Speeding Up the Death Certificate Process

When coroner’s office investigators have access to a deceased person’s medical records in the CORHIO health information exchange, they can more quickly issue death certificates.

When a death certificate is delayed, it can cause the grieving family a lot of stress. The burial or cremation cannot proceed. Making financial arrangements, handling the deceased’s assets like cars and houses, and filing a life insurance claim can all be delayed.

For cases where the deceased has been under a physician’s care, a death certificate is issued by that physician. But in the event of a sudden, unexplained or suspicious death, the coroner or medical examiner’s office is called in to help.

To assist coroner’s officers with their cause of death and identification investigations, the CORHIO Board of Directors recently approved language to include Coroners and Medical Examiners (non-HIPAA covered entities) in HIE Governing Principles and Policies. This means coroners and medical examiners can now access patient data in the Community Health Record.

“The sooner we can receive and review medical records, the sooner the cases can be resolved allowing for the family to proceed with the grieving process,” said Andrea McGinnis, Investigator, Office of the Denver Medical Examiner.

“Sometimes families are waiting on the death certificate,” said Brandon Gerber, Investigator, Arapahoe County Coroner. “It’s easier to make decisions based on the latest information and CORHIO really helps with all the avenues of our investigations – we don’t have to wait anymore.”

Investigating Cause of Death

The primary use case for CORHIO is to gather medical history information on the deceased, to aid in cause of death investigations.

“Two of our primary responsibilities are investigations into cause and manner of death,” said McGinnis. “There are many instances when there are no family or friends who can verbally identify medical history; sometimes because we haven’t located them and other times because the decedent didn’t disclose that information. Access to medical records can help us establish chronic problems as well as recent issues that may have resulted in or contributed to the death.”

“Say a 61-year-old dies at home and has a limited medical history, but we can see in the HIE that they did go to a physician’s office in the recent past, we can work with the primary care physician to sign the death certificate, as this type of case shouldn’t involve a coroner,” said Lisa Vantine, Office Administrator, Arapahoe County Coroner.

Identifying Next of Kin

A vital part of the process in a coroner’s office is identifying next of kin, who is responsible for the deceased. This can be very difficult in certain circumstances, such as a homeless individual with no permanent residence where other family members might reside.

“By being able to access multiple facesheets, we can learn the names and information for emergency contacts and family members,” said McGinnis. “In some cases, the records will even discuss family history—where we can learn more about the family and possible next of kin.”

“We use the demographic information as breadcrumbs to follow if it’s unclear who the next of kin is. For example, we might see that someone is divorced based on their last intake form from a doctor visit,” said Gerber.

Quality Reporting

Arapahoe County Coroner and Office of the Denver Medical Examiner are two of only four coroner’s offices in Colorado to be nationally accredited by the National Association of Medical Examiners. This program requires high standards for death investigation and autopsy performance and maintenance of certain records and statistics to monitor the quality of service provided.

“We are required to track and report our turn-around times for case closure, as well as identification and next of kin notification for our accreditation,” said McGinnis. “Our access to the records in CORHIO allows us to find next of kin we might not have known about as quickly before; it allows us to review records faster and close out cases sooner—these things help improve our turn-around times.”

Arapahoe County Coroner has a goal to finalize death certificates and documentation within 60 days, even for the toughest cases. They see the CORHIO health information exchange as a way to accomplish this goal.

“CORHIO will absolutely help – we hope to shorten our document finalization window considerably,” said Vantine. “We’re already noticing that it is – if the records are on CORHIO and everything is in order, we can do it in a day now.”