Best Practice Scenario • Web-based EBRS at birthing facilities • Validates NCHS edits at time of data entry • If record passes all validations, jurisdiction allows auto registration • EBRS automatically generates IJE natality file and loads in STEVE • STEVE transmits IJE file to NCHS in real time
1. 0 Best Practice LIVE BIRTH Hospital Completes Birth Record System Automatically Performs NCHS Validations Correct Errors and Resubmit for Validation N Passes all NCHS edits? Y Submit Record to VR Jurisdiction Via Web Local Registration Required? Y Go To 2. 0 N Paternity Acknowledgement Required? Y Go To 3. 0 N QA Before Registration? N END Generate Routine Submissions to NCHS using STEVE VR Database System Auto Registers Record Y Go To 4. 0
Potential Reporting Delays: Local Registration • Often a paper process • Longer filing deadlines due to geographic or staffing issues • Manual record delivery • Keyed into local systems • Electronic record sent to central office on hold • Central office must match, log, stamp and key in local registration info
2. 0 Local Registration LIVE BIRTH A 1 Hospital Completes Birth Record System Automatically Performs NCHS Validations Correct Errors and Resubmit for Validation N Passes all NCHS edits? B 2 N Submit Record to VR Jurisdiction Via Web Hold for X Days Record Received From Local Registrar? Y Match Records, Manually Stamp, Log, Key Local File Number C 1 Register Record Y Print and Send Paper Record to Local Registrar Manually Logs, Reviews and Files Record A 2 Mail or Deliver Record to VR Jurisdiction VR Database END B 1 C 2 Timeliness Metrics: A. Number of days from date of birth to when paper record is received from local registrar (A 1 to A 2). B. Number of days from when record is received from local registrar to when record is registered (B 1 to B 2). C. Number of days from when record is registered to when it is submitted to NCHS (C 1 to C 2). Generate Routine Submissions to NCHS END
Potential Reporting Delays: Paternity Affidavits • Delay registration pending PA from birth hospital • If not established in hospital, awaiting parental paper work or court order • Jurisdiction can usually proceed to register record without father’s information if paternity documents not received within specified time frame • Subsequent inclusion of the father’s information on the birth certificate after registration must be by court order
3. 0 Paternity Affidavit D 1 Timeliness Metrics: LIVE BIRTH D. E. Hospital Completes Birth Record Hospital Records Husband’s Info as Father Y Mother Married To Father? Number of days from date of birth to when paternity affidavit is received (D 1 to D 2). Number of days from when paternity affidavit is received to when record is registered (E 1 to E 2). N Hospital Provides Paternity Documents to Parents Paternity Affidavit Signed in Hospital? Hospital Submits Record with Father’s Info Y N Hospital Submits Record without Father’s Info System Automatically Performs NCHS Validations Correct Errors and Resubmit for Validation N Passes all NCHS edits? Y Submit Record to VR Jurisdiction Via Web Paternity Affidavit Needed? Signed/notarized Paternity Affidavit Received? Y E 1 N Y N D 2 Verify Father’s Info Correct and Complete END Generate Routine Submissions to NCHS E 2 VR Database Register Record Hold for X Days
Potential Reporting Delays: Pre-registration Quality Assurance • Jurisdiction does QA prior to registration • Request corrections from birth hospital • Wait until corrections received from hospital • Key corrections into record • Re-do QA steps • Register and submit
4. 0 QA before Registration Timeliness Metrics: F. G. Number of days from when hospital is requested to correct errors until errors are corrected. (H 1 to H 2) I. Hospital Completes Birth Record Number of days from when record fails edits until request submitted to hospital to correct errors (G 1 to G 2). H. LIVE BIRTH Number of days from when record is received until QA is performed (F 1 to F 2). Number of days from when errors are corrected until record is registered (I 1 to I 2). System Automatically Performs NCHS Validations F 1 Correct Errors and Resubmit for Validation N Passes all NCHS edits? Y Submit Record to VR Jurisdiction Via Web F 2 G 1 Record Fails QA? Perform QA On Record G 2 Request Hospital Correction of Errors Y N I 2 Hold for X Days Register Record Hospital Corrections Received? END Generate Routine Submissions to NCHS VR Database Y H 2 I 1 Update Record With Corrections N H 1
Best Practice Recommendations To Improve Timeliness • Eliminate local registration where possible • Allow local registrar access to central VR database for online local registration • Don’t hold up processing of electronic record pending receipt of paper record • Do not delay birth registration when paternity documents not received • Do not delay birth registration to conduct QA; perform QA after records have been submitted to NCHS; provide corrected records subsequently if needed
Take the Time to Improve • Conduct analysis of your own business practices • Check your system’s performance reports • Use the flow diagrams or make your own • Measure your timeliness performance • Identify areas for improvement and set tangible targets • Ask NAPHSIS for help with business process improvement
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