1

NATIONAL COMMISSION 

ON FORENSIC SCIENCE

Electronic Networking of Medical Examiner 

and Coroner Offices in the United States

 

Type of Work Product

Policy Recommendation developed by the Medicolegal Death Investigation Subcommittee.

Recommendation

The National Commission on Forensic Science requests that the Attorney General of the United 

States approve policy that recommends the implementation of an electronic communication 

network for all medical examiner and coroner offices in the United States, to be developed and 

implemented by 2017 in conjunction with the Centers for Disease Control and Prevention and 

other federal agencies with interest in medicolegal death investigation. 

Implementation Strategy

The National Institute of Justice and CDC would establish and fund a Working Group in 2015 to 

prepare a specific plan to develop a Medical Examiner and Coroner Electronic Information 

Network (MECIN). 

The working group would include at least one representative from each of the following, including 

a sufficient number of members from the medical examiner and coroner communities:

 National Association of Medical Examiners

 International Association of Coroners and Medical Examiners

 The National Institute of Justice

 The Centers for Disease Control and Prevention’s National Violent Death Reporting 

System 

 The Organization of Scientific Area Committees MDI Subcommittee

 The Department of Homeland Security

 The National Center for Health Statistics

 The International Association of Chiefs of Police

 An entity which has developed on-line databases used by medical examiners and coroners

The working group would identify:

 The major goals for the system

 A standard, permanent email address format for every coroner and medical examiner office

 A method to ensure that all medical examiners and corners in the United States have 

internet access at a minimum, and preferably, an email service provider and address

 A parent entity for the system, which would manage, administrate, maintain the system, 

and develop policy for system use and access. Developing a method for keeping the 

MECIN current is a critical component of the system’s success.

 A method to obtain necessary computer hardware and to develop needed software
2

 How dissemination of, and requests for information would be controlled. 

 In states with a state medical examiner having regional offices or also having coroners, 

whether information would flow only to the state medical examiner for distribution as 

needed, and/or directly to the other medicolegal officers in the state.

 A way that the system could be managed by an entity which is not subject to survey and 

information collection limitations imposed on federal agencies. 

 Funding sources to support development, implementation, and ongoing administration and 

maintenance of the system once up and running. 

The working group would meet in mid-2015 and by the end of 2015, complete the above tasks. A 

system developer would be identified in late 2015 and the system would be implemented by the 

end of 2016. The Appendix contains a breakdown of costs, which would total approximately 

$130,000 in the first year and then approximately $62,000 per year thereafter. States would bear 

the cost of ensuring internet access for all coroners and/or medical examiners in the state. 

Statement of Issue

There is not, and never has been an electronic communication system which would allow 

communication with all medical examiners and coroners (ME/Cs) in the United States. Such a 

system would be valuable for disseminating relevant information to medical examiners and 

coroners and for collecting information when needed. An electronic communication system has 

great potential for the public health, public safety, justice, legal, and medical communities. 

Background

The Centers for Disease Control and Prevention (CDC) once had a Medical Examiner/Coroner 

Information Sharing Program (MECISP). One of the many goals of the original program was to 

facilitate communication among death investigators, the public health community, federal 

agencies, and other interested groups (1). As such, the MECISP published a directory that 

described the structure of death investigation systems by state, and listed names and contact 

persons for all medicolegal jurisdictions in the United States. The MECISP did not include an 

electronic communication system which covered all coroners and medical examiners in the United 

States. CDC’s National Center for Health Statistics is currently developing a program to promote

public health activities in offices of medical examiners and coroners. The goals are envisioned to 

be participating in the development and promotion of standards for death investigation, for the 

collection and automation of death investigation data, and for death certificate reporting; and to 

coordinate efforts with other interested agencies to accomplish these goals and to avoid duplication 

of effort. As it was for its predecessor program, facilitating communication among death 

investigators, the public health community and federal agencies is critical to the goals. This 

program currently lacks funds to fully realize the goals of the envisioned program. 

Currently, CDC maintains a Health Alert Network (HAN) for sharing cleared information about 

urgent public health incidents which provides an avenue of communication with medical 

examiners and coroners on issues related to public health (3). The HAN collaborates with federal, 

state, territorial, and city/county partners to develop protocols and stakeholder relationships for 

distributing the information. Currently, all ME/Cs can voluntary sign onto HAN and receive 

messages. ME/C may also receive messages when the content is deemed appropriate by the state 

or local HAN coordinator. CDC’s Clinical Outreach and Communication Activity (COCA) is also 
3

available to provide information to stakeholders about public health threats and emergency 

preparedness (4). To date, very few COCA activities and HAN alerts have been specifically 

targeted medical examiners and coroners as an audience. CDC’s NCHS has email contacts for 

state and local vital records registrars who process death certificates as part of their duties, and in 

turn, most vital records registrars maintain contact with medical examiners and coroners in their 

jurisdiction to facilitate communication around death certification, including the quality of medical 

information reported on the death certificate (2). The information from death certificates is used 

to compile statistics on the causes of death in the US and is used for medical and public health 

research and prevention. 

Each of the CDC networks serves a very specific purpose and limits the messages sent to those 

that are scientifically or otherwise vetted. The systems are designed around public health and 

safety communication, and around maintaining the high quality mortality data needed for public 

health. However, there are many issues of relevance to medical examiners and coroners which are 

not directly related to public health and safety. 

There are electronic databases and hardcopy manuals with contact information for medical 

examiners and coroners in the United States, but email addresses are often lacking (4). Even in 

states which have on-line coroner or medical examiner association directories, email contact 

information is often absent (or inaccurate), as in Georgia and Mississippi, for example, and many 

other states (5,6). The unavailability of email addresses makes it difficult to assemble a complete 

list of email addresses for all ME/Cs in the United States. Because many coroner offices are in 

small rural areas, in the not-to-distant past, some such offices lacked computers (some may still be 

in this situation) or reliable internet access, also posing obstacles to wide spread electronic 

communication with ME/Cs. Most coroners are elected and the coroner may change when 

elections occur, or they may have term limits, thus requiring updates of contact information such 

as email addresses. Appointed medical examiners may be replaced as well. Even in coroner states 

which also have a state medical examiner, the ability of the state medical examiner to electronically 

contact all coroners in the state may be limited. A concerted effort to assemble a list of email 

addresses for the nearly 3000 ME/Cs in the United States showed that the percent of obtainable 

email addresses ranged from 20% to 100% among the states with an average of 84% (7). All of 

these obstacles explain why a global electronic communication system for ME/Cs has not yet 

emerged. These obstacles can be overcome, however, with thoughtful planning, and would need 

to be addressed during development of the MECIN system 

If there were an electronic communication system for all ME/Cs in the United States, important 

information could be disseminated to the ME/Cs by multiple entities. Such entities include, but are 

not limited to, the CDC, US Drug Enforcement Agency (DEA) and its High Intensity Drug 

Trafficking Area program (HIDTA), US Department of Transportation (which includes the FAA 

and NHTSA), Federal Emergency Management Agency (FEMA), Department of Homeland 

Security (DHS), Food and Drug Administration (FDA), Consumer Product Safety Commission 

(CPSC), the National Institute of Justice (NIJ), state health departments, the newly formed 

Organization of Scientific Area Committees (OSAC) which will be developing guidelines and 

standards, the National Commission on Forensic Science and its subcommittees, the National 

Association of Medical Examiners (NAME), the International Association of Coroners and 

Medical Examiners (IAC&ME), and other such agencies and organizations. All of the 
4

aforementioned conduct activities which are directly relevant to medicolegal death investigation. 

For example, a recent email was sent through the CDC’s HAN regarding the death of an infant 

due to a fatal fungal infection resulting from ingestion of a dietary supplement product (8). This

information is important for ME/Cs to know, but the number of ME/Cs receiving the advisory 

nationwide undoubtedly varied by state and probably did not reach all ME/Cs in the United States. 

There are many other instances in which quick and/or global communication with ME/Cs would 

be helpful. For example, there are probably coroners and medical examiners in the United States 

which are unfamiliar with the NIJ Guide for the Death Scene Investigator which has existed for 15 

years, or the concept of excited delirium, or the emergence of fentanyl produced by clandestine 

labs in overdose cases involving heroin. Many more examples could be cited. 

If an electronic communication system for ME/Cs were to emerge, it is foreseeable that the system 

could be used not only to disseminate important information, but also to collect information from 

ME/Cs for public health, public safety, and other purposes. Thus, the system could be used to 

conduct what might be regarded as surveys. Federal regulations limit surveys. Thus, it would be 

preferable to have the communication system be managed by an entity which is not subject to 

survey limitations imposed on federal agencies. 

The MDI-Subcommittee envisions an electronic communication system which would enable the 

following:

1) Dissemination of information which is important to ME/Cs. This would include public 

health and safety alerts, guidelines, standards, and other useful procedural alerts and 

information;

2) Ability for ME/Cs to make inquiries which would be reviewed and addressed

3) A repository for important documents such as guidelines, standards, protocols, and 

resources which are available to assist in death investigations

4) Facilitation of research involving medical examiners, coroners, and death investigation

5) Announcements of importance such as grant and funding opportunities

6) A controlled, limited access directory of contact information for all ME/Cs in the United 

States 

7) Access by all ME/Cs via the internet and/or email

8) Controlled access to the system via a user registration and verification process

9) Updating of ME/C contact information and profile when a given ME/C is replaced

10) A standardized email and/or username algorithm such that the email address/username is 

predictable, jurisdiction-based, and permanent even if a given ME/C is replaced by another

The National Missing and Unidentified Persons System (NamUs) could serve as a model for 

MECIN development and management. NamUs started as a pilot project of a working group 

through a volunteer effort, eventually became funded by the National Institute of Justice, was 

further developed, and now is administered within a health sciences laboratory setting with funded 

workers and an advisory group. 
5

References

1) Hanzlick R. The Centers for Disease Control and Prevention's Medical Examiner/Coroner 

Information Sharing Program (MECISP). J Forensic Sci 1997;42:531-2.

2) Personal communication. Margaret Warner. National Center for Health Statistics. 

October 14, 2014. 

3) CDC Health Alert Network. Available at http://www.bt.cdc.gov/han/

4) CDC. Clinical Outreach and Communication Activity 

http://emergency.cdc.gov/coca/calls/

5) National Directory of Law Enforcement Administrators. National Public Safety 

Information Bureau. Stevens Point, Wisconsin. 2014. See also safetysource.com 

6) Georgia Coroners Association Coroner Directory. 

See http://georgiacoronersassoc.org/coroner-directory

7) Mississippi Coroner-Medical Examiner Association Coroner Directory.

See http://mscoroner.com/coroners.pdf

8) Personal Communication. Steve Clark. Occupational Research and Assessment. Big 

Rapids, Michgan. November 26, 2014. 

9) CDC Health Advisory. Fatal Gastrointestinal Mucormycosis in an Infant Following 

Ingestion of Contaminated Dietary Supplement – Connecticut, 2014. Distributed by the 

CDC Health Advisory Network. November 25, 2014. 

APPENDIX

Estimated Costs of the Proposed MECIN system

Task Frequency Estimated Cost

Initial 2-3 day meeting of working group One time $10,000 

Email server system hardware and software One time 2,500

Collection and entry of email addresses and standard email 

addresses

One time $50,000

Development of on-line database and email server system One time $50,000

Overhead One Time $17,000

One-time costs $129,500

Data storage Ongoing 200/year*

IT Support and Help Desk Ongoing 12,000/year

System and user management (1 FTE) Ongoing 50,000/year

Ongoing Costs $62,200/year

(*) This could approximately double each year.

Thus, first year costs would approximate $130,000 and subsequent annual costs would be about 

$62,000.