C-CDA on FHIR
1.2.0 - STU 1 United States of America flag

This page is part of the C-CDA on FHIR Implementation Guide (v1.2.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

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Official URL: http://hl7.org/fhir/us/ccda/ImplementationGuide/hl7.fhir.us.ccda Version: 1.2.0
Active as of 2020-10-19 Computable Name: CCDAonFHIR

2024 Publication of C-CDA ↔ FHIR US Core Mapping

The current release of this IG adds relevant mapping content from C-CDA ↔ FHIR mapping project which was related to the original C-CDA on FHIR work. These mappings are included under the "Mapping" heading and will undergo future updates for additional content.

Overview

Consolidated CDA (C-CDA) is one of the most widely implemented implementation guides for CDA and covers a significant scope of clinical care. Its target of the ‘common/essential’ elements of healthcare is closely aligned with FHIR’s focus on the ‘80%’. There is significant interest in industry and government in the ability to interoperate between CDA and FHIR and C-CDA is a logical starting point. Implementers and regulators have both expressed an interest in the ability to map between FHIR and C-CDA.

This Implementation Guide (IG) defines a series of FHIR profiles on the Composition resource to represent the various document types in C-CDA and provides an initial mapping of C-CDA and FHIR content. To do the former, this IG profiles Composition for various document types and link the profiles created under the US Core project for any coded entries that would normally be included in C-CDA sections. To have a simpler, more streamlined standard that reuses existing work and focuses on the 80% that implementers actually need in production systems, the resources of US Core represents a portion of the 80% needed for coded entries of CCD, Care Plan & Discharge Summary.

The Composition profiles in this IG do not require coded data in any section. This is a departure from C-CDA, which requires coded data for Problems, Results, Medications, etc. This departure is intentional, as the C-CDA requirement for one or more coded entries in these sections resulted in some very complicated workarounds using nullFlavors to handle the fact that sometimes a patient is not on any medications, or has no current problems. In general, FHIR takes the approach that if something is nullable, it should simply be optional to ease the burden on implementers, thus C-CDA on FHIR does not require any coded entries, but rather uses the “required if known” approach, meaning that if an implementer’s system has data for a section that requires data under Meaningful Use, they need to send it, but if they have no data there is no need for a null entry.

Scope

To represent Consolidated CDA Templates for Clinical Notes (C-CDA) 2.1 templates using FHIR profiles.

This first stage of the project defines all the C-CDA document-level profiles on the Composition resource and contained sections.

Any coded data used by sections will be represented using relevant U.S. Core FHIR profiles where they exist. FHIR profiles defined by other work groups or unconstrained FHIR resources may also be referenced if no appropriate US Core Profile exist.

For further information see the pdf-based C-CDA specification, StructureDefinition C-CDA specification, original project scope and mapping project scope.

Authors (Composition Profiles, Extensions and CapabilityStatement )

Name Email/URL
HL7 Structured Documents Working Group http://hl7.org/Special/committees/structure
Rick Geimer rick.geimer@lantanagroup.com
Sarah Gaunt sarah.gaunt@lantanagroup.com
Brett Marquard brett@waveoneassociates.com
Corey Spears spears.corey@gmail.com
Meenaxi Gosai meenaxi.gosai@lantanagroup.com

Authors (C-CDA ↔ FHIR Mapping)

Name Email/URL
HL7 Cross Group Projects http://hl7.org/Special/committees/cgp
HL7 Structured Documents Working Group http://hl7.org/Special/committees/structure
Jay Lyle jay.lyle@jpsys.com
John D'Amore johnd@moreinformatics.com
Natalee Agassi natalee.agassi@oracle.com
Chun Li Chun.Li@availity.com
Ken Lord klord@mdixinc.com
Catherine Hoang Catherine.Hoang2@va.gov
Bill Ormerod william.ormerod@oracle.com
Benjamin Flessner benjamin.flessner@availity.com
Brett Marquard brett@waveoneassociates.com
Christopher Vitale Christopher.Vitale@availity.com
Sajjad Hussain sshussain@google.com
Gene Beyer gene.beyer@oracle.com
Gay Dolin gdolin@namasteinformatics.com
Lisa Nelson LNelson@advaultinc.com
Deb Loniewski loniewskid@michigan.gov

Dependencies

Package hl7.fhir.us.core#4.0.0

The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Mon, Jun 28, 2021 19:09+0000+00:00)

Package hl7.fhir.uv.extensions#5.1.0-snapshot1

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Tue, Mar 12, 2024 13:29+1100+11:00)

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.us.ccda.r4) and R4B (hl7.fhir.us.ccda.r4b) are available.

Global Profiles

There are no Global profiles defined

IP Statements

This publication includes IP covered under the following statements.

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