, OVR has engaged its partners to understand their needs and challenges with data collection. You have shared your ideas and provided a lot of feedback about what works best for you. We understand that OVR must consider the statewide system of vital records before making changes and we realize that there are real needs to modify and customize forms. OVR has just scratched the surface on form revisions and is gaining momentum as it moves forward. See the updates about specific forms below:
Birth Certificate Application
OVR revised the birth certificate application in December 2017. To eliminate mistakes and reduce the need for resubmissions, OVR added instructions at the top of the form and separated tangible interest categories for public and confidential records. On page two, we added a sentence that allows for transfer of the requester’s payment to another applicant if the requester is not eligible to receive the certificate. Page two also details fees for one certificate and multiple copies of the same record, services such as rush processing and shipping, and payment types accepted by OVR.
OVR’s expectation for county vital records offices was to adopt and adapt the form. We learned that this was not simple. OVR created a Word version of the Birth Certificate Application for county vital records offices to customize. Some offices had difficulty adding or removing information specific to their county. OVR learned that a one-size-fits-all approach to forms is unrealistic and that we should provide a number of stripped down Word documents and clear instructions about customizing the forms.
OVR had the Birth Certificate Application translated into four languages spoken by many of our customers. Now the Birth Certificate Application is available in Hmong, Karen, Somali, and Spanish as well as English at OVR Birth Certificates.
Last week, OVR sent out Word versions of the English language Birth Certificate Application for county vital records offices to customize because of changes to the tangible interest sections. See the GovDelivery email Two Revised Applications.
Worksheet and Instructions for Creating Your Child’s Birth Record
Through the Beginnings and Beyond Engagement (BABE) Project, OVR examined how birth registrars interact with new mothers to collect information. OVR sought to understand and document needs before rushing to improve tools used in birth registration. Because of the collaboration with facilities and the input from birth registrars, OVR re-designed a “mother’s worksheet” that is more effective in collecting birth data, explaining the reasons behind the questions, and informing mothers of their responsibility to report accurate and complete information. Because OVR observed birth registrars answering questions and having to explain the worksheet, OVR created new instructions to help mothers name their babies, know how the data will be used, and understand when and why a second parent is recorded on their child’s birth record. The BABE project also exposed a significant language barrier for non-English speaking families. In response, OVR is translating the Worksheet and instructions for creating your child’s birth record (PDF) released in September of 2017 into the languages most requested by birth registrars and families. OVR will post Spanish, Somali, Hmong, and Karen translations soon.
Birth Record Amendment Packet
The Birth Record Amendment Packet is completely new. It replaces the old Birth Record Amendment Application and the 2013 “Birth Record Amendments” information sheet.
The new packet contains three parts: Instructions (for filling out the application), “What you need to know about supporting documents” and a Birth Record Amendment Application. A team of Office of Vital Records employees developed the nine-page packet over the last four months. Find the packet on the MDH Birth Record Amendments webpage. OVR sent county vital records offices a GovDelivery email named Updated forms on October 5.
Statement to Identify
For situations where someone making a request for a certified birth or death record does not have acceptable identification, the law allows for someone who knows the requestor to attest to the requestor’s identity. A form with easy to understand instructions and plain-language data fields is necessary. Staff in local vital records offices identified this situation as important to them. OVR updated the Statement to Identify in a manner that requires little to no customization by local offices. We distributed the form on October 5, 2018 via GovDelivery. Find the Statement to Identify form on the County Vital Record Office Forms webpage.
MR&C User Agreements
OVR grants professionals access to MR&C if they have a business need. An individual must complete a user agreement before OVR can create a user account. These forms are critical to the security of MR&C, data security and identity protection. OVR takes this responsibility seriously and creates user accounts only after verifying the credentials of the individuals who request access. MR&C User Agreements vary by type of user. Medical professionals who certify death records can complete a user agreement and designate one or more staff to enter cause of death data into MR&C on their behalf. OVR is updating MR&C user agreements to convey the responsibilities of MR&C users, specify user activities and data usage more clearly. Find the various MR&C user agreements on the Office of Vital Records website under For Professionals on the left side of the page.
Next Steps
OVR is in the process of revising many other forms. Lessons learned from the early form revisions identified above are informing future revisions and have helped OVR set realistic expectations for form adoption and support provided for customization. Forms soon to be released include a revised death certificate application and revised death record amendment applications. In general, look for more two-page forms that make page one nearly universal and page two customizable for the services offered and information about the local office.
Finally, as OVR continues to rollout new and revised paper and electronic forms, partners will have opportunities to provide input, feedback and suggestions. Soon OVR will begin a project to integrate e-payment with MR&C. With that project paving the way, OVR expects to offer both traditional forms and online requests to the options that customers and partners have available.
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