Cervical Cancer Screening CDS for OpenMRS
0.1.0 - ci-build International flag

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

Architecture

CQL Library Architecture

All decision libraries include a shared Common library that provides patient demographics, HIV status, and clinical history retrieval.

CervicalCancerScreeningCommon (shared definitions)
  |
  +-- CervicalCancerScreeningDecision (eligibility, cascade routing)
  +-- CervicalCancerTriageDecision (HPV+ VIA triage)
  +-- CervicalCancerTreatmentDecision (ablation eligibility, modality)
  +-- CervicalCancerFollowUpDecision (retest scheduling, WLHIV double follow-up)

FHIR Resource Dependencies

PlanDefinition (ECA rule)
  --> Library (CQL wrapper)
        --> CQL source (text/cql)
        --> ELM compiled (application/elm+json)

Each PlanDefinition references its Library via the library element. Library resources contain base64-encoded CQL and ELM in their content array, populated by the IG Publisher during build.

Data Requirements

The CQL retrieves three FHIR resource types from the patient record:

Resource Purpose Key Codes (CIEL)
Patient Age, sex –
Observation HPV tests, VIA results, treatments 170145, 151185, 166706, 162812, 165084
Condition HIV status, cervical cancer, CIN diagnoses 138405, 116023, 145809, 145807, 145806

OpenMRS FHIR2 Constraints

This IG targets the OpenMRS FHIR2 module, which has specific constraints:

  • No Procedure resource: Treatments (thermal ablation, cryotherapy, LEEP) are recorded as Observations with treatment concept codes and value = Positive (CIEL 703)
  • SNOMED URI: OpenMRS uses http://snomed.info/sct/ (with trailing slash) rather than the standard http://snomed.info/sct
  • ServiceRequest: Read-only in OpenMRS FHIR2

Terminology Approach

The CQL uses CIEL concept IDs as the primary code system (https://cielterminology.org), matching the OpenMRS concept dictionary. CIEL concepts are mapped to SNOMED CT, LOINC, and ICD-10 in the OpenMRS concept dictionary.

The CQL retrieves observations using .code.coding.code contains '<CIEL code>' patterns and checks result values using CIEL Positive (703) and Negative (664).

CQL Evaluation

The CQL is designed for client-side evaluation using the JavaScript cql-execution engine against the OpenMRS FHIR R4 endpoint. This architecture follows the approach validated by Bacher et al. in "FHIRing up OpenMRS" (AMIA 2024, PMC11141833).

Production deployment target: OpenMRS O3 microfrontend running cql-execution in the browser, with FHIR data fetched from the local OpenMRS instance.