Advanced Topics in Death Registration

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Advanced Topics in Death Registration
Never Sign a Death Certificate Again
TERdeath.texasvsu.org
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What is an Electronic Death Certificate?
An Electronic death record is one that is
completed entirely in TER by the Funeral
Director, Medical Certifier and Local Registrar.
It requires

• Demographic Data Entry which initiates the record
  in TER, assigns the appropriate medical
  certifier, and assigns the appropriate local
  registrar. The medical certifier is notified by
  email of the record in TER awaiting their
  completion.
• Medical Certification is the electronic
  equivalent of placing a signature on a paper
  form. When the medical data entry is complete,
  the medical certification process is accessed by
  the medical certifier to apply their PIN to the
  record.

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What is an Electronic Death Certificate?
continued . . .
An Electronic death record is one that is
completed entirely in TER by the Funeral
Director, Medical Certifier and Local Registrar.
It requires

• Demographic Verification which finalizes the
  duties of the funeral home by electronically
  signing the record and releases the record to the
  local registrar for processing.
• Local Registrar Record Acceptance will contain
  death records that have been electronically
  signed by the medical certifier (medically
  certified) and electronically signed by the
  funeral director (demographically verified) and
  that still need to have a local file number and
  file date assigned.

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Electronic Death Certificate
Funeral Home
The participating Funeral Home will data enter
the death certificate information (demographic
tabs 1-5) using the TER software, initiating the
social security verification process. The
funeral director will designate a medical
certifier. Once the record has been medically
certified by the participating medical certifier,
the funeral home will receive a notification
prompt (e-mail) informing them such. Then, the
funeral home will place their order for certified
copies via TER and demographically verify/release
the record.
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Electronic Death Certificate
Funeral Home
Medical Certifier
The participating Medical Certifier will
receive a notification prompt (e-mail) informing
them that an electronic death certificate is
awaiting medical certification. The Medical
Certifier will log into TER, complete medical
tabs 1-3 and medically certify the record.
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Electronic Death Certificate
Funeral Home
Medical Certifier
Local Registrar
The participating Local Registrar will log into
TER daily and check the work queue for pending
electronic death records to be filed. The local
registrar will assign a Local File Number and
Local File Date, save and release the record to
the state and print the record for office
use/issuance.
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Lets get started.
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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 email contains the name of the funeral home
The basic information about the deceased
And the unique EDR
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Medically Certify a Death in TER

• Access the Internet by clicking on the
  icon
• Copy https//ter.tdh.state.tx.us to the address
  bar
• Select Enter or

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Enter User Name Password
Click Login
Dr. Kilgore
Select Location
Click OK
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Under Functions, click Medical Data Entry or
click on icon
This screen is called the Main Menu
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This screen is called the Medical Data Entry
screen
From the Medical Data Entry screen, click the
Search Record icon
Lets retrieve the record.
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or select Search from the Registration menu
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This is the search record screen
You can search with any combination of items
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Enter your search information or EDR
Click Find
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The system will bring back all records matching
the search criteria
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Click on the desired record or records the
row(s) will become highlighted
Click Select Records
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The selected record will be displayed
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Or click to choose Filter Option
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Click to access records in queue
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Select record to process.
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Start entering on Medical 1 tab
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Enter First Name and Tab to advance to the next
item
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If there is no middle name, press TAB to skip
to the next field.
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If an item is skipped, you will be asked if you
mean NONE or if you need to complete the item
later if you say NO, the item will resolve
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Enter the rest of the information, tabbing from
field to field
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Select Date of Death Type
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Select Type of Place of Death
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Type the first letter of the name of the Place of
Death
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Select Place of Death
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The Certifier section will already be completed
based upon the funeral directors designation
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Complete the rest of the items. Clicking TAB
from the AM/PM field will move you to the next
page of information
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We are now on the Medical 2 Tab
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Complete each item by selecting to appropriate
response from the pull-down lists
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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.
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Responding NO to the Injury question will gray
out the rest of the injury questions and not
allow entry
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The Manner of Death implies that an injury did
occur
This is an example of a cross-check
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Changing the response to Yes will resolve the
conflict
Click OK to continue
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Complete each item by entering information
requested or selecting responses from pull-downs
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We are now on the Medical 3 Tab
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If the cause of death has not yet been
determined, click the Cause of Death Pending box
You must also type PENDING on Line A
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If the cause of death is known, enter the
information on lines A D, as appropriate,
tabbing from field to field until complete
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If there are no contributing conditions, tab past
this field
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Click No to continue and the field will be
resolved
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Cause of DeathWhy Should You Care?

• Information from the death certificate, including
  the cause of death, is used to generate official
  mortality statistics such as
• Life expectancy
• Deaths and death rates by cause of death,
  geographic area and socio-demographic
  characteristics
• Leading causes of death
• Infant and maternal mortality rates

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Cause of DeathWhy Should You Care?

• Mortality statistics generated from death
  certificates are used to
• Assess the general health of the population
• Examine medical problems which may be found among
  specific groups of people
• Indicate areas in which medical research may have
  the greatest impact on reducing mortality
• Allocate medical services, funding, and other
  resources

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Example
Approximate interval between onset and death
Condition which directly preceded death
Antecedent condition
Underlying cause
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Example
Approximate interval between onset and death
30 minutes
Cerebral contusion
30 minutes
Fractured skull
30 minutes
Blunt impact to head
30 minutes
Collision of two motor vehicles
Acute ethanol intoxication
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General Guidelines

• Avoid abbreviations
• Do not report mechanisms or modes of dying
• Cardiac or respiratory arrest
• Cardio-pulmonary or cardio-respiratory arrest
• Asystole (cardiac arrest)
• Be as specific as possible about the conditions
  reported
• If information with regard to specificity,
  etiology or the cause of death is unknown,
  indicate explicitly that this is the case

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General Guidelines
Continued . . .

• Terms such as probable or presumed are OK
• Avoid terms such as old age, senescence, or
  infirmity
• The certification should represent your best
  medical opinion
• 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

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The system will bring you back to Medical 1
Click the SAVE icon before continuing
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Your information is now stored in the system
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Medical Certification
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Click the MEDICAL CERTIFICATION icon to
electronically sign the record
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If a field was not completed, you will see this
message
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Quick tip Using the Unresolved List feature can
help quickly identify missing information.
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Click on Unresolved List
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Close Unresolved List screen by clicking the red X
Any unresolved fields will be indicated
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Incomplete, or Unresolved, fields will be
displayed in bright yellow
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And click the SAVE icon to store the information
Enter the appropriate response
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Once again, click the MEDICAL CERTIFICATION
icon to electronically sign the record
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Click Yes to continue
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The basic information is displayed
The type of certifier is checked and the
appropriate certification statement is displayed
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Click Preview to view the entire medical
certification portion of the death certificate
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Click Certify to electronically sign the
death certificate
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Click OK
Enter your PIN
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Success! You are now finished with this record
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The information locks down and cannot be changed
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De-Certify
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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.
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Click the De-Certify icon
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Click OK
The record is now De-certified
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The record is now open and information can be
corrected as needed
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After all changes are made, the record must be
electronically certified again
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Medical Amendment
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Retrieve the record and select the Medical
Amendment icon
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Enter medical certifiers PIN number
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Cause of Death section unlocks
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Click Save.
Type the new cause of death statement, include
approx. interval and other significant conditions
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Click to print medical abstract.
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Note new cause of death.
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How can I Participate?

• Fax Request for TER Death
• Receive Updates
• Visit VS E-Death Website
• www.dshs.state.tx.us/vs/edeath

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Questions?Comments?

• Please email your questions and
• comments to
• HELP-TER_at_dshs.state.tx.us