Lithuanian Colorectal Cancer Implementation Guide
0.0.1 - ci-build Lithuania flag

Lithuanian Colorectal Cancer Implementation Guide, published by Lithuanian Medical Library. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7LT/ig-lt-colorectal/ and changes regularly. See the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Structures: Questionnaires

These define forms used by systems conforming to this implementation guide to capture or expose data to end users.

Questionnaire: ESPBI Colonoscopy Form

ESPBI form for colonoscopy in the Lithuanian colorectal cancer screening programme.

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

Bowel Preparation Quality (LT Colorectal)

Profile for recording bowel preparation quality assessment using the Boston Bowel Preparation Scale (BBPS) in the Lithuanian colorectal cancer screening program. Quality is poor when total < 6 points, or at least one segment has a score of 0 or 1.

Colon Polyp Observation (LT Colorectal)

Profile for recording a colon polyp, enforcing the inclusion of size, Paris/NICE classifications, and SMSA scoring.

Colonoscope Reach (LT Colorectal)

Profile for recording how far the colonoscope reached during a colorectal cancer screening program. Used to calculate the Cecum intubation rate.

Colonoscopy Bleeding Control (LT Colorectal)

Profile for recording bleeding control procedures performed during colonoscopy in the Lithuanian colorectal cancer screening program. Captures the method used (clip, epinephrine injection, etc.).

Colonoscopy Complication Presence (LT Colorectal)

Profile for recording whether there was a complication after diagnostic colonoscopy.

Colonoscopy Complication Type (LT Colorectal)

Profile for recording the complication type after diagnostic colonoscopy. This observation is recorded only if complication presence is Yes.

Colonoscopy Composition (LT Colorectal)

Colonoscopy screening episode composition for the Lithuanian colorectal cancer prevention program. Links all observations and procedures from a colonoscopy examination into a single clinical document.

Colonoscopy Conclusion (LT Colorectal)

Profile for recording the final diagnostic conclusion of a colonoscopy examination in the Lithuanian colorectal cancer screening program.

Colonoscopy Procedure (LT Colorectal)

Profile for recording the colonoscopy procedure in the Lithuanian colorectal cancer screening program. Captures whether the procedure was performed with or without anesthesia, video colonoscope usage, and withdrawal time.

Colonoscopy Report (LT Colorectal)

Colonoscopy screening report for the Lithuanian colorectal cancer prevention program. Wraps a ColonoscopyCompositionLtColorectal and aggregates structured results from the colonoscopy procedure.

Colonoscopy Wall Injury Detail (LT Colorectal)

Profile for recording Sydney classification and action taken after colon wall injury during diagnostic colonoscopy. This observation is recorded only if accidental organ perforation during a procedure or perforation of large intestine was selected as the complication type.

Diagnostic Report: Fecal Occult Blood Test

Diagnostic report representing a fecal occult blood test examination based on stool specimen analysis using an immunochemical method.

Histological Diagnosis (LT Colorectal)

Profile for recording histological diagnosis results from polyp or tumor biopsy specimens in the Lithuanian colorectal cancer screening program. Captures histological type, dysplasia grade, radicalism of removal, tumor budding, invasion depth, and MMR protein expression.

Molecular Test Result (LT Colorectal)

Profile for recording molecular test results in the Lithuanian colorectal cancer screening program. Covers MSI (microsatellite instability), KRAS, NRAS, and BRAF V600E mutation testing. Each test is a separate Observation instance.

Default for adenocarcinoma: all molecular tests are automatically indicated but may be postponed.

Observation: Fecal Occult Blood Test Result

Profile for recording the result of a fecal occult blood test in the context of colorectal cancer screening.

Screening CarePlan (LT Colorectal)

CarePlan tracking the colorectal cancer screening programme cycle. Captures programme enrollment, current status, scheduled activities (FOBT testing, colonoscopy referrals, follow-up intervals), and care recommendations after colonoscopy.

Tumor Finding (LT Colorectal)

Profile for recording tumor findings during colonoscopy in the Lithuanian colorectal cancer screening program. Captures location, description, and links to biopsy procedures.

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

BBPS Colon Segments

SNOMED CT codes representing the three segments of the colon evaluated in the Boston Bowel Preparation Scale.

Bleeding Control Method

Methods used for controlling bleeding during or after colonoscopy.

Bowel Preparation Method

Methods of bowel preparation timing for colonoscopy.

Bowel Preparation Quality

SNOMED CT codes representing the overall quality of bowel preparation for a colonoscopy procedure.

Bowel Preparation Score Values (Boston Scale)

SNOMED CT codes representing the Boston Bowel Preparation Scale segment scores (0 to 3 points).

Bowel Preparation Substances

Substances used for bowel preparation before colonoscopy.

Colonoscope Reach

SNOMED CT anatomical structures identifying how far the colonoscope reached during the examination.

Colonoscopy Complication Presence

Indicates whether there was a complication after diagnostic colonoscopy.

Colonoscopy Complication Type

Complications that may occur after diagnostic colonoscopy.

Colonoscopy Wall Injury Action

Actions taken after colon wall injury during diagnostic colonoscopy.

Colorectal - Yes/No VS

Standard Yes/No qualifier values for the Colorectal screening program.

Colorectal Anatomy

Shared SNOMED CT codes representing the anatomical segments of the colon and rectum. Used for recording locations of tumors, polyps, and colonoscope reach.

Colorectal Conclusion

SNOMED CT codes representing the final diagnostic conclusions of the colonoscopy.

Colorectal Histological Diagnosis

Histological diagnosis categories for pathological examination in the colorectal cancer screening program.

Degree of Differentiation

Histologic grade / degree of differentiation for colorectal carcinoma.

Dysplasia Grade

Grades of dysplasia for histological assessment in colorectal pathology.

FOBT Qualitative Result

Qualitative result values for fecal occult blood testing.

Fecal Occult Blood Test Codes

LOINC codes for fecal occult blood (hemoglobin) testing.

Hydropreparation Substance

Substances used for submucosal injection (hydropreparation) during polypectomy.

Intravascular Invasion

Vascular invasion status for colorectal carcinoma.

Invasion Depth

Depth of invasion classification (Haggitt and Kikuchi) for colorectal lesions.

Lumen Filling Method

Method used to distend the colonic lumen during polypectomy.

MMRP Expression Status

Mismatch repair protein expression status (microsatellite instability assessment) for colorectal carcinoma.

Molecular Test Result

Result values for molecular testing in the colorectal cancer screening program.

Molecular Test Type

Types of molecular tests performed in the colorectal cancer screening program: MSI, KRAS, NRAS, and BRAF V600E.

NICE Classification

NBI International Colorectal Endoscopic (NICE) classification for prediction of polyp histology.

Paris Endoscopic Classification

Paris endoscopic classification of superficial neoplastic lesions for polyp morphology assessment.

Polyp Access Difficulty

Difficulty of access to the polyp during endoscopy, used in SMSA scoring.

Polyp Predicted Histology

Virtual chromoendoscopy-based predicted histological type of a colorectal polyp.

Polypectomy Instrument

Instruments used for polypectomy during colonoscopy.

Polypectomy Method

Methods used for polypectomy during colonoscopy.

Polypectomy Technique

Thermal technique used during polypectomy.

Poorly Differentiated Clusters (PDC) Grade

Grading of poorly differentiated clusters in colorectal carcinoma.

Radicalism of Removal

Assessment of completeness of lesion removal (R classification).

Resection Type

Whether the lesion was removed en bloc or piecemeal.

Squamous Cell Carcinoma Grading

Grading for squamous cell carcinoma of the colorectum.

Sydney Classification

Sydney classification types for colon wall injury during diagnostic colonoscopy.

Tumor Budding

Tumor budding classification for colorectal carcinoma.

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

Colorectal - Local Polyp Codes CS

Local codes for polyp classifications (Paris, NICE, Access, SMSA) used in the Lithuanian colorectal screening program.

SNOMED CT Extension for Colorectal Screening

Extension CodeSystem for concepts used in the Lithuanian colorectal cancer screening program that are not available in SNOMED CT.

Sydney Classification for Colon Wall Injury

Sydney classification for deep mural injury (DMI) of the colon occurring during colonoscopy. The classification describes the severity of injury to the colon wall layers and helps guide appropriate management.

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Diagnostic Report: FOBT Qualitative Not Detected (example)

Example of a diagnostic report for a qualitative fecal occult blood test with 'Not detected' result.

Observation: Accidental Organ Perforation During Procedure (example)

Example of an observation recording accidental organ perforation during a procedure after diagnostic colonoscopy.

Observation: Anesthesia Complication After Diagnostic Colonoscopy (example)

Example of an observation recording complication of anesthesia after diagnostic colonoscopy.

Observation: BRAF V600E - Postponed (example)

Example of a BRAF V600E mutation test that has been postponed.

Observation: Bowel Prep Quality Effective (example)

Example of an observation recording that the bowel preparation was effective (adequate quality).

Observation: Bowel Prep Quality Inadequate (example)

Example of an observation recording that the bowel preparation was inadequate (poor quality).

Observation: Colonoscope Reach Cecum (example)

Example of an observation recording that the colonoscope reached the Cecum.

Observation: Colonoscope Reach Terminal Ileum (example)

Example of an observation recording that the colonoscope reached the Terminal ileum.

Observation: Colorectal - BBPS Left Colon (3 points)

Example of an observation recording an excellent (3 points) Boston scale score for the Left colon.

Observation: Colorectal - BBPS Transverse Colon (2 points)

Example of an observation recording a good (2 points) Boston scale score for the Transverse colon.

Observation: Colorectal - Bowel Prep Quality & Total Score (Effective)

Example of a single observation recording both the overall Effective quality and the Total Boston Scale score.

Observation: Colorectal - Bowel Prep Quality & Total Score (Inadequate)

Example of a single observation recording both the overall Inadequate quality and the Total Boston Scale score.

Observation: Colorectal - Bowel Prep Quality (Not Done)

Example of an observation recording that the bowel preparation was not done (no Boston scale score applicable).

Observation: Colorectal - Conclusion (Normal)

Records the final conclusion of the procedure as Normal.

Observation: Colorectal - Conclusion (Polyps & Diverticulosis)

Records the final conclusion showing Polyps and Diverticulosis.

Observation: Colorectal - Polyp Found (with SMSA & Details)

Example recording a colon polyp, properly mapped to the ColorectalPolypCodesLt CodeSystem.

Observation: Colorectal - Tumor (Found)

Example recording the presence of a tumor, including its location and description.

Observation: Diagnostic Colonoscopy Complication Presence No (example)

Example of an observation recording that no complication occurred after diagnostic colonoscopy.

Observation: Diagnostic Colonoscopy Complication Presence Yes (example)

Example of an observation recording that a complication occurred after diagnostic colonoscopy.

Observation: FOBT Qualitative Detected (example)

Example of a qualitative fecal occult blood test result with 'Detected' value.

Observation: FOBT Qualitative Not Detected (example)

Example of a qualitative fecal occult blood test result with 'Not detected' value.

Observation: FOBT Quantitative (example)

Example of a quantitative fecal occult blood test result.

Observation: Hemorrhage After Diagnostic Colonoscopy (example)

Example of an observation recording hemorrhage of colon after diagnostic colonoscopy.

Observation: KRAS - Detected mutation (example)

Example of a KRAS mutation test with detected mutation result.

Observation: MSI - Set (example)

Example of a microsatellite instability (MSI) test with established result.

Observation: NRAS - Undefined mutation (example)

Example of an NRAS mutation test with no mutation detected.

Observation: Perforation of Large Intestine (example)

Example of an observation recording perforation of large intestine after diagnostic colonoscopy.

Observation: Wall Injury Detail Type 3 with Clip (example)

Example showing Sydney classification type 3 and closure by clip after colon wall injury during diagnostic colonoscopy.

Observation: Wall Injury Detail Type 4 with Suture (example)

Example showing Sydney classification type 4 and closure by suture after colon wall injury during diagnostic colonoscopy.

Observation: Wall Injury Detail Type 5 with Operation (example)

Example showing Sydney classification type 5 and operation on colon after colon wall injury during diagnostic colonoscopy.

Organization: Vilniaus miesto ligoninė (example)

Example of a healthcare organization

Patient: Jonas Petrauskas (example)

An example Patient conforming to the Lithuanian Base Profile.

Practitioner: Dr. Petras Kazlauskas (example)

An example Practitioner conforming to the Lithuanian Base Profile.

Procedure: Bleeding Control by Clip (example)

Example showing closure by clip under the reason of bleeding control.

Procedure: Bleeding Control by Epinephrine (example)

Example showing injection of epinephrine under reason of bleeding control.

Procedure: Colonoscopic control of colon bleeding (example)

Example of colonoscopic control of colon bleeding.

Procedure: Colorectal - Tumor Biopsy (Postponed)

Example recording that the biopsy of the discovered tumor was postponed.

Procedure: Screening Colonoscopy (example)

Example of screening colonoscopy.

Procedure: Screening Colonoscopy With Anesthesia (example)

Example of screening colonoscopy where anesthesia and/or sedation is recorded as the reason.

QuestionnaireResponse: ESPBI Colonoscopy (example)

A completed ESPBI colonoscopy form for the Lithuanian colorectal cancer screening programme. Shows a colonoscopy with anesthesia, adequate bowel preparation (BBPS 7), cecum reached, one sigmoid polyp removed with cold snare, no complications, conclusion: polyps found, next colonoscopy in 3 years.

Specimen: Stool for FOBT (example)

Example of a stool specimen used for fecal occult blood testing.