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Clinical Documentation Architecture (CDA)S&I Framework One-Pager Series, Side 1

S&I Framework: ONC brought together providers, health IT vendors, states, federal partners, government agencies, the standards community and the research community to examine how to improve the exchange of clinical information among providers, patients and other authorized entities electronically in support of meaningful use and IOM-identified needs for improvement in the quality of care.

CDA Overview

  • Challenge
  • The healthcare community faces implementation challenges regarding navigation of the source IGs.
  • Source CDA IGs contain multiple layers of references to other documents rather than including section level content in one document.
  • The resulting occurrence forces developers to follow a reference trail in order to implement standards.
  • Background
  • CDA is an XML-based standard prescribed by HL7 that specifies the encoding, structure, and semantics for the exchange of clinical document information.
  • There are several source Implementation Guides (IG) that are covered by the CDA standard:
    • Eight Health Story IGs
    • HITSP/C32
    • HITSP/C83
    • HL7 and IHE Templates
    • HITSP/C48
  • Solution
  • The CDA project consolidates existing disparate IGs through a harmonization process that eliminates current implementation challenges - unclear documentation, lack of technical guidance, and a general overlap of standards – that EHR implementers face.
  • CDA uses model-driven tools development that enables the reusability of templates to republish IGs for future initiatives.




CDA Objectives and Progress

There were several charter objectives identified during the launch of the CDA Consolidation project, under the S&I Framework, focusing on the rapid development of a Consolidated CDA Implementation Guide:

Consolidate the HL7/Health Story clinical document type IGs and HITSP/C32, and HL7 and IHE templates into a single library of CDA Templates using model-driven tools to re-publish them from this library

Objective 1

Resolve the ‘peel the onion’ problem: deliver a single, implementation-ready, implementer-friendly package, which includes both textual and computable

Objective 4

Rapid demonstration of templated CDA for health information exchange, according to PCAST recommendations

Development of a testing solution to enable implementers to validate their output

Objective 2

Objective 5

Provide a real world demonstration of model-driven standards development using MDHT and the CDC/NCI Template Database (Tdb)

Objective 3

Clinical Documentation Architecture (CDA) S&I Framework One-Pager Series, Side 2

CDA Tooling Process

The approach for CDA consolidation is a three step process that begins by identifying the source CDA standards to be consolidated, consolidates the identified guides, and generates critical published outputs to provide to implementers.

  • The Consolidated CDA IG is expressed in two ways: The document submitted through HL7 ballot and the outputs generated through Model-Driven Health Tools (MDHT) and Tdb.
  • MDHT serves as the tool used to enable consolidation and can be used to generate Java API, validation tools, and sample code to reference in support of implementation.

CDA Adoption Approach

The CDA project utilizes the following approach to enable an organization to transition to the Consolidated CDA Standard. The project considers the following stakeholders: State HIE, Beacon Communities, LTPAC, VLER, the ToC Initiative, and healthcare vendors:

Key Links


S&I Framework Wiki


CDA Wiki Overview


Health Story IGs

Step 1: Identify Current Standards Used by an organization to determine the level of fit and gaps between their current state and the Consolidated CDA IG.

Step 2: Define Constrained CDA byrecommending optional and required data fields that organizations need to be supported.


Health Level 7 (HL7)

Step 3: Adopt Constrained CDA toprovide an incremental milestone towards transitioning to the full CDA standard. Vendors should be engaged to support the implementation of constrained CDA.


ONC Website

Step 4: Transition to Consolidated CDA IGby identifying the gaps that need to be bridged between the current state and full standard. Vendors will need to expand their involvement to also support the implementation of the Consolidated CDA IG.