C-CDA on FHIR
2.0.0-ballot - STU 2 Ballot
C-CDA on FHIR
2.0.0-ballot - STU 2 Ballot
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
This page provides a mapping from CDA to FHIR. For the FHIR to CDA mapping, please refer to Medications FHIR → CDA. For guidance on how to read the table below, see Reading the C-CDA ↔ FHIR Mapping Pages
Medications to MedicationRequestMedications shown below represent the moodCode="INT" in CDA. For mapping histories of medication use from CDA, no consensus was established. We welcome feedback on this topic. For more information, please see chat.fhir.org and related stream
Medication Timing and Frequency
C-CDA represents both timing (start date / end date) and frequency (when and how often to take) using <effectiveTime> elements. The first (represented in XPath as /effectiveTime[1]) represents the timing. If it contains <low> and/or <high> timestamps, this represents the .timing.repeat.boundsPeriod information of MedicationRequest.dosageInstruction. If, instead, the first effectiveTime only contains a single @value attribute, it represents a .timing.event dateTime value.
The second <effectiveTime> represents the frequency and contains the attribute @operator="A" to indicate it is an intersection with the first effectiveTime. It must also have an @xsi:type attribute which identifies the type of frequency as PIVL_TS (Periodic Interval) or EIVL_TS (Episodic Interval). PIVL_TS is the most common and represents a frequency corresponding to .timing.repeat.frequency / .timing.repeat.period / .timing.repeat.periodUnit. These relationship of three fields is described in FHIR: "Event occurs frequency times per period". For example: "Every 8 hours" would become 1 / 8 / h (one time every eight hours), while "TID" would become 3 / 1 / d (three times every one day).
EIVL_TS represents an event-based frequency, such as "1 hour after meal". The CDA <event code="xx"> corresponds to FHIR's .timing.when and the optional <offset> corresponds to .timing.offset.
The C-CDA Example Search site maintains a document of Common Medication Frequencies which can be cross-referenced with a similar table in FHIR's Timing Data Type to properly map CDA frequencies to FHIR timing values.
| C-CDA¹ Medication Activity substanceAdministration |
FHIR MedicationRequest |
Transform Steps |
|---|---|---|
| /@negationInd="true" | set .doNotPerform=true | |
| @moodCode | .intent | CDA coding ↔ FHIR CodeableConcept Mood to intent |
| /id | .identifier | CDA id ↔ FHIR identifier |
| /statusCode | .status | Pay attention to the definitions of active and completed in the FHIR medicationrequest-status code system. C-CDA may list a medication state as “completed” (i.e. the prescription writing has been completed), but containing dates in the future. This may more align with a FHIR status of “active” than “completed” which indicates all actions implied by the prescription have been completed CDA statusCode → FHIR status |
| /effectiveTime[1]/@value | .dosageInstruction.timing.event | Constraint: Use this when effectiveTime@value is populated CDA ↔ FHIR Time/Dates |
| /effectiveTime[1]/low | .dosageInstruction.timing.repeat.boundsPeriod.start | Constraint: Use this when effectiveTime/@value is not populated CDA ↔ FHIR Time/Dates |
| /effectiveTime[1]/high | .dosageInstruction.timing.repeat.boundsPeriod.end | Constraint: Use this when effectiveTime/@value is not populated CDA ↔ FHIR Time/Dates |
| Periodic Frequency /effectiveTime[operator="A" and xsi:type="PIVL_TS"] …/@institutionSpecified …/period/@value …/period/@unit |
.dosageInstruction.timing.repeat.frequency .dosageInstruction.timing.repeat.period .dosageInstruction.timing.repeat.periodUnit |
Compare: C-CDA Common Medication Frequencies and FHIR Timing Data Type to determine whether frequency or period should be used.If CDA period contains low and high (e.g. a range like 4-6 hours or 3-4 times a day), map low the same as @value (e.g. to repeat.period or repeat.frequency) and map high to repeat.periodMax or repeat.frequencyMax depending on whether it is a frequency or period. |
| Event-Based Timing /effectiveTime[operator="A" and xsi:type="EIVL_TS"] …/event/@code …/offset |
.dosageInstruction.timing.repeat.when .dosageInstruction.timing.repeat.offset |
@code vocabulary matches .when CDA offset must be converted to minutes for FHIR |
| /routeCode | .dosageInstruction.route | CDA coding ↔ FHIR CodeableConcept |
| /approachSiteCode | .dosageInstruction.site | CDA coding ↔ FHIR CodeableConcept |
| /doseQuantity | .dosageInstruction.doseAndRate.doseQuantity | CDA ↔ FHIR Quantity |
| /rateQuantity | .dosageInstruction.doseAndRate.rateQuantity | CDA ↔ FHIR Quantity |
| /maxDoseQuantity/numerator | .dosageInstruction.maxDosePerPeriod.numerator | CDA ↔ FHIR Quantity |
| /maxDoseQuantity/denominator | .dosageInstruction.maxDosePerPeriod.denominator | CDA ↔ FHIR Quantity |
| /administrationUnitCode | Medication.form | See below |
| /consumable/manufacturedProduct/manufacturedMaterial/code | .medicationCodeableConcept OR .medicationReference |
CDA coding ↔ FHIR CodeableConcept Only one of these fields may be populated. When generating a Medication resource (see below), use the medicationReference field. |
| /consumable/manufacturedProduct/manufacturerOrganization | Medication.manufacturer | See below |
| /author | .requester & Provenance |
CDA ↔ FHIR Provenance |
| /author/time | .authoredOn | Earliest, if more than one. CDA ↔ FHIR Time/Dates |
| Drug Vehicle /participant[@typeCode="CSM"]/playingEntity/code |
Medication.ingredient | See below |
| Indication /entryRelationship[@typeCode="RSON"]/observation/value |
.reasonCode | CDA coding ↔ FHIR CodeableConcept |
| Free text sig /entryRelationship/substanceAdministration[code/@code="76662-6"]/text |
.dosageInstruction.text | |
| Instruction Activity /entryRelationship[@typeCode="SUBJ" and @inversionInd="true"]/act |
.dosageInstruction.patientInstruction .dosageInstruction.additionalInstruction |
act/text or act/code/originalText can map to patientInstructions. If coded, can map to additionalInstruction. |
| Supply Order /entryRelationship[@typeCode="REFR"]/substanceAdministration[@moodCode="INT"] |
Note: moodCode=INT means supply, moodCode=EVN means dispense, which is not documented here. | |
| ../effectiveTime/high | .dispenseRequest.validityPeriod.end | CDA ↔ FHIR Time/Dateslow would similarly map to start, but only high is called out in C-CDA. |
| ../repeatNumber | .dispenseRequest.numberOfRepeatsAllowed | Caution: in CDA, repeatNumber indicates total number of dispenses allowed. In FHIR, this field is exclusive of the original dispense. So the numberOfRepeatsAllowed will be one less than repeatNumber. |
| ../quantity | .dispenseRequest.quantity | CDA ↔ FHIR Quantity |
| Comment Activity /entryRelationship/act[code/@code="48767-8"]/text |
Annotation .note |
See Comment → Annotation |
| /precondition | .asNeededBoolean = true | The presence of a precondition element indicates asNeededBoolean should be true. More complex maps may be possible with .asNeededCodeableConcept. |
1. XPath abbrievated for C-CDA Medication Activity as:
ClinicalDocument/component/structuredBody/component/section[code/@code="10160-0"]/entry/substanceAdministration
MedicationRequest (and other resources) may represent the medication as a simple CodeableConcept. But when additional information about the medication needs to be conveyed, a Medication resource should be created instead and referenced by the MedicationRequest resource. Implementers may also opt to always create Medication resources.
| C-CDA¹ Medication Activity substanceAdministration |
FHIR Medication |
Transform Steps |
|---|---|---|
| /administrationUnitCode | .form | CDA coding ↔ FHIR CodeableConcept |
| /consumable/manufacturedProduct/manufacturedMaterial/code | .code | CDA coding ↔ FHIR CodeableConcept |
| /consumable/manufacturedProduct/manufacturerOrganization | Organization .manufacturer |
|
| Drug Vehicle /participant[@typeCode="CSM"]/playingEntity/code |
.ingredient.itemCodeableConcept | Set .isActive = falseCDA coding ↔ FHIR CodeableConcept |
| CDA Medication Example | FHIR MedicationRequest and Medication Resources |
|---|---|
|
<substanceAdministration classCode="SBADM" moodCode="INT">
<templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
<id root="cdbd33f0-6cde-11db-9fe1-0800200c9a66"/>
<statusCode code="active"/>
<effectiveTime xsi:type="IVL_TS">
<low value="20120806"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<effectiveTime xsi:type="PIVL_TS" operator="A">
<period xsi:type="IVL_PQ">
<low value="4" unit="h"/>
<high value="6" unit="h"/>
</period>
</effectiveTime>
<repeatNumber value="1"/>
<routeCode
code="C38288"
codeSystem="2.16.840.1.113883.3.26.1.1"
codeSystemName="NCI Thesaurus"
displayName="Oral Route of Administration"/>
<doseQuantity value="1"/>
<maxDoseQuantity >
<numerator value="6" unit="{spray}" />
<denominator value="1" unit="{day}" />
</maxDoseQuantity>
<administrationUnitCode
code="C48501"
codeSystem="2.16.840.1.113883.3.26.1.1"
codeSystemName="National Cancer Institute (NCI) Thesaurus"
displayName="Inhalation dosing unit"/>
<consumable>
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
<code
code="1190220"
codeSystem="2.16.840.1.113883.6.88"
codeSystemName="RxNorm"
displayName="ACTUAT albuterol 0.1 MG/ACTUAT ... Spray"/>
</manufacturedMaterial>
<manufacturerOrganization>
<name>Good Vaccines Inc</name>
</manufacturerOrganization>
</manufacturedProduct>
</consumable>
<author>
<!-- Time the author noted that patient is on medication -->
<templateId root="2.16.840.1.113883.10.20.22.4.119"/>
<time value="201309111603-0700"/>
<assignedAuthor>
<!-- Author maps to Provenance
not included in this example -->
</assignedAuthor>
</author>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.24"/>
<code code="412307009"
displayName="Drug vehicle"
codeSystem="2.16.840.1.113883.6.96"/>
<playingEntity classCode="MMAT">
<code code="387390002"
displayName="sodium chloride"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED"/>
<name>sodium chloride</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="COMP">
<!-- Medication Free Text SIG -->
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.147"/>
<code code="76662-6" codeSystem="2.16.840.1.113883.6.1"/>
<text>
<!-- Resolves to: 2 puffs every 4-6 hours as needed -->
<reference value="#MedicationSig_PRN_222222"/>
</text>
<consumable>
<manufacturedProduct>
<manufacturedLabeledDrug nullFlavor="NA"/>
</manufacturedProduct>
</consumable>
</substanceAdministration>
</entryRelationship>
<entryRelationship typeCode="RSON">
<observation classCode="OBS" moodCode="EVN">
<!-- Indication (V2) -->
<templateId root="2.16.840.1.113883.10.20.22.4.19" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.19"/>
<id extension="44" root="1.3.6.1.4.1.22812.3.99930.3.4.1.3"/>
<code
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
code="404684003"
displayName="Clinical finding"/>
<statusCode code="completed"/>
<effectiveTime>
<low nullFlavor="NI"/>
</effectiveTime>
<value xsi:type="CD"
code="56018004"
codeSystem="2.16.840.1.113883.6.96"
displayName="wheezing" />
</observation>
</entryRelationship>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<act classCode="ACT" moodCode="INT">
<!-- Instruction (V2) -->
<templateId root="2.16.840.1.113883.10.20.22.4.20" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.20"/>
<code code="1153465004"
displayName="Education about overdosing"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<text>Do not overtake</text>
<statusCode code="completed"/>
</act>
</entryRelationship>
<entryRelationship typeCode="REFR">
<supply classCode="SPLY" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.18" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.4.18"/>
<id root="1.2.3.4.56789.1" extension="cb734647-fc99-424c-a864-7e3cda82e704" />
<statusCode code="completed" />
<effectiveTime>
<high value="20121106" />
</effectiveTime>
<!-- Note in FHIR this is one less, so: 1 -->
<repeatNumber value="2" />
<quantity value="3" />
<product>
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<id root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/>
<manufacturedMaterial>
<code
code="1190220"
codeSystem="2.16.840.1.113883.6.88"
codeSystemName="RxNorm"
displayName="ACTUAT albuterol 0.1 MG/ACTUAT ... Spray"/>
</manufacturedMaterial>
</manufacturedProduct>
</product>
</supply>
</entryRelationship>
<precondition typeCode="PRCN">
<criterion>
<templateId root="2.16.840.1.113883.10.20.22.4.25" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.4.25"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" />
<value xsi:type="CD"
code="56018004"
codeSystem="2.16.840.1.113883.6.96"
displayName="Wheezing" />
</criterion>
</precondition>
</substanceAdministration>
|
Note: The following shows a MedicationRequest resource with a Medication resource embedded in its contained property. This was done for ease of creating a single, visual, highlighted example, but implementers may choose to create separate, external resources according to their own policy.
{
"resourceType": "MedicationRequest",
"id": "7fc60296-0667-4a44-86e5-4c432403532e",
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:cdbd33f0-6cde-11db-9fe1-0800200c9a66"
}
],
"status": "active",
"intent": "plan",
"medicationReference": {
"reference": "#containedMed"
},
/* Only one of these can be sent.
If not including a Medication resource
the code can just be sent in codeableConcept
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "1190220",
"display": "ACTUAT albuterol 0.1 MG/ACTUAT ... Spray"
}
]
}, */
"subject": {
"reference": "Patient/18025725"
},
"authoredOn": "2013-09-11T16:03:00-07:00",
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "56018004",
"display": "wheezing"
}
]
}
],
"dosageInstruction": [
{
"text": "2 puffs every 4-6 hours as needed",
"patientInstruction": "Do not overtake",
"additionalInstruction": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "1153465004",
"display": "Education about overdosing"
}
]
}
],
"timing": {
"period": 4,
"periodMax": 6,
"periodUnit": "h"
},
"asNeededCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "56018004",
"display": "wheezing"
}
]
},
"route": {
"coding": [
{
"system": "http://ncithesaurus-stage.nci.nih.gov",
"code": "C38288",
"display": "Oral Route of Administration"
}
]
},
"doseAndRate": [
{
"doseQuantity": {
"value": 1
}
}
],
"maxDosePerPeriod": {
"numerator": {
"value": 6,
"unit": "{spray}",
"code": "{spray}",
"system": "http://unitsofmeasure.org"
},
"denominator": {
"value": 1,
"unit": "{day}",
"code": "{day}",
"system": "http://unitsofmeasure.org"
}
}
}
],
"dispenseRequest": {
"numberOfRepeatsAllowed": 1,
"validityPeriod": {
"end": "2012-11-06"
},
"quantity": {
"value": 3
}
},
"contained": [{
"resourceType": "Medication",
"id": "containedMed",
"code": {
"coding": [{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "1190220",
"display": "ACTUAT albuterol 0.1 MG/ACTUAT ... Spray"
}]
},
"form": {
"coding": [
{
"system": "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
"code": "C48501",
"display": "Inhalation dosing unit"
}
]
},
"manufacturer": {
// If more details exist, would map to Organization resource
"display": "Good Vaccines Inc"
},
"ingredient": [{
"itemCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "387390002",
"display": "sodium chloride"
}
]
}
}]
}]
}
|
The consensus mapping example developed through multiple vendors are available below:
IG © 2020+ HL7 International / Cross-Group Projects. Package hl7.fhir.us.ccda#2.0.0-ballot based on FHIR 4.0.1. Generated 2024-12-17
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