1. Introduction By Attendees and Opening Statements.
Review of minutes from April 26, 1999 TAG meeting.
Main purpose of this meeting is to discuss AMRs with 150-200 received
and acted on annually.
Review of Contacts at AVSS Sites: names and telephone numbers.
2. Version 4.9 Updates.
Version 4.9 was released today and must be installed at all
sites before 1/1/2000 due to race/ethnicity changes and new birth
certificate form. This version (4.9) has been extensively alpha
tested and was beta tested in Sacramento County (thanks to John
Moehring). It is believed be ready for Y2K and the new forms.
The most important changes are related to AMR 99-026, which allows
up to three race responses for mother and father. Race choices
will be restricted to a CBC list containing nearly 900 values.
The new race prompting is scheduled to go into effect automatically
on 1/1/2000. From then on the new VS-10D forms (Rev 1/00) must
be used regardless of the infant's date of birth. Pretesting for
the 2000 Census indicates a small percentage of multiple races
will be reported.
An All County Letter (99-14) was mailed on 10/27/99 describing
the vital record changes that will occur on 1/1/2000. The new
forms will be mailed to LRDs next week and the LRDs are to distribute
them to hospitals. Rod Palmieri stated that LRDs should not reject
documents that are correct, but on the wrong form, at least for
a short while. The new VS-10D forms were carefully reviewed for
quality to attempt to maintain the critical vertical spacing of
six lines per inch and it is expected that these forms (Rev 1/00)
will be better than previous ones (Rev 5/97). Nevertheless, the
AVSS Project has made a recent change to the HP LASERJET FORM
ALIGNMENT suboption to permit vertical adjustments in 1/10 inch
increments. The HP 1100 is the AVSS Project's current recommended
printer for hospitals. There is a problem with the Rev 1/00 form
and Fields 20A/23A and 21B/23B in that there is a chance that
a maximizing the length of both of these will have the printed
text touch the dividing line. It was the consensus that 21B/23B
should be reduced in length by one character.
The Version 4.9 Release Notes and Update Procedures were discussed.
While most 4.9 updates will be accomplished by means of a staff
(LRD or AVSS Project) site visit, some will be performed remotely
by modem. The planned update schedule that would complete updates
in all LRDs and hospitals by 1/1/2000 was presented.
There are no substantive changes for death certificates in Version
4.9, and very minor changes for the CMR option.
Revised pages of AVSS Quick Reference Manual reflecting some minor
changes related to multiple race reporting and HP LASERJET FORM
ALIGNMENT were distributed and discussed.
3. Site Interdependency and DHS Use of AVSS
A primary goal is a consistent database at LRDs and DHS with
identical number of events (births, deaths, CMRs).
The DHS use of AVSS birth data by the Birth Information Data Base
was described by Alan Oppenheim. The 1998 AVSS birth data is now
being reconciled with the OVR imaging system. As the state becomes
more dependent on AVSS as the primary source of birth data, it
is more important to coordinate LRD and OVR activities. Continued
progress could lead to AVSS becoming the official state database
for births.
4. AVSS Modification Requests (AMRs): Review and Discussion.
Explanation of AMR factors: need for consistency and standardization,
cost vs benefit, number of sites affected, etc.
98-085: A small number of Los Angeles County hospitals have traditionally
collected (as part of the birth registration process) maternal
and infant variables that are not on the birth certificate. Because
this feature is non-standard, it is erased when the annual update
is performed. The AVSS Project feels that it needs approval from
TAG/OVR before restoring these prompts. Rod Palmieri feels that
a decision should be postponed until the Decennial Revision, which
may add additional fields. Hospitals could lobby OVR to have these
fields added to the birth certificate.
99-069: OK to print Field 17 (Date Accepted For Registration)
as part of the LFN ASSIGNMENT process. OVR will investigate the
possibility of also having AVSS print Field 16 (Local Registrar's
Signature); note: Ventura County is already typing the name of
the health officer and then having a deputy registrar initial
it.
99-075: OVR and AVSS cannot assign an official maternity hospital
code to an unlicensed maternity facility. If legislation is passed,
perhaps that could change.
99-104: TAG recommends following the AMR evaluation: changes in
the CDC Places of Death List should be coordinated centrally through
the AVSS Project, not performed locally.
99-116: Already programmed into Ver 4.9 to improve quality control
of father's and mother's state/country of birth (LCA Fields 8
and 11). Additional information is displayed if text is entered
that does not match the list, and non-list choices are made more
difficult. Users should contact the AVSS Project if they wish
to a country not on the list.
99-117: Would require LRD resolution of non-list values for Fields
8 and 11 for foreign imports. TAG recommends: Not yet, but revisit
after 99-116 has been in place for a year or more.
99-118: It was decided that reallocating Seal and Replace records
from OVR to the LRDs is not feasible due to the manner in which
OVR processes these records.
99-041 (revisited): Creating a Perinatal Birth Cohort File is
a large undertaking that will be pursued with the Maternal and
Child Health Branch (see Section 8.G below).
5. Year 2000.
While AVSS itself is Y2K compliant, there has been considerable
interest in testing AVSS systems for Y2K compliance. The procedure
for doing this has been published by the AVSS Project, but it
should be emphasized that testing should be done on a non-operational
(backup) system.
Various Y2K contingency plans were discussed. If hospital computers
fail, then birth clerks can type birth certificates manually.
If the LRD computers also fail, they can mail paper certificates
to OVR.
Vital records are traditionally revised prior to the decennial
Census, and should have occurred in 1999. However, due to the
Y2K concerns, the process was delayed until 2002 and now may be
as late as 2003. There will likely be a number of new fields and
some existing fields may be deleted. Since the AVSS data structure
is fundamentally based on the field numbers, it would be very
disruptive and require a major effort if the existing field numbers
changed. Adding new field numbers would not be a problem, however.
There is talk about eliminating the need for signatures on birth
certificates. Contact Jane McKendry if you wish to contribute
to the revision process.
There was discussion about AVSS training introduced at this point.
The AVSS Project will produce a Local Registrar's manual to cover
topics related to AVSS birth registration by the LRD. The AVSS
Project provides some training to LRDs via the telephone Help
Desk and during the site visits related to annual updates, but
does not offer on-site training on demand, partly because it would
be very expensive due to the size of the State. Thus, it would
like OVR to be more involved. Indeed, OVR is considering the possibility
of adding a two-hour AVSS training session to the Spring workshops.
There was discussion of the need for cross-training at the LRDs
to provide more continuity following staffing changes and the
possibility that LRDs could assist each other as has been done
in the past.
6. Electronic Death Registration System.
AVSS/EDR pilot is continuing in Santa Barbara County, in spite
of the problem of obtaining certifier signatures. A 'second pass'
enhancement was made to address the problem. In this approach,
only the medical portion and the official form is first printed
on blank paper, then the certifier's signature is obtained. Later,
after the personal data are available and entered into AVSS/EDR,
the certificate is placed in the laser printer for the second
time and the personal data fields are overprinted. This procedure
was implemented on in April 1999 and increased the participation
rate for the two remaining active funeral homes from 35% to 70%.
Ron Williams presented the details of the AVSS/EDR procedures,
menus, data flow, and authorizations.
Ray Wilson presented a CFDA-sponsored approach to electronic certification,
called PCL (Physician Certifier Line), that will use biometric
voice printing. Ron Williams was concerned about the complexity
it would add to AVSS/EDR and stated that there would have to be
a legal opinion by DHS and UC attorneys agreeing that UC would
not be liable for damages in case of the inappropriate/erroneous/fraudulent
use of PCL. He was also concerned that the PCL proposal does not
appear to rigorously require the certifier to identify the exact
copy of the death certificate that is being certified. Rod Palmeiri
stated that DHS feels that the PCL approach will fulfill legal
requirements. An AMR will be required if AVSS is to be interfaced
with PCL. The EDRS Task Force may draft such an AMR.
7. Confidential Morbidity Report (Discussion Led By Mark Starr:
See attached CMR Topics).
CMR reporting form will possibly be revised: still accepting
suggestions/comments.
May wish to revisit AMR 99-004 to add a tickler list for DMRs.
Will be submitting a new AMR to have add ~DELETE to disease list
and delete records, but maintain ICD code.
Will also be submitting an AMR to allow AVSS to import ASCII data
from foreign CMR systems.
Outstanding issues: revised ASCII output file layout, revised
disease list, expanded and updated Serotype/Subtype list.
Need for CMR Users Group, updated documentation, user training,
and volunteers to help with AVSS/CMR.
8. AVSS Automated Birth-Death Matching.
A handout described the current status: beginning in January
1999, AVSS electronic death certificates (CDCs) were automatically
transmitted from LRD computers to the AVSS/OVR computer in Sacramento,
then reallocated.
The automatic birth-death matching rate increased from 72% as
received from the LRD to 90% at OVR.
Follow up interactive matching increased the match rate to nearly
95%. The remaining non-matches were frequently cases that need
further investigation due to unusual circumstances surrounding
the death.
There were more false matches at the state level, but it should
be possible to nearly eliminate them with minor modifications
to the matching algorithm.
The AVSS Project will investigate the possibility of back-transferring
OVR-matched records to the LRDs.
Ideally, all LRDs would enter deaths by means of the CDC quick
registration. Advantages to the LRD are: indexing, reallocation
from other LRDs, birth/death matching, and reports to the registrar
of voters. There is the possibility that OVR could enter CDCs
for some of the smaller LRDs.
With the completion of birth-death matching, there is now the
possibility of producing a timely provisional birth cohort file
using AVSS. There is a need to develop a new file layout since
the existing one has variables that are no longer relevant or
not available in AVSS (for example, an accurate ICD code for underlying
cause of death). One possibility is to add some death-related
variables to the end of the CBC 1400 byte record; for example,
age of death.
It would also be useful to build a perinatal birth cohort file
that would include fetal deaths. Although older versions of AVSS
incorporated fetal deaths, there is no longer an operational fetal
death module.
ICD-10: Building it into the AVSS CDC form would be a significant
task and would require a machine-readable file. Preliminary indications
are that it would be expensive to acquire. An AMR would be required.
9. Bar Coding of LFN and SFN.
The advantages of using the AVSS LFN assignment module to
print LFNs and their corresponding bar codes was discussed. Orange
County wishes to begin bar coding soon. OVR is also interested
in adding SFN and its bar code via AVSS. This would result in
completing the AVSS hierarchical data structure by creating a
single database at the state level with births filed by SFN (as
opposed to the current multiple LRD databases with births filed
by LFN).
10. EAB/NANA.
Parents (one or both?) must soon (April 2000) have a valid
SSN before a SSN will be issued to the child through NANA. SSA
will send a letter if the parents' SSNs are invalid.
11. AVSS Census Tracting.
Work continuing by Scott Shepard of DM Information to improve
AVSS census tracting routines.
Current match rate is 80-85%, which can be improved by by relaxing
the assumptions defining a match. However, the program needs to
be beta tested before implementation. John Moehring of Sacramento
County volunteered.
12. Equipment/Operating System Recommendations.
AVSS is a DOS-based program and it is preferred to have a
low-cost dedicated computer running DOS 6. If it is absolutely
necessary to run on Win 9x, then the procedure posted on the AVSS
web page must be followed.
There is now an NT version of AVSS. It is scheduled to be installed
at OVR next week. Depending on the outcome, it may be possible
to implement AVSS/NT in some LRDs, but only if they are well-qualified
and capable of undertaking the sole responsibility for all network-related
technical support. The network version would be expensive and
not appropriate for hospitals. AVSS/NT also raises the possibility
of making AVSS available on the Internet.
Printing birth certificates on blank paper, as is now being done
by AVSS/EDR, would require a significant amount of programming.
It would also require all AVSS printers to have PostScript capability.
PCPLUS for DOS is recommended for terminal emulation, but it does
not run on faster CPUs. The Windows alternatives at QVT/Term 4.3
(shareware at $35) and Procomm Connections (about $115).
13. AVSS Technical Assistance.
Nearly all LRDs have paid their FY 98-99 contributions of
$1,500 plus $500 per added AVSS site. FY 99-00 invoices have already
been mailed and more than one-half of LRDs have already paid.
Updated March 28, 2000 by RL Williams
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