SUMMARY OF DISCUSSION - AVSS TAG MEETING
Sacramento, California
December 5, 2001

1. Introduction By Attendees and Opening Statements.
   A. The difficulty in procuring a Sacramento Airport meeting place following September 11 was discussed. Participants will now have to pay for parking. It is hoped that the logistics for arranging the next meeting will be less difficult.
   B. Review of summary from June 6, 2001 TAG meeting. Note: TAG summaries are available on the Web at: http://www.avss.ucsb.edu/tag.htm
   C. Larry Portigal, who has been on the TAG core group since TAG's inception in 1988, has accepted a position at OVR and consequently will not be able to represent an LRD. He has therefore resigned his TAG position. Ron Williams presented Larry with a letter of recognition and thanks for his valuable services to TAG for nearly 14 years. John Moehring recently announced that he is leaving his position at the Sacramento Department of Public Health so he will also no longer be able to represent an LRD. Later in the day Natlee Hapeman of Santa Barbara County was appointed to fill the LRD vacancy. While it may be desirable to add one more LRD representative, the current Core group is reasonably balanced with two OVR representatives, two LRD members, one CMR member, and one from UCSB.
2. Version 4.11 Update.
   A. Since Version 4.11 will be a minor update with no immediate need for implementation, it will not be distributed until early 2002. This will allow input from this meeting to be incorporated into the new version.
   B. Beta testing usually occurs in November, but will also be delayed until early 2002. A volunteer LRD will be needed. Sacramento County has often volunteered, but it is probably not appropriate this time due to John Moehring's departure. Later in the day Anne Cubley and Ying-Ling Wang of Alameda County volunteered.
3. AVSS Modification Requests (AMRs): Review and Discussion.
   01-063: Suzanne Whitley of Calaveras County requested that Positive Tuberculin Skin Test (Positive PPT or LTBI) be added to the AVSS/CMR disease list. The request was approved as a non-reportable disease. There was some discussion about adding a CONVERTER/REACTOR sub-prompt for this condition, but it was deferred.
   01-066: Version 4.10 requires that LIST TO BE SENT TO HEALTH DEPARTMENT be used by hospitals for all records in order to assure the exact correspondence between the electronic record and the paper certificate. Some LRDs, however, appear to be circumventing this requirement by running the LIST … sub-option at the LRD. This defeats the quality assurance aspect of the procedure for those hospitals running AVSS remotely. This AMR suggests that the LIST … be allowed only for non-remote (dial-in) hospitals. Danita Wallace of Los Angeles County reported that there had been instances where hospitals ran LIST …, but it was not reflected at the LRD. This could possibly be due to problems with modem communications between the hospital and the LRD. The AVSS Project will work with Los Angeles County to determine the cause. The AMR was tentatively approved, pending more investigation.
   01-078: It was agreed to develop a new standard report, similar to one now installed in Monterey and Sonoma Counties, to add pregnancy status and the full name of the reporter.
   01-079: After some discussion, a committee composed of Myrna Epstein, Michael Samuel, Mark Starr, and Ron Williams, will attempt to develop a more comprehensive ASCII output file format for the variables contained in AVSS/CMR.
   01-081: It was agreed to include a FETAL DEATH CERTIFICATE (FDC) option in Version 4.11. It would function in the same manner as the current DEATH RECORD (CDC) option in that in would allow data entry for statistical purposes, but would not be an electronic registration system and thus would not print fetal death certificates.
   01-082: AMR 00-073 will be implemented in Version 4.11 and will require more stringent passwords. This AMR suggests that all passwords be programmed to expire simultaneously following the 4.11 update so that users can be informed in a coordinated manner regarding the new requirement. The group consensus was that this approach would not be advantageous and thus it was not approved. Passwords will expire according to the current schedule.
   01-084: This AMR was not in the handout, but Alan Oppenheim had submitted it earlier and presented it at the meeting. For births (LCAs), AVSS LFN Assignment prints the LFN and optionally prints the Local Registrar's signature and date of registration, but, for deaths, AVSS LFN Assignment only prints the LFN. This same capability should be added for death records (CDCs). It was agreed that this AMR is a good idea.
   01-090: The AVSS Project has proposed printing on "plain paper" four additional vital records forms [(VS10D, VS24(S), VS24(L), VS24A)] in addition to the current two (VS11E and VS9E). This would require AVSS/NET, Postscript printer, and the approval of OVR. Michael Rodrian stated that OVR believes it is a good idea, but needs to further study issues related to paper stock and fraud prevention. He gave a tentative OK for the AVSS Project to proceed.
   01-091: If plain paper printing of amendments is made possible by the incorporation of AMR 01-090 above, then producing paper copies of amendments using AVSS/NET becomes feasible. This AMR would enable that capability, was endorsed by the TAG participants, and will be reviewed by OVR.
   01-094: Since AVSS no longer allows LRDs to edit registered electronic birth certificates (LCAs), some LRDs are circumventing this restriction by using AMEND CERTIFICATE inappropriately (when there is no paper amendment). This AMR will change the warning notice for both the EDIT CERTIFICATE and AMEND CERTIFICATE to remind users that they should use AMEND only when there is a signed Affidavit/Amendment. It was agreed that this should be incorporated into Version 4.11.
   01-097: AVSS presently allows LRDs to register births when the Date of Registration (Field 17) is more than one year later than the Date of Birth (Field 4A). It was agreed that, according to the Health and Safety Code, this should not be allowed.
   01-104: This AMR was not in the handout, but John Moehring and Alan Oppenheim raised the issue in relation to AMR 01-097 above. Problem: Hospitals are inappropriately producing Verification Letters for home births. Solution: Develop a home birth classification that will disallow the printing of Verification Letter and relate home birth passwords to this classification during Version 4.11 updates. It was agreed that this AMR is a good idea.
4. The Future Of AVSS.
   A. Ron Williams is planning to retire in 2002 and wishes to provide for continuity of AVSS funding, staffing, and project direction after that date. The plan is to have OVR assume the major responsibility with TAG continuing to provide guidance. Michael Rodrian stated that he agreed with that concept, and had initiated a Budget Change Proposal to hire AVSS staff as state employees, but, because of Governor Davis' hiring freeze, it is has been postponed until July 2003. In the meantime, Ron is willing to come back part time to manage an MCH contract and the AVSS activities associated with LRD funding.
   B. Sue Ollis and Ron Williams reported on the progress to modernize the AVSS computer architecture using the Internet and the AVSS/NET pilot project in Merced County. User satisfaction has been positive with generally good response times, although Merced County shares its Internet resources with public schools, so there are peak load slowdowns. With the exception of an area-wide power failure, the AVSS/NET sever has been quite reliable. The most frequent problem has been the loss of security settings for SecureCRT on older Merced County workstations. This problem has become infrequent with the upgrading of equipment. AVSS Project staff have successfully performed secure ASCII file transfers with encryption using SecureFX, so that LRDs will be able to create confidential data on the AVSS/NET server and access them using the Internet.
   C. The AVSS Project will begin to offer AVSS/NET to other LRDs on a selective and incremental basis. Minimum resources include: continuous broadband Internet access for all AVSS sites at the onset, Windows98 or higher computers, and a readily-available local area network specialist. Because of the extra licensing costs of SecureCRT, SecureFX, and the M version necessary to support AVSS/NET the cost of AVSS licensing will increase to $500 every three years for each client workstation. At the present time this would include access to the AVSS/NET server: the AVSS Project would be responsible for providing that the server resources be available on the Internet, while the LRDs and hospitals would be responsible for Internet access and the workstations.
   D. Joe Quintanilla of Orange County suggested that a model Memorandum of Understanding between hospitals and LRDs be drafted that would outline the responsibilities of all parties. Michael Rodrian stated that local VRIP funds could be used to purchase the workstations.
5. Assigning State File Number Using AVSS.
   A. AVSS was designed to mirror the hierarchical aspects of California's vital records registration system whereby a record begins at a hospital or funeral home, is registered first at the local registration district, then registered again at the state Office of Vital Records. A local registration number (or local file number or LFN) is assigned at the local level and a state file number (SFN) at the state. While OVR has been using AVSS since 1995, it has not assigned SFN and has had to rely on LFN. The many advantages of incorporating SFN into AVSS were discussed. The good news is that some innovative barcode scanning and printing techniques were developed and implemented at OVR in September 2001 that made it possible to incorporate SFN into the AVSS database. This process has improved the quality of the birth registration procedures at OVR by identifying paper certificates for which there is no electronic record and for records with incomplete data. It has also identified records where the numerical LFN does not agree with its barcode.
   B. LRDs should void out any LFN barcodes for which there have been alterations in the printed LFN. This can be accomplished by using black ink to mark out a white line within the barcode.
   C. Michael Rodrian reported that the availability of SFN from AVSS has improved the indexing capability of OVR's imaging system, called FileNet.
   Additionally, this improvement will allow SFN to eventually be included in the linked birth cohort file.
6. Confidential Morbidity Report (Discussion Led By Mark Starr: See attached CMR Topics).
   A. Mark Starr announced that Surveillance and Statistics Section will be moving to another Sacramento location in January and then again in 2003, but can still be contacted at 916-445-5948 and at mstarr1@dhs.ca.gov. The AVSS disease list will have to be updated to include Smallpox and Varicella. Sonoma County is interested in testing the Foreign Import suboption for CMRs.
7. Foreign Birth Certificate Systems/HIPAA Regulations.
   A. Site of Care (SOC) is starting a long term development project and has requested feedback on how to improve its features related to AVSS. Electronic downloading was mentioned as one example. The AVSS Project position remains that the transfer of ASCII data from SOC to AVSS should be the joint responsibility of SOC and the affected LRD. Flora Hernandez of Yolo County reported that there have been problems with missing birth certificates from a SOC hospital and that it would be useful to have SOC produce reports to assist in tracking births events.
   B. The AVSS Project is beginning to receive queries regarding the HIPAA compliance of AVSS. It is believed that AVSS is exempt according to HIPPA Privacy Rule requirements under Section 164.412(b)(1). Michael Rodrian would like to know if anyone approaches AVSS to request a change due to HIPAA.
8. Entering Death Certificates Into AVSS/Electronic Death Registration
   A. All County Letter 01-04 communicates the concept of using AVSS to address the current backlog of death certificates that have "pending" for the cause of death. The Office of Vital Records will reimburse LRDs that adopt this procedure at rate of $1.00 per AVSS electronic death record and 26 LRDs have agreed to participate. Five additional LRDs are still working on contracts.
   B. About 800 records are pending. Feedback from LRDs has been positive. Several new AVSS reports will be included in the next release to assist in the process.
   C. Michael Rodrian reported on the initiative to obtain funding for electronic death registration. A fee increase was approved, but can't be implemented at the present time.
   D. Natlee Hapeman reported that the Santa Barbara EDR pilot is still operating successfully with an additional funeral home now participating.
9. AVSS Technical Assistance.
   A. A draft letter to LRDs requesting FY 01-02 contributions of $1,500 plus $500 per added AVSS site was mailed. There has been an excellent response to the request with all but ten LRDs already paying. Only two LRDs are behind on their FY 00-01 payments. The AVSS project thanks all LRDs for their funding.
10. New Business
    A. Don Fields announced that the OVR Workshops will be held in Santa Cruz on March 19-22, 2002, in Anaheim on April 9-12, and in Eastern El Dorado County on April 23-26.
    
    Acknowledgment: This summary is based on notes taken by Emily Lehman and Natlee Hapeman, and was written by Ronald Williams.

1. SSS Updates

-- Bioterrorism Preparedness and Response program

-- CMR form and Title 17 (sec. 2500, 2505, etc.) regulations revisions: Emergency regulation changes (for Bioterrorism) effective 11/5/01; CMR disease list updated (on FORMS web-site - see below); Full reg. changes (and CMR revisions) pending (comments welcome)

-- 5-year CD Report (1994-1998) distributed; 1999-2000 CD Report in progress

-- Case report forms available in PDF format (view/print only; many are now fillable)
on our web-site (above) - Click on Publications, then scroll to FORMS
section and click on the link; Username: cdforms, Password: broadstreet

-- Electronic laboratory-based reporting (ELR) / California Electronic Laboratory disease Alert and Reporting (CELDAR) system: Second demonstration project completed (Internet transmission using ELR standards from 3 labs, Vendor: IBM). Feasibility study approved and pilot development now underway. CDC bioterrorism funding.

-- Proposed pilot of provider-based internet PH reporting (w/ Lawrence Livermore
National Labs and DHS Health Info. & Strategic Planning, Calif. HealthCare Foundation): No further progress between DHS and CHCF. Design includes integration with AVSS, HMOs, etc.

-- National Electronic Disease Surveillance System (NEDSS): Grant-funded (CDC)
project to use data and architecture standards in surveillance systems --> interoperable surveillance systems (NEDSS = system of systems).
Assessment and Planning completed in Year 1; limited funding received for Element Development just awarded for Year 2; current development focused on the Integrated Data Repository element (Vendor: Simi Group). More NEDSS info: http://www.cdc.gov/od/hissb

-- HIPAA (Health Insurance Portability and Accountability Act): Privacy and Security rules most relevant; PH reporting is exempt, but still possible impact and need for compliance

2. Old Business

-- CMR Users Group / Annual Morbidity Meeting, June 2001: Approx. 60% of follow-up completed; meet again June 2002?? Location??
-- AVSS-CMR: AVSS foreign data import -- pilot? need?
Combined AVSS/Reporting Manual -- staff working on this in available time -- send suggestions/ideas

Updated December 14, 2001 by RL Williams
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