Modernizing Medical Examiner and Coroner Data Systems

What data modernization is and why it matters

Data modernization refers to the reshaping of data to create modern, integrated, and real-time data systems. More timely and accurate data facilitate health surveillance that can protect us all from any health threat. It is not just about technology, but about putting the right people, processes, and policies in place. The goal is to move from siloed data systems to connected, resilient, adaptable, and sustainable systems that can help solve problems before they happen and reduce the harm caused by the problems that do happen.

Goals

For the Medicolegal Death Investigation (MDI) Office:

Reduced data entry efforts for death certification process
Reduced effort exchanging data with others, such as NVDRS, organ procurement organizations, state health departments
Increase access to data for office functioning and research
Allow comparisons with other MDI offices who have adopted the MDI data standard

For users of Medicolegal Death Investigation data:

Increased timeliness and reduced effort for data exchange
Standard data elements from MDI offices

Technical resources and tools for MDI modernization

The ability of different information systems, devices and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational and geographic boundaries, to provide timely and seamless portability of information. Data architectures, application interfaces and standards enable data to be accessed and shared appropriately and securely, within all applicable settings and with relevant stakeholders.

Software-based systems used by the MDI office to provide case management capabilities. They either utilize standard software systems that are developed by the individual office to be used as a CMS or are a commercial product purchased from a vendor. The specific functionality of CMS variers but typically enables:

Systematic management of case-related processes and procedures
Standardized data entry
Query and data searching
Report generation
Simplified dissemination of case materials
Secure user permissions and audit trail

The Forensic Technology Center of Excellence published a report reviewing information on CMS, product details in the form of a landscape of CMS products, considerations for implementing a CMS and case studies illustrating best practices and lessons learned from the incorporation of CMS into death investigations. A Landscape Study of Electronic Case Management Systems for Medical Examiners and Coroners.

An application programming interface, or API, allows services and products to communicate with each other and leverage each other’s data and functionality through a documented interface. APIs offer security by design because their position as middleman facilitates the functionality between two systems.

The FHIR API – HealthIT.gov

A key element for data modernization is the development of data standards. Variation exists in the information that medical examiners and coroners maintain on a death investigation. Work towards such a minimum set of common data elements began in 1995 in a report from CDC authored by Drs. Randy Hanzlick and Gib Parrish. The National Institute of Standards and Technology (NIST) Organization of Scientific Area Committees (OSAC) Crime Scene/Death Investigation Medicolegal Death Investigation (MDI) Subcommittee has continued to work on this effort MDI data commonly collected and exchanged_REFERENCE_07092021_0.pdf (nist.gov). In December 2022,the MDI Data Exchange Work Group sponsored by the Forensic Technology Center of Excellence updated the minimum list, documented in Data Exchange Practices of Medicolegal Death Investigation.

The standards being used to enable interoperability in vital statistics reporting. HL7’s FHIR® (pronounced “fire”) standards enable health systems to communicate information using a common framework. Similar to the way the internet works, FHIR standards help break complex health information into small, reusable to meet a variety of information needs.

Guidance is available to help MDI offices use FHIR resources to exchange data with others using standards-based interoperable solutions. The MD FHIR IG lays a foundation for the expansion of automated, standards-driven information exchange. The current version has been developed to define the exchange of data between CMS and EDRS to medically certify deaths.

Raven is an open-source, proof-of-concept platform that serves as a reference implementation and provides testing tools for interoperability between case management systems (CMS) and other external actors. The external actors are those data sources with which CMS need to communicate to exchange Medicolegal Death Investigation (MDI) data, and may include, but not be limited to, electronic death registration systems (EDRS) and forensic toxicology laboratory information management systems (LIMS).

The current Raven tooling and tests aid developers in implementing the MDI FHIR record format by validating FHIR messages against MDI IG guidelines and FHIR-based extended API operations. Detail documentation is available from https://ravendocs.readthedocs.io/. Raven Dashboard is a runnable Raven app. Users can validate, import, view, and simulate MDI-based CMS data within this app.

Other resources

Report from the MDI Data Exchange Working Group documenting commonly exchanged data, recommendations on emerging drugs mapping/classification process/naming, and recommendations for the exchange of forensic data with other organizations
- Data Exchange Practices of Medicolegal Death Investigation
Resources for data modernization efforts with vital records offices’ electronic death registration systems
Impact of medical examiners and coroners in public health

From early data modernization implementers

“One of the most exciting things that we have been involved in this year is interoperability solutions with vital records. We have streamlined the process of certifying death certificates. We put in the death certificate information into our case management system. There is one button you click and you finalize the death certificate.”
Gail Parker, Office Manager, DeKalb Co. Georgia Medical Examiners Office

“The collaboration across organizations resulted in something greater than the individual parts and is a model for death certification.”
R. Ross Reichard, M.D., Chief Medical Examiner & Forensic Pathologist, Southern Minnesota Regional ME Office

“There is much value in gaining interoperability. Information does not have to be retyped into the electronic death registration system. Since going live, we have had zero internal clerical-based death certificate amendments, which is huge for us. Another major benefit is that our QA review is being done in real-time instead of quarterly. This changes has allowed access to accurate real-time data that can be pulled on demand.”
Monica Kendall, Death Investigations Supervisor, Southern Minnesota Regional ME Office