Transcript Health records and the role of the health sector 1| November 6, 2015

Health records and the role of the
health sector
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November 6, 2015
Changing role of the health sector
 Health sector focused largely on cause of death. Key CRVS agents
were Registrar General, Ministry of Interior or Justice, and National
Statistics Office.
 Countries such as Ethiopia and Rwanda using health workers as
active agents in nascent CRVS systems
 More active health sector role driven by:
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Demand for better statistics on MDGs, mortality in adults;
Increasing proportion of births and deaths taking place in health;
Use of electronic medical records which require unique identifiers;
Growing reach of ICT, such as mobile phones.
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Legal framework and procedures for
notification and registration
 Definitions of live birth and fetal death, aligned with ICD
standards
 Registration of deaths in newly born infants as both births and
deaths.
 Health facilities must report all births and deaths. Include
private, NGO, and social insurance providers.
 Death certificate should include checkbox on pregnancy status
of deceased woman of reproductive age. Deaths in women of
reproductive age investigated to identify maternal deaths.
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Legal framework and procedures for
notification and registration
 Specify the official documentation needed for burial or
cremation
 Specify who can certify death and cause of death; medical
certification by trained physicians.
 Use international form of the death certificate with deaths
ICD-compliant certified and coded.
 Specify legal and procedural processes for accidental
deaths (e.g. reporting to a coroner).
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Procedures and practices
 Rules and procedures stipulated for each step – notification,
registration and certification.
 Birth form should include attachment for medical details about
the birth, health of baby and mother. Use for record linking to
identify infant and maternal deaths.
 Rules and procedures should be described separately for
events outside of hospitals and for those that occur within
hospitals (both public and private).
 For vital events outside health facilities explore use of using
community health workers to report vital events to the local civil
registration authorities.
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Cause of death
 Certification – physician assigns cause of death using the ICD
form (which should be filled in its entirety).
 Coding – assigning cause of death on the medical certificate to
one of the specific ICD codes. This permits the cause of death
information on the certificate to be translated into statistical
categories and subsequently tabulated for dissemination and
use.
 Important that the public health value of such data is well
understood and there are regulations and procedures to ensure
proper certification and coding.
 Address social and legal constraints to correct certification.
Ensure confidentiality and privacy.
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Sudden deaths
 In cases of sudden death, physician should assess
whether death due to natural or external causes (accident,
suicide, homicide).
 Unnatural deaths referred to enquiry by coroner or special
medical examiner to conduct investigation into the
circumstances.
 Cause of death may initially be registered as unknown
pending outcome of the investigation. This can lead to
delays in finalizing the data.
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Coding
 Coding should be done by clinical coders and statistical assistants
with in-depth knowledge of ICD rules and procedures.
 Coding by physicians who certify cause of death not appropriate;
they lack detailed knowledge of ICD and not the best use of medical
skills.
 Centralized coding in MOH or NSO ensures common standards and
helps error detection and correction.
 Decentralized coding in hospital makes it easier to access records
and encourages local use of the data.
 Automated systems facilitate correct coding for most deaths but
specialist coders needed for complex and external causes
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Deaths outside medical settings
 Village leader or local registrar provides a lay opinion
about the cause of death.
 Non-medically certified data on causes of death are of little
value either at the individual level, for legal purposes, or at
the population level, for public health purposes.
 In statistical analyses these data should never be
combined with cause-of-death data that are medically
certified.
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Verbal autopsy
 Where deaths occur outside medical facilities, verbal autopsy can
used to determine cause of death.
 Verbal autopsy is designed to obtain information on cause of
death at the population level, not to legally assign cause of death
at the individual level.
 Uses standardised questionnaire to ask caregivers, friends or
family about signs and symptoms experienced by the deceased
person before death..
 Cause of death traditionally assigned by doctors. New computerassisted statistical tools automate cause assignment more costeffectively
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Data quality evaluation
 Data evaluation and critical assessment integral to all vital
statistics systems but often neglected.
 Completeness evaluated directly by monitoring statistical returns
and identifying gaps or discrepancies. Delayed registration
indicative of under-reporting. Direct and indirect demographic
techniques.
 Plausibility and consistency checks should be performed on
cause of death data to assess how robust and credible the data
are, and for what purpose they can be used.
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Conclusions
 Ministries of health have widespread network of health
care facilities, including hospitals, health centres, and
health posts, and outreach clinics.
 This stable, complex and functional network provides a
mechanism for reaching individuals and families in the
community.
 The health sector is a major user of vital events data for
health programme planning, monitoring and evaluation. It
is also increasingly contributing to the collection of birth
and death data through health care facilities.
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