Summary of Reports to OMB on NCIPC-NCHS Collaboration

DUIP/NCIPC and NCHS collaborations that are Responsive to SUDORS OMB#0920-1128 NOA
March, 2019
1.0 Background on Update
The Division of Unintentional Injury Prevention (DUIP), CDC is collaborating with the National Center for
Health Statistics (NCHS), CDC to streamline and improve the quality and timeliness of drug overdose
data collected on the death certificate as required by its NOA for the State Unintentional Drug Overdose
Reporting System (SUDORS) OMB# 0920-1128. The last update on this collaborative effort was provided
in August, 2018.
2.0 NOA language for SUDORS OMB#0920-1128
The following language is a quotation from the SUDORS’ OMB NOA:
“OMB clears this ICR consistent with the understanding that DUIP/NCIPC will continue to devote
resources to maximizing the long-term value of CDC’s investment in working with state health
departments and medical examiners/coroners to improve the timeliness of fatal opioid overdose
surveillance. More specifically, DUIP/NCIPC will continue to collaborate with NCHS (who has the lead in
working with states’ vital records agencies) on developing standardized, efficient, and sustainable
approaches to incorporating mutually agreed upon data elements into state death certificates. Efforts
during the first year will focus on broad development of ME/C standards and improving electronic
interoperability of ME/C case management systems that incorporate toxicology information and findings
from death scene investigations into vital statistics systems. Efforts during the second year of clearance
include multi-state piloting, and the third year of clearance will focus on broad implementation into
electronic death reporting.”
3.0 Current collaborations between DUP and NCHS as of March 2019
The primary purpose of the current DUIP/NCIPC collaborations with NCHS are to improve mortality
reporting on the death certificate, especially reporting of drug overdose deaths. These improvements
may indirectly improve SUDORS, which contains information abstracted from the death certificate. Also,
one of the collaborations supporting interoperability among ME/C case management systems, state vital
statistics, and state surveillance systems may directly enhance SUDORS reporting in some states.
Description of Current DUIP and NCHS Collaboration
Almost completed new ME/C guidance on certifying drug toxicity deaths: DUIP
funded and NCHS convened a working group of epidemiologists, medical
examiners and coroners (ME/C), vital records agency personnel, and
representatives of CDC to identify methods for improving the reporting of drug
overdose deaths on the death certificate.
• Deliverable: As a result of the workgroup, NCHS has drafted guidance
for ME/Cs in “A Reference Guide for Certification of Drug Toxicity
Deaths” that is under review and expected to be released sometime in
the summer 2019.
Complete effort to pilot an interoperable interface with popular ME/C
electronic case management system: NCHS completed a DUIP-funded effort to
pilot-test the feasibility, utility and scalability of creating interoperable
interfaces with popular ME/C electronic case management systems (i.e.,
MDILog or VertiQ). The project funded the Occupational Research and

OMB Requirement
Addressed

Addresses OMB requirement
to improve the
standardization of data
collected from ME/Cs.

Addresses OMB
requirements to support
development of ME/C
standards and improving
electronic interoperability of
ME/C case management

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Description of Current DUIP and NCHS Collaboration
Assessment (ORA) which collaborated with the National Association of Medical
Examiners and the International Association of Coroners & Medical Examiners.
• Lesson learned: While the pilot confirmed the utility of creating an
electronic database of toxicology findings, the pilot also identified
substantial barriers to establishing interoperable toxicology data and
other data elements not required on the death certificate. Examples of
barriers include the lack of standard data collection elements and
processes across ME/C systems and the fact that vendors may be
driven to develop technology to generate a profit.
Ten state interoperability project: The main collaborative activity between
NCHS and NCIPC is being funded through CDC’s Opioid Response Coordinating
Unit (ORCU). This 16 month initiative began in fall 2019 and received $5.9
million in funding. The initiative consists of three separate components: 1)
improve investigation of drug overdose deaths by updating the National
Association of Medical Examiners (NAME) position paper on death investigation
best practices and developing training materials to implement
recommendations, 2) enhance the capacity of vital registration jurisdictions to
collect quality drug information on death certificates, and 3) improve the
timeliness and quality of death certificate data as well as access to other
medical examiner and/or coroner (ME/C) data by improving the information
flow among ME/C agencies, state vital records offices, NCHS and state
surveillance systems such as SUDORS or the National Violent Death Reporting
System. In order to accomplish the second and third goal, 10 state vital
registration jurisdictions (IA, IN, KS, LA, MD, MS, NV, NM, UT and DC) have
joined an existing project to enhance interoperability between ME/C case
management systems and state vital records office electronic death registration
systems. Recipients are working to improve the timeliness and quality of
mortality records transmitted to NCHS, especially for the reporting of druginvolved deaths. Specifically, states are expected to work towards transmitting
at least 90% of their drug-involved deaths to NCHS within 90 days. Also, these
10 states must work towards electronically transmitting relevant mortality
records to a state public health surveillance program within 2 days of receiving
the cause of death codes from NCHS.
• Project update: All 10 funded states have created and submitted project
plans to NCHS with details of current barriers to timely collection and
transmission of drug mortality records. Also, states have proposed specific
strategies to overcome identified barriers. It is too early in the
implementation of these projects to report on lessons learned.
• Other notes: Instead of funding NCHS and DUIP collaborative activities
through the current Overdose Data to Action Notice of Funding
Announcement (CDC-RFA-CE19-1904) mentioned in the previous August
2018 update, ORCU allocated funding to this project because the project
and mechanism were more appropriate.
Improve automatic coding of drug overdose deaths by NCHS: CDC’s Opioid
Response Coordinating Unit (ORCU) is providing NCHS $1.9 million of funding to
modernize the cause of death coding system to auto code more deaths with
ICD-10-CM codes and provide more detail on substances contributing to drug
overdose deaths. Specifically, the three key components of this NCHS 16-month
project are: 1) accelerating efforts to modernize the NCHS cause of death
coding system to increase the percentage of records automatically coded from

OMB Requirement
Addressed

systems that incorporate
toxicology information and
findings from death scene
investigations into vital
statistics systems.

This initiative addresses two
OMB requirements: 1) broad
development of ME/C
standards and improving
electronic interoperability of
ME/C case management
systems that incorporate
toxicology information and
findings from death scene
investigations into vital
statistics systems and 2)
piloting interoperability
efforts across multiple
states.

This project will increase
both NCHS and state
electronic access and sharing
of data on the specific drugs
contributing to overdose
deaths. Consequently, it
addresses the OMB priority

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Description of Current DUIP and NCHS Collaboration
80% to over 90%, 2) accelerating the development of detailed coding for druginvolved deaths to better capture all the specific drugs involved and 3) providing
short-term funding to minimize delays in manual coding of deaths by hiring
additional contract staff to manually code deaths not automatically coded.
• Project update: It is too early in the implementation of these projects to
report on lessons learned.

OMB Requirement
Addressed

of broadly implementing
electronic death reporting.

4.0 Other ongoing CDC efforts to improve coordination
CDC operates the Opioid Response Coordinating Unit (ORCU) that brings together all CIO’s in CDC to
ensure coordination and integration of opioid surveillance activities across CDC.

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State Unintentional Drug Overdose Reporting System (SUDORS) OMB# 0920-1128
The National Center for Injury Prevention and Control (NCIPC) and National Center for Health Statistics
(NCHS) Collaboration Updates

Background
The Division of Unintentional Injury Prevention (DUIP), CDC is collaborating with the National Center for
Health Statistics (NCHS), CDC to streamline and improve the quality and timeliness of drug overdose
data collected on the death certificate as required by its NOA for State Unintentional Drug Overdose
Reporting System (SUDORS) OMB# 0920-1128. Planned collaborations have substantially expanded
since our last update to OMB. Current and future collaborations with NCHS are discussed below as well
as how they comply with the current NOA.
NOA language for OMB#0920-1128
OMB clears on this ICR consistent with the understanding that DUIP/NCIPC will continue to devote
resources to maximizing the long-term value of CDC’s investment in working with State health
departments and medical examiners/coroners to improve the timeliness of fatal opioid overdose
surveillance. More specifically, DUIP/NCIPC will continue to collaborate with NCHS (who has the lead in
working with States vital records agencies) on developing a standardized, efficient, and sustainable
approaches to incorporating mutually agreed upon data elements into State death certificates. Efforts
during the first year will focus on broad development of ME/C standards and improving electronic
interoperability of ME/C case management systems that incorporate toxicology information and findings
from death scene investigations into vital statistics systems. Efforts during the 2nd years of clearance
include multi-state piloting, and the 3rd year of clearance will focus on broad implementation into
electronic death reporting.
Current collaborations between DUP and NCHS
• DUIP funded and NCHS convened a working group of epidemiologists, medical examiners and
coroners (ME/C), vital records agency personnel, and representatives of CDC to identify methods for
improving the reporting of drug overdose deaths on the death certificate. As a result of the
workgroup, NCHS is currently working revising guidance for ME/Cs in “A Reference Guide for
Certification of Drug Toxicity Deaths”.
o Addresses OMB requirement to improve the standardization of data collected from ME/Cs.
• DUIP is funding and working with NCHS to pilot-test the feasibility, utility and scalability of creating
interoperable interfaces with popular ME/C electronic case management systems (i.e., MDILog or
VertiQ). The project funds Occupational Research and Assessment (ORA) which is collaborating with
the National Association of Medical Examiners and the International Association of Coroners &
Medical Examiners on the project. The pilot is nearing completion and has identified substantial
barriers to interoperability and collecting data elements not required on the death certificate that
will inform ongoing work.
o Addresses OMB requirements to work broad development of ME/C standards and improving
electronic interoperability of ME/C case management systems that incorporate toxicology
information and findings from death scene investigations into vital statistics systems.
Future collaborations between DUIP and NCHS

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NCHS will receive $5.9 million to enhance the capacity of ME/Cs and state vital records offices to
report high quality and timely drug overdose data on death certificates. The funding will be used to:
o Update the National Association of Medical Examiners (NAME) position paper on the
practice of death investigation and developing training materials to implement
recommendations within jurisdictions;
o Fund up to 15 states to add capacity to expand work on drug overdose data timeliness and
quality; and
o Improve the flow of information to state vital records offices and NCHS by funding 3
additional states to participate in a project to enhance interoperability of ME/C case
management systems and state vital records office electronic death registration systems.
o Projects will focus on data elements already collected on the death certificate due to legal
and operational challenges.
o Addresses two OMB requirements
 Broad development of ME/C standards and improving electronic interoperability of
ME/C case management systems that incorporate toxicology information and
findings from death scene investigations into vital statistics systems.
 Efforts during the 2nd years of clearance include multi-state piloting.
NCHS will receive $1.9 million dollars to modernize the cause of death coding system to auto code
more records and provide more detailed on substances contributing to drug overdose deaths.
Specifically, NCHS will:
o Accelerate efforts to modernize the NCHS cause of death coding system to increase the
percentage of records automatically coded from 80% to over 90%.
o Accelerate development of detailed coding for drug-involved deaths to better capture all
the specific drugs involved.
o Provide short term funding for additional contract manual coding capacity to minimize
delays in manual coding of deaths.
o Addresses three OMB requirements
 Broad development of ME/C standards and improving electronic interoperability of
ME/C case management systems that incorporate toxicology information and
findings from death scene investigations into vital statistics systems.
 Efforts during the 2nd years of clearance include multi-state piloting.
 Efforts during 3rd year of clearance will focus on broad implementation into
electronic death reporting.
DUIP will work with NCHS to fund additional work on interoperability of ME/C case management
systems at the state level as part of its current Data to Action NOFO. Discussions on whether the
funding will be a supplement to the Data to Action NOFO or allocated through other mechanisms
are ongoing and we will keep OMB updated.
o Addresses two OMB requirements
 Broad development of ME/C standards and improving electronic interoperability of
ME/C case management systems that incorporate toxicology information and
findings from death scene investigations into vital statistics systems.
 Efforts during the 2nd years of clearance include multi-state piloting.
CDC convened the Opioid Response Coordinating Unit (ORCU) that brought together all CIO’s in CDC
to ensure coordination and integration of opioid surveillance activities across CDC.

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