{
  "resourceType" : "PlanDefinition",
  "id" : "CervicalCancerTreatment",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b style=\"color: maroon\">Exception generating Narrative: unexpected non-end of element null::a  at line 166 column 55</b></p></div>"
  },
  "url" : "https://hopenahealth.com/fhir/cervical-cancer-cds/PlanDefinition/CervicalCancerTreatment",
  "version" : "0.1.0",
  "name" : "CervicalCancerTreatment",
  "title" : "Cervical Cancer Treatment — Ablation Eligibility and Modality Selection",
  "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 treatment of cervical pre-cancer lesions. Implements WHO ablation eligibility criteria and treatment modality selection. Presents the clinician with a point-of-care ablation eligibility checklist (transformation zone type, lesion extent, suspicion of cancer) and recommends thermal ablation, cryotherapy, or excision (LEEP/LLETZ) based on eligibility and available data.",
  "useContext" : [{
    "code" : {
      "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code" : "focus",
      "display" : "Clinical Focus"
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "1287592000",
        "display" : "Thermocauterization of cervix"
      }]
    }
  }],
  "jurisdiction" : [{
    "coding" : [{
      "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "code" : "001"
    }]
  }],
  "purpose" : "To guide treatment modality selection for women with HPV-positive, VIA-positive cervical pre-cancer, ensuring appropriate assessment of ablation eligibility and selection of the most suitable treatment method for the clinical setting.",
  "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 Guidance",
    "display" : "Ablation eligibility criteria: TZ type assessment, lesion extent, suspicion of cancer. Treatment preference: thermal ablation > cryotherapy > LEEP/LLETZ.",
    "url" : "https://www.who.int/publications/i/item/9789240030824",
    "document" : {
      "url" : "https://www.who.int/publications/i/item/9789240030824"
    }
  },
  {
    "type" : "composed-of",
    "display" : "Upstream: Triage routes VIA+ patients to treatment assessment",
    "resource" : "https://hopenahealth.com/fhir/cervical-cancer-cds/PlanDefinition/CervicalCancerTriage|0.1.0"
  },
  {
    "type" : "composed-of",
    "display" : "Downstream: Treated patients enter post-treatment follow-up",
    "resource" : "https://hopenahealth.com/fhir/cervical-cancer-cds/PlanDefinition/CervicalCancerFollowUp|0.1.0"
  }],
  "library" : ["https://hopenahealth.com/fhir/cervical-cancer-cds/Library/CervicalCancerTreatmentDecision|0.1.0"],
  "action" : [{
    "title" : "Treatment Assessment",
    "description" : "Evaluate treatment indication and determine appropriate modality for cervical pre-cancer",
    "trigger" : [{
      "type" : "named-event",
      "name" : "patient-view"
    }],
    "condition" : [{
      "kind" : "applicability",
      "expression" : {
        "language" : "text/cql-identifier",
        "expression" : "Treatment Is Indicated",
        "reference" : "Library/CervicalCancerTreatmentDecision"
      }
    }],
    "action" : [{
      "id" : "ablation-assessment",
      "title" : "Assess Ablation Eligibility",
      "description" : "Present ablation eligibility checklist for point-of-care clinical assessment. Ablation eligibility requires: (1) no suspicion of invasive/glandular disease, (2) TZ fully visible (Type 1 or 2), (3) lesion within probe reach.",
      "condition" : [{
        "kind" : "applicability",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Treatment Is Indicated",
          "reference" : "Library/CervicalCancerTreatmentDecision"
        }
      }],
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/action-type",
          "code" : "create"
        }]
      },
      "dynamicValue" : [{
        "path" : "payload[0].contentString",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Ablation Eligibility Checklist",
          "reference" : "Library/CervicalCancerTreatmentDecision"
        }
      },
      {
        "path" : "payload[1].contentString",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Treatment Recommendation",
          "reference" : "Library/CervicalCancerTreatmentDecision"
        }
      }]
    },
    {
      "id" : "contraindication-alert",
      "title" : "Ablation Contraindicated",
      "description" : "Known contraindication to ablation — recommend excision (LEEP/LLETZ)",
      "priority" : "urgent",
      "condition" : [{
        "kind" : "applicability",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Has Known Contraindication To Ablation",
          "reference" : "Library/CervicalCancerTreatmentDecision"
        }
      }],
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/action-type",
          "code" : "create"
        }]
      },
      "dynamicValue" : [{
        "path" : "payload[0].contentString",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Treatment Recommendation",
          "reference" : "Library/CervicalCancerTreatmentDecision"
        }
      }]
    },
    {
      "id" : "cin2-consideration",
      "title" : "CIN2+ Diagnosed — Consider Excision",
      "description" : "Patient has CIN2 or higher diagnosis — excision may be preferred even if TZ is ablation-eligible",
      "condition" : [{
        "kind" : "applicability",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Has CIN2 Or Higher Diagnosis",
          "reference" : "Library/CervicalCancerTreatmentDecision"
        }
      }],
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/action-type",
          "code" : "create"
        }]
      },
      "dynamicValue" : [{
        "path" : "payload[0].contentString",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Treatment Recommendation",
          "reference" : "Library/CervicalCancerTreatmentDecision"
        }
      }]
    },
    {
      "id" : "refer-oncology",
      "title" : "Cervical Cancer — Refer to Oncology",
      "description" : "Patient has cervical cancer diagnosis — refer for oncology management, not screening pathway treatment",
      "priority" : "urgent",
      "condition" : [{
        "kind" : "applicability",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Has Known Contraindication To Ablation",
          "reference" : "Library/CervicalCancerTreatmentDecision"
        }
      }],
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/action-type",
          "code" : "create"
        }]
      },
      "dynamicValue" : [{
        "path" : "payload[0].contentString",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Treatment Recommendation",
          "reference" : "Library/CervicalCancerTreatmentDecision"
        }
      }]
    }]
  }]
}