Consolidated Clinical Document Architecture

The Consolidated Clinical Document Architecture is one of the standards developed by HL7. The above video is by the American Office of the National Coordinator for Health Information Technology. The C-CDA is described as the building block for electronic health records. The C-CDA divides a document into four sections

  • Header
  • Body
  • Section
  • Narrative

The Header and Body terminology will be familiar to people who have built webpages in HTML. The document is divided into these four sections which can be thought of as boundaries. Adding these to a document makes it more difficult for a human to read but makes it easier for the programmer to tell the computer where to find the text. For example if the programmer is trying to extract the narrative from a clinical assessment that is recorded using the C-CDA they will be able to tell the program to extract the text within the boundaries defined by the Narrative.

Standards work very well for web pages where HTML facilitates the creation of webpages by browsers using the HTML coding. The healthcare environment is different from the internet but the creation of standards supports a universal health architecture with the potential for many important applications. This is particularly relevant for a Health Information Exchange.


HL7 is an organisation that develops a framework and standards for interoperability of health information systems. Their website can be found here and the organisation also has a well established social media presence. HL7 apply to the Interoperability Framework in the NHS Interoperability Handbook. The context of HL7 is explained below.

Patient Records

Patient records are central to the delivery of healthcare and serve a number of functions including the recording of clinical assessments and interventions. Aggregated data is also utilised at a local and national level to inform commissioning.

Electronic Patient Records

The digitisation of patient records offers a number of advantages over paper based records. These advantages include automated backup of records, reduced use of physical storage space (since paper based notes are switched to servers), off-site access to records using mobile devices and the potential to develop analytical clinical support tools which use computers to process clinical data to help improve clinical decisions. Not all healthcare services have electronic patient records but most providers are moving in this direction.

Getting Electronic Patient Records to Talk to Each Other

When patients move between healthcare providers – for instance between primary care and the hospital – they may find that one provider does not have information that the other provider has. There are many providers and many electronic paper record systems. For two systems to talk to each other they have to solve a number of problems. When these problems are solved a patient can move between providers and healthcare information can be accessed by the different providers. A key solution to this problem of health information gaps is the Health Information Exchange (HIE).

The Health Information Exchange

There are many definitions of what a Health Information Exchange is. (Hersh et al, 2015) define a HIE as follows:

Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations’

Whilst this definition is simple, the process of sharing clinical information between healthcare organisations is technically complex and encompasses a range of software, hardware and governance issues. The process of helping systems to talk to each other is helped by the development of standards. A set of standards is outlined in the NHS interoperability framework.

The Interoperability Framework

A digital copy of the Interoperability Handbook can be found at the NHS England website (NHS England, 2017). The handbook explains how an interoperability framework can support an interoperability strategy. The Interoperability Framework has three layers – a governance layer, an exchange layer and an interpretation layer.

The Standards Applicable to the Interoperability Framework

Appendix A in the Interoperability Handbook shows how various standards map onto the Interoperability Framework (NHS England, 2017).

Citations, accessed 8.4.17

There is also an NHS Digital Twitter account here.

Links to Other Posts in the Health Information Exchange Series

General Posts to Date on Health Information Exchanges

Posts on Examples of Health Information Exchanges

SNOMED CT®/ICD Mapping and Harmonisation Posts


ICD 1-10 Posts

ICD-11 Posts

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section


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