C-CDA on FHIR
2.0.0-ballot - STU 2 Ballot United States of America flag

C-CDA on FHIR, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ccda-on-fhir/ and changes regularly. See the Directory of published versions

C-CDA to FHIR Notes

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

Clinical Notes may appear in their own section or as an entry in any open section. They are identified by an <act> with a <code> value of 34109-9.

C-CDA to FHIR

C-CDA¹
Note Activity		 DocumentReference Transform Steps
/id .identifier CDA id ↔ FHIR identifier
/code/translation .type CDA coding ↔ FHIR CodeableConcept
NOTE: The root code in C-CDA is always 34109-9: Note. A more specific code may be sent in translation which should be sent as the DocumentReference.type. If there is no translation, however, 34109-9 may be sent as the type.
  .category Set to clinical-note.
/text/@mediaType
&
/text/text()		 .content.attachment.contentType
&
.content.attachment.data		 If @mediaType is present, then representation should = B64, and the inner-text contents are embedded base64-encoded data. In this case, the mediaType and base64-encoded data map 1:1 to attachment.contentType and .data.
/text/reference/@value .content.attachment.contentType
&
.content.attachment.data		 Convert the narrative element referenced by @value following Narrative Text guidance and use application/xhtml+xml as the contentType.
If the narrative has minimal markup (i.e. only <content> and <paragraph> elements which can be converted to line breaks), it can be converted to text/plain.
To send the raw CDA narrative without converting, use application/cda+xml, but this is less useful to receivers.
/effectiveTime .context.period CDA ↔ FHIR Time/Dates
/author .author C-CDA → FHIR Participation
/author/time .date CDA ↔ FHIR Time/Dates
/entryRelationship[@typeCode=COMP]/encounter
or
Parent <encounter> element
or
<encompassingEncounter>		 .context.encounter C-CDA requires an encounter for notes, but allows for context conduction. If the Note Activity is in an entryRelationship chain that includes an Encounter Activity, use that. Otherwise, if the document contains an <encompassingEncounter>, that is the encounter for the note.
CDA → FHIR Encounters
/reference/externalDocument/id .relatesTo.target.identifier CDA id ↔ FHIR identifier

Example

CDA Note Activity ExampleFHIR DocumentReference Resource
<act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.202" extension="2016-11-01"/> <code code="34109-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Note"> <!-- Code must match or be equivalent to section code --> <translation code="11488-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Consultation note"/> </code> <text mediaType="application/rtf" representation="B64"> e1xydGYxXGFuc2kgSGVsbG8gd29ybGQhfQ== <reference value="#ConsultNote1"/> </text> <statusCode code="completed"/> <!-- Clinically-relevant time of the note --> <effectiveTime value="20160908"/> <!-- Author Participation --> <author> <templateId root="2.16.840.1.113883.10.20.22.4.119"/> <!-- Time note was actually written --> <time value="20160908083215-0500"/> <assignedAuthor> <!-- Full author information is elsewhere in the document . --> <id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/> <!-- Becomes reference: Practitioner/DrSpecialist --> <assignedPerson> <name> <prefix>Dr.</prefix> <family>Specialist</family> </name> </assignedPerson> </assignedAuthor> </author> <entryRelationship typeCode="COMP"> <!-- Creates an encounter with reference: Encounter/123 --> <encounter> ... </encounter> </entryRelationship> <reference typeCode="REFR"> <externalDocument> <id root="4dc41c26-43a4-48d9-b17e-067890006b29" /> </externalDocument> </reference> </act>
{ "resourceType": "DocumentReference", "id": "642ed1f93eec840007aaec72", "language": "en-US", "status": "current", "type": { "text": "Note", "coding": [{ "code": "34109-9", "system": "http://loinc.org" }, { "code": "11488-4", "system": "http://loinc.org", "display": "Consultation Note" }] }, "category": [{ "text": "Clinical Note", "coding": [{ "code": "clinical-Note", "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "display": "Clinical Note" }] }], "subject": { "reference": "urn:uuid:a4986486-6599-4bb2-a7fb-e2deb8d50b5e" }, "date": "2016-09-08T08:32:15-05:00", "author": [{ "reference": "Practitioner/DrSpecialist" }], "content": [{ "attachment": { "data": "e1xydGYxXGFuc2kgSGVsbG8gd29ybGQhfQ==", "contentType": "application/rtf" } }], "context": { "period": { "start": "2016-09-08" }, "encounter": [{ "reference": "Encounter/123" }] }, "relatesTo": { "target": { "identifier": { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:4dc41c26-43a4-48d9-b17e-067890006b29" } } } }