Overview
In September 2020, The National Institute of Justice (NIJ) – in partnership with its Forensic Technology Center of Excellence (FTCOE) at RTI International and the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) – convened a virtual Medicolegal Death Investigation Data Exchange Working Group (MDI-Data-WG) over a 12-month period, forming 3 distinct subcommittees to focus on specific topics. Beginning in 2023, the Workflow Processes subcommittee, whose emphasis is to gather information about the collecting, storing, and reporting processes between MDI offices and others who either use or contribute to MDI data, has developed this resource as a guide to obtaining medical records for MDI.
This toolkit contains a full range of guidance resources, each with descriptions, to help medical examiner and coroner offices (MECs) obtain medical records. Starting with basic templates for requesting medical records, then moving into the value of remote access to electronic medical records/how to obtain them, this document explores different scenarios for how to help standardize data sharing between agencies. In this guidance toolkit, you will also find information regarding Health Information Exchanges (HIE), how to navigate security and privacy concerns, as well as state laws for medical records pertaining to medical examiners and coroners (MECs).
State Statutes & Request for Medical Records Letter Templates
Clicking on the states on the map below provides a list and links to various state statutes for medical records pertaining to MECs. Please note this is not by any means an exhaustive list, but a culmination of legislation to provide MECs a quick look at what currently exists. Some states have accompanying templates for your use (indicated with the information icon ⓘ), including templates to request medical records, subpoenas, and a template to explain HIPAA. This section also provides general information on how to obtain electronic medical records and types of records to request. A complete list of included statutes and templates can be accessed HERE.
How to Request Medical Records
First and foremost, you must ask. Some systems have on-line applications which require you to contact the Electronic Link Coordinator/Office of Information Security. If you already know the chief of pathology, that is a good starting point to have them reach out for you. You also may ask your local organ procurement organization to support your effort. Your access to the electronic medical record will help in making more timely decisions about deaths that fall under the medicolegal jurisdiction. If a hospital system rejects your request, you may consider proposing new legislation to grant this specific access or contact the Commissioner of the State Health Department for assistance.
Types of Medical Records to Request
When requesting medical records, it is helpful to be as specific as possible to receive the documents in an expeditious manner. Below are some examples of commonly needed medical records:
- Imaging (X-rays, CT scan, MRI scan)
- Healthcare Admissions (Hospital, Behavioral Health Facilities, Rehabilitation, Nursing Home)
- Healthcare Discharge
- Law Referencing Access to Records
- Law Specific To Access To Medical Records
- Law Mentioning Psych History
- Law Mentioning Medical Data or History
- Law Referencing Release of Records
- Law Specific to Release of Medical Records
Guidance Documents
This section provides links to various guidance documents ranging from PowerPoints on remote access of electronic medical records to license agreements for digital data sharing.
Medical Records
Student Health Records - HIPAA and FERPA Considerations
Security and Privacy of Medical Health Records (HIPAA)
Health Information Exchanges
Legal Resources
At the request of the National Center for Health Statistics, CDC’s Public Health Law Program assessed coroner and medical examiner laws across the 50 states and the District of Columbia. This website also includes a) Death investigation systems; b) Coroner training requirements; c) Medicolegal officers – Are coroners or medical examiners elected or appointed in each state; d) Does state law mandate that autopsies be performed by pathologists; e) Investigations and autopsies. This website does not include state laws for HIEs, medical record acquisitions, or public record request (i.e., open, closed, hybrid state for public access to death records).
Additional Resources
Groups to Socialize this Effort and Learn More
Below you will find a collection of professional organizations to help disseminate this toolkit and the resources developed through its conception. In addition to the some of the names you may be familiar with, hospital administrator conferences are also a great place to start standardizing this type of medical record data sharing and learning more about how to better communicate across agencies.
Here are some recommended professional organizations and conferences to disseminate our resources:
National Association of Medical Examiners (NAME)
The NAME is a premier professional organization for medical examiners, forensic pathologists, and medicolegal affiliates and administrators. NAME serves as a resource to individuals and jurisdictions seeking to improve medicolegal death investigation by continually working to develop and upgrade national standards for death investigation. They have an annual meeting each Fall, which you can learn more about through their website.
International Association of Coroners and Medical Examiners (IACME)
The International Association of Coroners and Medical Examiners (IACME) was founded in 1927 as an international association which prides itself on the recognition they have acquired at the federal level, regarding medicolegal matters. The IACME holds an annual training symposium, which is inclusive of many experienced speakers conducting training on a wide variety of topics. Medicolegal applicable exhibitors are also present to discuss product and office-related topics. To learn more, please visit their website.
American Board of Medicolegal Death Investigators (ABMDI)
The American Board of Medicolegal Death Investigators (ABMDI) is a voluntary national, not-for-profit, independent professional certification board that has been established to promote the highest standards of practice for medicolegal death investigators. ABMDI provides multiple educational opportunities and certificates to those who have proven their mastery of investigational techniques and who have successfully completed rigorous examination of their knowledge and skills in the field of medicolegal death investigation. To learn more, please visit their website.
American Academy of Forensic Sciences (AAFS)
The American Academy of Forensic Sciences (AAFS) is a multidisciplinary professional organization that provides leadership to advance science and its application to the legal system. AAFS hosts various conferences, meetings, and virtual educational events year-round in addition to their annual conference, which you can learn more about on their website.
American Association of Healthcare Administrative Management (AAHAM) Annual National Institute
This conference focuses on the field of patient account management, which is an integral part of any medical practice. As a professional in this field, it’s your job to handle important patient account paperwork, maintain records and ensure that all data is properly managed and filed. Attendees of the National Institute get the chance to network with colleagues, connect with new people and learn how to do their jobs more effectively, as typically over 500 members of the AAHAM attend each year.
Governance Institute Leadership Conferences
Several times a year in various cities around the US, the Governance Institute offers its leadership conferences for administrators serving on the boards of healthcare institutions. These conferences offer the opportunity for you to interact with many other professionals, build new connections and learn how to improve the quality of the healthcare organization that you work for. Through a variety of educational sessions, these conferences provide information that will help you create better alliances, better systems, and better financial management practices with the goal of improving patient care.
Health Care Administrators Association (HCAA) Executive Forum
The annual gathering of the HCAA is known as the “Executive Forum” and features a roster of speakers on subjects such as: current healthcare concerns, changes in legislation and the role of technology in the medical field. If there’s something you want to learn about the current state of medicine or how modern advances may affect the future of health care, the Executive Forum is the conference for you. Multiple speaking sessions from a diverse panel of experts provide an immersive experience that prepares you to be a better leader.
Below you will find a mixture of peer-reviewed articles and papers presented at conferences, each containing a summary of the material.
Implementation of Electronic Information Systems
Continuous Quality Improvement as a Management Concept for Death Investigation Systems
- Summary | This article identifies information flow through MDI systems as a potential area of continuous quality improvement.
- Summary | This article presents a survey of death investigation offices conducted in 2011 to evaluate the implementation of electronic information systems and the user’s satisfaction with these systems.
Electronic Death Registry in Medicolegal Death Investigation
- Summary | The goal of this whitepaper is to support policies and procedures within an organization, agency training on the importance of electronic death registration systems (EDRS) in medicolegal death investigation, and also to disseminate community awareness and collaboration efforts to improve how MDI data are exchanged and modernized. The audience includes practitioners, forensic laboratory and medical examiner/coroner leadership, and any interested entity that contributes to data exchange for death investigations.
Importance of Informatics
The Need for Informatics to Support Forensic Pathology and Death Investigation
- Manuscript Summary | This paper explores how Clinical Informatics (CI) and Forensic Pathology appear to be two subspecialties of medicine with little in common, as many equate informatics with the management of electronic medical records and forensics with the “criminal” investigation of homicides. These commonly held beliefs regarding forensics and informatics are simplistic and woefully incomplete… There are currently no standards regarding the structuring of data or interfaces for electronic DI databases. As a result, there is no effective way to transfer information between different agencies either in the same jurisdiction or between jurisdictions.
- Summary | The goal of this whitepaper is to support policies and procedures within an organization, agency training on the importance of information sharing between medicolegal death investigation offices and organ and tissue recovery organizations, and also to disseminate community awareness and collaboration efforts to improve how MDI data are exchanged and modernized. The audience includes practitioners, forensic laboratory and medical examiner/coroner leadership, and any interested entity that contributes to data exchange for death investigations.
Medical Record Acquisition and Relevance to the Field
HIPAA and Access to Medical Information by Medical Examiner and Coroner Offices
- Summary | This article provides an overview of the HIPAA (Health Insurance Portability and Accountability Act: 45 CFR § 164.512) as it pertains to disclosure of medical records to medical examiner and coroners. Rules regarding the disclosure of protected health information is also addressed for related entities, including: funeral home directors, organ procurement organizations, researchers, and for law enforcement purposes.
- Manuscript Summary | This paper explores a review centering on performing value-added autopsies on more cases to be certified by the medical examiner or coroner would add value by providing information for families, the civil justice community, the public health and safety communities, the medical care community, and for research purposes, including data which would not be available in the lack of autopsy.
Dissecting and Streamlining the Medical Record Acquisition Process in Death Investigation Systems
- Manuscript Summary | The first study examines the process of medical record acquisition at MDI offices in depth. The current project conducted two concurrent studies: 1) Survey regarding medical record acquisition, with methods including an online survey sent to the forensic pathologists and death investigators subscribed to the NAME listserv in the spring of 2016. And 2) Quality improvement project to provide direct access to electronic medical records (EMR), methods including a survey of California Sheriff-Coroner office staff (pop. ~ 1.5 million) before and after efforts to obtain direct medical record access.
Electronic Medical Records in Medicolegal Death Investigation
- Summary | The goal of this whitepaper is to support policies and procedures within an organization, agency training on the importance electronic medical records in medicolegal death investigation, and also to disseminate community awareness and collaboration efforts to improve how MDI data are exchanged and modernized. The audience includes practitioners, forensic laboratory and medical examiner/coroner leadership, and any interested entity that contributes to data exchange for death investigations.
Medicolegal Death Investigation Data Flow Interactive Map
This interactive graphical map helps users better understand the flow of data and the complex relationships between entities in a medicolegal death investigation. By using an interactive process map users can explore and drill down into specific details, and access additional information and resources, which helps provide a high-level global understanding of the diversity of data needs and requirements to inform process improvement and data standardization at the local, state, national and international levels.
Funding for this Forensic Technology Center of Excellence toolkit was provided by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice.
The opinions, findings, and conclusions or recommendations expressed in this toolkit are those of the authors(s) and do not necessarily reflect those of the U.S. Department of Justice.
Contact us at ForensicCOE@rti.org with any questions and subscribe to our newsletter for notifications.
A Product of the Working Group on Data Exchange in Medicolegal Death Investigation
- Suggested Citation | Forensic Technology Center of Excellence. General Provider Resources: Medical Records for Medicolegal Death Investigations Toolkit. (2023, December). Research Triangle Park, NC: RTI International. https://forensiccoe.org/2023-toolkit-medical-records-mdi/.
- The Forensic Technology Center of Excellence (FTCOE) is committed to periodically updating this resource to ensure its relevance. For suggestions or additions to enhance the comprehensiveness of this resource, please contact ForensicCOE@rti.org.
