OVERVIEW
In cooperation with local, state, and federal health agencies the University of California created the Automated Vital Statistics System (AVSS) to automate public health records. AVSS is used to improve the timeliness and accuracy of birth certificates by automating their production at the hospital of birth. In addition, it is used to automate other public health paper records such as confidential morbidity reports and death certificates.
The following summarizes important AVSS features:
PROGRAMMING LANGUAGE:
A more detailed description of these attributes follows:
PROGRAMMING LANGUAGE
AVSS is programmed in American National Standard M. The standard nature of this language permits portability of the program between different computer manufacturers and protection of software investment.
HARDWARE COMPATIBILITY
AVSS is implemented in more than 500 sites on DEC VAXs and numerous IBM PC clones. A mainstream PC is recommended.
SPACE REQUIREMENTS
In addition to the M interpreter/compiler, the AVSS program requires 6 megabytes of disk storage. On the PC version of AVSS, MUMPS adds another 1.6 megabytes, bringing the total to 7.6 megabytes. The amount of space required to store each AVSS record varies according to the number of data elements, but for birth certificates a value of 2.5 kilobytes per record is a good approximation.
NUMBER OF USERS PER COMPUTER
AVSS is multi-user and multi-tasking on both mini and microcomputers. Although AVSS will run on older PC, those with 486 or higher chips are recommended. Pentium machines can support 32 or more users. VAX implementations can also support scores of users.
PERFORMANCE
AVSS is optimized for transactionbased processing and thus has rapid response times for individual record filing and retrieval. Typical times to find and display a record are usually 1 second or less, depending on the type of computer. These times are nearly independent of the number of records contained in the data base, be it 100, 1,000 or 100,000 records.
OWNERSHIP AND COST
AVSS is copyrighted by the Regents of the University of California. A Software Agreement specifies a royalty charge of $250 per user terminal, renewable every three years. M is also required to run AVSS. A typical minicomputer M license costs $2,000 for eight users. The "runtime only" MSM-PC license is available through the AVSS Project for $250. Thus, the cost for a oneuser AVSS license on a PC including M is $500; each additional terminal adds $250, payable every three years.
INPUT/OUTPUT DEVICES
Since AVSS is programmed in M, it uses ASCII protocols for input and output. Communications parameters can be set by non programmers. Dozens of different commercial terminals and printers can be adapted to AVSS using menu choices.
COMMUNICATIONS
In addition to remote terminals, AVSS has the capability of supporting automatic database updates between computers of varying size and/or manufacturer. This process is entirely automated and requires no human intervention. Automatic dialing at preset times is followed by the transfer of selected portions of the satellite computer's data base. There is a builtin error checking procedure and retries when errors are detected. Automatic re-dialing takes place when there is a break in the telephone connection. Activity logs are maintained of the communication process.
TRANSACTION PROCESSING
Data base updates are performed at the transaction level. AVSS begins a transaction upon entry into the Registration or Edit sub-options. Only when the transaction ends will the record be filed and updates made. This usually occurs at the end of a session for a specific record, but the user also has the ability to force a filing at any point in the registration sequence. If the user abandons a registration session, AVSS will automatically force a filing after a time delay. In both cases the record is marked as incomplete. A separate registration sub-option is available to complete incomplete records.
DATA ENTRY
AVSS uses simple line-by-line prompting which is easy to learn and results in a minimum number of key strokes. Experienced users can complete a birth certificate in 3 to 4 minutes. This time includes all coding as well as filing the record on computer disk. Conditional branching of prompts and list processing speeds up data entry. A record can be displayed at any point during the registration process. In most cases the entire record can be displayed on a single video screen.
HELP
Typing a "?" or pressing the F1 key results in detailed user instructions on how to proceed. The resulting tutorial information reduces the need for written documentation and can be used to supplement training activities. Official guidelines for completing vital records and other legal documents can also be incorporated into the AVSS tutorial instructions, thus promoting standardization and uniformity of data collection.
INTER FIELD LOGIC
AVSS automatically evaluates the value of each data item as it is entered and then branches to the next prompt accordingly. For example, if the birth is a singleton there is no need to prompt for birth order. Defaults are also entered dynamically, depending on the values of previous prompts.
ERROR CHECKING AND VALIDATION
All AVSS data entry is subjected to error checks in accordance with the tutorial instructions. Different levels of errors exist, ranging from warnings to the complete rejection of incorrect values. Validation procedures are performed to compare values from different data fields for consistency.
LIST PROCESSING
Standardized lists are maintained on race, hospitals, all ICD-CM disease codes and nomenclature, zip codes, cities, counties, and countries, etc. Specialized lists can be created; for example, the list of certifiers at a specific hospital.
INDEXING
Individual records may be indexed (crossreferenced) by any number of identifiers. Typical indexes include Child's Name, Mother's Name, Father's Name, Local File Number, Patient File Number, Date of Birth, Date of Data Entry, or Date of Last Update. Index variables may be added retrospectively.
AUDIT TRAILS
An audit trail is maintained on all user interactions with AVSS records. Original and updated values of all edited records are retained and available from reports created by menu choice. Statistics may be generated on the user activity, including the average data entry time per record.
FORMS SUPPORTED
Although AVSS is primarily oriented toward vital statistics, it is actually a generalized approach to the automation of information contained on paper forms. Functions include data entry, error checking, validation, printing, editing, indexing, data retrieval and display, and reporting. The standard menu choices that apply to vital records also apply to other forms. In addition to the birth certificate being used in four states, AVSS also automates information from death certificates and confidential morbidity.
FORM LINKAGE
Information contained on one form can be automatically copied into another. For example, common data elements contained on the delivery record can be copied into the appropriate fields on the birth certificate. This eliminates redundant data entry and insures comparability across forms.
RELIABILITY AND ERROR RECOVERY
Based on MUMPS implementations that have been operating successfully in realtime medical settings, and having undergone over a decade of development, AVSS is a reliable software system. In the event of an error, however, there is automatic logging of the circumstances including provisions for user input. Both a MUMPS operating system and an AVSS data base integrity checker are also available. Automatic startup of the operating system integrity checker is provided as well as automatic backup of key site-specific system variables.
BACKUPS
AVSS provides the user with the ability to selectively backup portions of the data base. Records may be selected based on the type of form (e.g., birth certificate, death certificate, etc.), location of event, date of event, file number, or date the record was entered or updated. AVSS backups can be run as multitasking jobs and can thus be performed during user key entry activity.
SECURITY
In addition to password security, AVSS also incorporates "device" security; i.e., access to certain functions and/or parts of the data base can be restricted to selected terminals. Similarly, only users with certain "classifications" may access privileged functions and/or records. There is a security report to detect unauthorized accesses using invalid passwords. Passwords automatically expire if they are not changed every 120 days. Users can know only their own passwords; this includes those with the highest level of security access. Selected users, upon termination of employment may be prevented from accessing AVSS, but their interactive histories are maintained as a permanent record.
DOCUMENTATION
The AVSS Quick Reference User's Guide and Quick Reference User's Manual document the basic AVSS functions using the California Certificate of Live Birth as a model. The AVSS System Maintenance Manual is available for managing computer resources such as system status, job kill, monitoring terminal sessions, and database integrity checkers. There is also the Using The AVSS Report Generator. AVSS source code statements have been registered at the Library of Congress.
REPORTS
The AVSS Report Generator Query Database sub-option is a menudriven interactive tool for producing adhoc tabulations after entering selection criteria. he Query Database is flexible, easytouse, and does not require learning a complex syntax. A general purpose Report Editor is also available, under which there are dozens of preprogrammed reports. Expert AVSS users can also create their own sophisticated reports by means of the Report Editor. These reports may be run as multitasking jobs, delayed by request for night job startup, and the output saved to be retrieved at a later time.
CENSUS TRACTING
AVSS has the capability to convert a residence street address into the corresponding census tract code. This process is not just one of a table lookup involving as many as 250,000 entries, but accounts for variations in reporting addresses including abbreviations, spelling errors, and a variety of inconsistencies. For those jurisdictions that have converted their DIME files to the appropriate MUMPS array, approximately 80% of all AVSS street addresses are automatically converted into census tracts without human intervention. Most of the remaining 20% can be tracted interactively.
REALLOCATES
While most birthdeath registrations are by place of occurrence, AVSS has the ability to accommodate vital events that occurred outside the jurisdiction to residents of that jurisdiction (residence reallocations). AVSS can also automatically transfer residence reallocations by means of telecommunication. As with the hospital-to-registration district transfers, AVSS will automatically place a telephone call and begin selectively exchanging data with no need for human intervention. All California AVSS sites are presently participating in automatic nway reallocations between local registration districts.
ELECTRONIC RECORD TRANSMITTAL
In addition to transmitting data by means of telecommunications, AVSS can also use electronic media such as tape or diskette. Mirror images of records can be communicated between facilities by specifying date or file number ranges. Tapes or diskettes meeting the California Birth Certificate (CBC) Electronic Data Submission Requirements can be easily created.
DATA EXPORT
AVSS data can be exported in ASCII format to other computer systems by means of magnetic tape or diskette. For AVSSPC implementations, it is possible to create DOS files containing AVSS data.
DATA IMPORT
The ability to import data into AVSS from nonAVSS computers is now operational in several sites. AVSS can import data from batch key entry, from the Site of Care system, and from Kaiser Permanente.
SYSTEM MAINTENANCE
AVSS gives the user menudriven control over multi-user and multitasking computer resources without the need to be conversant in a programming language. Included are such processes as monitoring data entry on remote terminals, reporting the number and type of active jobs, killing jobs, reporting on free disk space, making backups, etc. This allows nonprogrammers to become system managers.
CERTIFIED ABSTRACTS
AVSS can automatically produce birth and death abstracts on bank note paper.
HIERARCHICAL INTEGRATION
Since it is written in the American National Standard computer language M, the AVSS program and data structure is identical at all levels of a hierarchical data network. This self-similar replication of software allows AVSS to integrate data bases that vary greatly in size and complexity by means of a simple file structure. This approach lends itself to regional integration.
SUMMARY
AVSS is a simple and reliable tool for managing information contained on a variety of public health records. It is installed in more than 500 sites on a wide range of hardware. Some implementations have been operating continuously for more than a decade. Its integrated and standardized approach and telecommunications capabilities have promoted consistent data entry procedures among many public and private institutions and it has improved the accuracy and timeliness of vital records data.
1-7-97 AVSSFACT.DOC
Updated June 25, 1997 by RL Williams
