Cervical Cancer Screening CDS for OpenMRS
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Cervical Cancer Screening CDS for OpenMRS, published by Hopena Health. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/dhes/cervical-cancer-cds/tree/main and changes regularly. See the Directory of published versions

Clinical Algorithm

WHO Algorithm 5: HPV DNA + VIA Triage

This IG implements Algorithm 5 from the WHO cervical cancer screening guideline. It applies to both the general population and women living with HIV (WLHIV), with population-specific parameters at each decision point.

Screening Cascade

HPV DNA test (self- or clinician-collected)
+-- HPV negative --> Return to routine screening
+-- HPV positive --> VIA triage
    +-- VIA positive --> Assess ablation eligibility --> Treat
    +-- VIA negative --> Schedule follow-up HPV retest
    +-- Suspicious for cancer --> Refer to oncology

Population Parameters

Parameter General Population WLHIV
Start screening age 30 25
Priority age range 30–49 25–49
Cessation After age 50 with 2 consecutive negatives After age 50 with 2 consecutive negatives
Screening interval (HPV DNA) 5-10 years 3-5 years
Post-triage-negative retest 24 months 12 months
Post-treatment retest 12 months 12 months, then 12 months again

CQL Library Mapping

Decision Point CQL Library PlanDefinition
Screening eligibility and scheduling CervicalCancerScreeningDecision CervicalCancerScreening
HPV-positive triage CervicalCancerTriageDecision CervicalCancerTriage
Treatment modality selection CervicalCancerTreatmentDecision CervicalCancerTreatment
Follow-up scheduling CervicalCancerFollowUpDecision CervicalCancerFollowUp
Shared definitions CervicalCancerScreeningCommon (included by all)

WHO Recommendations Covered

General population: Recs 1, 2, 3b, 5, 6, 7, 8, 11, 13, 14

WLHIV: Recs 21, 22, 23, 25, 26, 27, 28, 31, 33, 34

Cascade Statuses

The Screening Decision library assigns each patient a machine-readable Cascade Status value indicating their current position:

Status Meaning
not-eligible Does not meet age/sex criteria for screening
due-for-screening Eligible and screening is currently due
needs-triage HPV-positive, awaiting VIA triage
needs-treatment HPV+ and VIA+, treatment indicated
triage-negative-follow-up HPV+ VIA-, in follow-up retest window
post-treatment-follow-up Treated, in post-treatment retest window
routine-recall Last HPV negative, next screening not yet due
assess-cessation Age 50+ with 2 consecutive negatives

WLHIV Double Follow-Up (WHO Rec 33)

Women living with HIV require two consecutive negative HPV retests at 12-month intervals after treatment before returning to routine screening. The Follow-Up Decision library tracks the count of post-treatment HPV tests to manage this requirement.

Decision Modeling

For a formal analysis of how the CQL implementation relates to the WHO guideline text, including every interpretive decision made during implementation, see the Decision Modeling section.