used, and how it’s going to be safeguard- ed,” Dr. Garcia said.
Ms. Mann says a state data center
protected by firewalls and data encryp- tion houses death certificate information, which only authorized people can access. Ms. Harris says having more specific cause-of-death data will help the state:
• Monitor public rates of morbidity and mortality,
• Assist in scientific study and research, • Plan and monitor health policies and strategies,
• Provide a basis for seeking legislative changes,
• Prioritize health funding, and • Fund scientific research.
Properly listing causes of death in
TER takes education, practice, and ex- perience, Harris says, acknowledging that some physicians may not have been properly trained on how to complete death certificates accurately. (See “TER Training Available” below.) The Physician’s Handbook on Medical
Certification of Death, published by the Centers for Disease Control and Pre- vention, has instructions for physicians on cause-of-death certification and de- scribes how physicians can enter death information on certificates accurately. Visit
www.cdc.gov/nchs/data/misc/hb_ cod.pdf. Pages 17 through 30 feature case studies, some of which illustrate the proper way to enter conditions leading up to the immediate cause -f-death.
It’s the law Since Sept, 1, 2008, state law has re- quired all physicians who sign death cer- tificates to register in TER, maintained by the DSHS Vital Statistics Unit, and to complete death certificates electronically. Physicians have five days after receiving the death certificate to electronically complete their portion of the form. Back in 2010, more than 150 physi-
cians were in hot water with the Texas Medical Board (TMB) over complaints they didn’t complete death certificates within the time the law requires, a viola- tion that carries a $500 fee per offense.
Leigh Hopper, TMB public informa-
tion officer, says as of August, about 140 physicians had agreed to remedial plans for not using TER and/or not signing a death certificate in a timely manner. TMB Executive Director Mari Rob- inson says physicians have two options when notified of a violation. They can agree to the remedial plan, pay the $500 fine, and complete any required continu- ing medical education; or they can re- quest an informal settlement conference. The law says a person required to file a death certificate (typically the funeral director) “shall obtain the required medi- cal certification from an attending physi- cian if the death occurred under medical attendance for the care and treatment of the condition or disease process that contributed to the death.”
It also says an associate physician, the chief medical officer of the institu- tion where the person died, or the phy- sician who performed an autopsy may complete the medical certification if:
• The attending physician is unavail- able,
• The attending physician approves, • The person completing the medical certification has access to the de- ceased’s medical history, and
• The death is due to natural causes. TER training available
To register with and use the Texas Electronic Registrar (TER) death registration system, visit
www.dshs.state.tx.us/vs/edeath. For assistance with registering, email the TER Help Desk at
help-ter@dshs.state.tx.us. Free TER training is available online at https://texasvsu-ed
.org. The training explains how to use, log in to, and navigate the system and includes a video of an electronic record being completed. If you and your staff members need training on how to use TER, plan to attend the annual Texas Vital Statistics Conference Dec. 5–7 in Austin. To register and for more information, visit http://texaspha
.org, click on “Events (TPHA and Co-Sponsored)” and follow the prompts to Vital Statistics. Register before Nov. 16 for a dis- counted registration fee of $180. On-site registration is $200.
46 TEXAS MEDICINE November 2012
By law, when a physician does not have enough information to determine the cause of death, he or she may con- tact a justice of the peace or medical ex- aminer and request an inquest. To view chapter 193 of the Health and Safety Code relating to death records, visit
www.statutes.legis.state.tx.us/Docs/HS/ htm/
HS.193.htm.
No more excuses At this point, Dr. Garcia says, Texas phy- sicians should know they must use TER when filing a death certificate. “Physicians have had more than enough time to educate themselves on TER. If they haven’t registered, they need to do so immediately. They can’t make excuses anymore,” he said. DSHS says as of June, 1,558 funeral
homes, 4,897 funeral directors, 21,820 physicians, 794 justices of the peace,
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