LAW
Specifics, please Tell DSHS what killed a patient BY CRYSTAL CONDE Just listing “cardiac arrest” as a cause of
death in the Texas Electronic Registrar (TER) death registra- tion system doesn’t cut it anymore. That’s because the Texas Department of State Health Services (DSHS) wants physicians to be more specific when listing the cause of a patient’s death in the system. “From a public health perspective, the cause of death section is a very important portion of the death cer- tificate. Inaccurate data affect the usefulness of the state and national health database and all of the pro- grams planned and implemented as a result,” said Geraldine Harris, the state registrar. She says merely listing “cardiac
arrest” on a death certificate doesn’t provide a helpful, in-depth picture of what led to the patient’s death. “The person could have died from anything, such as natural disease, homicide, suicide, or drug overdose,” Ms. Harris said.
When a physician lists only car-
diac arrest on a death certificate, she says, medical examiners routinely have to request medical records to verify whether the death was due to natural causes.
“Sepsis” is another general term that is difficult to interpret from a death certificate.
“It could be that the decedent was in a car accident two weeks prior
and while in the hospital developed sepsis and died. This would make the death an accidental death due to a car crash, which must be reported to the medical examiner’s office,” Ms. Harris said. DSHS says cause of death information is the basis of the
state’s mortality statistics. It relies on accurate data to illus- trate how Texans fare on several health indicators, including heart disease, cancer, stroke, diabetes, and injuries. Inaccurate
“Physicians have had more than enough time to educate them- selves on TER. If they haven’t
registered, they need to do so immediately.”
and nonspecific cause of death data can hinder the state’s abil- ity to receive grant funding for targeted health interventions. According to Christine Mann, DSHS assistant press officer, once physicians list the immediate cause of death, TER then asks them to enter the chain of events — diseases, injuries, or complications — that directly caused the death, along with the corresponding interval between onset and death. TER provides four distinct rows for capturing the information. Physicians can help DSHS gather useful, accurate cause of death data by following the elec- tronic registration system’s prompts and including the chain of events leading up to the death. But Houston cardiologist A. To-
mas Garcia, MD, chair of the Texas Medical Association Board of Trust- ees, says the electronic death regis- try system “makes it difficult to be more specific when listing cause of death.” “The electronic death registry sys- tem needs to be set up differently so that once physicians have en- tered the immediate cause of death they can then easily enter the con- ditions that may have caused the death. The system provides only four entry lines for cause of death, and it’s not enough for physicians to accurately express the risk fac- tors and conditions that led to the
patient’s death. Once physicians are given more space to enter the information, then DSHS can connect the dots and study the data,” Dr. Garcia said He also encourages David Lakey, MD, DSHS commissioner, to meet with TMA leaders to discuss the department’s need for more specific cause-of-death data. “Texas physicians can help in this process, but we need to know who is going to control the data, how it’s going to be
November 2012 TEXAS MEDICINE 45
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