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Welcome to the State of Maine, Data Research and Vital Statistics online tutorial, for completing electronic death certificates, using Maine's Electronic Death Registration System, known as E.D.R.S.

For more information on how to use this tutorial, click the "help" link.

The State of Maine, Data Research and Vital Statistics, depends on health care clinicians to accurately report deaths in Maine. Information in the death record is used by both individuals and public health practitioners; and, it is a part of a permanent legal record.

Using the EDRS improves accuracy and reduces the time it takes to record a death.

It accomplishes this by flagging potential errors for your review, and correction if necessary, before you sign the record.

Once the data is accepted, it immediately becomes available to the family and other public health entities for identifying needs, detecting trends and allocating resources.

The objectives for this tutorial are that you will know how to:

Now let's discuss how to use the EDRS.

Before requesting to become an EDRS user, you must complete all sections of this online tutorial and pass a post-test. You cannot advance to the post-test without first viewing the entire online tutorial.

After completing this tutorial, click the "register for an EDRS account" button on the EDRS home page to register to become a user. Be sure to request access for each location that you practice at.

You will then receive an email with a link to the EDRS system, along with a username and password.

To log in, type in your username and password. Then click the login button.

If you forget your password, EDRS allows you to reset your own password. From the log in screen, click on the words "Forgot your password".

Enter your username and the code that appears on the security image; then click the "Next" button. Answer the security question and click "Next." A message appears stating a temporary password has been sent to your email address. Click the "Continue" button and you are returned to the Login screen.

Retrieve the automated message from your email. Copy and paste the temporary password into the password box that appears on the login screen and reenter your username. Follow the directions for changing your password.

If you certify deaths at more than one office, be sure to select the appropriate location for the death being certified.

You are now at the "Home Page."

The "Home page" displays links to the menus you use most frequently. The two links seen immediately are "Messages and Current Activities."

Click on the "Messages" link.

Any message sent to you appears here.

To read a message, click on it using the "FROM" column.

To open a death record from this screen, click on the decedent’s name or the "record number" link.

We recommend that you keep all messages. If you choose to delete messages, be aware that deleted messages CANNOT be restored. Do Not delete messages unless you are sure that you will not need them.

To delete a single message, click on the box to the right of the message, then click "Remove from list."

To delete all messages at once, first click on the box to the right of the words "Date Sent." Then click "Remove from List."

To create and send messages, click the "Send Message" button.

Select a recipient for your message, by clicking on "Recipients." Type in the last name of the person you want to send a message to. Then, click "Find." This brings up a list of users matching the name you entered.

Click the box next to the name of the user you want to send a message to, and click the "Add" button. To open the text box for typing messages, click the "Save" button.

If you decide you don't want to send the message, click on the box next to the recipient's name and click the "Remove Recipient" button. Then click "Save."

There are three options for sending messages. To select one, click on it from the "send by" drop down box:

Be sure to type in a topic for your message in the subject line. Type your message and click the "Send" button.

Current Activities is another link shown on your home page. This is where you will find a list of records that require your immediate attention.

Click on any category listed to bring up records requiring your attention for that category.

Select and open a record, by clicking on its name or case I.D. Red arrows appearing on the left hand side of the navigation bar indicate those pages requiring your attention.

Before proceeding, let's explain the page navigation buttons found at the bottom of most EDRS screens.

The validate page button checks for errors and omissions and offers suggestions for correcting your entry. EDRS compares your entries to commonly used medical terms and etiology and returns a list of suggestions for corrections if necessary. It also saves the data you entered on that page.

We recommend that you validate each page as you go. However EDRS also allows you to validate the entire record before certifying it by clicking "Validate Registration" from the navigation menu.

Validation messages appear at the bottom of each page. They explain why the entry is, or may be, in error so that you can make corrections, if necessary.

If you receive a validation error, change or override the error and then validate the page again.

Click the "Next" button to proceed through the death registry process. You can also go directly to other pages by using the menu on the navigation bar.

To save data entered on a page, without checking it for errors, click the "Save" button.

The "Clear" button clears data fields two ways.

It removes data from the last field entered on pages that have been saved or validated or... It clears all fields on the page if the page has not.

Some data fields have an icon that looks like a pencil eraser next to them. This icon also clears data entered in that field.

You can go to the last page you were on by clicking the "Return" button.

The "magnifier slash look-up" icon allows you to search for information. This feature only appears next to fields that are searchable. Type in the first two or more characters, followed by a percent sign, to search for information.

Some pages offer a "spell check" option. It appears either as an "ABC" icon or as a button at the bottom of the page.

The "Status bar" only appears at the top of pages listed in the "Navigation bar." It tracks both the status of a death record and data that might prevent a death record from being completed.

The Views button offers additional edits and corrections. Some of the features include spelling, commonly used abbreviations, ill defined and rare causes of death.

You can also change your password from the Home page. Click on the option "Main" and select "Change Password" from the dropdown menu.

Enter your password in the "Old Password" box, and then enter a new password in the "New Password" box. Re-enter the new password in the "Confirm Password" box. You must enter the exact same password in both boxes.

Passwords must be at least 8 characters in length and should be a combination of letters, numbers, uppercase and lowercase characters.

Answer the security question and click on the "Save" button. Your password is changed.

Medical certifiers, medical examiners or funeral practitioners may start a case.

If a funeral practioner starts the case, you will receive a computer generated message requesting medical certification.

If a medical certifier starts the case, the funeral practioner can later locate the case and complete the personal information.

To start or edit a case, click on the "Life Events" tab at the top of the home page. From the drop down menu, click on the "Death" tab and click on "Start/Edit New Case."

Type in the first and last name, along with the date of death and gender of the decedent.

Click on the Search button.

The search results appear. If the case you are looking for appears, click on the record to open it. Once in the record, click on the "Pronouncement" option to start the medical portion of the death record

If there are no matching cases, click the "Start New Case" button. Then, click "Next" to start the medical portion of the death record.

On the pronouncement page, enter the "Date of death," if not already filled in, and a modifier to explain if the date is the actual date, or another option from the drop down menu.

The "Date of death" field has a calendar control that populates the date in the correct format for you.

Next, enter the "Time of death" and the modifier that explains whether the time is exact or approximate. If the time of death is unknown, type in 99:99 and the system automatically fills the "time of death" with "unknown."

We recommend that you always click "Validate Page" after entering data on each page. This saves your data and identifies and lists possible errors. The errors can be fixed at this time or, in some cases, overridden.

Click the "Next" button to go to the "Place of death" page.

If you started the case, the facility name and address automatically fills in with the location selected when you logged in to the EDRS.

If the funeral practitioner started the case, the place of death may already be filled in for you.

If the "Place of Death" does not appear, click on the "Type of place of death" and select the where the death occurred from the drop down menu.

You can search by clicking on the magnifier icon. Type in the first few letters of the name, followed by a percent sign. When you find the correct place of death, click on it. If you select a hospital facility, the address auto-fills. If the name doesn’t appear in the list, you can manually type it in.

If the death occurred at a home, but it is not the home of the decedent, be sure to select "Other Specify" from the dropdown menu options. Selecting "Decedent’s home" automatically fills in the address field with the home address of the decedent. Also select "Other Specify" when deaths occur in places such as hiking trails, bodies of water and roadways.

The "medical record number" is optional, so you may leave it blank.

Click on "Validate page" to check for errors. Then click "Next" to go to the "Cause of Death" page.

On the "Cause of death" page, list the sequence of events that lead to the death. Enter both the immediate cause and the underlying cause, or causes, on separate lines.

Click on the link at the top of the page for recommendations on how to describe the cause of death. If you cannot determine the etiology, you can include words like probable, presumed, unspecified or unknown etiology.

List the immediate cause of death in line A. Do not enter a terminal event, like cardiac arrest or respiratory arrest, as these are descriptions of death.

List underlying causes individually on lines B, C, and D. You can check your spelling by clicking on the EDRS spell check icon.

Now provide the best estimate of the time interval between the onset of each condition and the time of death. Enter this in the space provided to the right. Be sure to make an entry for each condition listed on lines a, b, c, and d. In some cases the interval will need to be approximated. Approximations are better than simply entering "Unknown," however, if the time of onset is entirely unknown; state that the interval is "Unknown." Do Not Leave these items blank.

Use the text box at the bottom of the page to describe other significant conditions and events that contributed to the death, but did not result in the underlying cause of death. You can also list operations and procedures related to the causes listed on lines b, c, or d.

When you have completed this page, click "Validate Page" to check for errors. Click the "Next" button to go to the "Other factors" page.

Here you can record other factors that may have contributed to a death, or provide additional information about a decedent.

This includes autopsy status, pregnancy status, tobacco use and manner of death. If the decedent is a female, age 65 or younger, you must answer the pregnancy question. Also indicate if, in your opinion, the use of tobacco contributed to the death.

Report the "Manner of death" as natural, only if it was due solely, or nearly totally, to disease and/or the aging process. As a certifying clinician, you will only certify death records for deaths that occur naturally.

All deaths due to falls, accidents, injury, overdose, poisoning, suicide, or homicide, must be referred to a Medical Examiner, who then assigns it a Medical Examiner case number.

Click "Validate page" to check for errors; then click "Next."

Only Medical Examiners are taken to the "Injury" page. All other Medical Certifiers are brought to the "Certifier" page. Let's review the "Injury" page.

This page is enabled only if the "Manner of death" is other than natural.

Medical Examiners must enter the "Date of injury." Use the calendar control to autofill the date in the correct format for you.

Click on the "Date of Injury" modifier to explain details.

Now, enter the "Time of Injury." If the time is unknown, type in 99:99 and the system automatically fills the "Time of death" with "unknown."

Click on the "Time of Injury" modifier to explain details.

Complete all remaining fields. If the place of death is "Other," EDRS requires that you enter the name of the town, but the actual road name or street number is not required. For instance, if the death was a drowning, select "Other," then enter the name of the lake, and the name of the town.

Click "Next" to go to the "Certifier page."

On the Certifier page, your name and address should already be filled in. It is based on the location you selected when you logged in to the EDRS. Your name must appear on this page if you are signing the death record.

Select your "Certifier type" from the dropdown list at the top of the page.

The "Date signed" field automatically populates once you certify the case.

Now you are ready to check your record for completeness and certify it. To do this, click the "Validate Page" button.

You must address all validation results by overriding the message, or correcting the error, before the record can be certified.

The "Certify" page only becomes available if no errors exist. The link appears just below the "Certifier" link on the navigation bar. This indicates that the record is ready to be signed.

To sign a death record, click the "Certify" link from the "Navigation bar."

An affirmation message appears. To sign the record, place a checkmark in the “check box” to affirm that you are the authorized certifier and, that, to the best of your knowledge, the information is correct.

Click the "Affirm" button.

A message will appear showing "Authentication Successful". When you receive this message, you have completed the record.

Should you realize that you need to add or change information, you can do so, as long as the case is not yet registered. Look on the status bar at the top of the screen to verify that the record has not been registered. It will say "not registered."

To make changes, you must "uncertify" the case first. To do this, Click the "Certify" link again, and click on the "Uncertify" button. You will be asked if you are sure you want to uncertify the registration. Click "OK" and a message pops up stating that the registration has been uncertified.

Now you can make changes. After the changes have been made, click the "Certify" link again and repeat the affirmation process.

Remember that once a case is registered, you need to submit an "Amendment" to make changes.

If you want to keep a paper copy of death records that you certify, EDRS enables you to print copies.

While the record is open, click on the "Print Forms" link from the "Navigation bar."

Click on the option called "Working copy." Open the file, and then click on the "Print" icon. The print box opens. Click "OK" to print the copy.

There may be times when you need to read or record comments about a death. EDRS can store these comments with the death record. To create or read comments about a death, you must first find and open the record.

While the record is open, click on the "Comments" link from the "Navigation bar."

If comments already exist, a check mark appears next to the link. You can read existing comments or, to make a new comment, click on "New Comment."

Choose a "Comment type" from the drop down menu and type your comment. When finished, click the "Save" button.

Any death not occurring naturally needs to be referred to a Medical Examiner.

To refer a case, open the death record and click on the "Refer to Medical Examiner" link from the "Navigation bar." A message to the Medical Examiner will automatically appear, but you can type additional information as needed.

Click the "Save" button and a message is automatically sent to the Medical Examiner.

Once the Medical Examiner accepts the case, you no longer have access to it.

Medical Examiners can locate cases that have been referred to them by clicking on either their "Messages" or "Queues" link from their home page.

To open referrals from the messages link, click on the decedent's name.

To locate referrals from the "Queues" link located on the "Home" page, click on the link, and then click on the option named "Registration Work Queue." From the dropdown list named "Queue" click the option named "ME review required." You can narrow the results by using the available filters.

Click on the decedent's name to open the case. Once the case is open, click the "ME review case" option from the "Navigation bar." Select the "referral action" from the dropdown box.

Assign a Medical Examiner case number for the record and click "Save."

The EDRS only allows one user to certify a death record. This is to prevent multiple versions of the record from being submitted to the Vital Records office.

If a different certifier needs to access a death record that you certified, you will need to relinquish ownership. Note that this does not apply to Medical Examiner cases. Once you relinquish ownership, you no longer have access to that death record.

To relinquish ownership, log in to the EDRS; search for the record; and open it. Once in the record, click on the "Relinquish Case" link.

Click "OK" to relinquish the case or click "Cancel" to retain ownership.

Amendments are corrections to a record that has already been registered. If you find you need to amend a record, EDRS has a simple process for making electronic corrections.

To amend a record, Log in to EDRS. Click on "Life Events" from the Main menu, then click on "Death" and "Locate case."

Enter the last name and/or date of death in the search fields and click the "Search" button. A link to the case should appear. Click on this link to open the death certificate.

Click on the "Amendment" link from the "Navigation bar" and the "Amendment page" appears.

Click on the option "Medical" from the "Type of amendment" dropdown box. You now have the option to add a description of the amendment. Click "Save."

The page refreshes and the amendment date auto-fills for you. A new field called "Page to Amend" appears at the bottom of the page. Click the page you need to amend from the drop down list and the selected page appears.

Make your corrections. Click "Save." You can make another amendment by clicking on another page from the dropdown menu and proceeding as before. When you have finished making all your corrections, click on the "Validate Amendment" button to check for errors.

The validation results appear at the bottom of the page. Review the corrections. Click "save."

Next, click the "Amendment Affirmation" link from the "Amendments Menu." To confirm the changes you made, place a checkmark in the checkboxes and click the Affirm button.

When you receive the message "Authentication Successful," you have completed the record.

Once the Affirm button is selected, an automated email is sent to Vital Records indicating the amendment is ready for approval.

Our goal is to process amendments within 24 to 48 hours after automated notification that the amendment has been affirmed.

This concludes the training on completing death certificates using the EDRS. For security reasons, be sure to logout when you are finished. This takes you out of the EDRS system and clears the browser.

You can log out using either the logout button in the top upper-right corner or the logout link from the Main menu on the Home page.

All Maine EDRS users are required to view the online "Improving the Cause of Death Reporting" tutorial. Click on the "Cause of Death Tutorial" button to view this training.