SUMMARY OF DISCUSSION - AVSS TAG MEETING
Sacramento, California
December 5, 2000

1. Introduction By Attendees and Opening Statements.

1. Due to the retirement of Rod Palmieri and the reassignment of Deborah Martin there were two vacancies on the TAG "Core" group. As shown on the letterhead, these have been filled by Michael Rodrian and Mark Starr. However, since this leaves only two LRD representatives, it was felt that another one or two LRD members should be added. John Moehring has agreed to serve and one more LRD representative is likely to be added. The Core group has traditionally served as a "quick response" advisory body between the semi-annual TAG meetings.
2. Luis Rico, Don Fields, and Karen Flanigan, new OVR staff, were introduced by Michael Rodrian.
3. Review of summary from May 16, 2000 TAG meeting. Note: TAG summaries are available on the Web at: http://www.avss.ucsb.edu/tag.htm

2. Version 4.9, 4.9A, 4.9B, and 4.10 Updates.

1. Version 4.9 was released on November 9, 1999 and all 250+ AVSS servers throughout the state were updated before January 1, 2000 to be ready for the new birth certificate forms that allowed up to three race responses for mother and father. Although this update met the tight time schedule and fulfilled Y2K standards, there were some minor bugs. First was an inadvertent change in Version 4.9 that made Field 36 (Mother's Middle Name) on the Death Record a required field, whereas it should be optional. There was also a need to add 'SCAT' to the list of choices for Field 41 (Type of Disposition) on the Death Record. Because of the need to correct these problems, an updated Version 4.9A was prepared. Since the problems did not affect hospitals, only the LRDs were updated to 4.9A. Another problem was related to using the ^Skip and ^File commands within the multiple race prompts. For this reason it was necessary to program an additional version (4.9B) and both the LRDs and the hospitals were updated with this version. Since 4.9B incorporated many of the updates that would have ordinarily been contained in the annual update, there will be a more relaxed schedule in implementing Version 4.10, which differs little from Version 4.9B.
2. The Release Notes for Version 4.10 were reviewed. The most important change is that a Hospital Birth Record must be flagged as SENT using LIST TO BE SENT TO HEALTH DEPARTMENT before it can be registered as a birth certificate. Another important change is the re-ordering of the GENERATE FILE suboptions under the BIRTH CERTIFICATE option. The Release Notes are posted on the Web at http://www.avss.ucsb.edu/release.htm

3. AVSS Modification Requests (AMRs): Review and Discussion.

00-038: The possibility of adding a user name to the password for extra security in case AVSS goes on the Internet was discussed. This is related to AMR 00-073 below, and both were discussed together.

00-040: The suggestion of reprogramming the LFN ASSIGNMENT suboption or adding a new DATE OF REGISTRATION ASSIGNMENT suboption, so that the LFN and Field 17 could be printed independently, was rejected since OVR staff felt that the two fields were too closely associated with each other.

00-044: The suggestion to no longer use zip code to set defaults for county and city of address was not approved; however, there may be a need to revisit this AMR in the future.

00-073: Placing more restrictions on the type of passwords that can be used was felt to be a good idea. If AVSS passwords are strengthened, it might negate the need to add user name since it would be unlikely that two persons would attempt to use the same password, which is presently the (undesirable) case. After some discussion it was agreed to implement the password restrictions and revisit the need for adding the user name at a later time.

Michael Rodrian reported some OVR topics including statute changes affecting vital records at this point:

1. Licensed birthing centers are to be added to the AVSS hospital list and are authorized to use AVSS if resources allow.
2. The cost of death certificates is increasing by $2.00 on 1/1/2001 with the funds going to DOJ for DNA tracking.
3. A new certificate will be issued if a gender error has occurred, going back to 1905.
4. The cost of amendments will increase by $1.00 to $20.00, effective 1/1/2001.
5. Certified midwives will be treated the same as MDs with respect to birth registration and will not be given blank forms.
6. The Department of Finance is using the multiple race data.
7. There will be a one-day workshop on using AVSS and vital statistics in conjunction with the Spring OVR workshops.

4. The Future Of AVSS.

1. Ron Williams is planning to retire on June 30, 2002 at the end of his current three-year MCH contract and wishes to provide for continuity of AVSS funding, staffing, and project direction after that date. The plan is to have OVR assume the major responsibility with TAG continuing to provide guidance. Michael Rodrian stated that he agreed with that concept, was initiating a Budget Change Proposal to provide funding, but was unsure as to how it would end up. He restated his commitment to continuing TAG and he is committed to maintaining the high standards for the current system and sharing data as well as decision-making with the LRDs.
2. Ron Williams reported on the plan to modernize the AVSS computer architecture using the Internet. Based on Windows NT/2000, the plan is to use SSH (Secure Shell) encryption technology to establish secure Telnet sessions to a central AVSS/NT server. Each LRD would have its own 'virtual' computer on the server so that the basic AVSS data structure would remain unchanged. This would involve two servers at the central site: an encryption (SSH) server connected through the Internet to a user workstation running a terminal emulation program (similar to ProComm) called SecureCRT, and an AVSS/NT server connected to the SSH server in a secure environment. Under this plan AVSS would migrate to a modern computer platform, but to users it would appear functionally identical to the present DOS-based system. The AVSS Project will be establishing a new AVSS/Internet facility at UCSB in early 2001 that will have redundant severs (two SSH and two AVSS/NT) and broad band (100 Mbps) Internet access. There have been preliminary discussions with Merced County as a possible pilot site.

5. Electronic Death Registration System.

1. Michael Rodrian reported that he attended the NAPHSIS meetings in Atlanta and there was considerable interest in EDR system and in developing standards. Financing such a system is a concern and he has made a proposal to Department of Finance.
2. Placer County is hosting a pilot for the Physician Certification Line.
3. Natlee Hapeman reported that two funeral homes are still using AVSS/EDR with an 80% participation rate.

6. Confidential Morbidity Report (Discussion Led By Mark Starr: See attached CMR Topics).

1. Mark Starr can be contacted at mstarr1@dhs.ca.gov

7. AVSS Automated Birth-Death Matching.

1. MCH is providing funding to improve AVSS birth-infant death matching and to possibly incorporate it into the ongoing OVR operations. Matching is preferably performed at the state level since family mobility can result in a change in residence during the first year of life and consequently infant death certificates may not be reallocated back to the LRD of birth. When AVSS attempts to match such an infant death at the local level, the birth certificate will not be in the LRD database and thus cannot be matched. This limitation does not exist at the state level, where a 95% match rate for 1999 infant deaths was attained. A new 'cross-match' index (BD) has been created that provides a linkage between AVSS birth and death certificates, regardless of age. Following the completion of birth-death matching at the state, this index and all infant CDCs have been distributed to selected LRDs with good results.

8. Equipment/Operating System Recommendations.

1. Computer systems at a number of older AVSS installations are beginning to show signs of age with possible operational disruptions and one incident of data loss. This problem is exacerbated by older tape backup devices. Additionally, contemporary computers may not be compatible with the Arnet multiple port serial boards that provide multiuser access to AVSS databases, although Digi boards offer a possible alternative. The AVSS Project has developed the means to refurbish these older systems with new disk drives/controllers and improved methods of database backup using removable hard disks. A number of LRDs have been updated by this means with the resultant systems more reliable and running 5-10 times faster. LRDs having hardware that is showing signs of malfunction or poor performance should contact the AVSS Project for assistance.

9. AVSS Technical Assistance.

Many LRDs have paid their FY 00-01 contributions of $1,500 plus $500 per added AVSS site.

Acknowledgment: This summary is based on notes taken by Natlee Hapeman, Emily Lehman, and Larry Portigal. It was written by Ronald Williams.

1. SSS Update

-- 5-year CD Report (1994-1998) - currently in DHS report approval process;

1999 CD Report nearly complete

-- Case report forms now available in PDF format (view/print only) on our web-site

(above) - Username: cdforms, Password: broadstreet

-- Electronic laboratory-based reporting (ELR): California Electronic Laboratory disease Alert and Reporting (CELDAR) system - in-house demonstration project w/ MDL & ITSD - now operational; modest increases in grant funding from CDC for Bioterrorism Preparedness and NEDSS (see below) - to pilot with LHD labs, HMO lab, State veterinary lab, commercial lab

[Reminder: Laboratory and syndromic electronic reporting pilot w/ No Cal Kaiser (6 months) was completed in early 2000 -- web-site still available.

URL: http://www.dhs.ca.gov/phip, Username: PHIP, Password: broadstreet; NOTE: Provisional Northern California Kaiser Lab data only. Prototype for web-based data access in future -- CHECK IT OUT!!]

-- National Electronic Disease Surveillance System (NEDSS): Grant-funded (CDC)

project to use data and arhcitecture standards in surveillance systems --> interoperable surveillance systems (NEDSS = "system of systems").

California DHS funded for 1) Assessment and Planning, and 2) Element Development (1 element: "Integrated Data Repository" - will build out CELDAR). More NEDSS info: http://www.cdc.gov/od/hissb

-- Proposed pilot of provider-based internet PH reporting (w/ Lawrence Livermore

National Labs and DHS Health Info. & Strategic Planning, Calif. HealthCare Foundation funding): Pilot proposal for CD reporting completed by LLNL

2. "Old Business"

-- CMR form and Title 17 regulations revisions: Emergency regulation changes

submitted, CMR revisions waiting on reg. changes (comments still welcome)

-- AVSS-CMR: Deletions ("~DELETE" for DISEASE) - see AMR

AVSS foreign data import - see AMR

CMR/Reporting Manual updates/additions - assigned to new staff

member in Branch

Still pending: Revisions of disease list (re-working), subtype list, and

download (ASCII) file layout; CMR Users' Group

Updated March 9, 2001 by RL Williams
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