Medicolegal Death Investigation (MDI)
1.0.0 - STU 1 US

This page is part of the Medicolegal Death Investigation (MDI) (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

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Official URL: Version: 1.0.0
Active as of 2022-08-25 Computable Name: MedicolegalDeathInvestigation


This US-specific implementation guide (IG) provides guidance on the exchange of information to and from medicolegal death investigation (MDI) information systems. It supports interoperability between the MDI systems of medical examiner and coroner (ME/C) offices, forensic toxicology and other laboratory information management systems (LIMS), electronic death reporting systems (EDRS) of jurisdictional vital records offices, and ancillary workflows whose systems have the capability of utilizing Fast Healthcare Interoperability Resources (FHIR). The guide provides MDI system developers with the technical details and best practices to standardize MDI fields and interfaces. Stakeholders may use the narrative portions of this guide to inform policies and practices for data exchange between systems contributing to death investigations. This guide can serve as a base for local specifications.

Technical Overview

This MDI implementation guide is based upon FHIR R4.0.1 and is a U.S. Realm Specification.

This version of the specification defines FHIR resources to support two workflows:

  • Death investigation findings sent from an MDI system to an EDRS via a document bundle: Bundle - Document MDI to EDRS
  • Forensic toxicology specimen analysis results sent from a forensic toxicology laboratory to an MDI information system via a message bundle: Bundle – Message Toxicology to MDI

This guide includes the following sections, listed at the top of each page in the menu bar:

  • Home: Summary description and technical overview
  • Background: Information on MDI dataflows and actors, the current work, and relationship to other implementation guides, as well as likely future MDI FHIR specification development
  • Best Practices: Guidance on implementation and use of this specification
  • Specification: Technical details on implementing the specification
  • Terminology: List of all value sets used in this guide
  • Downloads: Links for downloading the full implementation guide package as well as format-specific definitions files and example files in XML, JSON, and TTL
  • Artifacts Index Summary: List of all FHIR artifacts specified by this guide, with brief descriptions


The audience for this implementation guide includes architects and developers of MDI and associated information management systems, such as forensic toxicology LIMS, as well as medical examiners, coroners, death investigators, and other professionals who collect and analyze data for medicolegal death investigations. Business analysts and policy managers can also benefit from a basic understanding of the use of MDI data exchange to support interoperability. Implementers of this MDI FHIR standard must have the following US Core profiles implemented for each applicable use case:

MDI systems and EDRS implementing the Bundle - Document MDI to EDRS for transmitting and receiving a Composition - MDI to EDRS:

Forensic toxicology laboratories and MDI systems implementing the Bundle – Message Toxicology to MDI for transmitting and receiving a DiagnosticReport - Toxicology Lab Result to MDI:


  • HL7 International - Public Health Work group,
  • Cynthia Bush (OD),
  • Kate Brett (DVS),
  • Margaret Warner (DVS),
  • Diana Wright,