How are CDA and C-CDA Benefitting the Healthcare IT Industry?

How are CDA and C-CDA Benefitting the Healthcare IT Industry?
Have you ever heard about the terms- CDA and C-CDA in the healthcare industry? Clinical Data Architecture is a markup standard developed by Health Level 7 International. It defines the structure of medical records, including progress and discharge summaries. 

Sometimes these documents also include text and other types of multimedia. Whereas, C-CDA contains a library of CDA and includes progress notes, consultation notes, and continuity of care document. CDA specifications are flexible and are used to constrain the generic CDA specification. Let us now understand these terms in-depth. 

What is Clinical Data Architecture (CDA)?

CDA is an XML based standard for encoding documents for easy data exchange. It specifies the syntax and offers a framework specifying the full semantics of a clinical document. It was in 2000 when the first CDA R1 was approved, and in 2005, the later one, i.e., CDA R2, was approved. 

CDA is used across healthcare organizations, including clinics, hospitals, and regulatory authorities. It is the most widely adopted HL7 standard and uses a common design structure with six characteristics, namely, Stewardship (maintained by a trusted organization), Context, Human readability (a person can read the material), Wholeness (the full document), Persistence, and potential for authentication. 

It is based on the Extensible Markup Language (XML) and uses HL7’s Reference Information Model, which puts data in an administrative context and express how data is connected. It also takes advantage of coding systems such as LOINC and SNOM CT. 

With the HL7 format, clinical data architecture allows health IT system and electrical health records to process documents, while also permitting people to read them on mobile devices. It is a step to make sure that patient records can be read by any EHR system. The CDA standard is certified by ANSI and has been adopted as an ISO standard, ISO/HL7 27932:2009. 

Benefits of Clinical Data Architecture

1. It is a flexible standard that can be read and processed by humans and machines. 
2. It can be reused in multiple applications. 
3. It allows displaying a patient’s medical history in one document. 
4. It aims to eliminate message variability that HL7 V2 is prone to. 
5. It does not identify a specific method for sharing the data in a document. Options can include, MIME (multi-purpose Internet Mail Extensions), HyperText Transfer Protocol (HTTP), DICOM (Digital Imaging and Communication in Medicine). Along with the continuity of care record (CCR) standard, CDA forms the basis for the CCD and patient document information exchange. 

Challenges Faced Due to Clinical Data Architecture

Thought it offers a range of benefits to the healthcare industry, it has certain limitations too. When it comes to validation, different customers use different validation methods; this sometimes couldn’t match the available ones. Furthermore, having incomplete information can make it challenging to create different documents. CDA is not compatible with HL7 V2. 

What Do You Understand by Consolidated CDA?

It is one of the popular implementation guides for CDA and covers an important part of clinical care. Its mission of the essential elements is closely associated with FHIR’s focus. It allows you to interoperate between VDA and FHIR and C-CDA. 

The Implementation guide shares a series of FHIR profiles and represents several document types in C-CDA. This release does not map the C-CDA template to FHIR profiles and accomplish the C-CDA case using composition resource profiles that are created under this project. 

The composition profiles in IG (implementation guide) do not require coded data in any part. It is a departure from C-CDA and requires coded data for results and medications. 

The consolidated CDA contains a library of CDA templates and integrates the healthcare enterprise and HITSP (Health Information Technology Standards Panel). It represents HL7 health story guides and related components of IHE patient care Coordination and Continuity of Care.  

Basic Things to Know About Consolidated CDA

1. It Aims to Arrange the Documents at One Place

Consolidated CDA organizes all documents in one place. To represent C-CDA templates for clinical notes: 2.1 templates use FHIR profiles. The first stage of the project defines all the consolidated CDA profiles on the Composition resource and differents sections. 

The coded data that is used is represented using U.S core FHIR profiles where they exist. These profiles are defined by groups or unconstrained FHIR resources. 

2. Different Types of Documents Included in Consolidated CDA

The CDA implementation guide includes nine types of commonly used CDA documents, namely, procedure note, progress note, discharge summary, consultation notes, operative notes, unstructured notes, continuity of care document, DICOM Diagnostic Imaging Reports, and history and physical. Each of these documents is defined in the C-CDA implementation guide. 

3. The Rule of Meaningful Use Stage Refer to the Adoption of C-CDA for Summary Care Records

The proposed rule did not describe the CCD document template within the C-CDA standard. However, it is assumed that the CCD document is the basic standard among the nine Consolidated CDA documents. 

4. The Data Elements Present in the CCDA Summary Describe Different Things

Data portability creates a set of export summaries for all patients in EHR technology. 

It allows a site to create export summary CCDA documents. Clinical Summary creates a summary for the patient. This summary is provided electronically to the patient. The transition of Care creates a transition of referral summary.  


In the creation of C-CDA, HL7 reviewed the existing HL7 Health Story guides and the additional information from HITSP and Stage 1 Meaningful use. Implementators moving from C-CDA to FHIR should know that the goal of the project is to address the same case as clinical documentation for primary and transfer of care scenarios, but the methodologies and values in FHIR are different from those C-CDA. 

1. The sets used in FHIR are not aligned with those C-CDA.
2. It has different procedure templates and core procedure profiles.
3. In C-CDA, multiple observations are wrapped in an organizer, whereas, in FHIR, the observation resource contains multiple observations as subcomponents.

How CDA and C-CDA are Different

The Clinical Document Architecture is a markup standard for the semantics of exchanged clinical documents. These documents are encoded in Extensible Markup Language. It is a document that should contain a patient’s history whenever settings are changed. 

Whereas, Consolidated Clinical Document Architecture issued for an implementation specifies a library of templates and is used for a set of specific document types. CCDA is technically specified in the laws and contains more information than a CCD. CCD keeps on changing to meet government regulations and fixing the errors in the old version.

Final Words

When it comes to healthcare services, we at Covetus have a team of experts who knows the ins and outs of the healthcare industry. They have expertise in different healthcare standards, including HL7, ICD-9, ICD-10, and more. Our team offers highly scalable healthcare solutions and undertakes the challenges promptly. 
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