Reengineering Vital Registration and Statistics Systems [Response to Letter]

Dr Nasseri has registered valid concerns (1) about reengineering vital registration and statistics systems for the United States (2), many of which I share. Certainly the move to state-of-the-art information technology will not be the only key to rejuvenating the vital statistics system. We must not miss this opportunity to improve both the quality and the content of the information provided by these reengineered systems. The expanded data set derived from the new standard certificates, once implemented by the new systems, will improve data content extensively. These certificates are available on the Internet (3). Considerable work lies ahead in finding innovative ways to improve data quality for both new and old data items. Dr Nasseri also suggests a number of demographic indicators for the death certificate that would have analytic and research value, including the place (country) of birth of the decedents' parents and occupation. Some of these items are of great potential value. The panel of experts (4) that recommended to the Secretary of the Department of Health and Human Services the new and revised data items to be included in the new standard certificates consisted of a broad range of data providers and users as well as state vital registrars and statisticians. Three questions guided the panel's decisions on maintaining or revising old items and adding new items: 1) Is the item needed for legal, research, statistical, or public health programs? 2) Is the item collectable with reasonable completeness and accuracy? 3) Is the vital statistics system the best source for this information? The panel worked exceedingly hard and successfully to balance important public health needs with the most appropriate mechanism to collect information with the concern that the collection of this information not be an unreasonable burden for respondents. As Dr Nasseri notes, state registration and health officials are free to add items to their own vital records systems when they believe these additional questions are needed for state purposes. With an advanced and flexible information technology infrastructure in place, such additions become more practical at the state level and could in the future serve as a method to effectively pilot test items for inclusion in new national standards. State data users and providers need to be very involved in implementing and updating these systems in their own state. Information on place of birth of the decedent is requested on the death certificate, and information on place …