Medicolegal Death Investigation (MDI) FHIR Implementation Guide
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Medicolegal Death Investigation (MDI) FHIR Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.0.1-cibuild built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-mdi-ig/ and changes regularly. See the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Capability Statements

Minimal server capabilities expecetd for MDI data exchange partners.

CapabilityStatement - Electronic Death Reporting System (EDRS) Server

This resource describes the expected capabilities of the Electronic Death Registration System (EDRS) server, which is responsible for providing responses to the queries submitted by a client. Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.

CapabilityStatement - Forensic Toxicology Laboratory Server

This resource describes the expected minimum capabilities of the toxicology lab server.

CapabilityStatement - MDI CMS Server

This resource describes expected minimum capabilities of an MDI CMS server which is responsible for providing responses to the queries submitted by a client. Clients have the option of choosing from this list to access necessary data.

MDI Profiles for Death Certificate

Profiles defined for exchanging death investigation data between and MDI CMS and EDRS for death certificate development.

Bundle - Document MDI and EDRS

This Bundle profile represents a Document Bundle exchanged between an MDI CMS and EDRS. It can be used for bi-directional exchange. It contains a Composition - MDI and EDRS.

Composition - MDI and EDRS

This Composition profile represents data exchanged between an MDI CMS and an EDRS.

MDI Cause Of Death Part 1

The Observation - MDI Cause of Death Part 1 profile places constraints on the VRDR profile CauseOfDeathPart1

Forensic Toxicology Profiles

Profiles defined for exchanging forensic toxicology data.

Bundle - Message Toxicology to MDI

This Bundle profile represents a Message Bundle from a forensic toxicology laboratory to an MDI information management system. It contains a Message Header and a DiagnosticReport - Toxicology Lab Result to MDI.

DiagnosticReport - Toxicology Lab Result to MDI

This profile contains constraints to the US Core Diagnostic Report Profile to address the use case for sending data from a forensic toxicology laboratory information management system to an MDI information management system. Each analyzed specimen, represented by a Specimen - Toxicology Lab resource, must be referenced by at least one Observation - Toxicology Lab Result and may be referenced by more than one Observation - Toxicology Lab Result. For specimens received but not analyzed, the laboratory should provide a reason for no analysis in the DiagnosticReport.conclusion and/or each unanalyzed specimen’s Specimen - Toxicology Lab Specimen.note.

MessageHeader - Toxicology to MDI

This MessageHeader identifies the DiagnosticReport being sent from a forensic toxicology laboratory information system to an MDI information management system.

Observation - Toxicology Lab Result

This Observation profile describes forensic toxicology laboratory test results from analysis of a specimen sent by a Medical Examiner, Coroner, or autopsy performer to the laboratory.

Specimen - Toxicology Lab

This Specimen profile identifies and describes the specimen sent by a Medical Examiner, Coroner, or autopsy performer to a toxicology lab for analysis. For specimens received but not analyzed, the laboratory should provide a reason for no analysis in the DiagnosticReport.conclusion and/or each unanalyzed specimen’s Specimen - Toxicology Lab Specimen.note. The laboratory may use the Specimen.condition to describe the state of the specimen via codes from the extensible value set hl7VS-specimenCondition and/or use the Specimen.note to describe details or issues about the specimen.

MDI Administrative Profiles

Profile for supporting exchange of death investigation documents.

DocumentReference - MDI Report

This DocumentReference profile constrains the US Core DocumentReference Profile to support exchanging death investigation documents, such as an Autopsy Report or Investigator’s Narrative. The content may be included as inline base64 encoded data or be provided by direct reference (e.g., URL). The document type is required and is constrained by US Core to a LOINC value whose SCALE is DOC in the LOINC database or is the HL7 v3 Code System NullFlavor concept 'unknown'.

Death Certificate Review Profiles

Profiles defined for death certificate review use cases.

Bundle - Document Death Certificate Review

This profile represents a Document Bundle from an EDRS for a Death Certificate Review.

Bundle - Message Death Certificate Review

This Bundle profile represents a Message Bundle about a Death Certificate Review.

Composition - Death Certificate Review

This Composition contains information for a request to review death certificate data, for death data quality improvement, cremation clearance, and other workflows. It can contain EDRS death certificate structured data.

MessageHeader - Death Certificate Review

This MessageHeader identifies a Death Certificate Review document bundle and additional review information.

Observation - Communicable Disease

This Observation profile describes TBD.

Observation - Embalmed

This Observation profile indicates if the decedent body was embalmed.

Observation - Medical Information Data Quality

This Observation profile describes TBD.

Observation - Personal Information Data Quality

This Observation profile describes TBD.

Organization - Crematorium

Crematorium

Extensions

Extensions defined by this IG.

Extension - Cremation Clearance Authorization Status

This Extension indicates the authorization status of the Cremation Clearance.

Extension - Cremation Clearance Coroner Status

This Extension indicates whether the Cremation Clearance is a Cononer workflow or not.

Extension - Cremation Clearance Signature Status

This Extension indicates whether the Cremation Clearance has been signed or not.

Extension - Death Certificate Status

This Extension indicates Death Certificate workflow status.

Extension - Medical Examiner Certification Affirmation

This Extension indicates whether the Medical Examiner certification has been affirmed or not.

Extension - Tracking Number

This Extension contains a tracking number, such as a case number or file number assigned by an MDI information management system or EDRS, and can represent other tracking numbers, if required.

CodeSystems

Code systems defined by this IG. Examplecode systems contain examples of codes typically defined by each implementation or jurisdiction.

Death Certificate Review Example

This code system contains example codes for death certificate review.

Medicolegal Death Investigation Codes

Local codes for items that lack an appropriate LOINC code. This codesystem is only for use in the MDI use cases supported by this implementation guide, and should not be used elsewhere.

Value Set

Values sets defined by this IG. Example values sets contain examples of codes typically defined by each implementation or jurisdiction.

Registration example

This value set contains example codes for Death Certificate registration status.

Tracking Number Type

This value set contains codes to that identify the type of tracking number.

ValueSet - Certified Workflow example

This value set contains example codes for Death Certificate certification workflow status.

ValueSet - Cremation Clearance Observations example

This value set contains example codes for Cremation Clearance Observations.

ValueSet - Cremation Clearance Signed example

This value set contains example codes for the signature status of the Cremation Clearance.

ValueSet - Cremation Clearance Status example

This value set contains example codes for Cremation Clearance status.

ValueSet - Death Certificate Review Observations example

This value set contains example codes for Death Certificate Review Observations.

ValueSet - Death Certificate Review Reason example

This value set contains example codes for the reason for a death certificate review.

ValueSet - Embalmed example

This value set contains example codes for embalmed status of the Decedent.

ValueSet - Medical Data Quality Review example

This value set contains example codes for medical data quality review.

ValueSet - Medical Examiner Certification Affirmation example

This value set contains example codes for the status of Medical Examiner Certification Affirmation.

ValueSet - Personal Data Quality Review example

This value set contains example codes for personal data quality review.

MDI-defined Resource Examples for Death Certificate

Examples of MDI-defined resources for death certificate development.

Bundle - MDI and EDRS - Freeman

Bundle - MDI and EDRS: Freeman example

MDI and EDRS Composition - draft

MDI and EDRS Composition: Draft example with status=preliminary, author & attester using data-absent-reason extension

MDI and EDRS Composition - Freeman

MDI and EDRS Composition: Freeman example

MDI Cause of Death Part 1 - Freeman

MDI Cause of Death Part 1 (Observation): Freeman example

MDI Cause of Death Part 1 - Freeman, quantity interval

MDI Cause of Death Part 1 (Observation): Freeman example, specifying interval quantity (days)

MDI-defined Resource Examples for Forensic Toxicology

Examples of MDI-defined resources for forensic toxicology data exchange.

Bundle - Message Toxicology to MDI - Freeman

Bundle - Message Toxicology to MDI: Freeman example

DiagnosticReport - Toxicology Lab Result to MDI - Freeman

DiagnosticReport - Toxicology Lab Result to MDI: Freeman example

MessageDefinition - Toxicology System

MessageDefinition - Toxicology System: This resource defines the characteristics of a message that can be shared between a forensic toxicology system and a medical examiner/coroner system.

MessageHeader - Toxicology to MDI - Freeman

MessageHeader - Toxicology to MDI: Freeman example

Observation - Toxicology Lab Result - 4-anpp Blood Freeman

Observation - Toxicology Lab Result: 4-anpp Blood Freeman example

Observation - Toxicology Lab Result - 4-anpp Urine Freeman

Observation - Toxicology Lab Result: 4-anpp Urine Freeman example

Observation - Toxicology Lab Result - Acetylfentanyl Blood Freeman

Observation - Toxicology Lab Result: Acetylfentanyl Blood Freeman example

Observation - Toxicology Lab Result - Acetylfentanyl Urine Freeman

Observation - Toxicology Lab Result: Acetylfentanyl Urine Freeman example

Observation - Toxicology Lab Result - Ethanol Blood Freeman

Observation - Toxicology Lab Result: Ethanol Blood Freeman example

Observation - Toxicology Lab Result - Ethanol Urine Freeman

Observation - Toxicology Lab Result: Ethanol Urine Freeman example

Observation - Toxicology Lab Result - Ethanol Vitreous Humor Freeman

Observation - Toxicology Lab Result: Ethanol Vitreous Humor Freeman

Observation - Toxicology Lab Result - Fentanyl Blood Freeman

Observation - Toxicology Lab Result: Fentanyl Blood Freeman example

Observation - Toxicology Lab Result - Fentanyl Urine Freeman

Observation - Toxicology Lab Result: Fentanyl Urine Freeman example

Observation - Toxicology Lab Result - Norfentanyl Urine Freeman

Observation - Toxicology Lab Result: Norfentanyl Urine Freeman example

Observation - Toxicology Lab Result - Xylazine Urine Freeman

Observation - Toxicology Lab Result: Xylazine Urine Freeman example

Specimen - Toxicology Lab - Freeman Bile

Specimen - Toxicology Lab: Freeman bile example

Specimen - Toxicology Lab - Freeman Blood

Specimen - Toxicology Lab: Freeman blood examples

Specimen - Toxicology Lab - Freeman Liver

Specimen - Toxicology Lab: Freeman liver example

Specimen - Toxicology Lab - Freeman Stomach Contents

Specimen - Toxicology Lab: Freeman stomach contents example

Specimen - Toxicology Lab - Freeman Urine

Specimen - Toxicology Lab: Freeman urine example

Specimen - Toxicology Lab - Freeman Vitreous Humor

Specimen - Toxicology Lab: Freeman vitreous humor example

MDI-defined Resource Examples for Administrative Profiles

Examples of MDI-defined resources for exchange of death investigation documents.

DocumentReference - MDI Report - Autopsy Report example

DocumentReference - MDI Report: Autopsy Report example

DocumentReference - MDI Report - Investigator's Narrative example

DocumentReference - MDI Report: Investigator's Narrative example

MDI-defined Resource Examples for Death Certificate Review

Examples of MDI-defined resources for death certificate review use cases.

Death Certificate Review example for cremation clearance request (example 3)

Death Certificate Review for cremation clearance request

Death Certificate Review example for cremation clearance response (example 4)

Death Certificate Review for cremation clearance response

Death Certificate Review example for death data review request (example 1)

Death Certificate Review for death data review request

Death Certificate Review example for death data review response (example 2)

Death Certificate Review for death data review response

Observation - Communicable Disease - ex1

Observation - Communicable Disease: example 1

Observation - Embalmed - ex1

Observation - Embalmed: example 1

Observation - Medical Information Data Quality - ex1

Observation - Medical Information Data Quality: example 1

Observation - Personal Information Data Quality - ex1

Observation - Personal Information Data Quality: example 1

Other Examples

Examples of resources defined elsewhere and included in (used by) MDI examples. These are examples of profiles defined in Vital Records Death Reporting (VRDR), Vital Records Common Library (VRCL), US Core, and the base FHIR specification.

Death Certificate for review for cremation clearance request

Death Certificate - CCR example 1

Practitioner - Vital Records - Dr. Sam Jones

Example of Practitioner - Vital Records: Dr. Sam Jones, medical examiner and death pronouncer for Freeman death investigation examples.

US Core Organization - GA Dept Public Health

Example of US Core Organization - Georgia State Department of Public Health, Div. Vital Records

US Core Organization - UF Health Pathology Labs, Forensic Toxicology Laboratory

Example of US Core Organization - UF Health Pathology Labs, Forensic Toxicology Laboratory

US Core Organization – State Medical Examiner

Example of US Core Organization - State Medical Examiner Office

US Core Patient - Alice J. Freeman

Example of US Core Patient - Alice J. Freeman, decedent

US Core Patient - Unknown Name

US Core Patient: Unknown Name - Decedent where there is no information known about the patient. Assume that the system will assign a tracking number (e.g., medical record number, case number, or other).

US Core Practitioner - Dr. Bruce Goldberger

Example of US Core Practitioner - Dr. Bruce Goldberger, toxicologist

US Core Practitioner - Dr. J.M. Lehz

Example of US Core Practitioner - Dr. J.M. Lehz, autopsy performer

US Core Practitioner – Death Pronouncement Performer

Example of US Core Practitioner - Death Pronouncement Performer, used in the VRDR Death Date Observation.performer role.

VRDR Autopsy Performed Indicator

Example of VRDR Autopsy Performed Indicator (Observation) for death certificate review examples.

VRDR Autopsy Performed Indicator - Freeman

Autopsy Performed Indicator: Freeman example (vrdr-autopsy-performed-indicator)

VRDR Cause Of Death Part 1

Example of VRDR Cause Of Death Part 1 (Observation) for death certificate review examples.

VRDR Cause of Death Part 2

Example of VRDR Cause of Death Part 2 (Observation) for death certificate review examples.

VRDR Cause of Death Part 2 - Freeman

Cause of Death Part 2: Freeman example (vrdr-cause-of-death-part2)

VRDR Death Certification Procedure - Freeman

Death Certification Procedure: Freeman example (vrdr-death-certification)

VRDR Death Certifier

Example of VRDR Death Certification Procedure for death certificate review examples.

VRDR Death Certifier

Example of VRDR Death Certifier (Practitioner) for death certificate review examples.

VRDR Death Date

Example of VRDR Death Date (Observation) for death certificate review examples.

VRDR Death Date - Freeman

Death Date: Freeman death date, location, death pronouncer example (vrdr-death-date)

VRDR Death Location

Example of VRDR Death Location (Location) for death certificate review examples.

VRDR Death Location - address string

Death Location: address as string, Freeman example (vrdr-death-location)

VRDR Death Location - Atlanta GA

Death Location: Atlanta GA, Freeman example (vrdr-death-location)

VRDR Death Location - Lat/Long

Death Location: latitude & longitude, other example (vrdr-death-location)

VRDR Decedent

Example of VRDR Decedent (Patient) for death certificate review examples

VRDR Decedent Age

Example of VRDR Decedent Age (Observation) for death certificate review examples.

VRDR Decedent Disposition Method

Example of VRDR Decedent Disposition Method (Observation) for death certificate review examples.

VRDR Decedent Education Level

Example of VRDR Decedent Education Level (Observation) for death certificate review examples.

VRDR Decedent Father

Example of VRDR Decedent Father (RelatedPerson) for death certificate review examples.

VRDR Decedent Military Service

Example of VRDR Decedent Military Service (Observation) for death certificate review examples.

VRDR Decedent Mother

Example of VRDR Decedent Mother (RelatedPerson) for death certificate review examples.

VRDR Decedent Pregnancy

Example of VRDR Decedent Pregnancy (Observation) for death certificate review examples.

VRDR Decedent Pregnancy - Freeman

Decedent Pregnancy: Freeman example (vrdr-decedent-pregnancy-status)

VRDR Decedent Usual Work

Example of VRDR Decedent Usual Work (Observation) for death certificate review examples.

VRDR Disposition Location

Example of VRDR Disposition Location for death certificate review examples.

VRDR Disposition Method - Freeman

Disposition Method: Freeman example (vrdr-decedent-disposition-method)

VRDR Examiner Contacted

Example of VRDR Examiner Contacted (Observation) for death certificate review examples.

VRDR Funeral Home

Example of VRDR Funeral Home (Organization) for death certificate review examples.

VRDR Injury Incident

Example of VRDR Injury Incident (Observation) for death certificate review examples.

VRDR Injury Incident - Freeman

Injury Incident: Freeman medication ingestion example (vrdr-injury-incident)

VRDR Injury Location

Example of VRDR Injury Location for death certificate review examples.

VRDR Injury Location - Atlanta GA

Injury Location: Atlanta GA, Freeman example (vrdr-injury-location)

VRDR Manner of Death

Example of VRDR Mortician (Practitioner) for death certificate review examples.

VRDR Manner of Death - Freeman

Manner of Death: Freeman - accidental example (vrdr-manner-of-death)

VRDR Mortician

Example of VRDR Mortician (Practitioner) for death certificate review examples.

VRDR Tobacco Use Contributed To Death

Example of VRDR Tobacco Use Contributed To Death (Observation) for death certificate review examples

VRDR Tobacco Use Contributed To Death - Freeman

obacco Use Contributed To Death: Freeman example (vrdr-tobacco-use-contributed-to-death)

Parameters

TBD

mdi-tracking-number-search

TBD

Parameters - SNOMED US Version

Parameters - SNOMED US Version

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Bundle - Document Death Certificate Review, example 1

Bundle - Document Death Certificate Review example 1

Bundle - Message Death Certificate Review Example

Bundle - Message Death Certificate Review, example 1

MessageHeader - Death Certificate Review Example 1

MessageHeader - Death Certificate Review, example 1

Organization – Crematorium example

Example of Organization - Crematorium

VR Practitioner

Example of VR Practitioner for death certificate review examples.