Dissecting and Streamlining the Medical Record Acquisition Process in Death Investigation Systems

Though medicolegal death investigation (MDI) systems are generally associated with criminal justice, they serve an integral role in the realm of public health and safety. Medicolegal death investigation offices collect information, including medical records, from a variety of outside sources. For data to travel efficiently, transmission should be fully integrated between the MDI office and external organizations. This is often not the case. Delays in the transmission of medical records in particular lead to subsequent delays in autopsy report completion and death certification or to resource waste in cases where a timely record would have let the pathologist know an autopsy was not required. Almost no peer-reviewed literature currently exists regarding the problem of record acquisition by MDI systems. To develop a better understanding of how electronic medical records have impacted MDI systems, we conducted a mixed methods survey through the National Association of Medical Examiners (NAME) e-mail listserv. We inquired about the medical records acquisition processes at MDI systems around the nation to gauge opinions about the use of electronic health data and the integration of MDI data in public health. Concurrently, we piloted a quality improvement project at the Alameda County Sheriff-Coroner's Office (ACSCO) in Oakland, California, in which we worked with various hospitals to get ACSCO employees direct access to decedents' electronic health records. With data from the survey and pilot project, we were able to document the barriers encountered when attempting to reform medical record acquisition and to suggest systemic changes to reduce delays and wasted resources.