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== Purpose ==
+
==Purpose==
 +
''THIS PAGE HAS BEEN MIGRATED TO THE SDWG CONFLUENCE SITE LOCATED [https://confluence.hl7.org/display/SD/CDA+Extensions HERE].''
 +
 
 
This page documents extensions to CDA R2 which have been created for use in CDA Release 2.0 Implementation Guides.
 
This page documents extensions to CDA R2 which have been created for use in CDA Release 2.0 Implementation Guides.
  
=== SDTC Extensions ===
+
===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.
 
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.
  
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An extension is a collection of element or attribute declarations and rules for their application to the CDA Release 2.0.
 
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 <strike>urn:hl7-org:stdc</strike>.
+
 
* All extensions are optional. An extension may be used, but need not be.
+
*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 <strike>urn:hl7-org:stdc</strike>.
* Extension element names shall be derived from attributes defined in the RIM.
+
*All extensions are optional. An extension may be used, but need not be.
* Each extension element shall use the same HL7 vocabularies and data types as used by CDA Release 2.0.  
+
*Extension element names shall be derived from attributes defined in the RIM.
* Each extension element shall use the same conventions for order and naming as is used by the current HL7 tooling.
+
*Each extension element shall use the same HL7 vocabularies and data types as used by CDA Release 2.0.
* 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.
+
*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.
 
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.
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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:   
 
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:   
* [[http://gforge.hl7.org/gf/project/strucdoc/frs/ SDWG GForge location which holds CDA Schema with approved sdtc extensions]]
+
 
 +
*[[http://gforge.hl7.org/gf/project/strucdoc/frs/ SDWG GForge location which holds CDA Schema with approved sdtc extensions]]
  
 
This document summarizes the process used to publish a new CDA Schema file with the sdtc extensions.
 
This document summarizes the process used to publish a new CDA Schema file with the sdtc extensions.
* [[http://wiki.hl7.org/images/1/19/Process_for_publishing_a_new_CDA_Schema_20170915.pdf CDA Schema Publishing Process Documentation]]
 
  
{|border='1' width='800px'
+
*[[http://wiki.hl7.org/images/1/19/Process_for_publishing_a_new_CDA_Schema_20170915.pdf CDA Schema Publishing Process Documentation]]
|width='100px'|Extension||Definition||width='100px'|'''Defined by'''||width='75px'|Approved on||width='75px'|Implemented on||width='100px'|Used by
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 +
{| border="1" width="800px"
 +
| width="100px" |Extension||Definition|| width="100px" |'''Defined by'''|| width="75px" |Approved on|| width="75px" |Implemented on|| width="100px" |Used by
 
|-
 
|-
  
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Add to
 
Add to
* componentOf/encompassingEncounter
+
 
* Cardinality: [0..1]
+
*componentOf/encompassingEncounter
 +
*Cardinality: [0..1]
 
|
 
|
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
|November, 2014  
+
|November, 2014
| June 2015  
+
|June 2015
 
|
 
|
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|-
 
|-
  
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Add to
 
Add to
* Person
+
 
* Cardinality: [0..1]
+
*Person
 +
*Cardinality: [0..1]
 
|
 
|
* CCD v1.0
+
*CCD v1.0
 
|April 1, 2007 / Revisited and approved, March 5, 2015
 
|April 1, 2007 / Revisited and approved, March 5, 2015
| April 2015
+
|April 2015
 
|
 
|
 
|-
 
|-
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|sdtc:birthTime||The &lt;sdtc:birthTime&gt; 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.
 
|sdtc:birthTime||The &lt;sdtc:birthTime&gt; 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.
 
|
 
|
* HITSP C32
+
*HITSP C32
 
|pre-process
 
|pre-process
 
|July 6, 2012
 
|July 6, 2012
 
|
 
|
* CCDA
+
*CCDA
* QRDA
+
*QRDA
 
|-
 
|-
  
 
|sdtc:deceasedInd
 
|sdtc:deceasedInd
 
|The deceasedInd extension is used to record that the recordTarget or subjectPerson is deceased.
 
|The deceasedInd extension is used to record that the recordTarget or subjectPerson is deceased.
* recordTarget/patientRole/patient
+
 
* subject/relatedSubject/subject
+
*recordTarget/patientRole/patient
* Cardinality: [0..1]
+
*subject/relatedSubject/subject
 +
*Cardinality: [0..1]
 
|
 
|
* CCD
+
*CCD
 
|July, 2014
 
|July, 2014
 
|July, 2014
 
|July, 2014
 
|
 
|
* CCDA
+
*CCDA
* HITSP C32
+
*HITSP C32
* QRDA
+
*QRDA
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|-
 
|-
  
 
|sdtc:deceasedTime
 
|sdtc:deceasedTime
 
|The deceasedTime extension is used to record the time of death for the recordTarget or subjectPerson.
 
|The deceasedTime extension is used to record the time of death for the recordTarget or subjectPerson.
* recordTarget/patientRole/patient
+
 
* subject/relatedSubject/subject
+
*recordTarget/patientRole/patient
* Cardinality: [0..1]
+
*subject/relatedSubject/subject
 +
*Cardinality: [0..1]
 
|
 
|
* CCD
+
*CCD
 
|July, 2014
 
|July, 2014
 
|July, 2014
 
|July, 2014
 
|
 
|
* CCDA
+
*CCDA
* HITSP C32
+
*HITSP C32
* QRDA
+
*QRDA
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|-
 
|-
  
 
|stdc:desc
 
|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.
 
|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.
* recordTarget/patientRole/patient
+
 
* subject/relatedSubject/subject
+
*recordTarget/patientRole/patient
* person
+
*subject/relatedSubject/subject
* Cardinality: [0..1]
+
*person
| N/A
+
*Cardinality: [0..1]
 +
|N/A
 
|Date UNK / Revisited and approved, March 5, 2015
 
|Date UNK / Revisited and approved, March 5, 2015
| April 2015
+
|April 2015
 
|
 
|
 
|-
 
|-
Line 113: Line 123:
 
|The sdtc:dischargeDispositionCode element allows the discharge disposition to be recorded for an encounter act.
 
|The sdtc:dischargeDispositionCode element allows the discharge disposition to be recorded for an encounter act.
 
|
 
|
* HITSP C32
+
*HITSP C32
 
|July, 2012
 
|July, 2012
 
|July, 2012
 
|July, 2012
 
|
 
|
* CCDA
+
*CCDA
* QRDA
+
*QRDA
 
|-
 
|-
  
 
|sdtc:ethnicGroupCode
 
|sdtc:ethnicGroupCode
 
|This ethnicGroupCode extension is used to record additional ethnicity groups for the recordTarget or subjectPerson.
 
|This ethnicGroupCode extension is used to record additional ethnicity groups for the recordTarget or subjectPerson.
* recordTarget/patientRole/patient
+
 
* subject/relatedSubject/subject
+
*recordTarget/patientRole/patient
* Cardinality: [0..*]
+
*subject/relatedSubject/subject
 +
*Cardinality: [0..*]
 
|
 
|
* CCDA
+
*CCDA
 
|December, 2014
 
|December, 2014
 
|February, 2015
 
|February, 2015
 
|
 
|
* CCDA
+
*CCDA
 
|-
 
|-
 
  
 
|sdtc:functionCode
 
|sdtc:functionCode
 
|The sdtc:functionCode extension element allows the function that the participant is doing to be recorded.   
 
|The sdtc:functionCode extension element allows the function that the participant is doing to be recorded.   
* perfomer and participant for entries. It currently is available for these data elements in the header and just needs to be added for entry representation.
+
 
* Cardinality: [0..1]
+
*perfomer and participant for entries. It currently is available for these data elements in the header and just needs to be added for entry representation.
 +
*Cardinality: [0..1]
 
|
 
|
* Care Team member representation
+
*Care Team member representation
 
|May 10, 2017
 
|May 10, 2017
 
|December 11, 2017
 
|December 11, 2017
 
|
 
|
* C-CDA R2.1 Companion Guide for Additional Templates
+
*C-CDA R2.1 Companion Guide for Additional Templates
 
|-
 
|-
 
  
 
|sdtc:id
 
|sdtc:id
Line 152: Line 162:
 
The id extension in the family history organizer on the related subject allows for unique identification of the family member(s). (CCDA)
 
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)
 
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)
* subject/relatedSubject
+
 
* Cardinality: [0..*]
+
*subject/relatedSubject
 +
*Cardinality: [0..*]
 
|
 
|
* CCD
+
*CCD
 
|July, 2014
 
|July, 2014
 
|July, 2014
 
|July, 2014
 
|
 
|
* CCDA
+
*CCDA
* HITSP C32
+
*HITSP C32
* QRDA
+
*QRDA
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|-
 
|-
  
Line 168: Line 179:
 
|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.
 
|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:
 
Add to:
* Observation
+
 
* SubstanceAdministration
+
*Observation
* Supply
+
*SubstanceAdministration
* Procedure
+
*Supply
* Encounter
+
*Procedure
* Act
+
*Encounter
* Cardinality: [0..*]
+
*Act
 +
*Cardinality: [0..*]
 +
 
 
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.
 
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.
 
|
 
|
* QRDA Cat I R3
+
*QRDA Cat I R3
 
|March 19, 2015
 
|March 19, 2015
 
|April 2015
 
|April 2015
 
|
 
|
* QRDA Cat I R3
+
*QRDA Cat I R3
 
|-
 
|-
  
 
|sdtc:multipleBirthInd
 
|sdtc:multipleBirthInd
 
|The multipleBirthInd extension is used to record that the recordTarget or subjectPerson is part of a multiple birth.
 
|The multipleBirthInd extension is used to record that the recordTarget or subjectPerson is part of a multiple birth.
* recordTarget/patientRole/patient
+
 
* subject/relatedSubject/subject
+
*recordTarget/patientRole/patient
* Cardinality: [0..1]
+
*subject/relatedSubject/subject
 +
*Cardinality: [0..1]
 
|
 
|
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|November, 2014
 
|November, 2014
 
|February, 2015
 
|February, 2015
 
|
 
|
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|-
 
|-
  
 
|sdtc:multipleBirthOrderNumber
 
|sdtc:multipleBirthOrderNumber
 
|The multipleBirthOrderNumber extension is used to record the order number within a multiple birth that the recordTarget or subjectPerson was born in.  
 
|The multipleBirthOrderNumber extension is used to record the order number within a multiple birth that the recordTarget or subjectPerson was born in.  
* recordTarget/patientRole/patient
+
 
* subject/relatedSubject/subject
+
*recordTarget/patientRole/patient
* Cardinality: [0..1]
+
*subject/relatedSubject/subject
 +
*Cardinality: [0..1]
 
|
 
|
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|November, 2014
 
|November, 2014
 
|February, 2015
 
|February, 2015
 
|
 
|
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|-
 
|-
  
Line 213: Line 228:
 
|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."
 
|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."
 
Add to:  
 
Add to:  
* Supply
+
 
* Encounter
+
*Supply
* Cardinality: [0..1]
+
*Encounter
 +
*Cardinality: [0..1]
 
|
 
|
* QRDA Cat I
+
*QRDA Cat I
 
|Reviewed 4/23/2015
 
|Reviewed 4/23/2015
|Proposal Withdrawn  
+
|Proposal Withdrawn
 
|
 
|
* QRDA Cat I
+
*QRDA Cat I
 
|-
 
|-
  
 
|sdtc:patient
 
|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.
 
|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.
* AssignedEntity
+
 
* Cardinality: [0..1]
+
*AssignedEntity
 +
*Cardinality: [0..1]
 
|
 
|
* HITSP C83 v2.0.1
+
*HITSP C83 v2.0.1
 
|January 31, 2010 / Revisited and approved, March 5, 2015
 
|January 31, 2010 / Revisited and approved, March 5, 2015
| April 2015
+
|April 2015
 
|
 
|
 
|-
 
|-
Line 237: Line 254:
 
|sdtc:precondition1
 
|sdtc:precondition1
 
|The sdtc:precondition1 extension allows for the association of a criterion with a reference range (ObservationRange), which allows the expression in a lab report that a reference range is conditional on some criterion such as patient sex or age (or a combination of criterion).
 
|The sdtc:precondition1 extension allows for the association of a criterion with a reference range (ObservationRange), which allows the expression in a lab report that a reference range is conditional on some criterion such as patient sex or age (or a combination of criterion).
* ObservationRange
+
 
* Cardinality: [0..*]
+
*ObservationRange
 +
*Cardinality: [0..*]
 +
|
 +
*C-CDA Supplemental Templates for Infectious Disease
 +
|June 28, 2018
 +
|July 8, 2018
 
|
 
|
* C-CDA Supplemental Templates for Infectious Disease
+
*C-CDA Supplemental Templates for Infectious Disease
| June 28, 2018
 
| July 8, 2018
 
|
 
* C-CDA Supplemental Templates for Infectious Disease
 
 
|-
 
|-
  
 
|sdtc:priorityNumber
 
|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 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.   
 
|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 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.   
* organizer/component
+
 
* Cardinality: [0..1]
+
*organizer/component
 +
*Cardinality: [0..1]
 
|
 
|
* Personal Advance Care Plan
+
*Personal Advance Care Plan
 
|1/28/2016
 
|1/28/2016
 
|June 2016
 
|June 2016
 
|
 
|
* Personal Advance Care Plan
+
*Personal Advance Care Plan
 
|-
 
|-
  
 
|sdtc:raceCode||The raceCode extension allows for multiple races to be reported for a patient.
 
|sdtc:raceCode||The raceCode extension allows for multiple races to be reported for a patient.
* recordTarget/patientRole/patient
+
 
 +
*recordTarget/patientRole/patient
 
||
 
||
* HITSP C32
+
*HITSP C32
 
|July, 2012
 
|July, 2012
 
|July, 2012
 
|July, 2012
 
|
 
|
* CCDA
+
*CCDA
* HITSP C32
+
*HITSP C32
* QRDA
+
*QRDA
 
|-
 
|-
  
 
|sdtc:raceCode
 
|sdtc:raceCode
 
|This raceCode extension is used to record additional race codes for the subject.
 
|This raceCode extension is used to record additional race codes for the subject.
* subject/relatedSubject/subject
+
 
* Cardinality: [0..*]
+
*subject/relatedSubject/subject
 +
*Cardinality: [0..*]
 
|
 
|
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|November, 2014
 
|November, 2014
 
|February, 2015
 
|February, 2015
 
|
 
|
* [[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
+
*[[http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf IHE QRPH BFDR-e]]
 
|-
 
|-
  
Line 286: Line 307:
 
|The signatureText extension adds an attribute for authenticator and legalAuthenticator to record encoded digital signature information.
 
|The signatureText extension adds an attribute for authenticator and legalAuthenticator to record encoded digital signature information.
 
|
 
|
* Complete Document for Payers (CDP)
+
*Complete Document for Payers (CDP)
 
|Searching for this date.
 
|Searching for this date.
 
|July, 2014
 
|July, 2014
 
|
 
|
* Complete Document for Payers (CDP)
+
*Complete Document for Payers (CDP)
 
|-
 
|-
  
Line 296: Line 317:
 
|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.
 
|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.
 
|
 
|
* [[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=335 HL7 Implementation Guide for CDA® Release 2: Questionnaire Form Definition Document, Release 1]]
+
*[[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=335 HL7 Implementation Guide for CDA® Release 2: Questionnaire Form Definition Document, Release 1]]
 
|January, 2014
 
|January, 2014
 
|January, 2014
 
|January, 2014
 
|
 
|
* [[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=335 HL7 Implementation Guide for CDA® Release 2: Questionnaire Form Definition Document, Release 1]]
+
*[[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=335 HL7 Implementation Guide for CDA® Release 2: Questionnaire Form Definition Document, Release 1]]
 
|-
 
|-
  
 
|sdtc:text
 
|sdtc:text
 
|The text extension adds the text element to the organizer act. Every other act has a text element, so this was needed to make the organizer act consistent with other acts. It also is needed to support mapping between the organizer act in CDA and the list resource in FHIR.
 
|The text extension adds the text element to the organizer act. Every other act has a text element, so this was needed to make the organizer act consistent with other acts. It also is needed to support mapping between the organizer act in CDA and the list resource in FHIR.
* organizer
+
 
* Cardinality: [0..1]
+
*organizer
|
+
*Cardinality: [0..1]
 
|
 
|
* C-CDA
+
*C-CDA
 
|Novermber, 2018
 
|Novermber, 2018
|TBD
+
|April, 2019
 
|
 
|
* C-CDA
+
*C-CDA
 
|-
 
|-
  
Line 319: Line 340:
 
|The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.
 
|The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.
 
|
 
|
* QRDA
+
*QRDA
 
|July, 2012
 
|July, 2012
 
|January, 2013
 
|January, 2013
 
|
 
|
* QRDA
+
*QRDA
 
|-
 
|-
  
Line 329: Line 350:
 
|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.
 
|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.
 
|
 
|
* QRDA
+
*QRDA
 
|July, 2012
 
|July, 2012
 
|January, 2013
 
|January, 2013
 
|
 
|
* QRDA
+
*QRDA
 
|-
 
|-
 
|}
 
|}
  
=== Other HL7 Extensions ===
+
===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.
 
The following extensions have been approved by other HL7 Working Groups or Affiliates for use in CDA Release 2.0 Implementation Guides.
  
==== Extensions Netherlands ====
+
====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.
 
The following extensions have been created by Nictiz for use in CDA Release 2.0 Implementation Guides. Created due to requirements in The Netherlands.
  
{|border='1' width='800px'
+
{| border="1" width="800px"
|width='100px'|Extension||Definition||width='100px'|'''Defined'''/Used by
+
| width="100px" |Extension||Definition|| width="100px" |'''Defined'''/Used by
 
|-
 
|-
  
Line 357: Line 378:
  
 
||
 
||
* '''Nictiz, Pharmacy, zorgtoepassing medicatieproces'''
+
*'''Nictiz, Pharmacy, zorgtoepassing medicatieproces'''
 
|-
 
|-
 
|}
 
|}
  
=== Non-HL7 Extensions ===
+
===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.
 
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.
  
{|border='1' width='800px'
+
{| border="1" width="800px"
|width='100px'|Extension||Definition||width='100px'|'''Defined'''/Used by
+
| width="100px" |Extension||Definition|| width="100px" |'''Defined'''/Used by
 
|-
 
|-
  
Line 379: Line 400:
  
 
||
 
||
* '''IHE PCC TF'''
+
*'''IHE PCC TF'''
 
|-
 
|-
  
Line 398: Line 419:
  
 
||
 
||
* '''IHE Pharmacy Prescription'''
+
*'''IHE Pharmacy Prescription'''
 
|-
 
|-
  
Line 405: Line 426:
 
   <templateId root="1.3.6.1.4.1.12559.11.10.1.3.1.3.1"/>  
 
   <templateId root="1.3.6.1.4.1.12559.11.10.1.3.1.3.1"/>  
 
   <manufacturedMaterial classCode="MMAT" determinerCode="KIND">
 
   <manufacturedMaterial classCode="MMAT" determinerCode="KIND">
   <code code=" " displayName="Pyrimon" codeSystem=" "codeSystemName=" "/>
+
   <code code=" " displayName="Pyrimon" codeSystem=" " codeSystemName=" " />
 
   <name>Pyrimon</name>
 
   <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"/>
 
   <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"/>
Line 411: Line 432:
  
 
||
 
||
* '''Smart Open Services for European Patients (epSOS)'''
+
*'''Smart Open Services for European Patients (epSOS)'''
 
|-
 
|-
  
Line 425: Line 446:
 
       <!-- National medicinal product code (package-level) -->
 
       <!-- National medicinal product code (package-level) -->
 
       <pharm:code code=" " displayName=" " codeSystem=" " codeSystemName=" "/>
 
       <pharm:code code=" " displayName=" " codeSystem=" " codeSystemName=" "/>
      <!-- Brand name (package) -->
+
      <!-- Brand name (package) -->
 
       <pharm:name>...</pharm:name>
 
       <pharm:name>...</pharm:name>
 
       <pharm:formCode code=" " displayName=" "
 
       <pharm:formCode code=" " displayName=" "
Line 435: Line 456:
  
 
||
 
||
* '''IHE Pharmacy Prescription'''
+
*'''IHE Pharmacy Prescription'''
 
|-
 
|-
 
  
 
|epsos:asContent||The CDA extension: epsos:asContent describes the packaging of the medication.<br>
 
|epsos:asContent||The CDA extension: epsos:asContent describes the packaging of the medication.<br>
Line 452: Line 472:
 
   </epsos:containerPackagedMedicine>  
 
   </epsos:containerPackagedMedicine>  
 
  </epsos:asContent>
 
  </epsos:asContent>
 
  
 
||
 
||
* '''Smart Open Services for European Patients (epSOS)'''
+
*'''Smart Open Services for European Patients (epSOS)'''
 
|-
 
|-
  
Line 471: Line 490:
  
 
||
 
||
* '''IHE Pharmacy Prescription'''
+
*'''IHE Pharmacy Prescription'''
 
|-
 
|-
  
Line 484: Line 503:
 
   </epsos:generalizedMedicineClass>
 
   </epsos:generalizedMedicineClass>
 
  </epsos:asSpecializedKind>  
 
  </epsos:asSpecializedKind>  
 
  
 
||
 
||
* '''Smart Open Services for European Patients (epSOS)'''
+
*'''Smart Open Services for European Patients (epSOS)'''
 
|-
 
|-
  
Line 506: Line 524:
 
  </pharm:ingredient>
 
  </pharm:ingredient>
 
  <pharm:ingredient classCode="ACTI">
 
  <pharm:ingredient classCode="ACTI">
  <!-- strength of ingredient -->
+
    <!-- strength of ingredient -->
 
   <pharm:quantity>
 
   <pharm:quantity>
 
       <pharm:numerator xsi:type="PQ" value=" " unit=" "/>
 
       <pharm:numerator xsi:type="PQ" value=" " unit=" "/>
Line 519: Line 537:
  
 
||
 
||
* '''IHE Pharmacy Prescription'''
+
*'''IHE Pharmacy Prescription'''
 
|-
 
|-
  
Line 535: Line 553:
 
  </epsos:ingredient>
 
  </epsos:ingredient>
 
  </epsos:ingredient>
 
  </epsos:ingredient>
 
  
 
||
 
||
* '''Smart Open Services for European Patients (epSOS)'''
+
*'''Smart Open Services for European Patients (epSOS)'''
 
|-
 
|-
  
Line 549: Line 566:
 
           <epsos:code code="C03EA01" codeSystem="2.16.840.1.113883.6.73" codeSystemName="ATC" displayName="hydrochlorothiazide and potassium-sparing agents"/>
 
           <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:name>AMILORIDE+IDROCLOROTIAZIDE</epsos:name>
          <!-- ATC code of the 1st sub-ingredients-->
+
            <!-- ATC code of the 1st sub-ingredients-->
 
           <epsos:subIngredient classCode="ACTI">
 
           <epsos:subIngredient classCode="ACTI">
 
                     <epsos:quantity>
 
                     <epsos:quantity>
Line 559: Line 576:
 
                     </epsos:ingredient>
 
                     </epsos:ingredient>
 
           </epsos:subIngredient>
 
           </epsos:subIngredient>
          <!-- ATC code of the 2nd sub-ingredients-->
+
            <!-- ATC code of the 2nd sub-ingredients-->
 
           <epsos:subIngredient classCode="ACTI">
 
           <epsos:subIngredient classCode="ACTI">
 
                     <epsos:quantity>
 
                     <epsos:quantity>
Line 570: Line 587:
 
             </epsos:subIngredient>
 
             </epsos:subIngredient>
 
   </epsos:ingredient>
 
   </epsos:ingredient>
             
+
             
 
||
 
||
* '''Smart Open Services for European Patients (epSOS)'''
+
*'''Smart Open Services for European Patients (epSOS)'''
 
|-
 
|-
  
Line 580: Line 597:
 
  ...
 
  ...
 
   <!-- The appropriate reference range is selected according to patient sex and age   
 
   <!-- The appropriate reference range is selected according to patient sex and age   
      (2 criteria)-->
+
        (2 criteria)-->
 
   <referenceRange typeCode="REFV">
 
   <referenceRange typeCode="REFV">
 
     <observationRange classCode="OBS" moodCode="EVN.CRT">
 
     <observationRange classCode="OBS" moodCode="EVN.CRT">
Line 605: Line 622:
 
   </referenceRange>
 
   </referenceRange>
 
   ...
 
   ...
 
+
             
             
 
 
||
 
||
* '''IHE Laboratory'''
+
*'''IHE Laboratory'''
 
|-
 
|-
  
Line 624: Line 640:
 
  </documentationOf>  
 
  </documentationOf>  
 
  ...
 
  ...
             
+
           
 
||
 
||
* '''IHE Laboratory'''
+
*'''IHE Laboratory'''
 
|-
 
|-
  
Line 635: Line 651:
  
 
||
 
||
* '''NEHTA Australia'''
+
*'''NEHTA Australia'''
 
|-
 
|-
  
Line 647: Line 663:
 
  </nehta:asEntityIdentifier>
 
  </nehta:asEntityIdentifier>
 
||
 
||
* '''NEHTA Australia'''
+
*'''NEHTA Australia'''
 
|-
 
|-
  
Line 653: Line 669:
 
  <nehta:multipleBirthInd xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0" value="true" />
 
  <nehta:multipleBirthInd xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0" value="true" />
 
||
 
||
* '''NEHTA Australia'''
+
*'''NEHTA Australia'''
 
|-
 
|-
  
Line 659: Line 675:
 
  <nehta:multipleBirthOrderNumber xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0" value="2" />
 
  <nehta:multipleBirthOrderNumber xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0" value="2" />
 
||
 
||
* '''NEHTA Australia'''
+
*'''NEHTA Australia'''
 
|-
 
|-
  
Line 668: Line 684:
 
         <originalText>Senior Medical Oncologist</originalText>
 
         <originalText>Senior Medical Oncologist</originalText>
 
     </nehta:code>
 
     </nehta:code>
    <!-- Occupation -->
+
    <!-- Occupation -->
 
     <nehta:jobCode code="253314" codeSystem="2.16.840.1.113883.13.62"
 
     <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"
 
         codeSystemName="1220.0 - ANZSCO - Australian and New Zealand Standard Classification of Occupations, First Edition, 2006"
 
         displayName="Medical Oncologist"/>
 
         displayName="Medical Oncologist"/>
    <!-- Employment Type -->
+
    <!-- Employment Type -->
 
     <nehta:jobClassCode code="FT" codeSystem="2.16.840.1.113883.5.1059"
 
     <nehta:jobClassCode code="FT" codeSystem="2.16.840.1.113883.5.1059"
 
         codeSystemName="HL7:EmployeeJobClass" displayName="full-time"/>
 
         codeSystemName="HL7:EmployeeJobClass" displayName="full-time"/>
    <!-- Employer Organisation -->
+
    <!-- Employer Organisation -->
 
     <nehta:employerOrganization>
 
     <nehta:employerOrganization>
        <!-- Department/Unit -->
+
        <!-- Department/Unit -->
 
         <name>GP Clinic</name>
 
         <name>GP Clinic</name>
 
         <asOrganizationPartOf>
 
         <asOrganizationPartOf>
 
             <wholeOrganization>
 
             <wholeOrganization>
                <!-- Organisation Name -->
+
                <!-- Organisation Name -->
 
                 <name use="ORGB">GP Clinics</name>
 
                 <name use="ORGB">GP Clinics</name>
                <!-- Entity Identifier -->
+
                <!-- Entity Identifier -->
 
                 <nehta:asEntityIdentifier classCode="IDENT">
 
                 <nehta:asEntityIdentifier classCode="IDENT">
 
                     <nehta:id assigningAuthorityName="HPI-O"
 
                     <nehta:id assigningAuthorityName="HPI-O"
Line 696: Line 712:
 
  </nehta:asEmployment>
 
  </nehta:asEmployment>
 
||
 
||
* '''NEHTA Australia'''
+
*'''NEHTA Australia'''
 
|-
 
|-
 
|nehta:asIngredient||Medicine/Vaccine ingredient.
 
|nehta:asIngredient||Medicine/Vaccine ingredient.
 
   <manufacturedMaterial>
 
   <manufacturedMaterial>
     <code code="IFXB" codeSystem="1.2.36.1.2001.1005.17"
+
     <code code="IFXB" codeSystem="1.2.36.1.2001.1005.17" codeSystemName="Australian Vaccine Code" displayName="Infanrix-Hep B" />
        codeSystemName="Australian Vaccine Code"
 
        displayName="Infanrix-Hep B"/>
 
 
     <nehta:asIngredient classCode="INGR" xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0">
 
     <nehta:asIngredient classCode="INGR" xmlns:nehta="http://ns.electronichealth.net.au/Ci/Cda/Extensions/3.0">
 
         <nehta:ingredientManufacturedMaterial classCode="MMAT"
 
         <nehta:ingredientManufacturedMaterial classCode="MMAT"
Line 714: Line 728:
 
  </manufacturedMaterial>
 
  </manufacturedMaterial>
 
||
 
||
* '''NEHTA Australia'''
+
*'''NEHTA Australia'''
 
|-
 
|-
  
Line 727: Line 741:
  
 
||
 
||
* '''NEHTA Australia'''
+
*'''NEHTA Australia'''
 
|-
 
|-
 
|}
 
|}

Latest revision as of 21:40, 6 August 2019

Purpose

THIS PAGE HAS BEEN MIGRATED TO THE SDWG CONFLUENCE SITE LOCATED HERE.

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.

If you develop a CDA R2.0 Implementation Guide and use extensions from the sdtc namespace, you should register your use of the extension by notifying a SDWG Co-Chair or report your usage on the SDWG listServe so that this index can be kept up to date.

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:

This document summarizes the process used to publish a new CDA Schema file with the sdtc extensions.

Extension Definition Defined by Approved on Implemented on Used by
sdtc:admissionReferralSourceCode This element is a coded concept that represents the type of referral. Its RIM source class is PatientEncounter.

Add to

  • componentOf/encompassingEncounter
  • Cardinality: [0..1]
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)

Add to

  • Person
  • Cardinality: [0..1]
  • CCD v1.0
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.
  • HITSP C32
pre-process July 6, 2012
  • CCDA
  • QRDA
sdtc:deceasedInd The deceasedInd extension is used to record that the recordTarget or subjectPerson is deceased.
  • recordTarget/patientRole/patient
  • subject/relatedSubject/subject
  • Cardinality: [0..1]
  • CCD
July, 2014 July, 2014
sdtc:deceasedTime The deceasedTime extension is used to record the time of death for the recordTarget or subjectPerson.
  • recordTarget/patientRole/patient
  • subject/relatedSubject/subject
  • Cardinality: [0..1]
  • CCD
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.
  • recordTarget/patientRole/patient
  • subject/relatedSubject/subject
  • person
  • Cardinality: [0..1]
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.
  • HITSP C32
July, 2012 July, 2012
  • CCDA
  • QRDA
sdtc:ethnicGroupCode This ethnicGroupCode extension is used to record additional ethnicity groups for the recordTarget or subjectPerson.
  • recordTarget/patientRole/patient
  • subject/relatedSubject/subject
  • Cardinality: [0..*]
  • CCDA
December, 2014 February, 2015
  • CCDA
sdtc:functionCode The sdtc:functionCode extension element allows the function that the participant is doing to be recorded.
  • perfomer and participant for entries. It currently is available for these data elements in the header and just needs to be added for entry representation.
  • Cardinality: [0..1]
  • Care Team member representation
May 10, 2017 December 11, 2017
  • C-CDA R2.1 Companion Guide for Additional Templates
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)

  • subject/relatedSubject
  • Cardinality: [0..*]
  • CCD
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:

  • Observation
  • SubstanceAdministration
  • Supply
  • Procedure
  • Encounter
  • Act
  • Cardinality: [0..*]

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.

  • QRDA Cat I R3
March 19, 2015 April 2015
  • QRDA Cat I R3
sdtc:multipleBirthInd The multipleBirthInd extension is used to record that the recordTarget or subjectPerson is part of a multiple birth.
  • recordTarget/patientRole/patient
  • subject/relatedSubject/subject
  • Cardinality: [0..1]
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.
  • recordTarget/patientRole/patient
  • subject/relatedSubject/subject
  • Cardinality: [0..1]
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."

Add to:

  • Supply
  • Encounter
  • Cardinality: [0..1]
  • QRDA Cat I
Reviewed 4/23/2015 Proposal Withdrawn
  • QRDA Cat I
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.
  • AssignedEntity
  • Cardinality: [0..1]
  • HITSP C83 v2.0.1
January 31, 2010 / Revisited and approved, March 5, 2015 April 2015
sdtc:precondition1 The sdtc:precondition1 extension allows for the association of a criterion with a reference range (ObservationRange), which allows the expression in a lab report that a reference range is conditional on some criterion such as patient sex or age (or a combination of criterion).
  • ObservationRange
  • Cardinality: [0..*]
  • C-CDA Supplemental Templates for Infectious Disease
June 28, 2018 July 8, 2018
  • C-CDA Supplemental Templates for Infectious Disease
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 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.
  • organizer/component
  • Cardinality: [0..1]
  • Personal Advance Care Plan
1/28/2016 June 2016
  • Personal Advance Care Plan
sdtc:raceCode The raceCode extension allows for multiple races to be reported for a patient.
  • recordTarget/patientRole/patient
  • HITSP C32
July, 2012 July, 2012
  • CCDA
  • HITSP C32
  • QRDA
sdtc:raceCode This raceCode extension is used to record additional race codes for the subject.
  • subject/relatedSubject/subject
  • Cardinality: [0..*]
November, 2014 February, 2015
sdtc:signatureText The signatureText extension adds an attribute for authenticator and legalAuthenticator to record encoded digital signature information.
  • Complete Document for Payers (CDP)
Searching for this date. July, 2014
  • Complete Document for Payers (CDP)
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:text The text extension adds the text element to the organizer act. Every other act has a text element, so this was needed to make the organizer act consistent with other acts. It also is needed to support mapping between the organizer act in CDA and the list resource in FHIR.
  • organizer
  • Cardinality: [0..1]
  • C-CDA
Novermber, 2018 April, 2019
  • C-CDA
sdtc:valueSet The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.
  • QRDA
July, 2012 January, 2013
  • QRDA
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.
  • QRDA
July, 2012 January, 2013
  • QRDA

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>
  • Nictiz, Pharmacy, zorgtoepassing medicatieproces

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