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

C-CDA to FHIR Allergies

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



C-CDA to FHIR

C-CDA¹
Allergy Intolerance observation		 FHIR
AllergyIntolerance		 Transform Steps & Notes
(act parent to observation) ../../@statusCode .clinicalStatus For more information on how status is managed in Allergy Concern Act wrapper, refer to C-CDA guidance, see 5.2.7.1
@negationInd   See constraints under /participant
/id .identifier CDA id ↔ FHIR identifier
/effectiveTime/low .onsetDateTime CDA ↔ FHIR Time/Dates
effectiveTime/high should not be mapped within onset (DateTime or Period)
/value .type
&
.category		 CDA coding ↔ FHIR CodeableConcept
CDA value → FHIR type
CDA value → FHIR category
/author .recorder
&
Provenance		 Constraint: Only map single CDA author to FHIR recorder
Guidance on CDA ↔ FHIR Provenance
/author/time .recorded Constraint: Only map earliest author/time
CDA ↔ FHIR Time/Dates
/participant/participantRole
/playingEntity/code		 .code Constraint: When CDA negation is absent or false
CDA coding ↔ FHIR CodeableConcept
/participant/participantRole/playingEntity/code
&
/value		 .code Constraint: When CDA negation is true and nullFlavor is used in playingEntity/code
CDA No known allergy → FHIR code
When negation is true and playingEntity/code is populated, either populate text in FHIR or use mapping of equivalent negated concept (e.g. map latex substance to no known latex allergy [1003774007, SNOMED CT] )
Status
observation/code@code="33999-4"
/entryRelationship/observation/value		 .clinicalStatus CDA coding ↔ FHIR CodeableConcept
Reaction
entryRelationship@typeCode="MFST"
/entryRelationship/observation/id		 .reaction.id
  
/entryRelationship/observation
/effectiveTime/low		 .reaction.onset CDA ↔ FHIR Time/Dates
effectiveTime/high should not be mapped within onset
/entryRelationship/observation/value .reaction.manifestation CDA coding ↔ FHIR CodeableConcept
Both use SNOMED clinical findings with minor valueSet definition differences
Severity
nested inside Reaction entryRelationship/code@code="SEV"
/entryRelationship/observation/entryRelationship/observation/value		   CDA coding ↔ FHIR CodeableConcept
This should be nested in CDA within the respective allergic reaction observation
Criticality
observation/code@code="82606-5"
/entryRelationship/observation/value		 .criticality CDA coding ↔ FHIR CodeableConcept
Allergy Criticality value → Criticality
Comment Activity
entryRelationship/act/code@code="48767-8"
/entryRelationship/act/text		 Annotation
.note		  

1. XPath abbrievated for C-CDA Allergy Intolerance as:
ClinicalDocument/component/structuredBody/component/section[(@code="48765-2")]/entry/act/entryRelationship/observation

When authors or other provenance are recorded in the parent Allergy Concern Act, it is recommended that those data be mapped to the FHIR AllergyIntolerance.

Illustrative example

An illustrative example with higlighting is shown above based on the consensus of mapping and guidance. Not all possible elements in CDA or FHIR may be represented. To access the content for the above example, click on the links below.


Links to example content

The consensus mapping example developed through multiple vendors are available below:

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