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

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Oficialus URL: https://hl7.lt/fhir/colorectal/ImplementationGuide/lt.hl7.fhir.colorectal				Versija: 0.0.1	Paryškinti teksto pakeitimus?
					Mašiniškai apdorojamas pavadinimas: LTColorectal

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Lithuanian Colorectal Cancer Prevention and Early Diagnosis Implementation Guide

Introduction and Purpose

This Implementation Guide specifies how to consistently represent and exchange structured clinical data related to the Lithuanian Colorectal Cancer Prevention Programme using the HL7® FHIR® standard.

The guide supports the national programme for early detection of colorectal cancer, with a primary focus on fecal occult blood testing (FOBT), colonoscopy examinations, and histopathological diagnosis, together with structured capture of clinically relevant examination findings and diagnostic outcomes.

Its purpose is to enable:

• consistent and high-quality data capture across healthcare providers, laboratories, and endoscopy centers,
• semantic interoperability between screening, laboratory, endoscopy, pathology, and referral systems,
• structured reporting for programme coordination, quality assurance, monitoring, and secondary use,
• and reliable longitudinal tracking of participants across screening, diagnostic investigation, and treatment pathways.

The guide is developed as part of the national ADP project, which aims to support coordinated, data-driven management of preventive and early diagnostic programmes in Lithuania.

Scope

This guide focuses on the colorectal cancer prevention and early diagnosis workflow, covering screening tests, diagnostic colonoscopy procedures, and pathological confirmation of lesions.

It covers the following clinical domains:

• fecal occult blood testing (FOBT) as the primary screening method,
• colonoscopy procedures performed following positive screening results,
• documentation of colonoscopic findings, including polyps, tumors, and other pathological changes,
• classification and description of detected lesions, including size, morphology, location, and risk classification,
• histopathological examination of biopsy and polypectomy samples, including diagnosis and tumour characterization,
• and quality indicators of the colonoscopy procedure, supporting monitoring of programme performance.

The guide models colorectal cancer prevention as a screening-driven diagnostic pathway, where positive stool test results lead to colonoscopic investigation, followed by histopathological confirmation when suspicious lesions are detected.

Key Modelling Principles

The modelling approach is based on the following core principles:

1. Separation of screening, diagnostic procedures, and pathology results
   Screening tests, colonoscopic procedures, and histopathological findings are represented as separate but connected elements of the clinical workflow.

2. Structured representation of colonoscopy findings
   Colonoscopic findings such as polyps, tumors, and other lesions are recorded in a structured manner, including anatomical location, size, morphology, and classification systems used during endoscopic evaluation.

3. Support for procedural quality indicators
   The model allows recording of colonoscopy quality metrics, including bowel preparation quality, completeness of examination, and complications, which are essential for monitoring screening programme effectiveness.

4. Explicit modelling of lesion characteristics and treatment actions
   Detected polyps and lesions are described using structured attributes and may include actions such as biopsy or polypectomy, allowing integration with pathology results and follow-up recommendations.

5. Integration of histopathological diagnosis
   Histological examination results provide definitive classification of lesions, including adenomas, serrated polyps, inflammatory conditions, and malignant tumors, enabling consistent diagnostic interpretation.

6. Terminology-based interoperability
   The guide relies on internationally recognised terminologies and classifiers, especially SNOMED CT, and where relevant also LOINC, ICD-10-AM, and ICD-O, to ensure semantic consistency across systems and healthcare institutions.

Content of the Guide

This guide provides:

• FHIR profiles and extensions supporting colorectal cancer screening and diagnostic workflows,
• structured modelling of fecal occult blood tests used for screening,
• structured representation of colonoscopy examination data, including procedural details and findings,
• modelling of colonoscopic lesions, including polyps and suspected malignancies,
• structured capture of biopsy and polypectomy procedures,
• modelling of histopathological examination results for colorectal tissue samples,
• terminology bindings using SNOMED CT, LOINC, ICD-10-AM, and ICD-O,
• structured example instances illustrating realistic screening and diagnostic scenarios,
• mappings from the national colorectal cancer prevention dataset to interoperable FHIR artefacts,
• and identification of gaps and future development needs.

At the current stage, the guide focuses on the core data structures required for colorectal cancer screening and diagnostic procedures, including stool testing, colonoscopy reporting, and pathology results. Further refinement, terminology expansion, and clinical validation will be performed in subsequent iterations.

Why Use This Guide?

By adopting this guide, implementers and healthcare institutions can:

1. Interoperability: Ensure consistent and comparable colorectal cancer screening and diagnostic data across healthcare systems.
2. Data Quality: Improve the consistency, completeness, and reusability of screening, endoscopy, and pathology data.
3. Clinical Utility: Support structured reporting of colonoscopy findings, biopsy results, and diagnostic conclusions.
4. Programme Monitoring: Enable population-level analysis of screening participation, detection rates, and procedure quality indicators.
5. Longitudinal Care: Support follow-up of patients across screening cycles, colonoscopy procedures, and treatment pathways.

Navigate the sections below to access the profiles, terminology bindings, and detailed examples needed to implement the standard.

Contributors

Name	Role	Organization
Igor Bossenko	Primary Author	HELEX Solutions
Audra Stepanauskaite	Co-Author	LMB
Kati Laidus	Co-Author	HELEX Solutions
Martynas Bieliauskas	Co-Author	LMB
Albert Kuslevic	Co-Author	LMB