{ "resourceType" : "PlanDefinition", "id" : "CervicalCancerFollowUp", "text" : { "status" : "extensions", "div" : "

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" }, "url" : "https://hopenahealth.com/fhir/cervical-cancer-cds/PlanDefinition/CervicalCancerFollowUp", "version" : "0.1.0", "name" : "CervicalCancerFollowUp", "title" : "Cervical Cancer Follow-Up — Post-Treatment and Post-Triage Scheduling", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type", "code" : "eca-rule", "display" : "ECA Rule" }] }, "status" : "draft", "experimental" : true, "date" : "2026-03-08", "publisher" : "Hopena Health", "contact" : [{ "name" : "Hopena Health", "telecom" : [{ "system" : "url", "value" : "https://hopenahealth.com" }] }, { "name" : "Dan Heslinga", "telecom" : [{ "system" : "url", "value" : "https://hopenahealth.com" }] }], "description" : "Clinical decision support rule for follow-up scheduling after cervical cancer treatment or triage-negative result. Manages post-treatment HPV DNA retest timing (12 months for both populations), post-triage-negative retest timing (12 months WLHIV, 24 months general), WLHIV double follow-up tracking (two consecutive negative HPV retests), return-to-routine-screening criteria, and re-entry to triage/treatment when follow-up HPV retest is positive.", "useContext" : [{ "code" : { "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type", "code" : "focus", "display" : "Clinical Focus" }, "valueCodeableConcept" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "243877001", "display" : "Cancer cervix screening" }] } }], "jurisdiction" : [{ "coding" : [{ "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm", "code" : "001" }] }], "purpose" : "To ensure timely follow-up after cervical cancer treatment or triage-negative results, preventing loss to follow-up in the screening cascade. Manages population-specific follow-up intervals and tracks WLHIV double follow-up requirements.", "copyright" : "Copyright 2026 Hopena Health. License: Apache 2.0", "relatedArtifact" : [{ "type" : "derived-from", "label" : "WHO Guideline", "display" : "WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, 2nd edition (2021)", "url" : "https://www.who.int/publications/i/item/9789240030824", "document" : { "url" : "https://www.who.int/publications/i/item/9789240030824" } }, { "type" : "citation", "label" : "WHO Recommendations", "display" : "General: Recs 11 (post-triage-neg 24mo), 12 (post-colp-normal), 13 (post-treatment 12mo). WLHIV: Recs 31 (post-triage-neg 12mo), 32 (post-colp-normal), 33 (post-treatment double follow-up).", "url" : "https://www.who.int/publications/i/item/9789240030824", "document" : { "url" : "https://www.who.int/publications/i/item/9789240030824" } }, { "type" : "composed-of", "display" : "Upstream: Treated patients enter post-treatment follow-up", "resource" : "https://hopenahealth.com/fhir/cervical-cancer-cds/PlanDefinition/CervicalCancerTreatment|0.1.0" }, { "type" : "composed-of", "display" : "Upstream: Triage-negative patients enter post-triage follow-up", "resource" : "https://hopenahealth.com/fhir/cervical-cancer-cds/PlanDefinition/CervicalCancerTriage|0.1.0" }], "library" : ["https://hopenahealth.com/fhir/cervical-cancer-cds/Library/CervicalCancerFollowUpDecision|0.1.0"], "action" : [{ "title" : "Follow-Up Assessment", "description" : "Evaluate follow-up status for women with active post-treatment or post-triage-negative follow-up", "trigger" : [{ "type" : "named-event", "name" : "patient-view" }], "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Has Active Follow Up", "reference" : "Library/CervicalCancerFollowUpDecision" } }], "action" : [{ "id" : "retest-positive-reenter", "title" : "Follow-Up HPV Retest Positive — Re-enter Cascade", "description" : "Post-treatment or post-triage HPV retest is positive — patient must re-enter the triage/treatment pathway", "priority" : "urgent", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Post Treatment Retest Is Positive", "reference" : "Library/CervicalCancerFollowUpDecision" } }], "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/action-type", "code" : "create" }] }, "dynamicValue" : [{ "path" : "payload[0].contentString", "expression" : { "language" : "text/cql-identifier", "expression" : "Follow Up Recommended Action", "reference" : "Library/CervicalCancerFollowUpDecision" } }] }, { "id" : "post-treatment-retest-due", "title" : "Post-Treatment HPV Retest Due", "description" : "12 months have elapsed since treatment — HPV DNA retest is now due", "priority" : "routine", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Post Treatment Retest Is Due", "reference" : "Library/CervicalCancerFollowUpDecision" } }], "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/action-type", "code" : "create" }] }, "dynamicValue" : [{ "path" : "payload[0].contentString", "expression" : { "language" : "text/cql-identifier", "expression" : "Follow Up Recommended Action", "reference" : "Library/CervicalCancerFollowUpDecision" } }] }, { "id" : "post-treatment-retest-approaching", "title" : "Post-Treatment HPV Retest Approaching", "description" : "Post-treatment retest is approaching (within 2 months) — schedule the follow-up visit", "priority" : "routine", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Post Treatment Retest Is Approaching", "reference" : "Library/CervicalCancerFollowUpDecision" } }], "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/action-type", "code" : "create" }] }, "dynamicValue" : [{ "path" : "payload[0].contentString", "expression" : { "language" : "text/cql-identifier", "expression" : "Follow Up Recommended Action", "reference" : "Library/CervicalCancerFollowUpDecision" } }] }, { "id" : "wlhiv-second-retest", "title" : "WLHIV Double Follow-Up — Second Retest Needed", "description" : "WLHIV patient had first negative post-treatment HPV retest — second retest at 12 months required before return to routine screening (WHO Rec 33)", "priority" : "routine", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "WLHIV Needs Second Follow Up Test", "reference" : "Library/CervicalCancerFollowUpDecision" } }], "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/action-type", "code" : "create" }] }, "dynamicValue" : [{ "path" : "payload[0].contentString", "expression" : { "language" : "text/cql-identifier", "expression" : "Follow Up Recommended Action", "reference" : "Library/CervicalCancerFollowUpDecision" } }] }, { "id" : "post-triage-negative-retest-due", "title" : "Post-Triage-Negative HPV Retest Due", "description" : "HPV+/VIA- patient's follow-up interval has elapsed — HPV DNA retest is due (12 months WLHIV, 24 months general)", "priority" : "routine", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Post Triage Negative Retest Is Due", "reference" : "Library/CervicalCancerFollowUpDecision" } }], "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/action-type", "code" : "create" }] }, "dynamicValue" : [{ "path" : "payload[0].contentString", "expression" : { "language" : "text/cql-identifier", "expression" : "Follow Up Recommended Action", "reference" : "Library/CervicalCancerFollowUpDecision" } }] }, { "id" : "post-triage-negative-waiting", "title" : "Post-Triage-Negative — Awaiting Retest Interval", "description" : "HPV+/VIA- patient is in the waiting period before follow-up HPV retest is due", "priority" : "routine", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Is Post Triage Negative", "reference" : "Library/CervicalCancerFollowUpDecision" } }], "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/action-type", "code" : "create" }] }, "dynamicValue" : [{ "path" : "payload[0].contentString", "expression" : { "language" : "text/cql-identifier", "expression" : "Follow Up Recommended Action", "reference" : "Library/CervicalCancerFollowUpDecision" } }] }, { "id" : "return-to-routine", "title" : "Return to Routine Screening", "description" : "Follow-up complete — patient can return to routine screening interval", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Can Return To Routine Screening", "reference" : "Library/CervicalCancerFollowUpDecision" } }], "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/action-type", "code" : "create" }] }, "dynamicValue" : [{ "path" : "payload[0].contentString", "expression" : { "language" : "text/cql-identifier", "expression" : "Follow Up Recommended Action", "reference" : "Library/CervicalCancerFollowUpDecision" } }] }] }] }