FHIR MDI Implementation Guide
Conformance Statement
Zeph natively produces FHIR R4 resources conforming to the HL7 Medicolegal Death Investigation (MDI) Implementation Guide. Every Bundle, Composition, Observation, and Patient resource is constructed against the published StructureDefinition profiles — not proprietary formats.
What is the HL7 FHIR MDI IG?
The HL7 FHIR Medicolegal Death Investigation Implementation Guide is a published HL7 standard that defines how medical examiner and coroner offices exchange death investigation data with vital records systems, state EDRS (Electronic Death Registration Systems), and national surveillance programs like CDC NVDRS and SUDORS.
It specifies exact FHIR R4 profiles — extensions of the base Patient, Observation, Composition, and Bundle resources — that an MDI system must produce for a submission to be machine-readable by receiving systems.
IACME accreditation standards and CDC data quality programs increasingly require participating offices to use FHIR-compliant exports. Vendors that produce proprietary flat-file exports force agencies to write custom ETL middleware; Zeph produces standards-conformant FHIR Bundles natively from the API.
Implemented StructureDefinition Profiles
Every FHIR resource produced by Zeph declares its canonical profile URL in the
meta.profile element,
so HAPI FHIR validators and receiving systems can validate the resource automatically.
us-core-patient-decedent Decedent demographics: legal name, DOB, date of death, gender, race (OMB codes), ethnicity (OMB codes), SSN (masked). Extended US Core Patient with MDI-specific constraints.
name.family + name.givenbirthDate (ISO-8601)deceasedDateTime or deceasedBooleangender (FHIR AdministrativeGender)OMB race extensionOMB ethnicity extension us-core-practitioner Medical examiner or certifying physician. NPI identifier recorded when available.
name.textNPI identifier (system: http://hl7.org/fhir/sid/us-npi)qualification.code (MD/DO) Observation-cause-of-death-part1 Cause of death line A (immediate cause). Coded using LOINC 80358-5. Free-text value recorded in valueCodeableConcept.text when no SNOMED code is available.
code: LOINC 80358-5subject → Patient (Decedent)performer → PractitionervalueCodeableConcept.text (cause string)component: interval (e.g. "minutes", "hours") Observation-manner-of-death Manner of death. Coded to SNOMED CT using the MDI-mandated value set. Zeph maintains a full SNOMED map for Homicide, Suicide, Accident, Natural, Undetermined, Could Not Be Determined, and Pending Investigation.
code: LOINC 69449-7valueCodeableConcept: SNOMED CT (e.g. 27935005 Homicide, 44301001 Suicide, 7878000 Accident, 38605008 Natural, 65037004 Undetermined) Observation-toxicology-lab-result Individual toxicology findings — one Observation per substance. Supports LOINC codes for each substance, specimen type, numeric result value with unit, and qualitative interpretation.
code: LOINC code per substance (when available)specimen.type: Blood / Vitreous / Urine / LivervalueQuantity or valueStringinterpretation: Positive / Negative / Detected Composition-mdi-and-edrs The MDI-and-EDRS Composition document — the "cover sheet" that links all case resources. Coded to LOINC 86807-5 (Death investigation). Contains sections for demographics, cause/manner, circumstances, and exam.
type.coding: LOINC 86807-5subject → Patient (Decedent)author → Practitionerextension: tracking-number (case number, EDRS file number, tox lab number)section: demographics, cause-manner, circumstances, exam Bundle-document-mdi-and-edrs The outermost FHIR document Bundle containing all resources for a case. Type = document. Signed with SHA-256 bundle ID. First entry is always the Composition; subsequent entries are all referenced resources.
type: documentid: SHA-256 (uuid v4)timestamp: ISO-8601 generation timeentry[0]: Compositionentry[1..n]: Patient, Practitioner, Observations Terminology & Value Sets
LOINC Codes Used
86807-5 Death investigation document type (Composition type) 80358-5 Cause of death line A (Observation) 69449-7 Manner of death (Observation) 81956-5 Date and time of death 69444-8 Date and time pronounced dead 11378-7 Vital signs section (toxicology obs fallback) SNOMED CT — Manner of Death
27935005 Homicide 44301001 Suicide 7878000 Accident 38605008 Natural 65037004 Undetermined 185973002 Could Not Be Determined pending Pending Investigation (text fallback) OMB Race Codes
1002-5 American Indian or Alaska Native 2028-9 Asian 2054-5 Black or African American 2076-8 Native Hawaiian or Other Pacific Islander 2106-3 White UNK Unknown (v3-NullFlavor) OMB Ethnicity Codes
2135-2 Hispanic or Latino 2186-5 Not Hispanic or Latino UNK Unknown (v3-NullFlavor) Configured National Export Endpoints
Zeph ships with pre-configured FHIR endpoints for the two primary national MDI surveillance programs. The same FHIR Bundle produced for EDRS submissions is reused — no extra data entry required.
CDC NVDRS
NVDRShttps://nvdrs.cdc.gov/fhir/mdi/Bundle
National Violent Death Reporting System. Operated by the CDC. Collects circumstance data for all violent deaths (homicide, suicide, unintentional injury). State health departments aggregate ME/coroner data into NVDRS.
Profile note: Uses Bundle-document-mdi-and-edrs with NVDRS circumstance extensions.
SUDORS
SUDORShttps://sudors.wv.gov/fhir/mdi/Bundle
State Unintentional Drug Overdose Reporting System. Funded by CDC. Requires granular toxicology fields (substance, route, level, specimen). Zeph enforces mandatory tox fields before a SUDORS export can be generated.
Profile note: Uses Observation-toxicology-lab-result with LOINC substance codes. Missing required fields blocked at export.
Built-in Case Validation
Zeph includes a validateMdiCase() function
that runs before any FHIR Bundle export and returns a structured validation result:
Validation errors (block export)
- Decedent demographics missing (name required)
- Cause of death not recorded
- Manner of death not set (cannot map to SNOMED CT)
- Case status not CLOSED (draft bundles blocked)
- EDRS file number absent when state EDRS endpoint selected
Validation warnings (export allowed)
- Date of birth not recorded (deceasedBoolean used)
- NPI not on file for certifying physician
- Contributing conditions empty
- No toxicology findings attached
- Tox lab case number not set
State EDRS Adapter Matrix
Each state EDRS has unique authentication, transport, and field-mapping requirements. Zeph uses an adapter pattern so new states can be added without changing the core FHIR library. The following state adapters ship in the current release:
| State | Adapter ID | EDRS System | Transport | Status |
|---|---|---|---|---|
| California | CA | CA-EDRS / CDPH | FHIR R4 REST + OAuth 2.0 | Implemented |
| New York | NY | NY EDRS / NYSDOH | FHIR R4 REST + OAuth 2.0 | Implemented |
| West Virginia | WV | WV EDRS / WVDHHR | FHIR R4 REST (SUDORS) + OAuth 2.0 | Implemented |
| Additional States | — | Per-state adapter | Adapter pattern — contact sales | On roadmap |
Request a FHIR Conformance Test Package
We can provide a sample FHIR Bundle (anonymized) for validation with HAPI FHIR Validator or the HL7 Touchstone testing platform. Request one from our team.
Request Sample Bundle