Improving completeness & reducing errors in medical certification of cause of death: The impact of electronic mortality software in a tertiary care centre in South India

Background & objectives Mortality statistics are crucial for understanding public health. Accurate medical certification of cause of death (MCCD) is essential for good mortality statistics. However, the quality of MCCD form-filling remains a concern. Based on the learnings from the ICMR-National Centre for Disease Informatics and Research (ICMR-NCDIR), e-Mortality software implementation project, our institute developed and used a new in-house mortality software for MCCD from January 2021. This study compared MCCD forms before and after implementation of the mortality software. Methods The study was conducted from March 2024 to July 2024 in the department of Medicine at a tertiary care teaching institute in Puducherry. We analysed 105 hand-written forms from the year 2020 and 105 software-generated forms from the year 2021, focusing on completeness, errors, and International Classification of Diseases-10 (ICD-10) compatibility. We checked 13 items for completeness. Errors were categorised as major or minor, depending on how they affected ICD-10 coding. Results The proportion of completeness improved from 4 to 19 per cent after software introduction (P<0.001). Minor errors significantly decreased from 96 to 81 per cent (P<0.002). About 88 per cent of hand-written forms had major errors, which was significantly reduced to 42 per cent in software-generated forms (P<0.001). Compatibility of the underlying cause of death for generating ICD-10 coding improved from 73 to 96 per cent (P<0.001). Interpretation & conclusions The findings of this study suggest that our mortality software significantly improved completeness and modestly reduced errors. Other institutions may consider adopting an electronic format for MCCD to improve completeness and accuracy. We emphasise regular training of doctors and auditing of MCCD forms to further improve the quality of death certification.