on health inequities, with one part of the commission’s work specifically related to performance measures and their use in guiding fund allocations to hospitals and other service providers. Van Dyck commented that California has worked to enforce standardized reporting by individual counties (providing data in the same format), cognizant of the federal-state partnership performance measures that it provides to MCHB and other agencies. Standardized reporting not only eases the process of producing the reports to federal grant supervisors, but also serves as a quality improvement and assessment tool for the state. Van Dyck said that developments such as these have been particularly interesting given worries among the states when MCHB began making state-level performance data public on its website about 10 years ago: states were concerned that people were going to use the data for unfair comparisons or to try to make individual states look bad.
MCHB provides direct grant support to states to enable information system improvement. At the time of the workshop, van Dyck said that this work was initially focused on improvements in selected states. MCHB has provided funds to Massachusetts and New Jersey to help them implement a web-based electronic birth record system (with infrastructure improvements that also facilitate conversion to the 2003 revised standard birth certificate). MCHB has also initiated a broader project with the Indiana State Department of Health to develop a fully integrated child health system: combining collection and processing of vital records, early hearing impairment detection and intervention, newborn dried blood spot screening, lead screening, participation in the WIC program (Special Supplemental Nutrition Program for Women, Infants, and Children), and birth defects. The ideal for the project is a system that is not subject to the same kind of duplicative work and clashing standards that may result when systems operate in an independent, stand-alone fashion. Van Dyck said that Indiana has also linked this system with the Indiana Health Information Exchange, with the additional benefit of providing a comprehensive electronic medical record on Indiana children to their medical providers.
Samuel Preston (University of Pennsylvania) opened the workshop session on the use of vital statistics in making population and fiscal projections by observing that projections are useful in understanding the future of the U.S. population—not as some remote abstraction but as estimates with very significant consequences. In particular, projections are important to assessing the future solvency of entitlement programs such as Social Security, which is required by law to be in close actuarial balance over a projected 75-year period. As another example, he noted the important social rami-