Monday, June 13, 2016

CDA/CCD Coming to Apple's HealthKit!

HK and HL7, together at last!

Today I was fortunate to be able to attend the keynote presentation for Apple's annual Worldwide Developers Conference, or WWDC (aka, "dub dub"). The presentation itself focused on Apple's four primary OSs: watchOS, tvOS, macOS (bye "Mac OS X"!), and iOS. Personally, the most exciting keynote announcement (besides emojis that are 3x the size!!!) was a new apps called Swift Playgrounds, intended to help teach children to code. My 10 year-old daughters will love it (heck, I will love it)!

But for me, the most exciting announcement did not come as part of the keynote. The most exciting announcement is that for iOS 10, Apple will add support for HL7's Clinical Document Architecture (CDA) and the Continuity of Care Document (CCD) directly to HealthKit. For those unfamiliar with CDA/CCD, it's basically a standard way (using XML) to describe an individual's health history in a single, structured data format.

This means that any app (such an EHR patient portal app) will be able to share a CCD with the user in order to save it to HealthKit, and that any app can then get permission to read the CCD from HealthKit.

In other words, this gives a user more control over his/her medical information than ever before.

This is huge. I've spoken previously about paternalism in medicine and how patients are often the least empowered of their own care team. This needs to change fast, and Apple's inclusion of CCD as a first class citizen in HealthKit will usher in a new breed of health apps that empower patients and give them more choice in what they can do with their health information. The is one of the precise goals of the NIH and ONC's Sync for Science project: to allow individuals to 1) access and 2) donate their data to science.

The contents of the CCD are also informing the work on SMART and FHIR related to the Argonaut Implementation Program, which aims to standardize the way we implement FHIR on various systems, focusing on use cases that represent what the CCD can do.

Ultimately, the more we can put users in control of their own health, the better of they will be. I welcome this significant step in that direction.

Update: The developer documentation isn't yet available, but the placeholders for HKCDADocument and HKCDADocumentSample are on the web.


  1. This is great news for everyone, regardless if you call us patients or consumers or doctor...

  2. Awesome - simply put. Google is gonna be next

  3. Putting the power in the patients' hands! Will HealthKit parse the CDA? Or store and render the document, or both? What versions of CDA does HealthKit support? CCD C32, CCDA 2.1?

  4. According to the presentation on this subject (, HealthKit will parse 4 data elements: title, patient, custodian, and author names. It will also store and render the document. I haven't yet seen which versions will be supported, but my guess would be as broad support as possible so that users aren't inconvenienced by error messages.

  5. Kudos to Apple for taking these steps!
    Mind you there are parsers out there already (my personal project)

    But nothing would compare to having Apple's muscle behind this task for sure.


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