Executive Summary

Major findings

• Current coronial information systems are not able to provide the quality of information or efficient access to information which is required by both the coroners and major users of coronial data. They are mainly paper-based, have few systematic ways of indexing data and vary in terms of detail and quality of information
• There is a commitment by coroners to the development of a better information system and the sharing of this information with appropriate, interested parties.
• Development is limited by lack of resources, lack of familiarity with and access to modern computer technology in many jurisdictions, and a fragmented approach by the many users of information.
• There is a need to develop a systematic way of investigating and recording information about deaths, taking into account the needs of major users of information, and using systematic coding procedures.
• Major users expend a great deal of effort and large amounts of money accessing coronial data. Much of this is due to the way in which records are stored and a lack of appropriate indexing systems. Even where information from coroners is coded by external agencies, the resulting indexing systems are not provided to the coroner for use in the performance of coronial duties.
• Reallocation of these resources to an efficient computerised system would allow ongoing operation of the system with increased utility of coronial information to all users.
• The estimated maximum cost of establishing the system is approximately $270,000. Annual running costs would be around $210,000. Use and upgrading of existing facilities should reduce these costs.
• A national coronial information system will contribute significantly to planning the prevention of death and injury. This has the potential to produce major reductions in the costs of injury to Australian society.

Technical Recommendations

1. It is recommended that coroners and administrative personnel from each jurisdiction develop plans for computerised administrative systems that include at least a common core of information which can support a national coronial information system. This may include cooperative development of systems or merging into a single system.
2. It is recommended that the Australian Coroners' Society (ACS), in conjunction with specialists with an interest in particular causes of death, design standard investigation and recording protocols for significant classes of death and promulgate these for the investigation process.
3. It is recommended that the ACS develop a set of standards for the reporting of findings and promulgate this for use by all coroners in Australia.
4. It is recommended that the ACS develop a standard approach to facilitate the reporting of matters which are transferred to other courts and, where necessary, that coroners request that changes be made to Coroner's Acts to permit this approach to be implemented.
5. It is recommended that a strategy be developed by interested parties, including the coroners and major users, to develop a national coroners' database during the 1995-96 financial year, with a view to stage one operation commencing in early 1996.

Recommendations of coroners and users

The meeting endorsed these five recommendations and made the following additional recommendations:

1. That the ACS:
   1. endorse the findings of the feasibility study;
   2. approach the State and Federal attorneys-general to gain support and resources for the development of a national coronial information system (NCIS);
   3. seek the formal commitment of major users to the establishment of the NCIS;
   4. establish a timetable for the implementation of the NCIS;
   5. establish a steering committee whose charter includes the oversight of the establishment of the NCIS, nomination of an auspicing body and site of operations, and establishment of ongoing management mechanisms. The steering committee shall include State coroners or their nominees (empowered to act on their behalf) and representatives of major user groups.
2. That each coronial jurisdiction take steps to inform its Attorney-General and other relevant decision makers of its support for the development of an NCIS as outlined in the needs and feasibility report.
3. That organisations which are major users of coronial information indicate in writing to the ACS:
   1. in principle endorsement of an NCIS;
   2. ways in which they can facilitate and resource the development and operation of the NCIS;
   3. appropriate points of contact for further negotiation.