Transcript Electronic Death Registration “Never Sign a Death Certificate Again” Presented by Texas Department of State Health Services Texas Vital Statistics www.texasvsu.org.

Electronic Death Registration
“Never Sign a Death Certificate Again”
Presented by
Texas Department of State Health Services
Texas Vital Statistics
www.texasvsu.org
Electronic Death Registration is
Required By Law
Health and Safety Code §193.002 requires the
person in charge of interment or in charge of
removal of a body from a registration district for
disposition to file death certificates electronically as
specified by the State Registrar.
Likewise, Health and Safety Code §193.005 requires
that medical certifiers on a death certificate submit
the medical certification and attest to its validity
using an electronic process (currently Texas
Electronic Registrar) approved by the State
Registrar.
Fast Facts
As of October 10, 2009:

There are 1,364 funeral homes registered to use TER

There are 8,114 physicians registered to use TER

There are 319 local registrars registered to use TER

All 13 County Medical Examiner’s offices registered to use TER

44.67% of all death certificates are fully electronic.
92% of all Social Security numbers are successfully validated
using TER

Texas Electronic Registrar Is:
• Internet Application
• Accommodates all levels of participation
• Initiates social security verification process
• Edits, cross-checks, SSN verification – all reduce
potential errors
• Result – a faster, more efficient, more accurate
process
What about my Signature?
• When Funeral Directors and Medical Certifiers (Physicians, JP’s, ME’s)
are entered as users in TER, they are assigned a temporary PIN
(Personal Identification Number).
• The first time each Funeral Director or Medical Certifier verifies/certifies
a record, they will be required to change the PIN to a number only they
will know.
• This PIN must be kept confidential; therefore, each Funeral Director
and each Medical Certifier MUST verify/certify their own records (in
other words, the signature process cannot be delegated to office staff).
• The PIN holds the same legal standing on the electronic death
certificate as a signature has traditionally held on the paper certificate.
Computer Specifications
 1.0 gigabyte processor speed or faster with 512MB
of RAM or more
 Adobe Acrobat Reader
 Pentium 4 or equivalent
 Windows XP Operating System
 Web browser with Flash Player (7.0 or greater)
 Internet access at 56K or better
 1024 x 768 resolution color monitor
How can do I register to use
TER?
 Go Texas Electronic Registration Page:
www.requestTER.texasvsu.org
 Complete the online Registration Form
Enroll By Going Here
Once Enrolled You Will Receive an Email from
[email protected] that will include:
 Welcome to Texas Electronic Registrar Death Registration
 Computer specifications
 Resources and website information
 Service Level Agreement
 Confidential and Non-disclosure Agreement
 User ID, Password and PIN number
 [email protected] or [email protected]
 Password Guidance document
 Remote Access Security Policies document
Example of the Start up email from
[email protected]
User Setup
STATE Vital Statistics Office
VSU will set up one
Local Administrator
who will Add,
Remove, and Modify
Users in TEDR,
Medical Certifiers and
other staff.
Local Administrator
Office Manager Medical Certifier Medical Certifier
Staff
*see back of TER brochure
Staff
Let’s get started.
The notification prompt will be in the form of an email, or
can be sent to any other electronic device that uses an
email address (pager, PDA, etc).
The email contains
the name of the
funeral home
And the unique EDR #
The basic
information about
the deceased
Accessing The Record
• Access the Internet by clicking on the
icon.
• Copy https://ter2.dshs.state.tx.us/edeath to
the address bar.
https://ter2.dshs.state.tx.us/edeath
• Select ‘Enter’ or
icon.
This is Called The Portal
Page.
Click on ‘Thin Client
Application’
Logging into TER
Enter
User Name
Password
Click
Login
Dr. Kilgore
Select
Location
Click OK
Under ‘Functions’,
click Medical Data
Entry or click on
icon
This screen
is called the
Main Menu
From the Medical
Data Entry screen,
click the ‘Search
Record’ icon
This is the
Let’s retrieve
Medical
Data
the record.
Entry
screen
or, select ‘Search’
from the
registration menu
This is the
Search
Record screen
You can search with
any combination of
items
Enter your search
information or EDR #
Click ‘Find’
The system will
retrieve all records
matching the search
criteria
Click on the desired
record or records –
the row(s) will
become highlighted
Click ‘Select
Records’
The selected record
will be displayed
or, click to choose
Filter Option
Choose desired
filter option
Click to access
records in queue
Select record
to complete
The Demographic
Information that has been
entered by the Funeral
Home will pre-populate in
the corresponding fields in
Medical Tab 1
The selected record
will be displayed
Start entering data
on Medical 1 tab
If you do not wish to enter
a Medical Record number,
tab, with your ‘Tab’ button.
When the Soft-Check
Alert’ Appears, select ‘No’
if you do not wish to
complete this item at a
later time or ‘Yes’ if you
do.
The ‘Medrec’ field and the
‘MECase Number’ Field are
optional. However you still
have to tab through the
fields to resolve them.
MEs and JPs:
If your information is different from the
Demographic your can add, edit, or delete the
information that is different.
If there is no middle
name, press ‘TAB’ to
skip to the next field.
A box will appear that will
indicate that your information is
different from what the Funeral
Home has put in the System.
Medical Certifiers will have to indicate the date of death
type.
If there is more than one Medical
Certifier with your particular facility,
you can select another physician if the
physician that was assigned is unable
to sign the death certificate. i.e.
Attending Physician is out and an
Associate Physician Has Approval by
the Attending Physician in Accordance
to HSC §193.005(c) to complete the
medical certification.
Review the time of death
and make that it is
accurate in accordance to
your records. You may
edit this if you need to. 24
hour clock (military time)
is acceptable.
We are now on the
Medical 2 Tab
Complete each item by
selecting the appropriate
response from the pulldown lists
Quick tip – TER Death will not allow a physician to certify a
manner of death other than ‘Natural’. A message will be
displayed notifying the physician, who should then ‘DECLINE’
the record. The funeral home can re-designate the record to
the appropriate JP or ME for certification.
Why Can’t A Doctor Put the Manner of Death
as Accident?
Code of Criminal Procedure Art. 49.04. DEATHS REQUIRING
AN INQUEST.
• (a) A justice of the peace shall conduct an inquest into the death of a
person who dies in the county served by the justice if:
– (1) the person dies in prison under circumstances other than those
described by Section 501.055(b), Government Code, or in jail;
– (2) the person dies an unnatural death from a cause other than a
legal execution;
– (3) the body or a body part of a person is found, the cause or
circumstances of death are unknown, and:
• (A) the person is identified; or
• (B) the person is unidentified;
Why Can’t A Doctor Put the Manner of
Death as Accident?
• Art. 49.04. DEATHS REQUIRING AN INQUEST
(cont.).
– (4) the circumstances of the death indicate that the death may
have been caused by unlawful means;
– (5) the person commits suicide or the circumstances of the death
indicate that the death may have been caused by suicide;
– (6) the person dies without having been attended by a physician;
– (7) the person dies while attended by a physician who is unable to
certify the cause of death and who requests the justice of the
peace to conduct an inquest; or
– (8) the person is a child younger than six years of age and an
inquest is required by Chapter 264, Family Code.
Why Can’t A Doctor Put the Manner of
Death as Accident?
• Art. 49.04. DEATHS REQUIRING AN INQUEST
(cont.).
• (b) Except as provided by Subsection (c) of this section, a
physician who attends the death of a person and who is
unable to certify the cause of death shall report the death
to the justice of the peace of the precinct where the death
occurred and request that the justice conduct an inquest.
• (c) If a person dies in a hospital or other institution and an
attending physician is unable to certify the cause of death,
the superintendent or general manager of the hospital or
institution shall report the death to the justice of the peace
of the precinct where the hospital or institution is located.
Why Can’t A Doctor Put the Manner of
Death as Accident?
• Art. 49.16. ORDERS AND DEATH
CERTIFICATES.
– The justice of the peace or other person who
conducts an inquest under this subchapter shall
sign the death certificate and all orders made
as a necessary part of the inquest.
NO
Responding ‘NO’ to the Injury
question will “disable” the rest
of the injury questions and not
allow entry
The Manner of
Death implies that
an injury did occur
This is an example
of a cross-check
Changing the
response to Yes will
resolve the conflict
Click ‘OK’ to
continue
Complete each item by entering information requested or
selecting responses from pull-downs
We are now on the
Medical 3 Tab
If the cause of death has not yet been determined,
check the “Cause of Death Pending” box
You must also type
“PENDING” on Line A
If the cause of death is known, enter the information on
lines A – D, as appropriate, TABBING from field to field
until complete
With certain wording TEDR will give medical
certifiers alerts to give additional assistance in
writing good Cause of Death statements
If there are no contributing conditions, TAB
past this field and select ‘No’ in the SoftCheck Alert.
Cause-of-Death Statements
WHAT’S SO IMPORTANT
ABOUT THAT?
Information Guidelines
•
Certification should represent your
“ Best Medical Opinion”
-This means that your expertise, experience, and
knowledge are valuable and necessary to provide
useful information.
-If for any reason your “Best Medical Opinion” changes,
the death certificate can be amended to reflect that
change ( there would be no legal repercussions from
the change)
Tips and Pointers
• “Probable” and “presumed” are allowed
• Be as specific as possible about conditions
reported
 Provide as much information as possible
 Avoid such terms as “old age”, “senescence”, or
“infirmity”
• If multiple morbid conditions are present and the
underlying cause is uncertain, construct a logical
sequence for Part I and then list other conditions
in Part II
Tips and Pointers
• Avoid abbreviations
• Do not report only mechanisms or modes
of dying
Cardiac or respiratory arrest
Cardio-pulmonary or cardio-respiratory arrest
Asystole (cardiac arrest)
• Indicate explicit information with regard to
specificity, etiology, or if the cause of death
is unknown
Why It’s Important
• Two key vital
statistics uses:
DATA
RESEARCH
Why We Need You
• DATA
- Data needs to be accurate, complete,
detailed and uniform across the state.
- Data needs to be useful to other
physicians – pertinent to current health
issues.
DATA…
Mortality statistics by county and statewide
Health issues specific to geographic area,
socio-demographic, age, gender, ethnic
characteristics
Leading causes of death
Infant and maternal mortality rates
Trends in the effect of current health issues
on mortality
Why We Need You
• RESEARCH
Assess the general health of the population
Comparison of medical issues at the county
and state level
Indicate areas in which medical research may
have the greatest impact on reducing
mortality
Allocate medical services, funding, and other
resources
Example
Part I. Diseases, injuries, or complications that caused the death.
Immediate cause a.
Approximate
interval between
onset and death
Condition which directly preceded death
Due to (or as a consequence of)
Sequentially list
b.
antecedent
causes,
if any, leading to
the immediate
c.
cause with
underlying cause
last
d.
Antecedent condition
Due to (or as a consequence of)
Underlying cause
Due to (or as a consequence of)
Part II. Other significant conditions contributing to death but not resulting in the underlying cause
Example
Part I. Diseases, injuries, or complications that caused the death
Immediate cause
Sequentially list
antecedent
causes,
if any, leading to
the immediate
cause with
underlying
cause last
a.
Pneumonia
Approximate
interval between
onset and death
1 week
Due to (or as a consequence of)
b.
Renal Failure
4 weeks
Due to (or as a consequence of)
c.
Cerebral Thrombosis
7 weeks
Due to (or as a consequence of)
Part II. Other significant conditions contributing to death but not resulting in the underlying cause
Hypertension
Cause-of-Death Statements
• CDC’s website provides several links
to aid in writing cause-of-death
statements
 Multiple links on CDC’s National
Vital Statistics System page
 Recommended tutorial: NYC
Department of Health and Mental
Hygiene online training on
improving causes of death
reporting
www.nyc.gov/html/doh/media/video/icdr/index.html
Who Can Certify Deaths?
Physicians
 Certify natural deaths
 Primary care physician would
have best knowledge of patient
medical
Medical Examiners and Justices of
the Peace
 Certify un-natural deaths
 May request autopsy
 See handbook for list of cases
requiring a medical examiner /
JPs
www.cdc.gov/nchs/about/major/dus/handbk.htm
YOU ARE THE KEY
• The data provided by
the TER system is
only as good as the
information provided
on the death
certificate
• You are not just
signing a death
certificate – you are
investing in the future
of improved medicine!
I Have Completed the Death
Record
• How Do I Sign the Death Certificate?
• How Do I Get Something for My Files?
• How Do I let the Funeral Home Know I am
Done?
Click the ‘SAVE’ icon
before continuing
The system will bring you
back to Medical 1 tab
Your information is now
stored in the system
Click the ‘MEDICAL CERTIFICATION’ icon to electronically
“sign” the record
Click ‘Yes’ to
continue
If a field was not completed, you will see this message
Quick tip – Using the Unresolved List feature can help
quickly identify missing information.
Any unresolved fields will
be indicated
Close Unresolved
List screen by
clicking the red X
Incomplete or Unresolved fields will be displayed in
bright yellow
And click the ‘SAVE’ icon
to store the information
Enter the appropriate response
Click the ‘MEDICAL CERTIFICATION’ icon to electronically
“sign” the record
Click ‘Yes’ to
continue
Click ‘Yes’ to
continue
The basic information is
displayed
The type of certifier is checked and the
appropriate certification statement is displayed
Click ‘Preview’ to view the entire medical certification
portion of the death certificate
Or, click ‘Certify’ to electronically sign the death certificate
The first time you
Medically Certify a record
you will need to verify the
PIN number given to you
by VSU and assign a new
one.
Click ‘Certify’ again to
electronically sign the
death certificate
Click ‘OK’
Enter your PIN
Success! You are now finished with this record
The information “locks down” and cannot be changed
Notifying the Funeral Home
Once the record is electronically signed, TER
automatically sends an email to the funeral director
listed filing the death certificate that the medical
certifier has completed their portion of the record.
Quick tip – The certifier can make changes to the record
only until the record has been electronically accepted by
the Local Registrar. If changes are needed on a record
that has been electronically certified, the record must first
be “de-certified.”
Click the ‘De-Certify’
icon
The record is now
De-certified
Click ‘OK’
The record is now “open” and information can be corrected
as needed
After all changes are made, the record must be electronically
certified again
Questions?
Comments?
Please email your questions and
comments to:
[email protected]