Recent Activities of theNational Association forPublic Health Statistics

and Information Systems (NAPHSIS)

Mark Flotow Chief, Illinois Center for Health

StatisticsNAPHSIS President

Mission Statement

To provide national leadership and advocacy on behalf of its members to ensure the quality, security, confidentiality, and utility of vital records and health statistics as well as their integral role with health information systems, for monitoring and improving public health.

NAPHSIS Board of Directors President: Mark Flotow, Illinois President Elect: Jennifer Woodward, Oregon Past President: Isabelle Horon, Maryland Treasurer: Bruce Cohen, Massachusetts Secretary: Kelly Baker, Oklahoma Member at Large: Judy Moulder, Mississippi Member at Large: Rich McCoy, Vermont Member at Large: Lou Saadi, Kansas Member at Large: Linette Scott, California

NAPHSIS Committees Board of Directors Annual Meeting Audit Awards By-laws Communications Cost eHealth EVVE Innovations International &

Territorial Affairs

Inter-jurisdictional Exchange ( incl. STEVE)

Membership Nominating Past Presidents Registration Research Proposal

Review Resolutions Security Statistics Training

NAPHSIS Projects

State VSCP Contracts/NCHS

EVVE Data Cleaning Tool STEVE /IJE Model Law

Workgroup* Cause of Death e-

learning Technical Assistance

Re-engineering EBRs / EDRs

Business Process Improvement

* recently completed

Security Guide + FEWS

Vital Statistics Standards

Monthly Webinars Web Training

Resource Statistical

Definitions Reviews of

researcher data requests to NCHS

International Consulting

NAPHSIS Committees Board of Directors Annual Meeting Audit Awards By-laws Communications Cost eHealth EVVE Innovations International &

Territorial Affairs

Inter-jurisdictional Exchange ( incl. STEVE)

Membership Nominating Past Presidents Registration Research Proposal

Review Resolutions Security Statistics Training

NAPHSIS Security Guide

Challenges to Vital Records Systems

9/11 Impact on reform -- heightened public awareness

The Move toward Intelligence Reform Certificate Filing and Review

Out-of-Institution Births Delayed Certificate Filing

Application Processing and Verification of Identity Open vs. Closed Records Who is applying? Is identification required and is it valid? Is the applicant entitled? Identity Theft

Internal Security Physical Security Paper Security Personnel

Motion 2006 – 01To promote an awareness and

commitment to national security by . . .

Each jurisdiction designates a security coordinator,

Each jurisdiction adopts nationally-developed best practices,

NAPHSIS adopts these best practices as a standard and designates a security coordinator, and

The NAPHSIS security coordinator serves as a focal point among jurisdictional security coordinators to establish and promote uniformity of security procedures.

Intelligence Reform& Terrorism Prevention Act -

2004SEC. 7211. MINIMUM STANDARDS FOR

BIRTH CERTIFICATES.3(A) at a minimum, shall require

certification of the birth certificate by the State or local government custodian of record that issued the certificate, and shall require the use of safety paper or an alternative, equally secure medium, the seal of the issuing custodian of record, and other features designed to prevent tampering, counterfeiting, or otherwise duplicating the birth certificate for fraudulent purposes;

(D) may not require a single design to which birth certificates issued by all States must conform;

Why a NAPHSIS Security Guide?

To meet NAPHSIS Motion 2006-1

Intelligence Reform & Terrorism Prevention Act (IRTPA) of 2004 Regulations (pending)

Supplement the Model Act Establish uniformity among

jurisdictions

Foundation of the Security Guide

Model State Vital Statistics Act and Regulations 1992 revision currently 2011 revision pending approval

State/Jurisdictional Best Practices Intel Reform Workgroup

Recommendations Input from Contributors

Model State Vital Statistics Act

(+)Uniformity Among

Jurisdictions: Registration of Vital

Events Disclosure of

Information Amendments or

Corrections Security Features Penalties

(-)

Not mandated Influenced by States’

Rights Lacks legislative

attention Cost may become a

factor

Contributors to the Security Manual

National Center for Health Statistics (NCHS)

Dept. of State - Passport Services Dept. of Homeland Security - Forensic Labs NAPHSIS Corporate Sponsors - Technical Document Security Alliance (DSA) North American Security Products

Association-(NASPO) AAMVA – DMVs (Motor Vehicle

Administration)

Security Manual Contents

Delayed and Out-of-Institution Birth

Access to Vital Records

Birth Certification Document

Issuance Procedures

Physical Security Measures

Amendment/Correction

Topics include . . . Security

Coordinator Guidelines

Security Paper, Records/Data, & Money

Vendors Personnel Training Record Retention

Section 2Access to Vital Records

Vital records should be closed to the public

Restrict access to eligible requestors

All employees required to sign confidentiality statements

Government officials must present identification and written assurance the use is for official business

Maintain fraud activity files

Standardized application

Minimum set of biographic identifiers

Requestor should provide proof of identity

All birth records issued at local level should be from a central data base or image system

Non-restricted vital records(e.g., 100 yrs birth,

50 yrs death)

Section 3Birth Certification Document

Four layers of security

Overt, covert, and forensic features

Certification Document should be provided or approved by State Registrar

Security awareness

Security features comparison chart

Paper and printers: Printing in USA Level of security Supply chain Review product

Physical Security Measures

Access Control DevicesWho has keys? Where are they?

Badges, pass cards, other access devices

General Access QuestionsWho has access?

Staff SafetyAre your counter staff safe?

Physical Security Measures

Surveillance Who does your security? Procedures in place to report intruders?

Fire, Smoke, Water, Alarms and Notification Systems Are the systems in place? Do they have

regular maintenance? Are there emergency drills?

Disaster Preparedness/Business Continuity Do you have a comprehensive disaster

plan? Are records backed up off-site?

Additional Topics for Guidelines

Physical Security Measures (recently completed)

Destruction of Original Records and Other Documents Containing Confidential and Sensitive Information (in progress)

Amendments/Corrections Fee Accounting Security Training and Personnel Local Registrars and Satellite Offices Fraud Awareness

What is the Process for the Security Guidelines?

Initial Draft crafted and reviewed by the Security Committee

Draft sent to the NAPHSIS Board of Directors

Revised Draft sent to the Membership

Comments and additions reviewed Section made available on the

NAPHSIS Website (for members only!)

The NAPHSIS Security Guide: additional considerations . . .

An Internal Document - not available to public

A Living Document - continually changed and updated as best practices, technology, regulations, etc. evolve

May require a State or jurisdiction to change laws and regulations

May need to be revised once 2011 Revised Model Act is adopted

What Else Is NAPHSIS Doing?

EVVE Electronic

Verification of Vital Events

STEVEState and Territorial

Exchange of Vital Events

Model ActPartnering with

NCHS to revise 1992 version (Workgroup mission completed)

Fraud Early Warning System (FEWS)

In conjunction with motor vehicle partners and law enforcement

Fraud Early Warning System (FEWS)

FEWS is . . .

A secure system for reporting discovered fraudulent activities among the jurisdictions and with other government agencies

Administered by the American Association of Motor Vehicle Administrators (AAMVA) Functioning successfully NAPHSIS now included in this system

Funded and owned by the Federal Motor Carrier Safety Administration

FEWS Features

A secure database system (i.e., not e-mail) consisting of Incidents, Alerts and Updates

Post fraud alerts and receive instant notifications

Cross-referencing of incidents Post photos and document examples No cost to jurisdictions Searchable Configurable by geography Links to federal and association partners

FEWS Timetable for NAPHSIS

Initially, 8 states piloted for NAPHSIS (over two years)

More than 10 additional jurisdictions have joined after a NAPHSIS invitation to the membership to join

Training by AAMVA this month (October) for new participants and this new group will be part of the production whole in November or December

Goal is for all NAPHSIS jurisdictions to participate

Possible Enhancements or Uses for NAPHSIS

FEWS Posting area for fraudulent death

certificates List of suspicious addresses (e.g., get

frequently used) Fraudulent registration activities or

attempts to obtain a birth or death record

Additional points . . . Certain information can be viewed only by

Law Enforcement officials but there is no access by private entities

No access to Canadian jurisdictions for us in the USA

Inter-Jurisdiction Exchange of Vital

Records Information

The Challenge When a child is born in another state, who

has responsibility for follow up? Getting birth information from another

jurisdiction can be slow and unpredictable Residence jurisdiction may not get birth

record, or it may be delayed Residence jurisdiction has to re-distribute

fact of birth information to its own programs and agencies

Critical interventions may be missed or delayed

Introducing STEVE –State and Territorial

Exchange of Vital Events A secure messaging system for vital

records exchange between jurisdictions and with other public health programs and agencies

57 vital records jurisdictions will become STEVE trading partners

Based on Inter-jurisdictional Exchange Agreement administered by NAPHSIS

Automates and standardizes exchange process

Improvement over current system of paper copies, abstracts and line lists

What is Inter-jurisdictional Exchange?

IJE File Type From To

Natality File Jurisdiction where birth occurred

•Jurisdictions of residence of newborns•NCHS

Roster File(short form death notice)

Jurisdiction where death occurred

•Jurisdictions of birth of decedents•For birth/death matching for fraud prevention

Mortality File(sent twice, before and after coded cause)

Jurisdiction where death occurred

•Jurisdictions of residence of decedents•NCHS

Fetal Death File Jurisdiction where fetal death occurred

•Jurisdictions of residence of patients•NCHS

ITOP (Induced Termination of Pregnancy)

Jurisdiction where abortion occurred

Jurisdictions of residence of patients

Standard IJE File Format Used for Exchange

Uses standard flat file format Five file types defined by IJE Committee

Natality Mortality (includes cause of death literals and

codes) Roster (for birth/death matching) Fetal Death ITOP (induced terminations) – in development Marriage and divorce - future

NCHS reportable data embedded within layouts

Data content of each file type is configurable by sender at the data element level

InternetInternet

STEVE Transformation Modules (TMs) are installed at each jurisdiction for secure, point-to-point vital record exchange

S

Jurisdiction A’s TM

Jurisdiction B’s TM

IJE files IJ

E fi

les

Receiving TM

Vital Records

Newborn Hearing Screening

Immunization

Child SupportEnforcement

Research

If program mailboxes are set up by a jurisdiction, received IJE files are automatically delivered to them by the TM

When Is STEVE Coming?

National rollout began in March 2009

January 2014 deadline for implementation

Until all jurisdictions are trading partners, STEVE will support alternate electronic record exchanges with non-participants

STEVE-ER implementation in 2011 in territories

Each jurisdiction needs to have signed the IJE agreement

Alaska

California

Idaho +

Oregon

Washington +

Montana

Wyoming +

Utah

Colorado

ArizonaNew Mexico

Texas

Oklahoma

Kansas

Nebraska

South Dakota

North Dakota Minnesota

Wisconsin

Iowa

Illinois

OhioIndiana

Kentucky

WV

Virginia

N. Carolina

Georgia

Florida

AlabamaMS

Missouri

Arkansas

LA

Nevada

Hawaii

Michigan

PennsylvaniaNJ

New York CTMA

VT

NH

Maine

Tennessee

MD

DE

RI

DC

S. Carolina

State and Territorial Exchange of Vital Events (STEVE) Implementation by JurisdictionUpdated August 2011

Installed

In Preparation Puerto Rico

Guam

U.S. Virgin Islands

American Samoa

Northern Mariana Islands

NYC

+ Sharing IJE Files without using STEVE

Planning

Can Canadian Provinces and Territories Be Trading

Partners in STEVE? Placeholders built into STEVE currently

File layout differences – at what level would such differences need to be “translated” or converted?

Collection differences, such as race categories

Alternative: notification for fraud prevention purposes with a minimum of demographic characteristics for matching purposes (more than what is in current consular notices)

Alternative: focus on border states and provinces/territories

Other NAPHSIS Projects

Vital Statistics Standards Registration Security Issuance Data Collection Data Transmission Data Analysis and

Release Training Data and Record

Preservation Legal Authority

Alaska

California

Idaho

Oregon

Washington

Montana

Wyoming

Utah

Colorado

ArizonaNew Mexico

Texas

Oklahoma

Kansas

Nebraska

South Dakota

North Dakota Minnesota

Wisconsin

Iowa

Illinois

OhioIndiana

Kentucky

WV

Virginia

N. Carolina

Georgia

Florida

AlabamaMS

Missouri

Arkansas

LA

Nevada

Hawaii

Michigan

PennsylvaniaNJ

New York CT

MA

VT

NH

Maine

Tennessee

MD

DE

RI

DC

S. Carolina

EVVE Implementation – August 2011

New York City

On-line with EVVE (34) Implementation in progress (11)

Guam

American Samoa

Northern Mariana Islands

Puerto Rico U.S. Virgin Islands

eHealth or Health Information Exchange

huge interest from the states, cutting edge, future direction, etc.

new NAPHSIS committee may determine, ultimately, how VRs

are viewed, even shaped, in the larger health world

VRs in the USA are both civil registration and health

Looking at possible technical solutions, reviewing national standards documents, track jurisdictional pilots, provide communication to the membership

“Merci beaucoup” for your attention and patience!

Contact information:

Mark FlotowIllinois Center for Health Statistics/IL Dept Public Health525 West Jefferson StreetSpringfield, IL 62761

217.785.1064mark.flotow@illinois.gov

www.naphsis.org