• Background
• Environmental Factors
• Vital Statistics Information and Systems Objectives
• Vital Statistics Information and Systems Issues
• Glossary

Background

The Vital Statistics Council for Canada (the Council) is a successful partnership between the provincial/territorial registrars and Statistics Canada. The mission of the Council is to provide leadership in creating, promoting, supporting and maintaining an effective and efficient Canadian Vital Statistics System that integrates vital record registration and certification, and health statistics. As part of its mandate the Council has produced a strategic business plan for the period 1999 to 2004. The plan identifies six (6) strategic objectives, namely:

• Integrated Business Processes - support integrated and uniform practices for registering vital events.
• Contemporary Technologies - monitor technological change and explore ways to implement advances.
• Standard Data - define national vital statistics data standards for comparability and high quality assurance.
• Integrated Information Systems - promote the vital statistics system as a key component of an integrated health information system, including the use of associated information and data products.
• Collaborative Approach - consolidates existing client relationships and creates new partnerships in order to increase the Council's visibility, authority and effectiveness.
• Privacy Protection - manage personal privacy and confidentiality while recognising the dual demand of public protection and public information.

Environmental Factors

From an information technology perspective there are a number of environmental factors, both internal and external to the vital statistics business, that the Council needs to consider in the development of the information and systems plan.

External: The environmental factors, external to the Canadian Vital Statistics System can be summarised as follows:

• Demand for Information - the information revolution is underway - based on an insatiable demand for high quality, timely and relevant information.
• Internet - its use will continue to increase exponentially. Security remains a challenge, especially for personal health information.
• Interoperability - systems will increasingly talk with other systems, creating a transparency of information-information can be located anywhere.
• Information access - hand held devices will revolutionise data collection and access at the point of care.
• Electronic health record - until privacy and security issues are resolved, its implementation will continue to be limited.
• Standards consolidation - a few standards will begin to dominate-for example Portable Operating Systems Interface (POSIX) , Extensible Markup Language (XML) and Ethernet.

• Government Reform - most governments have initiated reform processes that focus on deregulation, downsizing and privatisation in a period where there has been a fundamental shift in responsibility to provincial and territorial governments.
• Health Infrastructure Initiatives - Almost all jurisdictions have initiated major health information system initiatives that are directed at supporting an empowered public, an integrated service delivery system, and the creation of health information resources. This is resulting in the redevelopment of Vital Statistics information systems across Canada.
• Health Information Legislation - many jurisdictions have passed or are planning to pass new health information legislation to support a more integrated health service delivery system. This new legislation is placing an increased focus on the need to balance personal privacy with access to information.
• Health Information and Systems Standards - the International Standards Organisation (ISO) and in Canada, CIHI and CSA have initiated a new process both globally and nationally to develop and adopt health information and technology standards. This will result in the adoption of international standards (e.g. HL7) and standards pertinent to Canada (e.g. ICD-10-CA).

Vital Statistics Information and Systems Objectives

Business Objectives:

• To support the evolution of existing client relationships and create new partnerships in order to improve the Canadian Vital Statistics System.
• To improve the usefulness of vital event information within the health care system in Canada.
• To provide for the online registration and certification of vital events in all jurisdictions in Canada.
• To support the reduction of fraud through the timely registration and sharing of vital event information among jurisdictions.
• To publish and disseminate online vital statistics information that will assist the public, health professionals and others with their respective decision making.

• To support the linkage of vital event information with other health care information (e.g. hospital records) to determine the health of Canadians, as well as the efficiency, effectiveness and responsiveness of the health care system.
• To support the development and measurement of health indicators that utilise vital event data.
• To create and publish a standard data dictionary of vital event data elements.
• To improve and expand the standard set of national vital event data elements to support new information requirements, such as population health, outcomes management and clinical decision support.
• To support the mapping of the Canadian Health Data Model to the logical data models used by the Canadian Vital Statistics System.
• To develop a comprehensive editing system that ensures high quality vital event data.
• To identify data quality priorities, improvements to data quality and where special projects are needed to improve data quality.
• To support studies evaluating data quality of vital event data by independently examining the data sources.
• To support the development and implementation of methodologies to provide users on the quality of the data collected, stored and processed by the Canadian Vital Statistics System.
• To improve the accuracy, timeliness and quality of vital event data in the development of health outcome information.
• To increase the accuracy, precision and consistency of geographic codes linked to health statistics.
• To develop a comprehensive set of data sharing agreements among Vital Statistics agencies across Canada.

• To provide vital event collection applications in a manner that ensures data quality and integrity.
• To provide analysis and reporting applications that enable jurisdictions to analyse data and disseminate data and information in a similar manner, thereby ensuring service equity.
• To provide application interfaces between vital statistics information systems and information systems of other organisations (e.g. provincial elections offices).

• To provide the necessary open systems infrastructure - hardware and software - to enable vital statistics information systems interoperability.
• To position the vital statistics information systems in each jurisdiction so that they are web-enabled and web-connected.
• To provide an information systems approach that permits national vital statistics to be shared for the purposes of supporting inter-jurisdictional registration and certification, as well as national and regional vital statistics analysis and reporting.

• To become actively involved with the development and adoption of global and national vital event data standards.
• To support the implementation of standard international/national classification and coding schema (e.g. ICD-10-CA) as appropriate.
• To implement international messaging standards (e.g. HL7) as appropriate.
• To support the implementation of technology standards that contribute to the interoperability of vital statistics information systems.

• To plan, develop, and implement principles, policies, practices, and documentation related to privacy and data collection, use and disclosure that are applicable to the Canadian Vital Statistics System.

Vital Statistics Information and Systems Issues

In order to achieve these objectives over the next 5 years the Vital Statistics Council for Canada needs to address some key information and systems issues. These have been identified as:

Business Issues

• Vital event information is not always available in a timely manner which limits its usefulness within the health care system in Canada.
• The potential for health and welfare fraud exists when vital event information is not registered and shared among jurisdictions in a timely manner.
• In some jurisdictions the integration of vital event registration and certification with the provisioning of health statistics is not well developed.

• The existing national set of common data elements needs to be expanded.
• In some jurisdictions the linking of vital event data with other population health and health determinant data is not in place.
• The new requirements to provide vital event data to support the continuum of care-outcomes management, and clinical decision support places new requirements on the type and quality of vital event data collected.
• The Vital Statistics common data elements are not well utilised in the data models and indicators of the health care system.
• Data quality issues exist and need to be appropriately addressed.
• A comprehensive approach to editing vital event data to ensure high quality is not in place.
• A precise understanding of the quality of vital event data does not exist.
• The accuracy, timeliness and quality of vital event data is at issue in some instances and limits the uses of the data.
• The accuracy, precision and consistency of geographic codes linked to vital event data needs to be improved.
• Necessary data sharing agreements for vital event data are not always in place.

• Significant disparities exist between jurisdictions with respect to hardware, software, and use literacy that inhibits interoperability and data access.
• The technologies to analyse present and disseminate vital statistics information varies significantly by jurisdiction.
• The vital event collection applications are not always in place that supports high data quality and integrity.
• The mechanisms to securely transmit vital event information over the Internet are not fully in place (e.g. Public Key Infrastructure).
• The application interfaces between vital statistics information systems and information systems of other organisations (e.g. provincial election's offices) are not always in place.
• Not all vital statistics systems in Canada fit with an open systems architecture that enables interoperability.
• Only a few vital statistics systems are web-enabled and web-connected.

• Leaders within the vital statistics system in Canada have yet to become well connected to the new national and international health information and standards development efforts.
• Common disease and intervention classification and coding schemes are not in place across Canada.
• Vital statistics agencies have yet to fully embrace international messaging standards (e.g. HL7).
• Each jurisdiction has its own set of technology standards that do not always enable national interoperability and data access.

• Health information legislation is rapidly changing across Canada, and has yet to be harmonised - the impacts on the vital statistics system has yet to be fully determined.
• The principles, policies, practices and documentation related to privacy and data collection, use and disclosure that are applicable to the Canadian Vital Statistics System have yet to be fully developed and harmonised across Canada.

Glossary

CIHI The Canadian Institute for Health Information (CIHI) plays a critical role in the development of Canada's health information system. CIHI is a federally chartered but independent, not-for-profit organisation. It brings programs, functions and activities from The Hospital Medical Records Institute (HMRI), The MIS Group, Health Canada (Health Information Division) and Statistics Canada (Health Statistics Division) together under one roof. In addition, the Institute is launching several new key initiatives as it assumes a leadership position in health information.

CSA The Canadian Standards Association is an independent, not-for-profit organisation supported by more than 8,000 members. We have a network of offices, partners, and strategic alliances in Canada, the U.S., and around the world. Established in 1919, CSA International is a leader in the field of standards development and the application of these standards through product certification, management systems registration, and information products.

HL7 Health Level Seven is a Standards Developing Organisation (SDO) operating in the healthcare arena. Health Level Seven's domain is clinical and administrative data. The Working Group develops specifications, the most widely used being a messaging standard that enables disparate healthcare applications to exchange keys sets of clinical and administrative data. The Health Level Seven Standard defines which data elements are to be sent, the data type and suggested length of each, and indicates whether the data element is required or optional and whether it may repeat. Like the segments, the fields must be sent in the order in which they are presented in the Standard. That way, both the sending and receiving systems know what data is expected, in what order, and in what format. The Health Level Standard also enables one system to query another for relevant information. For example, a physician's system could query the lab system for test results for a particular patient. Again, the information is ordered such that both systems know what data are expected to be exchanged.

ICD The International Classification of Diseases is designed for the classification of morbidity and mortality information for statistical purposes and for the indexing of hospital records by disease and operations, for data storage and retrieval. ICD-10 is the tenth revision to the set of coding.

IEEE The Institute of Electrical and Electronics Engineers, Inc. is a non-profit, technical professional association of more than 350,000 individual members in 150 countries. Through its members, the IEEE is a leading authority in technical areas ranging from computer engineering, biomedical technology and telecommunications, to electric power, aerospace and consumer electronics, among others. Through its technical publishing, conferences and consensus-based standards activities, the IEEE:

• produces 30 percent of the world's published literature in electrical engineering, computers and control technology
• holds annually more than 300 major conferences and
• has more than 800 active standards with 700 under development.

Posix The Portable Operating Systems Interface is IEEE standard 1003.1. Posix is a flavour of the Unix operating system.

XML A markup language is a mechanism to identify structures in a document. The Extensible Mark up Language specification defines a standard way to add markup to documents containing structured information. Structured information contains both content (words, pictures, etc.) and some indication of what role that content plays (for example, content in a section heading has a different meaning from content in a footnote, which means something different than content in a figure caption or content in a database table, etc.). Almost all documents have some structure.