The

HL7 Health Level Seven or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. These standards focus on the application layer, which is "la ...

Clinical Document Architecture (CDA) is an

XML Extensible Markup Language (XML) is a markup language and file format for storing, transmitting, and reconstructing arbitrary data. It defines a set of rules for encoding documents in a format that is both human-readable and machine-readable. ...

-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange. In November 2000, HL7 published Release 1.0. The organization published Release 2.0 with its "2005 Normative Edition."

Content

CDA specifies the syntax and supplies a framework for specifying the full semantics of a clinical document, defined by six characteristics: # Persistence # Stewardship # Potential for authentication # Context # Wholeness # Human readability CDA can hold any kind of clinical information that would be included in a patient's

medical record The terms medical record, health record and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdict ...

; examples include: * Discharge summary (following

inpatient care Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extreme ...

) *

History History (derived ) is the systematic study and the documentation of the human activity. The time period of event before the History of writing#Inventions of writing, invention of writing systems is considered prehistory. "History" is an umbr ...

physical Physical may refer to: *Physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally cons ...

* Specialist reports, such as those for medical imaging or

pathology Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in ...

An XML element in a CDA supports unstructured text, as well as links to composite documents encoded in

pdf Portable Document Format (PDF), standardized as ISO 32000, is a file format developed by Adobe in 1992 to present documents, including text formatting and images, in a manner independent of application software, hardware, and operating systems. ...

, docx, or

rtf RTF may refer to: Organisations * African Union Regional Task Force, the military operation of the RCI-LRA, 2011–2018. * Radiodiffusion-Télévision Française, a broadcaster in France, 1949–1964 * Russian Tennis Federation, the national go ...

, as well as image formats like

jpg JPEG ( ) is a commonly used method of lossy compression for digital images, particularly for those images produced by digital photography. The degree of compression can be adjusted, allowing a selectable tradeoff between storage size and image ...

and png. It was developed using the HL7 Development Framework (HDF) and it is based on the HL7 Reference Information Model (RIM) and the HL7 Version 3 Data Types. The CDA specifies that the content of the document consists of a mandatory textual part (which ensures human interpretation of the document contents) and optional structured parts (for software processing). The structured part relies on coding systems (such as from SNOMED and LOINC) to represent concepts.

Consolidated Clinical Document Architecture

In 2012, in response to conflicting CDAs in use by the

healthcare industry The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, ...

, the Office of the National Coordinator for Health Information Technology (ONC) streamlined commonly used templates to create the Consolidated-CDA (C-CDA).

Transport

The CDA standard doesn't specify how the documents should be transported. CDA documents can be transported using HL7 version 2 messages, HL7 version 3 messages, IHE protocols such as XDS, as well as by other mechanisms including:

DICOM Digital Imaging and Communications in Medicine (DICOM) is the standard for the communication and management of medical imaging information and related data. DICOM is most commonly used for storing and transmitting medical images enabling the integ ...

MIME Multipurpose Internet Mail Extensions (MIME) is an Internet standard that extends the format of email messages to support text in character sets other than ASCII, as well as attachments of audio, video, images, and application programs. Messa ...

attachments to

email Electronic mail (email or e-mail) is a method of exchanging messages ("mail") between people using electronic devices. Email was thus conceived as the electronic ( digital) version of, or counterpart to, mail, at a time when "mail" mean ...

http The Hypertext Transfer Protocol (HTTP) is an application layer protocol in the Internet protocol suite model for distributed, collaborative, hypermedia information systems. HTTP is the foundation of data communication for the World Wide Web, ...

or ftp.

Standard certification and adoption

The standard is certified by

ANSI The American National Standards Institute (ANSI ) is a private non-profit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States. The organ ...

. CDA Release 2 has been adopted as an ISO standard, ISO/

27932:2009.

Country-specific implementations

Australia

Australia's Personally Controlled Electronic Health Record (PCEHR), known as "My Health Record," uses a specialized implementation of HL7 CDA Release 2.

United Kingdom

In the UK the Interoperability Toolkit (ITK) utilises the 'CDA R2 from HL7 V3 - for CDA profiles' for the Correspondence pack. See 'What standards does ITK utilise?'

United States

In the U.S. the CDA standard is probably best known as the basis for the Continuity of Care Document (CCD) specification, based on the data model as specified by

ASTM ASTM International, formerly known as American Society for Testing and Materials, is an international standards organization that develops and publishes voluntary consensus technical standards for a wide range of materials, products, systems, a ...

Continuity of Care Record Continuity of Care Record (CCR) is a health record standard specification developed jointly by ASTM International, the Massachusetts Medical Society (MMS), the Healthcare Information and Management Systems Society (HIMSS), the American Academy ...

. The U.S. Healthcare Information Technology Standards Panel has selected the CCD as one of its standards.

References

External links

* * * * {{cite web , title=C-CDA to SQL app and API , website=cda2sql.com , url=https://www.cda2sql.com/ Standards for electronic health records Computer file formats Industry-specific XML-based standards