Vital Records Medicolegal Death Investigation (MDI) FHIR Implementation Guide
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This page is part of the Medicolegal Death Investigation (MDI) (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

Artifacts Summary

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

MDI Capability Statements

CapabilityStatement - Electronic Death Reporting System (EDRS) Server

This resource describes the expected capabilities of the Electronic Death Registration System (EDRS) Server actor, which is responsible for providing responses to the queries submitted by the EDRS Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by EDRS Servers are defined. EDRS 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 capabilities of the toxicology lab Server actor which is responsible for providing responses to the queries submitted by toxicology lab Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by toxicology lab Servers are defined. toxicology lab Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.

CapabilityStatement - MDI CMS Server

This resource describes expected capabilities of an MDI CMS Server which is responsible for providing responses to the queries submitted by a Client. It lists FHIR profiles and search parameters that, at a minimum, should be supported by MDI CMS Servers. MDI CMS Clients have the option of choosing from this list to access necessary data.

MDI Profiles

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.

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.

Composition - MDI and EDRS

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

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.

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’.

MDI Cause Of Death Part 1

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

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 Extensions

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.

MDI CodeSystems

CodeSystem - MDI

This code system contains codes for use in death investigations and reporting.

MDI Value Set

ValueSet - Tracking Number Type

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

MDI Parameters

Parameters - SNOMED US Version

Parameters - SNOMED US Version

Examples of MDI-defined resources

Bundle - MDI and EDRS - Freeman

Bundle - MDI and EDRS: Freeman example

Bundle - Message Toxicology to MDI - Freeman

Bundle - Message Toxicology to MDI: Freeman example

MDI and EDRS Composition - Freeman

MDI and EDRS Composition: Freeman example

MDI and EDRS Composition - draft

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

DiagnosticReport - Toxicology Lab Result to MDI - Freeman

DiagnosticReport - Toxicology Lab Result to MDI: Freeman example

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

Message Definition 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 - Cause of Death Part 1 - Freeman

Observation - Cause of Death Part 1: Freeman example

Observation - MDI Cause of Death Part 1 - Freeman - quantity interval

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

Examples of resources defined elsewhere included in MDI examples

Observation - Disposition Method - Freeman

Observation - Disposition Method: Freeman example

Location - Death - Atlanta GA Freeman

Location - Death: Atlanta GA Freeman example

Location - Death - Lat/Long

Location - Death: latitude & longitude example

Location - Death - Freeman address string

Location - Death: address as string example

Location - Injury - Atlanta GA Freeman

Location - Injury: Atlanta GA Freeman example

Observation - Autopsy Performed Indicator - Freeman

Observation - Autopsy Performed Indicator: Freeman example

Observation - Contributing Cause of Death Part 2 - Freeman

Observation - Contributing Cause of Death Part 2: Freeman example

Observation - Death Date - Freeman

Observation - Death Date: Freeman death date, location, death pronouncer example

Observation - Decedent Pregnancy - Freeman

Observation - Decedent Pregnancy: Freeman example

Observation - Manner of Death - Freeman

Observation - Manner of Death: Freeman - accidental example

Observation - Tobacco Use - Freeman

Observation - Tobacco Use: Freeman example

Observation - How Death Injury Occurred - Freeman - Medication ingestion

Observation - How Death Injury Occurred: Freeman - Medication ingestion (fentanyl) example

Procedure - Death Certification - Freeman

Procedure - Death Certification: 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

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

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

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

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 - Dr. Sam Jones

Example of US Core Practitioner - Dr. Sam Jones, death pronouncer