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CDA R2 Extensions

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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 that 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.

Extension Definition Defined/Used by
sdtc:asPatientRelationship Each participant other than an informant may have zero or more relationship roles with the patient. Each of these roles can be expressed by an asPatientRelationship element which further describes the type of role in a code element. The informant participant already supports specification of the relationship between the informant and the patient via the RelatedEntity class, and therefore should not include this extension.(CCD)
  • CCD
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.
  • CCDA
  • HITSP C32
  • QRDA
sdtc:deceasedInd The deceasedIndextension (= “true” or “false”) in the family history organizer on the related subject is used inside to indicate if a family member is deceased.
  • CCD
  • CCDA
  • HITSP C32
  • QRDA
sdtc:deceasedTime The deceasedTime extension in the family history organizer on the related subject allows for reporting the date and time a family member died.
  • CCD
  • CCDA
  • HITSP C32
  • QRDA
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. N/A
sdtc:dischargeDispositionCode The sdtc:dischargeDispositionCode element allows the provider to record a discharge disposition in an encounter activity.
  • CCDA
  • HITSP C32
  • QRDA
sdtc:id 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)

The id extension in the family history organizer on the related subject allows for unique identification of the family member(s). (CCDA)

  • CCD
  • CCDA
  • HITSP C32
  • QRDA
sdtc:patient The sdtc:patient extension element allows for the patient identifier used by a given provider to be reported. The provider in their role as an assigned entity is related to the patient.
  • HITSP C32
  • IHE PCC TF
sdtc:raceCode The raceCode extension allows for multiple races to be reported for a patient.
  • CCDA
  • HITSP C32
  • QRDA
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.
  • Structured Form Definition
sdtc:valueSet The valueSet extension attribute allows the implementer to reference a particular value set from which a code was drawn. This extension represents a preadoption of the HL7 R2 Datatypes valueSet attribute
  • QRDA
sdtc:valueSetVersion The valueSetVersion extension attribute allows the implementer to reference a specific version of a value set. This extension represents a preadoption of the HL7 R2 Datatypes valueSetVerson attribute
  • QRDA

A W3C Schema representing these extensions, and incorporating them in the correct locations in the HL7 CDA Release 2 Schema can be found in the [QRDA Release 2 Draft Standard for Trial Use]

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.

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>
  • IHE PCC TF
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=" "/>
   ....
  • IHE Pharmacy Prescription
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">
  
  <name>Pyrimon</name>
  <epsos:formCode code="10604000" displayName="Eye drops, solution"  codeSystem="1.3.6.1.4.1.12559.11.10.1.3.1.44.1" codeSystemName="EDQM"/>
 ...
  • Smart Open Services for European Patients (epSOS)
pharm:asContent The CDA extension: pharm:asContent describes the packaging of the medication.

The pharm:code element provides the code for the particular package.
The pharm:name element describes brand name.
The pharm:formCode element provides the code for the particular package.
The pharm:lotNumberText element provides a string representation of a possible lot number.
The pharm:capacityQuantity element described the capacity of the packaging.

<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>
  • IHE Pharmacy Prescription
epsos:asContent The CDA extension: epsos:asContent describes the packaging of the medication.

The epsos:name describes brand name.
The epsos:formCode element provides the code for the particular package.
The epsos:capacityQuantity element described the capacity of the packaging.

<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>


  • Smart Open Services for European Patients (epSOS)
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.
The pharm:name element may be used for the plain text 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>
  • IHE Pharmacy Prescription
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.
The epsos:name element may be used for the plain text 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>


  • Smart Open Services for European Patients (epSOS)
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.
The pharm:quantity element contains the numerator and denominator of the strength ratio.

<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>
  • IHE Pharmacy Prescription
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.
The epsos:quantity element contains the numerator and denominator of the strength ratio.

<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>


  • Smart Open Services for European Patients (epSOS)
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.
The epsos:quantity element contains the numerator and denominator of the strength ratio.

<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>
  • Smart Open Services for European Patients (epSOS)
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>
 ...


  • IHE Laboratory
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".
This sub-element serviceEvent/statusCode is optional. When it is not present the serviceEvent is assumed to be in the status "completed".

...
<documentationOf>
   <serviceEvent>
       <lab:statusCode code=”active”>
               <performer>
                ...
               </performer>
   </serviceEvent>
</documentationOf> 
...
  • IHE Laboratory
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"/>
  • NEHTA Australia
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>
  • NEHTA Australia
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" />
  • NEHTA Australia
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" />
  • NEHTA Australia
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>
  • NEHTA Australia
nehta:asIngredient Medicine/Vaccine ingredient. 
 <manufacturedMaterial>
   
   <nehta:asIngredient classCode="INGR" xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0">
       <nehta:ingredientManufacturedMaterial classCode="MMAT"
           determinerCode="KIND">
           <nehta:code>
               <originalText>Diphtheria</originalText>
           </nehta:code>
       </nehta:ingredientManufacturedMaterial>
   </nehta:asIngredient>
   ...
</manufacturedMaterial>
  • NEHTA Australia
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>
  • NEHTA Australia
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