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

Plain Language Summary goes here

## Home Page

Official URL: http://hl7.org/fhir/us/ccda/ImplementationGuide/hl7.fhir.us.ccda | Version: 2.0.0-ballot
IG Standards status: Trial-use | Computable Name: CCDAonFHIR

> 2025 Ballot of C-CDA ↔ FHIR US Core Mapping

> The current release of this IG adds relevant mapping content from C-CDA ↔ FHIR mapping project which was related to the original C-CDA on FHIR work. These mappings are included under the "Mapping" heading and will undergo future updates for additional content.

### Overview

Consolidated CDA (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 (IG) defines a series of FHIR profiles on the Composition resource to represent the various document types in C-CDA and provides an initial mapping of C-CDA and FHIR content. To do the former, this IG profiles Composition for various document types and link the profiles created under the US Core project for any coded entries that would normally be included in C-CDA sections. To have a simpler, more streamlined standard that reuses existing work and focuses on the 80% that implementers actually need in production systems, the resources of US Core represents a portion of the 80% needed for coded entries of CCD, Care Plan & Discharge Summary.

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

### 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 represented using relevant U.S. Core FHIR profiles where they exist. FHIR profiles defined by other work groups or unconstrained FHIR resources may also be referenced if no appropriate US Core Profile exist.

For further information see the pdf-based C-CDA specification, StructureDefinition C-CDA specification, original project scope and mapping project scope.

### Authors (Composition Profiles, Extensions and CapabilityStatement )

Name | Email/URL
--- | ---
HL7 Structured Documents Working Group | http://hl7.org/Special/committees/structure
Rick Geimer | rick.geimer@lantanagroup.com
Sarah Gaunt | sarah.gaunt@lantanagroup.com
Brett Marquard | brett@waveoneassociates.com
Corey Spears | spears.corey@gmail.com
Meenaxi Gosai | meenaxi.gosai@lantanagroup.com

### Authors (C-CDA ↔ FHIR Mapping)

Name | Email/URL
--- | ---
HL7 Cross Group Projects | http://hl7.org/Special/committees/cgp
HL7 Structured Documents Working Group | http://hl7.org/Special/committees/structure
Jay Lyle | jay.lyle@jpsys.com
John D'Amore | johnd@moreinformatics.com
Natalee Agassi | natalee.agassi@oracle.com
Chun Li | Chun.Li@availity.com
Ken Lord | klord@mdixinc.com
Catherine Hoang | Catherine.Hoang2@va.gov
Bill Ormerod | william.ormerod@oracle.com
Benjamin Flessner | benjamin.flessner@availity.com
Brett Marquard | brett@waveoneassociates.com
Christopher Vitale | Christopher.Vitale@availity.com
Sajjad Hussain | sshussain@google.com
Gene Beyer | gene.beyer@oracle.com
Gay Dolin | gdolin@namasteinformatics.com
Lisa Nelson | LNelson@advaultinc.com
Deb Loniewski | loniewskid@michigan.gov

### Dependencies

IG | Package | FHIR | Comment
--- | --- | --- | ---
C-CDA on FHIR | hl7.fhir.us.ccda#2.0.0-ballot | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.5.0 | R4 | Automatically added as a dependency - all IGs depend on HL7 Terminology
US Core Implementation Guide | hl7.fhir.us.core#4.0.0 | R4 |
FHIR Bulk Data Access | hl7.fhir.uv.bulkdata#1.0.1 | R4 |
VSAC | us.nlm.vsac#0.3.0 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.1.0 | R4 |

Package hl7.fhir.us.core#4.0.0 The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Mon, Jun 28, 2021 19:09+0000+00:00)

Package hl7.fhir.uv.extensions.r4#5.1.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

### Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B} systems. Packages for both R4 (hl7.fhir.us.ccda.r4) and R4B (hl7.fhir.us.ccda.r4b) are available.

### Global Profiles

There are no Global profiles defined

### IP Statements

This publication includes IP covered under the following statements.

- ISO maintains the copyright on the country codes, and controls its use carefully. For further details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
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  - ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: AuthorizationExtension, CCDAonFHIR... Show 73 more, CCDAtoFHIRAddressUse, CCDAtoFHIRAdminsitrativeGender, CCDAtoFHIRAllergyIntoleranceCategory, CCDAtoFHIRAllergyIntoleranceType, CCDAtoFHIRAllergyStatus, CCDAtoFHIRConditionClinicalStatus, CCDAtoFHIRCriticality, CCDAtoFHIREncounterStatus, CCDAtoFHIRImmunizationStatus, CCDAtoFHIRMedActivityMood, CCDAtoFHIRMedicationStatus, CCDAtoFHIRNameUse, CCDAtoFHIRNoKnownAllergies, CCDAtoFHIRNullFlavorDataAbsentReason, CCDAtoFHIRProblemCategory, CCDAtoFHIRProblemStatus, CCDAtoFHIRProcedureStatus, CCDAtoFHIRResultReportStatus, CCDAtoFHIRResultStatus, CCDAtoFHIRSeverity, CCDAtoFHIRTelecomType, CCDAtoFHIRTelecomUse, CarePlan, CarePlanDocumentType, CcdaOnFhirClient, CcdaOnFhirServer, ConsultDocumentType, ConsultationNote, ContinuityOfCareDocument, DataEntererExtension, DiagnosticImagingReport, DischargeSummary, DischargeSummaryDocumentTypeCode, FHIRtoCCDAAddressUse, FHIRtoCCDAAdminsitrativeGender, FHIRtoCCDAAllergyIntoleranceCategory, FHIRtoCCDAAllergyIntoleranceType, FHIRtoCCDAAllergyStatus, FHIRtoCCDACriticality, FHIRtoCCDADataAbsentReasonNullFlavor, FHIRtoCCDAImmunizationRefusal, FHIRtoCCDAImmunizationSite, FHIRtoCCDAImmunizationStatus, FHIRtoCCDAMedicationStatus, FHIRtoCCDANameUse, FHIRtoCCDANoKnownAllergies, FHIRtoCCDAObservationStatus, FHIRtoCCDAProblemCategory, FHIRtoCCDAProblemStatus, FHIRtoCCDAProcedureStatus, FHIRtoCCDASeverity, FHIRtoCCDATelecomType, FHIRtoCCDATelecomUse, HPDocumentType, HistoryAndPhysical, InformantExtension, InformationRecipientExtension, LOINCImagingDocumentCodes, OperativeNote, OrderExtension, ParticipantExtension, PerformerExtension, ProcedureNote, ProcedureNoteDocumentTypeCodes, ProgressNote, ProgressNoteDocumentTypeCode, ReferralDocumentType, ReferralNote, SurgicalOperationNoteDocumentTypeCode, TransferDocumentType, TransferSummary, USRealmHeader and VersionNumber
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  - Vaccine Administered Code Set (CVX): Immunization/CF-immunization, Immunization/FC-immunization and Immunization/immunization
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  - Unified Code for Units of Measure (UCUM): Observation/observation-vitals-temp
- These codes are excerpted from Digital Imaging and Communications in Medicine (DICOM) Standard, Part 16: Content Mapping Resource, Copyright © 2011 by the National Electrical Manufacturers Association.
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  - DICOM Controlled Terminology Definitions: Composition/Diagnostic-Imaging-Report-Example and DiagnosticImagingReport
- This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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  - LOINC: Bundle/Complete-Document-Bundle-Example, CarePlan... Show 35 more, CarePlanDocumentType, Composition/Care-Plan-Example, Composition/Consultation-Note-Example, Composition/Continuity-of-Care-Document-Example, Composition/Diagnostic-Imaging-Report-Example, Composition/Discharge-Summary-Example, Composition/History-and-Physical-Example, Composition/Operative-Note-Example, Composition/Procedure-Note-Example, Composition/Progress-Note-Example, Composition/Referral-Note-Example, Composition/Transfer-Summary-Example, Consent/consent-example-basic, ConsultDocumentType, ConsultationNote, ContinuityOfCareDocument, DiagnosticImagingReport, DischargeSummary, DischargeSummaryDocumentTypeCode, HPDocumentType, HistoryAndPhysical, LOINCImagingDocumentCodes, Observation/observation-lab-urine, Observation/observation-smoker, Observation/observation-vitals-temp, OperativeNote, ProcedureNote, ProcedureNoteDocumentTypeCodes, ProgressNote, ProgressNoteDocumentTypeCode, ReferralDocumentType, ReferralNote, SurgicalOperationNoteDocumentTypeCode, TransferDocumentType and TransferSummary
- This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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  - SNOMED Clinical Terms&reg; (SNOMED CT&reg;): AllergyIntolerance/CF-allergy, AllergyIntolerance/FC-allergy... Show 16 more, AllergyIntolerance/allergy-intolerance, Bundle/Complete-Document-Bundle-Example, Composition/Care-Plan-Example, Composition/Diagnostic-Imaging-Report-Example, Composition/Operative-Note-Example, Composition/Procedure-Note-Example, Composition/Transfer-Summary-Example, Condition/CF-problem, Condition/FC-problem, Condition/condition-problem, Encounter/example-1, Observation/observation-smoker, Procedure/CF-procedure, Procedure/procedure-rehab, Procedure/rehab and ServiceRequest/colonoscopy
- This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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  - AllergyIntolerance Clinical Status Codes: AllergyIntolerance/CF-allergy, AllergyIntolerance/FC-allergy and AllergyIntolerance/allergy-intolerance
  - Condition Category Codes: Condition/CF-problem, Condition/FC-problem and Condition/condition-problem
  - Condition Clinical Status Codes: Condition/CF-problem, Condition/FC-problem and Condition/condition-problem
  - Consent Scope Codes: Consent/consent-example-basic
  - Observation Category Codes: Observation/observation-lab-urine, Observation/observation-smoker and Observation/observation-vitals-temp
  - Organization type: Acme Clinic, Acme Labs and Bundle/Complete-Document-Bundle-Example
  - identifierType: Bundle/Complete-Document-Bundle-Example, Patient/example and Practitioner/ccda-practitioner-example
  - ActClass: Composition/Consultation-Note-Example, Composition/Continuity-of-Care-Document-Example and Composition/History-and-Physical-Example
  - ActCode: Consent/consent-example-basic, Encounter/encounter-1 and Encounter/example-1
  - Confidentiality: AllergyIntolerance/FC-allergy, Condition/FC-problem, Immunization/FC-immunization and MedicationRequest/FC-medication
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  - Race & Ethnicity - CDC: Bundle/Complete-Document-Bundle-Example, Patient/CF-patient and Patient/example
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  - RxNorm: AllergyIntolerance/CF-allergy, AllergyIntolerance/FC-allergy, MedicationRequest/CF-medication, MedicationRequest/FC-medication and MedicationStatement/medication-statement

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