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Section 1: Primary Standards
Section 1a: Clinical Document Architecture (CDA®)
Section 2: Clinical and Administrative Domains

CDA® Release 2

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.

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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).

Current Normative Release
CDA® R2.0 Online Edition 2024, 2024年08月20日

Also available as an Informative Release
CDA® R2.0 Structure Definition Format

ALTERNATIVE NAMES

CDA® Release 2 may also go by the following names or acronyms:

"Reaffirmation of HL7 V3 Standard: Clinical Document Architecture, Release 2", "Clinical Document Architecture, R2", "Clinical Document Architecture, R2 (Reaffirmation)", CDAR2, CDA R2

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

IMPLEMENTATIONS/CASE STUDIES

  • In the United States, Sequoia/eHealthExchange support exchange of billions of CDA documents annually
  • Health information exchange (HIE) is well established in the European Union through eHealthNetwork/myhealth@eu
  • Australia and New Zealand (in addition to other nations) support widespread use and multiple document types
  • Multiple Implementation Guides using CDA R2.0 are cited in national regulations among multiple countries
  • Dozens of academic studies have examined the use of CDA documents

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.Extensive structured information may also be relayed in CDA documents, which are widely cited in interoperability regulations worldwide.

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.

The current normative version of CDA is Release 2.0. Previous efforts to advance the standard, such as 2.1, did not achieve industry adoption and future work on structured clinical documents are expected to primarily focus on Fast Healthcare Interoperability Resources for the future.

RELATED DOCUMENTS

CDA® Release 2

(Download) (4.35 MB)

C-CDA (HL7 CDA® R2 Implementation Guide: Consolidated CDA Templates for Clinical Notes, Edition 4 - US Realm) (View Brief)
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)

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 Attachment Implementation Guide: Exchange of C-CDA Based Documents, Release 2 - US Realm (View Brief)

(Download) (1.12 MB)

HL7 CDA® R2 FHIR® StructureDefinition Format, Edition 1 (View Brief)
HL7 CDA® R2 IG: C-CDA Templates for Clinical Notes R1 Companion Guide, Release 1 - US Realm (View Brief)

(Download) (3.25 MB)

HL7 CDA® R2 IG: C-CDA Templates for Clinical Notes R2.1 Companion Guide, Release 4.1 - 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 Occupational Data for Health Release 1, STU Release 1.1 - 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: C-CDA R2.1; Advance Directives Templates, Release 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: C-CDA Supplemental Templates for Unique Device Identifier (UDI) for Implantable Medical Devices, Release 1 - US Realm (View Brief)

(Download) (1.04 MB)

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 3.0.1 - US Realm (View Brief)

(Download) (16.13 MB)

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) (13.77 MB)

HL7 CDA® R2 Implementation Guide: Healthcare Associated Infection (HAI) Reports, Release 4, STU 4 - US Realm (View Brief)
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 Antimicrobial Use (AU) in Long Term Care Facilities (HAI_AULTC_CDA), STU Edition 1.1.0 - 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 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 Document, Edition 1 STU3.1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Personal Healthcare Monitoring Report, Release 1 (View Brief)

(Download) (1.39 MB)

HL7 CDA® R2 Implementation Guide: Pharmacist Care Plan Document, Release 1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Pharmacy Templates, Edition 1 STU Release 2 (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 3.1.1 - US Realm (View Brief)
HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 1 - US Realm (View Brief)

(Download) (1.27 MB)

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 2 - US Realm (View Brief)

(Download) (1.75 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 Clinical Document Architecture (CDA®) R2.0 Specification Online Navigation, Edition 2024 (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 - US Realm (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 Informative Document: C-CDA Rubric Criteria, Release 1 - US Realm (View Brief)

(Download) (583 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® 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.

TOPICS

  • Attachments
  • Clinical Quality
  • Patient Care
  • Patient Referral
  • Public Health

BALLOT TYPE

  • Normative

STATUS DATE

2015年02月27日

RESPONSIBLE WORK GROUP

PRODUCT TYPE

  • ANSI-approved

STAKEHOLDERS

  • Clinical and Public Health Laboratories
  • EHR, PHR Vendors
  • Emergency Services Providers
  • Health Care IT Vendors
  • Healthcare Institutions
  • HIS Vendors
  • Local and State Departments of Health
  • Payors
  • Quality Reporting Agencies
  • Regulatory Agency
  • Standards Development Organizations (SDOs)

FAMILY

  • CDA

CURRENT STATE

  • Stable

REALM

  • Universal

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