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It should come as no surprise that public health officials are keenly interested in what causes people to die. Most deaths fall into a handful of categories nationwide with heart disease and cancer together account for almost half of all deaths. Other common diseases like diabetes and influenza make up much of the remainder.

Though these deaths are certainly tragic, they are also known quantities. There isn’t a public health official in the U.S. who is unaware of cancer’s role in American deaths. As such, there is tremendous attention paid to combatting such diseases.

But what about the lesser-known quantities? Rapidly spreading diseases. Drug epidemics. Suicide. They are causes of death that often require swift and efficient action by state and federal officials. But in most states, those causes of death are reported manually. Hand-written records are sent via traditional mail or fax to their destinations at the relevant state department and Centers for Disease Control and Prevention (CDC). The process can take weeks or even months, creating an unacceptable lag between the event of a death and the review of the data.


Putting to use a $200,000 grant from the CDC, the DVRA and CNSI set out to develop a first-of-its-kind mobile application. This solution would allow physicians, medical officials or funeral directors to report causes of death to the New Hampshire Department of Health and Human Services and the CDC in near real-time.

Working within the CDC’s parameters, the DVRA drew up a concept. First, the app must allow health workers to pronounce and certify deaths in the field with ease. Then the app would have to report events to state offices and the CDC in near real-time. It should also improve the accuracy and detail of reporting. And – importantly – the app should recommend further action when necessary.

In seeking an IT vendor for the project, the DVRA turned to CNSI, a company widely known for its experience designing state Medicaid Management Information Systems (MMIS). In conjunction with its Michigan MMIS, CNSI had also recently rolled out an app that gives the state’s Medicaid population access to health care information and resources. The app – known as myHealthButton – was an innovative piece of public health technology that proved instantly valuable. The success of the project demonstrated to the DVRA that CNSI would be up to the task of developing an equally innovative app for New Hampshire.


Together, the team developed and launched an app that executed on the concept. Starting in January of 2017, physicians, medical officials and funeral directors – all of whom are first verified by the DVRA – were given access to the app. When a death occurs, the verified user can instantly report the cause of death and associated details. Many times, those associated details are the key – as they say, the devil is often in the details.

In the past, a cause of death report may have only listed “drug overdose,” but in NeCoD, the user is prompted to provide more detail – the specific type of drug and volume, for instance. Armed with a deeper understanding of the death – or a string of deaths – policy makers can respond more effectively. In this example, officials may recognize the spread of a new type of drug and relay that information to local law enforcement and health care workers.

Importantly, the system can become a two-way street. If CDC officials begin to see a pattern in the data, they can insert their own questions into the app so particular concerns are addressed on the ground.


The most immediate impact of NeCoD is improving the transmission speed of data from the state to CDC. The lag time between the event and review by the CDC has decreased from 30-40 days to 12 hours at the very longest.

As for physicians, medical officials and funeral directors, they save an immense amount of time and effort by using NeCoD, compared to traditional pen and paper methods. In addition, NeCoD also improves the accuracy of that day, which further expands the public health data base. This type of immediate, actionable data benefits these individuals and improves their ability to protect and serve their communities.

The long-term future for this technology is limitless. As the interoperability with other research entities—such as the National Center for Health Statistics—improves, NeCoD has the potential to serve as the gold standard for building an application programming interface (API). The standardization of an API Gateway provides rich, stable interoperability today, and into the future of electronic health records and health informatics.