Vital Insights: Medical Examiners and Coroners Data Modernization for Public Health Action.

Medical Examiner and Coroners' (MEC) offices are the cornerstone of forensic mortality investigations and important, although often underacknowledged, partners for public health. While structure and function of these offices vary by jurisdiction, generally they support medicolegal death investigations (MDI) and collect information on causes and circumstances of sudden, unexpected deaths.1,2 They exchange data with a variety of partners, including public health. In 2021, more than 1.4 million deaths were referred to MEC offices, of which approximately 700,000 were accepted for investigation.3 Because MDI data captures causes of death along with circumstances, risk factors, and environmental conditions surrounding deaths, MEC offices represent valuable sources of actionable data for preventing future mortality—particularly when these data are accessed and integrated into public health systems in a timely manner. The Centers for Disease Control and Prevention (CDC) maintain several registries and reporting systems that rely on MDI data nationally, such as the National Violent Death Reporting System (NVDRS), National Vital Statistics System (NVSS), and State Unintentional Drug Overdose Reporting System (SUDORS).4 MDI data are also vital to state-level data systems, including prescription drug monitoring programs, mortality reviews, forensic laboratories, and electronic death registration systems (EDRS). Many MECs, however, face limitations in data infrastructure, which affect timeliness, completeness, and interoperability of MDI data. Modernizing MEC office data infrastructure and strengthening interoperability with public health agencies offer an important opportunity to enhance public health surveillance, accelerate response to emerging threats, and support effective prevention policies and programs. The state of data infrastructure in medical examiner and coroners' offices Modern data systems and technologies that support data collection, management, and secure exchange are essential to improving the completeness, timeliness, and accessibility of MDI data. However, MEC offices face challenges familiar to public health agencies, where outdated technologies and fragmented data systems result in duplicative data entry, difficulties managing caseloads, and limitations to interagency and interjurisdictional data exchange. Some MEC offices lack access to basic technologies such as internet or electronic platforms that support MDI data input, management, and storage (ie, Case Management Systems, or CMS).1,5 In addition, the lack of standardized data formats or exchange mechanisms can hinder data reporting to external national and state-level systems.6 Data infrastructure challenges are further compounded by increasing caseloads and workforce shortages in MEC offices.5 Together, these dynamics can affect data quality and timeliness, delay the identification of emerging public health issues, and limit opportunities for early intervention. Modernizing MEC data infrastructure and advancing data exchange with key partners can help translate MDI data into actionable insights for public health practice and policy. Efforts to modernize should be prioritized and scaled based on the context, resources, and needs of an MEC office, and may include: Implementing new technologies (eg, equipment purchase, adopting or upgrading a CMS). Supporting standard data exchange formats and mechanisms (eg, implementing HL7's Fast Healthcare Interoperability Resources, or FHIR). Pursuing data exchange efforts with public health, laboratories, and other key data partners. Exploring applications of artificial intelligence (AI) to generate more rapid data insights. Examining current efforts and future directions MEC offices' modernization needs align with broader public health data modernization efforts led by CDC, which aim to improve timeliness, quality, and interoperability of public health data. Within CDC, the Collaborating Office for Coroners and Medical Examiners (COMEC) works to support collaboration between public health agencies and MEC offices, and advance MDI data collection, automation, and information sharing.7 Recent efforts toward data modernization in MEC offices have been varied and supported by a number of partners, with support from CDC COMEC. One of these initiatives is MDI Connect, a forum for MEC offices, their data sharing partners (including public health), and software vendors to design, build, and test standards-based data exchange practices. This effort was funded by COMEC with additional support from Bloomberg Philanthropies, and implemented by CDC Foundation and the Association of State and Territorial Health Officials, with contributing technical and subject matter expertise from Georgia Tech Research Institute, the International Association of Coroners and Medical Examiners, and the National Association of Medical Examiners. Launched in 2022, MDI Connect has provided grants and technical assistance to 22 pilot projects that tested the HL7 MDI FHIR Implementation Guide (IG) in real-world settings and created local IGs for several other potential MEC data-sharing opportunities.8 These pilots focused on exchanging laboratory/toxicology, NVDRS, and SUDORS data, as well as sharing organ procurement information and transmitting death certificates for review or cremation clearance. Lessons learned from these pilot projects informed updates to both the MDI FHIR IG and multiple project implementation tools for MEC offices and their data partners to use as they start data modernization projects.9,10 Complementary efforts, such as the National Network of Public Health Institutes' CDC-funded activities, have supported MEC offices by providing grants to support CMS adoption and interoperability with EDRS.11 By enabling near real-time, standardized data exchange, these efforts allow public health agencies to move from retrospective analysis of mortality trends to earlier detection of emerging threats, which creates opportunities to intervene before patterns become widespread. As many MEC offices continue to explore and invest in modern data standards, such as FHIR-based data exchange, others are considering emerging technologies to further enhance the value of MDI data. Several MEC offices, commonly in larger jurisdictions, are beginning to use their CMS to produce dashboards and data visualizations that support insights for community partners, public health agencies, and policymakers. Some are also adopting a growing array of analytic tools that integrate with their CMS to support these efforts. Just as public health agencies are examining AI use cases and applicability, MEC offices are also beginning to explore projects that use generative and predictive AI tools, such as privately trained AI models, to generate more near–real-time insights from both structured CMS and unstructured data sources. Integrating narrative reports, scene investigations, and toxicology findings with structured CMS MDI data may allow for more comprehensive analysis of mortality patterns that can be used by public health to identify trends. Early exploratory use cases for applying AI to the analysis of integrated MEC data are highlighted below. In each of these cases, timely AI-enabled insights can inform targeted outreach, resource allocation, and policy interventions aimed at preventing similar deaths. Overdose death and accompanying drug scene paraphernalia Preventable hypothermia deaths and overlapping risk factors Overdose death and toxicology insights, especially for multisubstance toxicity In addition, several MEC offices have also incorporated applied forensic epidemiologists into their staff who use public health methods to analyze CMS data. These professionals can serve as critical liaisons between MEC offices and public health entities, providing interpretation of aggregated mortality data and supporting timely public health responses.12 The role of public health in advancing MEC data modernization Public health agencies have a pivotal partnership role to play in advancing MEC data modernization by: Building relationships with MEC offices in their jurisdictions to identify shared data priorities, needs, and opportunities to coordinate future efforts, including grant applications. Working collaboratively with MEC offices to establish and expand FHIR-based data exchange with public health data systems. Incorporating representatives from MEC offices in data modernization advisory committees or relevant workgroups to promote coordination and alignment across modernization efforts. Accelerating data insights through the engagement of applied public health and forensic epidemiologists in MDI analytic activities, including the development of dashboards and exploration of AI technologies. Codeveloping informatics and epidemiology practicums that provide students with work experience in both public health agencies and MEC offices, with the goal of supporting an interdisciplinary data workforce. MEC offices offer a wealth of data that can help identify emerging mortality trends, assess the impact of prevention programs and policies, and inform public health decision-making and practice. Modernizing MEC data infrastructure with public health partners can transform MDI data into integrated, timely intelligence that supports public health decision-making and action.