Use of Death Records to Augment Notifiable Conditions Reporting in Washington State, 2010-2012 *

BACKGROUND:  Healthcare providers are required to report newly diagnosed notifiable conditions including the case’s vital status according to state regulations, but it is uncertain how many cases remain unreported. Death certificates could potentially serve as a data source for detecting unreported deaths due to notifiable conditions. The objectives of this project were two-fold. First, we evaluated the usefulness of electronic death records to augment notifiable conditions reporting in Washington.  Second, we evaluated differences between death records filed electronically and those filed by paper to determine if delays in reporting and lack of an alert system for certificates filed on paper affect notifiable conditions reporting.

METHODS:  We searched multiple fields in the cause of death section on death records filed at the Department of Health during 2010-2012 using specific keywords for acute infectious notifiable conditions. Death records listing notifiable conditions were matched to deaths in the Public Health Issue Management System (PHIMS), Washington’s electronic notifiable conditions database. Capture-recapture analysis was used to estimate the total number of fatal cases of acute infectious notifiable conditions in Washington residents. Timeliness and data completeness of death records were also assessed.

RESULTS:  During 2010-2012, we identified 167 and 128 acute infectious notifiable condition deaths in death records and PHIMS, respectively; 64 deaths were detected by both systems.  Capture-recapture analysis estimated 332 fatal cases of these conditions could be expected over the three years (95% CI: 327,337). PHIMS alone identified 39% of total estimated cases; using PHIMS with death record data increased identification to 70%. Electronic filing of death records was very timely, with a median of 4 days to visibility. Death record data were highly complete. Analysis of variance showed no significant differences by method of filing and percent reported to PHIMS.

CONCLUSIONS:  Use of electronic death records will augment the current notifiable condition reporting system and potentially improve mortality estimates and disease control. We recommend implementation of prospective comparison of death records with PHIMS, continued and expeditious transition to electronic death record filing, and a comprehensive list of notifiable condition keyword alerts for electronic death records.