Breaking Down Barriers for Drug Death Data

Each year, about 100,000 people die in the state of New York, not including deaths that occur within New York City. The momentous task of reporting these deaths falls to the state’s 3,000 funeral directors, 57 county coroner and medical examiners’ offices, 1,400+ local registrars, and approximately 70,000 licensed medical certifiers.

Sharing fast, accurate death information between all these people is essential, especially when faced with an evolving crisis like the epidemic of deaths from drug overdoses.

However, in New York State, our systems for reporting deaths were often bottlenecked, which led to delays in getting information that could be used to save lives. To meet the increasing demands brought on by the drug overdose crisis, we had to break down the barriers so that death information could flow more freely between all of our people and systems.

A community to share solutions

New York was one of the first six states to join a nationwide “Implementers’ Community” to modernize drug death data. Led by the National Center for Health Statistics, the community is charged with thinking in visionary and creative ways about how to make death data more usable for action through the use of FHIR®-enabled data interoperability.

The Implementers’ Community connected us with other states working on interoperability problems, as well as with others who touch death data at every step of the way, from medical examiners and coroners to health IT experts and innovative research partners.

One of the important lessons we gleaned from the community is that improving data begins with finding and solving problems for the many data providers involved. We took that knowledge and began working directly with our own data providers to better understand their individual workflows, challenges, and needs.

Uncovering the issues

When we talked with some of the thousands of people responsible for death reporting in our state, we found they were frequently impacted by the same kinds of issues. For example, we found that some registrars in rural districts had limited internet access, making it difficult for them to convert from paper-based systems to the state’s new Electronic Death Registration System (EDRS).

Many of our medical examiners reported similar bottlenecks. Some didn’t yet have electronic case management systems, and one medical examiner’s office didn’t even have essential computer equipment. Other common delays included waiting for toxicology lab results or having a slow process for correcting and finalizing “pending” death certificates.

We also found that medical certifiers were not getting the training they needed to provide complete and accurate cause-of-death information on death certificates. This is a major challenge throughout New York, just as it is in other states.

We realized that each of these individual problems was contributing to the bigger issue of delayed data for the whole state. Knowing the challenges our data providers faced meant that we could help “unstick” these data flow points while making their individual tasks a little easier.

Tackling obstacles at the source

We began addressing these challenges one at a time. For example, we focused on moving everyone from paper-based reporting to electronic reporting in the EDRS. To help our medical examiners and coroners, the New York Department of Health worked with the Association of State and Territorial Health Officials to contract with private vendor ImageTrend to offer electronic case management systems to those who need them, free of charge. The Department of Health also helped the Bureau of Vital Records secure funding to get computer equipment for medical examiners’ and coroners’ offices where it was lacking, helping them to improve their timeliness and accuracy.

To improve the skills of medical certifiers, the Bureau of Vital Records designed a new online course, Mastering the Cause of Death in the 21st Century, which can be used by any state to help train those who certify deaths.

We are also currently piloting a fully electronic correction process for death certificates that has helped drop processing times from days or weeks to just minutes. This is a huge step in a crisis when every second counts.

Collaboration matters

Breaking down these barriers is making a difference as we work to prevent lives being claimed by opioids and other drugs. Collaborations with our individual data providers are helping get timely, high quality data into the hands of those who need it most. Thanks to electronic death registration systems, we’re now completing and registering 96% of state death certificates electronically within 72 hours of the death – a significant improvement from just a few years ago.

Working with the Implementers’ Community has inspired us to find new ways to unify our resources and systems to improve drug death data. As a result, the state of New York is poised to better handle not only the crisis of deaths from drug overdoses, but any future threat to public health.