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Clinical Document Architecture (CDA)

Clinical Document Architecture

Clinical Document Architecture (CDA) is a Health Level 7 (HL7) standard that provides a framework for the encoding, formatting and semantics of electronic documents. CDC’s National Healthcare Safety Network (NHSN) supports CDA import of certain healthcare-associated infection (HAI) data. To assist programmers in creating standards for reporting via CDA import, NHSN offers an Implementation Guide and associated materials based fully on HL7-balloted CDA document specifications. Types of data that can be reported include event reports, denominator data, and process-of-care measures.

While it is possible for healthcare facilities to internally implement CDA for HAI reporting, NHSN recommends considering a software or electronic health record (EHR) vendor with demonstrated expertise in this area.  For a self-identified list of vendors implementing CDA reporting to NHSN, please visit the APIC website.


Getting Started

If you are a healthcare facility interested in reporting data to NHSN via CDA with the services of an external software vendor, start by talking to your IT staff to determine whether your facility has worked with any of the self-identified vendors on the APIC list (see link above) and whether any of the vendors’ software is currently implemented in your system. 

If you are a vendor or facility interested in implementing CDA reporting on your own, or to learn more about requirements for CDA creation, send an email request to the NHSN CDA mailbox: and ask for the HL7 CDA Implementation Toolkit.  The toolkit contains the latest CDA Implementation Guide (IG), all associated vocabularies and value sets, business rules, example files, and other documentation necessary to implement CDA reporting into NSHN.  Also, let us know if you would like to be on our mailing list for updates and announcements related to CDA reporting to NHSN.


Schematron Validator

The Lantana Group provides a Schematron Validator that can be utilized to validate CDAs in an effective and efficient way. The Schematron Validator tests XML files for compliance to the CDA Release 2 (R2) standard, as well as the data constraints imposed by the Implementation Guide.  However, the Schematron Validator does not test the data for NHSN rules outlined in the NHSN Protocol documents.  These rules are described in the Implementation Toolkit and can only be validated by submitting your CDA documents directly to NHSN through a test facility. Access the validation tool provided by Lantana.


Object Identifier (OID) assignment procedure

Within each release of the HL7 Implementation Guide for CDA R 2: NHSN Healthcare- Associated Infection (HAI) Reports document, guidance is provided for uniquely identifying a facility that sends CDA reports to NHSN.  Please refer to the following document for instructions to obtain an assigned OID for your facility: Object Identifier (OID) assignment procedure [PDF - 23KB] October 2011

Data (Events & Reports) accepted at this time via CDA import into NHSN include:  (Please note the NHSN HAI Implementation Guide Release number)

  • Primary Bloodstream Infection (BSI) (NHSN R2 & R5)
  • Surgical Site Infection (SSI) (NHSN R2 & R5)
  • Denominator for Procedure (NHSN R2 & R5)
  • Central Line Insertion Practices Adherence (CLIP)  Monitoring (NHSN R5)
  • Urinary Tract Infection (UTI)  (NHSN R5)
  • Laboratory-identified MDRO or CDI Event (LabID) (NHSN R5)
  • Denominators for Intensive Care Unit (ICU)/Other Locations (not NICU and SCA) (NHSN R2 & R5)
  • Denominators for Neonatal Intensive Care Unit (NICU) (NHSN R5)
  • Denominators for Specialty Care Area (SCA)  (NHSN R5)
  • Denominators for Antibiotic Use –Pharmacy option (NHSN R6)


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    National Healthcare Safety Network
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    Atlanta, GA 30333
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