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 1.2.0 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 Procedures

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

Note on template selection

C-CDA 2.1 describes three templates for Procedures: Procedure Activity Act, Procedure Activity Observation, and Procedure Activity Procedure. Procedure Activity Procedure is the most complete, containing everything the other two contain except Observation.value, and several properties not contained by the others. The C-CDA 2.1 Companion Guide points out that “most vendors successfully and exclusively use the . . . Procedure Activity Procedure,” and it then specifies this template for “all interventional, non-interventional, surgical, diagnostic, or therapeutic procedures or treatments pertinent to the patient historically at the time the document is generated.” For this reason, we begin with this most common pattern in this publication. Additional guidance for the other two templates (which will be very similar) will be forthcoming.

C-CDA to FHIR

C-CDA¹ Procedure Activity procedure	FHIR Procedure	Transform Steps
/@negationInd=”true”	set status=”not-done”
/id	.identifier	CDA id ↔ FHIR identifier
/code	.code	CDA coding ↔ FHIR CodeableConcept
/statusCode	.status	CDA statusCode → FHIR status
/effectiveTime	.performedDateTime	Constraint: Use this when effectiveTime@value is populated CDA ↔ FHIR Time/Dates If no effectiveTime content is provided, put the FHIR [data-absent-reason] (https://hl7.org/fhir/R4/extension-data-absent-reason.html) extension on the performedDateTime element.
/effectiveTime/low	.performedPeriod.start	Constraint: Use this when effectiveTime@value is not populated CDA ↔ FHIR Time/Dates
/effectiveTime/high	.performedPeriod.end	Constraint: Use this when effectiveTime@value is not populated CDA ↔ FHIR Time/Dates
/targetSiteCode	.bodySite	CDA coding ↔ FHIR CodeableConcept
/author	.recorder & Provenance	CDA ↔ FHIR Provenance If a latest author can be identified, map to .recorder. Any author with a time can be put in Provenance.
/performer/assignedEntity	.performer.actor	May map to Practitioner, PractitionerRole, or Organization onBehalfOf should not be used when actor is a Practitioner or PractitionerRole
Service Delivery Location /participant[@typeCode=”LOC”]/participantRole	.location
Indication /entryRelationship[@typeCode=”RSON”]/observation/value	.reasonCode	CDA coding ↔ FHIR CodeableConcept
Comment Activity /entryRelationship/act[code/@code=”48767-8”]/text	Annotation .note

1. XPath abbrievated for C-CDA Procedure as:
ClinicalDocument/component/structuredBody/component/section[code/@code=”47519-4”]/entry/procedure

Illustrative example

Click on Here To See Highlighted Example

Links to example content

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

• Procedure CDA example
• Procedure 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