Death Counts! Evaluation of The District of Columbia Electronic Death Registration System

BACKGROUND: Accurate, comprehensive death records are important for monitoring mortality causes and trends and developing evidence-based programs and policies. The Electronic Death Registration System (EDRS) has replaced most paper-based systems over the past decade to provide greater efficiency and security. In 2004, the District of Columbia (DC) Department of Health (DOH) developed a secure, web-based EDRS used by healthcare personnel, funeral directors, and DOH staff to create, share, and store records for deaths that occur in DC. The purpose of this study was to evaluate the EDRS system attributes including usefulness, data quality, and timeliness. 

METHODS: This evaluation examined performance attributes of the DC EDRS using the 2001 MMWR Guidelines for Evaluating Surveillance Systems. Interviews with DOH Vital Records Department staff and hospital personnel identified strengths and limitations of the EDRS. To capture time lag in reporting and assess data quality, two data extracts (June and November 2012) were analyzed for deaths that occurred January—May 30, 2012. Time was examined for two intervals from date of death—time to certifier signature and time to file with the registrar—and by DC residence status, method of disposition (burial versus cremation), and certifier type. Age, sex, race/ethnicity, education, occupation, and tobacco use were selected to examine record completeness. Analyses were performed with SAS version 9.3. 

RESULTS:  There were 178 more death records in the November than the June data extract. Average age of death, excluding fetal and infant deaths, was 69 years. Most deaths occurred ‘naturally’ (93%), among blacks (67%) and DC residents (68%). Education level was unknown for only 2% and occupation was missing for 4.5% of records; 51% of records reported tobacco use contributing to death was ‘unknown.’ Sixty-seven percent of records were certified within two days. Only 18% of records were filed within five days, with an average time of 12 days (0–101 days) for the June extract and 15 days (0–235 days) for the November extract. The time to file death records was greater for DC residents, cremations, and medical examiner-certified deaths. 

CONCLUSIONS: Completeness of demographic data was sufficient for death reporting. Tobacco use data may not be useful for studying risk factors. Delays in death reporting could be attributable to EDRS dataflow complexity and persistent paper-based data collection. Increased quality assurance activities will enhance the usefulness of EDRS data for local and national needs assessments.