CDA — The HL7 Document Standard
An HL7 standard for clinical document structure. Each CDA file carries a human-readable narrative and a machine-readable coded section — readable by both physicians and software.
When Patients Move, Their Clinical Records Must Follow.
CDA and C-CDA define how care summaries, discharge records, and referral notes move securely between providers, health systems, and digital health platforms.
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Understanding Clinical Document Architecture
CDA and C-CDA are XML-based standards for structuring clinical documents so they can be exchanged and understood across any EHR or health system.
C-CDA — The U.S. Implementation
The ONC-mandated U.S. implementation of CDA. Defines templates — CCD, Discharge Summary, Referral Note, Care Plan — that every certified EHR must generate and receive.
Coded Vocabularies
C-CDA encodes clinical content using SNOMED CT, LOINC, RxNorm, and ICD-10-CM — the standardized vocabularies that make documents truly machine-readable.
What CDA & C-CDA Exchange Covers — Generation, Parsing, and Exchange
We implement clinical document exchange for care management platforms, transitional care products, referral networks, and any digital health team that needs structured clinical data from across a patient's care history.
Generate conformant C-CDA R2.1 documents from your clinical data — CCDs, Discharge Summaries, Referral Notes, Progress Notes, and Care Plans — validated against published templates and ONC certification conformance criteria.
Parse inbound C-CDA documents from any certified EHR — extracting structured clinical data (medications, allergies, problems, results, immunizations, vitals) into your data model, and handling real-world variability in C-CDA quality across vendors.
Exchange C-CDA documents over the Direct protocol — the U.S. standard for secure, point-to-point clinical messaging between providers — for referral workflows, care transition notifications, and provider-to-provider document exchange.
Connect to Health Information Exchanges that aggregate and distribute C-CDA documents across regional provider networks — enabling access to a patient's longitudinal clinical record from multiple care settings.
Convert between C-CDA and FHIR document formats so clinical content flows between legacy EHR systems that speak C-CDA and modern platforms that use FHIR resources — bidirectional and aligned with ONC and HL7 guidance.
Support clinical document exchange in Canadian provincial contexts — Ontario eReferral/eConsult formats, Alberta Netcare document access, and BC provincial infrastructure — aligned with Canadian terminology and provincial privacy legislation.
Why Clinical Document Exchange Is Critical for Care Continuity
The U.S. handles millions of care transitions every year. Information gaps during those transitions are a leading cause of readmissions, medication errors, and adverse events — and where structured document exchange earns its place.
Transitions Are Where Information Gets Lost
Patients discharged, transferred, or referred carry a clinical story that must travel with them. Research consistently links information gaps at these transitions to readmissions, medication errors, and adverse clinical events.
Structured Data Without a Custom API Per Provider
For care management, transitional care, chronic disease, behavioral health, and referral products, C-CDA provides structured clinical data from across a patient's history — without a bespoke integration with every provider they have ever seen.
C-CDA Quality Varies — Handle It Deliberately
The standard leaves room in how optional sections are populated and how data is coded. Vendor implementations and institutional data quality differ, so robust parsing handles that variability rather than assuming clean conformance.
Canada Is Building It Province by Province
Ontario's eReferral and eConsult programs, Alberta's Netcare document access, and pan-Canadian initiatives through Canada Health Infoway are progressively building out structured clinical document exchange.
C-CDA Exchange — Step by Step
Five stages from workflow definition to transport setup. Hover or tap a stage to see what it involves.
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Use Case Definition
Use Case Definition
Identify the clinical workflows your integration must support — discharge summaries, referral notes, care transitions. Each use case determines which templates and transport mechanisms apply.
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Document Template Selection
Document Template Selection
Choose the right C-CDA template — CCD, Discharge Summary, Referral Note — each with defined sections, required vocabularies, and conformance rules.
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Terminology Mapping
Terminology Mapping
Translate local codes to the standard vocabularies C-CDA requires — SNOMED CT, LOINC, RxNorm, ICD-10 — for every outbound 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.
Who This Is For
We build clinical document exchange for the products that depend on a patient's history travelling with them. Hover a card to see how we work with each.
Care Management & Transitional Care
Referral & Care Coordination Networks
Digital Health Products
Health Systems & EHR Vendors
Templates, Vocabularies & Exchange — The Building Blocks of Clinical Document Interoperability
C-CDA exchange spans the document templates that carry the clinical story, the coded vocabularies that make them machine-readable, the transport that moves them, and the Canadian provincial programs building the same capability. We work across all of it.
Templates
C-CDA Document Types
The standardized C-CDA R2.1 templates that every certified EHR must generate and receive.
Vocabularies
Coded Clinical Terminologies
The standard vocabularies that encode C-CDA content and make documents machine-readable.
Exchange
How Documents Move
The transport mechanisms that carry C-CDA documents between providers and platforms.
Conformance
Validation & Certification
The rules and tools that confirm a C-CDA document is conformant before it reaches production.
Conversion
C-CDA ↔ FHIR
Bidirectional conversion so document content flows between legacy C-CDA and modern FHIR platforms.
Canada
Canadian Provincial Programs
The provincial document exchange infrastructure and identifiers specific to the Canadian context.
The Clinical Document Stack We Build On
The standards, templates, validation tools, and exchange networks a conformant C-CDA implementation depends on — selected for the systems and workflows you need to connect to, not a fixed toolset.
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 the meaning intact. Book a consultation with our integration team and we will tell you what a correct, conformant C-CDA implementation looks like for your workflows.
Book a C-CDA Exchange Consultation
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Frequently Asked Questions
[ 1 ]
What is the difference between CDA and C-CDA?
CDA (Clinical Document Architecture) is the international HL7 standard for structured clinical documents. C-CDA (Consolidated CDA) is the U.S.-specific implementation guide that defines specific document templates — CCD, Discharge Summary, and others — and conformance rules built on top of the CDA standard.
[ 2 ]
What clinical data is typically found in a C-CDA document?
A complete Continuity of Care Document (CCD) contains the patient's active problems and diagnoses, current and historical medications, known allergies and intolerances, recent laboratory results, vital signs, immunization history, procedures performed, and relevant social and family history.
[ 3 ]
Why do C-CDA documents from different EHRs vary so much in quality?
The C-CDA standard defines conformance requirements, but leaves room for variation in how optional sections are populated, which coded vocabularies are used in practice, and how narrative text is structured. EHR vendors have implemented C-CDA generation differently over the years, and the quality of clinical coding in the underlying EHR data varies by institution.
[ 4 ]
What is Direct messaging and how does it relate to C-CDA?
Direct is a U.S. standard for secure, encrypted, point-to-point clinical messaging between providers — similar to email but with healthcare-specific security and trust requirements. C-CDA documents are commonly the payload attached to Direct messages, used when a hospital sends a discharge summary to a primary care physician, or a specialist sends a consultation note back to the referring provider.
[ 5 ]
Is C-CDA being replaced by FHIR?
C-CDA and FHIR are increasingly used together rather than as replacements. Many health systems are adding FHIR API capabilities while maintaining existing C-CDA document exchange. For digital health teams, practical interoperability today still requires C-CDA support — particularly for accessing longitudinal records from older or smaller health systems that may not yet have robust FHIR implementations.
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