The most common type of C-CDA document is the CCD (Continuity of Care Document). Refer to the article What is a CCD and what is its role in MU?, for an overview of the CCD document, its evolution, and its role in Meaningful Use Stage Two (MU2).

In a C-CDA CCD document, compliance with two document-level templates is generally asserted via two instances of the ClinicalDocument/templateId element.

Why Two ClinicalDocument/templateId Elements?
In a C-CDA CCD document, one of these two templateId elements asserts compliance to the C-CDA US Realm Header template that is required of every C-CDA document. The OID that is assigned to the root attribute of this templateId element is 2.16.840.1.113883.10.20.22.1.1.

The other of these two templateId elements asserts compliance to the CCD document template. The OID that is assigned to the root attribute of this templateId element is 2.16.840.1.113883.10.20.22.1.2.

Use of C-CDA CCD in MU2
MU2 does not required the use of a CCD document. In fact, MU2 does not require that any specific C-CDA document template be declared. It is sufficient in MU2 to declare compliance with the C-CDA US Realm Header template, alone. However, it is a good practice to always declare a C-CDA document template (to be a proper C-CDA document, compliance with at least one C-CDA document template is required, even though MU2 waives this requirement).

In most MU2 required scenarios and associated document types, the most fitting C-CDA document template to use is the CCD. Thus, the use of a C-CDA CCD document (with its two ClinicalDocument/templateId elements, as described above) is very common in an MU2 context as well.

Note, however, that asserting compliance with (and complying to the requirements of) the C-CDA CCD document template is NOT sufficient to meet MU2 requirements (refer to the article referenced above: What is a CCD and what is its role in MU?, for additional information).

Two Document-Level Template OIDs Can Be Confusing
For those starting out with C-CDA documents, the presence of two ClinicalDocument/templateId elements can be confusing. Which is the correct template ID for this type of document?

It is actually almost always the case in a C-CDA document (again, with the exception of the MU2 context that doesn’t require it) that there are two ClinicalDocument/templateId elements – one to assert overall C-CDA compliance (more specifically, compliance with the C-CDA US Realm Header template) and one to assert compliance to a specific C-CDA document template.

CDA in general (and, thus, C-CDA specifically) supports the declaration of multiple templateId elements at any level of the CDA XML hierarchy where the templateId element is used – at the document, section, and entry level. Refer to The templateId element, for additional information.

Other CDA PRO Know Articles Referenced In This Article