Continuity of Care (CCD) and Referral Note Documents

Introduction

Consolidated Clinical Document Architecture (C-CDA) files help healthcare providers share important information about patients. These XML-based files securely transfer details like medical conditions, allergies, and medications between systems. This guide explains how to use C-CDA files for sharing and updating patient data, as well as tips for exporting them to support ongoing care.

User's Guide

Importing C-CDA Files

Manual Import Process

1. Within Settings, locate CCDAs

2. In the upper right corner select import

3. Attach your CCDA xml file

4. You will get a pop-up notification confirming success

5. You can then review the CCDA and status in Ccda imports

   

Import Status Tracking

Canvas tracks all C-CDA import attempts with the following status indicators:

• Accepted: Import succeeded and data was processed

• Ingesting Error: Import failed (click record for error details)

You can monitor import progress and troubleshoot issues through the admin interface, which allows filtering by:

• Import status

• Document type (CCD, Referral Note)

• Whether patient matching was successful

• Import date

Import Note Processing

When a C-CDA is imported, Canvas creates a special note type (C-CDA Import) with unique state management:

• Confirm Import: Commits all commands and locks the note

• Discard: Deletes the note entirely

Understanding C-CDA Import Processing

Patient Matching

When C-CDA files are imported, Canvas attempts to match the patient information in the document to existing patients in the system. The matching process uses patient demographics such as:

• First, middle, and last name

• Date of birth

• Other identifying information

If a patient match is found, the C-CDA data will be imported and associated with that patient's record. If no match is found, the import will show "Patient not matched" status, and the clinical data cannot be processed until a patient match is established.

When a CCDA document is imported, each clinical object (conditions, medications, allergies) can contain multiple codings. Each coding includes:

• System (e.g., SNOMED, ICD-10, RxNorm)

• Code (e.g., 12395820315)

• Display (e.g., "Pneumonia")

Canvas saves all usable codings for each clinical object. A coding is considered unusable only when it has neither a system/code nor a display value.

Display Priority for Multiple Codings

When multiple codings exist for a single object, Canvas prioritizes display based on preferred coding systems:

• Conditions: ICD-10

• Medications: FDB MEDID

• Allergies: FDB DAM

Medication Enrichment

For medications only, Canvas performs coding enrichment:

• RxNorm codes are automatically mapped to FDB MEDID using internal services

• Both original RxNorm and new FDB codings are retained

• This enables native Canvas medication features like drug-drug interaction checking

Allergy and Condition Limitations

Currently, Canvas does not perform mapping for:

• Allergies: SNOMED or RxNorm to FDB

• Conditions: SNOMED to ICD-10

Important: Imported allergies will NOT be considered in drug-allergy interaction checking unless users manually search for the relevant FDB allergy concept in the generated Allergy command.

Coding System Recognition

For recognized coding systems:

• Canvas saves the coding with its original system

• Display names use the <display> value from the CCDA if available

• For allergies without display names, Canvas generates: <n> system=<s> code=<code> or UNKNOWN system=<s> code=<code>

For unrecognized coding systems:

• Canvas creates an "unstructured" coding

• Display format: system=<s> code=<code> display=<display> when display is available

• For allergies without display: <n> system=<s> code=<code> or UNKNOWN system=<s> code=<code>

Generating C-CDA Exports

C-CDA files can be generated as either Continuity of Care Documents (CCD) or Referral Notes. These XML files can be created by end-users from Canvas Settings or requested by patients through the patient app.

Creating C-CDA Files

1. Within Settings > CDA, select GENERATE button

2. Complete the C-CDA export form:

   • Search for patient by DOB (YYYY-MM-DD), name, or MRN

   • Select document type: CCD or Referral Note

   • Enter start date and end date for records

   • Select GENERATE

Export Status Tracking

Canvas tracks all C-CDA export attempts with detailed status monitoring:

Export Status Progression:

1. Started: Export request has been initiated

2. Processing: Document generation is in progress

3. Ready: Export completed successfully, available for download

4. Failed: Export encountered an error (click record for details)

Viewing C-CDA Files

1. Within Settings > CDA > C-CDAs, select View under C-CDA Actions column

2. Review user-friendly version of C-CDA data

3. Use Collapse All button to minimize sections

4. Use Table of Contents for easy navigation

C-CDA Section Management

Default sections included in C-CDA exports vary by document type:

CCD Sections:

• Allergies and intolerances

• Assessment

• Care team

• Notes

• Encounters

Referral Note Sections:

• Assessment

• Care team

• Functional status

• Goals

• Health concerns

• Immunizations

• Medical equipment

• Medications

• Mental status

• Plan of treatment

• Problems

• Procedures

• Reason for referral

• Results

• Social history

• Vital signs

• History of immunizations

Customizing Section Order

1. Within Settings > CDA > C-CDA Sections:

2. Click and drag the gray bar :::::::: icon to reorder sections

3. Check/uncheck Visible column to show/hide sections

4. Select Save to apply changes

5. Verify changes in the updated C-CDA Sections view

Patient App Access

Patients can independently request, view, download, and transmit their CCD and Referral Notes through the patient app when the PATIENT_APP_RECORDS setting is enabled.

[PLACEHOLDER: Link to Patient App Instructions for Patients article]

Configuration & Set Up

Required Feature Switches

• ccdaFeature: Enables C-CDA functionality in Canvas Settings

• PATIENT_APP_RECORDS: Allows patient app access to Health Records section

Permission Setup

Users must have C-CDA specific group permissions added to their Canvas profile to access C-CDA features once the feature switch is enabled.

Contact Canvas Support for adjustments if your permissions are not set correctly.

API Access

C-CDA files are available via API endpoints. See the Canvas API documentation for implementation details.

FAQ & Troubleshooting

Q: What should I do if my C-CDA import shows "Patient not matched"?

A: Verify that the patient demographics in the C-CDA file (name, date of birth) match an existing patient record in your system. You may need to create a patient record or update existing patient information to establish a successful match.

Q: Can I customize which sections appear in my C-CDA exports?

A: Yes, navigate to Settings > CDA > C-CDA Sections to show/hide sections and reorder them using the drag-and-drop interface.

Q: Are there API endpoints available for C-CDA files?

A: Yes, C-CDA files can be retrieved via API. See the Canvas API documentation for complete endpoint details.

Related Resources

• Canvas API Documentation - C-CDA Endpoints

Keywords: C-CDA, CCDA, CCD, Continuity of Care Document, Referral Notes, import, export, coding systems, ICD-10, SNOMED, RxNorm, FDB, allergies, medications, conditions, DataMotion, HISP, Direct Message, secure transmission

Categories: Data Management, Interoperability, Clinical Documentation, API, Patient App, Security