Audit Report on the Implementation of the Electronic Death Registration System by the Department of Health and Mental Hygiene

We performed an audit on the implementation of the Electronic Death Registration System by the Department of Health and Mental Hygiene (DoHMH). DoHMH’s mission is to promote and protect the health and mental health of all New York City residents. Among DoHMH’s responsibilities is the registration and issuance of birth and death certificates. DoHMH’s Bureau of Vital Statistics (Vital Statistics) is responsible for issuing all Certificates of Death for deaths that occur within the City of New York. The Burial-Death Registration Unit (Registration Unit) of Vital Statistics records information pertaining to each death in the DoHMH computer system and issues certified death certificates and permits for the burial, cremation, and transportation of human remains.

In 1998, the department began a system development initiative known as the Electronic Death Registration System (EDRS) to automate the functions of the Registration Unit. The initial effort was developed by IBM at a cost of $3.2 million but did not achieve the level of stability and functionality for deployment required by the Department. In April 2002, DoHMH started the second EDRS implementation effort. Dynamic Services International, Inc., (Dynamic) in partnership with VitalChek Network, Inc., (VitalChek) was selected as the vendor, at a total fixed cost of $1.3 million.

On March 31, 2003, VitalChek was assigned and assumed the EDRS contractual responsibilities of Dynamic. By 2004, a national model of standards for an EDRS was released by the National Association for Public Health Statistics and Information Systems (NAPHSIS) as a guide to assist states and jurisdictions interested in EDRS development. VitalChek agreed to adopt the national model in its New York City EDRS development and implementation over an approximate two-year time frame.

EDRS is designed to be a Web-based, paperless, and user-friendly system, with HIPAA-compliant security features to be accessed by authorized and registered New York City hospitals, medical providers, and funeral homes. Access is generally via the Internet to DoHMH’s Web interface, NYC MED. The development and implementation of EDRS was completed in June 2008. The system is currently on contractual annual maintenance with VitalChek until the year 2017.

Audit Findings and Conclusions

EDRS functions reliably, and information recorded in the database is accurate and secure from unauthorized access. EDRS is based on the national EDRS standards model, allows for future enhancements or upgrades, and was completed within original cost and time estimates. It has a disaster recovery and business continuity plan in place. Users are generally satisfied with the system.

However, we concluded that there were reporting and performance-monitoring issues that should be resolved to improve system usefulness. In terms of reporting, we noted that the EDRS capability to generate ad-hoc reports needs improvement, and that existing EDRS standard reports have not been fully tested for elimination of errors. With regard to performance-monitoring, we noted that the system could not produce a systems performance report showing daily scheduled maintenance, unscheduled maintenance, and downtime. In addition, DoHMH needs to develop a policy and procedures for handling future EDRS enhancements or upgrades, and review all open items previously recorded in Web Tracker for problem resolution.

Audit Recommendations

To address the audit issues, we make five recommendations, that DoHMH:

• Have the vendor correct the EDRS ad-hoc reports-generating capability to meet the required specifications.
• Test all available EDRS standard reports produced by the system, request resolution of all reports where problems were noted, and test the reports after the problems have been addressed.
• Institute or develop a proper system monitoring facility and set it to record EDRS service performance.
• Develop a policy and procedures for handling EDRS enhancements or upgrades.
• Review the status of all issues reported in Web Tracker, and where appropriate, close the reported issues and institute a stricter monitoring and periodic updating procedure for all those issues.