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 2.0.0-ballot2 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

MDI Changes

STU2 Ballots

The 2nd STU2 ballot (Jan. 2025) made the following changes:

• Added 9 new profiles for Death Certificate review workflow plus supporting extensions and example codes:
  • Bundle - Message Death Certificate Review
  • MessageHeader - Death Certificate Review
  • Bundle - Document Death Certificate Review
  • Composition - Death Certificate Review
  • Observation - Medical Information Data Quality
  • Observation - Personal Information Data Quality
  • Observation - Communicable Disease
  • Observation - Embalmed
  • Organization - Crematorium
• Code systems:
  • Renamed CodeSystem - MDI (CodeSystem-mdi-codes, CodeSystemMDI) to Medicolegal Death Investigation Codes (cs-mdi-codes, MDIcodes) per TSMG guidance
  • Added Death Certificate Review Example (cs-death-cert-review-example, DeathCertReviewExample)
• Added Use Cases narrative page and removed Terminology narrative page (no longer needed)

The 1st STU2 ballot (May 2024) of MDI incorporated refactoring, as described in the VRCL, Vital Records FHIR Implementation Guide Harmonization Plan page. Many of the MDI STU1.1 profiles, valuesets, codesystems, and extensions are now found elsewhere. For a detailed description of harmonization changes in the MDI IG, see the Content Transitions page.

MDI STU 1.1 (September 2023)

Overall

• Updated and clarified data element descriptions to indicate roles of the “death certifier” FHIR-41184
• Clarified language, updating terms such as “MDI system” to “MDI case management system (MDI CMS)” for the electronic data systems FHIR-36944, FHIR-41685

Profiles

Capability Statements:

• Changed name/title of "CapabilityStatement - Medical Examiner/Coroner Server" to "CapabilityStatement - MDI CMS Server" FHIR-36944
• Added rest definitions to CapabilityStatement - MDI CMS Server and to CapabilityStatement - Electronic Death Reporting System (EDRS) Server FHIR-41518
• Added text to CapabilityStatement - MDI CMS Server, CapabilityStatement - Electronic Death Reporting System (EDRS) Server, and CapabilityStatement - Forensic Toxicology Laboratory Server for more informative html rendering of each resource FHIR-41515

Bundle - Document MDI to EDRS:

• Changed profile name/title to “Bundle - Document MDI and EDRS” FHIR-41684

Composition - MDI to EDRS:

• Changed profile name/title to “Composition - MDI and EDRS” FHIR-41684
• Made identifier optional FHIR-39411, FHIR-39412, FHIR-39413
• Changed the author from (1..*) to (1..1) and updated the description and definition FHIR-41347
• Removed the data-absent-reason extension from the attester and updated the description and definition FHIR-41347
• Added guidance to Composition.section: if no information for a required section, use Composition.section:cause-manner.emptyReason. FHIR-40691
• Changed cardinality from (0..*) to (0..1) for entry:other-condition, entry:manner, entry:how-injury FHIR-40691
• Updated entry:cause to "Up to 4 lines of cause of death" FHIR-40691
• Added a slice to section:exam-autopsy.entry for autopsy location FHIR-39414
• Corrected cardinality of Composition.section:narratives.code from 0..1 to 1..1 FHIR-41871

Observation - Cause of Death Part 1:

• Updated to align with Vital Records Death Reporting (VRDR) STU2, v.2.1.0 value(x) structure & lineNumber.valueInteger FHIR-41185
• Added valueQuantity and valueString options for interval.value(x) FHIR-41185
• Fixed the interval component to correctly display value[x] options on all 3 tabs (Differential, Key Elements, and Snapshot) FHIR-41643
• Improved Observation.component:interval.value[x] description to inform and guide users that the Quantity is only to be used for an amount of time FHIR-41643

Observation - Contributing Cause of Death Part 2: Updated to align with Vital Records Death Reporting (VRDR) STU2, v.2.1.0 performer cardinality, changed from (1..1) to (0..*) FHIR-41185

Observation - Death Date:

• Added choice of dateTime or period to Observation.value(x) FHIR-40470
• Added time to dateTime as choices for datetimePronouncedDead.value(x) to align with VRDR FHIR-40470
• Updated Observation.value[x].extension:partialDateTime to reference http://hl7.org/fhir/us/vrdr/StructureDefinition/PartialDateTime and updated short description FHIR-41647

Observation - How Death Injury Occurred: Updated Observation.value[x].extension:partialDateTime to reference http://hl7.org/fhir/us/vrdr/StructureDefinition/PartialDateTime and updated short description FHIR-41647

Observation - Autopsy Performed Indicator: Constrained performer to US Core Practitioner Profile FHIR-41346

Observation - Tobacco Use Contributed to Death: Updated to align with Vital Records Death Reporting (VRDR) STU2, v.2.1.0 code display FHIR-41185

Bundle - Message Toxicology to MDI: made identifier optional FHIR-39413

DocumentReference - MDI Report: Added profile of US Core DocumentReference Profile for exchange of death investigation documents, such as Autopsy Reports and Investigator’s Narratives. FHIR-41348

Extensions

• Removed Extension structure definitions: Extension-partial-date-time, Extension-date-year, Extension-date-month, Extension-date-day, and Extension-date-time; replaced uses with reference (url) to Vital Records Death Reporting (VRDR) extensions, thus creating a formal dependence on VRDR) FHIR-41647

Terminology

• Updated code displays to match source code systems (e.g., SNOMED CT)
• Removed unused valuesets: ValueSet - Units of Age; ValueSet - Yes, No, Not Applicable

Narrative Pages

Overall: Clarified language , updating terms such as “MDI system” to “MDI case management system (MDI CMS)” for the electronic data systems FHIR-36944

Best Practice: Updated guidance on absent data FHIR-41347

Security Recommendations: New page added and corrected information FHIR-41642

Terminology: Updated text to clarify similarities with VRDR FHIR-41519

Change Log: New page added FHIR-41184

Artifact Index:

• Moved MessageDefinition – Toxicology System to Toxicology Profiles grouping FHIR-41516
• Created new grouping, Administrative Profiles, for DocumentReference - MDI Report FHIR-41348

Examples:

• Updated "MDI and EDRS Composition - Freeman" example file to show death certifier roles FHIR-41184
• Added "MDI and EDRS Composition - draft" example file with author and attester not yet named (using the data-absent-reason). FHIR-41347
• Added "Observation - Cause of Death Part 1 - Freeman - quantity interval" example file
• Added "Observation - Death Date - period" and "Observation - Death Date - partial date" example files
• Added "Location - Death - Freeman address string" and "Location - Death - Lat/Long" example files
• Removed "US Core Practitioner - Dr. Jane Jones" example file and added "US Core Practitioner - Dr. J.M. Lehz" example file
• Added "DocumentReference - MDI Report - Autopsy Report" and "DocumentReference - MDI Report - Investigator's Narrative" example files