This page documents the alignment between the AeHIN MCCoD Implementation Guide and the openEHR death_summary archetype (openEHR-EHR-EVALUATION.death_summary.v0). It explains the role of the openEHR archetype in this IG's design, the nature and limits of the alignment, and provides a full element-level mapping table.

Role of openEHR in This IG

The openEHR death_summary archetype serves as the data modeling reference for this IG — it is not a dependency, a runtime requirement, or a target implementation technology. No openEHR tooling is required to implement this IG.

Its role is specifically as the L2 data dictionary authority within the WHO SMART Guidelines framework adopted by this IG. The archetype provides:

• An internationally governed, clinician-reviewed clinical data model for cause-of-death information, maintained by the openEHR Foundation through a formal editorial and review process
• Precise, unambiguous data element definitions that validate the clinical correctness of FHIR data element choices in this IG
• A technology-neutral representation that predates and is independent of any particular implementation technology, including FHIR
• Explicit semantic alignment with the WHO MCCoD form, ICD mortality coding concepts, and WHO maternal death surveillance definitions

Every profile element in this IG that corresponds to a WHO MCCoD form field carries an explicit mapping to its openEHR archetype path in the FSH source, using the mapping identity openEHR.

openEHR death_summary Archetype

The openEHR-EHR-EVALUATION.death_summary.v0 archetype is a maximal dataset archetype — it captures all clinically relevant information about a patient's death, of which the WHO MCCoD form is a subset. Key archetype clusters relevant to this IG are:

Archetype Cluster / Element	Archetype Path	Corresponds to WHO MCCoD
Cause of death — immediate cause	death_summary/cause_of_death/immediate_cause	Frame A, Part 1, Line a
Cause of death — antecedent causes	death_summary/cause_of_death/antecedent_cause[1..3]	Frame A, Part 1, Lines b, c, d
Onset to death interval	death_summary/cause_of_death/duration	Frame A — Time interval from onset to death
Underlying cause of death	death_summary/underlying_cause_of_death	Frame A — Underlying cause (ICD-selected)
Contributing factors	death_summary/contributing_factors	Frame A, Part 2 — Other significant conditions
Manner of death	death_summary/manner_of_death	Frame B — Manner of death
Surgical history	death_summary/surgical_history	Frame B — Surgery within last 4 weeks
Autopsy	death_summary/autopsy	Frame B — Autopsy requested / findings used
External cause	death_summary/external_cause	Frame B — External cause or poisoning
Place of occurrence	death_summary/external_cause/place_of_occurrence	Frame B — Place of occurrence of external cause
Fetal or infant death	death_summary/fetal_or_infant_death	Frame B — Fetal or infant death section
Pregnancy status	death_summary/pregnancy_status	Frame B — Women of reproductive age section

Full Element Alignment Table

The following table maps every data element in this IG to its corresponding openEHR archetype path and WHO MCCoD form field. Elements marked N/A in the openEHR column represent process metadata or FHIR-specific structural elements that do not have a direct clinical archetype equivalent.

Frame A — Cause of Death Chain

FHIR Element	Profile	openEHR Path	WHO MCCoD Form Field
extension[linePosition].valueCode	MCCoDCauseOfDeathCondition	cause_of_death/sequence	Frame A, Part 1 — Line a / b / c / d
code.text (line a)	MCCoDCauseOfDeathCondition	cause_of_death/immediate_cause/DV_TEXT	Frame A, Part 1, Line a — text field
code.coding (line a)	MCCoDCauseOfDeathCondition	cause_of_death/immediate_cause/DV_CODED_TEXT	Frame A, Part 1, Line a — coded
code.text (lines b/c/d)	MCCoDCauseOfDeathCondition	cause_of_death/antecedent_cause[n]/DV_TEXT	Frame A, Part 1, Lines b/c/d — text field
code.coding (lines b/c/d)	MCCoDCauseOfDeathCondition	cause_of_death/antecedent_cause[n]/DV_CODED_TEXT	Frame A, Part 1, Lines b/c/d — coded
extension[onsetToDeathInterval].valueString	MCCoDCauseOfDeathCondition	cause_of_death/duration	Frame A, Part 1 — Time interval from onset to death
code.text	MCCoDUnderlyingCauseOfDeath	underlying_cause_of_death/DV_TEXT	Frame A — Underlying cause of death (text)
code.coding	MCCoDUnderlyingCauseOfDeath	underlying_cause_of_death/DV_CODED_TEXT	Frame A — Underlying cause of death (coded)
extension[dorisDerived].valueBoolean	MCCoDUnderlyingCauseOfDeath	N/A — process metadata for ICD-11/DORIS	N/A — process audit element
code.text	MCCoDContributingCondition	contributing_factors/DV_TEXT	Frame A, Part 2 — condition text
code.coding	MCCoDContributingCondition	contributing_factors/DV_CODED_TEXT	Frame A, Part 2 — condition code
extension[onsetToDeathInterval].valueString	MCCoDContributingCondition	contributing_factors/duration	Frame A, Part 2 — time interval in brackets

Frame B — General Medical Data

FHIR Element	Profile	openEHR Path	WHO MCCoD Form Field
valueCodeableConcept	MCCoDMannerOfDeath	manner_of_death/DV_CODED_TEXT	Frame B — Manner of death
valueCodeableConcept	MCCoDAutopsyPerformed	autopsy/requested	Frame B — Was an autopsy requested?
component[findingsUsed].valueCodeableConcept	MCCoDAutopsyPerformed	autopsy/findings_used	Frame B — Were findings used in certification?
valueCodeableConcept	MCCoDSurgeryPerformed	surgical_history/performed	Frame B — Was surgery performed within last 4 weeks?
effectiveDateTime	MCCoDSurgeryPerformed	surgical_history/date	Frame B — Date of surgery
component[reason].valueString	MCCoDSurgeryPerformed	surgical_history/reason	Frame B — Reason for surgery
effectiveDateTime	MCCoDInjuryIncident	external_cause/date_of_injury	Frame B — Date of injury
component[description].valueString	MCCoDInjuryIncident	external_cause/description	Frame B — Description of external cause / poisoning agent
component[placeOfOccurrence].valueCodeableConcept	MCCoDInjuryIncident	external_cause/place_of_occurrence/DV_CODED_TEXT	Frame B — Place of occurrence of external cause

Frame B — Fetal or Infant Death

FHIR Element	Profile	openEHR Path	WHO MCCoD Form Field
component[multiplePregnancy].valueCodeableConcept	MCCoDFetalOrInfantDeath	fetal_or_infant_death/multiple_pregnancy	Frame B — Multiple pregnancy
component[stillborn].valueCodeableConcept	MCCoDFetalOrInfantDeath	fetal_or_infant_death/stillborn	Frame B — Stillborn?
component[hoursSurvived].valueInteger	MCCoDFetalOrInfantDeath	fetal_or_infant_death/hours_survived	Frame B — Hours survived if death within 24h
component[birthWeight].valueQuantity	MCCoDFetalOrInfantDeath	fetal_or_infant_death/birth_weight	Frame B — Birth weight in grams
component[gestationalAge].valueQuantity	MCCoDFetalOrInfantDeath	fetal_or_infant_death/gestational_age	Frame B — Completed weeks of pregnancy
component[motherAge].valueQuantity	MCCoDFetalOrInfantDeath	fetal_or_infant_death/mother_age	Frame B — Age of mother in years
component[perinatalMaternalConditions].valueString	MCCoDFetalOrInfantDeath	fetal_or_infant_death/maternal_conditions	Frame B — Conditions of mother affecting fetus/newborn

Frame B — Women of Reproductive Age

FHIR Element	Profile	openEHR Path	WHO MCCoD Form Field
component[pregnantWithinYear].valueCodeableConcept	MCCoDPregnancyStatus	pregnancy_status/pregnant_within_year	Frame B — Was the deceased pregnant within past year?
component[pregnancyTiming].valueCodeableConcept	MCCoDPregnancyStatus	pregnancy_status/timing	Frame B — Timing of pregnancy relative to death
component[pregnancyContributedToDeath].valueCodeableConcept	MCCoDPregnancyStatus	pregnancy_status/contributed_to_death	Frame B — Did the pregnancy contribute to the death?

Gaps and Differences

The following differences between the openEHR death_summary archetype and this IG are intentional design decisions, not alignment failures:

Topic	openEHR Archetype	This IG	Rationale
Onset-to-death interval type	DV_DURATION (structured)	string (free text)	Clinical estimates on death certificates are inherently imprecise and do not conform to structured duration semantics. Free text preserves clinical language faithfully.
Underlying cause — DORIS flag	Not present in archetype	extension[dorisDerived] — mandatory	ICD-11/DORIS is not yet reflected in the v0 archetype. The extension adds process audit capability required for ICD-11 implementations.
Line position identifier	Implicit sequence within cluster	extension[linePosition] — explicit code (a/b/c/d)	FHIR Condition resources are independent — unlike openEHR cluster slots which have implicit positional ordering, FHIR resources need an explicit discriminator to establish ordering.
Death date and time	death_summary/date_of_death	Patient.deceasedDateTime (base FHIR Patient)	FHIR already provides Patient.deceased[x] for date of death. Duplicating this in a Condition or Observation would be redundant. Member countries may profile Patient to make this element must-support.
Place of death	death_summary/place_of_death	Not profiled in this IG	Place of death is not on the WHO MCCoD form (it is on civil registration forms). This IG scope is the MCCoD form only. Member countries may add place of death via national extension.
Cause coding system	DV_CODED_TEXT — no system binding	Extensible binding to mccod-cause-of-death-codes	The openEHR archetype intentionally does not bind to a specific terminology. This IG adds an extensible ValueSet that declares known ICD system URIs while preserving the same openness.

Archetype Elements Not Covered by This IG

The openEHR death_summary archetype is a maximal dataset. The following archetype elements are outside the scope of the WHO MCCoD form and are therefore not profiled in this IG. Member countries MAY include these in national extensions:

• Place of death
• Death registration number
• Informant details
• Funeral director details
• Additional demographic data beyond what is on the MCCoD form

How to Read the Mappings

Every FSH profile in this IG includes explicit openEHR mapping declarations using the FHIR StructureDefinition.mapping element with identity openEHR. These mappings are visible in the profile definitions and in the logical model FSH source. To view them:

• Navigate to any profile page (e.g. MCCoDCauseOfDeathCondition ) and select the Mappings tab
• View the logical model FSH source files (logical-frame-a.fsh, logical-frame-b.fsh) which carry all three mappings per element: WHO MCCoD form field, openEHR archetype path, and FHIR profile target