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This page is a continuation from the ONC Grant Project Page Wiki page to support projects within the following ONC Grant funded opportunity:  Maturing C-CDA and FHIR Implementation (2019 - )
(The full title of the Funding Opportunity Announcement (FOA) is: Closing the Gap between Standards Development and Implementation-Maturing the Consolidated Clinical Document Architecture (C-CDA) and Fast Healthcare Interoperability Resources (FHIR) Standard)

The following are brief descriptions of each project created under the Maturing C-CDA and FHIR Implementation (2019 - ) ONC grant.  Project deliverables are also linked with each project.  

Project: Flat FHIR (Bulk Data & Push)


Ballot the FHIR Bulk Data Implementation Guide (IG) in HL7’s 2019 May ballot cycle; develop a test suite and utility to verify vendor compliance with the bulk data spec Flat FHIR format; design a Bulk Data import approach; maintain reference implementation by adding performance monitoring and User/Traffic management.

FY20 Scope of Work

  1. Bulk Data Testing Tool - Continued maintenance support & development
  2. Create and distribute a survey to gather feedback from known implementers
    1. What parts of the spec are supported now?
    2. What they plan to support down the road
    3. What extensions are supported
    4. What extensions are/would be most valuable
  3. Discussions with CMS (Digital Services Team) to understand their experience implementing a bulk data server.
  4. Support Import Specification

FY19 Scope of Work

  1. Develop a prototype test suite and utility to verify vendor compliance with the bulk data spec Flat FHIR format
  2. Confirm Authentication Approach
  3. Maintain Reference Implementation
  4. Design Bulk Data Import Approach
  5. Continue to Maintain Active Participation in the FHIR Community
  6. Prepare a Final Report summarizing results of the project.
  7. Ballot the FHIR Bulk Data Implementation Guide (IG)


  1. FHIR Bulk Data Test Suite Design_v2.pdf
  2. HL7 Bulk Data 2019 Final Report.pdf
  3. FY20 Deliverable 4 - SMART_HL7 FHIR bulk data implementations_Deliverable4.pdf
    a. Publication with HL7 and ONC on implementation adoption
    b. Maintain a live-listing website of client implementations
  4. FY20 Deliverable 5 - Process for adding extensions to the standard_Deliverable5.pdf
    a. Evaluate the process for adding extensions to the standard
    b. List potentially valuable extensions to update the standard which demonstrate real world efficacy

  5. FY20 Deliverable 6 - Prototype reference server for testing bulk data import clients
    This is a proof of concept prototype implementation of the Bulk Data Import proposal, currently available at The prototype app is available online at There is also a link to it in the footer of the bulk data server’s front page at

    This is an early implementation that could serve several purposes:

    1. Proof of concept - proof that the spec is usable and can work without customizations
    2. Provide a backend that performs validations and replies according to the spec, so that developers can test their clients against it.
    3. The UI can also be used as code generator (eg.: as CURL request builder)

    It should be noted that we do not enforce file size limits for the imported files, but also do not store imported FHIR resources in our database for more than 10 minutes.
    A more generic version of the UI could be developed in the future to use against any server.

Project: Unified HL7 Terminology Governance (UTG)


Develop a working demonstration pilot for UTG-based terminology maintenance system; debug and test tool; provide Project Management

UTG Project Page

UTG Project Management Page


UTG Document Repository Page (including project plan)

The current rendered pages for UTG content can be viewed here:

Webinars: Linked on the Project Specific Help page:

Project: C-CDA Implementation-A-Thons


Engage industry players (vendors, healthcare providers, payers and health information exchanges) via a C-CDA Implementation-A-Thon track within the FHIR Connecathon.  The objective of the 2-day event is to improve the quality and consistency of C-CDA implementers.  The IAT involves hands-on exercises to reduce variability among C-CDA documents and the ability to share best practice experiences.

C-CDA IAT Project Page


2020.05.20 Virtual IAT Track Agenda

C-CDA IAT: September 14-15, 2019 (Atlanta, Georgia)

Results from the C-CDA IAT in Atlanta are written up here:

C-CDA IAT: January 12-13, 2019 (San Antonio, Texas)

Results from the C-CDA IAT in San Antonio are written up here: 

Project: Improve FHIR JIRA Ballot Process & Tooling


Determine how best to get information to participants without overwhelming them; Create dashboards that allow users to quickly see relevant information; Document the JIRA ballot process; Complete and test the MIF conversion process. 


Project: FHIR Implementation Guide Publication Coordinator 


Monitor the FHIR IG publishing and balloting processes;  facilitate review/ approval of the IGs that will be published in a given ballot cycle; provide educational materials on processes related to the publication and balloting of IGs.



FHIR IG Checklists:

Project: FHIR Connectathon Administrator


Prepare a FHIR Connectathon communication plan, a pre-connectathon and post-connectathon survey; an orientation package for all track leads and an event report.


September 2020 FHIR Connectathon (Virtual) (CAT 25)

Communication Plan: CommPlan-CAT25.xlsx
HL7 FHIR Connectathon 25 Feedback Pre Event Survey.xlsx
HL7 FHIR Connectathon 25 Feedback Post Event Survey.xlsx

Wrap Up Slides - September 2020 CAT25.pptx
Lessons Learned - September 2020 CAT25.pptx

Orientation Package for all Track Leads –  this has evolved into multiple resources:
Track Lead Check Lists on this page:
Track Lead Resources:
Track Orientation Slide Template:

May 2020 FHIR Connectathon (Virtual) (CAT 24)

HL7 Pre Connectathon Survey - May 2020 Connectathon 24 
Pre Connectathon Info Session and recording.
Connectathon Report Out - May 2020 Connectathon 24

January 2020 FHIR Connectathon (CAT 23)

Communication Plan & Pre/Post Connectathon Surveys – January 2020 Connectathon 23
Orientation Package for all Track Leads
Wrap Up Slides - January 2020 Connectathon 23
Outcomes Track Report - January 2020 Connectathon 23

September 2019 FHIR Connectathon (CAT 22)

September 2019 Pre Connectathon 22 Survey.xlsx
FHIR Connectathon Info Session 9.10.19 - September 2019.pptx
CAT22 Wrap Up Slides - September 2019.pptx
CAT22 Feedback Survey - September 2019.pdf
HL7 FHIR Connectathon 22 Outcomes Report - September 2019.docx

May 2019 FHIR Connectathon (CAT 21)

Connectathon Communication Plan - CAT21 - May 2019.xlsx
Pre Connectathon Survey available upon request via as it contains confidential information.
Orientation Package for all Track Leads
Post CAT21 Feedback Survey Response Data - 2019 May.pdf
Event Report - May 2019

January 2019 FHIR Connectation (CAT 20)

Connectathon Communication Plan - CAT20 - January 2019.xlsx
January 2019 Pre Connectathon 20 Survey.xlsx
Orientation Package for all Track Leads
HL7 FHIR Connectathon 20 FeedbackSurvey - January 2019.xlsx
Event Report - January 2019

Previous FHIR Connectathons

Project: Compare IPS & Argonaut US Core IGs (COMPLETE)


Perform a comparison between the International Patient Summary and the Argonaut / US Core implementation guides


White Paper: Argonaut vs. IPS: A Compare and Contrast between Two FHIR Implementation Guides

A list of the differences in terms of FHIR resources used, required elements, vocabularies, constrains and REST interactions and operations.

Project: FHIR Product Support


Provide increased administrative support for standards development, publication and maintenance to facilitate the release of each new version of the FHIR core specification work as well as with other key FHIR SMEs to implement specific improvements for long-term, sustainable FHIR processes and tools.


Project: US Core Ballot Reconciliation Support (COMPLETE)


Provide support for reconciliation and publication of the US Core Implementation Guide, based on FHIR R4, which was balloted in the January 2019 ballot cycle. This new ballot added support for Clinical Notes, fixed errata logged since publication of R3, and upgraded all the Resources to support the FHIR R4 release and closed on January 7th, 2019.  Rreview and reconcile comments; update the US Core FHIR Implementation Guide to submit it for final publication.  


US Core R4 Implementation Guide

Project: FHIR Fact Sheets (COMPLETE)


Create HHS branded webinars and other learning materials that provide guidance on selection of FHIR releases, Implementation Guides, profiles, etc. to be used within projects.  The target audience will be federal government project/program managers leading HL7 related projects.

A total of 15 17 Fact Sheets will be created.

FHIR Fact Sheets - ONC Tech Lab Innovation - Confluence

Fact Sheets - Work in Progress


FHIR Fact Sheets - ONC Tech Lab Innovation - Confluence

Project: C-CDA Web Publication Tooling (COMPLETE)


Produce a sustainable, efficient means of publishing new versions of C-CDA (and potentially CDA in a later phase) as a Web Specification (similar to FHIR).  The output of this project will be tooling together with necessary supporting documentation to support publication of C-CDA and CDA implementation guides through the FHIR IG Publisher


2020 January: Lantana's current version of IG is published here:

Sean McIlvenna recommended this link instead for the c-cda publication: It’s using the CI build, which is generally better.

  1. improved export from trifolia
  2. including primitive constraints
  3. created custom publish template
  4. worked with grahame to fix a few bugs
  5. added a 8 core "complex" profiles
  6. adding a bunch of narrative
  7. uses the brand new templating methods developed by lloyd
  8. vastly improved the base cda "ig" as it is defined in FHIR

Project: C-CDA Companion Guide Update (COMPLETE)


The prior version of the companion guide is specific to a rule, the 2015 ONC Certification rule.  The ONC published a new proposed rule in 2019 which necessitates updates to the companion guide. This project consists of project management support and content development for the update of the companion guide to support C-CDA implementations in the US consistent with ONC timelines. Updates may include new C-CDA templates and other revisions to meet industry requirements, for example changes in government requirements.  The set of updates for any release SHALL require approval by the Structured Documents Work Group and the US Realm Steering Committee.

Addionally, QA and editing of the C-CDA sample files that will be associated with the published C-CDA R2.1 Companion Guide Update. These files have already passed the ONC Validator and the ONC Scorecard. The QA is to encompass evaluating the rendered documents, including sensical header (administrative data) and comparing the entries with the rendered section text. Focus will include known problematic areas such as time and effectiveTime format and rendering and ensuring that the coded entry data makes clinical sense and accurately aligns with rendered information.


HL7 CDA® R2 Implementation Guide: C-CDA Templates for Clinical Notes Companion Guide, Release 2 STU - US Realm

Project: C-CDA Release 2.2 – Phase 1 (Postponed)


Create Volume 1 for C-CDA R2.2 using existing C-CDA R2.1 plus updates being proposed for Companion Guide and using Trifolia on FHIR for this work, so as to keep both of these documents aligned during the C-CDA Companion Guide Ballot Reconciliation. The C-CDA Volume 1 content created will be aligned with balloted C-CDA R2.1 Companion Guide R2 and in conjunction with tooling revisions and ready for STU Update commenting.


Project: FHIR IG Workshop (COMPLETE)


To be held September 11-13, 2019 in Atlanta.  The goal of this event is to build capacity within the HL7 community for creating and reviewing high quality FHIR IGs so as to be in a better position to handle the expected future increase in volume.  The agenda for Wednesday and Thursday will focus on best practices in FHIR IG Development, including understanding the IG Publisher, preparing a good quality specification and review of Melva’s FHIR IG Publication Checklist.  On Friday morning there will be a workshop focused on terminology considerations - both for creating IGs and for reviewing balloted IGs.  Friday afternoon will conclude with a half-day workshop for best practices in reviewing FHIR IG ballots (IG consistency review).

Individuals Interested in FHIR IG Development (waitlist)

FHIR IG Workshop FAQs


Recordings from the workshop are now available by day:


Day 2:

Day 3:

Project: FHIR Bulk Data Meeting (COMPLETE)


To be held in November 6, 2019;  Boston Children's Hospital to lead the event (similar to the event held in December 2017) which will focus on their Bulk Data work.


The final report for the FHIR Bulk Data Meeting held in Boston on November 6th is available at the SMART Health IT web site:

Project: Ballot the IPS FHIR Implementation Guide (COMPLETE)


Complete the remaining updates needed to the FHIR IPS Implementation Guide (IG) content so that it publishes correctly and is ready for the final submission and balloted in the September 2019 ballot cycle;


Project: FHIR Terminology Server Support


Provide support for the FHIR Terminology Server including, but not limited to, rebuilding the FHIRServer project when code updates are made; updating SNOMED CT to the latest versions; additional terminology server support as needed.


Project: Finish the IG Publisher Templates Framework (COMPLETE)


Modify the existing FHIR IG Publisher Templates Framework into a single new framework that uses the (newly developed and highly alpha) publisher template approach, as well as make other changes that were agreed upon at the Montreal WGM; complete all modifications by the September 2019 WGM,


Project: US Core Updates for Provenance (COMPLETE)


Perform updates to the US Core FHIR Implementation Guide to prepare it for STU publication as follows:

  • Develop and finalize approval/plan for STU Update
    • Key items: Provenance; MedicationRequest; Devices – Implantable Devices; New query guidance for multiple patients; Pulse Oximetry; Updated guidance
  • Review and reconcile US Core gForge trackers
  • Pre-STU trackers applied; Publish fixed STU update version for commenting
  • Collect comments and review them onsite at the September 2019 Working Group Meeting


The IG was published on September 3, 2019 for STU Comment publication and a copy of it is located here:   .   The final address for this publication to be announced. 

Regarding publishing the updates, the repository for all the material is  at   .   The final address for this publication is to be    

Project: eLTSS Reference Implementation (COMPLETE)


Apply eLTSS IG FHIR constraints to resources (eLTSS profiles)


Project: Rubric Reconciliation (COMPLETE)


Management of ballot comment reconciliation of comments placed against the HL7 Informative Document: C-CDA Rubric, Release 1. Including incorporation of resolution edits into the guide and managing the guide through publication on the HL7 website.


Project: FHIR Build and Implementation Guide (IG) Publishing


Support the HL7 FHIR Build and Implementation Guide Publishing tasks as directed by the HL7 FHIR Product Director and the HL7 CTO. Ultimately, the purpose is to take over responsibility for supporting FHIR Build and IG Publishing tasks, relieving Grahame Grieve of this work

Make improvements to the development, publication and build tools for the core FHIR specification and associated FHIR Implementation Guides to more efficiently accommodate new use cases and new features, reduce risk dependencies, improve quality and consistency and allow for generation of a substantially expanded volume of new implementation guides.

Streamline processes used to issue new releases of the FHIR Core Specification, layered products such as CDS Hooks and FHIRCast, and FHIR Implementation Guides by additional publication and build managers without depending upon the direct involvement of HL7’s FHIR Product Director.

Progress Reports:


Project: FHIR Survey


The goals of the survey will be to inform the Office of the National Coordinator (ONC) about the current and envisioned uses of the HL7 FHIR standard, to assist the federal government in measuring standards uptake and in planning actions to improve, support, and regulate the use of I.T. in the healthcare industry.


Project: C-CDA R2.1 Value Set Updates (COMPLETE)


Provide program management and technical support to conduct the annual update of the value sets used in C-CDA R2.1 by performing the following:

  1. Technical execution to compile the VSAC release package and review/update value set definitions used in C-CDA R2.1 and all associated companion and supplemental implementation guides.
  2. Provision of training and creation of documentation that supports the capacity building pilot project also proposed for 2020.
  3. Review of interdependencies between C-CDA R2.1 value sets, C-CDA on FHIR, and QRDA value sets

The ONC funded prior work on C-CDA Value Sets in Fiscal Year 2016:


  • Population of and deliver to National Library of Medicine (NLM), the required Value Set Expansion Release Requirements Request
  • Publication by VSAC of the approved C-CDA R2.1 Value Set Expansion Package
  • Delivery of report on the findings and recommendations from analysis of interdependencies between C-CDA R2.1 value sets and value sets used in C-CDA on FHIR

The National Library of Medicine is pleased to announce the VSAC publication and downloadable files of the 2020-07-13 release of the HL7 Consolidated Clinical Document Architecture (C-CDA) R2.1 value sets, authored by the HL7 Terminology group.

There are several ways you can access the C-CDA value sets:

  • VSAC Welcome Page: The Search button of the HL7 C-CDA Value Sets program block leads you to the VSAC Search Value Sets web browser, presorted by this HL7 C-CDA release. The Download link leads you to the C-CDA Value Sets section of the Download tab and supplies prepackaged downloadable files.
  • VSAC Download Tab: Here, you can download the Excel, pipe-delimited text files, and XML files, Code System Versions Currently in C-CDA R2.1 Value Sets, a list of C-CDA R2.1 Value Sets Available in VSAC, and a list of C-CDA R2.1 Value Sets Unavailable in VSAC. The published downloadable C-CDA R2.1 2020-07-13 release excludes fourteen C-CDA value sets for which VSAC does not have the required supporting code systems.
  • VSAC Search Value Sets Tab: Use a web browser to search, sort, filter and view details for all or individual value sets; use the Export Search Results button to download a catalog of C-CDA value set expansions; increase the paging up to 120 rows, and use the checkboxes to download all C-CDA value set expansions as Excel, XML, or Text files. Navigate to the Search Value Sets tab, select the HL7 C-CDA program, and select the C-CDA R2.1 2020-07-13 release.
  • VSAC SVS API: Given a C-CDA value set identifier (OID) that you can obtain by any of the above methods, use an SVS API call, such as: [ R2.1 2020-07-13&ticket=service-ticket] For additional information on API authentication and usage, see our API documentation.

Please send any questions or feedback regarding VSAC functionality to: NLM Customer Support.

Sincerely, The NLM VSAC Team

Project: FHIR Registry Enhancements


Perform enhancements to the FHIR registry (hosted at as described below:

  1. Registry included results. Ensure all versioned resources for ready-to-use packages from the package registry are searchable, including the content from non-prerelease Simplifier packages which indicate to be ready to publish to the registry.
  2. FHIR version. Modifications will be made to the FHIR registry so that STU3, R4 and any newer released FHIR version packages (as soon as they are implemented in Simplifier) are included.
  3. Better filtering options. The User Interface will be extended with these filters: Resource category, Resource, FHIR version.
  4. Better ranking. Modify weights of fields, like putting more emphasis on the search result in a title of a resource based on testing with HL7 International.
  5. Better display of results. Contractor will leverage the logic Simplifier already has for pulling out an interesting title and description for each resource.
  6. Framework upgrade. A new React-based user interface will be developed.
  7. Measuring the use of the FHIR Registry with Google Analytics

    1. An HL7 Google Analytics account will be set up, including settings to not track users on an individual level, if not already existing. HL7 will be provided administration level access to this account, or, if already existing, HL7 will provide Contractor administration level access to make necessary changes.

    2. A privacy policy page will be added to the FHIR Registry, based on content provided by HL7.

    3. Contractor will add Google Analytics tracking code to all application pages so their visits are being measured.

    4. Contractor will add Google Analytics tags to important user interface elements to make sure their usage is being measured.

  8. Registry Feedback and Search Tuning

    1. Based on feedback from HL7 and the HL7 FHIR community final tweaks and small changes will be made to the FHIR Registry, in the order prioritized by HL7. This can, for example, include textual changes, weighting of the components of the search algorithm or adding a resource filter on the package overview page.


  • Improved registry results that include all released FHIR versions
  • Filters extended with improved ranking and display
  • Framework upgraded
  • Google Analytics account created; tracking code and tags added

Project: Consolidated Clinical Document Architecture (C-CDA) Web Publication Tooling – Phase 2: Task Period 1 (COMPLETE)


The Phase 1 project resulted in a proof of concept where CDA templates are represented using FHIR resources and published using the FHIR IG Publisher.  This project, Phase 2, will provide a publication-ready web version of the full C-CDA specification as follows:

  1. Tooling Enhancements for CDA
    1. Modify Trifolia on FHIR (ToF) tooling to support CDA publication.
    2. The CDA logical model and editorial support will be integrated into ToF
    3. ToF will acquire export capability for CDA content (including templates, terminology, validation rules, and narrative entries) expressed as FHIR StructureDefinition, ValueSet, and ImplementationGuide resources, thus creating “CDA profiles.”
    4. Update ToF with required user interface functionality and documentation
  2. CDA Section and Document Functionality (Iterative)
  3. Import Consolidated CDA (C-CDA) templates and test/debug the publication functions in an iterative process starting with the Problems and Allergies sections and continuing to incorporate all sections and entries required to support C-CDA implementation.
  4. Optional entries will be included if properly defined and do not generate errors while migrating from TWB to ToF.
  5. Work with HL7's Structured Docs Work Group to review any improperly defined optional entries to decide if they can be omitted (non-essential or never implemented) or if SDWG volunteers will use the errata process to address before import.
  6. Provide demonstrations of the above work to HL7's Structured Documents (SDWG) and CDA Management Workgroups (CMG)
  7. Perform Quality Assurance and testing of the web-based publishing solution for the C-CDA standard using the FHIR IG publish being developed above by:

    1. Working with the CDA Management Group to establish QA criteria/plan

    2. Attending review and feedback meetings with HL7, SDWG, CDA Management Group

    3. Preparing assessment summaries, etc.
      3 packages in total will be reviewed

      1. Trifolia-on-FHIR basic enhancements for CDA

      2. Problems & Allergies

      3. Medications, Results, Vitals & Immunizations


  • Incorporate CDA logic model so it is accessible to ToF components
  • Incorporate stakeholder feedback from the SDWG and other HL7 stakeholders gathered during proof of concept, define user interface (UI) improvements for CDA tooling of ToF
  • Update the ToF editor features to support CDA requirements
  • Update documentation for CDA functionality and describe editing method and tooling to maintain CDA profiles
  • Update toolset to accommodate CDA sections appropriate for that task
  • Tune ToF publication outputs to ensure they are valid per the FHIR specification and work with the FHIR IG Publisher
  • Update tool documentation and promote code base in GitHub to production
  • Demonstrate new functionality to HL7 governing bodies
  • Quality Assurance Testing Progress: QA of C-CDA 2.2 Templates
  • Quality Assurance Final Report:  20200930 MaxMD Report Out - HL7 CDA Web Publishing Project FINAL.doc.pdf

Project: Consolidated Clinical Document Architecture (C-CDA) Web Publication Tooling – Phase 2: Task Period 2


The Phase 2 - Task Period 1 project addressed allergies, medications, results, vitals & immunizations.  Task Period 2 work will focus on procedures, social history, encounters and final demonstration of the full package by February 1, 2021.



Project: US Core Errata (COMPLETE)


  1. Develop and finalize approval/plan US Core Errata Release
  2. Review and reconcile US Core JIRA trackers (up to 30)
  3. Apply trackers
  4. Collect comments
  5. Review newly identified errata; apply errata
  6. Final Publication review


  • Develop and finalize approval/plan US Core Errata Release
  • Review and reconcile US Core JIRA trackers - up to 30 (currently 25 logged)
  • Apply trackers
  • Collect comments over fixed 1-week period
  • Review newly identified errata
  • Apply any errata
  • Final Publication review
  • Submit final publication

The current version of US Core is being prepared for comment and publishing and can be seen here:

and the status of the project can be viewed here:  

September 2020:   The  US Core Errata has been published as V3.1.1 and can be seen here:

Project: UTG External Terminologies


  1. Provide planning, analysis, engagement and terminology subject matter expertise towards ensuring the HL7 Unified Terminology Governance (UTG) system is fit for purpose to be used as an authoritative source of information for terminology content from external organisations (those organisations outside HL7 International or its Affiliates) as required in HL7 standards.


  1. Undertaking a complete audit of the current external terminology content in UTG which including the following tasks:
    1. Determining the accuracy, currency and correctness of the content2 Determining the current external organisation's responsible for the content
    2. Determining whether the content is endorsed/supported by the responsible external organisations.
    3. Comparing the content to the other HL7 specifications, repositories and technical registries (e.g. the OID registry, the FHIR external terminologies page, etc) and, where differences are found, confirming which is correct.
    4. Confirming whether or not the content items remain in use in HL7 standards.
    5. Capturing all technical identifiers currently in use.
    6. Liaising with the HL7 Vocabulary Work Group, the HL7 Terminology Authority (HTA), and the HL7 product family management groups to capture concerns with the content currently in UTG.
    7. Describing the findings of the above tasks in a detailed report which provides clarity on what needs to be addressed in UTG for it to become the authoritative source for external terminology content.
  2. Lodging requests for engagement with external organisations to the HTA where required.
  3. Lodging requests to update UTG to address all content issues from the audit report.
  4. Supporting the development of plans to transition from existing HL7 resources which capture information about external content to UTG.