C-CDA on FHIR
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This page is part of the C-CDA on FHIR Implementation Guide (v1.2.0-ballot: STU 1 Ballot 4) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

FHIR to C-CDA Immunizations

FHIR US Core → C-CDA Mapping

While multiple vendors participated in CDA → FHIR mappings at a connectathon, only a single vendor (Cerner/Oracle) has participated in the FHIR → CDA mapping. We welcome feedback on these mappings which represent less than a multi-vendor consensus at this time.


This page provides a mapping from FHIR to CDA. For the CDA to FHIR mapping, please refer to Immunizations CDA → FHIR. For guidance on how to read the table below, see Reading the C-CDA ↔ FHIR Mapping Pages

FHIR to C-CDA

FHIR
Immunization		 C-CDA¹
Immunization Activity substanceAdministration		 Transform Steps
  @moodCode=”EVN” All FHIR Immunizations should be set to EVN moodCode in
.identifier /id CDA id ↔ FHIR identifier
.status /statusCode Constraint when status.value="not-done"
Set negationInd to true in CDA observation
.status /statusCode Constraint all other values of status
FHIR status → CDA statusCode
.statusReason Immunization Refusal Reason
entryRelationship@typeCode="RSON"
/entryRelationship/observation/code		 FHIR statusReason → CDA refusal
.vaccineCode /consumable/manufacturedProduct/manufacturedMaterial/code CDA coding ↔ FHIR CodeableConcept
.occurrenceDateTime /effectiveTime@value CDA ↔ FHIR Time/Dates
.manufacturer /consumable/manufacturedProduct/manufacturerOrganization  
.lotNumber /consumable/manufacturedMaterial/lotNumberText  
.site /approachSiteCode FHIR site → CDA approachSiteCode
.route /routeCode CDA coding ↔ FHIR CodeableConcept
.doseQuantity /doseQuantity  
.performer.actor /performer Constraint when .performer.function="AP"
CDA ↔ FHIR Provenance
Annotation
.note		 Comment Activity
entryRelationship/act/code@code="48767-8"
/entryRelationship/act/text		  
.reasonCode Indication
entryRelationship@typeCode="RSON"
/entryRelationship/observation/value		  
.education.documentType reference/ExternalDocument/code  
.education.reference /reference/ExternalDocument/id  
.reaction.id Reaction
entryRelationship@typeCode="MFST"
/entryRelationship/observation/id		 CDA id ↔ FHIR identifier
.reaction.date /entryRelationship/observation/effectiveTime CDA ↔ FHIR Time/Dates
.reaction.detail.valueCodeableConcept /entryRelationship/observation/value CDA coding ↔ FHIR CodeableConcept
.doseNumber[x].doseNumberPositiveInt /repeatNumber  

1. XPath abbrievated for C-CDA Immunization Activity as:
ClinicalDocument/component/structuredBody/component/section[(@code="11369-6")]/entry/substanceAdministration

Illustrative example

Links to example content

Note that these mappings have only been implemented by a single vendor to date.

Prior work and Expanded Spreadsheets

As reviewed in the methodology, a more comprehensive review was performed via spreadsheets. These spreadsheets have been consolidated and further revised in the tables above but are provided for reference here