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Section 1a: Clinical Document Architecture (CDA®)

CDA® (HL7 Clinical Document Architecture)

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).

 

 

Publication Date Version Description
CDA_R2.1 sequence
 
Current_Version January 2021 errata 2.1

Latest Published Version – Available for Implementer Review and Consideration 
(HL7_CDA_R2_1 2021Jan_errata) zip file

 November 2019 2.1

Initial Normative Release - Available for Implementer Review and Consideration (recently introduced, low adoption)
(HL7_CDA_R2_1 spec) zip file

CDA® R2.0 Sequence
 
Current_Version 2010 Normative Reaffirmation 2

 

January 2006 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)

 

 

 

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
  • Provides a mature and proven architecture for structured and unstructured documents that integrates with HL7 FHIR

IMPLEMENTATIONS/CASE STUDIES

  • 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.

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.

RELATED DOCUMENTS

CDA® (HL7 Clinical Document Architecture)
CDA® R2.1 (HL7 Clinical Document Architecture, Release 2.1) (View Brief)

(Download) (25.19 MB)

CDA® Release 1 (View Brief)

(Download) (1.95 MB)

CDA® Release 2 (View Brief)

(Download) (4.35 MB)

HL7 CCD to ASCII Blue Button Transform, Release 1 (View Brief)
HL7 CDA ® Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1, DSTU Release 1.1 – US Realm (View Brief)
HL7 CDA R2 Implementation Guide: Dental Data Exchange, Release 1, STU 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide International Patient Summary, Release 1 (View Brief)
HL7 CDA® R2 Implementation Guide: Ambulatory and Hospital Healthcare Provider Reporting to Birth Defect Registries Release 1 , STU 2 -US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Birth and Fetal Death Reporting, Release 1, STU Release 2 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: C-CDA R2.1 Supplemental Templates for Infectious Disease, Release 1, STU 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: C-CDA R2.1 Supplemental Templates for Nutrition, Release 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: C-CDA R2.1 Supplemental Templates for Pregnancy Status, Release 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Clinical Oncology Treatment Plan and Summary, Release 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Clinical Summary Relevant and Pertinent Data, Release 1 (View Brief)

(Download) (1.65 MB)

HL7 CDA® R2 Implementation Guide: Data Provenance, Release 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Emergency Medical Services; Patient Care Report, Release 1 – US Realm (View Brief)

(Download) (969 KB)

HL7 CDA® R2 Implementation Guide: ePOLST: Portable Medical Orders About Resuscitation and Initial Treatment, Release 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Exchange of C-CDA Based Documents; Periodontal Attachment, Release 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Healthcare Associated Infection (HAI) Reports, Release 3 - US Realm (View Brief)

(Download) (13.36 MB)

HL7 CDA® R2 Implementation Guide: Medication Therapy Management (MTM) Templates, Release 1 - US Realm (View Brief)

(Download) (2.77 MB)

HL7 CDA® R2 Implementation Guide: National Health Care Surveys (NHCS), R1 STU Release 3.1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: National Healthcare Safety Network (NHSN) Healthcare Associated Infection (HAI) Reports for Long Term Care Facilities (HAI-LTCF-CDA), Release 1, STU 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: NHSN Healthcare Associated Infection (HAI) Reports, Release 4, STU 2 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Orthodontic Attachment, Release 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Patient-Friendly Language for Consumer User Interfaces, Release 1 (View Brief)

(Download) (3.75 MB)

HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan (PACP) Document, Release 1 - US Realm STU Release 2 (View Brief)
HL7 CDA® R2 Implementation Guide: Personal Healthcare Monitoring Report, Release 1 (View Brief)

(Download) (1.39 MB)

HL7 CDA® R2 Implementation Guide: Pharmacy Templates, Release 1 (View Brief)
HL7 CDA® R2 Implementation Guide: Privacy Consent Directives, Release 1 (View Brief)

(Download) (785 KB)

HL7 CDA® R2 Implementation Guide: Public Health Case Report - the Electronic Initial Case Report (eICR) Release 2, STU Release 3.1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Quality Reporting Document Architecture (QRDA III), Release 1 - US Realm (View Brief)

(Download) (1.87 MB)

HL7 CDA® R2 Implementation Guide: Quality Reporting Document Architecture - Category I (QRDA I) - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Reportability Response, Release 1, STU Release 1.1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Supplemental QRDA Clinical Quality Data Sharing User Guide, Release 1 (View Brief)

(Download) (585 KB)

HL7 CDA® R2 Implementation Guide: Trauma Registry Data Submission, Release 1 - US Realm (View Brief)

(Download) (2.00 MB)

HL7 CDA® R2 Implementation Guide: Trauma Registry Data Submission, Release 2 - US Realm (View Brief)

(Download) (1.73 MB)

HL7 CDA® R2 Implementation Guide: Vital Records Death Reporting, Release 1 STU 2.1 - US Realm (View Brief)
HL7 CDA® Release 2 Implementation Guide: Additional CDA R2 Templates – Clinical Documents for Payers Set 1, Release 1 – US Realm (View Brief)
HL7 Implementation Guide for CDA® R2 - Supplement to Consolidated CDA for Attachments, Release 1 (View Brief)

(Download) (671 KB)

HL7 Implementation Guide for CDA® R2: Consult Notes, Release 1 (View Brief)
HL7 Implementation Guide for CDA® R2: History and Physical (H&P) Notes, Release 1 (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: Progress Note (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: Healthcare Associated Infection Reports, Release 2 - US Realm (View Brief)

(Download) (9.05 MB)

HL7 Implementation Guide for CDA® Release 2: Care Record Summary Discharge Summary (View Brief)
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, Release 1 (View Brief)

(Download) (4.46 MB)

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: 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: 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: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1 - US Realm (View Brief)

(Download) (4.88 MB)

HL7 Implementation Guide for CDA®, Release 2: Procedure Note, Release 1 (View Brief)
HL7 Implementation Guide for CDA®, Release 2: Unstructured Documents (View Brief)
HL7 Implementation Guide: S&I Framework Transitions of Care Companion Guide to Consolidated-CDA for Meaningful Use Stage 2, Release 1 – US Realm (View Brief)

(Download) (3.04 MB)

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) (3.30 MB)

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

(Download) (1.19 MB)

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)

Presentation: Overview of Care Record Summary (View Brief)

(Download) (227 KB)

Quick Start Guide for CDA R2 (View Brief)

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

BALLOT TYPE

  • Normative

STATUS DATE

RESPONSIBLE WORK GROUP

Structured Documents

STAKEHOLDERS

  • EHR, PHR Vendors
  • Health Care IT Vendors
  • Healthcare Institutions

FAMILY

  • CDA

CURRENT STATE

  • Active

REALM

  • Universal