Overview
The Jefferson CountyCoroner/Medical Examiner’s Office (JCCMEO) partnered with Acoer through the CDCMDI Connect project to improve data exchange with the Jefferson County DistrictAttorney’s Office (JCDA) [1, 2].
By replacing manual exchange methods with a secure, bi-directional data bridge using FHIR®-ApplicationProgramming Interface (API) specifications, this initiative enabled to improve case information transmission, enhance case tracking, and streamline death investigations.
The implementation of such standards-based data exchange and workflow automation strengthens public health monitoring and evidence-based decision-making, which could help save lives without adding an administrative burden.
Background
Jefferson County, located in the central part of Alabama, is the most populous county in the state, with approximately 662,000 residents, making up about 13% of the state's population [3]. Each year, the Jefferson County Coroner/Medical Examiner’s Office (JCCMEO) receives around 6,500 death notifications from law enforcement agencies and medical facilities, with 20% of these cases are subjects to jurisdictional guidelines in accordance with county law [4].
JCCMEO, like other medical examiner and coroner offices, is responsible for conducting medicolegal death investigations (MDIs) to determine the cause, manner and circumstances of unnatural and unexpected deaths, such as drug overdoses, homicides, suicides, and others. Additionally, they often serve as expert witnesses in court proceedings, providing testimony during trials where the decedent may be a victim.
Opportunities for Improvement
The high caseload and frequent court involvement create significant challenges in managing forensic and legal processes efficiently.
Without streamlined communication, data exchange and an effective case tracking system, delays can hinder both investigations and legal proceedings. Maintaining clear and timely communication, secure data sharing with the district attorney is essential for staying informed about trial schedules and case developments, ensuring that MDI office can fulfill this duty while managing other investigative responsibilities.
These challenges underscored the need for improved coordination tools and communication strategies to facilitate seamless collaboration between forensic and legal teams.
Solution
To address the challenges of data sharing and communication between the Jefferson County Coroner/Medical Examiner’s Office (JCCMEO) and the Jefferson County District Attorney’s Office (JCDA), the MDI Connect Project provided an effective solution.
MDI Connect, a joint initiative by the Centers for Disease Control and Prevention’s (CDC) Collaborating Office for Medical Examiners and Coroners (COMEC) and the CDC Foundation, aims to enhance data exchange and improve interoperability between MDI offices and public health, toxicology or other agencies through collaboration with data sharing partners, software vendors and others [5].
Acoer is an expert in developing and implementing advanced cryptographic technologies to enhance data privacy, security, and interoperability across multiple sectors, particularly in the MDI and healthcare space.
By collaborating with JCCMEO, Acoer developed a secure, automated data-sharing infrastructure, a platform called Health Data Explorer (HDE), that in addition to intuitive reporting, real-time data visualization and analytics, leverages advanced technologies, including Fast Healthcare Interoperability Resources (FHIR®) and blockchain, to enable data exchange between JCCMEO and JCDA, as well as other public health agencies with permission-based access.
(Adopted from MDI Connect project spotlight / JCCMEO poster [6])
Case Management Systems (CMSs) utilized by JCCMEO and JCDA can communicate with each other through FHIR® by using standardized APIs (Application Programming Interfaces) and data formats. FHIR® provides a framework for exchanging health-related information between systems in a consistent and interoperable way, enabling JCCMEO to share and access critical case information in real-time. Meanwhile, blockchain technology ensures the integrity and immutability of the data, allowing both the JCCMEO and JCDA to maintain secure, transparent, and tamper-proof records of case progress and related documentation.
This combination of FHIR® and blockchain significantly enhances the efficiency, accuracy, and trustworthiness of data exchanges, reducing manual efforts and minimizing errors.
Dr. Brandi McCleskey, MD
Associate Coroner/Medical Examiner
Jefferson County Coroner/Medical Examiner’s Office, Alabama, USA
“The blockchain technology allowed us to push our information out in real time. It's queryable. It's, it's verified. I know it's secure. Now, [stakeholders] can access information within a time frame that can actually save lives.”
Conclusion
The integration of FHIR® and blockchain technology marks a transformative shift in medical death investigations process, enabling real-time data exchange streamlining case information transmission, ensuring accurate case tracking, and providing timely court updates.
Traditionally, many national coroner/medical examiner offices still rely on outdated systems, such as paper records or basic spreadsheets, leading to significant delays in compiling health statistics—often taking six months to a year to generate comprehensive reports. By modernizing MDI data practices, this initiative facilitates secure, real-time data accessibility and strengthens public health responsiveness. With enhanced interoperability, agencies can quickly identify emerging health trends and implement data-driven interventions, ultimately contributing to more effective strategies for saving lives.