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

Decision Tables

Decision Table Comparison

This page presents the textualist and purposive decision tables side by side for each of the six decisions in Algorithm 5. Divergences are noted with references to the Interpretation Register.

1. Screening Decision

Determines whether a patient is eligible for cervical cancer screening and the recommended screening interval.

Textualist

Client Is Woman Age In Years Living With HIV Eligible Screening Interval
true [30..49] false true "every 5 to 10 years"
true [25..49] true true "every 3 to 5 years"
true <30 false false –
true <25 true false –
true >49 – false –
false – – false –

Purposive

Is Female Age In Years Is WLHIV Has Cervical Cancer Eligible Interval (years)
true [30..49] false false true 5
true [25..49] true false true 3
true <30 false false false –
true <25 true false false –
true >49 – false false –
true – – true false –
false – – – false –

Key divergences:

  • Interval resolved from text range to numeric lower bound (Register #1, #3)
  • Client Is Woman vs Patient.gender = 'female' (Register #2)
  • Cervical cancer exclusion added as input (Register #6)
  • HIV status determined from EHR Condition resource (Register #7)

2. Due for Screening

Determines whether screening is currently needed based on eligibility and screening history.

Textualist

Eligible Interval Years Since Last Screen Prior Result Screening Status
true – null – never screened – screen now
true "every 5 to 10 years" <5 negative not yet due
true "every 5 to 10 years" [5..10] negative within screening window
true "every 5 to 10 years" >10 negative past screening window
true "every 3 to 5 years" <3 negative not yet due
true "every 3 to 5 years" [3..5] negative within screening window
true "every 3 to 5 years" >5 negative past screening window
true – – positive prior positive – enter triage pathway
false – – – not eligible

Purposive

Eligible Interval (years) Years Since Last HPV Test Has Ever Been Screened Screening Status
true – – false due for screening
true not null >= interval true due for screening
true not null < interval true not yet due
false – – – not eligible

Key divergences:

  • Textualist has 3 states (not yet due, within window, past window); purposive has 2 (due, not yet due) (Register #8)
  • Single threshold at lower bound vs. screening window range (Register #8, #9)
  • Separate HasEverBeenScreened input vs. null encoding (Register #10)
  • No "prior positive" routing in purposive Due for Screening – handled by Triage Decision instead

3. Triage Decision

Routes HPV-positive patients based on VIA triage results.

Textualist

VIA Result Living With HIV Triage Status
positive – VIA positive – eligible for treatment
negative false VIA negative – repeat HPV test in 2 years
negative true VIA negative – repeat HPV test in 1 year
suspected cancer – suspected cancer – refer for evaluation and biopsy

Purposive

VIA Result Is WLHIV VIA After HPV Has Cervical Cancer Triage Status Retest Months
– – – true refer to oncology –
positive – true false VIA positive – proceed to treatment –
negative false true false VIA negative – repeat HPV test in 24 months 24
negative true true false VIA negative – repeat HPV test in 12 months 12
– – false false awaiting VIA triage –

Key divergences:

  • VIA positive = CIEL code 703; binary interpretation (Register #11)
  • "Suspected cancer" replaced with cervical cancer diagnosis proxy (Register #12)
  • VIA must occur after HPV test (temporal sequencing) (Register #13)
  • Follow-up intervals resolved to exact months (Register #14, #15)
  • "Awaiting triage" state added for real-world workflow (Register #16)

4. Ablation Eligibility

Determines whether ablative treatment is appropriate.

Textualist

Suspicion of Cancer TZ Type Ablation Eligible
true – false
false Type 1 true
false Type 2 true
false Type 3 false

Purposive

Has Cervical Cancer Has CIN2+ Known Contraindication Modality Recommendation
true – true excision – ablation contraindicated
false true false consider excision – CIN2+ diagnosed
false false false assess TZ at point of care

Key divergences:

  • Textualist computes eligibility from TZ type; purposive defers TZ to clinician (Register #18, #19)
  • CIN2+ modality preference added (Register #20)
  • Output is a recommendation string, not a boolean (Register #19)

5. Treatment Decision

Selects treatment modality based on triage and ablation eligibility.

Textualist

Triage Status Ablation Eligible Treatment Plan
VIA positive true ablative treatment
VIA positive false LLETZ
VIA negative (gen) – no treatment – repeat HPV in 2 years
VIA negative (WLHIV) – no treatment – repeat HPV in 1 year
suspected cancer – refer for evaluation and biopsy

Purposive

Triage Status Modality Recommendation Has Been Treated Treatment Plan
– – true already treated – see follow-up
refer to oncology – false refer to oncology
VIA positive assess TZ at point of care false assess TZ – ablation or excision
VIA positive consider excision (CIN2+) false consider excision (LEEP/LLETZ)
VIA positive ablation contraindicated false excision (LEEP/LLETZ)
VIA negative (24 months) – false no treatment – repeat HPV in 24 months
VIA negative (12 months) – false no treatment – repeat HPV in 12 months
awaiting VIA triage – false no treatment decision

Key divergences:

  • "Already treated" guard prevents re-treatment (Register #21)
  • Treatment modality is clinician-guided, not computed (Register #22)
  • Thermal ablation preferred over cryotherapy (Register #23)

6. Follow-up Decision

Determines post-treatment and post-triage-negative follow-up scheduling.

Textualist

Treatment Plan Histology Result Follow-up Plan
ablative treatment CIN3 or less post-treatment follow-up after 1 year
ablative treatment cancer cancer – further management
LLETZ CIN3 or less post-treatment follow-up after 1 year
LLETZ cancer cancer – further management
no treatment (gen) – repeat HPV test after 2 years
no treatment (WLHIV) – repeat HPV test after 1 year
refer for evaluation – evaluation, biopsy and further management

Purposive

Treatment Plan Is WLHIV Months Since Tx HPV After Tx Tests Since Tx Retest Positive Follow-up Plan Status
– – – true – true re-enter triage/treatment retest-positive-reenter
– true – true >=2 false return to routine (3-5 years) return-to-routine
– false – true >=1 false return to routine (5-10 years) return-to-routine
– true – true 1 false WLHIV second retest at 12 months wlhiv-awaiting-second-retest
– – >=12 false 0 – post-treatment HPV retest due post-treatment-retest-due
– – [10..12) false 0 – retest approaching post-treatment-retest-approaching
– – [0..10) false 0 – retest at 12 months post-treatment-waiting
no treatment (gen) false – – – – repeat HPV after 24 months post-triage-negative-waiting
no treatment (WLHIV) true – – – – repeat HPV after 12 months post-triage-negative-waiting
refer to oncology – – – – – oncology management refer-oncology

Key divergences:

  • No histology input; follow-up driven by HPV retest results (Register #30)
  • WLHIV double follow-up fully modeled (Register #26, #27)
  • 2-month "approaching" scheduling window (Register #25, #28)
  • Post-treatment HPV test must be strictly after treatment date (Register #29)
  • Return-to-routine criteria based on retest results, not histology (Register #31)
  • Known gap: general pop post-triage-negative return to routine not covered (Register #32)