{
  "resourceType" : "PlanDefinition",
  "id" : "CervicalCancerTriage",
  "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/CervicalCancerTriage",
  "version" : "0.1.0",
  "name" : "CervicalCancerTriage",
  "title" : "Cervical Cancer Triage — HPV-Positive VIA Assessment",
  "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 triage of HPV-positive women using VIA (visual inspection with acetic acid). Implements WHO Algorithm 5 triage pathway: HPV+ -> VIA triage -> route to treatment (VIA+), follow-up retest (VIA-), or oncology referral (suspicious for cancer). Applies to both general population and WLHIV with population-specific follow-up intervals.",
  "useContext" : [{
    "code" : {
      "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code" : "focus",
      "display" : "Clinical Focus"
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "35904009",
        "display" : "HPV DNA detection"
      }]
    }
  }],
  "jurisdiction" : [{
    "coding" : [{
      "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "code" : "001"
    }]
  }],
  "purpose" : "To guide clinical decision-making for women with positive HPV DNA test results, ensuring appropriate triage with VIA and correct routing to treatment, follow-up, or referral based on triage outcome.",
  "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 population: Recs 3b, 11. WLHIV: Recs 22, 23, 31. Algorithm 5: HPV DNA + VIA Triage.",
    "url" : "https://www.who.int/publications/i/item/9789240030824",
    "document" : {
      "url" : "https://www.who.int/publications/i/item/9789240030824"
    }
  },
  {
    "type" : "composed-of",
    "display" : "Upstream: Screening determines cascade position and routes HPV+ patients to triage",
    "resource" : "https://hopenahealth.com/fhir/cervical-cancer-cds/PlanDefinition/CervicalCancerScreening|0.1.0"
  },
  {
    "type" : "composed-of",
    "display" : "Downstream: VIA+ patients are routed to treatment assessment",
    "resource" : "https://hopenahealth.com/fhir/cervical-cancer-cds/PlanDefinition/CervicalCancerTreatment|0.1.0"
  }],
  "library" : ["https://hopenahealth.com/fhir/cervical-cancer-cds/Library/CervicalCancerTriageDecision|0.1.0"],
  "action" : [{
    "title" : "HPV-Positive Triage Assessment",
    "description" : "Evaluate triage status for women with positive HPV DNA test results",
    "trigger" : [{
      "type" : "named-event",
      "name" : "patient-view"
    }],
    "condition" : [{
      "kind" : "applicability",
      "expression" : {
        "language" : "text/cql-identifier",
        "expression" : "Triage Is Indicated",
        "reference" : "Library/CervicalCancerTriageDecision"
      }
    }],
    "action" : [{
      "id" : "perform-via",
      "title" : "Perform VIA Triage",
      "description" : "HPV DNA test is positive — perform VIA (visual inspection with acetic acid) to determine treatment pathway",
      "condition" : [{
        "kind" : "applicability",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Triage Is Indicated",
          "reference" : "Library/CervicalCancerTriageDecision"
        }
      }],
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/action-type",
          "code" : "create"
        }]
      },
      "dynamicValue" : [{
        "path" : "payload[0].contentString",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Triage Recommended Action",
          "reference" : "Library/CervicalCancerTriageDecision"
        }
      }]
    },
    {
      "id" : "via-positive-treat",
      "title" : "VIA Positive — Proceed to Treatment",
      "description" : "VIA triage is positive — assess ablation eligibility and treat",
      "condition" : [{
        "kind" : "applicability",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Proceed To Treatment",
          "reference" : "Library/CervicalCancerTriageDecision"
        }
      }],
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/action-type",
          "code" : "create"
        }]
      },
      "dynamicValue" : [{
        "path" : "payload[0].contentString",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Triage Recommended Action",
          "reference" : "Library/CervicalCancerTriageDecision"
        }
      }]
    },
    {
      "id" : "via-negative-followup",
      "title" : "VIA Negative — Schedule Follow-Up HPV Retest",
      "description" : "VIA triage is negative — schedule HPV DNA retest at 12 months (WLHIV) or 24 months (general population)",
      "condition" : [{
        "kind" : "applicability",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Proceed To Follow Up Retest",
          "reference" : "Library/CervicalCancerTriageDecision"
        }
      }],
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/action-type",
          "code" : "create"
        }]
      },
      "dynamicValue" : [{
        "path" : "payload[0].contentString",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Triage Recommended Action",
          "reference" : "Library/CervicalCancerTriageDecision"
        }
      }]
    },
    {
      "id" : "suspicious-refer",
      "title" : "Suspicious for Cancer — Refer to Oncology",
      "description" : "Findings are suspicious for invasive cancer — refer for definitive diagnosis and staging",
      "priority" : "urgent",
      "condition" : [{
        "kind" : "applicability",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Needs Referral",
          "reference" : "Library/CervicalCancerTriageDecision"
        }
      }],
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/action-type",
          "code" : "create"
        }]
      },
      "dynamicValue" : [{
        "path" : "payload[0].contentString",
        "expression" : {
          "language" : "text/cql-identifier",
          "expression" : "Triage Recommended Action",
          "reference" : "Library/CervicalCancerTriageDecision"
        }
      }]
    }]
  }]
}