OpenClinical logo

Standards

Standards for health information systems: Clinical Document Architecture

spacer

CDA
name Clinical Document Architecture
summary XML-based markup standard for the representation and transfer of clinical documents.

"CDA is a document markup standard that specifies the structure and semantics of a clinical document (such as a discharge summary or progress note) for the purpose of exchange. A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content. It can be transferred within a message and can exist independently, outside the transferring message." [Dolin et al, 2006]

The CDA leverages XML, the HL7 Reference Information Model (RIM), HL7 v3 data types, and coded vocabularies and "is being used also in electronic health records projects to provide a standard format for entry, retrieval and storage of health information."

location Developed in the USA
sponsor organisation HL7, ANSI
adoption date CDA release 1.0: 2000
CDA release 2.0 was approved as an ANSI standard in May 2005
clinical domains N/A
keywords document template, document management, patient data set, Patient Core Data Set, patient identifying information, patient data transfer, data sharing, interoperability, electronic health record, personal health record, patient safety, medical errors, HL7 Version 3, HL7 RIM Reference Information Model, WWW, XML, XML document, XML schema, standards.
developed by HL7
links  bullet  CDA (HL7)  bullet  Continuity of Care Record (CCR) [OC]  bullet  CDA Validator (from Alschuler Associates)
References

Dolin RH, Alschuler L, Boyer S et al. HL7 Clinical Document Architecture, Release 2. J Am Med Inform Assoc. 2006 Jan-Feb;13(1):30-9.

[PubMed]   []

" Clinical Document Architecture, Release One (CDA R1), became an American National Standards Institute (ANSI)-approved HL7 Standard in November 2000, representing the first specification derived from the Health Level 7 (HL7) Reference Information Model (RIM). CDA, Release Two (CDA R2), became an ANSI-approved HL7 Standard in May 2005 and is the subject of this article, where the focus is primarily on how the standard has evolved since CDA R1, particularly in the area of semantic representation of clinical events. CDA is a document markup standard that specifies the structure and semantics of a clinical document (such as a discharge summary or progress note) for the purpose of exchange. A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content. It can be transferred within a message and can exist independently, outside the transferring message. CDA documents are encoded in Extensible Markup Language (XML), and they derive their machine processable meaning from the RIM, coupled with terminology. The CDA R2 model is richly expressive, enabling the formal representation of clinical statements (such as observations, medication administrations, and adverse events) such that they can be interpreted and acted upon by a computer. On the other hand, CDA R2 offers a low bar for adoption, providing a mechanism for simply wrapping a non-XML document with the CDA header or for creating a document with a structured header and sections containing only narrative content. The intent is to facilitate widespread adoption, while providing a mechanism for incremental semantic interoperability. "

Dolin RH, Alschuler L, Beebe C et al. The HL7 Clinical Document Architecture. J Am Med Inform Assoc. 2001 Nov-Dec;8(6):552-69.

[PubMed]   [PubMed Central]

" Many people know of Health Level 7 (HL7) as an organization that creates health care messaging standards. Health Level 7 is also developing standards for the representation of clinical documents (such as discharge summaries and progress notes). These document standards make up the HL7 Clinical Document Architecture (CDA). The HL7 CDA Framework, release 1.0, became an ANSI-approved HL7 standard in November 2000. This article presents the approach and objectives of the CDA, along with a technical overview of the standard. The CDA is a document markup standard that specifies the structure and semantics of clinical documents. A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content. The document can be sent inside an HL7 message and can exist independently, outside a transferring message. The first release of the standard has attempted to fill an important gap by addressing common and largely narrative clinical notes. It deliberately leaves out certain advanced and complex semantics, both to foster broad implementation and to give time for these complex semantics to be fleshed out within HL7. Being a part of the emerging HL7 version 3 family of standards, the CDA derives its semantic content from the shared HL7 Reference Information Model and is implemented in Extensible Markup Language. The HL7 mission is to develop standards that enable semantic interoperability across all platforms. The HL7 version 3 family of standards, including the CDA, are moving us closer to the realization of this vision. "

Ferranti JM, Musser RC, Kawamoto K, Hammond WE. The clinical document architecture and the continuity of care record: a critical analysis. J Am Med Inform Assoc. 2006 May-Jun;13(3):245-52.

[PubMed]   []

" Health care provides many opportunities in which the sharing of data between independent sites is highly desirable. Several standards are required to produce the functional and semantic interoperability necessary to support the exchange of such data: a common reference information model, a common set of data elements, a common terminology, common data structures, and a common transport standard. This paper addresses one component of that set of standards: the ability to create a document that supports the exchange of structured data components. Unfortunately, two different standards development organizations have produced similar standards for that purpose based on different information models: Health Level 7 (HL7)'s Clinical Document Architecture (CDA) and The American Society for Testing and Materials (ASTM International) Continuity of Care Record (CCR). The coexistence of both standards might require mapping from one standard to the other, which could be accompanied by a loss of information and functionality. This paper examines and compares the two standards, emphasizes the strengths and weaknesses of each, and proposes a strategy of harmonization to enhance future progress. While some of the authors are members of HL7 and/or ASTM International, the authors stress that the viewpoints represented in this paper are those of the authors and do not represent the official viewpoints of either HL7 or of ASTM International. "

Klein A, Ganslandt T, Brinkmann L, Spitzer M, Ueckert F, Prokosch HU. Experiences with an Interoperable Data Acquisition Platform for Multi-Centric Research Networks Based on HL7 CDA. AMIA Annu Symp Proc. 2006;:986.

[PubMed]   []

" A remote data entry (RDE) module was successfully integrated within a Web-based telemedicine system1 in a German multi-centric research network for a rare disease called Epidermolysis Bullosa. The use of standards like XML and HL7 CDA (Clinical Document Architecture) for structured data storage, guarantees long-term accessibility and high level interoperability. "

spacer

acknowledgements
 
page history
Entry on OpenClinical: 27 July 2006
Last main update: 27 July 2006

 

Search this site
 

 

Privacy policy User agreement Copyright Feedback

Last modified:
© Copyright OpenClinical 2002-2011