CCD API

Recommended: Use FHIR DocumentReference $docref Operation

For new integrations, we recommend using the standardized US Core DocumentReference $docref operation instead of this legacy CCD API. The $docref operation provides:

• Standards-based FHIR approach for on-demand document generation
• Consistent interface across all FHIR APIs (supports both GET and POST methods)
• Support for both stable document search and on-demand generation
• Better integration with FHIR workflows

See DocumentReference $docref documentation for details.

Overview

The CareConnect CCD API enables an application to request the generation of Clinical Document Architecture (CDA) documents for a specific patient. This API supports various document types including Continuity of Care Documents (CCDs), consultation notes, discharge summaries, and other clinical documents.

Key Use Cases:

• Generate CCD documents for care transitions
• Create consultation notes for referrals
• Produce discharge summaries for patient handoffs
• Support regulatory reporting requirements

Base URLs:

Production

https://fhir.netsmartcloud.com/ccd

Preview

https://fhirtest.netsmartcloud.com/ccd

Supported CareRecords

The CCD API is supported by the following Netsmart CareRecords:

CareRecord	Support
GEHRIMED	Yes
Homecare	Yes
myAvatar	Yes
myEvolv	Yes
myUnity	Yes
TIER	Yes

Operations

Generate CDA Document

Generate a Clinical Document Architecture (CDA) document for a specific patient.

Endpoint: GET /ccd

Parameters

Name	Type	Required	Description
patient	string	Yes	The Patient ID as assigned by the CareRecord
documentTitle	string	No	The type of CDA document to generate. Default: CCD
start	date	No	Start date for data inclusion (YYYY-MM-DD format)
end	date	No	End date for data inclusion (YYYY-MM-DD format)

Supported Document Types

Document Type	documentTitle Value	LOINC Code	Status
Continuity of Care Document	CCD	34133-9	Default
Consultation Note	ConsultationNote	11488-4	Available
Discharge Summary	DischargeSummary	18842-5	Available
Electronic Initial Case Report	EICR	55751-2	Available
Emergency Healthcare Survey	EmergencyHealthcareSurvey	75619-7	Available
History and Physical Note	HistoryAndPhysicalNote	34117-2	Available
Inpatient Healthcare Survey	InpatientHealthcareSurvey	75619-7	Available
Outpatient Healthcare Survey	OutpatientHealthcareSurvey	75619-7	Available
Progress Note	ProgressNoteDoc	11506-3	Available
Public Health Case Report	PublicHealthCaseReport	34133-9	Available
Referral Note	ReferralNote	57133-1	Available
Unstructured Document	UnstructuredDocument	34133-9	Available
Transfer of Care	TransferOfCare	-	Reserved for future use

Authentication

The CCD API uses OAuth 2.0 Client Credentials flow for authentication. You must obtain an access token before making API requests.

Required Scope

• CCD - Required for accessing the CCD API

Request Access Token

Production

Client Credentials Flow with Client Secret

curl -X POST https://oauth.netsmartcloud.com/token \
  -H "Accept: application/fhir+json" \
  -H "Content-Type: application/x-form-urlencoded" \
  -d grant_type=client_credentials \
  -d client_id=YOUR_CLIENT_ID \
  -d client_secret=YOUR_CLIENT_SECRET \
  -d scope=CCD

Preview

Client Credentials Flow with Client Secret

curl -X POST https://oauthtest.netsmartcloud.com/token \
  -H "Accept: application/fhir+json" \
  -H "Content-Type: application/x-form-urlencoded" \
  -d grant_type=client_credentials \
  -d client_id=YOUR_CLIENT_ID \
  -d client_secret=YOUR_CLIENT_SECRET \
  -d scope=CCD

Examples

Basic CCD Request

Production

Generate CCD for Patient

curl -X GET 'https://fhir.netsmartcloud.com/ccd?patient=123' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/xml"

Preview

Generate CCD for Patient

curl -X GET 'https://fhirtest.netsmartcloud.com/ccd?patient=123' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/xml"

Advanced Examples

Production

Generate Consultation Note with Date Range

curl -X GET 'https://fhir.netsmartcloud.com/ccd?patient=123&documentTitle=ConsultationNote&start=2024-01-01&end=2024-01-31' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/xml"

Generate Discharge Summary

curl -X GET 'https://fhir.netsmartcloud.com/ccd?patient=456&documentTitle=DischargeSummary' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/xml"

Preview

Generate Consultation Note with Date Range

curl -X GET 'https://fhirtest.netsmartcloud.com/ccd?patient=123&documentTitle=ConsultationNote&start=2024-01-01&end=2024-01-31' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/xml"

Generate Discharge Summary

curl -X GET 'https://fhirtest.netsmartcloud.com/ccd?patient=456&documentTitle=DischargeSummary' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/xml"

Response Example

Successful CCD Generation

HTTP/2 200 OK
Date: Mon, 17 Jul 2023 20:31:58 GMT
Content-Type: application/xml;charset=ISO-8859-1
Content-Length: 91096
x-ntst-transaction-id: 755b292f-8a7b-4910-b08d-14cde37e191c

<?xml version="1.0" encoding="UTF-8"?>
<?xml-stylesheet type="text/xsl" href="NTSTCCDStyles.xsl"?>
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" 
                  xmlns="urn:hl7-org:v3" 
                  xsi:schemaLocation="urn:hl7-org:v3 CDA.xsd">
  <realmCode code="US"/>
  <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
  <templateId root="2.16.840.1.113883.10.20.22.1.2" extension="2015-08-01"/>
  <id extension="CCD-123" root="2.16.840.1.113883.19.5.99999.1"/>
  <code code="34133-9" codeSystem="2.16.840.1.113883.6.1" 
        codeSystemName="LOINC" displayName="Summarization of Episode Note"/>
  <title>Continuity of Care Document</title>
  <!-- Additional CDA content -->
</ClinicalDocument>

Integration Patterns

Common Workflows

1. Care Transition Documentation

# Step 1: Generate CCD for patient transfer
GET /ccd?patient=123&documentTitle=CCD

# Step 2: Include in care transition workflow
# Use generated CDA document for handoff

2. Consultation Documentation

# Step 1: Generate consultation note
GET /ccd?patient=456&documentTitle=ConsultationNote&start=2024-01-15&end=2024-01-15

# Step 2: Share with referring provider
# Include consultation details and recommendations

Response Formats

• Content-Type: application/xml;charset=ISO-8859-1
• Format: HL7 CDA R2 compliant XML
• Encoding: UTF-8
• Stylesheet: Includes XSL transformation for browser rendering

Error Handling

Common Error Scenarios

400 Bad Request

Missing Required Parameter

HTTP/2 400 Bad Request
Content-Type: application/json

{
  "error": "Bad Request",
  "message": "Missing required parameter: patient"
}

401 Unauthorized

Invalid or Missing Token

HTTP/2 401 Unauthorized
Content-Type: application/json

{
  "message": "Unauthorized"
}

Common Causes:

• Missing Authorization header
• Invalid or expired access token
• Insufficient scope (missing CCD scope)

404 Not Found

Patient Not Found

HTTP/2 404 Not Found
Content-Type: application/json

{
  "error": "Not Found",
  "message": "Patient with ID '123' not found"
}

500 Internal Server Error

Document Generation Failed

HTTP/2 500 Internal Server Error
Content-Type: application/json

{
  "error": "Internal Server Error",
  "message": "Failed to generate CDA document"
}

Troubleshooting Tips

• Authentication Issues: Verify access token and required CCD scope
• Patient Not Found: Confirm patient ID exists in target CareRecord
• Invalid Document Type: Check documentTitle parameter against supported values
• Date Format Errors: Ensure dates use YYYY-MM-DD format
• Generation Failures: Contact Netsmart support with transaction ID

Migration to FHIR DocumentReference $docref

For applications currently using the CCD API, we recommend migrating to the US Core DocumentReference $docref operation for on-demand document generation.

Benefits of Migration

• Standards-Based: Uses HL7 FHIR US Core standard operation
• Unified API: Single FHIR API for both document search and generation
• Better Discovery: CapabilityStatement documents available operations
• Consistent Authentication: Uses same OAuth flows as other FHIR resources
• Future-Proof: Aligned with industry standards and regulatory requirements

Migration Comparison

Feature	Legacy CCD API	FHIR $docref Operation
Endpoint	GET /ccd?patient={id}	GET or POST /DocumentReference/$docref
Request Format	Query parameters	Query parameters (GET) or FHIR Parameters (POST)
Response Format	CDA XML document	FHIR Bundle with DocumentReference + Binary
Authentication	OAuth with CCD scope	OAuth with FHIR scopes
Standards	Custom API	US Core IG
Discovery	Documentation only	CapabilityStatement

Example Migration

Legacy CCD API:

Production

curl -X GET 'https://fhir.netsmartcloud.com/ccd?patient=123' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/xml"

Preview

curl -X GET 'https://fhirtest.netsmartcloud.com/ccd?patient=123' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/xml"

FHIR $docref Operation (GET):

Production

curl -X GET 'https://fhir.netsmartcloud.com/provider/system-access/v2/DocumentReference/\$docref?patient=123' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/fhir+json"

Preview

curl -X GET 'https://fhirtest.netsmartcloud.com/provider/system-access/v2/DocumentReference/\$docref?patient=123' \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/fhir+json"

FHIR $docref Operation (POST with type parameter):

Production

curl -X POST https://fhir.netsmartcloud.com/provider/system-access/v2/DocumentReference/\$docref \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/fhir+json" \
    -H "Content-Type: application/fhir+json" \
    -d '{
  "resourceType": "Parameters",
  "parameter": [
    {
      "name": "patient",
      "valueId": "123"
    },
    {
      "name": "type",
      "valueCoding": {
        "system": "http://loinc.org",
        "code": "34133-9"
      }
    }
  ]
}'

Preview

curl -X POST https://fhirtest.netsmartcloud.com/provider/system-access/v2/DocumentReference/\$docref \
    -H "Authorization: Bearer {access_token}" \
    -H "Accept: application/fhir+json" \
    -H "Content-Type: application/fhir+json" \
    -d '{
  "resourceType": "Parameters",
  "parameter": [
    {
      "name": "patient",
      "valueId": "123"
    },
    {
      "name": "type",
      "valueCoding": {
        "system": "http://loinc.org",
        "code": "34133-9"
      }
    }
  ]
}'

Migration Resources

• DocumentReference Resource Documentation
• US Core DocumentReference $docref Operation
• FHIR Authorization Guide

Technical Specifications

Standards Compliance

• HL7 CDA R2: Full compliance with Clinical Document Architecture Release 2
• C-CDA: Consolidated Clinical Document Architecture templates
• LOINC Codes: Standard document type identification
• XML Schema: Validates against HL7 CDA XSD

Security

• OAuth 2.0: Client Credentials flow authentication
• HTTPS: All communications encrypted in transit
• Access Control: Tenant-based data isolation
• Audit Logging: All requests logged with transaction IDs