This is a pre-release of a future version of CCDA on FHIR (expected to be STU 1). There is no current official version.
For a full list of available versions, see the Directory of published versions .

C-CDA on FHIR Implementation Guide (IG)

Summary

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 defines a series of FHIR profiles on the Composition resource to represent the various document types in C-CDA. This release does not directly map every C-CDA template to FHIR profiles, rather tries to accomplish the C-CDA use case using Composition resource profiles created under this project (the equivalent of Level 2 CDA documents), and linking to the profiles created under the Data Access Framework (DAF) project for any coded entries that would normally be included in C-CDA sections. The hope is that this results in a simpler, more streamlined standard that reuses existing work and focuses on the 80% that implementers actually need in production systems (the hope is that US Core represents that 80% needed for coded entries).

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. his 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 sent it, but if they have no data there is no need for a null entry.

We encourage feedback on these Composition profiles, and the general approach to the project as a whole. We also encourage implementers who wish to see more of the coded data from C-CDA mapped to FHIR to comment on the US Core project and make their requests known there. Once US Core creates new profiles, this project can reference them.

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 accomplished by referencing relevant U.S. Core FHIR profiles.


This guide references the following US Core profiles.

Profile Name
U.S. Core AllergyIntolerance Profile
U.S. Core Condition Profile
U.S. Core DiagnosticRequest Profile
U.S. Core DiagnosticReport Results Profile
U.S. Core Encounter Profile
U.S. Core Family Member History Profile
U.S. Core Immunization Profile
U.S. Core MedicationStatement Profile
U.S. Core Organization Profile
U.S. Core Patient Profile
U.S. Core Practitioner Profile
U.S. Core Procedure Profile
U.S. Core Related Person Profile
U.S. Core Results Profile
U.S. Core Smoking Status Profile
U.S. Core Vital Signs Profile


References

Name Definition
HL7 Implementation Guide for CDA Release 2: Consolidated CDA Templates for Clinical Notes The Consolidated CDA (C-CDA) implementation guide contains a library of CDA templates, incorporating and harmonizing previous efforts from Health Level Seven (HL7), Integrating the Healthcare Enterprise (IHE), and Health Information Technology Standards Panel (HITSP). It represents harmonization of the HL7 Health Story guides, HITSP C32, related components of IHE Patient Care Coordination (IHE PCC), and Continuity of Care (CCD). C-CDA Release 1 included all required CDA templates in Final Rules for Stage 1 Meaningful Use and 45 CFR Part 170 Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule.
U.S. Data Access Framework (DAF) FHIR Implementation Guide (IG) A U.S. Realm guide for making use of FHIR resources to support queries between systems within an enterprise and across enterprises

Authors

Author Name Email
Rick Geimer rick.geimer@lantanagroup.com
Sarah Gaunt sarah.gaunt@lantanagroup.com
Brett Marquard brett@riverrockassociates.com
Corey Spears Corey.Spears@infor.com
Meenaxi Gosai meenaxi.gosai@lantanagroup.com