CDA R2 Extensions
Contents
Purpose
This page documents extensions to CDA R2 which have been created for use in CDA Release 2.0 Implementation Guides.
SDTC Extensions
The namespace for all Structured Documents Workgroup extensions in urn:hl7-org:sdtc. This namespace was used because at the time these extensions were created, the name of the Structured Documents Work Group was the Structured Documents Technical Committee. Approval of an extension to appear in the urn:hl7-org:sdtc namespace by the Structured Documents workgroup does not give the extension any status other than being eligible to appear in this list and that namespace. Some extensions have been published in Normative or Informative documents, and so have standing as being part of standard, DSTU or HL7 informative specification in the context of that specification.
Extensions created by the Structured Documents workgroup follow certain rules established during the creation of the HL7 CCD Implementation guide.
An extension is a collection of element or attribute declarations and rules for their application to the CDA Release 2.0.
- The namespace for extensions created by the HL7 Structured Documents Working Group (formerly Structured Documents Technical Committee) shall be urn:hl7-org:sdtc. Note: Some implementation guides have incorrectly reported the namespace as
urn:hl7-org:stdc. - All extensions are optional. An extension may be used, but need not be.
- Extension element names shall be derived from attributes defined in the RIM.
- Each extension element shall use the same HL7 vocabularies and data types as used by CDA Release 2.0.
- Each extension element shall use the same conventions for order and naming as is used by the current HL7 tooling.
- An extension element shall appear in the XML where the expected RIM element of the same name would have appeared had that element not been otherwise constrained from appearing in the CDA XML schema.
The following extensions have been approved by the HL7 Structured Documents Workgroup. The specification first defining the extension appear in bold. NOTE: While specifications defining the extension may come from organizations other than the HL7 Structured Documents Working Group, they were discussed with, and "approved" by the working group as being eligible to appear in the stdc namespace.
Extensions approved for the sdtc namespace are periodically implemented in a W3C Schema file which is versioned (by date) and published on the HL7 SDWG GForge site available here:
| Extension | Definition | Defined/Used by | Approved on | Implemented on |
| sdtc:admissionReferralSourceCode | This element is a coded concept that represents the type of referral. Its RIM source class is PatientEncounter.
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November, 2014 | June 2015 | |
| sdtc:asPatientRelationship | Each participant role other than an informant/relatedEntity may have zero or more relationship roles with the patient. Each of these roles can be expressed with an asPatientRelationship element which further describes the type of role using a code element. The informant/relatedEntity participant role already supports specification of the relationship between the informant and the patient via the RelatedEntity classCode, and therefore should not include this extension.(CCD)
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April 1, 2007 / Revisited and approved, March 5, 2015 | April 2015 |
| sdtc:birthTime | The <sdtc:birthTime> element allows for the birth date of any person to be recorded. The purpose of this extension is to allow the recording of the subscriber or member of a health plan in cases where the health plan eligibility system has different information on file than the provider does for the patient. |
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pre-process | July 6, 2012 |
| sdtc:deceasedInd | The deceasedInd extension is used to record that the recordTarget or subjectPerson is deceased.
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July, 2014 | July, 2014 |
| sdtc:deceasedTime | The deceasedTime extension is used to record the time of death for the recordTarget or subjectPerson.
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July, 2014 | July, 2014 |
| stdc:desc | The desc extension allows multimedia depictions of patients, healthcare providers, or other individuals to be included in a CDA document. It may be used in any person (or derived) entity, and appears after the entity name.
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N/A | Date UNK / Revisited and approved, March 5, 2015 | April 2015 |
| sdtc:dischargeDispositionCode | The sdtc:dischargeDispositionCode element allows the discharge disposition to be recorded for an encounter act. |
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July, 2012 | July, 2012 |
| sdtc:ethnicGroupCode | This ethnicGroupCode extension is used to record additional ethnicity groups for the recordTarget or subjectPerson.
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December, 2014 | February, 2015 |
| sdtc:id | This id extension is used to record the subject's medical record number or other id.
The id extension in the family history organizer on the related subject allows for unique identification of the family member(s). (CCDA) CDA Release 2.0 does not provide a mechanism to determine when two participants in different roles are in fact the same entity (i.e., an entity can be a person, organization or device). A CDA Document identifies each participant through the application of a role identifier. This identifier can be used to trace the participation of an entity in a given role, but cannot necessarily be used to determine that two entities are the same. While more role identities could be provided whose intended use is to unify the entities, this is better modeled through the use of an entity identifier. Therefore, to facilitate this capability, this guide defines an extension to CDA Release 2.0 that allows the person or organization playing the role to be uniquely identified, by the inclusion of an identifier on the entity. (CCD)
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July, 2014 | July, 2014 |
| sdtc:inFulfillmentOf1 | This is an actRelationship called inFulfillmentOf1 that represents the Fulfills General Relationship Operator in QDM 4.1.x in QDM-Base QRDA Category 1, R3 (uses FLFS actRelationship type which is not an allowed actRelationship (entryRelationship) type in CDA). Also create ActReference to contain the pointer to already existing class.
Add to:
Extension will be a pointer (reference) to an already existing order or recommendation. The id of the existing order or recommendation will be used to allow pointing to the already existing data without repeating it in the relationship (ActReference). InFulfillmentOf1 is the relationship between the act that is fulfilling the order/recommendation and that order/recommendation. |
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March 19, 2015 | April 2015 |
| sdtc:multipleBirthInd | The multipleBirthInd extension is used to record that the recordTarget or subjectPerson is part of a multiple birth.
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November, 2014 | February, 2015 | |
| sdtc:multipleBirthOrderNumber | The multipleBirthOrderNumber extension is used to record the order number within a multiple birth that the recordTarget or subjectPerson was born in.
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November, 2014 | February, 2015 | |
| sdtc:negationInd | The Quality Measures need to be able to state that something did not happen and the reason why that thing did not happen. This is accomplished by setting negationInd="true" and stating the reason (rationale) in a contained Reason template. This is needed for supply and encounters, however CDA has constrained the negationInd out of supply and encounter. (i.e. this device was not supplied because of reason x or this encounter did not happen because of reason y). On 4/23/3015 this proposal was withdrawn. Despite the argument for a consistent approach for negation on all act classes and acknowledgement of the issues unique to negation for observation acts, the proposal was withdrawn based on the requirement in the the CDA R2 standard, chapter 1.4 CDA Extensibility, "These extensions should not change the meaning of any of the standard data items, and receivers must be able to safely ignore these elements. Document recipients must be able to faithfully render the CDA document while ignoring extensions."
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Reviewed 4/23/2015 | Proposal Withdrawn |
| sdtc:patient | The sdtc:patient extension element allows for the patient's identifier, used by a given provider, to be reported. The provider in their role as an assigned entity is related to the patient.
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January 31, 2010 / Revisited and approved, March 5, 2015 | April 2015 |
| sdtc:priorityNumber | The sdtc:priorityNumber extension element allows the priority order of a set of acts to be reported through the use of this element in the component actRelationship of an organizer source act that holds the set of acts being ranked. The data type is real. However the RIM states, that priorityNumber is an integer specifying the relative preference for considering this relationship before other like-typed relationships having the same source Act. Relationships with lower priorityNumber values are considered before and above those with higher values.
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1/28/2016 | Not yet incorporated in the CDA R2 Schema |
| sdtc:raceCode | The raceCode extension allows for multiple races to be reported for a patient.
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July, 2012 | July, 2012 |
| sdtc:raceCode | This raceCode extension is used to record additional race codes for the subject.
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November, 2014 | February, 2015 | |
| sdtc:signatureText | The signatureText extension adds an attribute for authenticator and legalAuthenticator to record encoded digital signature information. |
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Searching for this date. | July, 2014 |
| sdtc:statusCode | The statusCode extension attribute allows the implementer to identify a ClinicalDocument that is in other than the completed state. It was created to support the Structured Form Definition IG to identify that the document itself is an unfinished product currently being completed for a patient. | January, 2014 | January, 2014 | |
| sdtc:valueSet | The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept. |
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July, 2012 | January, 2013 |
| sdtc:valueSetVersion | The valueSetVersion extension adds an attribute for elements with a CD dataType which indicates the version of the particular value set constraining the coded concept. |
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July, 2012 | January, 2013 |
Other HL7 Extensions
The following extensions have been approved by other HL7 Working Groups or Affiliates for use in CDA Release 2.0 Implementation Guides.
Extensions Netherlands
The following extensions have been created by Nictiz for use in CDA Release 2.0 Implementation Guides. Created due to requirements in The Netherlands.
| Extension | Definition | Defined/Used by |
| hl7nl:doseCheckQuantity | The CDA extension hl7nl:doseCheckQuantity represents the ratio of a quantity of a substance that was or is intended to be administered over a period of time. It exists in HL7 RIM Act Class 'SubstanceAdministration', is used in HL7v3 messaging in The Netherlands, but is not available in CDA.
<hl7nl:doseCheckQuantity xmlns:hl7nl="urn:hl7-nl:v3" xmlns="urn:hl7-org:v3"> <numerator xsi:type="PQ" value="6"> <translation value="6" code="245" codeSystem="2.16.840.1.113883.2.4.4.1.900.2" displayName="Stuk"/> </numerator> <denominator xsi:type="PQ" value="1" unit="wk"/> </hl7nl:doseCheckQuantity> |
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Non-HL7 Extensions
The following extensions have been created and/or approved for use in CDA Release 2.0 Implementation Guides by organizations other than HL7 or its affiliates.
| Extension | Definition | Defined/Used by |
| pcc:replacementOf | The <replacementOf> extension element is applied to a section appearing in a PHR Update
Document to indicate that that section's content should replace that of a previously existing section. The identifier of the previously existing section is given so that the PHR Manager receiving the Update content will know which section to replace. The model for this extension is shown below. <pcc:replacementOf xmlns:pcc='urn:ihe:pcc:hl7v3'> <pcc:externalDocumentSection> <pcc:id root='58FCBE50-D4F2-4bda-BC1C-2105B284BBE3'/> <pcc:externalDocumentSection/> </pcc:replacementOf> |
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| pharm:formCode | The CDA extension pharm:formCode represents the form of the medication (e.g. tablet, capsule, liquid).
<manufacturedProduct xmlns:pharm="urn:ihe:pharm:medication" classCode="MANU"> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.2"/> <templateId root="2.16.840.1.113883.10.20.1.53"/> <manufacturedMaterial classCode="MMAT" determinerCode="KIND"> <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/> <!-- National medicinal product code (brand-level) --> <code code=" " displayName=" " codeSystem=" " codeSystemName=" "/> <!-- Brand name --> <name>... </name> <!-- Pharmaceutical dose form --> <pharm:formCode code=" " displayName=" " codeSystem=" " codeSystemName=" "/> .... |
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| epsos:formCode | The CDA extension epsos:formCode represents the form of the medication (e.g. tablet, capsule, liquid).
<manufacturedProduct xmlns:epsos="urn:epsos-org:ep:medication"classCode="MANU">
<templateId root="1.3.6.1.4.1.12559.11.10.1.3.1.3.1"/>
<manufacturedMaterial classCode="MMAT" determinerCode="KIND">
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| pharm:asContent | The CDA extension: pharm:asContent describes the packaging of the medication. The pharm:code element provides the code for the particular package. <pharm:asContent classCode="CONT">
<pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
<pharm:code code=" " displayName=" " codeSystem=" " codeSystemName=" "/>
<pharm:name>...</pharm:name>
<pharm:formCode code=" " displayName=" "
codeSystem=" " codeSystemName=" "/>
<pharm:lotNumberText>...</pharm:lotNumberText>
<pharm:capacityQuantity value=" " unit=" "/>
</pharm:containerPackagedMedicine>
</pharm:asContent>
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| epsos:asContent | The CDA extension: epsos:asContent describes the packaging of the medication. The epsos:name describes brand name. <epsos:asContent classCode="CONT">
<epsos:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
<epsos:name>Pyrimon 5 ml Eye Drops</epsos:name>
<epsos:formCode code="30008000" displayName="Bottle"codeSystem="1.3.6.1.4.1.12559.11.10.1.3.1.44.1" codeSystemName="EDQM"/>
<epsos:capacityQuantity value="5" unit="ml"/>
<epsos:capTypeCode code="30022000" codeSystem=" 1.3.6.1.4.1.12559.11.10.1.3.1.44.1" displayName="Dropper applicator" codeSystemName="EDQM"/>
</epsos:containerPackagedMedicine>
</epsos:asContent>
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| pharm:asSpecializedKind | The CDA extension: pharm:asSpecializedKind describes a generic equivalent of the medication described in the current Medicine entry. The pharm:code element contains the coded representation of the generic medicine. <pharm:asSpecializedKind classCode="GRIC">
<pharm:generalizedMedicineClass classCode="MMAT">
<pharm:code code=" " displayName="Generic Equivalent"
codeSystem=" " codeSystemName=" "/>
<pharm:name>...</pharm:name>
</pharm:generalizedMedicineClass>
</pharm:asSpecializedKind>
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| epsos:asSpecializedKind | The CDA extension: epsos:asSpecializedKind describes a generic equivalent of the medication described in the current Medicine entry. The epsos:code element contains the coded representation of the generic medicine. <epsos:asSpecializedKind classCode="GRIC">
<epsos:generalizedMedicineClass classCode="MMAT">
<epsos:code nullFlavor="NA"/>
<epsos:name>Chloramphenicol/ Dexamethasone</epsos:name>
</epsos:generalizedMedicineClass>
</epsos:asSpecializedKind>
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| pharm:ingredient | The CDA extension: pharm:ingredient represents active ingredient(s) of the medication. The pharm:quantity element represents the strength of the active ingredient(s) as the ratio of the active ingredient(s) to a unit of medication. <pharm:ingredient classCode="ACTI">
<pharm:quantity>
<pharm:numerator xsi:type="PQ" value=" " unit=" "/>
<pharm:denominator xsi:type="PQ" value=" " unit=" "/>
</pharm:quantity>
<pharm:ingredient classCode="MMAT" determinerCode="KIND">
<pharm:code code=" " displayName="Active Ingredient 1"
codeSystem=" " codeSystemName=" "/>
<pharm:name>Active Ingredient 1</pharm:name>
</pharm:ingredient>
</pharm:ingredient>
<pharm:ingredient classCode="ACTI">
<pharm:quantity>
<pharm:numerator xsi:type="PQ" value=" " unit=" "/>
<pharm:denominator xsi:type="PQ" value=" " unit=" "/>
</pharm:quantity>
<pharm:ingredient classCode="MMAT" determinerCode="KIND">
<pharm:code code=" " displayName="Active Ingredient 2"
codeSystem=" " codeSystemName=" "/>
<pharm:name>Active Ingredient 2</pharm:name>
</pharm:ingredient>
</pharm:ingredient>
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| epsos:ingredient | The CDA extension: epsos:ingredient represents the active ingredient of the medication. The epsos:quantity element represents the strength of the active ingredient as the ratio of the active ingredient to a unit of medication. <epsos:ingredient classCode="ACTI">
<epsos:quantity>
<epsos:numerator unit="mg" value="5" xsi:type="epsos:PQ"/>
<epsos:denominator unit="1" value="1" xsi:type="epsos:PQ"/>
</epsos:quantity>
<epsos:ingredient classCode="MMAT" determinerCode="KIND">
<epsos:code code="G04BD04 " codeSystem="2.16.840.1.113883.6.73" codeSystemName="ATC" displayName="oxybutynin"/>
<epsos:name>oxybutynin</epsos:name>
</epsos:ingredient>
</epsos:ingredient>
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| epsos:subingredient | The CDA extension: epsos:ingredient represents active ingredient(s) of the medication. The epsos:quantity element represents the strength of the active ingredient(s) as the ratio of the active ingredient(s) to a unit of medication. <epsos:ingredient classCode="MMAT" determinerCode="KIND">
<epsos:code code="C03EA01" codeSystem="2.16.840.1.113883.6.73" codeSystemName="ATC" displayName="hydrochlorothiazide and potassium-sparing agents"/>
<epsos:name>AMILORIDE+IDROCLOROTIAZIDE</epsos:name>
<epsos:subIngredient classCode="ACTI">
<epsos:quantity>
<epsos:numerator unit="mg" value="5" xsi:type="epsos:PQ"/>
<epsos:denominator unit="1" value="1" xsi:type="epsos:PQ"/>
</epsos:quantity>
<epsos:ingredient classCode="MMAT" determinerCode="KIND">
<epsos:code code="C03DB01" codeSystem="2.16.840.1.113883.6.73" codeSystemName="ATC" displayName="amiloride"/>
</epsos:ingredient>
</epsos:subIngredient>
<epsos:subIngredient classCode="ACTI">
<epsos:quantity>
<epsos:numerator unit="mg" value="50" xsi:type="epsos:PQ"/>
<epsos:denominator unit="1" value="1" xsi:type="epsos:PQ"/>
</epsos:quantity>
<epsos:ingredient classCode="MMAT" determinerCode="KIND">
<epsos:code code="C03AA03" codeSystem="2.16.840.1.113883.6.73" codeSystemName="ATC" displayName="hydrochlorothiazide"/>
</epsos:ingredient>
</epsos:subIngredient>
</epsos:ingredient>
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| lab:precondition | The CDA extension: lab:precondition adds a precondition actRelationship between ObservationRange class and Criterion class of the CDA entry model. The Clinical Statement of CDA does not support the association of a criterion with a reference range, thus forbidding expressing in a Laboratory Report that a reference range is conditioned by the patient’s sex, and/or the patient’s age. The proposed extension enables expression of these criteria. ...
<referenceRange typeCode="REFV">
<observationRange classCode="OBS" moodCode="EVN.CRT">
<value xsi:type="IVL_PQ">
<low value="4.50" unit="10*6/mm3"/>
<high value="6.00" unit="10*6/mm3"/>
</value>
<lab:precondition typeCode="PRCN">
<lab:criterion classCode="COND">
<lab:code code="SEX"/>
<lab:value xsi:type="CD" code="M" codeSystem="2.16.840.1.113883.5.1"/>
</lab:criterion>
</lab:precondition>
<lab:precondition typeCode="PRCN">
<lab:criterion classCode="COND">
<lab:code code="AGE"/>
<lab:value xsi:type="IVL_PQ">
<lab:low value="35" unit="Y"/>
<lab:high value="55" unit="Y"/>
</lab:value>
</lab:criterion>
</lab:precondition>
</observationRange>
</referenceRange>
...
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| lab:statusCode | The CDA extension: lab:statusCode adds the ability to represent a status code on the documentationOf/ServiceEvent element. The Laboratory Report Content Module can express both final and non-final reports. To distinguish between the two, the statusCode element has been added to the documentationOf/serviceEvent element. A non-final report is a report documenting a serviceEvent, which is in the status "active". ...
<documentationOf>
<serviceEvent>
<lab:statusCode code=”active”>
<performer>
...
</performer>
</serviceEvent>
</documentationOf>
...
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| nehta:completionCode | The lifecycle status of a document. Values: Interim, Final, Withdrawn. The model for this extension is shown below.
<completionCode xmlns="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0" code="F" codeSystem="1.2.36.1.2001.1001.101.104.20104" codeSystemName="NCTIS Document Status Values" displayName="Final"/> |
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| nehta:asEntityIdentifier | An identifier assiciated with a Patient, Person, Organisation, Entity, or PlayingEntity. This is the otherIds pattern from the patient DMIM. The content is the id, and optionally a code (often from v2 table 0203) and/or a place. The model for this extension is shown below.
<nehta:asEntityIdentifier classCode="IDENT" xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0"> <nehta:id root="..." extension="..."/> <nehta:code code="..." codeSystem="..."/> <nehta:assigningGeographicArea classCode="PLC"> <nehta:name>National Identifier</nehta:name> </nehta:assigningGeographicArea> </nehta:asEntityIdentifier> |
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| nehta:multipleBirthInd | An indication that this person was part of multiple birth.
<nehta:multipleBirthInd xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0" value="true" /> |
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| nehta:multipleBirthOrderNumber | The order in which this person was born if part of a multiple birth.
<nehta:multipleBirthOrderNumber xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0" value="2" /> |
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| nehta:asEmployment | A person's occupation and employer.
<nehta:asEmployment classCode="EMP" xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0"> <nehta:code> <originalText>Senior Medical Oncologist</originalText> </nehta:code> <nehta:jobCode code="253314" codeSystem="2.16.840.1.113883.13.62" codeSystemName="1220.0 - ANZSCO - Australian and New Zealand Standard Classification of Occupations, First Edition, 2006" displayName="Medical Oncologist"/> <nehta:jobClassCode code="FT" codeSystem="2.16.840.1.113883.5.1059" codeSystemName="HL7:EmployeeJobClass" displayName="full-time"/> <nehta:employerOrganization> <name>GP Clinic</name> <asOrganizationPartOf> <wholeOrganization> <name use="ORGB">GP Clinics</name> <nehta:asEntityIdentifier classCode="IDENT"> <nehta:id assigningAuthorityName="HPI-O" root="1.2.36.1.2001.1003.0.8003621231167899"/> <nehta:assigningGeographicArea classCode="PLC"> <nehta:name>National Identifier</nehta:name> </nehta:assigningGeographicArea> </nehta:asEntityIdentifier> </wholeOrganization> </asOrganizationPartOf> </nehta:employerOrganization> </nehta:asEmployment> |
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| nehta:asIngredient | Medicine/Vaccine ingredient.
<manufacturedMaterial>
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| nehta:desc | A text description of the product. While the data type ED would allow for a full product monograph to be carried in this attribute, this practice is to be avoided, because product monograph document structures (Structured Product Labeling) should be used instead for such documents. The description attribute is mainly to be used for brief descriptions which users of product catalogs can use to quickly distinguish this product from other similar products in a list of products.
<manufacturedProduct>
<manufacturedMaterial>
....
<nehta:desc xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0">Prodeine Forte, 30mg, 20 tablets.</nehta:desc>
....
</manufacturedMaterial>
</manufacturedProduct>
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