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 in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

C-CDA to FHIR Problems

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

This mapping demonstrates how problems in the C-CDA Problems Section would map to FHIR Conditions. Problems in other sections will map similarly, but may map to different profiles (e.g. US Core Encounter Diagnosis) or have different categories (e.g. health-concern).

Note that C-CDA includes a Concern wrapper act from which status may be read; most of the elements are within the dependent Observation entry.

C-CDA to FHIR

C-CDA¹ Problem Concern Act	FHIR Condition and Health Concern	Transform Steps
From the parent section, use code@code	.category	CDA section → FHIR category Note: The section of a Problem Observation affects its FHIR category.
/statusCode	.clinicalStatus	/statusCode → .clinicalStatus is to be used only if the C-CDA Problem Status Observation (see below) is missing. For more information on how status is managed in Problem Concern Act wrapper, refer to C-CDA guidance, see 5.2.6.1 Concern Status → Condition Clinical Status
All of the following are a Problem observation nested inside the Problem Concern act. Each observation should become a distinct FHIR Condition resource. /entryRelationship[@typeCode=”SUBJ”]/observation prefix to rows below²
/@negationInd=true	set .verificationStatus=”refuted” or adjust .code for negated concept
/id	.identifier	CDA id ↔ FHIR identifier
/code	.category	CDA coding ↔ FHIR CodeableConcept
/effectiveTime/low	.onsetDateTime	CDA ↔ FHIR Time/Dates
/effectiveTime/high	.abatementDateTime	If present (or high/@nullFlavor=UNK), the .clinicalStatus must be inactive, remission, or resolved. If C-CDA status fields map to .clinicalStatus of active, relapse, or recurrence, suggest setting .clinicalStatus to inactive for FHIR conformance. If high/@nullFlavor=UNK, populate ._abatementDateTime.extension with Data Absent Reason, since in C-CDA, the “UNK” high effectiveTime has been the recommended way to indicate “resolved problem but unknown resolution date.” CDA ↔ FHIR Time/Dates
/value	.code	Constraint: When CDA negation is absent or false CDA coding ↔ FHIR CodeableConcept
/author	.recorder & Provenance	.recorder should be authoritative (latest) author if there are multiple CDA ↔ FHIR Provenance
/author/time	.recordedDate	Earliest, if more than one CDA ↔ FHIR Time/Dates
Problem Status /entryRelationship/observation[code/@code=”33999-4”]/value	.clinicalStatus	CDA Problem Status Observation value → FHIR clinicalStatus
Date of Diagnosis /entryRelationship/act[code/@code=”77975-1”]/effectiveTime	.extension:assertedDate	CDA ↔ FHIR Time/Dates See US CORE Condition for additional guidance
Comment Activity /entryRelationship/act[code/@code=”48767-8”]/text	Annotation .note

1. XPath abbrievated for C-CDA Problem Concern act as:
ClinicalDocument/component/structuredBody/component/section[code/@code=”11450-4”]/entry/act/

2. XPath abbrievated for C-CDA Problem Observation as:
ClinicalDocument/component/structuredBody/component/section[code/@code=”11450-4”]/entry/act/entryRelationship[@typeCode=”SUBJ”]/observation/

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

Illustrative example

Click on Here To See Highlighted Example

Links to example content

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

• Problem CDA example
• Condition FHIR example

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