FEATURING: Kelly M. Baker, State Registrar and Center for Health Statistics Director, Oklahoma State Department of Health, Moore, Oklahoma


At 2:56 pm on May 20, 2013, a category F5 tornado touched down in Moore, Oklahoma. During its 40 minutes on the ground, the tornado carved a 17 mile path of destruction through the town, killing 25 Oklahomans and injuring 377 in its wake. Preliminary cost estimates of the damage were in the billions.

Kelly Baker of the Oklahoma State Department of Health was on the ground for at least a week, registering deaths and issuing new birth certificates to survivors so they could begin the process of re-establishing their identities and rebuilding their lives. Kelly and her colleagues could more easily respond to families’ needs in real-time because of electronic birth and death registration systems. “Because we’re electronic, we were able to go on site with laptops, log directly into the system, ask interview questions of victims to identify who they were, and issue a certificate within 1-2 minutes,” said Kelly. “Victims need their birth certificates fast, because those displaced by a tornado need it to receive government support.”

This was a marked difference from her experience before the systems modernization, when a similar F5 Torando hit Moore in 2003. At the time, Oklahoma was still processing paper-based vital records, manually and responding to families’ needs could take days.

The electronic systems quickly provided accurate death reports to dispel erroneous field reports from media that overstated the death toll, and allowed Kelly and her team to quickly protect the identities of those lost, preventing further victimization by identity thieves. “We could link to electronic birth records and notify other states to lock down those records and protect the identities of deceased,” said Kelly. “This is extremely important because of the media, everyone knows the names of the victims and all their personal information is out there.” Use of valid birth certificates is one of the most powerful tools in the arsenal of criminals seeking to commit fraud.

The electronic death registration system will facilitate Oklahoma’s future disaster response planning. Kelly was able to quickly reconfigure the system to record tornado-related deaths so within hours, the medical examiner was able to report the deaths as tornado-related, even if the cause of death hadn’t been determined. “And now that records are flagged in system, we can compare deaths to past events for public health analyses and prepare emergency response in the future,” said Kelly. “Electronic makes it much easier to do that than with paper.”

Electronic Death Registrations by Jurisdiction


Electronic birth and death registration systems improve planning, monitoring, and response at the state and local level by producing more, better, faster vital statistics. As Kelly explained:

In our office, it used to take us 75 minutes per paper record to deal with amendments. In 2008, it took us 2,500 man hours. But with electronic death registration systems, it now takes only two minutes per record and our man hours dropped to 166 in 2012. We’ve almost doubled the records we are able to amend because we have more time. It’s given us the ability to flex our resources and put them elsewhere.

These systems also help the federal government monitor our nation’s health and reduce waste, fraud, and abuse in federal benefits programs. The goal is to have all states reporting births and deaths electronically to maximize the data’s utility to the federal government. Nevertheless, too many states and territories continue to rely on paper-based records, a practice which compromises the accuracy, timeliness, interoperability, and security of these data and the records themselves (see map). Within states with electronic systems, many haven’t the resources to expand technical assistance to, and maximize electronic death reporting by data providers, in particular, funeral directors and physicians. And some early adopters can’t modernize their systems to keep pace with new technology. Kelly worries about the future of her systems:

Systems age out very quickly. We started designing ours nine years ago, and we’re hitting the five year anniversary for our electronic birth registration system. When you hit 10 years, you have to think about upgrading or completely replacing the system. Technology is always evolving. It is resource intensive to keep up with new needs and new security requirements.

For decades, the states and territories have enjoyed productive partnerships with the National Center for Health Statistics (NCHS) in the Centers for Disease Control and Prevention (CDC) and other federal agencies. With federal support, states have made great strides in moving from paper to electronic reporting of vital events. However, as a result of federal austerity measures and severe state budget shortfalls, states and territories that had planned to upgrade and implement electronic systems have seen funding for these projects erode. States and territories need the federal government’s help to complete building a 21st Century vital statistics system. But as long as austerity continues, progress remains at a standstill.

National Association for Public Health Statistics and Information Systems

i Mayo Clinic

ii U.S. Identifies Tainted Heparin in 11 Countries, New York Times, 6/12/2008