The MDI Standard

What is FHIR?

HL7 Fast Healthcare Interoperability Resources (FHIR) is a successor to HL7’s earlier industry standards healthcare messaging, HL7v2.x and HL7v3.x. It builds upon those standards to produce a modern interoperability standard, enabling the easy exchange of healthcare records across systems.

FHIR is built around the concept of “Resources”, logically distinct entities that serve as the minimum granularity for transfer. For example, the Patient resource represents core patient demographic data and serves a focal reference for many other resources. Other resources include clinical concepts such as Condition or an Observation.

FHIR is currently up to its R5 release, though R4 is still the most prevalent of the modern releases and continues to be the release in which most development is focused. For a complete list of FHIR R4 Resources and their respective maturities, please see the FHIR R4 Resource List.

What is MDI FHIR IG?

The Medicolegal Death Investigation (MDI) FHIR Implementation Guide (IG) is a FHIR implementation guide detailing the proper method of using FHIR resources to construct a FHIR version of a Death and Toxicology Reporting. The MDI standard is developed to support modernization of interoperability between Coroner/Medical Examiner case management systems (CMS) and other systems such as Electronic Death Registrar Systems (EDRS) and Toxicology Lab Information and Management System (LIMS).

The Raven Platform uses the MDI IG for handling death records, importing MDI data and exporting to FHIR resources. The Raven Platform allows users to import their own data into FHIR MDI resources and store them on the Raven FHIR Server.

MDI IG is still in the draft version and being evolved as more data elements are considered. The MDI IG will follow the HL7 FHIR IG development cycles and will become mature over the development cycles.

For a more detailed breakdown of MDI contents, please see the official MDI Implementation Guide.

Overview of MDI Workflows

Currently, two workflows are defined in the MDI IG, MDI-to-EDRS and Toxicology-to-MDI. The MDI IG defines profiles to describe the required content structures for the workflows.

MDI-to-EDRS

MDI-to-EDRS workflow represents the interoperability between MDI case management system (CMS) and state’s electronic death registration system (EDRS). In MDI IG, this workflow is supported by MDI-to-EDRS profiles. As it happens in most states, the case is mostly created by funeral directors. Thus, this workflow begins with an initial case created at the EDRS. CMS first searches EDRS for a case and retrieves the case with limited decedent’s demographics. CMS may update the case during the journey of the death investigation. When the investigation is completed, the case shall be certified and submitted to EDRS.

In this workflow, users can validate the MDI-to-EDRS FHIR bundle documents, load the documents, and submit to EDRS. It’s highly recommended for users to first validate the FHIR data before loading to Raven. For those who do not have their own dataset or are not ready to produce the dataset, Raven allows users to search the Raven FHIR Server, load the case and play with the case. Users can explore the raw FHIR data along with the rendered data in forms.

Toxicology-to-MDI

Toxicology-to-MDI workflow represents the interoperability between forensic toxicology laboratory information management system (LIMS) to an MDI case management system (CMS). In MDI IG, this workflow is supported by Toxicology-to-MDI profiles. This workflow is bidirectional. There is an inital lab order sent from CMS with samples. After lab work is performed, the lab report is sent back to CMS from LIMS. Currently, the MDI IG specifies the lab reporting direction only and uses FHIR messaging for the data exchanges.

Users can validate the Toxicology-to-MDI FHIR bundle messages and store the messages in Raven FHIR server.