SMART DAK Cervical Cancer Screening
0.0.1 - ci-build
SMART DAK Cervical Cancer Screening, published by Dan Heslinga (independent contributor). 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/dhes/smart-dak-cxca/ and changes regularly. See the Directory of published versions
| Draft as of 2026-05-14 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="CXCAD18SRecallScheduling"/>
<meta>
<profile
value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<div>
<table class="grid dict">
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">CXCAD18SRecallScheduling</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-CXCAD18SRecallScheduling.html">CXCA.D18.S — Recall Scheduling</a></td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.0.1</td>
</tr>
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">CXCA.D18.S — Recall Scheduling</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<b>system: </b> <span><a href="http://terminology.hl7.org/7.1.0/CodeSystem-plan-definition-type.html">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>
</p>
<p style="margin-bottom: 5px;">
<b>code: </b> <span>eca-rule</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2026-05-14 00:50:23+0000</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">Dan Heslinga (independent contributor)</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>Decision support for recall and re-call per Mongolia MOH Order A/641 (2020) section 2.3. Evaluates seven timeout triggers (HPV sample timeout, positive-result follow-up timeout, biopsy timeout, treatment-after-biopsy timeout, cytology unread timeout, second-reminder, missed scheduled exam) and instantiates a CommunicationRequest reminder for each fired trigger. The 187 LTFU women from the April 2026 Khan-Uul pilot represent the empirical case for why this layer matters — DE39 (positive-result follow-up timeout, 4 weeks) is the trigger that should fire for each of them.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-CXCAD18SRecallSchedulingLogic.html">CXCAD18SRecallSchedulingLogic</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Actions: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td>
<b> Recall — HPV sample result missing more than 3 weeks:</b> An HPV sample was dispatched more than 3 weeks ago and no result has been entered. Issue a reminder to follow up with the lab.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Recall — HPV sample result timeout)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-CXCAD18ReminderCommunicationRequest.html">CXCAD18 — Recall Reminder CommunicationRequest</a><br/>
</td>
</tr>
<tr>
<td>
<b> Recall — positive screening result without follow-up exam after 4 weeks:</b> A positive screening result was entered more than 4 weeks ago and no follow-up examination has been recorded. Issue a reminder to the patient and the clinician. THIS IS THE LTFU-PREVENTION TRIGGER — the 187 women lost to follow-up in the April 2026 Khan-Uul pilot would each have had this trigger fire.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Recall — positive result follow-up timeout)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-CXCAD18ReminderCommunicationRequest.html">CXCAD18 — Recall Reminder CommunicationRequest</a><br/>
</td>
</tr>
<tr>
<td>
<b> Recall — biopsy result missing more than 4 weeks:</b> A biopsy sample was received at the lab more than 4 weeks ago and no histopathology result has been entered. Follow up with the lab.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Recall — biopsy result timeout)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-CXCAD18ReminderCommunicationRequest.html">CXCAD18 — Recall Reminder CommunicationRequest</a><br/>
</td>
</tr>
<tr>
<td>
<b> Recall — no treatment record more than 4 weeks after positive biopsy:</b> A positive biopsy result has been entered for more than 4 weeks and no treatment record exists. Issue a reminder to schedule treatment.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Recall — treatment after positive biopsy timeout)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-CXCAD18ReminderCommunicationRequest.html">CXCAD18 — Recall Reminder CommunicationRequest</a><br/>
</td>
</tr>
<tr>
<td>
<b> Recall — cytology slide unread more than 2 weeks at lab:</b> A cytology slide was received more than 2 weeks ago and no cytologist conclusion has been entered. Follow up with the lab.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Recall — cytology slide unread timeout)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-CXCAD18ReminderCommunicationRequest.html">CXCAD18 — Recall Reminder CommunicationRequest</a><br/>
</td>
</tr>
<tr>
<td>
<b> Recall — second reminder needed (first sent more than 4 weeks ago):</b> A first reminder was sent more than 4 weeks ago and the underlying gap remains unresolved. Issue a second reminder.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Recall — second reminder needed)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-CXCAD18ReminderCommunicationRequest.html">CXCAD18 — Recall Reminder CommunicationRequest</a><br/>
</td>
</tr>
<tr>
<td>
<b> Recall — missed scheduled examination:</b> Patient missed a scheduled examination. Immediate reminder — no timeout wait.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Recall — missed scheduled examination)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-CXCAD18ReminderCommunicationRequest.html">CXCAD18 — Recall Reminder CommunicationRequest</a><br/>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CXCAD18SRecallSchedulingLogic"/>
</extension>
<extension url="name">
<valueString
value="Recall — treatment after positive biopsy timeout"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @output: CXCA.D#DE41 "Recall: treatment timeout after positive biopsy (4 weeks)"
*/
define "Recall — treatment after positive biopsy timeout":
"TreatmentAfterPositiveBiopsyTimedOut""/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CXCAD18SRecallSchedulingLogic"/>
</extension>
<extension url="name">
<valueString value="Recall — HPV sample result timeout"/>
</extension>
<extension url="statement">
<valueString
value="// =============================================================================
// Recall trigger rules — one per A/641 section 2.3 timeout
// =============================================================================
/*
* @output: CXCA.D#DE38 "Recall: HPV sample result timeout (3 weeks)"
*/
define "Recall — HPV sample result timeout":
"HPVSampleResultTimedOut""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CXCAD18SRecallSchedulingLogic"/>
</extension>
<extension url="name">
<valueString value="Recall — positive result follow-up timeout"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @output: CXCA.D#DE39 "Recall: positive result follow-up timeout (4 weeks)"
* The single most important trigger — fires for the LTFU population from
* the April 2026 Khan-Uul pilot.
*/
define "Recall — positive result follow-up timeout":
"PositiveResultFollowUpTimedOut""/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CXCAD18SRecallSchedulingLogic"/>
</extension>
<extension url="name">
<valueString value="Recall — biopsy result timeout"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @output: CXCA.D#DE40 "Recall: biopsy result timeout (4 weeks)"
*/
define "Recall — biopsy result timeout":
"BiopsyResultTimedOut""/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CXCAD18SRecallSchedulingLogic"/>
</extension>
<extension url="name">
<valueString value="Recall — missed scheduled examination"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @output: CXCA.D#DE44 "Recall: missed scheduled examination"
* No timeout — fires immediately once a missed appointment is detected.
*/
define "Recall — missed scheduled examination":
"MissedScheduledExamination""/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CXCAD18SRecallSchedulingLogic"/>
</extension>
<extension url="name">
<valueString value="Recall — cytology slide unread timeout"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @output: CXCA.D#DE42 "Recall: cytology slide unread timeout (2 weeks)"
*/
define "Recall — cytology slide unread timeout":
"CytologySlideUnreadTimedOut""/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CXCAD18SRecallSchedulingLogic"/>
</extension>
<extension url="name">
<valueString value="Recall — second reminder needed"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @output: CXCA.D#DE43 "Recall: second reminder (4 weeks after first)"
*/
define "Recall — second reminder needed":
"FirstReminderUnresolvedAtSecondTimeout""/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="FHIR model information"/>
<resource
value="http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1"/>
</relatedArtifact>
<parameter>
<name value="TreatmentAfterPositiveBiopsyTimedOut"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="HPVSampleResultTimedOut"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="PositiveResultFollowUpTimedOut"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="BiopsyResultTimedOut"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="MissedScheduledExamination"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="CytologySlideUnreadTimedOut"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="FirstReminderUnresolvedAtSecondTimeout"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Recall — treatment after positive biopsy timeout"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Recall — HPV sample result timeout"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Recall — positive result follow-up timeout"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Recall — biopsy result timeout"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Recall — missed scheduled examination"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Recall — cytology slide unread timeout"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Recall — second reminder needed"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
</Library>
</contained>
<extension
url="http://smart.who.int/cxca/StructureDefinition/cxca-bindingness">
<valueCoding>
<system value="http://smart.who.int/cxca/CodeSystem/CXCA.Bindingness"/>
<code value="legal"/>
<display value="Legal — binding regulatory instrument"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements">
<valueCanonical value="#effective-data-requirements"/>
</extension>
<url
value="http://smart.who.int/cxca/PlanDefinition/CXCAD18SRecallScheduling"/>
<version value="0.0.1"/>
<name value="CXCAD18SRecallScheduling"/>
<title value="CXCA.D18.S — Recall Scheduling"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="eca-rule"/>
</coding>
</type>
<status value="draft"/>
<experimental value="false"/>
<date value="2026-05-14T00:50:23+00:00"/>
<publisher value="Dan Heslinga (independent contributor)"/>
<contact>
<name value="Dan Heslinga (independent contributor)"/>
<telecom>
<system value="url"/>
<value value="https://github.com/dhes"/>
</telecom>
</contact>
<description
value="Decision support for recall and re-call per Mongolia MOH Order A/641 (2020) section 2.3. Evaluates seven timeout triggers (HPV sample timeout, positive-result follow-up timeout, biopsy timeout, treatment-after-biopsy timeout, cytology unread timeout, second-reminder, missed scheduled exam) and instantiates a CommunicationRequest reminder for each fired trigger. The 187 LTFU women from the April 2026 Khan-Uul pilot represent the empirical case for why this layer matters — DE39 (positive-result follow-up timeout, 4 weeks) is the trigger that should fire for each of them."/>
<library
value="http://smart.who.int/cxca/Library/CXCAD18SRecallSchedulingLogic"/>
<action>
<title value="Recall — HPV sample result missing more than 3 weeks"/>
<description
value="An HPV sample was dispatched more than 3 weeks ago and no result has been entered. Issue a reminder to follow up with the lab."/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Recall — HPV sample result timeout"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"/>
</action>
<action>
<title
value="Recall — positive screening result without follow-up exam after 4 weeks"/>
<description
value="A positive screening result was entered more than 4 weeks ago and no follow-up examination has been recorded. Issue a reminder to the patient and the clinician. THIS IS THE LTFU-PREVENTION TRIGGER — the 187 women lost to follow-up in the April 2026 Khan-Uul pilot would each have had this trigger fire."/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Recall — positive result follow-up timeout"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"/>
</action>
<action>
<title value="Recall — biopsy result missing more than 4 weeks"/>
<description
value="A biopsy sample was received at the lab more than 4 weeks ago and no histopathology result has been entered. Follow up with the lab."/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Recall — biopsy result timeout"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"/>
</action>
<action>
<title
value="Recall — no treatment record more than 4 weeks after positive biopsy"/>
<description
value="A positive biopsy result has been entered for more than 4 weeks and no treatment record exists. Issue a reminder to schedule treatment."/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Recall — treatment after positive biopsy timeout"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"/>
</action>
<action>
<title value="Recall — cytology slide unread more than 2 weeks at lab"/>
<description
value="A cytology slide was received more than 2 weeks ago and no cytologist conclusion has been entered. Follow up with the lab."/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Recall — cytology slide unread timeout"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"/>
</action>
<action>
<title
value="Recall — second reminder needed (first sent more than 4 weeks ago)"/>
<description
value="A first reminder was sent more than 4 weeks ago and the underlying gap remains unresolved. Issue a second reminder."/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Recall — second reminder needed"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"/>
</action>
<action>
<title value="Recall — missed scheduled examination"/>
<description
value="Patient missed a scheduled examination. Immediate reminder — no timeout wait."/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Recall — missed scheduled examination"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"/>
</action>
</PlanDefinition>