Section 1: Primary Standards
Section 3: Clinical and Administrative Domains

CDA® Release 2

DESCRIPTION

The HL7 Version 3 Clinical Document Architecture (CDA®) is a document markup standard that specifies the structure and semantics of "clinical documents" for the purpose of exchange between healthcare providers and patients. It defines a clinical document as having the following six characteristics: 1) Persistence, 2) Stewardship, 3) Potential for authentication, 4) Context, 5) Wholeness and 6) Human readability.

A CDA can contain any type of clinical content -- typical CDA documents would be a Discharge Summary, Imaging Report, Admission & Physical, Pathology Report and more. The most popular use is for inter-enterprise information exchange, such as is envisioned for a US Health Information Exchange (HIE).

ALTERNATIVE NAMES

CDA® Release 2 may also go by the following names or acronyms:

"Clinical Document Architecture, R2", "Clinical Document Architecture, R2 (Reaffirmation)", CDAR2

TARGETS

  • Healthcare Providers
  • Healthcare IT Vendors
  • EHR and PHR Systems
  • Departmental Systems
  • Dictation/Transcription Vendors

BENEFITS

  • Supports the exchange of clinical documents between those involved in the care of a patient
  • Supports the re-use of clinical data for public health reporting, quality monitoring, patient safety and clinical trials
  • Can be reused in multiple applications

IMPLEMENTATIONS/CASE STUDIES

See the Implementation Guides for this Standard.

  • International users in countries where health information exchange (HIE) is well established such as Finland, Greece and Germany
  • Pilot HIEs in Canada, Japan, Korea, Mexico, Argentina and elsewhere
  • CDA is firmly in the plans for many of the nascent US HIEs and the US Military Health System
  • Columbia-Presbyterian in New York: Project on CDA note generation with knowledge management and controlled vocabulary
  • Queen Elizabeth II Hospital/Dalhousie University: CDA for decision support
  • Duke Clinical Research Institute: CDA as the Single Source Proof of Concept
  • The Mayo Clinic is the largest single producer of CDA documents, producing thousands of CDAs every week with the anticipation of reaching 50,000 notes per week

DEVELOPMENT BACKGROUND

CDA® grew out of work that originated outside of HL7 in early 1996 when a group of physicians including Tom Lincoln, John Spinosa, Dan Essin, John Mattison and Bob Dolin began to meet to discuss the potential for structured markup in clinical documents. The earliest draft was called the Kona Architecture and was developed in 1997 after the group had joined HL7. Since that time, many people have worked on it and the basic ideas have been refined and developed along with the HL7 Version 3 framework and the Reference Information Model (RIM). The original group morphed into the HL7 Structured Documents Work Group which is responsible for CDA and other HL7 document types.

CDA introduces the concept of incremental semantic interoperability. What this means is that there is a range of complexity allowed within the specification and users must set their own level of compliance. The minimal CDA is a small number of XML-encoded metadata fields (such as provider name, document type, document identifier, and so on) and a body which can be any commonly-used MIME type such as pdf or .doc (Microsoft Word) or even a scanned image file.

While the body of such a document would not be interpretable for applications like decision support, the minimal, standard metadata set and display characteristics mean that such a document could be filed, searched, categorized and retrieved along with more richly-encoded documents. They would all be equally readable at the point of care.

The most recent version of CDA is Release 2 which is used as the foundation for all current CDA Implementation Guides. CDA Release 3 is currently under development.

RESPONSIBLE WORK GROUP

Structured Documents

RELATED DOCUMENTS

CDA® Release 2

(Download) (4.35 MB)

CDA® Release 1 (View Brief)

(Download) (1.95 MB)

HL7 CCD to ASCII Blue Button Transform, Release 1 (View Brief) (Buy)
HL7 Implementation Guide for CDA® R2: Progress Note (View Brief)
Presentation: Overview of Care Record Summary (View Brief)

(Download) (227 KB)

Quick Start Guide for CDA R2 (View Brief)

IMPLEMENTATION GUIDES

HL7 Implementation Guide for CDA, Release 2®: Clinical Oncology Treatment Plan and Summary, DSTU Release 1 (View Brief)
HL7 Implementation Guide for CDA® R2 - Personal Healthcare Monitoring Report (View Brief)
HL7 Implementation Guide for CDA® R2: Patient Generated Document Header Template, Release 1 (View Brief)

(Download) (532 KB)

HL7 Implementation Guide for CDA® R2: Plan-to-Plan Personal Health Record (PHR) Data Transfer, Release 1 (View Brief)

(Download) (1.24 MB)

HL7 Implementation Guide for CDA® R2: Public Health Case Reports (US Realm) (View Brief)

(Download) (1.27 MB)

HL7 Implementation Guide for CDA® R2: Quality Reporting Document Architecture - Category I (QRDA) DSTU Release 2 (US Realm) (View Brief)
HL7 Implementation Guide for CDA® Release 2 - Level 1 and 2 - Care Record Summary (US realm) (View Brief)

(Download) (1.78 MB)

HL7 Implementation Guide for CDA® Release 2 – Level 3: Emergency Medical Services; Patient Care Report, Release 1 – US Realm (View Brief)

(Download) (969 KB)

HL7 Implementation Guide for CDA® Release 2: CDA Framework for Questionnaire Assessments, DSTU Release 2 (View Brief)
HL7 Implementation Guide for CDA® Release 2: Digital Signatures and Delegation of Rights, Release 1 (View Brief)
HL7 Implementation Guide for CDA® Release 2: Exchange of Clinical Trial Subject Data; Patient Narratives, Release 1 - US Realm (View Brief)
HL7 Implementation Guide for CDA® Release 2: Genetic Testing Reports, Release 1 (View Brief)
HL7 Implementation Guide for CDA® Release 2: Healthcare Associated Infection (HAI) Reports (View Brief)
HL7 Implementation Guide for CDA® Release 2: HIV/AIDS Services Report, Release 1 - US Realm (View Brief)

(Download) (3.04 MB)

HL7 Implementation Guide for CDA® Release 2: IHE Health Story Consolidation, Release 1.1 - US Realm (View Brief)

(Download) (6.75 MB)

HL7 Implementation Guide for CDA® Release 2: Long-Term Post-Acute Care Summary, DSTU Release 1 (US Realm) (View Brief)
HL7 Implementation Guide for CDA® Release 2: Patient Assessments, Release 1 (View Brief)
HL7 Implementation Guide for CDA® Release 2: Quality Reporting Document Architecture - Category III (QRDA III), DSTU Release 1 (View Brief)
HL7 Implementation Guide for CDA® Release 2: Questionnaire Form Definition Document, Release 1 (View Brief)
HL7 Implementation Guide for CDA® Release 2: Questionnaire Response Document, Release 1 (View Brief)
HL7 Implementation Guide for CDA® Release 2: Reference Profile for EHR Interoperability, Release 1 (View Brief)
HL7 Implementation Guide for CDA® Release 2: Trauma Registry Data Submission, Release 1 (View Brief)
HL7 Implementation Guide for CDA®, Release 2: Consent Directives, Release 1 (View Brief)
HL7 Implementation Guide for CDA®, Release 2: Procedure Note, Release 1 (View Brief)
HL7 Implementation Guides for CDA® R2: greenCDA Modules for CCD®, Release 1 (View Brief)

(Download) (610 KB)

HL7 Standard for CDA® Release 2: Imaging Integration; Basic Imaging Reports in CDA and DICOM, Release 1 (View Brief)

(Download) (2.04 MB)

HL7 Templates Standard: Specification and Use of Reusable Information Constraint Templates, Release 1 (View Brief)
HL7 Version 3 Implementation Guide for CDA® R2 L3: Neonatal Care Reports (NCR), R1 (View Brief)
HL7/ASTM Implementation Guide for CDA® R2 -Continuity of Care Document (CCD®) Release 1 (View Brief)

(Download) (4.10 MB)

ADDITIONAL DETAILS

For quick answers to the most frequently asked questions about the Clinical Document Architecture (CDA) standard, see the CDA® Frequently Asked Questions page at http://www.hl7.org/about/FAQs/index.cfm.