electronic death registration never sign a death certificate again presented by texas department of...

Electronic Death Registration“Never Sign a Death Certificate

Again”

Presented by Texas Department of State Health ServicesTexas 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 FactsAs of October 10, 2009:As of October 10, 2009:

There are 1,364 funeral homes registered to use TER There are 1,364 funeral homes registered to use TER

There are 8,114 physicians registered to use TERThere are 8,114 physicians registered to use TER

There are 319 local registrars registered to use TER There are 319 local registrars registered to use TER

All 13 County Medical Examiner’s offices registered to use TER All 13 County Medical Examiner’s offices registered to use TER

44.67% of all death certificates are fully electronic.44.67% of all death certificates are fully electronic.

92% of all Social Security numbers are successfully validated 92% of all Social Security numbers are successfully validated using TERusing 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 help-ter@dshs.state.tx.us 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

help-ter@dshs.state.tx.us or help-ter@texasvsu.org

Password Guidance document

Remote Access Security Policies document

Example of the Start up email from help-ter@dshs.state.tx.us

User Setup

O ffice M a na g er M e d ica l C e rtif ie r M e d ica l C e rtif ie r S ta ff S ta ff

L o ca l A d m in is tra to r

S T A T E V ita l S ta tist ic s O ffice

*see back of TER brochure

VSU will set up one Local Administrator who will Add, Remove, and Modify Users in TEDR, Medical Certifiers and other 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 basic information about

the deceased

The email contains the name of the

funeral home

And the unique EDR #

Accessing The Record• Access the Internet by clicking on the

icon.

• Copy https://ter2.dshs.state.tx.us/edeath to the address bar.

• Select ‘Enter’ or icon.

https://ter2.dshs.state.tx.us/edeath

This is Called The Portal Page.

Click on ‘Thin Client Application’

Enter User Name Password

Click Login

Select Location Click OK

Dr. Kilgore

Logging into TER

This screen is called the Main Menu

Under ‘Functions’, click Medical Data Entry or click on

icon

Let’s retrieve the record.

This is the Medical Data Entry screen

From the Medical Data Entry screen, click the ‘Search

Record’ icon

or, select ‘Search’ from the

registration menu

You can search with any combination of

items

This is the Search

Record screen

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 selected record will be displayed

The Demographic Information that has been

entered by the Funeral Home will pre-populate in the corresponding fields in

Medical Tab 1

Start entering data on Medical 1 tab

The ‘Medrec’ field and the ‘MECase Number’ Field are optional. However you still

have to tab through the fields to resolve them.

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.

If there is no middle name, press ‘TAB’ to skip to the next field.

MEs and JPs:If your information is different from the

Demographic your can add, edit, or delete the information that is different.

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 pull-

down 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.

Responding ‘NO’ to the Injury question will “disable” the rest of the injury questions and not

allow entry

NO

This is an example of a cross-check

The Manner of Death implies that an injury did occur

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 Soft-

Check 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)

• “Probable” and “presumed” are allowed• Be as specific as possible about conditions

reportedProvide as much information as possibleAvoid 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

Tips and Pointers

• Avoid abbreviations• Do not report only mechanisms or modes

of dyingCardiac or respiratory arrestCardio-pulmonary or cardio-respiratory arrestAsystole (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 statewideHealth issues specific to geographic area,

socio-demographic, age, gender, ethnic characteristics

Leading causes of deathInfant and maternal mortality ratesTrends in the effect of current health issues

on mortality

• 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

Why We Need You

ExampleApproximate

interval between onset and death

Part I. Diseases, injuries, or complications that caused the death.

Part II. Other significant conditions contributing to death but not resulting in the underlying cause

d.

Immediate cause a.

Due to (or as a consequence of)

b.

Due to (or as a consequence of)

c.

Due to (or as a consequence of)

Sequentially list antecedent causes, if any, leading to the immediate cause with underlying cause last

Condition which directly preceded death

Antecedent condition

Underlying cause

ExamplePart I. Diseases, injuries, or complications that caused the death Approximate

interval between onset and death

Immediate cause Pneumonia 1 week

Sequentially list antecedent causes, if any, leading to the immediate cause with underlying cause last

b.

c.

Renal Failure

Cerebral Thrombosis

4 weeks

7 weeks

a. Due to (or as a consequence of)

Due to (or as a consequence of)

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 deathsPrimary care physician would have best

knowledge of patient medical

Medical Examiners and Justices of the PeaceCertify un-natural deathsMay request autopsySee handbook for list of cases requiring a

medical examiner / JPswww.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?

The system will bring you back to Medical 1 tab

Click the ‘SAVE’ icon before continuing

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

Enter the appropriate response

And click the ‘SAVE’ icon to store the information

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

Enter your PIN

Click ‘OK’

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:

help-TER@dshs.state.tx.us