North Dakotas InHouse Development of EVER

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North Dakotas In-House Development of EVER
NAPHSIS 2006 San Diego, California

• Darin J. Meschke, State Registrar
• Director, Division of Vital Records
• June 6, 2006

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Birth Registration Our old way

• We register about 9,400 births each year (635,000
  pop.)
• Prior to 2006, we were still registering births
  on paper certificates
• Facilities manually typed up the birth
  certificates and sent them through the mail to
  our office.
• One staff person would audit and verify the
  information on the certificate and the paternity
  acknowledgment
• Office data entry staff would enter, then a
  second would re-enter the data for verification
• Paper copy would then be scanned for issuance

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Road Blocks

• Funding
• State general funded office
• Extra state funds hard to come by
• Interest/Support
• Department/Divisional support was lacking
• Processing times were never really bad doing it
  manually
• Received the NCHS Award in 2004

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Whose going to pay?

• In March 2005, we applied for some carryover BT
  funding as part of the PHIN/NEDSS initiative to
  enhance our Master Population Index (MPI).
• We made the argument that the faster we receive
  birth data from the hospitals, the faster we can
  populate our MPI so we will be better prepared
  for a mass prophylaxis if there is ever a need.

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Can we even do this?

• In anticipation of receiving funding, we began
  the planning process with our states Information
  Technology Department to develop the system.
• No time for formal RFP process
• Did not have time to write/review an RFP
• ITD was already our vendor for Vital Records
  systems
• Initial estimate was around 150K
• We used the Use Case specifications off the
  NAPHSIS website
• EBRS and MoVERS
• NAPHSIS staff traveled to ND to assist with
  preliminary use case discussions (A Big
  Thanks!!!!)
• Rose Trasatti was extremely helpful
• Kathi Mueller, SD also a tremendous help

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EBRS The real work begins

• In late May 2005, we received the approval from
  the CDC for our carry-over request
• 160K from our Focus Area B funding was
  redirected to develop a web based EBRS
• The planning process then got into full gear and
  ITD began developing in July 2005
• We already had an Oracle infrastructure in place
• Our back-office software was still going to be
  used
• ITD was creating a front-end web application for
  the hospitals to enter birth data

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Use the Use Cases

• ITD found the use cases to be extremely valuable
  during development
• Gave them a resource to use when they didnt
  completely understand what we wanted
• They modeled their documentation from the use
  cases
• VR staff also benefited
• Didnt have to explain every last little detail
• Allowed us to concentrate on the look and feel of
  the system and the major functionality, instead
  of the detailed programming questions.

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Working with hospitals

• As part of the development process, we formed a
  working group (VR, ITD and Hospitals)
• In our case, users very excited about EBRS
• To this point in the process, no negative
  criticism
• Local Bismarck (2) hospitals came in during
  development for some testing
• Very beneficial in understanding the differences
  between how each hospital conducts their business

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EBRS - User Acceptance Testing

• In late November 2005, we began our initial
  user-acceptance testing.
• Again, we used the use cases to make sure the
  primary functionality was working.
• Made sure that all of the required edits we being
  enforced.
• Local hospitals came in again to let us know what
  they liked and disliked (some problems found and
  changes made)

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EBRS - User Training

• In mid-December 2005, we began our hospital user
  training at four regional locations.
• North Dakota has a very small population but it
  does take a while to get across it.
• The Big Four, as we like to call our 4 largest
  cities (towns) were selected for this training.
• Fargo, Bismarck, Grand Forks and Minot
• I conducted all of the training personally at
  local hospitals
• I had the training schedule all planned out and
  during the first session, my wife called to
  inform me that my father had passed away.
• So I had to scrap the rest of that trip and do
  the training the week between Christmas and New
  Years. (But it all worked)
• Some additional development changes were made as
  a result of training and further testing, but ITD
  would make the corrections almost as fast as I
  could report them

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EBRS in North Dakota

• On January 3, 2006, we began accepting 2006 birth
  certificate information from all of the states
  birthing hospitals.
• 2003 U.S. Standard changes will also implemented
• 21 hospitals with approx. 125 users
• Hospital staff very appreciative of new system
• Complaints are very minimal and very positive
• One data entry/One Submitter per record
• User accounts maintained by the our office
• Passwords were a minor problem, but we made a
  system change to make changing them much easier.

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EBRS Lessons Learned

• Its not bad to be last
• Jumping from paper to Web-based
• A whole lot of help exists out there
• NAPHSIS
• Other states (plagiarism is a good thing)
• No need to reinvent the wheel on everything
• Get done what you can with the money you have
• EBRS only one part of EVER
• Ongoing process to get to Death and Fetal Death

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EBRS Lessons Learned

• System just needs to work, doesnt need to be
  absolute perfection.
• Start with a base and then expand
• Make use of the Use Cases
• Invaluable to our success
• Saves time for programmers and VR staff
• Dont be afraid to ask for help
• Other states
• NAPHSIS

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EBRS Lessons Learned

• Project Manager must stay on course
• ITD provided an exceptional PM
• ND has outstanding hospital staff
• Eager, willing to accept change
• Happy about electronic registration
• Make documents/worksheets available for download
• Small hospitals doesnt need to print 1000s

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Questions

• Darin J. Meschke, State Registrar
• Director, Division of Vital Records
• North Dakota Department of Health
• Phone [phone]
• dmeschke_at_nd.gov
• www.ndhealth.gov/vital