Introduction

The AeHIN Medical Certificate of Cause of Death (MCCoD) Implementation Guide defines FHIR R4 profiles, value sets, code systems, and implementation rules for the WHO International Form of Medical Certificate of Cause of Death .

This IG is published by the Asia eHealth Information Network (AeHIN) and is designed to be generic and adaptable by AeHIN member countries across Asia. Base FHIR profiles for Patient, Organization, Practitioner, and PractitionerRole are referenced without constraints so that member countries can extend them according to national requirements such as national identifier systems, registration numbers, and administrative fields.

Cause-of-death coding is ICD-version-agnostic, supporting both ICD-10 and ICD-11 as used across AeHIN member states. Countries using the WHO DORIS tool for ICD-11 mortality coding are explicitly supported through a dedicated underlying cause of death profile with a DORIS derivation flag.

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Scope

This IG covers the two frames of the WHO MCCoD form:

• Frame A (Mandatory): The cause of death chain — immediate cause (line a), antecedent causes (lines b, c, d), underlying cause of death, and other significant contributing conditions (Part 2). All Frame A elements are mandatory.
• Frame B (Optional): Other medical data — surgery within 4 weeks, autopsy, manner of death, external cause details, fetal or infant death specifics, and pregnancy status for women of reproductive age. All Frame B elements are optional but carry conditional guidance rules enforced as warning-level invariants.

The following base FHIR resources are used without profile constraints so that member countries may extend them nationally:

• Patient (deceased)
• Practitioner (certifying physician)
• PractitionerRole
• Organization (certifying institution)

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WHO SMART Guidelines Alignment

This IG is designed for alignment with the WHO SMART Guidelines L3 layer. The three-layer architecture adopted is:

• L1 — WHO Guidelines: WHO International Form of Medical Certificate of Cause of Death and ICD mortality coding rules (ICD-10 and ICD-11/DORIS)
• L2 — Data Adaptation Kit (DAK): AeHIN MCCoD data dictionary derived from the openEHR death_summary archetype (openEHR-EHR-EVALUATION.death_summary.v0)
• L3 — FHIR Implementation Guide: This IG — profiles, value sets, logical models, and computable invariants derived from the L2 data dictionary

FHIR Logical Models for Frame A and Frame B are provided as computable L3 data dictionaries with explicit mappings to the WHO MCCoD form fields, the openEHR death_summary archetype paths, and the target FHIR profile elements. See WHO SMART Guidelines Alignment for full details.

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openEHR Alignment

The data elements in this IG are validated against the openEHR death_summary archetype , an internationally governed clinical data model maintained by the openEHR community. This archetype serves as the data modeling authority for all Frame A and Frame B elements, ensuring that FHIR data element choices are clinically sound and internationally comparable.

Every profile element in this IG carries an explicit openEHR archetype path mapping. See openEHR Alignment for the full alignment table.

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Technical Overview

This guide provides regional FHIR profiles, value sets, code systems, logical models, and extensions that software developers and system implementers should use when designing digital health applications for cause-of-death reporting across AeHIN member countries. Using these standards ensures consistency, reduces duplication, and supports regional and international mortality data comparability.

The main sections of this IG are:

• Background and Context — WHO MCCoD form overview, AeHIN context, and rationale for key design decisions
• Design Decisions — Architectural choices including ICD-agnostic coding, DORIS support, openEHR alignment, and the separation of underlying cause of death
• Frame A: Cause of Death (Mandatory) — Profiles, cardinality rules, invariants, and guidance for the mandatory cause of death chain and underlying cause
• Frame B: Other Medical Data (Optional) — Profiles and conditional guidance for surgery, autopsy, manner of death, external cause, fetal/infant death, and pregnancy status
• Terminology — Code systems, value sets, and LOINC codes used in this IG
• Conformance — Conformance requirements, must-support obligations, and guidance for member country national extensions
• WHO SMART Guidelines Alignment — L1/L2/L3 layer documentation and logical model to profile mapping
• openEHR Alignment — Full alignment table between this IG and the openEHR death_summary archetype
• Artifact Index — Complete list of all profiles, extensions, value sets, code systems, and examples
• Examples — Worked example: complete MCCoD document for a myocardial infarction death (ICD-10 country, non-DORIS)
• Downloads — Downloadable package of this implementation guide and related artifacts

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Publication Status

This is version 0.1.0, a draft for AeHIN member country review. It has not yet been formally balloted or published. The canonical URL (http://mccod.w3datanet.com/fhir) is a temporary hosting URL for draft review. AeHIN will assign the official canonical URL before formal publication.

Note to reviewers: Feedback on profiles, terminology bindings, ICD-agnostic design, and national extension guidance is particularly welcome. Please raise issues through AeHIN channels or the IG repository.