CDA — The HL7 Document Standard
The HL7 document standard: each CDA file carries a human-readable narrative plus a machine-readable coded section.
Award-Winning CDA & C-CDA Integration
Understanding Clinical Document Architecture
CDA and C-CDA are XML standards for structuring clinical documents so they can be exchanged across any EHR or health system.
C-CDA — The U.S. Implementation
The ONC-mandated U.S. implementation, defining the templates every certified EHR must support: CCD, Discharge Summary, Referral Note, Care Plan.
Coded Vocabularies
SNOMED CT, LOINC, RxNorm, and ICD-10-CM — the standard vocabularies that make C-CDA content machine-readable.
What CDA & C-CDA Exchange Covers — Generation, Parsing, and Exchange
Clinical document exchange for care management platforms, transitional care products, and referral networks needing structured patient data.
Generate conformant C-CDA R2.1 documents — CCDs, Discharge Summaries, Referral Notes, Care Plans — validated against ONC criteria.
Parse inbound C-CDA from any certified EHR — extracting medications, allergies, problems, results, and vitals into your data model.
Exchange C-CDA documents over Direct — the U.S. standard for secure, point-to-point provider messaging — for referrals and transitions.
Connect to Health Information Exchanges that aggregate C-CDA across regional networks — accessing a patient's longitudinal record.
Bidirectional C-CDA to FHIR conversion so content flows between legacy EHRs and modern FHIR platforms — aligned with ONC and HL7.
Document exchange across Canadian provinces — Ontario eReferral/eConsult, Alberta Netcare, BC — with provincial privacy law.
Why Clinical Document Exchange Is Critical for Care Continuity
The U.S. handles millions of care transitions a year, and information gaps during them drive readmissions, medication errors, and adverse events.
Transitions Are Where Information Gets Lost
A patient's clinical story must travel with them through discharge, transfer, or referral. Gaps at these transitions drive readmissions and errors.
Structured Data Without a Custom API Per Provider
C-CDA delivers structured data from across a patient's history — for care management, chronic disease, and referral products — with no custom integration per provider.
C-CDA Quality Varies — Handle It Deliberately
The standard leaves room in how optional sections are populated and coded. Robust parsing handles that variability instead of assuming clean conformance.
Canada Is Building It Province by Province
Ontario eReferral/eConsult, Alberta Netcare, and Canada Health Infoway are building structured clinical document exchange province by province.
C-CDA Exchange — Step by Step
Five stages from workflow definition to transport setup.
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Use Case Definition Use Case Definition
Identify the workflows you must support — discharge summaries, referrals, care transitions — driving templates and transport.
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Document Template Selection Document Template Selection
Choose the right C-CDA template — CCD, Discharge Summary, Referral Note — each with its own sections and rules.
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Terminology Mapping Terminology Mapping
Translate local codes to the vocabularies C-CDA requires — SNOMED CT, LOINC, RxNorm, ICD-10 — for every document.
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Document Generation & Validation Document Generation & Validation
Generate C-CDA XML and validate against schematron rules using ONC ETT or the SITE C-CDA Validator before connecting to production.
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Exchange Mechanism Setup Exchange Mechanism Setup
Set up the right transport — Direct Secure Messaging, FHIR Document endpoints, or HIE query interfaces — based on your exchange partners.
CCD Document Generation — Continuity of Care Documents That Validate
The Continuity of Care Document is the C-CDA template most systems exchange first, and the one most often rejected. A CCD that passes a schema check can still fail conformance on template conformance statements, missing required entries or terminology bindings that do not match the value set. This is what we build so it validates the first time.
Conformant CCD Generation
C-CDA R2.1 Continuity of Care Documents built to the template conformance statements, not just to the schema — required sections, entries and narrative blocks populated from your data model rather than stubbed.
The Other C-CDA Document Types
Discharge Summary, Referral Note, Care Plan, Consultation Note, History and Physical, Progress Note and Transfer Summary. Each has its own required sections, so each is generated against its own template rather than a shared default.
Validation Before You Send
Documents are validated against the published implementation guide as they are generated — schema, Schematron and terminology bindings — so conformance failures surface in your pipeline rather than at the receiving system.
Narrative and Structured Entries in Step
A CCD carries both human-readable narrative and coded entries, and they must agree. We generate the narrative from the structured data so the two cannot drift, which is one of the most common causes of a document being technically valid but clinically wrong.
Terminology That Binds Correctly
Problems to SNOMED-CT, labs to LOINC, medications to RxNorm, procedures to CPT and ICD-10-PCS. Unmapped or stale local codes are the single most common reason a generated CCD is rejected downstream.
Inbound CCD Parsing
Generation is half the problem. We also parse inbound CCDs from any certified EHR — extracting medications, allergies, problems, results and vitals into your data model, and handling the quality variation that comes with documents from different vendors.
Who This Is For
We build clinical document exchange for products that depend on a patient's history travelling with them.
Care Management & Transitional Care
Discharge summaries, care plans, and problem lists that follow the patient into your workflows.
Referral & Care Coordination Networks
Referral notes and consultation reports move as C-CDA over Direct, keeping referral loops closed.
Digital Health Products
Structured clinical data across a patient's history via C-CDA documents, Direct, and HIE query.
Health Systems & EHR Vendors
C-CDA for ONC certification and provider exchange — conformant generation, parsing, and FHIR conversion.
Templates, Vocabularies & Exchange — The Building Blocks of Clinical Document Interoperability
The document templates, coded vocabularies, transport, and Canadian provincial programs that make up C-CDA exchange.
Templates
C-CDA Document Types
C-CDA R2.1 templates every certified EHR must generate.
Vocabularies
Coded Clinical Terminologies
Standard vocabularies that make documents machine-readable.
Exchange
How Documents Move
Transport mechanisms carrying C-CDA between providers.
Conformance
Validation & Certification
Rules and tools confirming C-CDA conformance pre-production.
Conversion
C-CDA ↔ FHIR
Bidirectional conversion between legacy C-CDA and FHIR.
Canada
Canadian Provincial Programs
Provincial document exchange infrastructure and identifiers.
The Clinical Document Stack We Build On
The standards, templates, and validation tools a conformant C-CDA implementation depends on.
H
HL7 CDA R2
C
C-CDA R2.1
C
CCD
D
Discharge / Referral / Care Plan
H
HL7 FHIR
S
SNOMED CT
L
LOINC
R
RxNorm
I
ICD-10-CM
D
Direct Secure Messaging
H
HIE Query
F
FHIR Document Endpoints
X
XDS / XCA
S
Schematron
O
ONC ETT
S
SITE C-CDA Validator
O
ONC Certification
O
Ontario eReferral / eConsult
A
Alberta Netcare
B
BC Provincial Exchange
C
Canada Health Infoway
A
AWS GovCloud
A
Azure Health Data Services
D
Docker / Kubernetes
M
Monitoring & Alerting
A Patient's Clinical Story Should Travel With Them. C-CDA Is How It Does.
Generation, parsing, and exchange over Direct, HIEs, and FHIR endpoints, with terminology that keeps meaning intact. Book a consultation to map your C-CDA implementation.
Book a C-CDA Consult
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Frequently Asked Questions
[ 1 ]
What is the difference between CDA and C-CDA?
CDA is the HL7 standard for clinical documents. C-CDA is the U.S. implementation guide that constrains it, defining the templates systems actually exchange — CCD, Discharge Summary, Referral Note and the rest. Building to base CDA rather than to the C-CDA templates is a common reason documents fail conformance.
[ 2 ]
What clinical data is typically found in a C-CDA document?
A Continuity of Care Document carries problems, medications, allergies, laboratory results, vital signs, immunizations, procedures and relevant history. Each section has required and optional entries, and which optional sections a vendor populates is a large part of why document quality varies.
[ 3 ]
Why do C-CDA documents from different EHRs vary so much in quality?
Optional sections are populated differently by each vendor, coding quality varies by institution, and narrative and structured entries are not always kept in step. A parser that assumes well-formed input will break on real-world documents, so inbound handling has to be defensive by design.
[ 4 ]
What is Direct messaging and how does it relate to C-CDA?
Direct is the U.S. standard for secure point-to-point clinical messaging between providers, and C-CDA documents are the usual payload. It is how referrals and transitions of care move when there is no shared HIE between the two organisations.
[ 5 ]
Is C-CDA being replaced by FHIR?
No — they run together and will for years. Health systems add FHIR APIs for application access while still exchanging C-CDA with older and smaller systems that have no FHIR endpoint. Most real integrations need both, which is why C-CDA to FHIR conversion matters as much as either standard on its own.
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