![](../gif/rain_lin.gif)
SUMMARY OF DISCUSSION - AVSS TAG
MEETING
Sacramento, California
May 16, 2000
1. Introduction By Attendees and Opening Statements.
- Review of minutes from November 8, 1999 TAG meeting.
2. Version 4.9 Updates.
Version 4.9 was released on November 9, 1999 to be
ready for the new birth certificate forms and to update all 250+
AVSS servers throughout the state before January 1, 2000. The
challenge was met according to schedule.
- The most important change in Version 4.9 was
related to AMR 99-026, which allows up to three race responses
for mother and father. Race choices were restricted to a CBC list
containing nearly 900 values. There was little negative feedback
from LRDs or hospitals. There were, however, some problems with
missing values for multiple races among imports from foreign systems
(Kaiser and Site of Care).
- The new birth certificate forms (VS-10D, Rev
1/00) proved to have more consistent vertical spacing than previous
ones (Rev 5/97). The AVSS Project also made changes to the HP
LASERJET FORM ALIGNMENT suboption to permit vertical adjustments
in 1/10 inch increments. As a result, there were no problems in
printing the new race values on the new forms. There was, however,
a problem related to the new ability to print Field 17 (Date of
Registration) under the LFN ASSIGNMENT suboption. This was due
to several reasons: variations in top margins on the new forms,
variations in laser printers, the minimal space available to print
the LFN barcode on the lower margin, the lack of user-adjustment
for vertical positioning of the LFN, and non-optimal spacing between
the LFN, its barcode, and Field 17. Alan Oppenheim reported that
LRDs were informed that it is permissible for hospitals to retain
the privacy notification (bottom portion) of the birth certificate,
so as to allow more space for printing the LFN barcode. AVSS was
modified to optimize the spacing of the printed fields and to
allow user adjustment of the initial vertical offset. These measures
appear to have solved the problem.
- There was a problem with miscoded races for AVSS/CMR
due to the change reflected in the CMR card going from one race
field that included Hispanic to two fields: one for race without
Hispanic and one for ethnicity, composed of Hispanic subchoices.
There was a miscoding error when the latter two fields were combined
to create a single field that would maintain consistency with
the historical single race field variable. There was also an inadvertent
change in Version 4.9 that made Field 36 (Mother's Middle Name)
on the Death Record a required field, whereas it should be optional.
Also there as a need to add 'SCAT' to the list of choices for
Field 41 (Type of Disposition) on the Death record. Because of
the need to correct these problems, an updated Version 4.9A was
prepared. Since the problems did not affect hospitals, only the
LRDs were updated to 4.9A.
- Since that time there was one significant problem
uncovered that will necessitate a hospital update: if a ^F or
^S command is used during the multiple race prompting, the record
will not be marked as incomplete. Thus, when the user attempts
to complete the remaining fields AVSS will not automatically prompt
for them so the user must edit each subsequent field, and could
overlook one or more. Although this occurs infrequently, it will
necessitate another update to all hospitals and LRDs. The new
version will be called 4.9B. Several other less significant corrections
will be included in this update.
3. AVSS Modification Requests (AMRs): Review and
Discussion.
99-120: OK to add OTHER to list of Salmonella Serotype
choices in the CMR. Also allow the user to specify; e.g. OTHER:SPECIFY.
99-128: OK to add the choice of ~DELETE to the DISEASE
list in the CMR form. The tilde (~) prefix will force this choice
to the bottom of the list in ASCII sorting sequences. CMR reports
will need to be modified to discount such cases. The original
ICD code will be retained so that the original disease choice
will be preserved. It was decided that a new CMR menu option called
(for example) MARK RECORD FOR DELETION would reset the value to
~DELETE automatically. Gail Cayton suggested that marking such
cases at the state level should result in the records being automatically
reallocated to the LRD. After some discussion this concept was
approved. It was agreed that Sacramento County should be the beta
test site.
99-130: LRDs with dialup hospitals and a telephone
'hunt' system would like to have user name displayed as part of
the SYSTEM STATUS display. While this is not possible using the
%SS routine, which is a MSM-written utility, it is feasible for
AVSS Project programmers to create an alternative. If that is
possible, the entire %SS display should be optimized to meet LRD
needs.
99-136: It was suggested that the need to accommodate
one-letter codes in order to report 'Any Mention Of' could be
accommodated by using 107A (Cause of Death). There was no consensus
on adding another prompted field to the CDC record. After some
discussion it was agreed that a new field called AMO would be
added to the CDC, but not prompted. This would allow LRDs who
wish to add this field to do so by using the EDIT CERTIFICATE
suboption while not imposing an extra prompt on other LRDs.
00-019: The 'radical' solution of requiring all hospitals
to use the LIST TO BE SENT TO HEALTH DEPARTMENT was approved by
all those present, understanding that records from foreign systems
would be exempt. This might be included in Version 4.9B. Riverside
County volunteered to be a beta test site. Before it is implemented,
LRDs should poll all their hospitals to be sure they are using
the LIST. This AMR would improve the quality of data, conform
to the historical pattern of incrementally tightening quality
controls, and in the worst case, the LRD would have to occasionally
run the LIST.
00-015: OK to develop a foreign import capability
for CMR as described in this AMR.
99-069 (revisited): Michael Rodrian and Alan Oppenheim
reported that it is OK to allow AVSS to print the health officer's
name in Field 16 (Local Registrar's Signature) as part of the
LFN Assignment process. Ventura County will serve as the beta
test site.
4. The Future Of AVSS.
- Ron Williams briefly described the history of
AVSS, beginning in 1980 and continually funded since then by federal
and state MCH grants and contracts. What started as primarily
a research project with some computer development has now become
primarily a computer project with much less research activity.
About one-half of the funding now comes from MCH with the remainder
from LRD technical assistance fees. The current 3-year state MCH
contract will expire on June 30, 2002, at which time Ron plans
to retire. He met with Peter Abbott, Alan Oppenheim, and Michael
Rodrian on February 15, 2000 to discuss the future of AVSS after
his departure. It was agreed that DHS would attempt to hire AVSS
technical staff as state employees. Michael Rodrian reported that
MCH will likely redirect funding to OVR, but a budget change proposal
must be written and approved, and he is committed to that process.
Whether and how LRDs would continue to pay technical assistance
fees (to DHS) is unclear at this time.
- Concern was expressed about the future role of
TAG. Michael Rodrian stated that TAG would continue, especially
since the LRDs will still be the beginning point of vital records
registration. He is committed to maintaining the high standards
for the current system and sharing data as well as decision-making
with the LRDs.
- Deborah Martin suggested that LRDs be reimbursed
at $1.00 per record for the data being transmitted to OVR since
the state passes it on to NCHS and collects associated fees. In
principle, this federal money should be shared with the providers
of the data. Ron Williams stated that AVSS could not have survived
without LRD assistance and they indeed deserve considerable credit
for their past and ongoing contributions. Michael Rodrian responded
that while it was unlikely that funds could be returned to the
LRDs, there might be a way of returning in-kind services.
- There was a question from Kyle Lumen about retaining
the two principal AVSS programmers (Peter Chen and John Marinko).
Ron Williams acknowledged their unsurpassed loyalty and devotion
to the AVSS Project and felt that they would likely give adequate
notice so as to train replacements should they decide to leave
or retire. With M classes being taught at UC Davis, it would be
more likely to find replacements in the Sacramento area than in
Santa Barbara.
- Ron Williams presented his view of the future
of the AVSS system architecture. AVSS began with users as terminal-based
clients in the early 1980s. By 1986 the first standalone PCs were
being installed in hospitals and this trend accelerated, especially
in Southern California. In his opinion the distributed PC model
has been more problematical and difficult to maintain than the
time-shared approach. He demonstrated an inexpensive 'AVSS Appliance'
having a small footprint that could replace PCs. Ron believes
that the future of AVSS lies with the client-server model, with
thin clients at hospitals and a central server at a single location.
- Pam Isaac asked when AVSS would be available
in the Windows NT environment. Ron Williams reported that it is
the AVSS Project policy to exhaustively test a new platform before
releasing it. AVSS/NT was installed at OVR in November 1999 and
has been performing very well. However, it is unlikely that a
LRD version will be released without first considering the Internet
approach since technical support for the AVSS/NT will be considerably
more complex and expensive. Since it is likely that DHS will be
providing technical assistance for AVSS after 2002, it is appropriate
that it be involved in the decision on where, when, and how to
implement AVSS/NT.
- Pam Isaac expressed concern as to whether the
central server model would allow LRDs to access their data as
is currently the case. Ron Williams responded that the Internet
model should look like the current distributed model, and, if
necessary, data could be sent to the LRDs on a periodic basis.
Pam responded that the state often charges fees for such services.
Michael Rodrian felt that was presently the case since there are
processing and data analysis costs required to produce other datasets,
but in the case of returning AVSS data, there would be no costs,
and thus no fees.
- A question was raised about the future of the
AVSS software license. Ron Williams reported that that issue is
being studied by University attorneys, including the Office of
Technology Transfer, with three possibilities: the Regents retain
the license and continue to charge fees according to the existing
formula (possibly revised to account for the Internet), the license
is sold to DHS, or the software is made public domain. The latter
is unlikely.
- Joe Quintanilla asked about converting from VAX-based
AVSS to NT since Orange County's VAX is becoming less reliable.
It was noted that Fresno County is upgrading their VAX hardware
and M software (Cache'), and that would suggest that it may be
possible for VAX systems to continue operations until the Internet
version is explored.
5. Vital Records Revision.
- Jane McKendry reported on the vital records (birth,
death, and fetal death) revision process, which occurs about every
ten years. The process begins with NCHS setting a national standard,
but each state may vary in the extent to which they meet that
standard. Jane has been gathering data on what various parties
would like to add or delete from the current certificates. Data
elements must be finalized in about one year in order to prepare
AVSS and other systems. Work groups will be established and meetings
scheduled. Changing data elements on the birth and fetal death
certificates will require legislation. The current NCHS model
birth certificate spans two pages, but it is likely the California
will limit its certificate to one page. It is possible that California
could gather additional data items electronically but not by paper,
like the current MAR variable for example. Those individuals wishing
to participate should contact Jane McKendry at cmckendr@dhs.ca.gov
or 916-445-6355.
6. Electronic Death Registration System.
- Natlee Hapemen reported that the AVSS/EDR pilot
is continuing in Santa Barbara County with about a 70% participation
rate for the two active funeral homes and about 35% overall. One
other funeral home is using it sporadically and another has requested
installation.
- Alan Oppenheim reported that NAPHSIS has received
funding to review EDR systems throughout the US, and SSA staff
visited Santa Barbara on February 14-16 to review progress on
AVSS/EDR. The AVSS Project and Santa Barbara County gave presentations.
A copy of the presentation overheads was contained in the TAG
handout. A report from NAPHSIS will be forthcoming soon. It is
expected that an Internet model will be recommended.
- The CFDA is developing and testing an approach
to electronic certification, called PCL (Physician Certifier Line),
that will use biometric voice printing. DHS will fund up to $10K
through Santa Barbara County to the AVSS project to see if an
interface between AVSS and PCL can be approached. Peter Chen will
be in charge of that project. If this is successful then it would
be necessary to develop a larger project to integrate PCL into
AVSS.
- Ron Williams reported that he has contacted UC
attorneys who have stated that there would have to an indemnification
agreement between DHS and UC attorneys agreeing that UC would
not be liable for damages in case of the inappropriate/erroneous/fraudulent
use of PCL to certify death certificates printed by means of AVSS.
7. Confidential Morbidity Report (Discussion Led
By Mark Starr: See attached CMR Topics).
- AMR 00-015 as discussed above would serve to
establish an AVSS standard in every LRD regardless of the type
of system that is eventually used for primary data entry of CMR
cards. This will facilitate the efficient transfer of CMR data
to the DHS/DCDC system and produce uniform reports throughout
the state. The variable record length format will allow foreign
systems to pass whatever information they have available for all
cases, assuming a minimum number of required data elements are
available.
- New staff at DCDC: Scott Schmolke (replacing
John Hastings) and Rosalie Trevejo.
- Mark Starr can be contacted at mstarr1@dhs.ca.gov
8. EAB/NANA.
- Michael Rodrian reported that SSA was going to
impose an administrative order to issue a SSN for the child only
if at least one parent's SSN was reported. However, a recent (5/3/00)
memo from SSA appears to negate that policy. There is considerable
confusion on the matter at present. Rod Palmieri stated that if
the parents' SSNs were missing or invalid a child's SSN would
be issued, but there would be followup.
9. Bar Coding of LFN and SFN.
- Orange County recently began bar coding but had
printer problems and a new one is on order. A releatively inexpensive
high performance laser scanner (PSC Quickscan 1000) is now available
for slightly over $200 as posted on the AVSS web site under Hardware
and also listed in the TAG handout.
10. AVSS Automated Birth-Death Matching.
- MCH is providing funding to improve AVSS birth-infant
death matching and to possibly incorporate it into the ongoing
OVR operations. Matching is preferably performed at the state
level since family mobility can result in a change in residence
during the first year of life and consequently infant death certificates
will not be reallocated back to the LRD of birth. When AVSS attempts
to match such an infant death at the local level, the birth certificate
will not be in the LRD database and thus cannot be matched. This
limitation does not exist at the state level, where a 95% match
rate for 1999 infant deaths was attained. The remaining non-matches
were frequently cases that need further investigation due to unusual
circumstances surrounding the death. There were also cases where
the age of death was in error on the AVSS death certificate since
the CDC record is batch entered by the LRDs. A new 'cross-match'
index (BD) was recently created at OVR. This index provides a
linkage between AVSS birth and death certificates, regardless
of age. Following the completion of birth-death matching at the
state, this index and all infant CDCs could be distributed to
all LRDs by means of a CD.
- Deborah Martin asked about the possibility of
producing a birth cohort file using AVSS. Ron Williams responded
that since most of the CDC mortality data was incomplete and unverified,
he believes that there is little useful infant mortality information
other than the age of death. Since this information already exists
in position 813 (Death Indicator) on the CBC 1400 byte record,
that format should suffice to produce neonatal and postneonatal
mortality statistics. The problem is how to set this field when
there is no date of death reported in Field 15A for those births
that AVSS has matched to deaths. There will be a need for OVR
to establish a policy on the proper procedures and how to return
the appropriate death indicator information to LRDs.
- Several participants suggested that it would
also be useful automate fetal deaths. The AVSS Project will investigate
this possibility.
11. Equipment/Operating System Recommendations.
- AVSS is a DOS-based program and it is ideally
hosted on a low-cost dedicated computer running DOS 6. If it is
necessary to run on Win 9x, then the procedure posted on the AVSS
web page must be followed.
- As reported above, there is now an NT version
of AVSS. This network version is expensive to install and maintain,
and is inappropriate for hospitals. The AVSS Project is also concerned
about installing it at LRDs and will defer to OVR in this decision
since UCSB will not be supporting LRDs after 2002. AVSS/NT also
raises the possibility of making AVSS available on the Internet,
which might be a better long-term solution to providing support
to hundreds of systems throughout the state. Ron Williams proposed
a 'central server' Internet model, actually composed of three
separate servers at the state level: one for hospitals, one for
LRDs, and one for OVR. This would require some significant changes
to AVSS, for example, adding user name in addition to password
for system access.
12. AVSS Technical Assistance.
- Nearly all LRDs have paid their FY 99-00 contributions
of $1,500 plus $500 per added AVSS site. Gail Cayton has written
a Local Registrar's Manual, which was circulated and is available
on the AVSS web site.
Acknowledgment: This summary is based on notes taken
by Peter Chen, Emily Lehman, and Larry Portigal.
Updated June 7, 2000 by RL Williams
Return To AVSS Home Page