CDA Examples
1.0.0 - active
CDA Examples
1.0.0 - active
CDA Examples, published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-Examples/ and changes regularly. See the Directory of published versions
This is an example of how one could report quality measures in a C-CDA document. It is not a C-CDA template, but could be included as a section (since open template) and is conformant to QRDA1 Measure Section constraints. It would not be appropriate for US QRDA submission.
This file includes examples of the following templates:
<!-- This is an example of how to include quality measure information (i.e. reported outcome) on an individual patient's C-CDA document -->
<!-- This uses templates from the QRDA1, which is not part of C-CDA, but is CDA conformant and a US national standard for reporting quality measures -->
<!-- This uses the "Measure Section" section where the measure logic (i.e. denominators, numerators) is imparted using negationInd of measure component observations -->
<!-- This example complies with QRDA1 measure section but may not suitable for formal quality reporting. Refer to QRDA1 and QRDA3 implementation guidance for more details -->
<!-- Per discussion with clinical quality improvement CQI workgroup, this aligns with how the Joint Commission encourage patient level reporting in QRDA1 documents. -->
<!-- For the measures shown in this section, the clinical data that support quality calculation could be included in other sections (e.g. problems, procedures, results, vital signs, etc.) -->
<!-- Thank you to Yan Heras and Gay Dolin + other members in CQI workgroup for consultation and feedback regarding the sample -->
<section xmlns="urn:hl7-org:v3">
<!-- Templates use QRDA1 1.1 (current reporting standard as of 2018) -->
<!-- This is the templateId for Measure Section -->
<templateId root="2.16.840.1.113883.10.20.24.2.2"/>
<!-- This is the templateId for Measure Section QDM -->
<templateId root="2.16.840.1.113883.10.20.24.2.3"/>
<code displayName="Measure Document" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1" code="55186-1"/>
<title>Measure Section</title>
<text>
<table width="100%" border="1">
<colgroup>
<col width="25%"/>
<col width="15%"/>
<col width="15%"/>
<col width="15%"/>
<col width="15%"/>
<col width="15%"/>
</colgroup>
<thead>
<tr>
<!-- Note that this table is an illustrative format that could be used to show human readable measure, but others are possible -->
<!-- Each of the fields in this table will be represented in machine readable as well as human readable -->
<!-- For each of the measures we provide a descriptive name and an identifier -->
<!-- The machine-readable entries will have the unique GUID reference to this measure, if available -->
<!-- An alternative option would be to include additional description of measure logic or a link in the human-readable -->
<!-- This aligns with what may be typically included from QRDA1 document -->
<th>Measure</th>
<th>Compliance Period</th>
<th>Denominator</th>
<th>Numerator</th>
<th>Exclusion</th>
<th>Outcome</th>
</tr>
</thead>
<tbody>
<tr>
<td>Diabetes Hemoglobin A1c Poor Control (CMS 122v5)</td>
<td>Jan 1 2017 - Dec 31 2017</td>
<td>yes</td>
<td>no</td>
<td>no</td>
<!-- Compliance here is based on the measure "Improvement Notation" from the Measure Definition -->
<!-- Since lower = better for CMS 122v5, a false numerator means complaince -->
<td>Compliant</td>
</tr>
<tr>
<td>Colorectal Cancer Screening (CMS 130v5)</td>
<td>Jan 1 2017 - Dec 31 2017</td>
<td>yes</td>
<td>no</td>
<td>no</td>
<!-- Compliance here is based on the measure "Improvement Notation" from the Measure Definition -->
<!-- Since higher = better for CMS 130v5, a false numerator means non-complaince -->
<td>Non-Compliant</td>
</tr>
<tr>
<td>Pneumococcal Vaccination Status for Older Adults (CMS 127v5)</td>
<td>Jan 1 2017 - Dec 31 2017</td>
<td>no</td>
<td>no</td>
<td>no</td>
<!-- Since this patient was not in initial population of measure, we show as not eligible -->
<td>Not Eligible</td>
</tr>
<tr>
<td>Controlling High Blood Pressure (CMS 165v5)</td>
<td>Jan 1 2017 - Dec 31 2017</td>
<td>yes</td>
<td>excl</td>
<td>yes</td>
<!-- Patient excluded due to a condition (e.g. Stage 5 CKD) -->
<td>Excluded</td>
</tr>
</tbody>
</table>
</text>
<!-- In a pilot with 8 different sites, the real-value was in providing human readable content in a timely manner -->
<!-- This proposed entry aligns with QRDA standards but is unlikely to be imported in near-term -->
<entry>
<!-- no denominator exclusion criteria available for this measure so omitted -->
<organizer moodCode="EVN" classCode="CLUSTER">
<templateId root="2.16.840.1.113883.10.20.24.3.98"/>
<templateId root="2.16.840.1.113883.10.20.24.3.97"/>
<id root="d7345481-b3b5-41e0-a8ae-03dabcd4a0cc"/>
<!-- A code element could be added to make organizer type more specific, although was not in the original QRDA1 template -->
<statusCode code="completed"/>
<!-- This reference contains the version specific identifier of the measure -->
<reference typeCode="REFR">
<externalDocument moodCode="EVN" classCode="DOC">
<!-- This includes an uuid identifier of the measure logic, For this example, -->
<!-- see https://ecqi.healthit.gov/system/files/ecqm/measures/CMS122v5_SimpleXML_2.xml -->
<!-- If no GUID available, the measure would at least be described using the text field -->
<id root="2.16.840.1.113883.4.738"
extension="40280381-51f0-825b-0152-229afff616ee"/>
<code displayName="Health Quality Measure Document"
codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="57024-2"/>
<text>Diabetes: Hemoglobin A1c Poor Control</text>
<versionNumber value="5"/>
</externalDocument>
</reference>
<!-- To specify the time period, a component has been added with the appropriate QRDA1 template (Reporting Parameters Act) -->
<component>
<act moodCode="EVN" classCode="ACT">
<templateId root="2.16.840.1.113883.10.20.17.3.8"/>
<id root="55a43e20-6463-46eb-81c3-9a3a1ad41225"/>
<code displayName="Observation Parameters"
codeSystem="2.16.840.1.113883.6.96" code="252116004"/>
<effectiveTime>
<!-- The beginning of the reporting period. -->
<low value="20170101000000-0500"/>
<!-- The ending of the reporting period. -->
<high value="20171231235959-0500"/>
</effectiveTime>
</act>
</component>
<component>
<!-- Set negationInd="false" to assert that the criteria are met by the included data.
Set negationInd="true" to assert that the criteria are NOT met by the included data.
Since this patient is in the denominator, negationInd is set to false -->
<observation negationInd="false" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="denominator"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="DENOM"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<!-- This includes an version specific uuid identifier of the specific measure component, (denominator in this example) -->
<!-- For example, see https://ecqi.healthit.gov/system/files/2017_CMS_QRDA_III_Eligible_Clinicians_and_EP_IG_final_0703_508.pdf -->
<id root="D346DA74-F16E-4159-BEDF-331BA28837FB"/>
</externalObservation>
</reference>
</observation>
</component>
<component>
<!-- Since this patient is NOT in the numerator, negationInd is set to true -->
<!-- Note that this measure has inverted numerator logic (i.e. numerator events are non-compliant) -->
<observation negationInd="true" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="numerator"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="NUMER"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<id root="6D01A564-58CC-4CF5-929F-B83583701BFE"/>
</externalObservation>
</reference>
</observation>
</component>
</organizer>
</entry>
<entry>
<organizer moodCode="EVN" classCode="CLUSTER">
<templateId root="2.16.840.1.113883.10.20.24.3.98"/>
<templateId root="2.16.840.1.113883.10.20.24.3.97"/>
<id root="32f4ad75-9e16-43f8-83f3-a1d906a147ab"/>
<statusCode code="completed"/>
<reference typeCode="REFR">
<externalDocument moodCode="EVN" classCode="DOC">
<id root="2.16.840.1.113883.4.738"
extension="40280381-51f0-825b-0152-22a1e7e81737"/>
<code displayName="Health Quality Measure Document"
codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="57024-2"/>
<text>Colorectal Cancer Screening</text>
<versionNumber value="5"/>
</externalDocument>
</reference>
<!-- To specify the time period, a component has been added with the appropriate QRDA1 template (Reporting Parameters Act) -->
<component>
<act moodCode="EVN" classCode="ACT">
<templateId root="2.16.840.1.113883.10.20.17.3.8"/>
<id root="55a43e20-6463-46eb-81c3-9a3a1ad41225"/>
<code displayName="Observation Parameters"
codeSystem="2.16.840.1.113883.6.96" code="252116004"/>
<effectiveTime>
<!-- The beginning of the reporting period. -->
<low value="20170101000000-0500"/>
<!-- The ending of the reporting period. -->
<high value="20171231235959-0500"/>
</effectiveTime>
</act>
</component>
<component>
<!-- Since this patient is in the denominator, negationInd is set to false -->
<observation negationInd="false" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="denominator"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="DENOM"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<id root="589C2FD6-6AA9-4AF8-9E1C-973170361917"/>
</externalObservation>
</reference>
</observation>
</component>
<component>
<!-- Since this patient is NOT in the numerator, negationInd is set to true -->
<!-- Note that this measure has typical numerator logic (i.e. numerator events are compliant) -->
<observation negationInd="true" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="numerator"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="NUMER"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<id root="52ADE511-39D4-4CBC-84B6-A82059741359"/>
</externalObservation>
</reference>
</observation>
</component>
<component>
<!-- Since this patient is NOT excluded, negationInd is set to true -->
<observation negationInd="true" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="denominator exclusions"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="DENEX"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<id root="93AA9C96-E1FE-435B-BA0B-FAF0C5592275"/>
</externalObservation>
</reference>
</observation>
</component>
</organizer>
</entry>
<entry>
<!-- no denominator exclusion criteria available for this measure so omitted -->
<organizer moodCode="EVN" classCode="CLUSTER">
<templateId root="2.16.840.1.113883.10.20.24.3.98"/>
<templateId root="2.16.840.1.113883.10.20.24.3.97"/>
<id root="f243a0e3-0590-4e86-85b7-2b49e86eb7c5"/>
<statusCode code="completed"/>
<reference typeCode="REFR">
<externalDocument moodCode="EVN" classCode="DOC">
<id root="2.16.840.1.113883.4.738"
extension="40280381-52fc-3a32-0153-1a646a2a0bfa"/>
<code displayName="Health Quality Measure Document"
codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="57024-2"/>
<text>Pneumonia Vaccination Status for Older Adults</text>
<versionNumber value="5"/>
</externalDocument>
</reference>
<!-- To specify the time period, a component has been added with the appropriate QRDA1 template (Reporting Parameters Act) -->
<component>
<act moodCode="EVN" classCode="ACT">
<templateId root="2.16.840.1.113883.10.20.17.3.8"/>
<id root="55a43e20-6463-46eb-81c3-9a3a1ad41225"/>
<code displayName="Observation Parameters"
codeSystem="2.16.840.1.113883.6.96" code="252116004"/>
<effectiveTime>
<!-- The beginning of the reporting period. -->
<low value="20170101000000-0500"/>
<!-- The ending of the reporting period. -->
<high value="20171231235959-0500"/>
</effectiveTime>
</act>
</component>
<component>
<!-- Since this patient is NOT in the denominator, negationInd is set to true -->
<observation negationInd="true" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="denominator"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="DENOM"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<id root="B57EA797-15A1-4C60-B34C-BAE292FE3B76"/>
</externalObservation>
</reference>
</observation>
</component>
<component>
<!-- Since this patient is NOT in the numerator, negationInd is set to true -->
<observation negationInd="true" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="numerator"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="NUMER"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<id root="CBD0926D-6088-44EE-883C-0A0F9E77E2A1"/>
</externalObservation>
</reference>
</observation>
</component>
</organizer>
</entry>
<entry>
<organizer moodCode="EVN" classCode="CLUSTER">
<templateId root="2.16.840.1.113883.10.20.24.3.98"/>
<templateId root="2.16.840.1.113883.10.20.24.3.97"/>
<id root="ee940592-38b1-44fe-a74b-83e1a479d651"/>
<statusCode code="completed"/>
<reference typeCode="REFR">
<externalDocument moodCode="EVN" classCode="DOC">
<id root="2.16.840.1.113883.4.738"
extension="40280381-51f0-825b-0152-22b98cff181a"/>
<code displayName="Health Quality Measure Document"
codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="57024-2"/>
<text>Controlling High Blood Pressure</text>
<versionNumber value="5"/>
</externalDocument>
</reference>
<!-- To specify the time period, a component has been added with the appropriate QRDA1 template (Reporting Parameters Act) -->
<component>
<act moodCode="EVN" classCode="ACT">
<templateId root="2.16.840.1.113883.10.20.17.3.8"/>
<id root="55a43e20-6463-46eb-81c3-9a3a1ad41225"/>
<code displayName="Observation Parameters"
codeSystem="2.16.840.1.113883.6.96" code="252116004"/>
<effectiveTime>
<!-- The beginning of the reporting period. -->
<low value="20170101000000-0500"/>
<!-- The ending of the reporting period. -->
<high value="20171231235959-0500"/>
</effectiveTime>
</act>
</component>
<component>
<!-- Since this patient is in the denominator, negationInd is set to false -->
<observation negationInd="false" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="denominator"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="DENOM"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<id root="E62FEBA3-0F98-460D-93CD-44314D7203A8"/>
</externalObservation>
</reference>
</observation>
</component>
<component>
<!-- Since this patient is excluded, they are NOT in numerator, negationInd is set to true -->
<observation negationInd="true" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="numerator"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="NUMER"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<id root="F9FEBF42-4B21-47A9-B03E-D2DA5CF8492B"/>
</externalObservation>
</reference>
</observation>
</component>
<component>
<!-- Since this patient is excluded, negationInd is set to false -->
<observation negationInd="false" moodCode="EVN" classCode="OBS">
<code xsi:type="CD" displayName="Assertion"
codeSystemName="ActCode" codeSystem="2.16.840.1.113883.5.4" code="ASSERTION"/>
<value xsi:type="CD" displayName="denominator exclusions"
codeSystemName="ObservationValue" codeSystem="2.16.840.1.113883.5.4" code="DENEX"/>
<reference typeCode="REFR">
<externalObservation moodCode="EVN" classCode="OBS">
<id root="55A6D5F3-2029-4896-B850-4C7894161D7D"/>
</externalObservation>
</reference>
</observation>
</component>
</organizer>
</entry>
</section>
IG © Health Level Seven. Package hl7.cda.examples#1.0.0 based on FHIR 5.0.0. Generated 2025-08-28
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