Dead reckoning

Publish Date

Death is final, but sometimes it takes a while to register – literally. For example, the government sometimes keeps sending Social Security checks to someone who has died, or bereaved family members have to delay organizing their loved one's personal business for weeks until they receive a death certificate.That is changing thanks to the Electronic Death Registration initiative, a Social Security Administration-led project that is moving states from a paper- to a Web-based system. But the change is coming slower than many would like. Several states have gotten so frustrated with one of the problems – a lack of cooperation from physicians – that they have passed laws requiring doctors to register deaths online."Physicians' participation is still a major issue" slowing the move, said Delton Atkinson, a senior official at the National Center for Health Statistics, a branch of the Centers for Disease Control and Prevention and a major user of states' death data.In 2001, SSA began providing states with an average of $500, 000 each to help them move to an electronic system. As a result, 31 percent of the 2.4 million annual deaths in the United States are now registered electronically.Death registration is a state responsibility, but the federal government has a big incentive to promote change. It can take states more than a year to collect their death information and forward it to the federal agencies that use it. For SSA, that delay means trying to recover money mistakenly sent to people who have already died.By contrast, when a death is registered electronically, SSA is notified instantaneously. The agency is already seeing significant savings, said Brian Cronin, director of the registry project at SSA. Although the agency doesn't have a precise number, the figure approaches millions of dollars a year. Equally important, Cronin said, is the increase in accuracy. Online verification prevents a registration from being completed unless the deceased's information matches a unique identity in SSA's database – a crucial feature for SSA. The agency paid to develop the software under the direction of its main partner in the project, the National Association for Public Health Statistics and Information Systems (NAPHSIS), which represents states' vital records offices. The online verification software allows each state's electronic death registration system to communicate with SSA's database. Beyond verifying identities against SSA's database, state systems also check entries in other fields for mistakes or inconsistencies. This goes a long way toward resolving one of the big weaknesses of paper registration: It is plagued by errors, which compromise the quality of the resulting data and cause delays while local or state officials try to correct mistakes and ambiguous entries.The increased speed and accuracy of electronic registration also help reduce the fraudulent use of dead people's identities, experts say. And it improves public health monitoring by enabling earlier identification of clusters of deaths that could signal epidemics, environmental contamination or bioterrorism. States' return on investmentAlthough the benefits of a national electronic registry are clear for the federal government, the return on investment for states is murkier. So far, 20 states, New York City and Washington, D.C., have introduced electronic death registries. In each case, the new systems exist alongside paper registration, which is being phased out. Another 18 states are planning or developing a system, and the remaining 12 haven't started."It hasn't gone as fast as we'd like, " Atkinson said. Officials say the problem is a lack of funds to cover the costs of installing and maintaining an electronic system. SSA's grants are part of a contract to begin linking state systems with the agency's online verification tool. But they cover only a quarter of the typical costs for developing and implementing an electronic death registry. The systems also require significant technical support for users. Each state has a slightly different process for registering deaths, which adds to the complexity of going completely electronic. For instance, states have been required for decades to collect death information based on the U.S. Standard Certificate of Death. However, there are differences among the states' certificates and especially in their workflows. Variations include who can initiate a certificate (a funeral director, a physician or either), whether it is filed with a local clerk or state registrar, and how burial permits are issued.As a result, rather than having one standard system, each state – and New York City and Washington, D.C., which are separate vital statistics jurisdictions – must buy or develop its own. This has been a boon to the half-dozen companies providing electronic death registration systems. Business prospects "look quite good to us, " said Vivek Gore, senior vice president of enterprise technology services at CNSI, which has sold electronic registration systems to New Hampshire and Georgia. However, he added, "there still are a lot of legacy systems that will have to be replaced."Even when states install new systems, they often find that physicians don't use them. That's not surprising given how convenient the traditional process is for doctors. In many states, a funeral director initiates the death certificate then carries it to the deceased's doctor to enter the cause of death and sign the document. And passing laws to mandate electronic death registration doesn't always work. New Jersey has had such a law since 2004, but it has largely been ignored – only 18 percent of the state's deaths are registered online. Yet there are signs that training and marketing might do the trick. More than a year ago, representatives from New Jersey's Bureau of Vital Statistics and Registration began visiting hospitals, nursing homes and other medical facilities to make presentations on how to use the system. In counties blanketed with presentations, 60 percent of deaths are now entered online.Keeping returns positive Despite those hurdles, states do eventually see a positive return, most officials say. First of all, there are the time savings when clerks at local or state offices no longer have to re-enter data from paper certificates. In New Jersey, those savings could justify the investment. Until just a few years ago, it took the state about a year to notify SSA of deaths. "At this interim stage, we notify SSA within a couple weeks, " said Joseph Komosinski, New Jersey's state registrar. When the national system is fully operational, SSA should receive notification only moments after a funeral director or doctor enters the information online.Moreover, the national death registry could have payoffs across the bureaucratic landscape. New Jersey's vital statistics bureau has already begun providing data automatically to other state agencies, allowing them, for example, to immediately cancel driver's licenses and voter registrations when an individual dies, blocking the fraudulent use of such documents.