Hamidreza Mahboobi

Narjes Mirabootalebi

Tahereh Khorgoei

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http://www.ephysician.ir electronicphysician@gmail.com 416OpinionElectronic Death Registration System (EDRS) in IranNarjes Mirabootalebi1, Hamidreza Mahboobi2, 3, Tahereh Khorgoei4, 51: Hormozgan University of Medical Sciences (HUMS), Bandarabbas, Iran2: Student Research Committee, Hormozgan University of Medical Sciences (HUMS), Bandar Abbas, Iran3: Payam Noor University (PNU), Tehran, Iran4: Psychiatric Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran5: Infectious and Tropical Disease Research center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran* Corresponding Author: Hamidreza Mahboobi, Shahid Mohammadi Hospital, Bandar Abbass, Iran. Tel:+98.9364300250. Email: hamidrezamahboobi@yahoo.comReceived: 11 May 2011Revised: 20 July 2011Accepted: 06 August 2011Published: 15 August 2011© 2009-2011 Electronic PhysicianAnnually, millions of deaths occurworldwide. Information about the number and thecauses of death is important for health care providersand for health policy managers for planninghealthcare services, targeting primary prevention,allocating funds, initiating public health measures,etc (1).Due to the large numbers of deathsoccurring in each area of the world, obtainingaccurate statistics about the number and the cause ofdeath isn’t simple (2).Traditionally, death registration was a paper-based process and death certificate registration wasalso paper-based. Problems with the paper-basedregistration of death certificates include (3):1- There is potential for permanent destructionof the records due to natural events such asburning or flooding.2- The registration process, copying of, andtransportation of these the records is timeconsuming and expensive.3- Access to the records is limited.4- It is very difficult to detect and correctpossible mistakes in the registration process.5- Collection of data at a national level andeven at a local level within a deathregistration office is a very difficult process.6- Each local death registration office mayhave a different method for reporting deaths.This may increase the difficulty of collectingand interpreting the information provided(1) An example of this is in the case ofcardiopulmonary arrest and subsequentdeath in the context of Chronic RenalFailure (CRF). This can be attributed torenal disease or cardiovascular disease. Suchdifferences can change statistics regardingcause of death and, potentially, health policymanager decisions (4).These problems prompted the developmentof a new “Electronic Death Registration System” (5).EDRS is a web-based registration system that allowsusers to create and edit death certificates online andgives the users the ability to access the informationonline (6). In this system, computers are used to enterhttp://www.ephysician.ir electronicphysician@gmail.com 417and maintain the data rather than the traditionalmethod of paper death certificates.EDRS is safe from natural disasters becauseof the ability to create backups, is more timeefficient, facilitates easy and quick copying ofrecords, allows access to records via Internet bymultiple uses, ensures easy correction of mistakes,and results in easy and quick transport of the recordsfrom local to national and international offices (7).By using EDRS, all local offices can choosea common method for reporting deaths, which willhelp with the collection and interpretation of the dataat the national and international level (8). Informationabout new deaths can be collected as the users enterthe data in the software and data analysis can beperformed more easily (9). Possible risks of errorswill be reduced by using EDRS for analyzing deathinformation at the national or international level.Despite these advantages, EDRS has somelimitations that prevent complete replacement ofmanual death registration systems. The limitations ofEDRS are discussed below:1) EDRS needs specific hardware andsoftware and also requires Internet access.This limits its use in certain local areas.Providing necessary equipment to localoffices requires financial support, whichmay not be feasible in all countries.2) Office workers, physicians, and medicalexaminers who are new to EDRS wouldneed education and training beforeundertaking the task of registration of deathcertificates. (10) In addition, all users ofEDRS need to have basic computer skillsand be competent in Internet use.3) Concern about the safety of digital records iscommon. One can reach the records onEDRS by finding the username andpassword.(11)Taking into account the above limitations,EDRS offers a way of providing a strong national andinternational death registration system to allow quickand easy access to accurate information. However,the use of EDRS should be piloted in selected localoffices in developing countries prior to widespreadimplementation to ensure that all advantages andlimitations, and the significance of these, are betterunderstood.In Iran in 2005, a standard death certificatewas developed. This was the first step fordevelopment of EDRS. But EDRS in Iran is still in itsinitial stages. As a result, problems are still inherentwithin it. These include:1- Lack of written instructions for correctcompletion of the items in the software2- Lack of written instructions for writing thecause of death3- Users are not limited (by their professionalfield)4- There is no written protocol for collectingthe dataAlso there are problems in the systemsoftware that should be solved.1- One cannot create a backup using thecurrent software.2- Lack of the possibility to define a specificuser for the software3- One cannot return to previously inputtedinformation to correct the mistakes4- The software cannot detect duplicate recordstherefore information may inputted severaltimesWe suggest the following for developmentof EDRS in Iran.1- Designing a system for sending informationonline2- Periodic education for physicians and otherstaff members is needed3- ICD-10 could be used as a reference forcauses of death4- Users in the field of medical records who arefamiliar with statistics, medical vocabularyand information technology can be helpful5- For each part of EDRS, complete andaccurate instructions should be preparedIn summary, noting the great number ofdeaths occurring annually in Iran and otherdeveloping countries, and the importance of dataobtained from the causes of death registered innational databases annually, development of EDRS isnecessary. Although there are problems currentlyassociated with the use of EDRS pilots in localoffices, these problems and limitations can be solved.This requires collaboration among physicians, healthcare policy makers, hospitals, and other enters relatedto death registration. Research projects in this fieldare lacking.http://www.ephysician.ir electronicphysician@gmail.com 418Acknowledgements:The authors of the paper kindly thankElizabeth Cottrell (University Hospital of NorthStaffordshire NHS Trust, England) for help withEnglish editing.References:1. Medical Examiners’ and coroners’ Handbook onDeath Registrationand Fetal Death Reporting: 2003revision. National Center for Health Statistics;Hyattsville, Maryland; April 2003. DHSS PublicationNo. (PHS) 2003-11102. National Center For Health Statistics.MortalityStatistics Of the United States,1992.Vol 2,MortalityPart A.Washington:public Health Service;19963.Vermont Electronic Death RegistrationSystem.Vermon Department of Health Agancy ofHuman Services Available From:http://www.healthvermont.gov/hc/edrs/aboutEDRS.aspx4. IMPROVING CAUSE OF DEATH REPORTING;The NewYork City Department of Health and MentalHygiene; October 2008; Vol. 27(9):71-785. What is Edrs:Adapted From Death RegistrationSystem In The United States. Available from:URL:www.naphsis.org6. Electronic Death Registration System:NewJerseyDepartment Of Health And Senior ServicesTrenton,NJ,USA vailable from:HTTP://naphasis.org20057. Information on the Electronic Death RegistrationSystem Available from:http://www.nyc.gov/html/doh/downloads/pdf/vr/vr-nyc-health-code-changes.pdf8. Electronic Death Registration Systems in theUnited States and Moetality Surveillance forPandemic Influnza Conference Call Noveber14.20079. Website of New Jersey Electronic DeathRegistration System. Department of Health andSenior Services; Available online at:http://edrs.nj.gov10. Whisnant,Steve,What Hospitals and Physiciansshould Know about Electronic Death RegistrationAvailable From:http://www.healthykansas.com/Certificaits/erave.html11. Toward an electronic death registration system inthe United States: report of the Steering Committeeto Reengineer the Death Registration Process. TheAmerican journal of forensic medicine andpathology. 1998;19(3):234-41. Epub 1998/10/06.

Electronic Death Registration System (EDRS) in Iran

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