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C-CDA

Medplum provides support for C-CDA (Consolidated Clinical Document Architecture) handling in accordance with the ONC Certification criteria (g)(7), (g)(9) and (b)(1) as well as developer utilities for working with C-CDA documents in the context of FHIR.

Overview​

Medplum provides the following functionality for C-CDA handling.

  • A C-CDA viewer that allows uploaded documents to be viewed in the Medplum App or in a react component.
  • The ability to Export C-CDA in the Medplum app or via API
  • An SDK for FHIR to C-CDA conversion.

C-CDA Viewer​

To access the C-CDA viewer, upload a C-CDA file as a FHIR Binary. The viewer will render the data for viewing in the application.

Export C-CDA​

To export patient data as C-CDA, navigate to https://app.medplum.com/Patient/<PATIENT_ID>/export in the Medplum App. There are several options for export, and exporting as C-CDA will create and download the XML file to the desktop.

Transitions of Care​

Medplum enables sending C-CDA to other systems via Direct Message to support transitions of care. To utilize the feature, implementors need to create a communication resource with the C-CDA attached as shown in the video.

FHIR Server Integration​

In addition to the core conversion functions, Medplum provides FHIR server operations for seamless C-CDA export:

  • Patient/{id}/$ccda-export: Exports a patient's data as a C-CDA document.

This operation is documented in the Medplum FHIR operations documentation.

Developer Utilities​

The @medplum/ccda package enables seamless conversion between C-CDA and FHIR, leveraging the International Patient Summary (IPS) format as a bridge. This approach ensures standardized representation of clinical data and facilitates interoperability with various healthcare systems.

Key Features:

  • C-CDA to FHIR: Convert a C-CDA document to a FHIR Composition bundle using the convertCcdaToFhir function.
  • FHIR to C-CDA: Convert a FHIR Composition bundle to a C-CDA document using the convertFhirToCcda function.
  • XML Parsing: Load a C-CDA document from an XML string using the convertXmlToCcda function.
  • XML Serialization: Serialize a C-CDA document to an XML string using the convertCcdaToXml function.

Usage​

import {
  convertCcdaToFhir,
  convertFhirToCcda,
  convertXmlToCcda,
  convertCcdaToXml,
} from '@medplum/ccda';

// Convert C-CDA to FHIR
const bundle = convertCcdaToFhir(ccda);

// Convert FHIR to C-CDA
const ccda = convertFhirToCcda(bundle);

// Load C-CDA from XML
const ccda = convertXmlToCcda(xml);

// Serialize C-CDA to XML
const xml = convertCcdaToXml(ccda);

Strategy and Alignment​

This library is designed to elegantly integrate the following standards and specifications:

  • FHIR R4: The underlying data model for representing healthcare resources.
  • US Core: A set of FHIR profiles and extensions for US healthcare interoperability.
  • USCDI: The United States Core Data for Interoperability, defining a standardized set of health data classes and elements.
  • International Patient Summary (IPS): A FHIR-based standard for exchanging patient summaries.
  • HL7 C-CDA: A widely used standard for clinical document exchange.
  • C-CDA R2.1 for USCDI v3: A specific implementation of C-CDA aligned with the USCDI v3 standard.

By aligning with these standards, this library ensures that C-CDA documents can be effectively converted to and from FHIR, enabling interoperability with modern healthcare systems and applications.

Additional Notes​

  • This library is actively maintained and updated to support the latest versions of FHIR, US Core, and C-CDA standards.