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Release: October 20, 1995
Contact: Mary Caffrey (609/258-5748)
Electronic Birth Records Show
Promise of Information Technology
The birth certificate, every American's first ``permanent record,'' is gradually joining the information age. That change, says Princeton University sociologist Paul Starr, represents a case study of how information technology can improve the workings of government. A computerized birth record system provides several advantages for policy-makers as they try to reform the nation's welfare and health-care delivery systems.
Starr's article, written with his wife, Sandra, reports the results of a state-by-state survey on the use of electronic birth certificates. Titled ``Reinventing Vital Statistics,'' the article appears in the September/October edition of _Public Health Reports_, published by the National Institutes of Health (NIH).
The Starrs brought complementary perspectives to their research. Paul Starr won a Pulitzer Prize for his book, ``The Social Transformation of American Medicine'' (1983). He was also one of the architects of President Clinton's original health-care reform plan. Sandra Starr worked with New Jersey officials to bring the electronic birth certificate to the state's hospitals. New Jersey's system is being implemented this year.
The article outlines recent advances in gathering birth data electronically. The Starrs surveyed vital records officials in 46 states as well as New York City and the District of Columbia. (Only four states - Ohio, Oklahoma, Kentucky and Arizona - reported no plans for an electronic birth certificate.) The method records less than 5 percent of all births in Pennsylvania and in New York City.
The Starrs found that by the end of 1994, 58 percent of all births in the United States were being recorded with an electronic birth certificate and transmitted electronically to a vital statistics agency. Electronic birth certificates are the norm in 18 states and the District of Columbia, and electronic systems are scheduled for expansion in more than a dozen other states. In the 39 states that reported at least some use of electronic birth certificates, the Starrs write, officials ``unanimously rated it as positive.''
According to the article, traditional paper birth certificates required three separate points for transferring information - the hospital, the local or county registrar, and the state agency. Information that is initially gathered by hand is eventually logged into a computer, with data tapes sent to the federal government.
This multi-step system creates many opportunities for errors, the Starrs write. Data must be corrected before it reaches federal officials. Preparing a birth record on a computer at the hospital and transmitting it electronically to state and federal agencies could reduce, and perhaps eliminate, the 12- to 15-month lag in federal reports on birth and mortality statistics, the Starrs write. They point to many benefits:
- Birth defects. Patterns could be spotted quickly, giving local health officials an early jump on learning the cause.
- Health care delivery. Public health professionals could more easily identify children who need vaccines.
- Welfare reform. Proposals before Congress put a priority on establishing paternity so that states can force fathers to support their children. The Starrs cite programs in Wisconsin and Virginia, which found that unmarried fathers are most likely to acknowledge paternity at the time of a child's birth.
- Lower costs. Electronic data-gathering can help hospitals and public records agencies to reduce the number of clerks, thus yielding savings for both.
The writers discuss resistance from the birth-record bureaucracy, whose workers might be laid off under a computerized system. In some areas, paper birth certificates were still required along with electronic transmission of the data. In those instances, states missed opportunities to save additional money.