Smile CDR v2024.08.PRE
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30.0.1CDA Exchange+ Module Introduction


C-CDA (Consolidated Clinical Document Architecture) is a standard that has been widely adopted in the healthcare industry for exchanging clinical documents. Based on the HL7 Clinical Document Architecture (CDA) standard, it provides a structured approach to capturing and sharing patient information in a consistent manner. However, with the healthcare industry moving towards the more modern FHIR standard, there is now a growing need to convert data between C-CDA and FHIR. Furthermore, the § 170.315(g)(9) ONC criterion mandates that EHR systems must import and export patient data in C-CDA format.

To meet these data exchange requirements, CDA Exchange+ offers a module that performs bidirectional transformations between CDA 2.1 and FHIR. This module applies a set of rules consistently in both directions, ensuring a robust and reliable conversion process. In addition to data conversion, the module also provides endpoints for persisting FHIR data extracted from C-CDA documents.

Smile CDR includes a CDA document generation tool capable of transforming a Bundle of FHIR resources into a CDA XML document and a CDA document import tool capable of transforming a CDA XML document into a Bundle of FHIR resources.

The following features are experimental and therefore, may not be fully functional for all use cases. Feedback for these features are welcome. Please get in touch to discuss if you are interested in implementing any of these new features during their early availability.

CDA Exchange+ provides bidirectional mapping for the following profiles and implementation guides:

  • CDA 2.1 <—> FHIR R4
  • CDA 2.1 <—> US Core 5.0.1

30.0.2CDA Export


In order to create a CDA document, you must first have a FHIR Bundle of type Document. In order to create a FHIR Bundle of type Document, you must first have a FHIR Composition.

Smile CDR's CDA module can generate a CDA document from your FHIR database in a single operation.

Your CDA document needs are likely unique, and so there is no hard-coded template in Smile that dictates what your CDA document includes. Instead, there is a rich API in the JavaScript Execution Environment that can be used to create CDA templates that suit your needs.

Once you have a CDA template, you can create a CDA document from a FHIR database with a single request using the CDA REST API. The creation of the Composition, Bundle of type document, and CDA XML document is all taken care of for you in that single operation.

The typical workflow for getting your Smile instance ready to create CDA documents is as follows:

  1. Instantiate a module of type CDA Exchange.
  2. Create a CDA JavaScript template using the functionality available through the JavaScript Execution Environment.
  3. POST your template to the CDA Exchange module.
  4. Apply your template. Depending on your template, you may be required to provide a number of arguments

The rest of this documentation will walk you through the workflow and prepare you to use the full capability of this module.

30.0.3CDA Import


Smile CDR's CDA module can transform a CDA document into a FHIR transaction-type Bundle and persist the resources in this Bundle to your FHIR repository.

When a CDA document is provided to the CDA REST API, the system will parse it, convert all the entries it finds into FHIR resources, collect these resources into a Bundle, and persist the bundle to the FHIR database in a single operation.

The id field of each entry in the CDA document will be used to establish references among the generated FHIR resources and to ensure that duplicate resources corresponding to the same entity are not created. This strategy is also used to deduplicate against the contents of the FHIR database. For best results, we recommend that each CDA entry have exactly one id assigned.

In order to enable the CDA import feature, the CDA Exchange module must be configured with an R4 persistence module. Other versions of the FHIR model are not supported at this time.

30.0.4Implementation roadmap


Smile CDR currently supports the generation and import of Continuity of Care (CCD) documents, including these sections for export and these sections for import. Implementation of additional document and section types is ongoing.

Smile CDR CDA generation currently only supports the patient parameter of the DocumentReference/$docref operation. Implementation of the remaining parameters is ongoing.

Smile CDR CDA import currently only supports documents that conform to the C-CDA 2.1 IG. Smile CDR currently only supports mapping CDA documents to FHIR R4 resources.

If you have CDA document generation or import needs that are not currently supported, please contact us.