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  February 26, 2018 

What is HL7 CDA - the HL7 Clinical Document Architecture?

What is HL7 CDA?

Charles Parisot on CDA

The Clinical Document Architecture is a HL7 standard for the representation and machine processing of clinical documents in a way which makes the documents both human readable and machine processable and guarantees preservation of the content by using the eXtensible Markup Language (XML) standard.  It is a useful an intuitive approach to management of documents which make up a large part of the clinical information processing arena.

There are plenty of HL7 CDA tools and resources, extensive HL7 CDA training and certification courses, a global workforce of HL7 CDA Experts and HL7 CDA Implementers as well as an extensive HL7 CDA Job market.

HL7 CDA Introduction & Information

What is HL7?  A simple introduction to the Health Level 7 eHealth Standards

What is Health Level 7?  A comprehensive HL7 Overview (WikiPedia)

What is HL7 International?  The official site of the HL7 organisation

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HL7 Books & eHealth Books we Recommend:

Download the HL7 Standards - CDA, V2.x, V3, Arden Syntax & EHR Functional Model


NEW: Meaningful Use and Beyond: A Guide for IT Staff in Health Care - Are you ready to take your IT skills to the healthcare industry?  This concise book explains how the US healthcare system is implementing Electronic Health Records ("EHRs") and other IT systems to comply with the US government’s Meaningful Use requirements.  A tremendous opportunity for tens of thousands of IT professionals, the Meaningful Use program requires a complete makeover of archaic paper records systems, cumbersome workflows and other outdated practices.  This book describes in detail how hospitals and doctors’ offices differ from other organizations that use IT and explains how to bridge the gap between clinicians and IT staff.

Electronic Health Records For Dummies - a helpful, plain-English guide for doctors, nurses and healthcare administrators to understand, implement and use an Electronic Health Record system.

Health Care Information Systems: A Practical Approach for Health Care Management - the Best Selling textbook in the field.  Mark Leavitt, MD, PhD, CCHIT Chairman said "With health care information technology now in the national policy spotlight, this book should be required reading for every health care administrator and student.


The HL7 CDA Book - by eminent expert Keith Boone provides clear and easy-to-use CDA implementation guidance with numerous examples.  The reader will learn not only how to implement the CDA standard, but also to understand its idioms and to "speak" the CDA language.

Introduction to HL7 V2.x Messaging (2nd Edition) - the most popular HL7 V2.x Messaging introductory Textbook.  Mike Henderson is widely recognized as a most experienced HL7 V2.x teacher and trainer.  He regularly teaches at the HL7 Education Summits in the US and co-authors the HL7 V2.x Analyst Certification exams.

HL7 V2.x Messaging Study Guide - the Study Guide to the above Textbook.  Both books are considered mandatory reading and study for candidates sitting the HL7 International V2.x Analyst Certification exam.

Verification Results for IT Standards: HL7 - a text focussing on the formal verification of standards in healthcare.

Download standards 

Principles of Health Interoperability HL7 and SNOMED - Healthcare depends on the two leading standards HL7 and SNOMED CT for functional and semantic interoperability.  Tim is one of the most experienced teachers of both HL7 V3 and SNOMED CT.

International Standards Online: ISO, ANSI, IEC, IEEE, CSA, BSI, DIN, etc. - easily and instantly download these popular eHealth Standards!

Managing Health Care Information Systems: A Practical Approach for Health Care Executives - the title says it all!

E-Health Care Information Systems: An Introduction for Students and Professionals - excellent

Browse more HL7 Books and Manuals HL7to learn the Secrets of Health Level 7.

Why is CDA needed?

The Clinical Document Architecture is a HL7 standard for the representation and machine processing of clinical documents in a way which makes the documents both human readable and machine processable and guarantees preservation of the content by using the eXtensible Markup Language (XML) standard.  It is a useful an intuitive approach to management of documents which make up a large part of the clinical information processing arena.

CDA is being used also in electronic health records projects to provide a standard format for entry, retrieval and storage of health information.  Many of the early CDA implementations eg discharge referral are of direct interest to Australian projects such as HealthConnect.

This is of much interest to those projects as the progress will help their understanding of the best data storage techniques for medical files.  Storing patient files and health records is a key part of running a successful medical facility, and whether you are researching CDA or the best O2 business phones reviews to improve inter-office communication, it is important to find the best.  CDA is most definitely a leader in its field.

All in all the development of a family of standards for interoperability under HL7 is somewhat inevitable.  CDA and CCOW (a standard for compatibility for modules within a clinical health record of are both examples.

A new standard for conduct of business between different sectors has emerged electronic business XML (ebXML).  The place of this standard and its position vis a vis HL7 needs exploration.

If you are planning to spend some of the summer break for catching up on some technical reading, you might want to buy The CDA Book!  This very popular book recently published by eminent CDA expert Keith Boone is an easy and clear introduction to using HL7's Clinical Document Architecture.  You will learn how to implement the CDA standard, understand its idioms, get easy-to-use implementation guidance with numerous examples and learn to "speak" the CDA language.

If CDA is not your thing, then here are more books on HL7 interoperability.

HL7 Technical Newsletter

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The Clinical Document Architecture is a Health Level Seven (HL7) standard for the creation of clinical documents using XML (extensible markup language).

XML is a process for adding (non-printable) characters to text documents to allow the computer system to process the text eg. change the format or presentation as in bolded text or to allocate specific meaning eg. storing data or encoding data embedded in the text. An simple example (of a complex system) would be:
     "This word will print as <bold> bold <\bold> and this word only".
 On screen this would appear as
     "This word will be printed as bold and this word only".
 Note: the use of the bracket structure is the method of embedding instructions in the text.

The CDA specifies the structure and semantics of clinical documents in health care (Dolin R, Alschuler L. et al. 2001). A document can be defined as a piece of text or information that would usually be authenticated by a signature eg. a progress note, a pathology request, a radiology report, or an account.  A CDA document may contain text, images and multimedia, coded data.  The CDA document can be:

Stored either permanently or temporarily as a document in a computer system; and
b.   Transmitted as the content of a message using E-mail, HL7 or any other messaging system.

CDA was created in the recognition that much of health care is involved in creating and managing documents and the document paradigm is well understood by clinicians and administrators.

A clinical document has the following features which form the framework for the CDA.:

  • Persistence
  • Stewardship
  • Authentication
  • Wholeness and context
  • Human readability

CDA aims to give priority to documents generated by clinicians in order to:

  • Standardise the format of the many thousands of typesof clinical documents
  • To support exchange of clinical information for human readability, and information processing;
  • To promote longevity of information by separating the data from the systems that store it (to avoid obsolescence as occurs with technological processes and by being computer platform independent;
  • Allow appropriate local adaptation of the standard to meet national or specific user requirements.
  1. Header - this contains the key descriptive information about the document (metadata) such as who wrote it, who is it intended for, type of document.
  2. Body - this contains the text of the document which may be structured at least under key headings or sections.  It is possible for the text to contain coded values.  It is also possible to have not text information in the body such as an image of an x-ray (using the DICOM standard representation)

CDA has been developed in 3 stages: Level 1 through Level 3.  Level one has a structured header and structured body of message with limited coding capacity for content.  Levels 2 and 3 impose more structure to allow the representation of "context" or constrained fields and more coded data.  The standard has been published for level 1 and level 2&3 are currently in draft stages.

CDA level 2&3 documents (along with the standard electronic health record architecture) require the use of templates and archetypes, which define the key information and context of complex health concepts such as family history or blood pressure.

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