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="CXCAD2DTHPVResultRouting"/>
<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;">CXCAD2DTHPVResultRouting</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-CXCAD2DTHPVResultRouting.html">CXCA.D2.DT — HPV Result Routing</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.D2.DT — HPV Result Routing</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 recommendation for routing after an HPV high-risk DNA test result returns. Implements the three-outcome decision tree from Mongolia MOH Order A/641 (2020) Fig 2.4: HPV negative → routine; HPV+ with negative cytology re-read → repeat HPV in 12 months; HPV+ with cytology ≥ ASC-US → refer to colposcopy.</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-CXCAD2DTHPVResultRoutingLogic.html">CXCAD2DTHPVResultRoutingLogic</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> HPV negative — return to routine screening:</b> HPV high-risk DNA test result is negative. No further investigation indicated. Return the patient to the routine screening cycle per the binding pathway (HPV at next target age, or cytology at next 3-yearly visit).
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Route — HPV negative, return to routine)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> HPV positive, cytology re-read negative — repeat HPV in 12 months:</b> HPV high-risk DNA test result is positive but the cytology re-read of the saved slide shows no significant abnormality (NILM). Per A/641 Fig 2.4, do not refer to colposcopy at this time. Repeat the HPV test in 12 months. If still positive at the 12-month recheck, the next evaluation will route to colposcopy. (Recall scheduling — Phase 5 chunk 7 deferred.)
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Route — HPV+, cytology negative, repeat HPV in 12 months)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> HPV positive, cytology ≥ ASC-US — refer to colposcopy:</b> HPV high-risk DNA test result is positive and the cytology re-read shows ≥ ASC-US (any of ASC-US, ASC-H, LSIL, HSIL per Bethesda 2014). Per A/641 Fig 2.4, refer the patient to colposcopy without delay. Create a proposed ServiceRequest for colposcopy.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(Route — HPV+, cytology ≥ ASC-US, refer to colposcopy)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-CXCAD2ColposcopyServiceRequest.html">CXCAD2 — Colposcopy Service Request</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="CXCAD2DTHPVResultRoutingLogic"/>
</extension>
<extension url="name">
<valueString
value="Route — HPV+, cytology negative, repeat HPV in 12 months"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @output: CXCA.D#DE35 "Route: repeat HPV test in 12 months"
* @bindingness: legal
* HPV result is positive but the cytology re-read shows no significant
* cellular abnormality (NILM / less than ASC-US). Per Fig 2.4, do not refer
* to colposcopy yet — recheck HPV in 12 months. If still positive at recheck,
* the next evaluation will route to colposcopy.
*/
define "Route — HPV+, cytology negative, repeat HPV in 12 months":
"HPVResultPositive"
and not "CytologyResultASCUSorWorse""/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CXCAD2DTHPVResultRoutingLogic"/>
</extension>
<extension url="name">
<valueString value="Route — HPV negative, return to routine"/>
</extension>
<extension url="statement">
<valueString
value="// =============================================================================
// Routing rules — three mutually-exclusive outcomes per A/641 Fig 2.4
// =============================================================================
/*
* @output: CXCA.D#DE34 "Route: return to routine screening"
* @bindingness: legal
* HPV result is negative — no further investigation indicated.
*/
define "Route — HPV negative, return to routine":
not "HPVResultPositive""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CXCAD2DTHPVResultRoutingLogic"/>
</extension>
<extension url="name">
<valueString
value="Route — HPV+, cytology ≥ ASC-US, refer to colposcopy"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @output: CXCA.D#DE36 "Route: refer to colposcopy"
* @bindingness: legal
* HPV result is positive and cytology re-read shows ≥ ASC-US (any of
* ASC-US, ASC-H, LSIL, HSIL per Bethesda 2014). Refer to colposcopy
* directly per A/641 Fig 2.4 (Op.Inst. 5.6 covers the colposcopy procedure).
*/
define "Route — HPV+, cytology ≥ ASC-US, refer to colposcopy":
"HPVResultPositive"
and "CytologyResultASCUSorWorse""/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</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="HPVResultPositive"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="CytologyResultASCUSorWorse"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name
value="Route — HPV+, cytology negative, repeat HPV in 12 months"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Route — HPV negative, return to routine"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Route — HPV+, cytology ≥ ASC-US, refer to colposcopy"/>
<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/CXCAD2DTHPVResultRouting"/>
<version value="0.0.1"/>
<name value="CXCAD2DTHPVResultRouting"/>
<title value="CXCA.D2.DT — HPV Result Routing"/>
<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 recommendation for routing after an HPV high-risk DNA test result returns. Implements the three-outcome decision tree from Mongolia MOH Order A/641 (2020) Fig 2.4: HPV negative → routine; HPV+ with negative cytology re-read → repeat HPV in 12 months; HPV+ with cytology ≥ ASC-US → refer to colposcopy."/>
<library
value="http://smart.who.int/cxca/Library/CXCAD2DTHPVResultRoutingLogic"/>
<action>
<title value="HPV negative — return to routine screening"/>
<description
value="HPV high-risk DNA test result is negative. No further investigation indicated. Return the patient to the routine screening cycle per the binding pathway (HPV at next target age, or cytology at next 3-yearly visit)."/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Route — HPV negative, return to routine"/>
</expression>
</condition>
</action>
<action>
<title
value="HPV positive, cytology re-read negative — repeat HPV in 12 months"/>
<description
value="HPV high-risk DNA test result is positive but the cytology re-read of the saved slide shows no significant abnormality (NILM). Per A/641 Fig 2.4, do not refer to colposcopy at this time. Repeat the HPV test in 12 months. If still positive at the 12-month recheck, the next evaluation will route to colposcopy. (Recall scheduling — Phase 5 chunk 7 deferred.)"/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression
value="Route — HPV+, cytology negative, repeat HPV in 12 months"/>
</expression>
</condition>
</action>
<action>
<title value="HPV positive, cytology ≥ ASC-US — refer to colposcopy"/>
<description
value="HPV high-risk DNA test result is positive and the cytology re-read shows ≥ ASC-US (any of ASC-US, ASC-H, LSIL, HSIL per Bethesda 2014). Per A/641 Fig 2.4, refer the patient to colposcopy without delay. Create a proposed ServiceRequest for colposcopy."/>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression
value="Route — HPV+, cytology ≥ ASC-US, refer to colposcopy"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/cxca/ActivityDefinition/CXCAD2ColposcopyServiceRequest"/>
</action>
</PlanDefinition>