Jan.18, 2018
The state of Texas is giving
new life to system that records how people died, and Texas doctors are
optimistic it will be easier to use and will lead to more accurate death
records, which collect vital data used to monitor public health.
Beginning this month, the Texas Department of State Health
Services (DSHS)—Vital Statistics Section will seek physicians’ input on the new
Texas Electronic Vital Events Registrar (TxEVER), a new system to create
death certificates. The Texas Medical Association’s (TMA’s) Texas Medicine magazine reports that TxEver will replace the decade-old
Texas Electronic Registrar (TER) in January 2019. Some
physicians and justices of the peace say the TER death certificate is difficult
to complete and, at times, may include faulty information.
Under TER, physicians must track down
accurate information about the deceased and complete an electronic death
certificate within five days of receiving it or face penalties from the Texas Medical Board (TMB). But the old TER system sends
doctors just one email – which physicians say they can easily miss – to notify
them to complete a death certificate,. In addition, some doctors say they never
received training on how to fill out TER death certificates. What’s more, often
the job of completing a death certificate falls to the deceased person's
attending physician at the time the person died. But that doctor might know
little about the patient's overall medical history, says TMA physician leader John
Holcomb, MD, a pulmonary and critical care specialist in San Antonio. As a
result, the information they do provide might represent a "best
guess" if the physician knows little about the patient's medical history.
“The word 'guess' is
probably not the best choice, but the circumstances leading to death are not
always clear cut, so you sometimes have to use your best judgment,” says Rodney Young, MD, a TMA
physician leader and professor of family medicine at Texas Tech University
Health Sciences Center in Amarillo. “We deal in probabilities all the time.
This is just another situation in which you deal in probabilities."
Since an autopsy can be the
most accurate way to determine how someone died, often the most accurate
reports occur when a medical examiner who did the post-death assessment
completes the death certificate. However, examiners autopsy only about one in
20 deaths.
Inaccuracies in determining and
recording the cause of death have serious repercussions for public health
because death certificates are the foundation of many vital statistics. If
physicians and policymakers don't have an accurate picture of what is killing
people, they cannot accurately shape health care policy. Even a few errors on
death certificates can have a profound impact on statewide death records for maternal
mortality, opioid use, and other problems, says David Lakey, MD, chair of the TMA
Council on Science and Public Health. "A few numbers could really skew the data for a relatively
rare event," Dr. Lakey said, citing an example. "Maternal mortality
is obviously a very important issue. In total numbers though, it's still
relatively low ― 130 women [or so per year]. So if there are 20 deaths
miscoded, you have a huge fluctuation in those numbers."
Even a physician’s choice of
words can result in problems. "If somebody has a stroke, that's [an OK
term to use]," Dr. Young in Amarillo says about the TER form. "But if
you call it a 'cerebrovascular accident,' the medical name for [a stroke], the
system will kick you out and say, 'I see the word 'accident,' that's a
non-natural cause of death. That has to go to the medical examiner.' … There
are a number of little scenarios like that."
DSHS says the new TxEVER
system will allow DSHS to control and modify the types of editing and error
messages that pop up when physicians fill out forms. TxEVER will also provide more accurate data
and a more user-friendly process for physicians, justices of the peace, medical
examiners, and funeral home directors (as well as ― in limited cases ―
physician assistants and nurse practitioners) to fill out death certificates. Victor
Farinelli, deputy state registrar for DSHS's Vital Statistics Section says, "We
want to make a more up-to-date, technology-forward system."
DSHS will set up a booth to
showcase TxEVER at TMA's 2018 Winter Conference on Jan.
26–28 in Austin and describe how to make the process easier for physicians. "It
still comes down to somebody filling out the form accurately to have reliable
data," Dr. Lakey said. "I think that's why physicians need to be part
of that process."
TMA is the largest state medical society in the nation,
representing more than 50,000 physician and medical student members. It is
located in Austin and has 112 component county medical societies around the
state. TMA’s key objective since 1853 is to improve the health of all Texans.
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Contact: Brent Annear (512) 370-1381; cell: (512) 656-7320; email: brent.annear[at]texmed[dot]org
Marcus Cooper (512)
370-1382; cell: (512) 650-5336; email: marcus.cooper[at]texmed[dot]org
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