Medplum provides support for C-CDA (Consolidated Clinical Document Architecture) handling in accordance with the [ONC Certification](/content/docs/compliance/onc/index.html) criteria (g)(7), (g)(9) and (b)(1) as well as developer utilities for working with C-CDA documents in the context of FHIR.

## Overview

Medplum provides the following functionality for C-CDA handling.

- A C-CDA viewer that allows uploaded documents to be viewed in the Medplum App or in a react component.
- The ability to Export C-CDA in the Medplum app or via API.
- An SDK for FHIR to C-CDA conversion.

## C-CDA Viewer

To access the C-CDA viewer, upload a C-CDA file as a FHIR Binary. The viewer will render the data for viewing in the application.

## Export C-CDA

To export patient data as C-CDA, navigate to `https://app.medplum.com/Patient/<PATIENT_ID>/export` in the Medplum App. There are several options for export, and exporting as C-CDA will create and download the XML file to the desktop.

## Transitions of Care

Medplum enables sending C-CDA to other systems via Direct Message to support transitions of care. To utilize the feature, implementors need to create a communication resource with the C-CDA attached as shown in the video.

## FHIR Server Integration

In addition to the core conversion functions, Medplum provides FHIR server operations for seamless C-CDA export:

- **`Patient/{id}/$ccda-export`:** Exports a patient's data as a C-CDA document.

This operation is documented in the [Medplum FHIR operations](/content/docs/api/fhir/operations/index.html) documentation.

## Developer Utilities

The `@medplum/ccda` package enables seamless conversion between C-CDA and FHIR, leveraging the International Patient Summary (IPS) format as a bridge. This approach ensures standardized representation of clinical data and facilitates interoperability with various healthcare systems.

**Key Features:**

- **C-CDA to FHIR:** Convert a C-CDA document to a FHIR Composition bundle using the `convertCcdaToFhir` function.
- **FHIR to C-CDA:** Convert a FHIR Composition bundle to a C-CDA document using the `convertFhirToCcda` function.
- **XML Parsing:** Load a C-CDA document from an XML string using the `convertXmlToCcda` function.
- **XML Serialization:** Serialize a C-CDA document to an XML string using the `convertCcdaToXml` function.

## Usage

```typescript
import {
  convertCcdaToFhir,
  convertFhirToCcda,
  convertXmlToCcda,
  convertCcdaToXml,
} from '@medplum/ccda';

// Convert C-CDA to FHIR
const bundle = convertCcdaToFhir(ccda);

// Convert FHIR to C-CDA
const ccda = convertFhirToCcda(bundle);

// Load C-CDA from XML
const ccda = convertXmlToCcda(xml);

// Serialize C-CDA to XML
const xml = convertCcdaToXml(ccda);
```

## Strategy and Alignment

This library is designed to elegantly integrate the following standards and specifications:

- **FHIR R4:** The underlying data model for representing healthcare resources.
- **US Core:** A set of FHIR profiles and extensions for US healthcare interoperability.
- **USCDI:** The United States Core Data for Interoperability, defining a standardized set of health data classes and elements.
- **International Patient Summary (IPS):** A FHIR-based standard for exchanging patient summaries.
- **HL7 C-CDA:** A widely used standard for clinical document exchange.
- **C-CDA R2.1 for USCDI v3:** A specific implementation of C-CDA aligned with the USCDI v3 standard.

By aligning with these standards, this library ensures that C-CDA documents can be effectively converted to and from FHIR, enabling interoperability with modern healthcare systems and applications.

## Additional Notes

- This library is actively maintained and updated to support the latest versions of FHIR, US Core, and C-CDA standards.