Section 1a: Clinical Document Architecture (CDA®)
CDA® (HL7 Clinical Document Architecture)
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).
|Current_Version January 2021 errata||2.1||
Latest Published Version – Available for Implementer Review and Consideration
Initial Normative Release - Available for Implementer Review and Consideration (recently introduced, low adoption)
CDA® R2.0 Sequence
|Current_Version 2010 Normative Reaffirmation||2||
Current Official Published Version
Equivalent content in an easier to navigate web framework (cda_r2_normativewebedition2010)
|April 2005||2.0||First Version of CDA 2.0 (no longer accessible on HL7.org)|
CDA® R1.0 Sequence
|November 2000||1.1||First version of CDA 1.0 (HL7_CDA_R1_FINAL)|
- Healthcare Providers
- Healthcare IT Vendors
- EHR and PHR Systems
- Departmental Systems
- Dictation/Transcription Vendors
- 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
- Provides a mature and proven architecture for structured and unstructured documents that integrates with HL7 FHIR
- 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
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.
CDA also supports the exchange of a rich set of structured data elements encompassed within an organization of standardized sections comprised by the document. The body of the document presents the information it contains in a human readable format. It also carries the information in data structures that are machine processable. The discrete data is interpretable for applications like decision support and quality measurement and can be used to improve efficiency and effectiveness of many clinical and administrative processes within healthcare.
CDA R2.0 is widely adopted throughout the world with heavy adoption in Canada, Austria, Denmark, France, New Zealand, and US. In April of 2019 the US Carequality reported a volume of over $35 Million C-CDA document available through its network.
CDA R2.1 requested publication in August 2019 and the newly formed HL7 CDA Management Group together with the HL7 Structured Workgroup will work with the implementer community to raise awareness of the changes and improvements to determine a feasible roadmap for adoption.
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.
RESPONSIBLE WORK GROUP
- EHR, PHR Vendors
- Health Care IT Vendors
- Healthcare Institutions