Introduction

Working Group on Data Exchange in Medicolegal Death Investigation

Working Group on Data Exchange in Medicolegal Death Investigation

Working Group on Data Exchange in Medicolegal Death Investigation

The National Institute of Justice and its Forensic Technology Center of Excellence convene the Working Group on Data Exchange in Medicolegal Death Investigation in collaboration with and supported by the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS). This working group is a diverse assembly of medicolegal death investigation professionals and ancillary professionals working to document and provide recommendations to enhance data exchange and collection in death investigation. This Medicolegal Death Investigation-Data Exchange-Working Group (MDI-Data-WG) gains insight from medical examiners, coroners, forensic investigators, epidemiologists, public health analysts, researchers, crime laboratory directors, law enforcement, federal agencies, toxicologists, and forensic pathologists acting as members, observers, and facilitators. The initial focus of this working group placed specific emphasis on three subcommittees: Frequently Used Data Elements, Taxonomy of Drugs Identified in Fatalities, and Forensic Science Data Exchange. Following breakout discussions during the December 2022 meeting, the working group will move forward with three subcommittees focusing on:

  • Data Elements
    • This group will continue to focus on information obtained during an MDI investigation including cause and manner-specific data elements; standardizing fields and definition of data elements allows data exchange among community members who need timely data, such as public health/surveillance and other drug related data systems (e.g., prescription drug monitoring programs, Overdose Detection Mapping Application Program [ODMAP]).
  • Emerging Drugs 
    • This group will continue to assist in developing methods of capturing and disseminating information on the types of drugs involved in deaths, including drug toxicology taxonomy and other categorizations and classification needs around drug naming, drug terms, drug mappings, and drug classification among MDI collaborators to facilitate information exchange of data related to drug overdose mortality. 
  • Workflow Processes 
    • This group will continue to gather information about the collecting, storing, and reporting processes between MDI offices and others who either use or contribute to MDI data. 

The goals of this working group are to 1) document the types of data that are commonly exchanged with public health and public safety partners and determine collective usage points, 2) provide suggestions on how to improve the naming process for emerging drugs, 3) guide the drug mapping/classification process, and 4) recommend needed enhancements to the operation of exchanging forensic data with other organizations. 

 Working Group Participants 

Kate Brett Matthew Gamette Robert Johnson Kathryn Pinneri
Ted Brown James Gill Kelly Keyes Eric Puster
Nichole Bynum Bruce Goldberger Bridget Kinnier Jeri Ropero-Miller
Carri Cottengim Laura Gould *Alex Krotulski Kriste Ross
Nicole Croom Christopher Harrison Sarah Lathrop Frances Scott
Chris Delcher Scott Hayes Jennifer Love *Jennifer Snippen
Dan Dye Bruce Houlihan Kate Maloney Margaret Warner
*Brian Ehret Donna Iula Christine Mattson Agnes Winokur
Erica Fornaro Linda Jackson Danielle McLeod-Henning Lucas Zarwell
John Fudenberg Tracey Johnson Bobbi Jo O'Neal * Designates Subcommittee Chair

Working Group Products

Graphic Description – Medicolegal Death Investigation Frequently Used Data Elements for Toxicology and Seized Drugs

Graphic Description – Medicolegal Death Investigation Frequently Used Data Elements for Toxicology and Seized Drugs

This graphic shows the list of data elements that should be considered and reported with toxicology and seized drug (chemistry) cases. This graphic also links these frequently used elements to sections within the report and to overarching categories of death investigation. Items represented as small, closed, and colored circles (e.g., Lab Name), located under each half circle (e.g., Lab and Case Information) are elements that are linked to each other. This graphic can be downloaded and used in training to ensure all are understood and considered for inclusion on reports. Additionally, the graphic can be used to develop checklist for toxicologists and chemists, develop programming characteristics for data developers to code laboratory information, or assist with standardization and consistency among data exchange as part of other resources.

Graphic Description – Frequently Used Data Elements Collection Systems and Primary Documentation

Graphic Description – Frequently Used Data Elements Collection Systems and Primary Documentation

This measles chart is intended to provide a graphical representation of government systems that collect similar death investigation data elements. The X axis represents five mortality collection systems, and the Y axis represents the frequently used data elements put together by the MDI-Data-WG. Layered on top of this information are sections of color that correspond to the primary documentation in the upper left-corner of where that information may typically come from (i.e., primary documentation source).

Graphic Description – Medicolegal Death Investigation Case Specific Frequently Used Data Elements and Chart

Graphic Description – Medicolegal Death Investigation Case Specific Frequently Used Data Elements and Chart

These case specific data elements are meant to be used in addition to the commonly collected data elements that should be collected and recorded for every case. For example, overarching data elements such as location, decedent name, and age are not reiterated in these case specific data element clusters. The intent of this is to highlight several specific case types (drowning, substance related, falls, firearm related, and sudden unexpected infant deaths) and the set of data elements that need to be collected when those types of cases are suspected by a MEC. The lists are not necessarily specific to investigating manner of death which requires additional data to be collected and recorded, and in certain situation multiple sets of these elements may need to be collected (such as a case that is suspected to be either substance related and/or drowning related). Ensuring that all frequently collected data elements as well as case specific data elements are collected help to better inform investigative and public health/safety practices. This graphic can be downloaded and used in agency training to ensure all data are collected. Additionally, the graphic can be used to develop programming requirements for data developers to code medicolegal death information or assist with standardization and consistency among data exchange as part of other resources.

Forensic Community Drug Database Conceptualization

White Paper – Forensic Community Drug Database Conceptualization

Medicolegal death investigations commonly encounter drugs, drug metabolites, and other related substances. Public health and safety agencies are tasked with tracking drugs and related outcomes, including fatal and nonfatal overdoses. To accomplish this task in an accurate and timely manner, there is a need for the standardization of drug names and nomenclature, as well as classification and taxonomy. In addition, there is a need for a collective and comprehensive resource, such as a forensic community drug database, that the medicolegal death investigation community can use to learn about drugs, linking associated chemical information, published articles, and other literature. Developing a system that would allow the forensic community and other collaborators to determine which drug terms are the same (i.e., synonyms) and the relationship between the drugs (e.g., metabolite, precursor), would benefit the death investigation, public health, and public safety communities, as well as forensic science research. 

General Provider Resources: Medical Records for Medicolegal Death Investigations Toolkit

General Provider Resources: Medical Records for Medicolegal Death Investigations Toolkit

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).

Interactive Map: Medicolegal Death Investigation Data Flow

Interactive Map: Medicolegal Death Investigation Data Flow

This interactive graphical map helps users better understand the flow of data and the complex relationships between entities in an MDI 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. 

Information Sharing Between Medicolegal Death Investigators and Toxicology Testing Services

Information Sharing Between Medicolegal Death Investigators and Toxicology Testing Services

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 toxicology testing services, 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. 

Information Sharing Between Medicolegal Death Investigation Offices and Organ and Tissue Recovery Organizations

Information Sharing Between Medicolegal Death Investigation Offices and Organ and Tissue Recovery Organizations

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. 

Electronic Medical Records in Medicolegal Death Investigation

Electronic Medical Records in Medicolegal Death Investigation

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. 

Electronic Death Registry in Medicolegal Death Investigation

Electronic Death Registry in Medicolegal Death Investigation

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. 

Data Exchange Practices of Medicolegal Death Investigation

Data Exchange Practices of Medicolegal Death Investigation

This document summarizes the opportunities for and challenges of increasing standardization and automation in approaches to collecting and exchanging data among MECs, investigators, forensic scientists, and other MDI collaborators identified by the MDI-Data-WG. It also identifies high-priority needs that, if fulfilled, will build a foundation toward implementing best practices and standards, promoting improved data collection and surveillance, and supporting data exchange for MDI.

The information collected in this document will impact MDI and forensic science communities in the United States by (1) defining, updating, and establishing the most frequently exchanged data elements that are necessary components of a comprehensive and modernized data exchange in MDI; (2) laying the framework for how drugs are named and how these names are communicated to others; and (3) documenting workflow processes, data exchange needs and processes, data standardization methods, and common language for the MDI systems and its stakeholders.

Medicolegal Death Investigation Frequently Used Data Elements

Medicolegal Death Investigation Frequently Used Data Elements

This graphic shows the final list of data elements that should be collected for every case. This graphic also links these frequently used elements to overarching categories of death investigation and indicates how these elements are integrated into the death investigation process. Italicized items are examples of information that could be provided during an investigation, and standard information is represented in normal text. This graphic can be downloaded and used in agency training to ensure all data are collected. Additionally, the graphic can be used to develop checklists for death investigators, develop programming requirements for data developers to code MDI information, or assist with standardization and consistency among data exchange as part of other resources.

Drug Taxonomy: Framework for Subclassification and Naming of Novel Psychoactive Substances

Drug Taxonomy: Framework for Subclassification and Naming of Novel Psychoactive Substances

This framework tool can assist forensic scientists seeking to better understand how drugs are classified by structural components. It is broken down by NPS classes (e.g., opioids) and then further subdivided by subclassifications of each NPS class (e.g., fentanyl analogs). This framework provides potential names for a substance, a figure with a drug structure from the subclass (with core components highlighted), and an example substance that fits within this subclassification. Users of this framework can easily follow this layout to understand how NPS are subclassified and how those drug molecules could be named. The framework was created to be a standalone poster to use as a reference. This alleviates scientists of the need to check multiple sources and allows for quicker association with naming convention and nomenclature. Although this framework tool helps users understand the drug-naming process, it does not provide a means to predict and name future unknown substances by simply following this subclassification scheme and framework.

Ideal State Required for Successful Medicolegal Death Investigation Data Exchange Across Data Exchange Entities

Ideal State Required for Successful Medicolegal Death Investigation Data Exchange Across Data Exchange Entities

This graphic shows the ideal state of medicolegal death investigation data exchange among data entities (i.e., data users and data producers). Data users and data producers are all data entities located in the outermost ring. Each data entity segment indicates specifically named data types or data exchanged systems within it. Arrows in the background indicate the primary (larger arrow), secondary (smaller arrow) or equivalent (equal arrow size) direction of data workflow either coming from the medicolegal death investigation system (i.e., medical examiner and coroner offices within the United States) or being provided to the medicolegal death investigation system indicated by the innermost ring. A middle ring indicates the "System of data programmers and technology developers" that play a professional role by assisting with modernization and digitization of data for the medicolegal death investigation system.

Currently Applied Naming Conventions for Various Subclassifications of Novel Psychoactive Substances

Currently Applied Naming Conventions for Various Subclassifications of Novel Psychoactive Substances

This document outlines recommended naming conventions for several popular novel psychoactive substances (NPS) subclassifications; however, it is not all-inclusive. Example figures and the currently used or existing naming conventions are included for each.

Related Resources

External Resources

Funding was provided by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. This work was also supported by the Centers for Disease Control and Prevention (Contract Number HHSM500201200008I, Task Order Number 200-2016-F-91567).

The opinions, findings, and conclusions or recommendations expressed in these resources are those of the author(s) and do not necessarily reflect those of the U.S. Department of Justice or the Centers for Disease Control and Prevention.

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