diff --git a/apply/screening-example.js b/apply/screening-example.js index 399ddcb3..881d8629 100644 --- a/apply/screening-example.js +++ b/apply/screening-example.js @@ -33,7 +33,7 @@ const elmJsonDependencyArray = [ JSON.parse(readFileSync('cql/ScreeningDesExposureLibrary.json')), JSON.parse(readFileSync('cql/ScreeningImmunocompromisedLibrary.json')), JSON.parse(readFileSync('cql/ScreeningAverageRiskLibrary.json')), - JSON.parse(readFileSync('cql/DisplayCervicalCancerMedicalHistory.json')), + JSON.parse(readFileSync('cql/DashboardLibrary.json')), JSON.parse(readFileSync('cql/CCSMCommonFunctions.json')), JSON.parse(readFileSync('cql/CDSConnectCommonsforFHIRv401.json')), ]; diff --git a/cql/AutogeneratedRiskTables.cql b/cql/AutogeneratedRiskTables.cql index 35d4edbd..5d25c6b6 100644 --- a/cql/AutogeneratedRiskTables.cql +++ b/cql/AutogeneratedRiskTables.cql @@ -11,19 +11,19 @@ include "FHIRHelpers" version '4.0.1' called FHIRHelpers // METADATA // Downloaded from: https://cervixca.nlm.nih.gov/RiskTables/ - // Date Generated: 10/07/2021 12:35:08 + // Date Generated: 31/05/2022 13:25:59 // Number of Risk Tables: 5 // Risk Tables: // 1 - Screening - // (last downloaded: Tue May 11 06:13:16 2021) + // (last downloaded: Tue May 31 10:30:43 2022) // 2 - Surveillance - // (last downloaded: Tue May 11 06:13:16 2021) + // (last downloaded: Tue May 31 10:30:43 2022) // 3 - Colposcopy Results - // (last downloaded: Tue May 11 06:13:16 2021) + // (last downloaded: Tue May 31 10:30:43 2022) // 4 - Post Colpo Surveillance - // (last downloaded: Tue May 11 06:13:16 2021) + // (last downloaded: Tue May 31 10:30:43 2022) // 5 - Post Treatment Surveillance - // (last downloaded: Tue May 11 06:13:16 2021) + // (last downloaded: Tue May 31 10:30:43 2022) // Export Risk Tables define ClinicalSituations: diff --git a/cql/CCSMCommonFunctions.cql b/cql/CCSMCommonFunctions.cql index 1f3dc37c..b73885e2 100644 --- a/cql/CCSMCommonFunctions.cql +++ b/cql/CCSMCommonFunctions.cql @@ -43,7 +43,7 @@ define function DateText(d FHIR.date): // @param d - a FHIR dateTime to get text for // @returns {System.String} the text representation of the dateTime define function DateTimeText(d FHIR.dateTime): - ToString(d.value) + First(SplitOnMatches(ToString(d.value), 'T')) // Returns a text representation of an instant using the CQL `ToString` function. // @param i - a FHIR instant to get text for diff --git a/cql/CCSMCommonFunctions.json b/cql/CCSMCommonFunctions.json index 11a92cb2..81bb23a3 100644 --- a/cql/CCSMCommonFunctions.json +++ b/cql/CCSMCommonFunctions.json @@ -118,13 +118,24 @@ "accessLevel" : "Public", "type" : "FunctionDef", "expression" : { - "type" : "ToString", - "operand" : { - "path" : "value", - "type" : "Property", - "source" : { - "name" : "d", - "type" : "OperandRef" + "type" : "First", + "source" : { + "type" : "SplitOnMatches", + "stringToSplit" : { + "type" : "ToString", + "operand" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "d", + "type" : "OperandRef" + } + } + }, + "separatorPattern" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "T", + "type" : "Literal" } } }, diff --git a/cql/CollateManagementData.cql b/cql/CollateManagementData.cql new file mode 100644 index 00000000..630f492e --- /dev/null +++ b/cql/CollateManagementData.cql @@ -0,0 +1,406 @@ +/* + Library: Management of Abnormal Cervical Cancer Screening Results + Author: CMS Alliance to Modernize Healthcare, operated by THE MITRE Corporation. + + (C) 2021 The MITRE Corporation. All Rights Reserved. + Approved for Public Release: 21-1556. + Distribution Unlimited. + + Unless otherwise noted, this work is available under an Apache 2.0 license. + It was produced by the MITRE Corporation for the Division of Cancer Prevention + and Control, Centers for Disease Control and Prevention in accordance with the + Statement of Work, contract number 75FCMC18D0047, task order number 75D30120F09743. +*/ + +library CollateManagementData version '1.1.0' + +using FHIR version '4.0.1' + +include FHIRHelpers version '4.0.1' called FHIRHelpers +include DashboardLibrary version '1.0.0' called Dash +include CCSMCommonFunctions version '1.0.0' called Common + +//------------------------------------------------------------------------------ +// CODE SYSTEMS, VALUE SETS, AND CODES +//------------------------------------------------------------------------------ + +//------------------------------------------------------------------------------ +// PARAMETERS +//------------------------------------------------------------------------------ + +parameter BiopsyLookbackPeriod default 25 years +parameter BiopsyReferralPeriod default 1 month +parameter HpvTestingGracePeriod default 6 months + +/***** BEGIN CDS LOGIC ********************************************************/ + +context Patient + +//------------------------------------------------------------------------------ +// FUNCTIONS +//------------------------------------------------------------------------------ + +define HpvTestingInterval: + 5 years + HpvTestingGracePeriod + +define function HPVTestingIntervalLookBack(LookBackDate System.DateTime): + Interval[LookBackDate - HpvTestingInterval, LookBackDate) + +// TODO: Confirm that we actually need this +define function GetEarlierDate(d1 System.DateTime, d2 System.DateTime): + if d1 is not null then + if d2 is not null then + if d1 same or before d2 then d1 + else d2 + else d1 + else + if d2 is not null then d2 + else null + +define function CytologyInterpretation(conclusions List): + Dash.CytologyInterpretation(conclusions) + +define function HpvInterpretation(conclusions List): + Dash.HpvInterpretation(conclusions) + +define function HighestRankedInterpretation(interpretations List): + Dash.HighestRankedInterpretation(interpretations) + +define function BiopsyInterpretation(conclusions List): + Dash.BiopsyInterpretation(conclusions) + +//------------------------------------------------------------------------------ +// DATA RETRIEVAL +//------------------------------------------------------------------------------ + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// HPV TESTS + +define HpvReports: + Dash.HpvDiagnosticReports + +define SortedHpvReports: + (HpvReports) H + return { + riskTableInput: HighestRankedInterpretation( + HpvInterpretation( + H.conclusionCode + ) + ), + allConclusions: H.conclusionCode, + date: Common.DiagnosticReportDate(H) + } + sort by date desc + +define MostRecentHpvReport: + if Count(SortedHpvReports) > 0 then + if SortedHpvReports[0].date included in HPVTestingIntervalLookBack(Today()) then + SortedHpvReports[0] + else + null + else + null + +define SecondMostRecentHpvReport: + if Count(SortedHpvReports) > 1 then + if SortedHpvReports[1].date included in HPVTestingIntervalLookBack(MostRecentHpvReport.date) then + SortedHpvReports[1] + else + null + else + null + +define ThirdMostRecentHpvReport: + if Count(SortedHpvReports) > 2 then + if SortedHpvReports[2].date included in HPVTestingIntervalLookBack(SecondMostRecentHpvReport.date) then + SortedHpvReports[2] + else + null + else + null + +define FourthMostRecentHpvReport: + if Count(SortedHpvReports) > 3 then + if SortedHpvReports[3].date included in HPVTestingIntervalLookBack(ThirdMostRecentHpvReport.date) then + SortedHpvReports[3] + else + null + else + null + +define MostRecentHpvResult: + MostRecentHpvReport.riskTableInput + +define SecondMostRecentHpvResult: + SecondMostRecentHpvReport.riskTableInput + +define ThirdMostRecentHpvResult: + ThirdMostRecentHpvReport.riskTableInput + +define FourthMostRecentHpvResult: + FourthMostRecentHpvReport.riskTableInput + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// CERVICAL CYTOLOGY + +define CervicalCytologyReports: + Dash.CervicalCytologyReports + +define SortedCytologyReports: + (CervicalCytologyReports) C + return { + riskTableInput: HighestRankedInterpretation( + CytologyInterpretation( + C.conclusionCode + ) + ), + allConclusions: C.conclusionCode, + date: Common.DiagnosticReportDate(C) + } + sort by date desc + +// Edge Cases: +// DONE: 1. HPV but no cytology (solution: just use HPV) +// TODO: 2. Cytology but no HPV (no solution: display error) +// NOTE: This is being updated based on "gaps" document + +define MostRecentCytologyCotest: + Coalesce( + (SortedCytologyReports) S + where S.date within 1 day of MostRecentHpvReport.date + ) + +define SecondMostRecentCytologyCotest: + Coalesce( + (SortedCytologyReports) S + where S.date within 1 day of SecondMostRecentHpvReport.date + ) + +define ThirdMostRecentCytologyCotest: + Coalesce( + (SortedCytologyReports) S + where S.date within 1 day of ThirdMostRecentHpvReport.date + ) + +define FourthMostRecentCytologyCotest: + Coalesce( + (SortedCytologyReports) S + where S.date within 1 day of FourthMostRecentHpvReport.date + ) + +define MostRecentCytologyCotestResult: + if MostRecentHpvReport is null then + null + else + if MostRecentCytologyCotest is null then + 'ALL' + else + MostRecentCytologyCotest.riskTableInput + +define SecondMostRecentCytologyCotestResult: + if SecondMostRecentHpvReport is null then + null + else + if SecondMostRecentCytologyCotest is null then + 'ALL' + else + SecondMostRecentCytologyCotest.riskTableInput + +define ThirdMostRecentCytologyCotestResult: + if ThirdMostRecentHpvReport is null then + null + else + if ThirdMostRecentCytologyCotest is null then + 'ALL' + else + ThirdMostRecentCytologyCotest.riskTableInput + +define FourthMostRecentCytologyCotestResult: + if FourthMostRecentHpvReport is null then + null + else + if FourthMostRecentCytologyCotest is null then + 'ALL' + else + FourthMostRecentCytologyCotest.riskTableInput + +// Just cytology... not necessarily a cotest +define MostRecentCytologyReport: + if Count(SortedCytologyReports) > 0 then + SortedCytologyReports[0] + else + null + +define MostRecentCytologyReportWasWithinPastFiveYears: + MostRecentCytologyReport.date >= Now() - 5 years + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// BIOPSIES / HISTOLOGY + +define BiopsyReports: + Common.LookBack( + Dash.HistologyDiagnosticReports, + BiopsyLookbackPeriod + ) + +define SortedBiopsyReports: + (BiopsyReports) B + return { + riskTableInput: HighestRankedInterpretation( + BiopsyInterpretation( + B.conclusionCode + ) + ), + allConclusions: B.conclusionCode, + date: Common.DiagnosticReportDate(B) + } + sort by date desc + +define MostRecentBiopsyReport: + if Count(SortedBiopsyReports) > 0 then + SortedBiopsyReports[0] + else + null + +define MostRecentBiopsyResult: + MostRecentBiopsyReport.riskTableInput + +define MostRecentBiopsyReferralPeriod: + Interval[MostRecentBiopsyReport.date - BiopsyReferralPeriod, MostRecentBiopsyReport.date) + +define ReferringHpvResult: + if MostRecentHpvReport.date included in MostRecentBiopsyReferralPeriod then + MostRecentHpvResult + else if SecondMostRecentHpvReport.date included in MostRecentBiopsyReferralPeriod then + SecondMostRecentHpvResult + else if ThirdMostRecentHpvReport.date included in MostRecentBiopsyReferralPeriod then + ThirdMostRecentHpvResult + else if FourthMostRecentHpvReport.date included in MostRecentBiopsyReferralPeriod then + FourthMostRecentHpvResult + else + 'ALL' + +define MostRecentCytologyBeforeBiopsy: + Coalesce( + (SortedCytologyReports) S + where S.date included in MostRecentBiopsyReferralPeriod + ) + +define MostRecentCytologyResultBeforeBiopsy: + MostRecentCytologyBeforeBiopsy.riskTableInput + +define ReferringCytologyResult: + if MostRecentCytologyCotest.date included in MostRecentBiopsyReferralPeriod then + MostRecentCytologyCotestResult + else if SecondMostRecentCytologyCotest.date included in MostRecentBiopsyReferralPeriod then + SecondMostRecentCytologyCotestResult + else if ThirdMostRecentCytologyCotest.date included in MostRecentBiopsyReferralPeriod then + ThirdMostRecentCytologyCotestResult + else if FourthMostRecentCytologyCotest.date included in MostRecentBiopsyReferralPeriod then + FourthMostRecentCytologyCotestResult + else if MostRecentCytologyBeforeBiopsy is not null then + MostRecentCytologyResultBeforeBiopsy + else + 'ALL' + +define MostRecentHpvResultPostBiopsy: + if MostRecentHpvReport.date occurs after MostRecentBiopsyReport.date then + MostRecentHpvResult + else + null + +define MostRecentCytologyResultPostBiopsy: + if MostRecentCytologyCotest.date occurs after MostRecentBiopsyReport.date then + MostRecentCytologyCotestResult + else + null + +define SecondMostRecentHpvResultPostBiopsy: + if SecondMostRecentHpvReport.date occurs after MostRecentBiopsyReport.date then + SecondMostRecentHpvResult + else + null + +define SecondMostRecentCytologyResultPostBiopsy: + if SecondMostRecentCytologyCotest.date occurs after MostRecentBiopsyReport.date then + SecondMostRecentCytologyCotestResult + else + null + +define ThirdMostRecentHpvResultPostBiopsy: + if ThirdMostRecentHpvReport.date occurs after MostRecentBiopsyReport.date then + ThirdMostRecentHpvResult + else + null + +define ThirdMostRecentCytologyResultPostBiopsy: + if ThirdMostRecentCytologyCotest.date occurs after MostRecentBiopsyReport.date then + ThirdMostRecentCytologyCotestResult + else + null + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// TREATMENTS + +// Find CIN2/CIN3 biopsy +define Cin2orCin3Biopsies: + SortedBiopsyReports S + where S.riskTableInput in {'CIN2','CIN3'} + +define MostRecentCin2orCin3Biopsy: + First(Cin2orCin3Biopsies) + +// Look for treatments after this CIN2/CIN3 biopsy +define CervicalPrecancerTreatments: + Dash.CervicalExcisionProcedures union + Dash.CervicalAblationProcedures + +define CervicalPrecancerTreatmentsAfterBiopsy: + CervicalPrecancerTreatments T + where Common.ProcedureDate(T) occurs after MostRecentCin2orCin3Biopsy.date + return { + date: Common.ProcedureDate(T) + } + sort by date + +define DateOfLastCervicalPrecancerTreatment: + Last( + CervicalPrecancerTreatmentsAfterBiopsy + ).date + +// Look for HPV/pap tests after treatment +define MostRecentHpvResultAfterTreatment: + if MostRecentHpvReport.date occurs after DateOfLastCervicalPrecancerTreatment then + MostRecentHpvResult + else + null + +define SecondMostRecentHpvResultAfterTreatment: + if SecondMostRecentHpvReport.date occurs after DateOfLastCervicalPrecancerTreatment then + SecondMostRecentHpvResult + else + null + +define ThirdMostRecentHpvResultAfterTreatment: + if ThirdMostRecentHpvReport.date occurs after DateOfLastCervicalPrecancerTreatment then + ThirdMostRecentHpvResult + else + null + +define MostRecentCytologyResultAfterTreatment: + if MostRecentHpvResultAfterTreatment is null then + null + else + MostRecentCytologyCotestResult + +define SecondMostRecentCytologyResultAfterTreatment: + if SecondMostRecentHpvResultAfterTreatment is null then + null + else + SecondMostRecentCytologyCotestResult + +define ThirdMostRecentCytologyResultAfterTreatment: + if ThirdMostRecentHpvResultAfterTreatment is null then + null + else + ThirdMostRecentCytologyCotestResult diff --git a/cql/CollateManagementData.json b/cql/CollateManagementData.json new file mode 100644 index 00000000..db1b0996 --- /dev/null +++ b/cql/CollateManagementData.json @@ -0,0 +1,2767 @@ +{ + "library" : { + "annotation" : [ { + "translatorOptions" : "", + "type" : "CqlToElmInfo" + } ], + "identifier" : { + "id" : "CollateManagementData", + "version" : "1.1.0" + }, + "schemaIdentifier" : { + "id" : "urn:hl7-org:elm", + "version" : "r1" + }, + "usings" : { + "def" : [ { + "localIdentifier" : "System", + "uri" : "urn:hl7-org:elm-types:r1" + }, { + "localIdentifier" : "FHIR", + "uri" : "http://hl7.org/fhir", + "version" : "4.0.1" + } ] + }, + "includes" : { + "def" : [ { + "localIdentifier" : "FHIRHelpers", + "path" : "FHIRHelpers", + "version" : "4.0.1" + }, { + "localIdentifier" : "Dash", + "path" : "DashboardLibrary", + "version" : "1.0.0" + }, { + "localIdentifier" : "Common", + "path" : "CCSMCommonFunctions", + "version" : "1.0.0" + } ] + }, + "parameters" : { + "def" : [ { + "name" : "BiopsyLookbackPeriod", + "accessLevel" : "Public", + "default" : { + "value" : 25, + "unit" : "years", + "type" : "Quantity" + } + }, { + "name" : "BiopsyReferralPeriod", + "accessLevel" : "Public", + "default" : { + "value" : 1, + "unit" : "month", + "type" : "Quantity" + } + }, { + "name" : "HpvTestingGracePeriod", + "accessLevel" : "Public", + "default" : { + "value" : 6, + "unit" : "months", + "type" : "Quantity" + } + } ] + }, + "contexts" : { + "def" : [ { + "name" : "Patient" + } ] + }, + "statements" : { + "def" : [ { + "name" : "Patient", + "context" : "Patient", + "expression" : { + "type" : "SingletonFrom", + "operand" : { + "dataType" : "{http://hl7.org/fhir}Patient", + "templateId" : "http://hl7.org/fhir/StructureDefinition/Patient", + "type" : "Retrieve" + } + } + }, { + "name" : "HpvTestingInterval", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Add", + "operand" : [ { + "value" : 5, + "unit" : "years", + "type" : "Quantity" + }, { + "name" : "HpvTestingGracePeriod", + "type" : "ParameterRef" + } ] + } + }, { + "name" : "HPVTestingIntervalLookBack", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "lowClosed" : true, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "name" : "LookBackDate", + "type" : "OperandRef" + }, { + "name" : "HpvTestingInterval", + "type" : "ExpressionRef" + } ] + }, + "high" : { + "name" : "LookBackDate", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "LookBackDate", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}DateTime", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "GetEarlierDate", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "d1", + "type" : "OperandRef" + } + } + } + }, + "then" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "d2", + "type" : "OperandRef" + } + } + } + }, + "then" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "SameOrBefore", + "operand" : [ { + "name" : "d1", + "type" : "OperandRef" + }, { + "name" : "d2", + "type" : "OperandRef" + } ] + } + }, + "then" : { + "name" : "d1", + "type" : "OperandRef" + }, + "else" : { + "name" : "d2", + "type" : "OperandRef" + } + }, + "else" : { + "name" : "d1", + "type" : "OperandRef" + } + }, + "else" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "d2", + "type" : "OperandRef" + } + } + } + }, + "then" : { + "name" : "d2", + "type" : "OperandRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}DateTime", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, + "operand" : [ { + "name" : "d1", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}DateTime", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "d2", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}DateTime", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "CytologyInterpretation", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "name" : "CytologyInterpretation", + "libraryName" : "Dash", + "type" : "FunctionRef", + "operand" : [ { + "name" : "conclusions", + "type" : "OperandRef" + } ] + }, + "operand" : [ { + "name" : "conclusions", + "operandTypeSpecifier" : { + "type" : "ListTypeSpecifier", + "elementType" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } + } ] + }, { + "name" : "HpvInterpretation", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "name" : "HpvInterpretation", + "libraryName" : "Dash", + "type" : "FunctionRef", + "operand" : [ { + "name" : "conclusions", + "type" : "OperandRef" + } ] + }, + "operand" : [ { + "name" : "conclusions", + "operandTypeSpecifier" : { + "type" : "ListTypeSpecifier", + "elementType" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } + } ] + }, { + "name" : "HighestRankedInterpretation", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "name" : "HighestRankedInterpretation", + "libraryName" : "Dash", + "type" : "FunctionRef", + "operand" : [ { + "name" : "interpretations", + "type" : "OperandRef" + } ] + }, + "operand" : [ { + "name" : "interpretations", + "operandTypeSpecifier" : { + "type" : "ListTypeSpecifier", + "elementType" : { + "type" : "TupleTypeSpecifier", + "element" : [ { + "name" : "text", + "elementType" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "rank", + "elementType" : { + "name" : "{urn:hl7-org:elm-types:r1}Integer", + "type" : "NamedTypeSpecifier" + } + } ] + } + } + } ] + }, { + "name" : "BiopsyInterpretation", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "name" : "BiopsyInterpretation", + "libraryName" : "Dash", + "type" : "FunctionRef", + "operand" : [ { + "name" : "conclusions", + "type" : "OperandRef" + } ] + }, + "operand" : [ { + "name" : "conclusions", + "operandTypeSpecifier" : { + "type" : "ListTypeSpecifier", + "elementType" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } + } ] + }, { + "name" : "HpvReports", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "HpvDiagnosticReports", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + }, { + "name" : "SortedHpvReports", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "H", + "expression" : { + "name" : "HpvReports", + "type" : "ExpressionRef" + } + } ], + "relationship" : [ ], + "return" : { + "expression" : { + "type" : "Tuple", + "element" : [ { + "name" : "riskTableInput", + "value" : { + "name" : "HighestRankedInterpretation", + "type" : "FunctionRef", + "operand" : [ { + "name" : "HpvInterpretation", + "type" : "FunctionRef", + "operand" : [ { + "type" : "Query", + "source" : [ { + "alias" : "X", + "expression" : { + "path" : "conclusionCode", + "scope" : "H", + "type" : "Property" + } + } ], + "return" : { + "distinct" : false, + "expression" : { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "X", + "type" : "AliasRef" + } ] + } + } + } ] + } ] + } + }, { + "name" : "allConclusions", + "value" : { + "path" : "conclusionCode", + "scope" : "H", + "type" : "Property" + } + }, { + "name" : "date", + "value" : { + "name" : "DiagnosticReportDate", + "libraryName" : "Common", + "type" : "FunctionRef", + "operand" : [ { + "name" : "H", + "type" : "AliasRef" + } ] + } + } ] + } + }, + "sort" : { + "by" : [ { + "direction" : "desc", + "path" : "date", + "type" : "ByColumn" + } ] + } + } + }, { + "name" : "MostRecentHpvReport", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Greater", + "operand" : [ { + "type" : "Count", + "source" : { + "name" : "SortedHpvReports", + "type" : "ExpressionRef" + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "0", + "type" : "Literal" + } ] + } + }, + "then" 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"name" : "ThirdMostRecentHpvResultPostBiopsy", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "After", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "ThirdMostRecentHpvReport", + "type" : "ExpressionRef" + } + }, { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "type" : "ExpressionRef" + } + } ] + } + }, + "then" : { + "name" : "ThirdMostRecentHpvResult", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "ThirdMostRecentCytologyResultPostBiopsy", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "After", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "ThirdMostRecentCytologyCotest", + "type" : "ExpressionRef" + } + }, { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "type" : "ExpressionRef" + } + } ] + } + }, + "then" : { + "name" : "ThirdMostRecentCytologyCotestResult", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "Cin2orCin3Biopsies", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "S", + "expression" : { + "name" : "SortedBiopsyReports", + "type" : "ExpressionRef" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "In", + "operand" : [ { + "path" : "riskTableInput", + "scope" : "S", + "type" : "Property" + }, { + "type" : "List", + "element" : [ { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "CIN2", + "type" : "Literal" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "CIN3", + "type" : "Literal" + } ] + } ] + } + } + }, { + "name" : "MostRecentCin2orCin3Biopsy", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "First", + "source" : { + "name" : "Cin2orCin3Biopsies", + "type" : "ExpressionRef" + } + } + }, { + "name" : "CervicalPrecancerTreatments", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Union", + "operand" : [ { + "name" : "CervicalExcisionProcedures", + "libraryName" : "Dash", + "type" : "ExpressionRef" + }, { + "name" : "CervicalAblationProcedures", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "CervicalPrecancerTreatmentsAfterBiopsy", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "T", + "expression" : { + "name" : "CervicalPrecancerTreatments", + "type" : "ExpressionRef" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "After", + "operand" : [ { + "name" : "ProcedureDate", + "libraryName" : "Common", + "type" : "FunctionRef", + "operand" : [ { + "name" : "T", + "type" : "AliasRef" + } ] + }, { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCin2orCin3Biopsy", + "type" : "ExpressionRef" + } + } ] + }, + "return" : { + "expression" : { + "type" : "Tuple", + "element" : [ { + "name" : "date", + "value" : { + "name" : "ProcedureDate", + "libraryName" : "Common", + "type" : "FunctionRef", + "operand" : [ { + "name" : "T", + "type" : "AliasRef" + } ] + } + } ] + } + }, + "sort" : { + "by" : [ { + "direction" : "asc", + "path" : "date", + "type" : "ByColumn" + } ] + } + } + }, { + "name" : "DateOfLastCervicalPrecancerTreatment", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Last", + "source" : { + "name" : "CervicalPrecancerTreatmentsAfterBiopsy", + "type" : "ExpressionRef" + } + } + } + }, { + "name" : "MostRecentHpvResultAfterTreatment", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "After", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentHpvReport", + "type" : "ExpressionRef" + } + }, { + "name" : "DateOfLastCervicalPrecancerTreatment", + "type" : "ExpressionRef" + } ] + } + }, + "then" : { + "name" : "MostRecentHpvResult", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "SecondMostRecentHpvResultAfterTreatment", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "After", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "SecondMostRecentHpvReport", + "type" : "ExpressionRef" + } + }, { + "name" : "DateOfLastCervicalPrecancerTreatment", + "type" : "ExpressionRef" + } ] + } + }, + "then" : { + "name" : "SecondMostRecentHpvResult", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "ThirdMostRecentHpvResultAfterTreatment", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "After", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "ThirdMostRecentHpvReport", + "type" : "ExpressionRef" + } + }, { + "name" : "DateOfLastCervicalPrecancerTreatment", + "type" : "ExpressionRef" + } ] + } + }, + "then" : { + "name" : "ThirdMostRecentHpvResult", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "MostRecentCytologyResultAfterTreatment", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "MostRecentHpvResultAfterTreatment", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + }, + "else" : { + "name" : "MostRecentCytologyCotestResult", + "type" : "ExpressionRef" + } + } + }, { + "name" : "SecondMostRecentCytologyResultAfterTreatment", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "SecondMostRecentHpvResultAfterTreatment", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + }, + "else" : { + "name" : "SecondMostRecentCytologyCotestResult", + "type" : "ExpressionRef" + } + } + }, { + "name" : "ThirdMostRecentCytologyResultAfterTreatment", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "ThirdMostRecentHpvResultAfterTreatment", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + }, + "else" : { + "name" : "ThirdMostRecentCytologyCotestResult", + "type" : "ExpressionRef" + } + } + } ] + } + } +} + diff --git a/cql/DisplayCervicalCancerMedicalHistory.cql b/cql/DashboardLibrary.cql similarity index 76% rename from cql/DisplayCervicalCancerMedicalHistory.cql rename to cql/DashboardLibrary.cql index b73d42ef..43cefd9b 100644 --- a/cql/DisplayCervicalCancerMedicalHistory.cql +++ b/cql/DashboardLibrary.cql @@ -12,7 +12,7 @@ Statement of Work, contract number 75FCMC18D0047, task order number 75D30120F09743. */ -library DisplayCervicalCancerMedicalHistory version '1.0.0' +library DashboardLibrary version '1.0.0' using FHIR version '4.0.1' @@ -82,6 +82,8 @@ valueset "High Risk HPV Positive Results": 'http://cts.nlm.nih.gov/fhir/ValueSet valueset "High Risk Positive HPV Results Without HPV16 or HPV18": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.263' valueset "Histologic CIN3": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.269' valueset "HPV Negative Results": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.268' +valueset "HSIL": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.256' +valueset "Normal Histology Finding": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.262' // Standard codes code "Yes": '373066001' from "SNOMED-CT" display 'Yes (qualifier value)' @@ -96,6 +98,18 @@ code "Negative": '260385009' from "SNOMED-CT" display 'Negative (qualifier value code "NILM": '373887005' from "SNOMED-CT" display 'Negative for intraepithelial lesion or malignancy (finding)' code "CIN2": '285838002' from "SNOMED-CT" display 'Cervical intraepithelial neoplasia grade 2 (disorder)' code "HSIL, Unspecified": '22725004' from "SNOMED-CT" display 'High-grade squamous intraepithelial lesion (morphologic abnormality)' +code "ASC-H": '441088002' from "SNOMED-CT" display 'Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding)' +code "CIN1": '285836003' from "SNOMED-CT" display 'Cervical intraepithelial neoplasia grade 1 (disorder)' +code "AGC": '441219009' from "SNOMED-CT" display 'Atypical glandular cells on cervical Papanicolaou smear (finding)' +code "HPV16+": '708298003' from "SNOMED-CT" display 'Deoxyribonucleic acid of Human papillomavirus 16 (substance)' +code "HPV18+": '708299006' from "SNOMED-CT" display 'Deoxyribonucleic acid of Human papillomavirus 18 (substance)' +code "LSIL": '62051000119105' from "SNOMED-CT" display 'Low grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding)' +code "ASC-US": '441087007' from "SNOMED-CT" display 'Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding)' +code "Atypical Endocervical Cells": '441094005' from "SNOMED-CT" display 'Atypical endocervical cells on cervical Papanicolaou smear (finding)' +code "Benign Endometrial Cells": '125155008' from "SNOMED-CT" display 'Endometrial cells, cytologically benign, in a postmenopausal woman (finding)' +code "Histiocytes": '14295007' from "SNOMED-CT" display 'Resident tissue macrophage (cell)' +code "AGC Favor Neoplasia": '373883009' from "SNOMED-CT" display 'Atypical glandular cells, favor neoplastic (morphologic abnormality)' +code "Endocervical Cells Favor Neoplasia": '373882004' from "SNOMED-CT" display 'Atypical endocervical cells, favor neoplastic (morphologic abnormality)' // Non-standard or "local" codes code "Diagnosis of Genital GvHD": 'GenitalGvHD' from "LOCAL" display 'Diagnosis of Genital GvHD' @@ -103,7 +117,8 @@ code "Abnormal Uterine or Vaginal Bleeding Question": 'AUVBQ' from "LOCAL" displ code "Visible Uterine or Vaginal Lesion Question": 'VUVLQ' from "LOCAL" display 'Does the patient have visible uterine or vaginal lesions?' code "DES Exposure Question": 'DESEQ' from "LOCAL" display 'Did the patient experience in utero exposure to diethylstilbesterol (DES)?' code "Future Pregnancy Concerns Question": 'FPCQ' from "LOCAL" display 'Does the patient have future pregnancy concerns related to treatment options?' - +code "Benign Glandular Cells": 'BGC' from "LOCAL" display 'Benign Glandular Cells' +code "Endometrial Stromal Cells": 'ESC' from "LOCAL" display 'Endometrial stromal cells' //------------------------------------------------------------------------------ // PARAMETERS //------------------------------------------------------------------------------ @@ -118,6 +133,77 @@ parameter AbnormalTestLookbackPeriod default 8 years context Patient +//------------------------------------------------------------------------------ +// FUNCTIONS +//------------------------------------------------------------------------------ + +define function CytologyInterpretation(conclusions List): + if conclusions is not null then + (conclusions) c + return + case + when c ~ "NILM" then {text: 'NILM', rank: 1} + when c ~ "ASC-US" then {text: 'ASC-US', rank: 2} + when c ~ "LSIL" then {text: 'LSIL', rank: 3} + when c ~ "ASC-H" then {text: 'ASC-H', rank: 4} + when c ~ "AGC" then {text: 'AGC', rank: 5} + when c in "HSIL" then {text: 'HSIL+', rank: 6} + else {text: 'ALL', rank: 0} + end + else + {{text: 'ALL', rank: 0}} + +/** + * Takes a list of HPV conclusion codes and maps each to a text value and a numerical + * ranking. The text value can be used as input to the risk tables and the numerical + * ranking is meant to convey precendence so that the most specific conclusion can + * be selected from amongst a group of codes. For instance, an HPV test may come back + * both as positive and positive for HPV16. We want to be able to select the latter + * in this case as input to the risk tables. + * @param conclusions - a list of CodeableConcepts + * @returns List + */ +define function HpvInterpretation(conclusions List): + (conclusions) c + return + case + when c ~ "HPV16+" then {text: 'HPV16+', rank: 4} + when c ~ "HPV18+" then {text: 'HPV16-, HPV18+', rank: 3} + when c in "High Risk HPV Positive Results" then {text: 'HPV-positive', rank: 2} + when c in "HPV Negative Results" then {text: 'HPV-negative', rank: 1} + else {text: 'ALL', rank: 0} + end + +/** + * Takes the output from HpvInterpretation() and returns the text of the + * interpretation with the highest rank. This allows more specific conclusions to + * take precedence over more general ones. + * @param interpretations - a list of tuples + * @returns System.String the text to be used as input to the risk tables + */ +define function HighestRankedInterpretation(interpretations List): + Last( + ( + (interpretations) I sort by rank + ) S + return S.text + ) + +/** + */ +define function BiopsyInterpretation(conclusions List): + (conclusions) c + return + case + when c in "Normal Histology Finding" then {text: '= 25 and AgeInYears() <= 65 and + TableRecommendation = '1-year follow-up' + ) then + { + action: 'Surveillance', + text: OneYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText + } + when ( + AgeInYears() > 65 and + TableRecommendation = '1-year follow-up' + ) then + { + action: 'Surveillance', + text: OneYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText + '\n\n' + Over65RecommendationText + } + when ( + AgeInYears() >= 25 and AgeInYears() <= 65 and + TableRecommendation = '3-year follow-up' + ) then + { + action: 'Surveillance', + text: ThreeYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText + } + when ( + AgeInYears() > 65 and + TableRecommendation = '3-year follow-up' + ) then + { + action: 'Surveillance', + text: ThreeYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText + '\n\n' + Over65RecommendationText + } + when ( + AgeInYears() >= 25 and AgeInYears() <= 65 and + TableRecommendation = '5-year follow-up' + ) then + { + action: 'Surveillance', + text: FiveYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText + } + when ( + AgeInYears() > 65 and + TableRecommendation = '5-year follow-up' + ) then + { + action: 'Surveillance', + text: FiveYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText + '\n\n' + Over65RecommendationText + } + when ( + AgeInYears() >= 25 and + TableRecommendation = 'Colposcopy' + ) then + { + action: TableRecommendation, + text: ColposcopyRecommendationText + } + when ( + AgeInYears() >= 25 and AgeInYears() <= 50 and + TableRecommendation = 'Colposcopy/Treatment' + ) then + { + action: TableRecommendation, + text: ColposcopyOrTreatmentRecommendationText + '\n\n' + TreatmentWithPregnancyConcernsRecommendationText + } + when ( + AgeInYears() > 50 and + TableRecommendation = 'Colposcopy/Treatment' + ) then + { + action: TableRecommendation, + text: ColposcopyOrTreatmentRecommendationText + } + when ( + AgeInYears() >= 25 and AgeInYears() <= 50 and + TableRecommendation = 'Treatment' + ) then + { + action: TableRecommendation, + text: TreatmentRecommendationText + '\n\n' + TreatmentWithPregnancyConcernsRecommendationText + } + when ( + AgeInYears() > 50 and + TableRecommendation = 'Treatment' + ) then + { + action: TableRecommendation, + text: TreatmentRecommendationText + } + else + null + end \ No newline at end of file diff --git a/cql/ManageCommonAbnormality.json b/cql/ManageCommonAbnormality.json new file mode 100644 index 00000000..023181e3 --- /dev/null +++ b/cql/ManageCommonAbnormality.json @@ -0,0 +1,1538 @@ +{ + "library" : { + "annotation" : [ { + "translatorOptions" : "", + "type" : "CqlToElmInfo" + } ], + "identifier" : { + "id" : "ManageCommonAbnormality", + "version" : "1.1.0" + }, + "schemaIdentifier" : { + "id" : "urn:hl7-org:elm", + "version" : "r1" + }, + "usings" : { + "def" : [ { + "localIdentifier" : "System", + "uri" : "urn:hl7-org:elm-types:r1" + }, { + "localIdentifier" : "FHIR", + "uri" : "http://hl7.org/fhir", + "version" : "4.0.1" + } ] + }, + "includes" : { + "def" : [ { + "localIdentifier" : "FHIRHelpers", + "path" : "FHIRHelpers", + "version" : "4.0.1" + }, { + "localIdentifier" : "Dash", + "path" : "DashboardLibrary", + "version" : "1.0.0" + }, { + "localIdentifier" : "Collate", + "path" : "CollateManagementData", + "version" : "1.1.0" + }, { + "localIdentifier" : "RiskTableLookup", + "path" : "AutogeneratedTableLookup", + "version" : "1.0.0" + } ] + }, + "contexts" : { + "def" : [ { + "name" : "Patient" + } ] + }, + "statements" : { + "def" : [ { + "name" : "Patient", + "context" : "Patient", + "expression" : { + "type" : "SingletonFrom", + "operand" : { + "dataType" : "{http://hl7.org/fhir}Patient", + "templateId" : "http://hl7.org/fhir/StructureDefinition/Patient", + "type" : "Retrieve" + } + } + }, { + "name" : "LookUpTable1", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "GetGeneralScreeningManagement", + "libraryName" : "RiskTableLookup", + "type" : "FunctionRef", + "operand" : [ { + "name" : "SecondMostRecentHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "SecondMostRecentCytologyCotestResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentCytologyCotestResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "GeneralScreeningManagementRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "LookUpTable1", + "type" : "ExpressionRef" + } + } + } + }, + "then" : { + "name" : "LookUpTable1", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "LookUpTable2", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "GetSurveillanceManagement", + "libraryName" : "RiskTableLookup", + "type" : "FunctionRef", + "operand" : [ { + "name" : "ThirdMostRecentHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "ThirdMostRecentCytologyCotestResult", + "libraryName" : 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+ } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "OneYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "Over65RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + 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"valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "ThreeYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "Greater", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "65", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "3-year follow-up", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "ThreeYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "Over65RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "65", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "5-year follow-up", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "FiveYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "Greater", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "65", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "5-year follow-up", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "FiveYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "Over65RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "name" : "ColposcopyRecommendationText", + "type" : "ExpressionRef" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy/Treatment", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "ColposcopyOrTreatmentRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "TreatmentWithPregnancyConcernsRecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "Greater", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy/Treatment", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "name" : "ColposcopyOrTreatmentRecommendationText", + "type" : "ExpressionRef" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Treatment", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "TreatmentRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "TreatmentWithPregnancyConcernsRecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "Greater", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Treatment", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "name" : "TreatmentRecommendationText", + "type" : "ExpressionRef" + } + } ] + } + } ], + "else" : { + "type" : "As", + "operand" : { + "type" : "Null" + }, + "asTypeSpecifier" : { + "type" : "TupleTypeSpecifier", + "element" : [ { + "name" : "action", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "text", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + } + } + } + } ] + } + } +} + diff --git a/cql/ManageRareAbnormality.cql b/cql/ManageRareAbnormality.cql new file mode 100644 index 00000000..2d55195c --- /dev/null +++ b/cql/ManageRareAbnormality.cql @@ -0,0 +1,1378 @@ +/* + Library: Management of Abnormal Cervical Cancer Screening Results + Author: CMS Alliance to Modernize Healthcare, operated by THE MITRE Corporation. + + (C) 2021 The MITRE Corporation. All Rights Reserved. + Approved for Public Release: 21-1556. + Distribution Unlimited. + + Unless otherwise noted, this work is available under an Apache 2.0 license. + It was produced by the MITRE Corporation for the Division of Cancer Prevention + and Control, Centers for Disease Control and Prevention in accordance with the + Statement of Work, contract number 75FCMC18D0047, task order number 75D30120F09743. +*/ + +library ManageRareAbnormality version '1.1.0' + +using FHIR version '4.0.1' + +include FHIRHelpers version '4.0.1' called FHIRHelpers +include CDSConnectCommonsforFHIRv401 version '1.0.0' called C3F +include DashboardLibrary version '1.0.0' called Dash +include CollateManagementData version '1.1.0' called Collate +include CCSMCommonFunctions version '1.0.0' called Common +include ScreeningSymptomaticLibrary version '1.0.0' called Symptomatic + +//------------------------------------------------------------------------------ +// CODE SYSTEMS, VALUE SETS, AND CODES +//------------------------------------------------------------------------------ + +codesystem "SNOMED-CT": 'http://snomed.info/sct' +codesystem "ICD-9": 'http://hl7.org/fhir/sid/icd-9-cm' +codesystem "ICD-10": 'http://hl7.org/fhir/sid/icd-10-cm' +codesystem "NULL FLAVOR": 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' +codesystem "LOCAL": 'http://OUR-PLACEHOLDER-URL.com' + +valueset "Premenopausal": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.254' // AKA: Premenopausal +valueset "All Results of High Risk HPV Test": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.233' +valueset "HSIL": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.256' +valueset "Normal Histology Finding": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.262' + +code "ASC-H": '441088002' from "SNOMED-CT" display 'Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding)' +code "CIN1": '285836003' from "SNOMED-CT" display 'Cervical intraepithelial neoplasia grade 1 (disorder)' +code "Atypical Endometrial Cells": '103646000' from "SNOMED-CT" display 'Atypical endometrial cells of undetermined significance (morphologic abnormality)' +code "Atypical Endocervical Cells": '441094005' from "SNOMED-CT" display 'Atypical endocervical cells on cervical Papanicolaou smear (finding)' +code "Endocervical AIS": '447760009' from "SNOMED-CT" display 'Endocervical adenocarcinoma in situ (disorder)' +code "AGC": '441219009' from "SNOMED-CT" display 'Atypical glandular cells on cervical Papanicolaou smear (finding)' +code "AGC Favor Neoplasia": '373883009' from "SNOMED-CT" display 'Atypical glandular cells, favor neoplastic (morphologic abnormality)' +code "Endocervical Cells Favor Neoplasia": '373882004' from "SNOMED-CT" display 'Atypical endocervical cells, favor neoplastic (morphologic abnormality)' +code "Unsatisfactory": '126481000119106' from "SNOMED-CT" display 'Vaginal Papanicolaou smear unsatisfactory for evaluation (finding)' +code "Absent Transformation Zone": '412716005' from "SNOMED-CT" display 'Cervical smear transformation zone cells absent (situation)' +code "Benign Endometrial Cells": '125155008' from "SNOMED-CT" display 'Endometrial cells, cytologically benign, in a postmenopausal woman (finding)' +code "Premenopausal Menorrhagia": '627.0' from "ICD-9" display 'Premenopausal menorrhagia' // AKA: Premenopausal +code "Excessive Bleeding in the Premenopausal Period": 'N92.4' from "ICD-10" display 'Excessive bleeding in the premenopausal period' // AKA: Premenopausal +code "Postmenopausal": '76498008' from "SNOMED-CT" display 'Postmenopausal state (finding)' +code "Histiocytes": '14295007' from "SNOMED-CT" display 'Resident tissue macrophage (cell)' +code "Unknown": 'UNK' from "NULL FLAVOR" display 'Unknown' +code "HPV16+": '708298003' from "SNOMED-CT" display 'Deoxyribonucleic acid of Human papillomavirus 16 (substance)' +code "HPV18+": '708299006' from "SNOMED-CT" display 'Deoxyribonucleic acid of Human papillomavirus 18 (substance)' +code "LSIL": '62051000119105' from "SNOMED-CT" display 'Low grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding)' +code "ASC-US": '441087007' from "SNOMED-CT" display 'Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding)' + +// Local codes +code "Benign Glandular Cells": 'BGC' from "LOCAL" display 'Benign Glandular Cells' +code "Endometrial Stromal Cells": 'ESC' from "LOCAL" display 'Endometrial stromal cells' + +//------------------------------------------------------------------------------ +// PARAMETERS +//------------------------------------------------------------------------------ + +/***** BEGIN CDS LOGIC ********************************************************/ + +context Patient + +//------------------------------------------------------------------------------ +// RECOMMENDATIONS FOR RARE ABNORMALITIES +//------------------------------------------------------------------------------ + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// RARE ABNORMALITY #1: Rare Cytology + +define MostRecentCytologyReport: + if Count(Collate.SortedCytologyReports) > 0 then + Collate.SortedCytologyReports[0] + else + null + +define MostRecentCytologyReportWasWithinPastFiveYears: + MostRecentCytologyReport.date >= Now() - 5 years + +define CytologyInterpretedAsAgc: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "AGC" + ) + +define CytologyInterpretedAsAgcFavorNeoplasia: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "AGC Favor Neoplasia" + ) + +define CytologyInterpretedAsAis: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC in Dash."AIS" + ) + +define CytologyInterpretedAsAgcOrAis: + CytologyInterpretedAsAgc or + CytologyInterpretedAsAis + +define CytologyInterpretedAsAtypicalEndometrialCells: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Atypical Endometrial Cells" + ) + +define CytologyInterpretedAsAtypicalEndocervicalCells: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Atypical Endocervical Cells" + ) + +define CytologyInterpretedAsEndocervicalAis: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Endocervical AIS" + ) + +define CytologyInterpretedAsEndocervicalCellsFavorNeoplasia: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Endocervical Cells Favor Neoplasia" + ) + +define CytologyUnsatisfactory: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Unsatisfactory" + ) + +define CytologyAbsentTransformationZone: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Absent Transformation Zone" + ) + +define CytologyInterpretedAsNilm: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ Dash."NILM" + ) + +define SecondMostRecentCytologyInterpretedAsNilm: + AnyTrue( + (SecondMostRecentCytologyReport.allConclusions) aC + return aC ~ Dash."NILM" + ) + +define CytologyInterpretedAsBenignEndometrialCells: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Benign Endometrial Cells" + ) + +define CytologyInterpretedAsBenignGlandularCells: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Benign Glandular Cells" + ) + +define CytologyInterpretedAsEndometrialStromalCells: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Endometrial Stromal Cells" + ) + +define CytologyInterpretedAsHistiocytes: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "Histiocytes" + ) + +define PremenopausalObservations: + C3F.Verified( + [Observation: "Premenopausal"] union + [Observation: "Premenopausal Menorrhagia"] union + [Observation: "Excessive Bleeding in the Premenopausal Period"] + ) + +define HasPremenopausalObservation: + Exists(PremenopausalObservations) + +define PostmenopausalObservations: + C3F.Verified( + [Observation: "Postmenopausal"] + ) + +define HasPostmenopausalObservation: + Exists(PostmenopausalObservations) + +//define Pregnant: +// Exists(Dash.PregnancyDiagnoses) or +// Exists(Dash.PregnancyObservations) + +define HistologyInterpretedAsCin1: + AnyTrue( + (Collate.MostRecentBiopsyReport.allConclusions) aC + return + aC ~ "CIN1" + ) + +define HistologyInterpretedAsNormal: + AnyTrue( + (Collate.MostRecentBiopsyReport.allConclusions) aC + return + aC in "Normal Histology Finding" + ) + +define HistologyInterpretedAsCin1OrNormal: + HistologyInterpretedAsCin1 or + HistologyInterpretedAsNormal + +define HistologyInterpretedAsCancer: + AnyTrue( + (Collate.MostRecentBiopsyReport.allConclusions) aC + return + aC in Dash."Histologic cancer" + ) + +define CancerDiagnosisAfterMostRecentCytology: + Exists( + Dash.CervicalCancerDiagnoses C + where Common.ConditionDate(C) > MostRecentCytologyReport.date + ) + +define AnyHpvSinceMostRecentCytology: + Exists( + (Collate.SortedHpvReports) B + where B.date >= MostRecentCytologyReport.date - 1 day + ) + +define UnknownHpvCotest: + Collate.MostRecentHpvReport.date within 1 day of MostRecentCytologyReport.date and + AnyTrue( + (Collate.MostRecentHpvReport.allConclusions) aC + return + aC ~ "Unknown" or + not (aC in "All Results of High Risk HPV Test") + ) + +define NegativeOrUnknownHpvCotest: + Collate.MostRecentHpvReport.date within 1 day of MostRecentCytologyReport.date and + AnyTrue( + (Collate.MostRecentHpvReport.allConclusions) aC + return + aC in Dash."HPV Negative Results" or + aC ~ "Unknown" or + not (aC in "All Results of High Risk HPV Test") + ) + +define PositiveUntypedHpvCotest: + Collate.MostRecentHpvReport.date within 1 day of MostRecentCytologyReport.date and + AnyTrue( + (Collate.MostRecentHpvReport.allConclusions) aC + return + aC in Dash."High Risk Positive HPV Results Without HPV16 or HPV18" + ) + +define PositiveHpv16or18Cotest: + Collate.MostRecentHpvReport.date within 1 day of MostRecentCytologyReport.date and + AnyTrue( + (Collate.MostRecentHpvReport.allConclusions) aC + return + aC ~ "HPV16+" or + aC ~ "HPV18+" + ) + +define HasRemovalOfCervixProcedures: + Exists(Dash.RemovalOfCervixProcedures) + +define HasAbsenceOfCervixDiagnoses: + Exists(Dash.AbsenceOfCervixDiagnoses) + +define HasAbsenceOfCervixObservations: + Exists(Dash.AbsenceOfCervixObservations) + +define AbsenceOrRemovalOfCervix: + HasRemovalOfCervixProcedures or + HasAbsenceOfCervixDiagnoses or + HasAbsenceOfCervixObservations + +define RecommendationForRareCytology: + case + // Subsequent Management + when ( // G1.4 + MostRecentCytologyReportWasWithinPastFiveYears and + ( + CytologyInterpretedAsAgc or + CytologyInterpretedAsAtypicalEndocervicalCells + ) and + Collate.MostRecentBiopsyReport.date 12 months or less after MostRecentCytologyReport.date and + HistologyInterpretedAsCin1OrNormal + ) then + { + action: 'RareCytologyG1.4', + text: 'For patients with cytology showing AGC not otherwise specified or atypical endocervical cells not otherwise specified in whom histologic HSIL (CIN 2+) or AIS/cancer is not identified, cotesting at one and two years is recommended. If both cotests are negative, repeat cotesting at 3 years is recommended. If any test is abnormal, then colposcopy is recommended (BII).' + } + when ( // G1.5 + MostRecentCytologyReportWasWithinPastFiveYears and + ( + CytologyInterpretedAsAgcFavorNeoplasia or + CytologyInterpretedAsEndocervicalCellsFavorNeoplasia or + CytologyInterpretedAsEndocervicalAis + ) and + not ( + CancerDiagnosisAfterMostRecentCytology or + ( + HistologyInterpretedAsCancer and + Collate.MostRecentBiopsyReport.date > MostRecentCytologyReport.date + ) + ) + ) then + { + action: 'RareCytologyG1.5', + text: 'For patients with atypical glandular or endocervical cells \'favor neoplasia\' or endocervical AIS cytology, if invasive disease is not identified during initial colposcopic workup, a diagnostic excisional procedure is recommended. The diagnostic excisional procedure used in this setting should provide an intact specimen with interpretable margins (BII). Endocervical sampling above the excisional bed is preferred (BII).' + } + // G.1 Evaluation of Cytology Interpreted as AGC or AIS + when ( // G1.1 + AgeInYears() < 35 and + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyInterpretedAsAgcOrAis and + not CytologyInterpretedAsAtypicalEndometrialCells and + not Dash.Pregnant + ) then + { + action: 'RareCytologyG1.1', + text: 'For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is also recommended for nonpregnant patients younger than 35 years at increased risk of endometrial neoplasia based on clinical indications (e.g., abnormal uterine bleeding, conditions suggesting chronic anovulation, or obesity) (AII).' + } + when ( // G1.2 + AgeInYears() >= 35 and + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyInterpretedAsAgcOrAis and + not CytologyInterpretedAsAtypicalEndometrialCells and + not Dash.Pregnant + ) then + { + action: 'RareCytologyG1.2', + text: 'For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is recommended in conjunction with colposcopy and endocervical sampling in nonpregnant patients 35 years or older with all categories of AGC and AIS (AII).' + } + when ( // G1.3 + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyInterpretedAsAgcOrAis and + CytologyInterpretedAsAtypicalEndometrialCells and + not Dash.Pregnant + ) then + { + action: 'RareCytologyG1.3', + text: 'For patients with atypical endometrial cells specified, initial evaluation limited to endometrial and endocervical sampling is preferred, with colposcopy acceptable at the time of initial evaluation. If colposcopy was deferred and no endometrial pathology is identified, additional evaluation with colposcopy is then recommended.' + } + // G.2 Unsatisfactory Cytology + when ( //G2.1 + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyUnsatisfactory and + ( + not AnyHpvSinceMostRecentCytology or + NegativeOrUnknownHpvCotest + ) + ) then + { + action: 'RareCytologyG2.1', + text: 'For patients with an unsatisfactory cytology result and no, unknown, or a negative HPV test result, repeat age-based screening (cytology, cotest, or primary HPV test) in 2 to 4 months is recommended (BIII). Triage using HPV testing is not recommended (DIII). Before repeat cytology, treatment to resolve atrophy or obscuring inflammation when a specific infection is present is acceptable (CIII).' + } + when ( //G2.2 + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyUnsatisfactory and + PositiveUntypedHpvCotest and + AgeInYears() >= 25 + ) then + { + action: 'RareCytologyG2.2', + text: 'For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test without genotyping for HPV 16 or HPV 18, repeat cytology in 2 to 4 months or colposcopy is acceptable (BII).' + } + when ( //G2.3 + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyUnsatisfactory and + PositiveHpv16or18Cotest and + AgeInYears() >= 25 + ) then + { + action: 'Colposcopy', + text: 'For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test with partial genotyping is positive for HPV 16 or HPV 18, direct referral for colposcopy is recommended (BII).' + } + // G.3 Absent Transformation Zone on Screening Cytology + when ( //G3.1 + AgeInYears() in Interval[21,30) and + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyAbsentTransformationZone and + CytologyInterpretedAsNilm + ) then + { + action: 'RareCytologyG3.1', + text: 'Routine screening is recommended (BIII). When cervical cytology alone is performed for screening, HPV testing as a triage test after negative cytology and absent endocervical cells/transformation zone component in this age group is unacceptable (DIII).' + } + when ( //G3.2 + AgeInYears() >= 30 and + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyAbsentTransformationZone and + CytologyInterpretedAsNilm and + ( + not AnyHpvSinceMostRecentCytology or + UnknownHpvCotest + ) + ) then + { + action: 'RareCytologyG3.2', + text: 'HPV testing is preferred (BIII). Repeat cytology in 3 years is acceptable if HPV testing is not performed (BIII). If HPV testing is performed, manage using Clinical Action Thresholds according to 2019 consensus guidelines.' + } + // G.4 Benign Endometrial Cells in Premenopausal Patients or Benign Glandular Cells in Posthysterectomy patients + when ( //G4.1 + HasPremenopausalObservation and + not Symptomatic.IsSymptomatic and + MostRecentCytologyReportWasWithinPastFiveYears and + ( + CytologyInterpretedAsBenignEndometrialCells or + CytologyInterpretedAsEndometrialStromalCells or + CytologyInterpretedAsHistiocytes + ) + ) then + { + action: 'RareCytologyG4.1', + text: 'For asymptomatic premenopausal patients with benign endometrial cells, endometrial stromal cells, or histiocytes, no further evaluation is recommended (BII).' + } + when ( //G4.2 + HasPostmenopausalObservation and + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyInterpretedAsBenignEndometrialCells + ) then + { + action: 'RareCytologyG4.2', + text: 'For postmenopausal patient with benign endometrial cells found via cytology, endometrial assessment is recommended (BII).' + } + when ( //G4.3 + AbsenceOrRemovalOfCervix and + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyInterpretedAsBenignGlandularCells + ) then + { + action: 'RareCytologyG4.3', + text: 'For patients \'post-hysterectomy\' with benign glandular cells identified via cytology, no further evaluation is recommended (BII).' + } + else + null + end + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// RARE ABNORMALITY #2: Exceptions to Colposcopy Clinical Action Threshold + +define CytologyInterpretedAsAscH: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "ASC-H" + ) + +define SecondMostRecentCytologyReport: + if Count(Collate.SortedCytologyReports) > 1 then + Collate.SortedCytologyReports[1] + else + null + +define TwoMostRecentCytologyReportsWithin5yearsApart: + SecondMostRecentCytologyReport.date within 5 years of MostRecentCytologyReport.date + +define SecondMostRecentCytologyUnsatisfactory: + AnyTrue( + (SecondMostRecentCytologyReport.allConclusions) aC + return aC ~ "Unsatisfactory" + ) + +define RecommendationForExceptionsToColposcopyThreshold: + case + when ( + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyInterpretedAsAscH + ) then + { + action: 'Colposcopy', + text: 'For patients with ASC-H cytology, colposcopy is recommended regardless of hrHPV result (AII).' + } + when ( + MostRecentCytologyReportWasWithinPastFiveYears and + PositiveHpv16or18Cotest and + CytologyInterpretedAsNilm + ) then + { + action: 'Colposcopy', + text: 'For patients with hrHPV 18-positive NILM or hrHPV 16-positive NILM, colposcopy is recommended (AII).' + } + when ( + MostRecentCytologyReportWasWithinPastFiveYears and + CytologyUnsatisfactory and + TwoMostRecentCytologyReportsWithin5yearsApart and + SecondMostRecentCytologyUnsatisfactory + ) then + { + action: 'Colposcopy', + text: 'Colposcopy should be performed after 2 consecutive unsatisfactory screening tests (CIII).' + } + else + null + end + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// RARE ABNORMALITY #3: Managing Histology Results + +define MostRecentBiopsyReportWasWithinPastYear: + Collate.MostRecentBiopsyReport.date >= Now() - 1 year + +define HistologyInterpretedAsCin2: + AnyTrue( + (Collate.MostRecentBiopsyReport.allConclusions) aC + return + aC ~ Dash."CIN2" + ) + +define HistologyInterpretedAsCin3: + AnyTrue( + (Collate.MostRecentBiopsyReport.allConclusions) aC + return + aC in Dash."Histologic CIN3" + ) + +define HistologyInterpretedAsAis: + AnyTrue( + (Collate.MostRecentBiopsyReport.allConclusions) aC + return + aC in Dash."AIS" + ) + +define HistologyInterpretedAsUnspecifiedHsil: + AnyTrue( + (Collate.MostRecentBiopsyReport.allConclusions) aC + return + aC ~ Dash."HSIL, Unspecified" + ) + +define PrecedingCytologyResults: + Coalesce( + (Collate.SortedCytologyReports) S + where S.date <= Collate.MostRecentBiopsyReport.date and + S.date >= Collate.MostRecentBiopsyReport.date - 6 months + ) + +define PrecedingCytologyIsHsil: + AnyTrue( + (PrecedingCytologyResults.allConclusions) aC + return + aC in "HSIL" + ) + +define PrecedingCytologyIsAscH: + AnyTrue( + (PrecedingCytologyResults.allConclusions) aC + return + aC ~ "ASC-H" + ) + +define PrecedingCytologyResultsBeforeSecondMostRecentBiopsy: + Coalesce( + (Collate.SortedCytologyReports) S + where S.date <= SecondMostRecentBiopsyReport.date and + S.date >= SecondMostRecentBiopsyReport.date - 6 months + ) + +define PrecedingCytologyBeforeSecondMostRecentBiopsyIsHsil: + AnyTrue( + (PrecedingCytologyResultsBeforeSecondMostRecentBiopsy.allConclusions) aC + return + aC in "HSIL" + ) + +define PrecedingCytologyBeforeSecondMostRecentBiopsyIsAscH: + AnyTrue( + (PrecedingCytologyResultsBeforeSecondMostRecentBiopsy.allConclusions) aC + return + aC ~ "ASC-H" + ) + +define SecondMostRecentBiopsyReport: + if Count(Collate.SortedBiopsyReports) > 1 then + Collate.SortedBiopsyReports[1] + else + null + +define SecondMostRecentHistologyInterpretedAsCin1: + AnyTrue( + (SecondMostRecentBiopsyReport.allConclusions) aC + return + aC ~ "CIN1" + ) + +define SecondMostRecentHistologyInterpretedAsNormal: + AnyTrue( + (SecondMostRecentBiopsyReport.allConclusions) aC + return + aC in "Normal Histology Finding" + ) + +define SecondMostRecentHistologyInterpretedAsCin1OrNormal: + SecondMostRecentHistologyInterpretedAsCin1 or + SecondMostRecentHistologyInterpretedAsNormal + +define MostRecentBiopsyReportWasWithinPast12months: + Collate.MostRecentBiopsyReport.date >= Now() - 12 months + +define MostRecentBiopsyReportWasWithinPast18months: + Collate.MostRecentBiopsyReport.date >= Now() - 18 months + +define TwoMostRecentBiopsyReportsWithin18monthsApart: + SecondMostRecentBiopsyReport.date within 18 months of Collate.MostRecentBiopsyReport.date + +define TwoMostRecentBiopsyReportsWithin15monthsApart: + SecondMostRecentBiopsyReport.date within 15 months of Collate.MostRecentBiopsyReport.date + +define RecentlyRespondedYesToFuturePregnancyConcernsQuestion: + C3F.MostRecent( + C3F.ObservationLookBack( + Dash.ResponsesToFuturePregnancyConcernsQuestion R + where R.value ~ Dash."Yes", + 3 months + ) + ) is not null + +define InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months: + First( + (Collate.SortedBiopsyReports) B + where B.date >= Now() - 18 months and + AnyTrue( + (B.allConclusions) aC + return + aC ~ Dash."HSIL, Unspecified" or + aC ~ Dash."CIN2" + ) + ) + +define InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years: + First( + (Collate.SortedBiopsyReports) B + where B.date >= Now() - 6 years and + AnyTrue( + (B.allConclusions) aC + return + aC ~ Dash."HSIL, Unspecified" or + aC ~ Dash."CIN2" + ) + ) + +define HistologyInterpretedAsUnspecifiedHsilOrCin2BeforeMostRecentBiopsy: + (Collate.SortedBiopsyReports) B + where + B.date 2 years or more before Collate.MostRecentBiopsyReport.date and + B.date 2.5 years or less before Collate.MostRecentBiopsyReport.date and + AnyTrue( + (B.allConclusions) aC + return + aC ~ Dash."HSIL, Unspecified" or + aC ~ Dash."CIN2" + ) + +define HasHistologyInterpretedAsUnspecifiedHsilOrCin2BeforeMostRecentBiopsy: + Exists(HistologyInterpretedAsUnspecifiedHsilOrCin2BeforeMostRecentBiopsy) + +define CytologyInterpretedAsLsil: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "LSIL" + ) + +define CytologyInterpretedAsAscus: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC ~ "ASC-US" + ) + +define MostRecentNegativeHsilSurveillanceResult: + if (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months is not null) then + Collate.MostRecentBiopsyReport.date 18 months or less after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months.date and + HistologyInterpretedAsCin1OrNormal and + MostRecentCytologyReport.date 18 months or less after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months.date and + ( + CytologyInterpretedAsLsil or + CytologyInterpretedAsAscus or + CytologyInterpretedAsNilm + ) + else + false + +define SecondMostRecentCytologyInterpretedAsLsil: + AnyTrue( + (SecondMostRecentCytologyReport.allConclusions) aC + return aC ~ "LSIL" + ) + +define SecondMostRecentCytologyInterpretedAsAscus: + AnyTrue( + (SecondMostRecentCytologyReport.allConclusions) aC + return aC ~ "ASC-US" + ) + +define SecondMostRecentNegativeHsilSurveillanceResult: + if (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months is not null) then + SecondMostRecentBiopsyReport.date 18 months or less after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months.date and + SecondMostRecentHistologyInterpretedAsCin1OrNormal and + SecondMostRecentCytologyReport.date 18 months or less after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months.date and + ( + SecondMostRecentCytologyInterpretedAsLsil or + SecondMostRecentCytologyInterpretedAsAscus or + SecondMostRecentCytologyInterpretedAsNilm + ) + else + false + +define SubsequentLowGradeHistologyReportsSinceInitialUnspecifiedHsilOrCin2InLast6Years: + if (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years is not null) then + Collate.SortedBiopsyReports R + where R.date after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years.date and + AnyTrue( + (R.allConclusions) aC + return + aC ~ "CIN1" or + aC in "Normal Histology Finding" + ) + else + null + +define SubsequentLowGradeCytologyReportsSinceInitialUnspecifiedHsilOrCin2InLast6Years: + if (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years is not null) then + Collate.SortedCytologyReports R + where R.date after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years.date and + AnyTrue( + (R.allConclusions) aC + return + aC ~ Dash."NILM" or + aC ~ "LSIL" or + aC ~ "ASC-US" + ) + else + null + +define MostRecentSurveillanceTestNegative: + ( + Collate.MostRecentHpvResult = 'HPV-negative' and + Collate.MostRecentCytologyCotestResult = 'NILM' + ) or + ( + Collate.MostRecentHpvResult = 'HPV-negative' and + Collate.MostRecentCytologyCotest is null + ) + +define CytologyInterpretedAsHsil: + AnyTrue( + (MostRecentCytologyReport.allConclusions) aC + return aC in "HSIL" + ) + +define RecommendationForHistologyResults: + case + // I.1 Management of Histologic HSIL, not Further Specified or Qualified + when ( + AgeInYears() >= 25 and + not RecentlyRespondedYesToFuturePregnancyConcernsQuestion and + MostRecentBiopsyReportWasWithinPastYear and + HistologyInterpretedAsUnspecifiedHsil + ) then + { + action: 'ManagementHistologyI1', + text: 'Treatment is preferred if histologic HSIL cannot be specified (e.g., reported as histologic HSIL or histologic HSIL [CIN 2,3]) (CIII), but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' + } + // I.2 Management of Histologic HSIL (CIN2 or CIN3) + when ( // I2.1 + AgeInYears() >= 25 and + not Dash.Pregnant and + MostRecentBiopsyReportWasWithinPastYear and + HistologyInterpretedAsCin3 + ) then + { + action: 'ManagementHistologyI2', + text: 'Treatment is recommended, and observation is unacceptable (AII). When treatment of histologic HSIL is planned, excisional treatment is preferred, and treatment with ablation is acceptable (BI). Outside of the setting of a clinical research trial, nonsurgical therapies, including topical agents, therapeutic vaccines, and other biologics, are unacceptable for the treatment of histologic HSIL (CIN 2 or CIN 3) (DIII). Hysterectomy is unacceptable as primary therapy solely for the treatment of histologic HSIL (CIN 2, CIN 3, or unqualified) (EII). When considering ablative therapy, in particular cryotherapy, ablation is unacceptable in the following circumstances as defined by the WHO: (a) the lesion extends into the canal and (b) when the lesion covers more than 75% of the surface area of the ectocervix or extends beyond the cryotip being used. Additional situations for which cryotherapy is not recommended include the following: (a) the squamocolumnar junction or the upper limit of any lesion is not fully visualized; (b) endocervical canal sample is diagnosed as CIN 2+ or CIN that cannot be graded; (c) after previous treatment for CIN 2+; (d) in the setting of inadequate biopsies of the cervix to confirm histologic diagnosis; and (e) if cancer is suspected (EIII).' + } + when ( // I2.2 + AgeInYears() >= 25 and + not Dash.Pregnant and not RecentlyRespondedYesToFuturePregnancyConcernsQuestion and + MostRecentBiopsyReportWasWithinPastYear and + HistologyInterpretedAsCin2 + ) then + { + action: 'ManagementHistologyI2', + text: 'Treatment is recommended unless the patient\'s concerns about the effect of treatment on future pregnancy outweigh concerns about cancer (BII). Observation is unacceptable when the squamocolumnar junction or the upper limit of the lesion is not fully visualized or when the results of an endocervical sampling, if performed, is CIN 2+ or ungraded (EIII). For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.\n\nWhen treatment of histologic HSIL is planned, excisional treatment is preferred, and treatment with ablation is acceptable (BI). Outside of the setting of a clinical research trial, nonsurgical therapies, including topical agents, therapeutic vaccines, and other biologics, are unacceptable for the treatment of histologic HSIL (CIN 2 or CIN 3) (DIII). Hysterectomy is unacceptable as primary therapy solely for the treatment of histologic HSIL (CIN 2, CIN 3, or unqualified) (EII). When considering ablative therapy, in particular cryotherapy, ablation is unacceptable in the following circumstances as defined by the WHO: (a) the lesion extends into the canal and (b) when the lesion covers more than 75% of the surface area of the ectocervix or extends beyond the cryotip being used. Additional situations for which cryotherapy is not recommended include the following: (a) the squamocolumnar junction or the upper limit of any lesion is not fully visualized; (b) endocervical canal sample is diagnosed as CIN 2+ or CIN that cannot be graded; (c) after previous treatment for CIN 2+; (d) in the setting of inadequate biopsies of the cervix to confirm histologic diagnosis; and (e) if cancer is suspected (EIII).' + } + // I.3 Management of CIN2 in Those Who Are Concerned About the Potential Effect of Treatment on Future Pregnancy Outcomes + when ( // I3.5 + AgeInYears() >= 25 and AgeInYears() <= 50 and + ( + HistologyInterpretedAsUnspecifiedHsil or + HistologyInterpretedAsCin2 + ) and + HasHistologyInterpretedAsUnspecifiedHsilOrCin2BeforeMostRecentBiopsy + ) then + { + action: 'ManagementHistologyI3', + text: 'If CIN 2 remains present for a 2-year period, treatment is recommended (CII).' + } + when ( // I3.4 + AgeInYears() >= 25 and AgeInYears() <= 50 and + (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years is not null) and + Count(SubsequentLowGradeHistologyReportsSinceInitialUnspecifiedHsilOrCin2InLast6Years) = 5 and + Count(SubsequentLowGradeCytologyReportsSinceInitialUnspecifiedHsilOrCin2InLast6Years) >= 5 and + RecentlyRespondedYesToFuturePregnancyConcernsQuestion + ) then + { + action: 'ManagementHistologyI3', + text: 'Surveillance with HPV-based testing is recommended every 3 years for 25 years after histologic HSIL (unspecified or CIN2) even if beyond the age of 65 (BII).' + } + when ( // I3.3 + AgeInYears() >= 25 and AgeInYears() <= 50 and + (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months is not null) and + MostRecentNegativeHsilSurveillanceResult + SecondMostRecentNegativeHsilSurveillanceResult and + RecentlyRespondedYesToFuturePregnancyConcernsQuestion + ) then + { + action: 'ManagementHistologyI3', + text: 'Subsequent surveillance with HPV-based testing should occur every year since the patient has demonstrated less than CIN2 and less than ASC-H during surveillance following a histologic unspecified or CIN2 result.' + } + when ( // I3.2 + AgeInYears() >= 25 and AgeInYears() <= 50 and + MostRecentBiopsyReportWasWithinPastYear and + HistologyInterpretedAsUnspecifiedHsil + RecentlyRespondedYesToFuturePregnancyConcernsQuestion + ) then + { + action: 'ManagementHistologyI3', + text: 'If the histologic HSIL cannot be specified as CIN 2, treatment is preferred, but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' + } + when ( // I3.1 + AgeInYears() >= 25 and AgeInYears() <= 50 and + MostRecentBiopsyReportWasWithinPastYear and + HistologyInterpretedAsCin2 and + RecentlyRespondedYesToFuturePregnancyConcernsQuestion + ) then + { + action: 'ManagementHistologyI3', + text: 'For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' + } + // I.4 Management of LSIL (CIN1) or Less Preceded by ASC-H or HSIL Cytology + when ( // I4.1 + AgeInYears() >= 25 and + MostRecentBiopsyReportWasWithinPastYear and + HistologyInterpretedAsCin1OrNormal and + PrecedingCytologyIsHsil + ) then + { + action: 'ManagementHistologyI4', + text: 'When CIN 2+ is not identified, HSIL cytology is managed more aggressively than ASC-H cytology. For cytology showing HSIL, but biopsy showing histologic LSIL (CIN 1) or less, either an immediate diagnostic excisional procedure or observation with HPV-based testing and colposcopy at 1 year is acceptable, provided in the latter case that the initial colposcopic examination fully visualized the squamocolumnar junction and the upper limit of any lesion, and that the endocervical sampling, if collected, was less than CIN 2 (BII). When CIN2+ is not identified histologically after an ASC-H or HSIL cytology result, it is acceptable to review the cytologic, histologic, and colposcopic findings. If the review yields a revised interpretation, management should follow guidelines for the revised diagnosis (CIII).' + } + when ( // I4.2 + AgeInYears() >= 25 and + MostRecentBiopsyReportWasWithinPastYear and + HistologyInterpretedAsCin1OrNormal and + PrecedingCytologyIsAscH + ) then + { + action: 'ManagementHistologyI4', + text: 'For ASC-H, if the colposcopic examination can fully visualize the squamocolumnar junction and the upper limit of any lesion and that the endocervical sampling, if collected, is negative, observation at 1 year with HPV-based testing with cotesting or primary hrHPV testing is recommended; a diagnostic excisional procedure is not recommended (BII).' + } + when ( // I4.3 - Recommendation #2 + AgeInYears() >= 25 and + MostRecentSurveillanceTestNegative and + Collate.MostRecentHpvReport.date >= Now() - 3.5 years and + ( + ( + ( + Collate.MostRecentBiopsyReport.date 18 months or less before Collate.MostRecentHpvReport.date and + HistologyInterpretedAsNormal and + TwoMostRecentBiopsyReportsWithin18monthsApart + ) and + ( + HasFirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy and + FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy.date 18 months or less before Collate.MostRecentHpvReport.date and + FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy.date 18 months or less after SecondMostRecentBiopsyReport.date + ) and + ( + SecondMostRecentHistologyInterpretedAsCin1OrNormal and + PrecedingCytologyBeforeSecondMostRecentBiopsyIsHsil + ) and + ( + not ( + MostRecentTreatmentDate 1 year or less after Collate.MostRecentBiopsyReport.date + ) or + MostRecentTreatment is null + ) + ) or + ( + ( + HasFirstNegativeSurveillanceTestAfterMostRecentBiopsy and + FirstNegativeSurveillanceTestAfterMostRecentBiopsy.date 18 months or less before Collate.MostRecentHpvReport.date and + FirstNegativeSurveillanceTestAfterMostRecentBiopsy.date 18 months or less after Collate.MostRecentBiopsyReport.date + ) and + ( + HistologyInterpretedAsCin1OrNormal and + PrecedingCytologyIsAscH + ) and + ( + not ( + MostRecentTreatmentDate 1 year or less after Collate.MostRecentBiopsyReport.date + ) or + MostRecentTreatment is null + ) + ) + ) + ) then + { + action: 'ManagementHistologyI4', + text: 'Retest with HPV-based testing (i.e., cotesting or primary hrHPV testing) every 3 years after surveillance tests are negative during the 2-year observation period following histologic LSIL (CIN1) or less preceded by ASC-H or HSIL cytology. Proceed with long-term surveillance (i.e., HPV-based testing every 3 years for at least 25 years, even if this is beyond the age of 65 years (BII).' + } + when ( // I4.3 - Recommendation #1 + AgeInYears() >= 25 and + ( + ( + ( + MostRecentBiopsyReportWasWithinPast18months and + HistologyInterpretedAsNormal and + TwoMostRecentBiopsyReportsWithin18monthsApart + ) and + ( + HasFirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy and + FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy.date > Now() - 18 months and + FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy.date 18 months or less after SecondMostRecentBiopsyReport.date + ) and + ( + SecondMostRecentHistologyInterpretedAsCin1OrNormal and + PrecedingCytologyBeforeSecondMostRecentBiopsyIsHsil + ) and + ( + not ( + MostRecentTreatmentDate 1 year or less after SecondMostRecentBiopsyReport.date + ) or + MostRecentTreatment is null + ) + ) or + ( + ( + HasFirstNegativeSurveillanceTestAfterMostRecentBiopsy and + FirstNegativeSurveillanceTestAfterMostRecentBiopsy.date > Now() - 18 months and + FirstNegativeSurveillanceTestAfterMostRecentBiopsy.date 18 months or less after Collate.MostRecentBiopsyReport.date + ) and + ( + HistologyInterpretedAsCin1OrNormal and + PrecedingCytologyIsAscH + ) and + ( + not ( + MostRecentTreatmentDate 1 year or less after Collate.MostRecentBiopsyReport.date + ) or + MostRecentTreatment is null + ) + ) + ) + ) then + { + action: 'ManagementHistologyI4', + text: 'HPV-based testing (i.e., cotesting or primary hrHPV testing) is recommended 1 year after the initial negative follow up result(s) when observation is elected after a histologic LSIL (CIN1) preceded by ASC-H or HSIL cytology.' + } + when ( // I4.5 + AgeInYears() >= 25 and + HistologyInterpretedAsCin1OrNormal and + ( + PrecedingCytologyIsHsil or + PrecedingCytologyIsAscH + ) and + ( + not ( + MostRecentTreatmentDate 1 year or less after Collate.MostRecentBiopsyReport.date + ) or + MostRecentTreatment is null + ) and + ( + ( + CytologyInterpretedAsHsil and + MostRecentCytologyReport.date 1 year or more after Collate.MostRecentBiopsyReport.date and + MostRecentCytologyReport.date less than 3 years after Collate.MostRecentBiopsyReport.date + ) or + ( + CytologyInterpretedAsAscH and + MostRecentCytologyReport.date 2 years or more after Collate.MostRecentBiopsyReport.date and + MostRecentCytologyReport.date less than 3 years after Collate.MostRecentBiopsyReport.date + ) + ) + ) then + { + action: 'ManagementHistologyI4', + text: 'A diagnostic excisional procedure is recommended for patients with HSIL cytology results at either the 1- or 2-year visit, or ASC-H results that persist at the 2-year visit (CIII).' + } + when ( // I4.4 + AgeInYears() >= 25 and + HistologyInterpretedAsCin1OrNormal and + ( + PrecedingCytologyIsHsil or + PrecedingCytologyIsAscH + ) and + ( + not ( + MostRecentTreatmentDate 1 year or less after Collate.MostRecentBiopsyReport.date + ) or + MostRecentTreatment is null + ) and + ( + ( + (MostRecentCytologyReport is not null) and + not CytologyInterpretedAsNilm and + not CytologyInterpretedAsHsil and + MostRecentCytologyReport.date 1 year or more after Collate.MostRecentBiopsyReport.date and + MostRecentCytologyReport.date less than 3 years after Collate.MostRecentBiopsyReport.date + ) or + ( + (Collate.MostRecentHpvReport is not null) and + Collate.MostRecentHpvResult != 'HPV-negative' and + Collate.MostRecentHpvReport.date 1 year or more after Collate.MostRecentBiopsyReport.date and + Collate.MostRecentHpvReport.date less than 3 years after Collate.MostRecentBiopsyReport.date + ) or + ( + // TODO: As written, this part of the path will not trigger. Going forward, we should look into a way to clarify the lookback for 'LSIL (CIN1) or Less Preceded by ASC-H or HSIL Cytology' so that it is not reliant on the MostRecentBiopsyReport + (Collate.MostRecentBiopsyReport is not null) and + not HistologyInterpretedAsNormal and + Collate.MostRecentBiopsyReport.date 1 year or more after Collate.MostRecentBiopsyReport.date and + Collate.MostRecentBiopsyReport.date less than 3 years after Collate.MostRecentBiopsyReport.date + ) + ) + ) then + { + action: 'Colposcopy', + text: 'If any test is abnormal during the observation period after a HSIL and ASC-H cytology, a repeat colposcopy is recommended, and management based on resulting biopsies is recommended.' + } + // I.5 Histologic LSIL (CIN1) Diagnosed Repeatedly for at Least 2 Years + when ( + AgeInYears() >= 25 and + MostRecentBiopsyReportWasWithinPast12months and + HistologyInterpretedAsCin1 and + SecondMostRecentHistologyInterpretedAsCin1 and + TwoMostRecentBiopsyReportsWithin15monthsApart + ) then + { + action: 'ManagementHistologyI5', + text: 'For patients 25 years or older with histologic LSIL (CIN 1) who is diagnosed at consecutive visits for at least 2 years, observation is preferred (BII) but treatment is acceptable (CIII). If treatment is selected and the entire squamocolumnar junction and all lesions were fully visualized during colposcopic examination, either excision or ablation treatments are acceptable (CII).' + } + // I.6 Management of AIS: Adoption of Society of Gynecologic Oncology Recommendations + when ( + AgeInYears() >= 25 and + MostRecentBiopsyReportWasWithinPastYear and + HistologyInterpretedAsAis + ) then + { + action: 'ManagementHistologyI6', + text: 'A diagnostic excisional procedure is recommended for all patients with a diagnosis of AIS on cervical biopsy to rule out invasive adenocarcinoma, even when definitive hysterectomy is planned. Excisional procedures should optimally remove an intact specimen to facilitate accurate interpretation of margin status. Although there is no preference for cold knife conization versus LEEP, intentional disruption of the specimen by performance of a LEEP followed by a \'top hat\' endocervical excision to achieve the desired specimen length is unacceptable. An excisional specimen length of at least 10 mm is preferred, and this can be increased to 18 to 20 mm for patients who are not concerned about the effect of treatment on future pregnancy. These dimensions are preferred regardless of whether hysterectomy is planned. After the initial diagnostic procedure, hysterectomy is the preferred management for all patients who have a histologic diagnosis of AIS, although fertility-sparing management for appropriately selected patients is acceptable. For patients with confirmed AIS with negative margins on the excisional specimen, simple hysterectomy is preferred. For patients with confirmed AIS with positive margins on the excisional specimen, re-excision to achieve negative margins is preferred, even if hysterectomy is planned. For patients with AIS and persistent positive margins for whom additional excisional procedures are not feasible, either a simple or modified radical hysterectomy is acceptable. After hysterectomy, surveillance per the ASCCP surveillance guidelines for treated CIN 2+ is recommended (Section J.3).\n\nFor patients of reproductive age who desire future pregnancy, fertility-sparing management with an excisional procedure is acceptable provided that negative margins have been achieved on the excisional specimen, and the patient is willing and able to adhere to surveillance recommendations. If negative margins cannot be achieved after maximal excisional attempts, fertility-sparing management is not recommended. For patients who undergo fertility-sparing management, surveillance with cotesting and endocervical sampling is recommended every 6 months for at least 3 years, then annually for at least 2 years, or until hysterectomy is performed. For patients who have consistently negative cotesting and endocervical sampling results for 5 years, extending the surveillance interval to every 3 years starting in the sixth year of surveillance is acceptable. Small retrospective studies have shown HPV test results to be the best predictor for recurrent disease. Therefore, for patients who have consistently negative cotesting and endocervical sampling results, continued surveillance is acceptable after completion of childbearing. For patients who have had positive HPV test results or abnormal cytology/histologic results during surveillance, hysterectomy at the completion of childbearing is preferred (see Figure 11).' + } + else + null + end + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// RARE ABNORMALITY #4: Surveillance After Abnormalities + +define MostRecentTreatment: + C3F.MostRecentProcedure( + Dash.CervicalAblationProcedures union + Dash.CervicalExcisionProcedures + ) + +define MostRecentTreatmentDate: + Common.ProcedureDate(MostRecentTreatment) + +define TreatmentInLastYear: + MostRecentTreatment P + where Common.ProcedureDate(P) >= Now() - 12 months + +define HasTreatmentInLastYear: + TreatmentInLastYear is not null + +define AnyHistologicHsil: + (Collate.SortedBiopsyReports) B + where AnyTrue( + (B.allConclusions) aC + return + aC ~ Dash."CIN2" or + aC in Dash."Histologic CIN3" or + aC ~ Dash."HSIL, Unspecified" + ) + +define HistologyInterpretedAsHistologicHsil: + HistologyInterpretedAsCin2 or + HistologyInterpretedAsCin3 or + HistologyInterpretedAsUnspecifiedHsil + +define SecondMostRecentHistologyInterpretedAsCin2: + AnyTrue( + (SecondMostRecentBiopsyReport.allConclusions) aC + return + aC ~ Dash."CIN2" + ) + +define SecondMostRecentHistologyInterpretedAsCin3: + AnyTrue( + (SecondMostRecentBiopsyReport.allConclusions) aC + return + aC in Dash."Histologic CIN3" + ) + +define SecondMostRecentHistologyInterpretedAsUnspecifiedHsil: + AnyTrue( + (SecondMostRecentBiopsyReport.allConclusions) aC + return + aC ~ Dash."HSIL, Unspecified" + ) + +define SecondMostRecentHistologyInterpretedAsHistologicHsil: + SecondMostRecentHistologyInterpretedAsCin2 or + SecondMostRecentHistologyInterpretedAsCin3 or + SecondMostRecentHistologyInterpretedAsUnspecifiedHsil + +define HistologicHsilWithin12MonthsBeforeTreatment: + AnyHistologicHsil B + where + B.date 12 months or less before MostRecentTreatmentDate + +define HasHistologicHsilWithin12MonthsBeforeTreatment: + Exists(HistologicHsilWithin12MonthsBeforeTreatment) + +define PositiveHrHpvTestAfterTreatment: + Collate.MostRecentHpvReport.date >= Now() - 12 months and + Collate.MostRecentHpvReport.date 12 months or less after MostRecentTreatmentDate and + AnyTrue( + (Collate.MostRecentHpvReport.allConclusions) aC + return + aC in Dash."High Risk HPV Positive Results" + ) + +define RareAbnormalityHighGradeHistology: + (Collate.SortedBiopsyReports) B + where AnyTrue( + (B.allConclusions) aC + return + aC ~ Dash."CIN2" or + aC in Dash."Histologic CIN3" or + aC ~ Dash."HSIL, Unspecified" or + aC in Dash."AIS" + ) + +define RareAbnormalityHighGradeHistologyBeforeTreatment: + if (MostRecentTreatment is not null) then + RareAbnormalityHighGradeHistology C + where + C.date 12 months or less before MostRecentTreatmentDate + else + null + +define CytologicHsilOrAgc: + (Collate.SortedCytologyReports) C + where AnyTrue( + (C.allConclusions) aC + return + aC in "HSIL" or + aC ~ "AGC" + ) + +define CytologicHsilOrAgcBeforeTreatment: + if (MostRecentTreatment is not null) then + CytologicHsilOrAgc C + where + C.date 12 months or less before MostRecentTreatmentDate + else + null + +define CytologyResultsBeforeTreatment: + if (MostRecentTreatment is not null) then + (Collate.SortedCytologyReports) C + where + C.date 12 months or less before MostRecentTreatmentDate + else + null + +define HasPersistentAscHBeforeTreatment: + if Count(CytologyResultsBeforeTreatment) >= 2 then + AnyTrue( + (CytologyResultsBeforeTreatment[0].allConclusions) aC + return aC ~ "ASC-H" + ) and + AnyTrue( + (CytologyResultsBeforeTreatment[1].allConclusions) aC + return aC ~ "ASC-H" + ) + else + false + +define TreatmentForHighGradeHistologyOrCytology: + if (MostRecentTreatment is not null) and + ( + Exists(RareAbnormalityHighGradeHistologyBeforeTreatment) or + Exists(CytologicHsilOrAgcBeforeTreatment) or + HasPersistentAscHBeforeTreatment + ) then + MostRecentTreatment + else + null + +define HasTreatmentForHighGradeHistologyOrCytology: + TreatmentForHighGradeHistologyOrCytology is not null + +define TreatmentForHighGradeHistologyOrCytologyDate: + Common.ProcedureDate(TreatmentForHighGradeHistologyOrCytology) + +define NegativeHrHpvTests: + Collate.SortedHpvReports R + where AnyTrue( + (R.allConclusions) aC + return + aC in Dash."HPV Negative Results" + ) + +define NegativeHrHpvTestsAsPartOfCotest: + from NegativeHrHpvTests H, Collate.SortedCytologyReports C + where H.date within 1 day of C.date + return H + +define NegativePrimaryHrHpvTests: + NegativeHrHpvTests except NegativeHrHpvTestsAsPartOfCotest + +define NegativeCytologyTests: + Collate.SortedCytologyReports R + where AnyTrue( + (R.allConclusions) aC + return + aC ~ Dash."NILM" + ) + +define NegativeCotests: + from NegativeHrHpvTests H, NegativeCytologyTests C + where H.date within 1 day of C.date + return H + +define NegativeSurveillanceTests: + ( + NegativePrimaryHrHpvTests union + NegativeCotests + ) + +define SortedNegativeSurveillanceTests: + NegativeSurveillanceTests H + where H.date is not null + return { + date: H.date + } + sort by date asc + +define NegativeSurveillanceTestsAfterMostRecentBiopsy: + SortedNegativeSurveillanceTests H + where H.date > Collate.MostRecentBiopsyReport.date + +define FirstNegativeSurveillanceTestAfterMostRecentBiopsy: + if Count(NegativeSurveillanceTestsAfterMostRecentBiopsy) > 0 then + NegativeSurveillanceTestsAfterMostRecentBiopsy[0] + else + null + +define HasFirstNegativeSurveillanceTestAfterMostRecentBiopsy: + FirstNegativeSurveillanceTestAfterMostRecentBiopsy is not null + +define NegativeSurveillanceTestsAfterSecondMostRecentBiopsy: + SortedNegativeSurveillanceTests H + where H.date > SecondMostRecentBiopsyReport.date + +define FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy: + if Count(NegativeSurveillanceTestsAfterSecondMostRecentBiopsy) > 0 then + NegativeSurveillanceTestsAfterSecondMostRecentBiopsy[0] + else + null + +define HasFirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy: + FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy is not null + +define NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology: + if HasTreatmentForHighGradeHistologyOrCytology then + SortedNegativeSurveillanceTests T + where T.date > TreatmentForHighGradeHistologyOrCytologyDate + else + null + +define InitialIntensiveSurveillancePeriod: + if Count(NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology) >= 4 then + ( + NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[0].date 2 years or more before NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[2].date and + NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[0].date 3 years or less before NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[2].date + ) or + ( + NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[1].date 2 years or more before NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[3].date and + NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[1].date 3 years or less before NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[3].date + ) + else + false + +define RecommendationForSurveillanceAfterAbnormalities: + case + // J.2 Short-Term Follow-up After Treatment for Histologic HSIL + when ( // J2.3 + HistologyInterpretedAsHistologicHsil and + Collate.MostRecentBiopsyReport.date 5 years or less after MostRecentTreatmentDate and + SecondMostRecentHistologyInterpretedAsHistologicHsil and + SecondMostRecentBiopsyReport.date 5 years or less before MostRecentTreatmentDate + ) then + { + action: 'ManagementSurveillanceJ2', + text: 'If recurrent histologic HSIL (CIN 2+) develops after excisional treatment, and repeat excision is not feasible or not desired, hysterectomy is recommended.' + } + when ( // J2.2 + PositiveHrHpvTestAfterTreatment and + HasHistologicHsilWithin12MonthsBeforeTreatment + ) then + { + action: 'ManagementSurveillanceJ2', + text: 'Colposcopy and appropriate biopsies should be performed if an hrHPV \'positive\' result after treatment for histologic HSIL (AIII).' + } + when ( // J2.1 + HasTreatmentInLastYear and + HasHistologicHsilWithin12MonthsBeforeTreatment + ) then + { + action: 'ManagementSurveillanceJ2', + text: 'After treatment, hrHPV-based testing is preferred at 6 months regardless of the margin status of the excisional specimen (BII). hrHPV-based testing includes cotesting and primary hrHPV testing. Follow-up at 6 months with colposcopy and ECC is acceptable (BIII). When margins are positive for CIN 2+ or ECC performed at the time of the excisional procedure shows CIN 2+ in patients 25 years or older who are not concerned about the potential effect of treatment on future pregnancy outcomes, repeat excision or observation is acceptable. For observation, HPV-based testing in 6 months is preferred; it is also acceptable to perform a colposcopy and ECC at 6 months.' + } + // J.3 Guidance for Long-Term Follow-up After Treatment for High-Grade Histology or Cytology + when ( // J3.1 + HasTreatmentForHighGradeHistologyOrCytology and + TreatmentForHighGradeHistologyOrCytologyDate >= Now() - 25 years and + not InitialIntensiveSurveillancePeriod + ) then + { + action: 'ManagementSurveillanceJ3', + text: 'In patients treated for histologic or cytologic HSIL, after the initial HPV-based test at 6 months, annual HPV or cotesting is preferred until 3 consecutive negative tests have been obtained (AII). Discontinuation of screening is recommended if a patient has a limited life expectancy. Management according to the highest-grade abnormality found on histology or cytology is recommended.' + } + when ( // J3.2 + HasTreatmentForHighGradeHistologyOrCytology and + TreatmentForHighGradeHistologyOrCytologyDate >= Now() - 25 years and + InitialIntensiveSurveillancePeriod + ) then + { + action: 'ManagementSurveillanceJ3', + text: 'In patients treated for histologic or cytologic HSIL, after the initial intensive surveillance period, continued surveillance at 3-year intervals is recommended for at least 25 years after treatment of high-grade histology (histologic HSIL, CIN 2, CIN 3, or AIS) or high-grade cytology (HSIL, AGC, or persistent ASC-H) even if this is beyond the age of 65 years (BII). When patients with a history of treated high-grade histology or cytology reach the age of 65 years, if they have completed the initial 25-year surveillance period, continued surveillance at 3-year intervals is acceptable and may continue as long as the patient is in reasonably good health (BIII). Discontinuation of screening is recommended if a patient has a limited life expectancy. Management according to the highest-grade abnormality found on histology or cytology is recommended.' + } + else + null + end + +define Recommendation: + Coalesce( + RecommendationForSurveillanceAfterAbnormalities, + RecommendationForHistologyResults, + RecommendationForExceptionsToColposcopyThreshold, + RecommendationForRareCytology + ) + +// TODO: Replace integers with textual symbol +define WhichRarityMadeTheRecommendation: + case + when RecommendationForSurveillanceAfterAbnormalities is not null then 4 + when RecommendationForHistologyResults is not null then 3 + when RecommendationForExceptionsToColposcopyThreshold is not null then 2 + when RecommendationForRareCytology is not null then 1 + else null + end diff --git a/cql/ManageRareAbnormality.json b/cql/ManageRareAbnormality.json new file mode 100644 index 00000000..ddca9b84 --- /dev/null +++ b/cql/ManageRareAbnormality.json @@ -0,0 +1,10166 @@ +{ + "library" : { + "annotation" : [ { + "translatorOptions" : "", + "type" : 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"type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "type" : "ExpressionRef" + } + } + } + } ] + } ] + }, { + "name" : "HistologyInterpretedAsCin1OrNormal", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG1.4", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients with cytology showing AGC not otherwise specified or atypical endocervical cells not otherwise specified in whom histologic HSIL (CIN 2+) or AIS/cancer is not identified, cotesting at one and two years is recommended. If both cotests are negative, repeat cotesting at 3 years is recommended. If any test is abnormal, then colposcopy is recommended (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "type" : "Or", + "operand" : [ { + "type" : "Or", + "operand" : [ { + "name" : "CytologyInterpretedAsAgcFavorNeoplasia", + "type" : "ExpressionRef" + }, { + "name" : "CytologyInterpretedAsEndocervicalCellsFavorNeoplasia", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsEndocervicalAis", + "type" : "ExpressionRef" + } ] + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "Or", + "operand" : [ { + "name" : "CancerDiagnosisAfterMostRecentCytology", + "type" : "ExpressionRef" + }, { + "type" : "And", + "operand" : [ { + "name" : "HistologyInterpretedAsCancer", + "type" : "ExpressionRef" + }, { + "type" : "Greater", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "type" : "ExpressionRef" + } + } ] + } ] + } ] + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG1.5", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients with atypical glandular or endocervical cells 'favor neoplasia' or endocervical AIS cytology, if invasive disease is not identified during initial colposcopic workup, a diagnostic excisional procedure is recommended. The diagnostic excisional procedure used in this setting should provide an intact specimen with interpretable margins (BII). Endocervical sampling above the excisional bed is preferred (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "Less", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "35", + "type" : "Literal" + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsAgcOrAis", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "CytologyInterpretedAsAtypicalEndometrialCells", + "type" : "ExpressionRef" + } + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "Pregnant", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG1.1", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is also recommended for nonpregnant patients younger than 35 years at increased risk of endometrial neoplasia based on clinical indications (e.g., abnormal uterine bleeding, conditions suggesting chronic anovulation, or obesity) (AII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "35", + "type" : "Literal" + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsAgcOrAis", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "CytologyInterpretedAsAtypicalEndometrialCells", + "type" : "ExpressionRef" + } + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "Pregnant", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG1.2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is recommended in conjunction with colposcopy and endocervical sampling in nonpregnant patients 35 years or older with all categories of AGC and AIS (AII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "name" : "CytologyInterpretedAsAgcOrAis", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsAtypicalEndometrialCells", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "Pregnant", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG1.3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients with atypical endometrial cells specified, initial evaluation limited to endometrial and endocervical sampling is preferred, with colposcopy acceptable at the time of initial evaluation. If colposcopy was deferred and no endometrial pathology is identified, additional evaluation with colposcopy is then recommended.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "name" : "CytologyUnsatisfactory", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Or", + "operand" : [ { + "type" : "Not", + "operand" : { + "name" : "AnyHpvSinceMostRecentCytology", + "type" : "ExpressionRef" + } + }, { + "name" : "NegativeOrUnknownHpvCotest", + "type" : "ExpressionRef" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG2.1", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients with an unsatisfactory cytology result and no, unknown, or a negative HPV test result, repeat age-based screening (cytology, cotest, or primary HPV test) in 2 to 4 months is recommended (BIII). Triage using HPV testing is not recommended (DIII). Before repeat cytology, treatment to resolve atrophy or obscuring inflammation when a specific infection is present is acceptable (CIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "name" : "CytologyUnsatisfactory", + "type" : "ExpressionRef" + } ] + }, { + "name" : "PositiveUntypedHpvCotest", + "type" : "ExpressionRef" + } ] + }, { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG2.2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test without genotyping for HPV 16 or HPV 18, repeat cytology in 2 to 4 months or colposcopy is acceptable (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "name" : "CytologyUnsatisfactory", + "type" : "ExpressionRef" + } ] + }, { + "name" : "PositiveHpv16or18Cotest", + "type" : "ExpressionRef" + } ] + }, { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test with partial genotyping is positive for HPV 16 or HPV 18, direct referral for colposcopy is recommended (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "lowClosed" : true, + "highClosed" : false, + "type" : "Interval", + "low" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "21", + "type" : "Literal" + }, + "high" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "30", + "type" : "Literal" + } + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyAbsentTransformationZone", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsNilm", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG3.1", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Routine screening is recommended (BIII). When cervical cytology alone is performed for screening, HPV testing as a triage test after negative cytology and absent endocervical cells/transformation zone component in this age group is unacceptable (DIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "30", + "type" : "Literal" + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyAbsentTransformationZone", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsNilm", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Or", + "operand" : [ { + "type" : "Not", + "operand" : { + "name" : "AnyHpvSinceMostRecentCytology", + "type" : "ExpressionRef" + } + }, { + "name" : "UnknownHpvCotest", + "type" : "ExpressionRef" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG3.2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV testing is preferred (BIII). Repeat cytology in 3 years is acceptable if HPV testing is not performed (BIII). If HPV testing is performed, manage using Clinical Action Thresholds according to 2019 consensus guidelines.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "HasPremenopausalObservation", + "type" : "ExpressionRef" + }, { + "type" : "Not", + "operand" : { + "name" : "IsSymptomatic", + "libraryName" : "Symptomatic", + "type" : "ExpressionRef" + } + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Or", + "operand" : [ { + "type" : "Or", + "operand" : [ { + "name" : "CytologyInterpretedAsBenignEndometrialCells", + "type" : "ExpressionRef" + }, { + "name" : "CytologyInterpretedAsEndometrialStromalCells", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsHistiocytes", + "type" : "ExpressionRef" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG4.1", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For asymptomatic premenopausal patients with benign endometrial cells, endometrial stromal cells, or histiocytes, no further evaluation is recommended (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "HasPostmenopausalObservation", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsBenignEndometrialCells", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG4.2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For postmenopausal patient with benign endometrial cells found via cytology, endometrial assessment is recommended (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "AbsenceOrRemovalOfCervix", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsBenignGlandularCells", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG4.3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients 'post-hysterectomy' with benign glandular cells identified 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Additional situations for which cryotherapy is not recommended include the following: (a) the squamocolumnar junction or the upper limit of any lesion is not fully visualized; (b) endocervical canal sample is diagnosed as CIN 2+ or CIN that cannot be graded; (c) after previous treatment for CIN 2+; (d) in the setting of inadequate biopsies of the cervix to confirm histologic diagnosis; and (e) if cancer is suspected (EIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "Pregnant", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "RecentlyRespondedYesToFuturePregnancyConcernsQuestion", + "type" : "ExpressionRef" + } + } ] + }, { + "name" : "MostRecentBiopsyReportWasWithinPastYear", + "type" : "ExpressionRef" + } ] + }, { + "name" : "HistologyInterpretedAsCin2", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementHistologyI2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Treatment is recommended unless the patient's concerns about the effect of treatment on future pregnancy outweigh concerns about cancer (BII). Observation is unacceptable when the squamocolumnar junction or the upper limit of the lesion is not fully visualized or when the results of an endocervical sampling, if performed, is CIN 2+ or ungraded (EIII). For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.\n\nWhen treatment of histologic HSIL is planned, excisional treatment is preferred, and treatment with ablation is acceptable (BI). 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"ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "2", + "type" : "Literal" + } ] + } + }, { + "value" : 2, + "unit" : "years", + "type" : "Quantity" + } ] + } ] + }, { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "0", + "type" : "Literal" + } ] + } + }, { + "lowClosed" : true, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "2", + "type" : "Literal" + } ] + } + }, { + "value" : 3, + "unit" : "years", + "type" : "Quantity" + } ] + }, + "high" : { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "2", + "type" : "Literal" + } ] + } + } + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "2", + "type" : "Literal" + } ] + } + } + } + } ] + } ] + }, { + "type" : "And", + "operand" : [ { + "type" : "SameOrBefore", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "1", + "type" : "Literal" + } ] + } + }, { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } ] + } + }, { + "value" : 2, + "unit" : "years", + "type" : "Quantity" + } ] + } ] + }, { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "1", + "type" : "Literal" + } ] + } + }, { + "lowClosed" : true, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } ] + } + }, { + "value" : 3, + "unit" : "years", + "type" : "Quantity" + } ] + }, + "high" : { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } ] + } + } + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } ] + } + } + } + } ] + } ] + } ] + }, + "else" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Boolean", + "value" : "false", + "type" : "Literal" + } + } + }, { + "name" : "RecommendationForSurveillanceAfterAbnormalities", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Case", + "caseItem" : [ { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "HistologyInterpretedAsHistologicHsil", + "type" : "ExpressionRef" + }, { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : false, + "highClosed" : true, + "type" : "Interval", + "low" : { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + }, + "high" : { + "type" : "Add", + "operand" : [ { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + }, { + "value" : 5, + "unit" : "years", + "type" : "Quantity" + } ] + } + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + } + } + } ] + } ] + }, { + "name" : "SecondMostRecentHistologyInterpretedAsHistologicHsil", + "type" : "ExpressionRef" + } ] + }, { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "SecondMostRecentBiopsyReport", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : true, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + }, { + "value" : 5, + "unit" : "years", + "type" : "Quantity" + } ] + }, + "high" : { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + } + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + } + } + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "If recurrent histologic HSIL (CIN 2+) develops after excisional treatment, and repeat excision is not feasible or not desired, hysterectomy is recommended.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "name" : "PositiveHrHpvTestAfterTreatment", + "type" : "ExpressionRef" + }, { + "name" : "HasHistologicHsilWithin12MonthsBeforeTreatment", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy and appropriate biopsies should be performed if an hrHPV 'positive' result after treatment for histologic HSIL (AIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "name" : "HasTreatmentInLastYear", + "type" : "ExpressionRef" + }, { + "name" : "HasHistologicHsilWithin12MonthsBeforeTreatment", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "After treatment, hrHPV-based testing is preferred at 6 months regardless of the margin status of the excisional specimen (BII). hrHPV-based testing includes cotesting and primary hrHPV testing. Follow-up at 6 months with colposcopy and ECC is acceptable (BIII). When margins are positive for CIN 2+ or ECC performed at the time of the excisional procedure shows CIN 2+ in patients 25 years or older who are not concerned about the potential effect of treatment on future pregnancy outcomes, repeat excision or observation is acceptable. For observation, HPV-based testing in 6 months is preferred; it is also acceptable to perform a colposcopy and ECC at 6 months.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "HasTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "type" : "GreaterOrEqual", + "operand" : [ { + "name" : "TreatmentForHighGradeHistologyOrCytologyDate", + "type" : "ExpressionRef" + }, { + "type" : "Subtract", + "operand" : [ { + "type" : "Now" + }, { + "value" : 25, + "unit" : "years", + "type" : "Quantity" + } ] + } ] + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "InitialIntensiveSurveillancePeriod", + "type" : "ExpressionRef" + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "In patients treated for histologic or cytologic HSIL, after the initial HPV-based test at 6 months, annual HPV or cotesting is preferred until 3 consecutive negative tests have been obtained (AII). Discontinuation of screening is recommended if a patient has a limited life expectancy. Management according to the highest-grade abnormality found on histology or cytology is recommended.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "HasTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "type" : "GreaterOrEqual", + "operand" : [ { + "name" : "TreatmentForHighGradeHistologyOrCytologyDate", + "type" : "ExpressionRef" + }, { + "type" : "Subtract", + "operand" : [ { + "type" : "Now" + }, { + "value" : 25, + "unit" : "years", + "type" : "Quantity" + } ] + } ] + } ] + }, { + "name" : "InitialIntensiveSurveillancePeriod", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "In patients treated for histologic or cytologic HSIL, after the initial intensive surveillance period, continued surveillance at 3-year intervals is recommended for at least 25 years after treatment of high-grade histology (histologic HSIL, CIN 2, CIN 3, or AIS) or high-grade cytology (HSIL, AGC, or persistent ASC-H) even if this is beyond the age of 65 years (BII). When patients with a history of treated high-grade histology or cytology reach the age of 65 years, if they have completed the initial 25-year surveillance period, continued surveillance at 3-year intervals is acceptable and may continue as long as the patient is in reasonably good health (BIII). Discontinuation of screening is recommended if a patient has a limited life expectancy. Management according to the highest-grade abnormality found on histology or cytology is recommended.", + "type" : "Literal" + } + } ] + } + } ], + "else" : { + "type" : "As", + "operand" : { + "type" : "Null" + }, + "asTypeSpecifier" : { + "type" : "TupleTypeSpecifier", + "element" : [ { + "name" : "action", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "text", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + } + } + } + }, { + "name" : "Recommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Coalesce", + "operand" : [ { + "name" : "RecommendationForSurveillanceAfterAbnormalities", + "type" : "ExpressionRef" + }, { + "name" : "RecommendationForHistologyResults", + "type" : "ExpressionRef" + }, { + "name" : "RecommendationForExceptionsToColposcopyThreshold", + "type" : "ExpressionRef" + }, { + "name" : "RecommendationForRareCytology", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "WhichRarityMadeTheRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Case", + "caseItem" : [ { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "RecommendationForSurveillanceAfterAbnormalities", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "4", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "RecommendationForHistologyResults", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "RecommendationForExceptionsToColposcopyThreshold", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "2", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "RecommendationForRareCytology", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "1", + "type" : "Literal" + } + } ], + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}Integer", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + } ] + } + } +} + diff --git a/cql/ManageSpecialPopulation.cql b/cql/ManageSpecialPopulation.cql new file mode 100644 index 00000000..6c423c04 --- /dev/null +++ b/cql/ManageSpecialPopulation.cql @@ -0,0 +1,644 @@ +/* + Library: Management of Abnormal Cervical Cancer Screening Results + Author: CMS Alliance to Modernize Healthcare, operated by THE MITRE Corporation. + + (C) 2021 The MITRE Corporation. All Rights Reserved. + Approved for Public Release: 21-1556. + Distribution Unlimited. + + Unless otherwise noted, this work is available under an Apache 2.0 license. + It was produced by the MITRE Corporation for the Division of Cancer Prevention + and Control, Centers for Disease Control and Prevention in accordance with the + Statement of Work, contract number 75FCMC18D0047, task order number 75D30120F09743. +*/ + +library ManageSpecialPopulation version '1.1.0' + +using FHIR version '4.0.1' + +include FHIRHelpers version '4.0.1' called FHIRHelpers +include CDSConnectCommonsforFHIRv401 version '1.0.0' called C3F +include DashboardLibrary version '1.0.0' called Dash +include CollateManagementData version '1.1.0' called Collate +include ManageRareAbnormality version '1.1.0' called Rare +include CCSMCommonFunctions version '1.0.0' called CCF + +//------------------------------------------------------------------------------ +// CODE SYSTEMS, VALUE SETS, AND CODES +//------------------------------------------------------------------------------ + +codesystem "SNOMED-CT": 'http://snomed.info/sct' +codesystem "ICD-9": 'http://hl7.org/fhir/sid/icd-9-cm' +codesystem "ICD-10": 'http://hl7.org/fhir/sid/icd-10-cm' +codesystem "NULL FLAVOR": 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' +codesystem "LOCAL": 'http://OUR-PLACEHOLDER-URL.com' + +valueset "Premenopausal": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.254' // AKA: Premenopausal +valueset "All Results of High Risk HPV Test": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.233' +valueset "HSIL": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.256' +valueset "Normal Histology Finding": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.262' + +code "ASC-H": '441088002' from "SNOMED-CT" display 'Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding)' +code "CIN1": '285836003' from "SNOMED-CT" display 'Cervical intraepithelial neoplasia grade 1 (disorder)' +code "LSIL": '62051000119105' from "SNOMED-CT" display 'Low grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding)' +code "ASC-US": '441087007' from "SNOMED-CT" display 'Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding)' + +//------------------------------------------------------------------------------ +// PARAMETERS +//------------------------------------------------------------------------------ + +/***** BEGIN CDS LOGIC ********************************************************/ + +context Patient + +//------------------------------------------------------------------------------ +// RECOMMENDATIONS FOR SPECIAL POPULATIONS +//------------------------------------------------------------------------------ + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// Special Populations Section K.1 Management of Patients Younger Than 25 Years + +define AssociatedHpvCotest: + Coalesce( + (Collate.SortedHpvReports) H + where H.date within 1 day of Under25And2YearsAgoCytologyReport.date + ) + +define ColposcopySinceMostRecentCytology: + Exists( + (Dash.ColposcopyProcedures) P + where CCF.ProcedureDate(P) >= Rare.MostRecentCytologyReport.date + ) + +define HistologicHsilCin2OrUnspecified: + First( + (Collate.SortedBiopsyReports) B + where AnyTrue( + (B.allConclusions) aC + return + aC ~ Dash."CIN2" or + aC ~ Dash."HSIL, Unspecified" + ) + ) + +define SubsequentLowGradeHistologyReportsSinceMostRecentHsilHistology: + (Collate.SortedBiopsyReports) B + where + B.date less than 2 years after HistologicHsilCin2OrUnspecified.date and + AnyTrue( + (B.allConclusions) aC + return + aC ~ "CIN1" or + aC in "Normal Histology Finding" + ) + +define SubsequentLowGradeCytologyReportsSinceMostRecentHsilHistology: + (Collate.SortedCytologyReports) C + where + C.date less than 2 years after HistologicHsilCin2OrUnspecified.date and + AnyTrue( + (C.allConclusions) aC + return + aC ~ Dash."NILM" or + aC ~ "LSIL" or + aC ~ "ASC-US" + ) + +define Under25AndLowGradeCytologyResults: + AgeInYears() < 25 and + ( + Rare.CytologyInterpretedAsLsil or + ( + Collate.MostRecentCytologyCotestResult = 'ASC-US' and + Collate.MostRecentHpvResult = 'HPV-positive' + ) or + ( + Rare.CytologyInterpretedAsAscus and + Collate.MostRecentCytologyCotestResult is null + ) + ) + +define Under25And2YearsAgoCytologyResults: + (Collate.SortedCytologyReports) C + where ( + C.date 2 years or more before Rare.MostRecentCytologyReport.date and + C.date 3 years or less before Rare.MostRecentCytologyReport.date) + +define Under25And2YearsAgoCytologyReport: + Under25And2YearsAgoCytologyResults[0] + +define Under25And2YearsAgoCytologyReportInterpretedAsLsil: + AnyTrue( + (Under25And2YearsAgoCytologyReport.allConclusions) aC + return aC ~ "LSIL" + ) + +define Under25And2YearsAgoCytologyReportInterpretedAsAscus: + AnyTrue( + (Under25And2YearsAgoCytologyReport.allConclusions) aC + return aC ~ "ASC-US" + ) + +define Under25And2YearsAgoLowGradeCytologyResults: + AgeInYears() < 25 and + ( + Exists(Under25And2YearsAgoCytologyResults) and + ( + Under25And2YearsAgoCytologyReportInterpretedAsLsil or + ( + Under25And2YearsAgoCytologyReportInterpretedAsAscus and + AssociatedHpvCotest.riskTableInput = 'HPV-positive' + ) or + ( + Under25And2YearsAgoCytologyReportInterpretedAsAscus and + AssociatedHpvCotest is null + ) + ) + ) + +define Under25AndSecondMostRecentLowGradeCytologyResults: + AgeInYears() < 25 and + ( + Rare.SecondMostRecentCytologyInterpretedAsLsil or + ( + Rare.SecondMostRecentCytologyInterpretedAsAscus and + AssociatedHpvCotest.riskTableInput = 'HPV-positive' + ) or + ( + Rare.SecondMostRecentCytologyInterpretedAsAscus and + AssociatedHpvCotest is null + ) + ) + +define HistologyInterpretedAsLessThanCin2AfterAbnormalCytologyScreening: + Rare.HistologyInterpretedAsCin1OrNormal and + Under25AndLowGradeCytologyResults and + Under25AndSecondMostRecentLowGradeCytologyResults and + Collate.MostRecentBiopsyReport.date 3 years or less after Rare.MostRecentCytologyReport.date + +define CytologyInterpretedAsAscusOrAbove: + Rare.MostRecentCytologyReport.riskTableInput in {'ASC-US','LSIL','ASC-H','AGC','HSIL+'} + +define SecondMostRecentCytologyInterpretedAsAscHOrHsil: + AnyTrue( + (Rare.SecondMostRecentCytologyReport.allConclusions) aC + return + aC ~ "ASC-H" or + aC in "HSIL" + ) + +define BiopsySinceMostRecentCytology: + Exists( + Collate.SortedBiopsyReports B + where B.date > Rare.MostRecentCytologyReport.date + ) + +define RecommendationForPatientsYoungerThan25: + case + // Heading 3: Management of Histology of Less than CIN2 Preceded by Cytology ASC-H and HSIL in Patients Younger than 25 Year + when ( // Heading3.3 + AgeInYears() < 25 and + not Dash.Pregnant and + Rare.HistologyInterpretedAsCin1OrNormal and + ( + Rare.CytologyInterpretedAsHsil or + Rare.CytologyInterpretedAsAscH + ) and + Rare.MostRecentCytologyReport.date more than 18 months after Collate.MostRecentBiopsyReport.date and + Rare.MostRecentCytologyReport.date less than 3 years after Collate.MostRecentBiopsyReport.date + ) then + { + action: 'LessThan253.3', + text: 'If a high-grade cytologic abnormality (HSIL, ASC-H) without histologic HSIL persists for 2 years, a diagnostic excisional procedure is recommended (unless the patient is pregnant). A diagnostic excisional procedure is recommended in patients when the squamocolumnar junction or the upper limit of all lesions are not fully visualized.' + } + when ( // Heading3.2 + AgeInYears() >= 21 and AgeInYears() < 25 and + Rare.HistologyInterpretedAsCin1OrNormal and + ( + CytologyInterpretedAsAscusOrAbove or + Rare.CytologyInterpretedAsAis + ) and + Rare.MostRecentCytologyReport.date less than 3 years after Collate.MostRecentBiopsyReport.date and + SecondMostRecentCytologyInterpretedAsAscHOrHsil and + Rare.SecondMostRecentCytologyReport.date less than 6 months before Collate.MostRecentBiopsyReport.date + ) then + { + action: 'Colposcopy', + text: 'Colposcopy is recommended for cytologic ASC-US or above on repeat testing following a CIN1 or < CIN1 result that is preceded by a cytologic ASC-H, AGC, AIS, or HSIL result. Clinicians should switch to using risk estimates when patients reach the age of 25 years.' + } + when ( // Heading3.1b + AgeInYears() < 25 and + Rare.HistologyInterpretedAsCin1OrNormal and + Rare.CytologyInterpretedAsHsil and + Rare.MostRecentCytologyReport.date less than 12 months before Collate.MostRecentBiopsyReport.date + ) then + { + action: 'LessThan25HSIL3.1b', + text: 'Observation is recommended with colposcopy and cytology at 1 and 2 years following a cervical histology result of CIN1 or = 2 and + Count(SubsequentLowGradeCytologyReportsSinceMostRecentHsilHistology) >= 2 + ) then + { + action: 'LessThan25HSILSurveillance', + text: 'Surveillance with colposcopy and cervical cytology should be performed at 1 year after the most recent cervical histology and cytology tests following an earlier histology HSIL (CIN2) or histologic HSIL, unspecified result.' + } + when ( // Heading4.1 + AgeInYears() < 25 and + Rare.MostRecentBiopsyReportWasWithinPastYear and + Rare.HistologyInterpretedAsCin3 + ) then + { + action: 'Treatment', + text: 'Treatment is recommended, and observation is unacceptable (EII)' + } + when ( // Heading4.2 + AgeInYears() < 25 and + Rare.MostRecentBiopsyReportWasWithinPastYear and + Rare.HistologyInterpretedAsCin2 + ) then + { + action: 'LessThan25Cin2', + text: 'Observation is preferred, and treatment is acceptable (BII). Observation includes colposcopy and cytology at 6-month intervals.' + } + when ( // Heading4.3 + AgeInYears() < 25 and + Rare.MostRecentBiopsyReportWasWithinPastYear and + Rare.HistologyInterpretedAsUnspecifiedHsil + ) then + { + action: 'LessThan25Unspecified', + text: 'Observation or treatment is acceptable after an unspecified histologic HSIL result. Observation includes colposcopy and cytology at 6-month intervals.' + } + // Heading 1 & Heading 2: Initial Management After an Abnormal Screening Test Result; Management of Cytology ASC-H and HSIL in Patients Younger than 25 Years + when ( // 2 + AgeInYears() < 25 and + Rare.MostRecentCytologyReportWasWithinPastFiveYears and + ( + Rare.CytologyInterpretedAsHsil or + Rare.CytologyInterpretedAsAscH or + Rare.CytologyInterpretedAsAgc or + Rare.CytologyInterpretedAsAis + ) and + not BiopsySinceMostRecentCytology + ) then + { + action: 'Colposcopy', + text: 'Colposcopy is recommended for individuals under 25 years old with cytologic HSIL, ASC-H, AGC or AIS (BII). Immediate treatment without histologic confirmation is not recommended for cytology HSIL or ASC-H. Clinicians should switch to using risk estimates when patients reach the age of 25 years.' + } + when ( // 4 + AgeInYears() < 25 and + Rare.MostRecentCytologyReportWasWithinPastFiveYears and + Collate.MostRecentCytologyCotestResult = 'ASC-US' and + Collate.MostRecentHpvResult = 'HPV-negative' + ) then + { + action: 'Cytology', + text: 'Cervical Cytology test (alone) is indicated 3 years after an ASC-US/HPV-Negative result. Clinicians should switch to using risk estimates when patients reach the age of 25 years.' + } + when ( // 5a + HistologyInterpretedAsLessThanCin2AfterAbnormalCytologyScreening and + Collate.MostRecentBiopsyReport.date > Now() - 12 months + ) then + { + action: 'LessThan25LSIL5a', + text: 'For patients under 25 years old perform cervical cytology one year following cervical histologic LSIL(CIN1) or Collate.MostRecentBiopsyReport.date) + ) then + { + action: 'LessThan25LSIL5b', + text: 'This patient is due now for cervical cytology screening. For patients under 25 years old, cervical cytology should be performed one year after a cervical histologic LSIL(CIN1) or = PregnancyOnset + ) + +define HistologicAisDuringPregnancy: + Exists( + (Collate.SortedBiopsyReports) B + where + B.date >= PregnancyOnset and + B.date <= PregnancyOnset + 42 weeks and + AnyTrue( + (B.allConclusions) aC + return + aC in Dash."AIS" + ) + ) + +define RecommendationForPregnantPatients: + case + // #1 is covered by the Common Abnormality Recommendation section. + when ( // K2.2 - Recommendation #1 + AgeInYears() >= 25 and + Dash.Pregnant and + FirstHistologyAfterPregnancyOnset.date > Now() - 1 year and + FirstHistologyAfterPregnancyOnset.riskTableInput in {'CIN2','CIN3'} + ) then + { + action: 'PregnantPatientK2', + text: 'Surveillance colposcopy and testing (with diagnostic cytology or HPV depending on age) is preferred every 12 to 24 weeks but deferring colposcopy to the postpartum period is acceptable (BII). In postpartum period, colposcopy is recommended no earlier than 4 weeks after delivery (BII). In patients diagnosed with histologic HSIL (CIN2 or CIN3) during pregnancy, if a lesion is detected at postpartum colposcopy, an excisional treatment procedure or full diagnostic evaluation (cervical cytology, HPV, and biopsy) is acceptable (BII). In the absence of a lesion on colposcopy, a full diagnostic evaluation is recommended/ expedited treatment is not recommended (BII). For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). If the histologic HSIL cannot be specified as CIN 2, treatment is preferred, but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' + } + when ( // K2.2 - Recommendation #2 + AgeInYears() >= 25 and + Dash.Pregnant and + HistologicAisDuringPregnancy + ) then + { + action: 'PregnantPatientK2', + text: 'Referral to a gynecologic oncologist is preferred if AIS is diagnosed during pregnancy, but management by a gynecologist skilled in the colposcopic diagnosis and treatment of AIS is acceptable (CIII).' + } + else + null + end + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// Special Populations Section K.3 Managing Patients With Immunosuppression + +define Immunocompromised: + Dash.Immunocompromised + +define MostRecentHpvReportWasWithinPastFiveYears: + Collate.MostRecentHpvReport.date > Now() - 5 years + +define TwoMostRecentCytologyReportsWithin18MonthsApart: + Rare.SecondMostRecentCytologyReport.date within 18 months of Rare.MostRecentCytologyReport.date + +define RecommendationForImmunosuppressedPatients: + case + when ( // K3.3 + Immunocompromised and + Rare.MostRecentCytologyReportWasWithinPastFiveYears and + ( + CytologyInterpretedAsAscusOrAbove or + Rare.CytologyInterpretedAsAis + ) and + Rare.SecondMostRecentCytologyReport.riskTableInput = 'ASC-US' and + TwoMostRecentCytologyReportsWithin18MonthsApart + ) then + { + action: 'Colposcopy', + text: 'Colposcopy is recommended when the patient is immunocompromised and is found to have cytologic ASC-US or higher or HPV positive after a cytologic ASC-US result.' + } + when ( // K3.1 + Immunocompromised and + ( + ( + Collate.MostRecentHpvResult = 'HPV-positive' and + Collate.MostRecentCytologyCotestResult = 'ASC-US' and + Rare.MostRecentCytologyReportWasWithinPastFiveYears + ) or + ( + Rare.MostRecentCytologyReportWasWithinPastFiveYears and + ( + Rare.MostRecentCytologyReport.riskTableInput in {'LSIL','ASC-H','AGC','HSIL+'} or + Rare.CytologyInterpretedAsAis + ) + ) or + ( + Collate.MostRecentHpvResult in {'HPV16+','HPV16-, HPV18+'} and + MostRecentHpvReportWasWithinPastFiveYears + ) + ) + ) then + { + action: 'ImmunosuppressedK3', + text: 'Colposcopy referral is recommended for immunocompromised patients of any age with cytology results of HPV-positive ASC-US or higher and for any cytology results of LSIL or worse.' + } + when ( // K3.2 + Immunocompromised and + Rare.MostRecentCytologyReportWasWithinPastFiveYears and + Rare.MostRecentCytologyReport.riskTableInput = 'ASC-US' + ) then + { + action: 'ImmunosuppressedK3', + text: 'Repeat cytology in 6 to 12 months when the patient is immunocompromised and is found to have cytologic ASC-US.' + } + else + null + end + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// Special Populations Section K.4 Managing Patients After Hysterectomy + +define MostRecentCervixRemovalProcedureDate: + CCF.ProcedureDate( + C3F.MostRecentProcedure( + Dash.RemovalOfCervixProcedures + ) + ) + +define CervixRemovalWithHighGradePrecancerOrCancerReasonCode: + Dash.RemovalOfCervixProcedures P + where AnyTrue( + (P.reasonCode) rC + return + rC in Dash."Cervical Precancer Disorders" or + rC in Dash."Diagnosis of Cervical cancer" or + rC ~ Dash."CIN2" or + rC in Dash."Histologic CIN3" or + rC ~ Dash."HSIL, Unspecified" or + rC in Dash."AIS" or + rC in Dash."Histologic cancer" + ) + +define MostRecentCervixRemovalObservationDate: + CCF.ObservationDate( + C3F.MostRecent( + Dash.AbsenceOfCervixObservations + ) + ) + +define MostRecentCervixRemovalDiagnosisDate: + CCF.Onset( + C3F.MostRecentCondition( + Dash.AbsenceOfCervixDiagnoses + ) + ) + +define CervixRemovalDate: + Coalesce( + MostRecentCervixRemovalProcedureDate, + MostRecentCervixRemovalObservationDate, + MostRecentCervixRemovalDiagnosisDate + ) + +define HighGradePreCancerCervicalLesionDate: + if Exists(Dash.CervicalPrecancerDisorders) then + { + date: CCF.ConditionDate(C3F.MostRecentCondition(Dash.CervicalPrecancerDisorders)) + } + else + null + +define CervicalCancerDiagnosisDate: + if Exists(Dash.CervicalCancerDiagnoses) then + { + date: CCF.ConditionDate(C3F.MostRecentCondition(Dash.CervicalCancerDiagnoses)) + } + else + null + +define HighGradeOrCancerHistologyResultsDate: + if Exists(Dash.HighGradeOrCancerHistologyResults) then + { + date: CCF.DiagnosticReportDate(CCF.MostRecentDiagnosticReport(Dash.HighGradeOrCancerHistologyResults)) + } + else + null + +define CauseForHysterectomyDates: + { + HighGradePreCancerCervicalLesionDate, + CervicalCancerDiagnosisDate, + HighGradeOrCancerHistologyResultsDate + } except { null } + +define SortedCauseForHysterectomyDates: + CauseForHysterectomyDates D + return D + sort by date desc + +define MostRecentCauseForHysterectomyDate: + if Count(SortedCauseForHysterectomyDates) > 0 then + SortedCauseForHysterectomyDates[0].date + else + null + +define HysterectomyPerformedForTreatment: + CervixRemovalDate 1 year or less after MostRecentCauseForHysterectomyDate or + Exists(CervixRemovalWithHighGradePrecancerOrCancerReasonCode) + +define NegativeSurveillanceTestsAfterHysterectomy: // NOTE: We should be able to refactor the LP4 Grade D Exclusions in a similar way + Rare.SortedNegativeSurveillanceTests T + where T.date >= CervixRemovalDate + +define InitialIntensiveSurveillancePeriodPostHysterectomy: + if Count(NegativeSurveillanceTestsAfterHysterectomy) >= 3 then + NegativeSurveillanceTestsAfterHysterectomy[2].date less than 5 years after CervixRemovalDate + else + false + +define RecommendationForManagingPatientsAfterHysterectomy: + case + when ( // K4.1 + CervixRemovalDate >= Now() - 25 years and + HysterectomyPerformedForTreatment and + not InitialIntensiveSurveillancePeriodPostHysterectomy + ) then + { + action: 'HysterectomyK4', + text: 'Three annual hrHPV-based tests with cotest or primary hrHPV test are recommended after a hysterectomy is performed for treatment of a high-grade precancer or cancer.' + } + when ( // K4.2 + CervixRemovalDate >= Now() - 25 years and + HysterectomyPerformedForTreatment and + InitialIntensiveSurveillancePeriodPostHysterectomy + ) then + { + action: 'HysterectomyK4', + text: 'HPV-based testing with cotest or primary hrHPV test is recommended every 3 years after a histologic HSIL (CIN2 or CIN3) or AIS results for 25 years, regardless of whether the patient has had a hysterectomy either for treatment or at any point during the surveillance period (CIII).' + } + else + null + end + +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ +// Special Populations Section K.5 Managing Patients Older Than 65 Years With a History of Prior Abnormalities + +define Over65RecommendationText: + 'If patients over age 65 years undergo HPV testing, cotesting, or cytology, management according to guidelines for patients aged 25 to 65 years is recommended (CII). If surveillance testing is recommended for either a history of abnormal screening results or treatment for precancer, discontinuing surveillance is unacceptable if the patient is in reasonably good health and testing is feasible (DII). Discontinuation of surveillance is recommended for patients with a limited life expectancy (EIII). This population will be managed based on logic defined for rare abnormalities and common abnormalities.' + +// If patients over age 65 years undergo HPV testing, cotesting, or cytology, management according to guidelines for patients aged 25 to 65 years is recommended (CII). Care recommendations for these individuals are covered within the Common Abnormality logic paths. +/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ + +define Recommendation: + Coalesce( + RecommendationForPatientsYoungerThan25, + RecommendationForPregnantPatients, + RecommendationForImmunosuppressedPatients, + RecommendationForManagingPatientsAfterHysterectomy + ) + +define WhichPopulationMadeTheRecommendation: + case + when RecommendationForPatientsYoungerThan25 is not null then 5 + when RecommendationForPregnantPatients is not null then 4 + when RecommendationForImmunosuppressedPatients is not null then 3 + when RecommendationForManagingPatientsAfterHysterectomy is not null then 2 + else null + end + diff --git a/cql/ManageSpecialPopulation.json b/cql/ManageSpecialPopulation.json new file mode 100644 index 00000000..4d0cd5da --- /dev/null +++ b/cql/ManageSpecialPopulation.json @@ -0,0 +1,4059 @@ +{ + "library" : { + "annotation" : [ { + 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"Collate", + "type" : "ExpressionRef" + } + }, { + "value" : 18, + "unit" : "months", + "type" : "Quantity" + } ] + } ] + } ] + }, { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : false, + "highClosed" : false, + "type" : "Interval", + "low" : { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, + "high" : { + "type" : "Add", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "value" : 3, + "unit" : "years", + "type" : "Quantity" + } ] + } + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "LessThan253.3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "If a high-grade cytologic abnormality (HSIL, ASC-H) without histologic HSIL persists for 2 years, a diagnostic excisional procedure is recommended (unless the patient is pregnant). A diagnostic excisional procedure is recommended in patients when the squamocolumnar junction or the upper limit of all lesions are not fully visualized.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "21", + "type" : "Literal" + } ] + }, { + "type" : "Less", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + } ] + }, { + "name" : "HistologyInterpretedAsCin1OrNormal", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Or", + "operand" : [ { + "name" : "CytologyInterpretedAsAscusOrAbove", + "type" : "ExpressionRef" + }, { + "name" : "CytologyInterpretedAsAis", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } ] + } ] + }, { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : false, + "highClosed" : false, + "type" : "Interval", + "low" : { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, + "high" : { + "type" : "Add", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "value" : 3, + "unit" : "years", + "type" : "Quantity" + } ] + } + } ] + } ] + }, { + "name" : "SecondMostRecentCytologyInterpretedAsAscHOrHsil", + "type" : "ExpressionRef" + } ] + }, { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "SecondMostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : false, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "value" : 6, + "unit" : "months", + "type" : "Quantity" + } ] + }, + "high" : { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy is recommended for cytologic ASC-US or above on repeat testing following a CIN1 or < CIN1 result that is preceded by a cytologic ASC-H, AGC, AIS, or HSIL result. Clinicians should switch to using risk estimates when patients reach the age of 25 years.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "Less", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "name" : "HistologyInterpretedAsCin1OrNormal", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsHsil", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } ] + }, { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : false, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "value" : 12, + "unit" : "months", + "type" : "Quantity" + } ] + }, + "high" : { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "LessThan25HSIL3.1b", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Observation is recommended with colposcopy and cytology at 1 and 2 years following a cervical histology result of CIN1 or ): - if conclusions is not null then - (conclusions) c - return - case - when c ~ Dash."NILM" then {text: 'NILM', rank: 1} - when c ~ "ASC-US" then {text: 'ASC-US', rank: 2} - when c ~ "LSIL" then {text: 'LSIL', rank: 3} - when c ~ "ASC-H" then {text: 'ASC-H', rank: 4} - when c ~ "AGC" then {text: 'AGC', rank: 5} - when c in "HSIL" then {text: 'HSIL+', rank: 6} - else {text: 'ALL', rank: 0} - end - else - {{text: 'ALL', rank: 0}} - -/** - * Takes a list of HPV conclusion codes and maps each to a text value and a numerical - * ranking. The text value can be used as input to the risk tables and the numerical - * ranking is meant to convey precendence so that the most specific conclusion can - * be selected from amongst a group of codes. For instance, an HPV test may come back - * both as positive and positive for HPV16. We want to be able to select the latter - * in this case as input to the risk tables. - * @param conclusions - a list of CodeableConcepts - * @returns List - */ -define function HpvInterpretation(conclusions List): - (conclusions) c - return - case - when c ~ "HPV16+" then {text: 'HPV16+', rank: 4} - when c ~ "HPV18+" then {text: 'HPV16-, HPV18+', rank: 3} - when c in Dash."High Risk HPV Positive Results" then {text: 'HPV-positive', rank: 2} - when c in Dash."HPV Negative Results" then {text: 'HPV-negative', rank: 1} - else {text: 'ALL', rank: 0} - end - -/** - * Takes the output from HpvInterpretation() and returns the text of the - * interpretation with the highest rank. This allows more specific conclusions to - * take precedence over more general ones. - * @param interpretations - a list of tuples - * @returns System.String the text to be used as input to the risk tables - */ -define function HighestRankedInterpretation(interpretations List): - Last( - ( - (interpretations) I sort by rank - ) S - return S.text - ) - -define function BiopsyInterpretation(conclusions List): - (conclusions) c - return - case - when c in "Normal Histology Finding" then {text: ' 0 then - if SortedHpvReports[0].date included in HPVTestingIntervalLookBack(Today()) then - SortedHpvReports[0] - else - null - else - null - -define SecondMostRecentHpvReport: - if Count(SortedHpvReports) > 1 then - if SortedHpvReports[1].date included in HPVTestingIntervalLookBack(MostRecentHpvReport.date) then - SortedHpvReports[1] - else - null - else - null - -define ThirdMostRecentHpvReport: - if Count(SortedHpvReports) > 2 then - if SortedHpvReports[2].date included in HPVTestingIntervalLookBack(SecondMostRecentHpvReport.date) then - SortedHpvReports[2] - else - null - else - null - -define FourthMostRecentHpvReport: - if Count(SortedHpvReports) > 3 then - if SortedHpvReports[3].date included in HPVTestingIntervalLookBack(ThirdMostRecentHpvReport.date) then - SortedHpvReports[3] - else - null - else - null - -define MostRecentHpvResult: - MostRecentHpvReport.riskTableInput - -define SecondMostRecentHpvResult: - SecondMostRecentHpvReport.riskTableInput - -define ThirdMostRecentHpvResult: - ThirdMostRecentHpvReport.riskTableInput - -define FourthMostRecentHpvResult: - FourthMostRecentHpvReport.riskTableInput - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// CERVICAL CYTOLOGY - -define CervicalCytologyReports: - Dash.CervicalCytologyReports - -define SortedCytologyReports: - (CervicalCytologyReports) C - return { - riskTableInput: HighestRankedInterpretation( - CytologyInterpretation( - C.conclusionCode - ) - ), - allConclusions: C.conclusionCode, - date: Common.DiagnosticReportDate(C) - } - sort by date desc - -// Edge Cases: -// DONE: 1. HPV but no cytology (solution: just use HPV) -// TODO: 2. Cytology but no HPV (no solution: display error) -// NOTE: This is being updated based on "gaps" document - -define MostRecentCytologyCotest: - Coalesce( - (SortedCytologyReports) S - where S.date within 1 day of MostRecentHpvReport.date - ) - -define SecondMostRecentCytologyCotest: - Coalesce( - (SortedCytologyReports) S - where S.date within 1 day of SecondMostRecentHpvReport.date - ) - -define ThirdMostRecentCytologyCotest: - Coalesce( - (SortedCytologyReports) S - where S.date within 1 day of ThirdMostRecentHpvReport.date - ) - -define FourthMostRecentCytologyCotest: - Coalesce( - (SortedCytologyReports) S - where S.date within 1 day of FourthMostRecentHpvReport.date - ) - -define MostRecentCytologyCotestResult: - if MostRecentHpvReport is null then - null - else - if MostRecentCytologyCotest is null then - 'ALL' - else - MostRecentCytologyCotest.riskTableInput - -define SecondMostRecentCytologyCotestResult: - if SecondMostRecentHpvReport is null then - null - else - if SecondMostRecentCytologyCotest is null then - 'ALL' - else - SecondMostRecentCytologyCotest.riskTableInput - -define ThirdMostRecentCytologyCotestResult: - if ThirdMostRecentHpvReport is null then - null - else - if ThirdMostRecentCytologyCotest is null then - 'ALL' - else - ThirdMostRecentCytologyCotest.riskTableInput - -define FourthMostRecentCytologyCotestResult: - if FourthMostRecentHpvReport is null then - null - else - if FourthMostRecentCytologyCotest is null then - 'ALL' - else - FourthMostRecentCytologyCotest.riskTableInput - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// BIOPSIES / HISTOLOGY - -define BiopsyReports: - Common.LookBack( - Dash.HistologyDiagnosticReports, - BiopsyLookbackPeriod - ) - -define SortedBiopsyReports: - (BiopsyReports) B - return { - riskTableInput: HighestRankedInterpretation( - BiopsyInterpretation( - B.conclusionCode - ) - ), - allConclusions: B.conclusionCode, - date: Common.DiagnosticReportDate(B) - } - sort by date desc - -define MostRecentBiopsyReport: - if Count(SortedBiopsyReports) > 0 then - SortedBiopsyReports[0] - else - null - -define MostRecentBiopsyResult: - MostRecentBiopsyReport.riskTableInput - -define MostRecentBiopsyReferralPeriod: - Interval[MostRecentBiopsyReport.date - BiopsyReferralPeriod, MostRecentBiopsyReport.date) - -define ReferringHpvResult: - if MostRecentHpvReport.date included in MostRecentBiopsyReferralPeriod then - MostRecentHpvResult - else if SecondMostRecentHpvReport.date included in MostRecentBiopsyReferralPeriod then - SecondMostRecentHpvResult - else if ThirdMostRecentHpvReport.date included in MostRecentBiopsyReferralPeriod then - ThirdMostRecentHpvResult - else if FourthMostRecentHpvReport.date included in MostRecentBiopsyReferralPeriod then - FourthMostRecentHpvResult - else - 'ALL' - -define MostRecentCytologyBeforeBiopsy: - Coalesce( - (SortedCytologyReports) S - where S.date included in MostRecentBiopsyReferralPeriod - ) - -define MostRecentCytologyResultBeforeBiopsy: - MostRecentCytologyBeforeBiopsy.riskTableInput - -define ReferringCytologyResult: - if MostRecentCytologyCotest.date included in MostRecentBiopsyReferralPeriod then - MostRecentCytologyCotestResult - else if SecondMostRecentCytologyCotest.date included in MostRecentBiopsyReferralPeriod then - SecondMostRecentCytologyCotestResult - else if ThirdMostRecentCytologyCotest.date included in MostRecentBiopsyReferralPeriod then - ThirdMostRecentCytologyCotestResult - else if FourthMostRecentCytologyCotest.date included in MostRecentBiopsyReferralPeriod then - FourthMostRecentCytologyCotestResult - else if MostRecentCytologyBeforeBiopsy is not null then - MostRecentCytologyResultBeforeBiopsy - else - 'ALL' - -define MostRecentHpvResultPostBiopsy: - if MostRecentHpvReport.date occurs after MostRecentBiopsyReport.date then - MostRecentHpvResult - else - null - -define MostRecentCytologyResultPostBiopsy: - if MostRecentCytologyCotest.date occurs after MostRecentBiopsyReport.date then - MostRecentCytologyCotestResult - else - null - -define SecondMostRecentHpvResultPostBiopsy: - if SecondMostRecentHpvReport.date occurs after MostRecentBiopsyReport.date then - SecondMostRecentHpvResult - else - null - -define SecondMostRecentCytologyResultPostBiopsy: - if SecondMostRecentCytologyCotest.date occurs after MostRecentBiopsyReport.date then - SecondMostRecentCytologyCotestResult - else - null - -define ThirdMostRecentHpvResultPostBiopsy: - if ThirdMostRecentHpvReport.date occurs after MostRecentBiopsyReport.date then - ThirdMostRecentHpvResult - else - null - -define ThirdMostRecentCytologyResultPostBiopsy: - if ThirdMostRecentCytologyCotest.date occurs after MostRecentBiopsyReport.date then - ThirdMostRecentCytologyCotestResult - else - null - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// TREATMENTS - -// Find CIN2/CIN3 biopsy -define Cin2orCin3Biopsies: - SortedBiopsyReports S - where S.riskTableInput in {'CIN2','CIN3'} - -define MostRecentCin2orCin3Biopsy: - First(Cin2orCin3Biopsies) - -// Look for treatments after this CIN2/CIN3 biopsy -define CervicalPrecancerTreatments: - Dash.CervicalExcisionProcedures union - Dash.CervicalAblationProcedures - -define CervicalPrecancerTreatmentsAfterBiopsy: - CervicalPrecancerTreatments T - where Common.ProcedureDate(T) occurs after MostRecentCin2orCin3Biopsy.date - return { - date: Common.ProcedureDate(T) - } - sort by date - -define DateOfLastCervicalPrecancerTreatment: - Last( - CervicalPrecancerTreatmentsAfterBiopsy - ).date - -// Look for HPV/pap tests after treatment -define MostRecentHpvResultAfterTreatment: - if MostRecentHpvReport.date occurs after DateOfLastCervicalPrecancerTreatment then - MostRecentHpvResult - else - null - -define SecondMostRecentHpvResultAfterTreatment: - if SecondMostRecentHpvReport.date occurs after DateOfLastCervicalPrecancerTreatment then - SecondMostRecentHpvResult - else - null - -define ThirdMostRecentHpvResultAfterTreatment: - if ThirdMostRecentHpvReport.date occurs after DateOfLastCervicalPrecancerTreatment then - ThirdMostRecentHpvResult - else - null - -define MostRecentCytologyResultAfterTreatment: - if MostRecentHpvResultAfterTreatment is null then - null - else - MostRecentCytologyCotestResult - -define SecondMostRecentCytologyResultAfterTreatment: - if SecondMostRecentHpvResultAfterTreatment is null then - null - else - SecondMostRecentCytologyCotestResult - -define ThirdMostRecentCytologyResultAfterTreatment: - if ThirdMostRecentHpvResultAfterTreatment is null then - null - else - ThirdMostRecentCytologyCotestResult - //------------------------------------------------------------------------------ // RECOMMENDATIONS FOR RARE ABNORMALITIES //------------------------------------------------------------------------------ - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// RARE ABNORMALITY #1: Rare Cytology - -define MostRecentCytologyReport: - if Count(SortedCytologyReports) > 0 then - SortedCytologyReports[0] - else - null - -define MostRecentCytologyReportWasWithinPastFiveYears: - MostRecentCytologyReport.date >= Now() - 5 years - -define CytologyInterpretedAsAgc: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "AGC" - ) - -define CytologyInterpretedAsAgcFavorNeoplasia: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "AGC Favor Neoplasia" - ) - -define CytologyInterpretedAsAis: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC in Dash."AIS" - ) - -define CytologyInterpretedAsAgcOrAis: - CytologyInterpretedAsAgc or - CytologyInterpretedAsAis - -define CytologyInterpretedAsAtypicalEndometrialCells: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Atypical Endometrial Cells" - ) - -define CytologyInterpretedAsAtypicalEndocervicalCells: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Atypical Endocervical Cells" - ) - -define CytologyInterpretedAsEndocervicalAis: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Endocervical AIS" - ) - -define CytologyInterpretedAsEndocervicalCellsFavorNeoplasia: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Endocervical Cells Favor Neoplasia" - ) - -define CytologyUnsatisfactory: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Unsatisfactory" - ) - -define CytologyAbsentTransformationZone: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Absent Transformation Zone" - ) - -define CytologyInterpretedAsNilm: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ Dash."NILM" - ) - -define SecondMostRecentCytologyInterpretedAsNilm: - AnyTrue( - (SecondMostRecentCytologyReport.allConclusions) aC - return aC ~ Dash."NILM" - ) - -define CytologyInterpretedAsBenignEndometrialCells: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Benign Endometrial Cells" - ) - -define CytologyInterpretedAsBenignGlandularCells: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Benign Glandular Cells" - ) - -define CytologyInterpretedAsEndometrialStromalCells: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Endometrial Stromal Cells" - ) - -define CytologyInterpretedAsHistiocytes: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "Histiocytes" - ) - -define PremenopausalObservations: - C3F.Verified( - [Observation: "Premenopausal"] union - [Observation: "Premenopausal Menorrhagia"] union - [Observation: "Excessive Bleeding in the Premenopausal Period"] - ) - -define HasPremenopausalObservation: - Exists(PremenopausalObservations) - -define PostmenopausalObservations: - C3F.Verified( - [Observation: "Postmenopausal"] - ) - -define HasPostmenopausalObservation: - Exists(PostmenopausalObservations) - -define Pregnant: - Exists(Dash.PregnancyDiagnoses) or - Exists(Dash.PregnancyObservations) - -define HistologyInterpretedAsCin1: - AnyTrue( - (MostRecentBiopsyReport.allConclusions) aC - return - aC ~ "CIN1" - ) - -define HistologyInterpretedAsNormal: - AnyTrue( - (MostRecentBiopsyReport.allConclusions) aC - return - aC in "Normal Histology Finding" - ) - -define HistologyInterpretedAsCin1OrNormal: - HistologyInterpretedAsCin1 or - HistologyInterpretedAsNormal - -define HistologyInterpretedAsCancer: - AnyTrue( - (MostRecentBiopsyReport.allConclusions) aC - return - aC in Dash."Histologic cancer" - ) - -define CancerDiagnosisAfterMostRecentCytology: - Exists( - Dash.CervicalCancerDiagnoses C - where Common.ConditionDate(C) > MostRecentCytologyReport.date - ) - -define AnyHpvSinceMostRecentCytology: - Exists( - (SortedHpvReports) B - where B.date >= MostRecentCytologyReport.date - 1 day - ) - -define UnknownHpvCotest: - MostRecentHpvReport.date within 1 day of MostRecentCytologyReport.date and - AnyTrue( - (MostRecentHpvReport.allConclusions) aC - return - aC ~ "Unknown" or - not (aC in "All Results of High Risk HPV Test") - ) - -define NegativeOrUnknownHpvCotest: - MostRecentHpvReport.date within 1 day of MostRecentCytologyReport.date and - AnyTrue( - (MostRecentHpvReport.allConclusions) aC - return - aC in Dash."HPV Negative Results" or - aC ~ "Unknown" or - not (aC in "All Results of High Risk HPV Test") - ) - -define PositiveUntypedHpvCotest: - MostRecentHpvReport.date within 1 day of MostRecentCytologyReport.date and - AnyTrue( - (MostRecentHpvReport.allConclusions) aC - return - aC in Dash."High Risk Positive HPV Results Without HPV16 or HPV18" - ) - -define PositiveHpv16or18Cotest: - MostRecentHpvReport.date within 1 day of MostRecentCytologyReport.date and - AnyTrue( - (MostRecentHpvReport.allConclusions) aC - return - aC ~ "HPV16+" or - aC ~ "HPV18+" - ) - -define HasRemovalOfCervixProcedures: - Exists(Dash.RemovalOfCervixProcedures) - -define HasAbsenceOfCervixDiagnoses: - Exists(Dash.AbsenceOfCervixDiagnoses) - -define HasAbsenceOfCervixObservations: - Exists(Dash.AbsenceOfCervixObservations) - -define AbsenceOrRemovalOfCervix: - HasRemovalOfCervixProcedures or - HasAbsenceOfCervixDiagnoses or - HasAbsenceOfCervixObservations - -define RecommendationForRareCytology: - case - // G.1 Evaluation of Cytology Interpreted as AGC or AIS - when ( - AgeInYears() < 35 and - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyInterpretedAsAgcOrAis and - not CytologyInterpretedAsAtypicalEndometrialCells and - not Pregnant - ) then - { - action: null, - text: 'For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is also recommended for nonpregnant patients younger than 35 years at increased risk of endometrial neoplasia based on clinical indications (e.g., abnormal uterine bleeding, conditions suggesting chronic anovulation, or obesity) (AII).' - } - when ( - AgeInYears() >= 35 and - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyInterpretedAsAgcOrAis and - not CytologyInterpretedAsAtypicalEndometrialCells and - not Pregnant - ) then - { - action: null, - text: 'For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is recommended in conjunction with colposcopy and endocervical sampling in nonpregnant patients 35 years or older with all categories of AGC and AIS (AII).' - } - when ( - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyInterpretedAsAgcOrAis and - CytologyInterpretedAsAtypicalEndometrialCells and - not Pregnant - ) then - { - action: null, - text: 'For patients with atypical endometrial cells specified, initial evaluation limited to endometrial and endocervical sampling is preferred, with colposcopy acceptable at the time of initial evaluation. If colposcopy was deferred and no endometrial pathology is identified, additional evaluation with colposcopy is then recommended.' - } - // Subsequent Management - when ( - MostRecentCytologyReportWasWithinPastFiveYears and - ( - CytologyInterpretedAsAgc or - CytologyInterpretedAsAtypicalEndocervicalCells - ) and - MostRecentBiopsyReport.date 12 months or less after MostRecentCytologyReport.date and - HistologyInterpretedAsCin1OrNormal - ) then - { - action: null, - text: 'For patients with cytology showing AGC not otherwise specified or atypical endocervical cells not otherwise specified in whom histologic HSIL (CIN 2+) or AIS/cancer is not identified, cotesting at one and two years is recommended. If both cotests are negative, repeat cotesting at 3 years is recommended. If any test is abnormal, then colposcopy is recommended (BII).' - } - when ( - MostRecentCytologyReportWasWithinPastFiveYears and - ( - CytologyInterpretedAsAgcFavorNeoplasia or - CytologyInterpretedAsEndocervicalCellsFavorNeoplasia or - CytologyInterpretedAsEndocervicalAis - ) and - not ( - CancerDiagnosisAfterMostRecentCytology or - ( - HistologyInterpretedAsCancer and - MostRecentBiopsyReport.date > MostRecentCytologyReport.date - ) - ) - ) then - { - action: null, - text: 'For patients with atypical glandular or endocervical cells “favor neoplasia” or endocervical AIS cytology, if invasive disease is not identified during initial colposcopic workup, a diagnostic excisional procedure is recommended. The diagnostic excisional procedure used in this setting should provide an intact specimen with interpretable margins (BII). Endocervical sampling above the excisional bed is preferred (BII).' - } - // G.2 Unsatisfactory Cytology - when ( - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyUnsatisfactory and - ( - not AnyHpvSinceMostRecentCytology or - NegativeOrUnknownHpvCotest - ) - ) then - { - action: null, - text: 'For patients with an unsatisfactory cytology result and no, unknown, or a negative HPV test result, repeat age-based screening (cytology, cotest, or primary HPV test) in 2 to 4 months is recommended (BIII). Triage using HPV testing is not recommended (DIII). Before repeat cytology, treatment to resolve atrophy or obscuring inflammation when a specific infection is present is acceptable (CIII).' - } - when ( - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyUnsatisfactory and - PositiveUntypedHpvCotest and - AgeInYears() >= 25 - ) then - { - action: null, - text: 'For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test without genotyping for HPV 16 or HPV 18, repeat cytology in 2 to 4 months or colposcopy is acceptable (BII).' - } - when ( - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyUnsatisfactory and - PositiveHpv16or18Cotest and - AgeInYears() >= 25 - ) then - { - action: null, - text: 'For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test with partial genotyping is positive for HPV 16 or HPV 18, direct referral for colposcopy is recommended (BII).' - } - // G.3 Absent Transformation Zone on Screening Cytology - when ( - AgeInYears() in Interval[21,30) and - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyAbsentTransformationZone and - CytologyInterpretedAsNilm - ) then - { - action: null, - text: 'Routine screening is recommended (BIII). When cervical cytology alone is performed for screening, HPV testing as a triage test after negative cytology and absent endocervical cells/transformation zone component in this age group is unacceptable (DIII).' - } - when ( - AgeInYears() >= 30 and - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyAbsentTransformationZone and - CytologyInterpretedAsNilm and - ( - not AnyHpvSinceMostRecentCytology or - UnknownHpvCotest - ) - ) then - { - action: null, - text: 'HPV testing is preferred (BIII). Repeat cytology in 3 years is acceptable if HPV testing is not performed (BIII). If HPV testing is performed, manage using Clinical Action Thresholds according to 2019 consensus guidelines.' - } - // G.4 Benign Endometrial Cells in Premenopausal Patients or Benign Glandular Cells in Posthysterectomy patients - when ( - HasPremenopausalObservation and - not Symptomatic.IsSymptomatic and - MostRecentCytologyReportWasWithinPastFiveYears and - ( - CytologyInterpretedAsBenignEndometrialCells or - CytologyInterpretedAsEndometrialStromalCells or - CytologyInterpretedAsHistiocytes - ) - ) then - { - action: null, - text: 'For asymptomatic premenopausal patients with benign endometrial cells, endometrial stromal cells, or histiocytes, no further evaluation is recommended (BII).' - } - when ( - HasPostmenopausalObservation and - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyInterpretedAsBenignEndometrialCells - ) then - { - action: null, - text: 'For postmenopausal patient with benign endometrial cells found via cytology, endometrial assessment is recommended (BII).' - } - when ( - AbsenceOrRemovalOfCervix and - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyInterpretedAsBenignGlandularCells - ) then - { - action: null, - text: 'For patients “post-hysterectomy” with benign glandular cells identified via cytology, no further evaluation is recommended (BII).' - } - else - null - end - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// RARE ABNORMALITY #2: Exceptions to Colposcopy Clinical Action Threshold - -define CytologyInterpretedAsAscH: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "ASC-H" - ) - -define SecondMostRecentCytologyReport: - if Count(SortedCytologyReports) > 1 then - SortedCytologyReports[1] - else - null - -define TwoMostRecentCytologyReportsWithin5yearsApart: - SecondMostRecentCytologyReport.date within 5 years of MostRecentCytologyReport.date - -define SecondMostRecentCytologyUnsatisfactory: - AnyTrue( - (SecondMostRecentCytologyReport.allConclusions) aC - return aC ~ "Unsatisfactory" - ) - -define RecommendationForExceptionsToColposcopyThreshold: - case - when ( - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyInterpretedAsAscH - ) then - { - action: null, - text: 'For patients with ASC-H cytology, colposcopy is recommended regardless of hrHPV result (AII).' - } - when ( - MostRecentCytologyReportWasWithinPastFiveYears and - PositiveHpv16or18Cotest and - CytologyInterpretedAsNilm - ) then - { - action: null, - text: 'For patients with hrHPV 18–positive NILM or hrHPV 16-positive NILM, colposcopy is recommended (AII).' - } - when ( - MostRecentCytologyReportWasWithinPastFiveYears and - CytologyUnsatisfactory and - TwoMostRecentCytologyReportsWithin5yearsApart and - SecondMostRecentCytologyUnsatisfactory - ) then - { - action: null, - text: 'Colposcopy should be performed after 2 consecutive unsatisfactory screening tests (CIII).' - } - else - null - end - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// RARE ABNORMALITY #3: Managing Histology Results - -define MostRecentBiopsyReportWasWithinPastYear: - MostRecentBiopsyReport.date >= Now() - 1 year - -define HistologyInterpretedAsCin2: - AnyTrue( - (MostRecentBiopsyReport.allConclusions) aC - return - aC ~ Dash."CIN2" - ) - -define HistologyInterpretedAsCin3: - AnyTrue( - (MostRecentBiopsyReport.allConclusions) aC - return - aC in Dash."Histologic CIN3" - ) - -define HistologyInterpretedAsAis: - AnyTrue( - (MostRecentBiopsyReport.allConclusions) aC - return - aC in Dash."AIS" - ) - -define HistologyInterpretedAsUnspecifiedHsil: - AnyTrue( - (MostRecentBiopsyReport.allConclusions) aC - return - aC ~ Dash."HSIL, Unspecified" - ) - -define PrecedingCytologyResults: - Coalesce( - (SortedCytologyReports) S - where S.date <= MostRecentBiopsyReport.date and - S.date >= MostRecentBiopsyReport.date - 6 months - ) - -define PrecedingCytologyIsHsil: - AnyTrue( - (PrecedingCytologyResults.allConclusions) aC - return - aC in "HSIL" - ) - -define PrecedingCytologyIsAscH: - AnyTrue( - (PrecedingCytologyResults.allConclusions) aC - return - aC ~ "ASC-H" - ) - -define PrecedingCytologyResultsBeforeSecondMostRecentBiopsy: - Coalesce( - (SortedCytologyReports) S - where S.date <= SecondMostRecentBiopsyReport.date and - S.date >= SecondMostRecentBiopsyReport.date - 6 months - ) - -define PrecedingCytologyBeforeSecondMostRecentBiopsyIsHsil: - AnyTrue( - (PrecedingCytologyResultsBeforeSecondMostRecentBiopsy.allConclusions) aC - return - aC in "HSIL" - ) - -define PrecedingCytologyBeforeSecondMostRecentBiopsyIsAscH: - AnyTrue( - (PrecedingCytologyResultsBeforeSecondMostRecentBiopsy.allConclusions) aC - return - aC ~ "ASC-H" - ) - -define SecondMostRecentBiopsyReport: - if Count(SortedBiopsyReports) > 1 then - SortedBiopsyReports[1] - else - null - -define SecondMostRecentHistologyInterpretedAsCin1: - AnyTrue( - (SecondMostRecentBiopsyReport.allConclusions) aC - return - aC ~ "CIN1" - ) - -define SecondMostRecentHistologyInterpretedAsNormal: - AnyTrue( - (SecondMostRecentBiopsyReport.allConclusions) aC - return - aC in "Normal Histology Finding" - ) - -define SecondMostRecentHistologyInterpretedAsCin1OrNormal: - SecondMostRecentHistologyInterpretedAsCin1 or - SecondMostRecentHistologyInterpretedAsNormal - -define MostRecentBiopsyReportWasWithinPast12months: - MostRecentBiopsyReport.date >= Now() - 12 months - -define MostRecentBiopsyReportWasWithinPast18months: - MostRecentBiopsyReport.date >= Now() - 18 months - -define TwoMostRecentBiopsyReportsWithin18monthsApart: - SecondMostRecentBiopsyReport.date within 18 months of MostRecentBiopsyReport.date - -define TwoMostRecentBiopsyReportsWithin15monthsApart: - SecondMostRecentBiopsyReport.date within 15 months of MostRecentBiopsyReport.date - -define RecentlyRespondedYesToFuturePregnancyConcernsQuestion: - C3F.MostRecent( - C3F.ObservationLookBack( - Dash.ResponsesToFuturePregnancyConcernsQuestion R - where R.value ~ Dash."Yes", - 3 months - ) - ) is not null - -define InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months: - First( - (SortedBiopsyReports) B - where B.date >= Now() - 18 months and - AnyTrue( - (B.allConclusions) aC - return - aC ~ Dash."HSIL, Unspecified" or - aC ~ Dash."CIN2" - ) - ) - -define InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years: - First( - (SortedBiopsyReports) B - where B.date >= Now() - 6 years and - AnyTrue( - (B.allConclusions) aC - return - aC ~ Dash."HSIL, Unspecified" or - aC ~ Dash."CIN2" - ) - ) - -define HistologyInterpretedAsUnspecifiedHsilOrCin2BeforeMostRecentBiopsy: - (SortedBiopsyReports) B - where - B.date 2 years or more before MostRecentBiopsyReport.date and - B.date 2.5 years or less before MostRecentBiopsyReport.date and - AnyTrue( - (B.allConclusions) aC - return - aC ~ Dash."HSIL, Unspecified" or - aC ~ Dash."CIN2" - ) - -define HasHistologyInterpretedAsUnspecifiedHsilOrCin2BeforeMostRecentBiopsy: - Exists(HistologyInterpretedAsUnspecifiedHsilOrCin2BeforeMostRecentBiopsy) - -define MostRecentNegativeHsilSurveillanceResult: - if (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months is not null) then - MostRecentBiopsyReport.date 18 months or less after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months.date and - HistologyInterpretedAsCin1OrNormal and - MostRecentCytologyReport.date 18 months or less after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months.date and - ( - CytologyInterpretedAsLsil or - CytologyInterpretedAsAscus or - CytologyInterpretedAsNilm - ) - else - false - -define SecondMostRecentNegativeHsilSurveillanceResult: - if (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months is not null) then - SecondMostRecentBiopsyReport.date 18 months or less after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months.date and - SecondMostRecentHistologyInterpretedAsCin1OrNormal and - SecondMostRecentCytologyReport.date 18 months or less after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months.date and - ( - SecondMostRecentCytologyInterpretedAsLsil or - SecondMostRecentCytologyInterpretedAsAscus or - SecondMostRecentCytologyInterpretedAsNilm - ) - else - false - -define SubsequentLowGradeHistologyReportsSinceInitialUnspecifiedHsilOrCin2InLast6Years: - if (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years is not null) then - SortedBiopsyReports R - where R.date after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years.date and - AnyTrue( - (R.allConclusions) aC - return - aC ~ "CIN1" or - aC in "Normal Histology Finding" - ) - else - null - -define SubsequentLowGradeCytologyReportsSinceInitialUnspecifiedHsilOrCin2InLast6Years: - if (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years is not null) then - SortedCytologyReports R - where R.date after InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years.date and - AnyTrue( - (R.allConclusions) aC - return - aC ~ Dash."NILM" or - aC ~ "LSIL" or - aC ~ "ASC-US" - ) - else - null - -define MostRecentSurveillanceTestNegative: - ( - MostRecentHpvResult = 'HPV-negative' and - MostRecentCytologyCotestResult = 'NILM' - ) or - ( - MostRecentHpvResult = 'HPV-negative' and - MostRecentCytologyCotest is null - ) - -define RecommendationForHistologyResults: - case - // I.1 Management of Histologic HSIL, not Further Specified or Qualified - when ( - AgeInYears() >= 25 and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsUnspecifiedHsil - ) then - { - action: null, - text: 'Treatment is preferred if histologic HSIL cannot be specified (e.g., reported as histologic HSIL or histologic HSIL [CIN 2,3]) (CIII), but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' - } - // I.2 Management of Histologic HSIL (CIN2 or CIN3) - when ( // 1 - AgeInYears() >= 25 and - not Pregnant and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsCin3 - ) then - { - action: null, - text: 'Treatment is recommended, and observation is unacceptable (AII). When treatment of histologic HSIL is planned, excisional treatment is preferred, and treatment with ablation is acceptable (BI). Outside of the setting of a clinical research trial, nonsurgical therapies, including topical agents, therapeutic vaccines, and other biologics, are unacceptable for the treatment of histologic HSIL (CIN 2 or CIN 3) (DIII). Hysterectomy is unacceptable as primary therapy solely for the treatment of histologic HSIL (CIN 2, CIN 3, or unqualified) (EII). When considering ablative therapy, in particular cryotherapy, ablation is unacceptable in the following circumstances as defined by the WHO: (a) the lesion extends into the canal and (b) when the lesion covers more than 75% of the surface area of the ectocervix or extends beyond the cryotip being used.97 Additional situations for which cryotherapy is not recommended include the following: (a) the squamocolumnar junction or the upper limit of any lesion is not fully visualized; (b) endocervical canal sample is diagnosed as CIN 2+ or CIN that cannot be graded; (c) after previous treatment for CIN 2+; (d) in the setting of inadequate biopsies of the cervix to confirm histologic diagnosis; and (e) if cancer is suspected (EIII).' - } - when ( // 2 - AgeInYears() >= 25 and - not Pregnant and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsCin2 - ) then - { - action: null, - text: 'Treatment is recommended unless the patient\'s concerns about the effect of treatment on future pregnancy outweigh concerns about cancer (BII). Observation is unacceptable when the squamocolumnar junction or the upper limit of the lesion is not fully visualized or when the results of an endocervical sampling, if performed, is CIN 2+ or ungraded (EIII). For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.\n\nWhen treatment of histologic HSIL is planned, excisional treatment is preferred, and treatment with ablation is acceptable (BI). Outside of the setting of a clinical research trial, nonsurgical therapies, including topical agents, therapeutic vaccines, and other biologics, are unacceptable for the treatment of histologic HSIL (CIN 2 or CIN 3) (DIII). Hysterectomy is unacceptable as primary therapy solely for the treatment of histologic HSIL (CIN 2, CIN 3, or unqualified) (EII). When considering ablative therapy, in particular cryotherapy, ablation is unacceptable in the following circumstances as defined by the WHO: (a) the lesion extends into the canal and (b) when the lesion covers more than 75% of the surface area of the ectocervix or extends beyond the cryotip being used.97 Additional situations for which cryotherapy is not recommended include the following: (a) the squamocolumnar junction or the upper limit of any lesion is not fully visualized; (b) endocervical canal sample is diagnosed as CIN 2+ or CIN that cannot be graded; (c) after previous treatment for CIN 2+; (d) in the setting of inadequate biopsies of the cervix to confirm histologic diagnosis; and (e) if cancer is suspected (EIII).' - } - // I.3 Management of CIN2 in Those Who Are Concerned About the Potential Effect of Treatment on Future Pregnancy Outcomes - when ( // 1 - AgeInYears() >= 25 and AgeInYears() <= 50 and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsCin2 and - RecentlyRespondedYesToFuturePregnancyConcernsQuestion - ) then - { - action: null, - text: 'For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' - } - when ( // 2 - AgeInYears() >= 25 and AgeInYears() <= 50 and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsUnspecifiedHsil - RecentlyRespondedYesToFuturePregnancyConcernsQuestion - ) then - { - action: null, - text: 'If the histologic HSIL cannot be specified as CIN 2, treatment is preferred, but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' - } - when ( // 3 - AgeInYears() >= 25 and AgeInYears() <= 50 and - (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months is not null) and - MostRecentNegativeHsilSurveillanceResult - SecondMostRecentNegativeHsilSurveillanceResult and - RecentlyRespondedYesToFuturePregnancyConcernsQuestion - ) then - { - action: null, - text: 'Subsequent surveillance with colposcopy and HPV-based testing should occur every year since the patient has demonstrated less than CIN2 and less than ASC-H during surveillance following a histologic unspecified or CIN2 result.' - } - when ( // 4 - AgeInYears() >= 25 and AgeInYears() <= 50 and - (InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast6Years is not null) and - Count(SubsequentLowGradeHistologyReportsSinceInitialUnspecifiedHsilOrCin2InLast6Years) >= 5 and - Count(SubsequentLowGradeCytologyReportsSinceInitialUnspecifiedHsilOrCin2InLast6Years) >= 5 and - RecentlyRespondedYesToFuturePregnancyConcernsQuestion - ) then - { - action: null, - text: 'Surveillance testing with colposcopy and HPV-based testing is recommended every 3 years for 25 years after histologic HSIL (unspecified or CIN2) even if beyond the age of 65 (BII).' - } - when ( // 5 - AgeInYears() >= 25 and AgeInYears() <= 50 and - ( - HistologyInterpretedAsUnspecifiedHsil or - HistologyInterpretedAsCin2 - ) and - HasHistologyInterpretedAsUnspecifiedHsilOrCin2BeforeMostRecentBiopsy - ) then - { - action: null, - text: 'If CIN 2 remains present for a 2-year period, treatment is recommended (CII).' - } - // I.4 Management of LSIL (CIN1) or Less Preceded by ASC-H or HSIL Cytology - when ( // 1 - AgeInYears() >= 25 and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsCin1OrNormal and - PrecedingCytologyIsHsil - ) then - { - action: null, - text: 'When CIN 2+ is not identified, HSIL cytology is managed more aggressively than ASC-H cytology. For cytology showing HSIL, but biopsy showing histologic LSIL (CIN 1) or less, either an immediate diagnostic excisional procedure or observation with HPV-based testing and colposcopy at 1 year is acceptable, provided in the latter case that the initial colposcopic examination fully visualized the squamocolumnar junction and the upper limit of any lesion, and that the endocervical sampling, if collected, was less than CIN 2 (BII). When CIN2+ is not identified histologically after an ASC-H or HSIL cytology result, it is acceptable to review the cytologic, histologic, and colposcopic findings. If the review yields a revised interpretation, management should follow guidelines for the revised diagnosis (CIII).' - } - when ( // 2 - AgeInYears() >= 25 and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsCin1OrNormal and - PrecedingCytologyIsAscH - ) then - { - action: null, - text: 'For ASC-H, if the colposcopic examination can fully visualize the squamocolumnar junction and the upper limit of any lesion and that the endocervical sampling, if collected, is negative, observation at 1 year with HPV-based testing with cotesting or primary hrHPV testing is recommended; a diagnostic excisional procedure is not recommended (BII).' - } - when ( // 3 - Recommendation #1 - AgeInYears() >= 25 and - ( - ( - ( - MostRecentBiopsyReportWasWithinPast18months and - HistologyInterpretedAsNormal and - TwoMostRecentBiopsyReportsWithin18monthsApart - ) and - ( - HasFirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy and - FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy.date > Now() - 18 months and - FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy.date 18 months or less after SecondMostRecentBiopsyReport.date - ) and - ( - SecondMostRecentHistologyInterpretedAsCin1OrNormal and - PrecedingCytologyBeforeSecondMostRecentBiopsyIsHsil - ) and - not ( - MostRecentTreatmentDate 1 year or less after SecondMostRecentBiopsyReport.date - ) - ) or - ( - ( - HasFirstNegativeSurveillanceTestAfterMostRecentBiopsy and - FirstNegativeSurveillanceTestAfterMostRecentBiopsy.date > Now() - 18 months and - FirstNegativeSurveillanceTestAfterMostRecentBiopsy.date 18 months or less after MostRecentBiopsyReport.date - ) and - ( - HistologyInterpretedAsCin1OrNormal and - PrecedingCytologyIsAscH - ) and - not ( - MostRecentTreatmentDate 1 year or less after MostRecentBiopsyReport.date - ) - ) - ) - ) then - { - action: null, - text: 'HPV-based testing (i.e., cotesting or primary hrHPV testing) is recommended 1 year after the initial negative follow up result(s) when observation is elected after a histologic LSIL (CIN1) preceded by ASC-H or HSIL cytology.' - } - when ( // 3 - Recommendation #2 - AgeInYears() >= 25 and - MostRecentSurveillanceTestNegative and - MostRecentHpvReport.date >= Now() - 3.5 years and - ( - ( - ( - MostRecentBiopsyReport.date 18 months or less before MostRecentHpvReport.date and - HistologyInterpretedAsNormal and - TwoMostRecentBiopsyReportsWithin18monthsApart - ) and - ( - HasFirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy and - FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy.date 18 months or less before MostRecentHpvReport.date and - FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy.date 18 months or less after SecondMostRecentBiopsyReport.date - ) and - ( - SecondMostRecentHistologyInterpretedAsCin1OrNormal and - PrecedingCytologyBeforeSecondMostRecentBiopsyIsHsil - ) and - not ( - MostRecentTreatmentDate 1 year or less after SecondMostRecentBiopsyReport.date - ) - ) or - ( - ( - HasFirstNegativeSurveillanceTestAfterMostRecentBiopsy and - FirstNegativeSurveillanceTestAfterMostRecentBiopsy.date 18 months or less before MostRecentHpvReport.date and - FirstNegativeSurveillanceTestAfterMostRecentBiopsy.date 18 months or less after MostRecentBiopsyReport.date - ) and - ( - HistologyInterpretedAsCin1OrNormal and - PrecedingCytologyIsAscH - ) and - not ( - MostRecentTreatmentDate 1 year or less after MostRecentBiopsyReport.date - ) - ) - ) - ) then - { - action: null, - text: 'Retest with HPV-based testing (i.e., cotesting or primary hrHPV testing) every 3 years after surveillance tests are negative during the 2-year observation period following histologic LSIL (CIN1) or less preceded by ASC-H or HSIL cytology. Proceed with long-term surveillance (i.e., HPV-based testing every 3 years for at least 25 years, even if this is beyond the age of 65 years (BII).' - } - when ( // 4 - AgeInYears() >= 25 and - HistologyInterpretedAsCin1OrNormal and - ( - PrecedingCytologyIsHsil or - PrecedingCytologyIsAscH - ) and - not ( - MostRecentTreatmentDate 1 year or less after MostRecentBiopsyReport.date - ) and - ( - ( - (MostRecentCytologyReport is not null) and - not CytologyInterpretedAsNilm and - not CytologyInterpretedAsHsil and - MostRecentCytologyReport.date 1 year or more after MostRecentBiopsyReport.date and - MostRecentCytologyReport.date less than 3 years after MostRecentBiopsyReport.date - ) or - ( - (MostRecentHpvReport is not null) and - MostRecentHpvResult != 'HPV-negative' and - MostRecentHpvReport.date 1 year or more after MostRecentBiopsyReport.date and - MostRecentHpvReport.date less than 3 years after MostRecentBiopsyReport.date - ) or - ( - // TODO: As written, this part of the path will not trigger. Going forward, we should look into a way to clarify the lookback for 'LSIL (CIN1) or Less Preceded by ASC-H or HSIL Cytology' so that it is not reliant on the MostRecentBiopsyReport - (MostRecentBiopsyReport is not null) and - not HistologyInterpretedAsNormal and - MostRecentBiopsyReport.date 1 year or more after MostRecentBiopsyReport.date and - MostRecentBiopsyReport.date less than 3 years after MostRecentBiopsyReport.date - ) - ) - ) then - { - action: null, - text: 'If any test is abnormal during the observation period after a HSIL and ASC-H cytology, a repeat colposcopy is recommended, and management based on resulting biopsies is recommended.' - } - when ( // 5 - AgeInYears() >= 25 and - HistologyInterpretedAsCin1OrNormal and - ( - PrecedingCytologyIsHsil or - PrecedingCytologyIsAscH - ) and - not ( - MostRecentTreatmentDate 1 year or less after MostRecentBiopsyReport.date - ) and - ( - ( - CytologyInterpretedAsHsil and - MostRecentCytologyReport.date 1 year or more after MostRecentBiopsyReport.date and - MostRecentCytologyReport.date less than 3 years after MostRecentBiopsyReport.date - ) or - ( - CytologyInterpretedAsAscH and - MostRecentCytologyReport.date 2 years or more after MostRecentBiopsyReport.date and - MostRecentCytologyReport.date less than 3 years after MostRecentBiopsyReport.date - ) - ) - ) then - { - action: null, - text: 'A diagnostic excisional procedure is recommended for patients with HSIL cytology results at either the 1- or 2-year visit, or ASC-H results that persist at the 2-year visit (CIII).' - } - // I.5 Histologic LSIL (CIN1) Diagnosed Repeatedly for at Least 2 Years - when ( - AgeInYears() >= 25 and - MostRecentBiopsyReportWasWithinPast12months and - HistologyInterpretedAsCin1 and - SecondMostRecentHistologyInterpretedAsCin1 and - TwoMostRecentBiopsyReportsWithin15monthsApart - ) then - { - action: null, - text: 'For patients 25 years or older with histologic LSIL (CIN 1) who is diagnosed at consecutive visits for at least 2 years, observation is preferred (BII) but treatment is acceptable (CIII). If treatment is selected and the entire squamocolumnar junction and all lesions were fully visualized during colposcopic examination, either excision or ablation treatments are acceptable (CII).' - } - // I.6 Management of AIS: Adoption of Society of Gynecologic Oncology Recommendations - when ( - AgeInYears() >= 25 and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsAis - ) then - { - action: null, - text: 'A diagnostic excisional procedure is recommended for all patients with a diagnosis of AIS on cervical biopsy to rule out invasive adenocarcinoma, even when definitive hysterectomy is planned. Excisional procedures should optimally remove an intact specimen to facilitate accurate interpretation of margin status. Although there is no preference for cold knife conization versus LEEP, intentional disruption of the specimen by performance of a LEEP followed by a “top hat” endocervical excision to achieve the desired specimen length is unacceptable. An excisional specimen length of at least 10 mm is preferred, and this can be increased to 18 to 20 mm for patients who are not concerned about the effect of treatment on future pregnancy. These dimensions are preferred regardless of whether hysterectomy is planned. After the initial diagnostic procedure, hysterectomy is the preferred management for all patients who have a histologic diagnosis of AIS, although fertility-sparing management for appropriately selected patients is acceptable. For patients with confirmed AIS with negative margins on the excisional specimen, simple hysterectomy is preferred. For patients with confirmed AIS with positive margins on the excisional specimen, re-excision to achieve negative margins is preferred, even if hysterectomy is planned. For patients with AIS and persistent positive margins for whom additional excisional procedures are not feasible, either a simple or modified radical hysterectomy is acceptable. After hysterectomy, surveillance per the ASCCP surveillance guidelines for treated CIN 2+ is recommended (Section J.3).\n\nFor patients of reproductive age who desire future pregnancy, fertility-sparing management with an excisional procedure is acceptable provided that negative margins have been achieved on the excisional specimen, and the patient is willing and able to adhere to surveillance recommendations. If negative margins cannot be achieved after maximal excisional attempts, fertility-sparing management is not recommended. For patients who undergo fertility-sparing management, surveillance with cotesting and endocervical sampling is recommended every 6 months for at least 3 years, then annually for at least 2 years, or until hysterectomy is performed. For patients who have consistently negative cotesting and endocervical sampling results for 5 years, extending the surveillance interval to every 3 years starting in the sixth year of surveillance is acceptable. Small retrospective studies have shown HPV test results to be the best predictor for recurrent disease. Therefore, for patients who have consistently negative cotesting and endocervical sampling results, continued surveillance is acceptable after completion of childbearing. For patients who have had positive HPV test results or abnormal cytology/histologic results during surveillance, hysterectomy at the completion of childbearing is preferred (see Figure 11).' - } - else - null - end - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// RARE ABNORMALITY #4: Surveillance After Abnormalities - -define MostRecentTreatment: - C3F.MostRecentProcedure( - Dash.CervicalExcisionProcedures union - Dash.CervicalAblationProcedures - ) - -define MostRecentTreatmentDate: - Common.ProcedureDate(MostRecentTreatment) - -define TreatmentInLastYear: - MostRecentTreatment P - where Common.ProcedureDate(P) >= Now() - 12 months - -define HasTreatmentInLastYear: - TreatmentInLastYear is not null - -define AnyHistologicHsil: - (SortedBiopsyReports) B - where AnyTrue( - (B.allConclusions) aC - return - aC ~ Dash."CIN2" or - aC in Dash."Histologic CIN3" or - aC ~ Dash."HSIL, Unspecified" - ) - -define HistologyInterpretedAsHistologicHsil: - HistologyInterpretedAsCin2 or - HistologyInterpretedAsCin3 or - HistologyInterpretedAsUnspecifiedHsil - -define SecondMostRecentHistologyInterpretedAsCin2: - AnyTrue( - (SecondMostRecentBiopsyReport.allConclusions) aC - return - aC ~ Dash."CIN2" - ) - -define SecondMostRecentHistologyInterpretedAsCin3: - AnyTrue( - (SecondMostRecentBiopsyReport.allConclusions) aC - return - aC in Dash."Histologic CIN3" - ) - -define SecondMostRecentHistologyInterpretedAsUnspecifiedHsil: - AnyTrue( - (SecondMostRecentBiopsyReport.allConclusions) aC - return - aC ~ Dash."HSIL, Unspecified" - ) - -define SecondMostRecentHistologyInterpretedAsHistologicHsil: - SecondMostRecentHistologyInterpretedAsCin2 or - SecondMostRecentHistologyInterpretedAsCin3 or - SecondMostRecentHistologyInterpretedAsUnspecifiedHsil - -define HistologicHsilWithin12MonthsBeforeTreatment: - AnyHistologicHsil B - where - B.date 12 months or less before MostRecentTreatmentDate - -define HasHistologicHsilWithin12MonthsBeforeTreatment: - Exists(HistologicHsilWithin12MonthsBeforeTreatment) - -define PositiveHrHpvTestAfterTreatment: - MostRecentHpvReport.date >= Now() - 12 months and - MostRecentHpvReport.date 12 months or less after MostRecentTreatmentDate and - AnyTrue( - (MostRecentHpvReport.allConclusions) aC - return - aC in Dash."High Risk HPV Positive Results" - ) - -define RareAbnormalityHighGradeHistology: - (SortedBiopsyReports) B - where AnyTrue( - (B.allConclusions) aC - return - aC ~ Dash."CIN2" or - aC in Dash."Histologic CIN3" or - aC ~ Dash."HSIL, Unspecified" or - aC in Dash."AIS" - ) - -define RareAbnormalityHighGradeHistologyBeforeTreatment: - if (MostRecentTreatment is not null) then - RareAbnormalityHighGradeHistology C - where - C.date 12 months or less before MostRecentTreatmentDate - else - null - -define CytologicHsilOrAgc: - (SortedCytologyReports) C - where AnyTrue( - (C.allConclusions) aC - return - aC in "HSIL" or - aC ~ "AGC" - ) - -define CytologicHsilOrAgcBeforeTreatment: - if (MostRecentTreatment is not null) then - CytologicHsilOrAgc C - where - C.date 12 months or less before MostRecentTreatmentDate - else - null - -define CytologyResultsBeforeTreatment: - if (MostRecentTreatment is not null) then - (SortedCytologyReports) C - where - C.date 12 months or less before MostRecentTreatmentDate - else - null - -define HasPersistentAscHBeforeTreatment: - if Count(CytologyResultsBeforeTreatment) >= 2 then - AnyTrue( - (CytologyResultsBeforeTreatment[0].allConclusions) aC - return aC ~ "ASC-H" - ) and - AnyTrue( - (CytologyResultsBeforeTreatment[1].allConclusions) aC - return aC ~ "ASC-H" - ) - else - false - -define TreatmentForHighGradeHistologyOrCytology: - if (MostRecentTreatment is not null) and - ( - Exists(RareAbnormalityHighGradeHistologyBeforeTreatment) or - Exists(CytologicHsilOrAgcBeforeTreatment) or - HasPersistentAscHBeforeTreatment - ) then - MostRecentTreatment - else - null - -define HasTreatmentForHighGradeHistologyOrCytology: - TreatmentForHighGradeHistologyOrCytology is not null - -define TreatmentForHighGradeHistologyOrCytologyDate: - Common.ProcedureDate(TreatmentForHighGradeHistologyOrCytology) - -define NegativeHrHpvTests: - SortedHpvReports R - where AnyTrue( - (R.allConclusions) aC - return - aC in Dash."HPV Negative Results" - ) - -define NegativeHrHpvTestsAsPartOfCotest: - from NegativeHrHpvTests H, SortedCytologyReports C - where H.date within 1 day of C.date - return H - -define NegativePrimaryHrHpvTests: - NegativeHrHpvTests except NegativeHrHpvTestsAsPartOfCotest - -define NegativeCytologyTests: - SortedCytologyReports R - where AnyTrue( - (R.allConclusions) aC - return - aC ~ Dash."NILM" - ) - -define NegativeCotests: - from NegativeHrHpvTests H, NegativeCytologyTests C - where H.date within 1 day of C.date - return H - -define NegativeSurveillanceTests: - ( - NegativePrimaryHrHpvTests union - NegativeCotests - ) - -define SortedNegativeSurveillanceTests: - NegativeSurveillanceTests H - where H.date is not null - return { - date: H.date - } - sort by date asc - -define NegativeSurveillanceTestsAfterMostRecentBiopsy: - SortedNegativeSurveillanceTests H - where H.date > MostRecentBiopsyReport.date - -define FirstNegativeSurveillanceTestAfterMostRecentBiopsy: - if Count(NegativeSurveillanceTestsAfterMostRecentBiopsy) > 0 then - NegativeSurveillanceTestsAfterMostRecentBiopsy[0] - else - null - -define HasFirstNegativeSurveillanceTestAfterMostRecentBiopsy: - FirstNegativeSurveillanceTestAfterMostRecentBiopsy is not null - -define NegativeSurveillanceTestsAfterSecondMostRecentBiopsy: - SortedNegativeSurveillanceTests H - where H.date > SecondMostRecentBiopsyReport.date - -define FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy: - if Count(NegativeSurveillanceTestsAfterSecondMostRecentBiopsy) > 0 then - NegativeSurveillanceTestsAfterSecondMostRecentBiopsy[0] - else - null - -define HasFirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy: - FirstNegativeSurveillanceTestAfterSecondMostRecentBiopsy is not null - -define NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology: - if HasTreatmentForHighGradeHistologyOrCytology then - SortedNegativeSurveillanceTests T - where T.date > TreatmentForHighGradeHistologyOrCytologyDate - else - null - -define InitialIntensiveSurveillancePeriod: - if Count(NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology) >= 4 then - ( - NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[0].date 3 years or more before NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[2].date and - NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[0].date 5 years or less before NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[2].date - ) or - ( - NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[1].date 3 years or more before NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[3].date and - NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[1].date 5 years or less before NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology[3].date - ) - else - false - -define RecommendationForSurveillanceAfterAbnormalities: - case - // J.2 Short-Term Follow-up After Treatment for Histologic HSIL - when ( // 1 - HasTreatmentInLastYear and - HasHistologicHsilWithin12MonthsBeforeTreatment - ) then - { - action: null, - text: 'After treatment, hrHPV-based testing is preferred at 6 months regardless of the margin status of the excisional specimen (BII). hrHPV-based testing includes cotesting and primary hrHPV testing. Follow-up at 6 months with colposcopy and ECC is acceptable (BIII). When margins are positive for CIN 2+ or ECC performed at the time of the excisional procedure shows CIN 2+ in patients 25 years or older who are not concerned about the potential effect of treatment on future pregnancy outcomes, repeat excision or observation is acceptable. For observation, HPV-based testing in 6 months is preferred; it is also acceptable to perform a colposcopy and ECC at 6 months.' - } - when ( // 2 - PositiveHrHpvTestAfterTreatment and - HasHistologicHsilWithin12MonthsBeforeTreatment - ) then - { - action: null, - text: 'Colposcopy and appropriate biopsies should be performed if an hrHPV “positive” result after treatment for histologic HSIL (AIII).' - } - when ( // 3 - HistologyInterpretedAsHistologicHsil and - MostRecentBiopsyReport.date 5 years or less after MostRecentTreatmentDate and - SecondMostRecentHistologyInterpretedAsHistologicHsil and - SecondMostRecentBiopsyReport.date 5 years or less before MostRecentTreatmentDate - ) then - { - action: null, - text: 'If recurrent histologic HSIL (CIN 2+) develops after excisional treatment, and repeat excision is not feasible or not desired, hysterectomy is recommended.' - } - // J.3 Guidance for Long-Term Follow-up After Treatment for High-Grade Histology or Cytology - when ( // 1 - HasTreatmentForHighGradeHistologyOrCytology and - TreatmentForHighGradeHistologyOrCytologyDate >= Now() - 25 years and - not InitialIntensiveSurveillancePeriod - ) then - { - action: null, - text: 'In patients treated for histologic or cytologic HSIL, after the initial HPV-based test at 6 months, annual HPV or cotesting is preferred until 3 consecutive negative tests have been obtained (AII). Discontinuation of screening is recommended if a patient has a limited life expectancy. Management according to the highest-grade abnormality found on histology or cytology is recommended.' - } - when ( // 2 - HasTreatmentForHighGradeHistologyOrCytology and - TreatmentForHighGradeHistologyOrCytologyDate >= Now() - 25 years and - InitialIntensiveSurveillancePeriod - ) then - { - action: null, - text: 'In patients treated for histologic or cytologic HSIL, after the initial intensive surveillance period, continued surveillance at 3-year intervals is recommended for at least 25 years after treatment of high-grade histology (histologic HSIL, CIN 2, CIN 3, or AIS) or high-grade cytology (HSIL, AGC, or persistent ASC-H) even if this is beyond the age of 65 years (BII). When patients with a history of treated high-grade histology or cytology reach the age of 65 years, if they have completed the initial 25-year surveillance period, continued surveillance at 3-year intervals is acceptable and may continue as long as the patient is in reasonably good health (BIII). Discontinuation of screening is recommended if a patient has a limited life expectancy. Management according to the highest-grade abnormality found on histology or cytology is recommended.' - } - else - null - end - define RareAbnormalityRecommendation: - Coalesce( - RecommendationForSurveillanceAfterAbnormalities, - RecommendationForHistologyResults, - RecommendationForExceptionsToColposcopyThreshold, - RecommendationForRareCytology - ) + ManageRareAbnormality.Recommendation define WhichRarityMadeTheRecommendation: - case - when RecommendationForSurveillanceAfterAbnormalities is not null then 4 - when RecommendationForHistologyResults is not null then 3 - when RecommendationForExceptionsToColposcopyThreshold is not null then 2 - when RecommendationForRareCytology is not null then 1 - else null - end + ManageRareAbnormality.WhichRarityMadeTheRecommendation //------------------------------------------------------------------------------ // RECOMMENDATIONS FOR SPECIAL POPULATIONS //------------------------------------------------------------------------------ - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// Special Populations Section K.1 Management of Patients Younger Than 25 Years - -define CytologyInterpretedAsLsil: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "LSIL" - ) - -define CytologyInterpretedAsAscus: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC ~ "ASC-US" - ) - -define CytologyInterpretedAsHsil: - AnyTrue( - (MostRecentCytologyReport.allConclusions) aC - return aC in "HSIL" - ) - -define SecondMostRecentCytologyInterpretedAsLsil: - AnyTrue( - (SecondMostRecentCytologyReport.allConclusions) aC - return aC ~ "LSIL" - ) - -define SecondMostRecentCytologyInterpretedAsAscus: - AnyTrue( - (SecondMostRecentCytologyReport.allConclusions) aC - return aC ~ "ASC-US" - ) - -define AssociatedHpvCotest: - Coalesce( - (SortedHpvReports) H - where H.date within 1 day of SecondMostRecentCytologyReport.date - ) - -define ColposcopySinceMostRecentCytology: - Exists( - (Dash.ColposcopyProcedures) P - where Common.ProcedureDate(P) >= MostRecentCytologyReport.date - ) - -define HistologicHsilCin2OrUnspecified: - First( - (SortedBiopsyReports) B - where AnyTrue( - (B.allConclusions) aC - return - aC ~ Dash."CIN2" or - aC ~ Dash."HSIL, Unspecified" - ) - ) - -define SubsequentLowGradeHistologyReportsSinceMostRecentHsilHistology: - (SortedBiopsyReports) B - where - B.date less than 2 years after HistologicHsilCin2OrUnspecified.date and - AnyTrue( - (B.allConclusions) aC - return - aC ~ "CIN1" or - aC in "Normal Histology Finding" - ) - -define SubsequentLowGradeCytologyReportsSinceMostRecentHsilHistology: - (SortedCytologyReports) C - where - C.date less than 2 years after HistologicHsilCin2OrUnspecified.date and - AnyTrue( - (C.allConclusions) aC - return - aC ~ Dash."NILM" or - aC ~ "LSIL" or - aC ~ "ASC-US" - ) - -define Under25AndLowGradeCytologyResults: - AgeInYears() < 25 and - ( - CytologyInterpretedAsLsil or - ( - MostRecentCytologyCotestResult = 'ASC-US' and - MostRecentHpvResult = 'HPV-positive' - ) or - ( - CytologyInterpretedAsAscus and - MostRecentCytologyCotestResult is null - ) - ) - -define TwoMostRecentCytologyReports2To3YearsApart: - SecondMostRecentCytologyReport.date 2 years or more before MostRecentCytologyReport.date and - SecondMostRecentCytologyReport.date 3 years or less before MostRecentCytologyReport.date - -define Under25AndSecondMostRecentLowGradeCytologyResults: - AgeInYears() < 25 and - ( - SecondMostRecentCytologyInterpretedAsLsil or - ( - SecondMostRecentCytologyInterpretedAsAscus and - AssociatedHpvCotest.riskTableInput = 'HPV-positive' - ) or - ( - SecondMostRecentCytologyInterpretedAsAscus and - AssociatedHpvCotest is null - ) - ) - -define HistologyInterpretedAsLessThanCin2AfterAbnormalCytologyScreening: - HistologyInterpretedAsCin1OrNormal and - Under25AndLowGradeCytologyResults and - Under25AndSecondMostRecentLowGradeCytologyResults and - MostRecentBiopsyReport.date 3 years or less after MostRecentCytologyReport.date - -define CytologyInterpretedAsAscusOrAbove: - MostRecentCytologyReport.riskTableInput in {'ASC-US','LSIL','ASC-H','AGC','HSIL+'} - -define SecondMostRecentCytologyInterpretedAsAscHOrHsil: - AnyTrue( - (SecondMostRecentCytologyReport.allConclusions) aC - return - aC ~ "ASC-H" or - aC in "HSIL" - ) - -define BiopsySinceMostRecentCytology: - Exists( - SortedBiopsyReports B - where B.date > MostRecentCytologyReport.date - ) - -define RecommendationForPatientsYoungerThan25: - case - // Heading 1 & Heading 2: Initial Management After an Abnormal Screening Test Result; Management of Cytology ASC-H and HSIL in Patients Younger than 25 Years - when ( // 1 - Under25AndLowGradeCytologyResults - ) then - { - action: 'Cytology', - text: 'Repeat cytology alone at one and two years is recommended after an initial low-grade cytology screening result of LSIL, ASC-US HPV-positive, or ASC-US result without HPV testing (BII). Clinicians should switch to using risk estimates when patients reach the age of 25 years.' - } - when ( // 2 - AgeInYears() < 25 and - MostRecentCytologyReportWasWithinPastFiveYears and - ( - CytologyInterpretedAsHsil or - CytologyInterpretedAsAscH or - CytologyInterpretedAsAgc or - CytologyInterpretedAsAis - ) and - not BiopsySinceMostRecentCytology - - ) then - { - action: 'Colposcopy', - text: 'Colposcopy is recommended for individuals under 25 years old with cytologic HSIL, ASC-H, AGC or AIS (BII). Immediate treatment without histologic confirmation is not recommended for cytology HSIL or ASC-H. Clinicians should switch to using risk estimates when patients reach the age of 25 years.' - } - when ( // 3 - Under25AndLowGradeCytologyResults and - Under25AndSecondMostRecentLowGradeCytologyResults - and TwoMostRecentCytologyReports2To3YearsApart - ) then - { - action: 'Colposcopy', // NOTE: Do we want to continue adding 'actions' to the Rare Abnormality recommendations? - text: 'Colposcopy is recommended if low-grade cytology persists at the 2-year follow up visit after low-grade cytology results (BII). Clinicians should switch to using risk estimates when patients reach the age of 25 years.' - } - when ( // 4 - AgeInYears() < 25 and - MostRecentCytologyReportWasWithinPastFiveYears and - MostRecentCytologyCotestResult = 'ASC-US' and - MostRecentHpvResult = 'HPV-negative' - ) then - { - action: 'Cytology', - text: 'Cervical Cytology test (alone) is indicated 3 years after an ASC-US/HPV-Negative result. Clinicians should switch to using risk estimates when patients reach the age of 25 years.' - } - when ( // 5a - HistologyInterpretedAsLessThanCin2AfterAbnormalCytologyScreening and - MostRecentBiopsyReport.date > Now() - 12 months - ) then - { - action: null, - text: 'For patients under 25 years old perform cervical cytology one year following cervical histologic LSIL(CIN1) or MostRecentBiopsyReport.date) - ) then - { - action: null, - text: 'This patient is due now for cervical cytology screening. For patients under 25 years old, cervical cytology should be performed one year after a cervical histologic LSIL(CIN1) or = 21 and AgeInYears() < 25 and - HistologyInterpretedAsCin1OrNormal and - ( - CytologyInterpretedAsAscusOrAbove or - CytologyInterpretedAsAis - ) and - MostRecentCytologyReport.date less than 3 years after MostRecentBiopsyReport.date and - SecondMostRecentCytologyInterpretedAsAscHOrHsil and - SecondMostRecentCytologyReport.date less than 6 months before MostRecentBiopsyReport.date - ) then - { - action: null, - text: 'Colposcopy is recommended for cytologic ASC-US or above on repeat testing following a CIN1 or < CIN1 result that is preceded by a cytologic ASC-H, AGC, AIS, or HSIL result. Clinicians should switch to using risk estimates when patients reach the age of 25 years.' - } - when ( // 3 - AgeInYears() < 25 and - not Pregnant and - HistologyInterpretedAsCin1OrNormal and - ( - CytologyInterpretedAsHsil or - CytologyInterpretedAsAscH - ) and - MostRecentCytologyReport.date more than 18 months after MostRecentBiopsyReport.date and - MostRecentCytologyReport.date less than 3 years after MostRecentBiopsyReport.date - ) then - { - action: null, - text: 'If a high-grade cytologic abnormality (HSIL, ASC-H) without histologic HSIL persists for 2 years, a diagnostic excisional procedure is recommended (unless the patient is pregnant). A diagnostic excisional procedure is recommended in patients when the squamocolumnar junction or the upper limit of all lesions are not fully visualized.' - } - // Heading 4: Management of Histologic HSIL (CIN2 or CIN3) for Patients Younger Than 25 Years - when ( // 1 - AgeInYears() < 25 and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsCin3 - ) then - { - action: 'Treatment', - text: 'Treatment is recommended, and observation is unacceptable (EII)' - } - when ( // 2 - AgeInYears() < 25 and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsCin2 - ) then - { - action: null, - text: 'Observation is preferred, and treatment is acceptable (BII). Observation includes colposcopy and cytology at 6-month intervals.' - } - when ( // 3 - AgeInYears() < 25 and - MostRecentBiopsyReportWasWithinPastYear and - HistologyInterpretedAsUnspecifiedHsil - ) then - { - action: null, - text: 'Observation or treatment is acceptable after an unspecified histologic HSIL result. Observation includes colposcopy and cytology at 6-month intervals.' - } - when ( // 4 - AgeInYears() < 25 and - HistologicHsilCin2OrUnspecified is not null and - Count(SubsequentLowGradeHistologyReportsSinceMostRecentHsilHistology) >= 2 and - Count(SubsequentLowGradeCytologyReportsSinceMostRecentHsilHistology) >= 2 - ) then - { - action: null, - text: 'Surveillance with colposcopy and cervical cytology should be performed at 1 year after the most recent cervical histology and cytology tests following an earlier histology HSIL (CIN2) or histologic HSIL, unspecified result.' - } - when ( // 5 - AgeInYears() < 25 and - ( - HistologyInterpretedAsCin2 or - HistologyInterpretedAsUnspecifiedHsil - ) and - ( - SecondMostRecentHistologyInterpretedAsCin2 or - SecondMostRecentHistologyInterpretedAsUnspecifiedHsil - ) and - SecondMostRecentBiopsyReport.date within 2 years of MostRecentBiopsyReport.date - ) then - { - action: 'Treatment', - text: 'Treatment is recommended. Excisional treatment is recommended when the squamocolumnar junction or the lesions(s) are not fully visualized.' - } - else - null - end - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// Special Populations Section K.2 Management of Patients During Pregnancy - -define PregnancyOnset: - Coalesce( - Common.Onset( - C3F.MostRecentCondition( - Dash.PregnancyDiagnoses - ) - ), - Common.ObservationDate( - C3F.MostRecent( - Dash.PregnancyObservations - ) - ) - ) as System.Date - -define FirstHistologyAfterPregnancyOnset: - Last( - (SortedBiopsyReports) B - where B.date >= PregnancyOnset - ) - -define HistologicAisDuringPregnancy: - Exists( - (SortedBiopsyReports) B - where - B.date >= PregnancyOnset and - B.date <= PregnancyOnset + 42 weeks and - AnyTrue( - (B.allConclusions) aC - return - aC in Dash."AIS" - ) - ) - -define RecommendationForPregnantPatients: - case - // #1 is covered by the Common Abnormality Recommendation section. - when ( // 2 - Recommendation #1 - AgeInYears() >= 25 and - Pregnant and - FirstHistologyAfterPregnancyOnset.date > Now() - 1 year and - FirstHistologyAfterPregnancyOnset.riskTableInput in {'CIN2','CIN3'} - ) then - { - action: null, - text: 'Surveillance colposcopy and testing (with diagnostic cytology or HPV depending on age) is preferred every 12 to 24 weeks but deferring colposcopy to the postpartum period is acceptable (BII). In postpartum period, colposcopy is recommended no earlier than 4 weeks after delivery (BII). In patients diagnosed with histologic HSIL (CIN2 or CIN3) during pregnancy, if a lesion is detected at postpartum colposcopy, an excisional treatment procedure or full diagnostic evaluation (cervical cytology, HPV, and biopsy) is acceptable (BII). In the absence of a lesion on colposcopy, a full diagnostic evaluation is recommended/ expedited treatment is not recommended (BII).\n\nFor patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). If the histologic HSIL cannot be specified as CIN 2, treatment is preferred, but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' - } - when ( // 2 - Recommendation #2 - AgeInYears() >= 25 and - Pregnant and - HistologicAisDuringPregnancy - ) then - { - action: null, - text: 'Referral to a gynecologic oncologist is preferred if AIS is diagnosed during pregnancy, but management by a gynecologist skilled in the colposcopic diagnosis and treatment of AIS is acceptable (CIII).' - } - else - null - end - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// Special Populations Section K.3 Managing Patients With Immunosuppression - -define Immunocompromised: - Dash.Immunocompromised - -define MostRecentHpvReportWasWithinPastFiveYears: - MostRecentHpvReport.date > Now() - 5 years - -define TwoMostRecentCytologyReportsWithin18MonthsApart: - SecondMostRecentCytologyReport.date within 18 months of MostRecentCytologyReport.date - -define RecommendationForImmunosuppressedPatients: - case - when ( // 1 - Immunocompromised and - ( - ( - MostRecentHpvResult = 'HPV-positive' and - MostRecentCytologyCotestResult = 'ASC-US' and - MostRecentCytologyReportWasWithinPastFiveYears - ) or - ( - MostRecentCytologyReportWasWithinPastFiveYears and - ( - MostRecentCytologyReport.riskTableInput in {'LSIL','ASC-H','AGC','HSIL+'} or - CytologyInterpretedAsAis - ) - ) or - ( - MostRecentHpvResult in {'HPV16+','HPV16-, HPV18+'} and - MostRecentHpvReportWasWithinPastFiveYears - ) - ) - ) then - { - action: null, - text: 'Colposcopy referral is recommended for immunocompromised patients of any age with cytology results of HPV-positive ASC-US or higher and for any cytology results of LSIL or worse.' - } - when ( // 2 - Immunocompromised and - MostRecentCytologyReportWasWithinPastFiveYears and - MostRecentCytologyReport.riskTableInput = 'ASC-US' - ) then - { - action: null, - text: 'Repeat cytology in 6 to 12 months when the patient is immunocompromised and is found to have cytologic ASC-US.' - } - when ( // 3 - Immunocompromised and - MostRecentCytologyReportWasWithinPastFiveYears and - ( - CytologyInterpretedAsAscusOrAbove or - CytologyInterpretedAsAis - ) and - SecondMostRecentCytologyReport.riskTableInput = 'ASC-US' and - TwoMostRecentCytologyReportsWithin18MonthsApart - ) then - { - action: null, - text: 'Colposcopy is recommended when the patient is immunocompromised and is found to have cytologic ASC-US or higher or HPV positive after a cytologic ASC-US result.' - } - else - null - end - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// Special Populations Section K.4 Managing Patients After Hysterectomy - -define MostRecentCervixRemovalProcedureDate: - Common.ProcedureDate( - C3F.MostRecentProcedure( - Dash.RemovalOfCervixProcedures - ) - ) - -define CervixRemovalWithHighGradePrecancerOrCancerReasonCode: - Dash.RemovalOfCervixProcedures P - where AnyTrue( - (P.reasonCode) rC - return - rC in Dash."Cervical Precancer Disorders" or - rC in Dash."Diagnosis of Cervical cancer" or - rC ~ Dash."CIN2" or - rC in Dash."Histologic CIN3" or - rC ~ Dash."HSIL, Unspecified" or - rC in Dash."AIS" or - rC in Dash."Histologic cancer" - ) - -define MostRecentCervixRemovalObservationDate: - Common.ObservationDate( - C3F.MostRecent( - Dash.AbsenceOfCervixObservations - ) - ) - -define MostRecentCervixRemovalDiagnosisDate: - Common.Onset( - C3F.MostRecentCondition( - Dash.AbsenceOfCervixDiagnoses - ) - ) - -define CervixRemovalDate: - Coalesce( - MostRecentCervixRemovalProcedureDate, - MostRecentCervixRemovalObservationDate, - MostRecentCervixRemovalDiagnosisDate - ) - -define HighGradePreCancerCervicalLesionDate: - if Exists(Dash.CervicalPrecancerDisorders) then - { - date: Common.ConditionDate(C3F.MostRecentCondition(Dash.CervicalPrecancerDisorders)) - } - else - null - -define CervicalCancerDiagnosisDate: - if Exists(Dash.CervicalCancerDiagnoses) then - { - date: Common.ConditionDate(C3F.MostRecentCondition(Dash.CervicalCancerDiagnoses)) - } - else - null - -define HighGradeOrCancerHistologyResultsDate: - if Exists(Dash.HighGradeOrCancerHistologyResults) then - { - date: Common.DiagnosticReportDate(Common.MostRecentDiagnosticReport(Dash.HighGradeOrCancerHistologyResults)) - } - else - null - -define CauseForHysterectomyDates: - { - HighGradePreCancerCervicalLesionDate, - CervicalCancerDiagnosisDate, - HighGradeOrCancerHistologyResultsDate - } except { null } - -define SortedCauseForHysterectomyDates: - CauseForHysterectomyDates D - return D - sort by date desc - -define MostRecentCauseForHysterectomyDate: - if Count(SortedCauseForHysterectomyDates) > 0 then - SortedCauseForHysterectomyDates[0].date - else - null - -define HysterectomyPerformedForTreatment: - CervixRemovalDate 1 year or less after MostRecentCauseForHysterectomyDate or - Exists(CervixRemovalWithHighGradePrecancerOrCancerReasonCode) - -define NegativeSurveillanceTestsAfterHysterectomy: // NOTE: We should be able to refactor the LP4 Grade D Exclusions in a similar way - SortedNegativeSurveillanceTests T - where T.date >= CervixRemovalDate - -define InitialIntensiveSurveillancePeriodPostHysterectomy: - if Count(NegativeSurveillanceTestsAfterHysterectomy) >= 3 then - NegativeSurveillanceTestsAfterHysterectomy[2].date less than 5 years after CervixRemovalDate - else - false - -define RecommendationForManagingPatientsAfterHysterectomy: - case - when ( // 1 - CervixRemovalDate >= Now() - 25 years and - HysterectomyPerformedForTreatment and - not InitialIntensiveSurveillancePeriodPostHysterectomy - ) then - { - action: null, - text: 'Three annual hrHPV-based tests with cotest or primary hrHPV test are recommended after a hysterectomy is performed for treatment of a high-grade precancer or cancer.' - } - when ( // 2 - CervixRemovalDate >= Now() - 25 years and - HysterectomyPerformedForTreatment and - InitialIntensiveSurveillancePeriodPostHysterectomy - ) then - { - action: null, - text: 'HPV-based testing with cotest or primary hrHPV test is recommended every 3 years after a histologic HSIL (CIN2 or CIN3) or AIS results for 25 years, regardless of whether the patient has had a hysterectomy either for treatment or at any point during the surveillance period (CIII).' - } - else - null - end - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// Special Populations Section K.5 Managing Patients Older Than 65 Years With a History of Prior Abnormalities - -define Over65RecommendationText: - 'If patients over age 65 years undergo HPV testing, cotesting, or cytology, management according to guidelines for patients aged 25 to 65 years is recommended (CII). If surveillance testing is recommended for either a history of abnormal screening results or treatment for precancer, discontinuing surveillance is unacceptable if the patient is in reasonably good health and testing is feasible (DII). Discontinuation of surveillance is recommended for patients with a limited life expectancy (EIII). This population will be managed based on logic defined for rare abnormalities and common abnormalities.' - -// If patients over age 65 years undergo HPV testing, cotesting, or cytology, management according to guidelines for patients aged 25 to 65 years is recommended (CII). Care recommendations for these individuals are covered within the Common Abnormality logic paths. - define SpecialPopulationRecommendation: - Coalesce( - RecommendationForPatientsYoungerThan25, - RecommendationForPregnantPatients, - RecommendationForImmunosuppressedPatients, - RecommendationForManagingPatientsAfterHysterectomy - ) + ManageSpecialPopulation.Recommendation define WhichPopulationMadeTheRecommendation: - case - when RecommendationForPatientsYoungerThan25 is not null then 5 - when RecommendationForPregnantPatients is not null then 4 - when RecommendationForImmunosuppressedPatients is not null then 3 - when RecommendationForManagingPatientsAfterHysterectomy is not null then 2 - else null - end + ManageSpecialPopulation.WhichPopulationMadeTheRecommendation //------------------------------------------------------------------------------ // RECOMMENDATIONS FOR COMMON ABNORMALITIES //------------------------------------------------------------------------------ -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// COMMON ABNORMALITY #1: Abnormal Results -// Tables 1A and 1B -define LookUpTable1: - RiskTableLookup.GetGeneralScreeningManagement( - SecondMostRecentHpvResult, - SecondMostRecentCytologyCotestResult, - MostRecentHpvResult, - MostRecentCytologyCotestResult - ) - -define GeneralScreeningManagementRecommendation: - if LookUpTable1 is not null then LookUpTable1 - else null - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// COMMON ABNORMALITY #2: Surveillance following results not requiring immediate colposcopic referral -// Tables 2A, 2B, and 2C -define LookUpTable2: // NOTE: Review whether we are correctly handling the multiple negative cotests referenced in Table 2b and 2c - RiskTableLookup.GetSurveillanceManagement( - ThirdMostRecentHpvResult, - ThirdMostRecentCytologyCotestResult, - SecondMostRecentHpvResult, - SecondMostRecentCytologyCotestResult, - MostRecentHpvResult, - MostRecentCytologyCotestResult - ) - -define SurveillanceManagementRecommendation: - if LookUpTable2 is not null then LookUpTable2 - else null - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// COMMON ABNORMALITY #3: Receipt of colposcopy/biopsy results -// Table 3 -define LookUpTable3: // NOTE: Review whether we need to look at history going further back - RiskTableLookup.GetColposcopyResultsManagement( - ReferringHpvResult, - ReferringCytologyResult, - MostRecentBiopsyResult - ) - -define ColposcopyResultsManagementRecommendation: - if LookUpTable3 is not null then LookUpTable3 - else null - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// COMMON ABNORMALITY #4: Surveillance visit following colposcopy/biopsy finding less than CIN 2 -// Tables 4A and 4B -define LookUpTable4: - RiskTableLookup.GetPostColposcopyManagement( - ReferringHpvResult, - ReferringCytologyResult, - MostRecentBiopsyResult, - ThirdMostRecentHpvResultPostBiopsy, - ThirdMostRecentCytologyResultPostBiopsy, - SecondMostRecentHpvResultPostBiopsy, - SecondMostRecentCytologyResultPostBiopsy, - MostRecentHpvResultPostBiopsy, - MostRecentCytologyResultPostBiopsy - ) - -define PostColposcopyManagementRecommendation: - if LookUpTable4 is not null then LookUpTable4 - else null - -/*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*/ -// COMMON ABNORMALITY #5: Follow-up after treatment for CIN2 or CIN 3 -// Tables 5A and 5B -define LookUpTable5: - RiskTableLookup.GetPostTreatmentManagement( - MostRecentBiopsyResult, - ThirdMostRecentHpvResultAfterTreatment, - ThirdMostRecentCytologyResultAfterTreatment, - SecondMostRecentHpvResultAfterTreatment, - SecondMostRecentCytologyResultAfterTreatment, - MostRecentHpvResultAfterTreatment, - MostRecentCytologyResultAfterTreatment - ) - -define PostTreatmentManagementRecommendation: - if LookUpTable5 is not null then LookUpTable5 - else null +define CommonAbnormalityRecommendation: + ManageCommonAbnormality.Recommendation -define CommonAbnormalityRecommendationText: - Coalesce( - PostTreatmentManagementRecommendation, - PostColposcopyManagementRecommendation, - ColposcopyResultsManagementRecommendation, - SurveillanceManagementRecommendation, - GeneralScreeningManagementRecommendation - ) +// NOTE: Needed for testing +define RecommendationFromRiskTable: + ManageCommonAbnormality.TableRecommendation define WhichTableMadeTheRecommendation: - case - when PostTreatmentManagementRecommendation is not null then 5 - when PostColposcopyManagementRecommendation is not null then 4 - when ColposcopyResultsManagementRecommendation is not null then 3 - when SurveillanceManagementRecommendation is not null then 2 - when GeneralScreeningManagementRecommendation is not null then 1 - else null - end - -define J1RecommendationText: - 'After abnormal cervical cancer screening test results for patients 25 years or older, colposcopic biopsy results, or treatment of histologic HSIL, surveillance with either HPV testing alone or cotesting is preferred (AI). Surveillance with cervical cytology alone is acceptable only if testing with HPV or cotesting is not feasible (CIII). Cytology is recommended at 6-month intervals when 1-year intervals are recommended for HPV or cotesting, and annually when 3-year intervals are recommended for HPV or cotesting (AII).' - -define TreatmentWithPregnancyConcernsRecommendationText: - 'Endocervical curettage, endometrial biopsy, and treatment without biopsy are unacceptable during pregnancy (EIII). A diagnostic excisional procedure or repeat biopsy is recommended only if cancer is suspected based on cytology, colposcopy, or histology (BII).\n\nFor patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). If the histologic HSIL cannot be specified as CIN 2, treatment is preferred, but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' - -define OneYearSurveillanceRecommendationText: - 'When patients have an estimated risk of CIN 3+ based on history and current results that is below the threshold for immediate colposcopy (4.0% immediate risk) and above the 3-year follow-up threshold (≥0.55% at 5 years), repeat testing in 1 year with HPV-based testing is recommended (AII).' - -define ThreeYearSurveillanceRecommendationText: - 'When patients have an estimated 5-year CIN 3+ risk of 0.15% or greater but less than 0.55% based on history and current test results, repeat testing in 3 years with HPV-based testing is recommended (AII).' - -define FiveYearSurveillanceRecommendationText: - 'When patients have an estimated 5-year CIN 3+ risk of less than 0.15% based on past history and current test results, return to routine screening at 5-year intervals using HPV-based testing is recommended (AII).' - -define ColposcopyRecommendationText: - 'For patients 25 years or older, when patients have an estimated immediate risk of diagnosis of CIN 3+ of 4.0% or greater based on history and current results, referral to colposcopy is recommended (AII).\n\nEndocervical curettage, endometrial biopsy, and treatment without biopsy are unacceptable during pregnancy (EIII). A diagnostic excisional procedure or repeat biopsy is recommended only if cancer is suspected based on cytology, colposcopy, or histology (BII).' - -define ColposcopyOrTreatmentRecommendationText: - 'For nonpregnant patients 25 years or older with an estimated immediate risk of CIN 3+ 25% or greater and less than 60% based on history and current results, treatment using an excisional procedure without previous biopsy confirmation or histologic evaluation with colposcopy and biopsy are both acceptable (AII).' - -define TreatmentRecommendationText: - 'For nonpregnant patients 25 years or older with an estimated immediate risk of CIN 3+ of 60% or greater based on history and current results, treatment using an excisional procedure without previous biopsy confirmation is preferred but colposcopy with biopsy is acceptable (BII).' - -define PositivePrimaryHpv: - AnyTrue( - (MostRecentHpvReport.allConclusions) aC - return aC in Dash."High Risk HPV Positive Results" - ) and - MostRecentCytologyCotest is null - -define CommonAbnormalityRecommendation: - case - when ( - PositivePrimaryHpv is not null and - not (MostRecentCytologyReport.date after MostRecentHpvReport.date) and - not (MostRecentBiopsyReport.date after MostRecentHpvReport.date) - ) then - { - action: null, - text: 'Per the ASCCP Risk Management Guidelines (Egemen et al.), reflex testing with cervical cytology is indicated as surveillance given the patient’s history of abnormal results in order to provide an evidence-based care recommendation.' - } - when ( - AgeInYears() >= 25 and AgeInYears() <= 65 and - CommonAbnormalityRecommendationText = '1-year follow-up' - ) then - { - action: CommonAbnormalityRecommendationText, - text: OneYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText - } - when ( - AgeInYears() > 65 and - CommonAbnormalityRecommendationText = '1-year follow-up' - ) then - { - action: CommonAbnormalityRecommendationText, - text: OneYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText + '\n\n' + Over65RecommendationText - } - when ( - AgeInYears() >= 25 and AgeInYears() <= 65 and - CommonAbnormalityRecommendationText = '3-year follow-up' - ) then - { - action: CommonAbnormalityRecommendationText, - text: ThreeYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText - } - when ( - AgeInYears() > 65 and - CommonAbnormalityRecommendationText = '3-year follow-up' - ) then - { - action: CommonAbnormalityRecommendationText, - text: ThreeYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText + '\n\n' + Over65RecommendationText - } - when ( - AgeInYears() >= 25 and AgeInYears() <= 65 and - CommonAbnormalityRecommendationText = '5-year follow-up' - ) then - { - action: CommonAbnormalityRecommendationText, - text: FiveYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText - } - when ( - AgeInYears() > 65 and - CommonAbnormalityRecommendationText = '5-year follow-up' - ) then - { - action: CommonAbnormalityRecommendationText, - text: FiveYearSurveillanceRecommendationText + '\n\n' + J1RecommendationText + '\n\n' + Over65RecommendationText - } - when ( - AgeInYears() >= 25 and - CommonAbnormalityRecommendationText = 'Colposcopy' - ) then - { - action: CommonAbnormalityRecommendationText, - text: ColposcopyRecommendationText - } - when ( - AgeInYears() >= 25 and AgeInYears() <= 50 and - CommonAbnormalityRecommendationText = 'Colposcopy/Treatment' - ) then - { - action: CommonAbnormalityRecommendationText, - text: ColposcopyOrTreatmentRecommendationText + '\n\n' + TreatmentWithPregnancyConcernsRecommendationText - } - when ( - AgeInYears() > 50 and - CommonAbnormalityRecommendationText = 'Colposcopy/Treatment' - ) then - { - action: CommonAbnormalityRecommendationText, - text: ColposcopyOrTreatmentRecommendationText - } - when ( - AgeInYears() >= 25 and AgeInYears() <= 50 and - CommonAbnormalityRecommendationText = 'Treatment' - ) then - { - action: CommonAbnormalityRecommendationText, - text: TreatmentRecommendationText + '\n\n' + TreatmentWithPregnancyConcernsRecommendationText - } - when ( - AgeInYears() > 50 and - CommonAbnormalityRecommendationText = 'Treatment' - ) then - { - action: CommonAbnormalityRecommendationText, - text: TreatmentRecommendationText - } - else - null - end - -// TODO: Add Errata section + ManageCommonAbnormality.WhichTableMadeTheRecommendation //------------------------------------------------------------------------------ // CDS OUTPUTS @@ -2655,10 +193,19 @@ define CommonAbnormalityPresent: not RareAbnormalityPresent define ServiceRequestCode: - null + ManagementRecommendation.action define ServiceRequestOrderDetail: - null + ManagementRecommendation.text + +define RecommendColposcopy: + ManagementRecommendation.action = 'Colposcopy' + +define RecommendSurveillance: + ManagementRecommendation.action = 'Surveillance' + +define RecommendTreatment: + ManagementRecommendation.action = 'Treatment' define ManagePatientUnder25: WhichPopulationMadeTheRecommendation = 5 diff --git a/cql/ManagementLibrary.json b/cql/ManagementLibrary.json index 950492a3..33075e75 100644 --- a/cql/ManagementLibrary.json +++ b/cql/ManagementLibrary.json @@ -33,8 +33,20 @@ "version" : "4.0.1" }, { "localIdentifier" : "Dash", - "path" : "DisplayCervicalCancerMedicalHistory", + "path" : "DashboardLibrary", "version" : "1.0.0" + }, { + "localIdentifier" : "ManageCommonAbnormality", + "path" : "ManageCommonAbnormality", + "version" : "1.1.0" + }, { + "localIdentifier" : "ManageRareAbnormality", + "path" : "ManageRareAbnormality", + "version" : "1.1.0" + }, { + "localIdentifier" : "ManageSpecialPopulation", + "path" : "ManageSpecialPopulation", + "version" : "1.1.0" }, { "localIdentifier" : "Common", "path" : "CCSMCommonFunctions", @@ -300,17 +312,17 @@ "name" : "SNOMED-CT" } }, { - "name" : "Benign Glandular Cells", - "id" : "BGC", - "display" : "Benign Glandular Cells", + "name" : "Endometrial Stromal Cells", + "id" : "ESC", + "display" : "Endometrial stromal cells", "accessLevel" : "Public", "codeSystem" : { "name" : "LOCAL" } }, { - "name" : "Endometrial Stromal Cells", - "id" : "ESC", - "display" : "Endometrial stromal cells", + "name" : "Benign Glandular Cells", + "id" : "BGC", + "display" : "Benign Glandular Cells", "accessLevel" : "Public", "codeSystem" : { "name" : "LOCAL" @@ -334,916 +346,6 @@ "type" : "Retrieve" } } - }, { - "name" : "HpvTestingInterval", - "context" : "Patient", - "accessLevel" : "Public", - "expression" : { - "type" : "Add", - "operand" : [ { - "value" : 5, - "unit" : "years", - "type" : "Quantity" - }, { - "name" : "HpvTestingGracePeriod", - "type" : "ParameterRef" - } ] - } - }, { - "name" : "HPVTestingIntervalLookBack", - "context" : "Patient", - "accessLevel" : "Public", - "type" : "FunctionDef", - "expression" : { - "lowClosed" : true, - "highClosed" : false, - "type" : "Interval", - "low" : { - "type" : "Subtract", - "operand" : [ { - "name" : "LookBackDate", - "type" : "OperandRef" - }, { - "name" : "HpvTestingInterval", - "type" : "ExpressionRef" - } ] - }, - "high" : { - "name" : "LookBackDate", - "type" : "OperandRef" - } - }, - "operand" : [ { - "name" : "LookBackDate", - "operandTypeSpecifier" : { - "name" : "{urn:hl7-org:elm-types:r1}DateTime", - "type" : "NamedTypeSpecifier" - } - } ] - }, { - "name" : "GetEarlierDate", - "context" : "Patient", - "accessLevel" : "Public", - "type" : "FunctionDef", - "expression" : { - "type" : "If", - "condition" : { - "asType" : "{urn:hl7-org:elm-types:r1}Boolean", - "type" : "As", - "operand" : { - "type" : "Not", - "operand" : { - "type" : "IsNull", - "operand" : { - "name" : "d1", - "type" : "OperandRef" - } - } - } - }, - "then" : { - "type" : "If", - "condition" : { - "asType" : "{urn:hl7-org:elm-types:r1}Boolean", - "type" : "As", - "operand" : { - "type" : "Not", - "operand" : { - "type" : "IsNull", - "operand" : { - "name" : "d2", - "type" : "OperandRef" - } - } - } - }, - "then" : { - "type" : "If", - "condition" : { - "asType" : "{urn:hl7-org:elm-types:r1}Boolean", - "type" : "As", - "operand" : { - "type" : "SameOrBefore", - "operand" : [ { - "name" : "d1", - "type" : "OperandRef" - }, { - "name" : "d2", - "type" : "OperandRef" - } ] - } - }, - "then" : { - "name" : "d1", - "type" : "OperandRef" - }, - "else" : { - "name" : "d2", - "type" : "OperandRef" - } - }, - "else" : { - "name" : "d1", - "type" : "OperandRef" - } - }, - "else" : { - "type" : "If", - "condition" : { - "asType" : "{urn:hl7-org:elm-types:r1}Boolean", - "type" : "As", - "operand" : { - "type" : "Not", - "operand" : { - "type" : "IsNull", - "operand" : { - "name" : "d2", - "type" : "OperandRef" - } - } - } - }, - "then" : { - "name" : "d2", - "type" : "OperandRef" - }, - "else" : { - "asType" : "{urn:hl7-org:elm-types:r1}DateTime", - "type" : "As", - "operand" : { - "type" : "Null" - } - } - } - }, - "operand" : [ { - "name" : "d1", - "operandTypeSpecifier" : { - "name" : "{urn:hl7-org:elm-types:r1}DateTime", - "type" : "NamedTypeSpecifier" - } - }, { - "name" : "d2", - "operandTypeSpecifier" : { - "name" : "{urn:hl7-org:elm-types:r1}DateTime", - "type" : "NamedTypeSpecifier" - } - } ] - }, { - "name" : "CytologyInterpretation", - "context" : "Patient", - "accessLevel" : "Public", - "type" : "FunctionDef", - "expression" : { - "type" : "If", - "condition" : { - "asType" : "{urn:hl7-org:elm-types:r1}Boolean", - "type" : "As", - "operand" : { - "type" : "Not", - "operand" : { - "type" : "IsNull", - "operand" : { - "name" : "conclusions", - "type" : "OperandRef" - } - } - } - }, - "then" : { - "type" : "Query", - "source" : [ { - "alias" : "c", - "expression" : { - "name" : "conclusions", - "type" : "OperandRef" - } - } ], - "relationship" : [ ], - "return" : { - "expression" : { - "type" : "Case", - "caseItem" : [ { - "when" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "c", - "type" : "AliasRef" - }, { - "type" : "ToConcept", - "operand" : { - "name" : "NILM", - "libraryName" : "Dash", - "type" : "CodeRef" - } - } ] - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "NILM", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "1", - "type" : "Literal" - } - } ] - } - }, { - "when" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "c", - "type" : "AliasRef" - }, { - "type" : "ToConcept", - "operand" : { - "name" : "ASC-US", - "type" : "CodeRef" - } - } ] - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "ASC-US", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "2", - "type" : "Literal" - } - } ] - } - }, { - "when" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "c", - "type" : "AliasRef" - }, { - "type" : "ToConcept", - "operand" : { - "name" : "LSIL", - "type" : "CodeRef" - } - } ] - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "LSIL", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "3", - "type" : "Literal" - } - } ] - } - }, { - "when" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "c", - "type" : "AliasRef" - }, { - "type" : "ToConcept", - "operand" : { - "name" : "ASC-H", - "type" : "CodeRef" - } - } ] - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "ASC-H", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "4", - "type" : "Literal" - } - } ] - } - }, { - "when" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "c", - "type" : "AliasRef" - }, { - "type" : "ToConcept", - "operand" : { - "name" : "AGC", - "type" : "CodeRef" - } - } ] - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "AGC", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "5", - "type" : "Literal" - } - } ] - } - }, { - "when" : { - "type" : "InValueSet", - "code" : { - "name" : "c", - "type" : "AliasRef" - }, - "valueset" : { - "name" : "HSIL", - "type" : "ValueSetRef" - } - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "HSIL+", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "6", - "type" : "Literal" - } - } ] - } - } ], - "else" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "ALL", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "0", - "type" : "Literal" - } - } ] - } - } - } - }, - "else" : { - "type" : "List", - "element" : [ { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "ALL", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "0", - "type" : "Literal" - } - } ] - } ] - } - }, - "operand" : [ { - "name" : "conclusions", - "operandTypeSpecifier" : { - "type" : "ListTypeSpecifier", - "elementType" : { - "name" : "{urn:hl7-org:elm-types:r1}Concept", - "type" : "NamedTypeSpecifier" - } - } - } ] - }, { - "name" : "HpvInterpretation", - "context" : "Patient", - "accessLevel" : "Public", - "type" : "FunctionDef", - "expression" : { - "type" : "Query", - "source" : [ { - "alias" : "c", - "expression" : { - "name" : "conclusions", - "type" : "OperandRef" - } - } ], - "relationship" : [ ], - "return" : { - "expression" : { - "type" : "Case", - "caseItem" : [ { - "when" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "c", - "type" : "AliasRef" - }, { - "type" : "ToConcept", - "operand" : { - "name" : "HPV16+", - "type" : "CodeRef" - } - } ] - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "HPV16+", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "4", - "type" : "Literal" - } - } ] - } - }, { - "when" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "c", - "type" : "AliasRef" - }, { - "type" : "ToConcept", - "operand" : { - "name" : "HPV18+", - "type" : "CodeRef" - } - } ] - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "HPV16-, HPV18+", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "3", - "type" : "Literal" - } - } ] - } - }, { - "when" : { - "type" : "InValueSet", - "code" : { - "name" : "c", - "type" : "AliasRef" - }, - "valueset" : { - "name" : "High Risk HPV Positive Results", - "libraryName" : "Dash", - "type" : "ValueSetRef" - } - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "HPV-positive", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "2", - "type" : "Literal" - } - } ] - } - }, { - "when" : { - "type" : "InValueSet", - "code" : { - "name" : "c", - "type" : "AliasRef" - }, - "valueset" : { - "name" : "HPV Negative Results", - "libraryName" : "Dash", - "type" : "ValueSetRef" - } - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "HPV-negative", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "1", - "type" : "Literal" - } - } ] - } - } ], - "else" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "ALL", - "type" : "Literal" - } - }, { - "name" : "rank", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}Integer", - "value" : "0", - "type" : "Literal" - } - } ] - } - } - } - }, - "operand" : [ { - "name" : "conclusions", - "operandTypeSpecifier" : { - "type" : "ListTypeSpecifier", - "elementType" : { - "name" : "{urn:hl7-org:elm-types:r1}Concept", - "type" : "NamedTypeSpecifier" - } - } - } ] - }, { - "name" : "HighestRankedInterpretation", - "context" : "Patient", - "accessLevel" : "Public", - "type" : "FunctionDef", - "expression" : { - "type" : "Last", - "source" : { - "type" : "Query", - "source" : [ { - "alias" : "S", - "expression" : { - "type" : "Query", - "source" : [ { - "alias" : "I", - "expression" : { - "name" : "interpretations", - "type" : "OperandRef" - } - } ], - "relationship" : [ ], - "sort" : { - "by" : [ { - "direction" : "asc", - "path" : "rank", - "type" : "ByColumn" - } ] - } - } - } ], - "relationship" : [ ], - "return" : { - "expression" : { - "path" : "text", - "scope" : "S", - "type" : "Property" - } - } - } - }, - "operand" : [ { - "name" : "interpretations", - "operandTypeSpecifier" : { - "type" : "ListTypeSpecifier", - "elementType" : { - "type" : "TupleTypeSpecifier", - "element" : [ { - "name" : "text", - "elementType" : { - "name" : "{urn:hl7-org:elm-types:r1}String", - "type" : "NamedTypeSpecifier" - } - }, { - "name" : "rank", - "elementType" : { - "name" : "{urn:hl7-org:elm-types:r1}Integer", - "type" : "NamedTypeSpecifier" - } - } ] - } - } - } ] - }, { - "name" : "BiopsyInterpretation", - "context" : "Patient", - "accessLevel" : "Public", - "type" : "FunctionDef", - "expression" : { - "type" : "Query", - "source" : [ { - "alias" : "c", - "expression" : { - "name" : "conclusions", - "type" : "OperandRef" - } - } ], - "relationship" : [ ], - "return" : { - "expression" : { - "type" : "Case", - "caseItem" : [ { - "when" : { - "type" : "InValueSet", - "code" : { - "name" : "c", - "type" : "AliasRef" - }, - "valueset" : { - "name" : "Normal Histology Finding", - "type" : "ValueSetRef" - } - }, - "then" : { - "type" : "Tuple", - "element" : [ { - "name" : "text", - "value" : { - "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "= 2 and Last(HpvTestsForGradeD).date after Now() - 5 years else - false + false \ No newline at end of file diff --git a/cql/ScreeningAverageRiskLibrary.json b/cql/ScreeningAverageRiskLibrary.json index 943740af..9b599d61 100644 --- a/cql/ScreeningAverageRiskLibrary.json +++ b/cql/ScreeningAverageRiskLibrary.json @@ -41,7 +41,7 @@ "version" : "1.0.0" }, { "localIdentifier" : "Dash", - "path" : "DisplayCervicalCancerMedicalHistory", + "path" : "DashboardLibrary", "version" : "1.0.0" }, { "localIdentifier" : "Symptomatic", diff --git a/cql/ScreeningDesExposureLibrary.cql b/cql/ScreeningDesExposureLibrary.cql index 222041ae..df9450e8 100644 --- a/cql/ScreeningDesExposureLibrary.cql +++ b/cql/ScreeningDesExposureLibrary.cql @@ -18,7 +18,7 @@ using FHIR version '4.0.1' include CDSConnectCommonsforFHIRv401 version '1.0.0' called C3F include FHIRHelpers version '4.0.1' called FHIRHelpers -include DisplayCervicalCancerMedicalHistory version '1.0.0' called Dash +include DashboardLibrary version '1.0.0' called Dash include CCSMCommonFunctions version '1.0.0' called Common include TopLevelScreeningLibrary version '1.0.0' called Entry @@ -114,7 +114,7 @@ define IsIncludedAndNotExcluded: define RecommendationText: if IsIncludedAndNotExcluded then - 'Consider individualized care for this patient due to a gap in evidence-based care recommendations for individuals with DES exposure in utero. Previous guidelines (i.e., "Antenatal Exposure to DES: Lessons Learned...Future Concerns" CME Review Article and the ACOG Practice Bulletin #168 "Cervical Cancer Screening and Prevention”) recommended annual cervical cytology screening for individuals with DES exposure in utero, with tissue sampling that includes collection of endocervical and ectocervical cells, as well as cells from vaginal fornices.' + 'Consider individualized care for this patient due to a gap in evidence-based care recommendations for individuals with DES exposure in utero. Previous guidelines (i.e., "Antenatal Exposure to DES: Lessons Learned...Future Concerns" CME Review Article and the ACOG Practice Bulletin #168 "Cervical Cancer Screening and Prevention") recommended annual cervical cytology screening for individuals with DES exposure in utero, with tissue sampling that includes collection of endocervical and ectocervical cells, as well as cells from vaginal fornices.' else null diff --git a/cql/ScreeningDesExposureLibrary.json b/cql/ScreeningDesExposureLibrary.json index e5983646..178d9855 100644 --- a/cql/ScreeningDesExposureLibrary.json +++ b/cql/ScreeningDesExposureLibrary.json @@ -33,7 +33,7 @@ "version" : "4.0.1" }, { "localIdentifier" : "Dash", - "path" : "DisplayCervicalCancerMedicalHistory", + "path" : "DashboardLibrary", "version" : "1.0.0" }, { "localIdentifier" : "Common", @@ -339,7 +339,7 @@ }, "then" : { "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : "Consider individualized care for this patient due to a gap in evidence-based care recommendations for individuals with DES exposure in utero. Previous guidelines (i.e., \"Antenatal Exposure to DES: Lessons Learned...Future Concerns\" CME Review Article and the ACOG Practice Bulletin #168 \"Cervical Cancer Screening and Prevention”) recommended annual cervical cytology screening for individuals with DES exposure in utero, with tissue sampling that includes collection of endocervical and ectocervical cells, as well as cells from vaginal fornices.", + "value" : "Consider individualized care for this patient due to a gap in evidence-based care recommendations for individuals with DES exposure in utero. Previous guidelines (i.e., \"Antenatal Exposure to DES: Lessons Learned...Future Concerns\" CME Review Article and the ACOG Practice Bulletin #168 \"Cervical Cancer Screening and Prevention\") recommended annual cervical cytology screening for individuals with DES exposure in utero, with tissue sampling that includes collection of endocervical and ectocervical cells, as well as cells from vaginal fornices.", "type" : "Literal" }, "else" : { diff --git a/cql/ScreeningImmunocompromisedLibrary.cql b/cql/ScreeningImmunocompromisedLibrary.cql index 44416e6a..8bb93b18 100644 --- a/cql/ScreeningImmunocompromisedLibrary.cql +++ b/cql/ScreeningImmunocompromisedLibrary.cql @@ -18,7 +18,7 @@ using FHIR version '4.0.1' include CDSConnectCommonsforFHIRv401 version '1.0.0' called C3F include FHIRHelpers version '4.0.1' called FHIRHelpers -include DisplayCervicalCancerMedicalHistory version '1.0.0' called Dash +include DashboardLibrary version '1.0.0' called Dash include CCSMCommonFunctions version '1.0.0' called Common include TopLevelScreeningLibrary version '1.0.0' called Entry @@ -295,7 +295,7 @@ define ProposedDateOfNextScreening: define ProposeImmediateTesting: Count(NilmCytologyReportsSinceImmunosuppressionOnset) = 0 or - ProposedDateOfNextScreening same or before Today() + ProposedDateOfNextScreening same or before Now() define RecommendationText: if ProposeImmediateTesting then diff --git a/cql/ScreeningImmunocompromisedLibrary.json b/cql/ScreeningImmunocompromisedLibrary.json index 5c7b450b..a0974043 100644 --- a/cql/ScreeningImmunocompromisedLibrary.json +++ b/cql/ScreeningImmunocompromisedLibrary.json @@ -33,7 +33,7 @@ "version" : "4.0.1" }, { "localIdentifier" : "Dash", - "path" : "DisplayCervicalCancerMedicalHistory", + "path" : "DashboardLibrary", "version" : "1.0.0" }, { "localIdentifier" : "Common", @@ -1460,6 +1460,30 @@ "type" : "Now" } } + }, { + "name" : "temp1", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Count", + "source" : { + "name" : "NilmCytologyReportsSinceImmunosuppressionOnset", + "type" : "ExpressionRef" + } + } + }, { + "name" : "temp2", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "SameOrBefore", + "operand" : [ { + "name" : "ProposedDateOfNextScreening", + "type" : "ExpressionRef" + }, { + "type" : "Now" + } ] + } }, { "name" : "ProposeImmediateTesting", "context" : "Patient", @@ -1485,10 +1509,7 @@ "name" : "ProposedDateOfNextScreening", "type" : "ExpressionRef" }, { - "type" : "ToDateTime", - "operand" : { - "type" : "Today" - } + "type" : "Now" } ] } ] } diff --git a/cql/ScreeningSymptomaticLibrary.cql b/cql/ScreeningSymptomaticLibrary.cql index 89a750ef..a9ad8378 100644 --- a/cql/ScreeningSymptomaticLibrary.cql +++ b/cql/ScreeningSymptomaticLibrary.cql @@ -18,7 +18,7 @@ using FHIR version '4.0.1' include CDSConnectCommonsforFHIRv401 version '1.0.0' called C3F include FHIRHelpers version '4.0.1' called FHIRHelpers -include DisplayCervicalCancerMedicalHistory version '1.0.0' called Dash +include DashboardLibrary version '1.0.0' called Dash include CCSMCommonFunctions version '1.0.0' called Common include TopLevelScreeningLibrary version '1.0.0' called Entry diff --git a/cql/ScreeningSymptomaticLibrary.json b/cql/ScreeningSymptomaticLibrary.json index 533fbe49..313b953b 100644 --- a/cql/ScreeningSymptomaticLibrary.json +++ b/cql/ScreeningSymptomaticLibrary.json @@ -33,7 +33,7 @@ "version" : "4.0.1" }, { "localIdentifier" : "Dash", - "path" : "DisplayCervicalCancerMedicalHistory", + "path" : "DashboardLibrary", "version" : "1.0.0" }, { "localIdentifier" : "Common", diff --git a/cql/TopLevelScreeningLibrary.cql b/cql/TopLevelScreeningLibrary.cql index 6c785c07..93803243 100644 --- a/cql/TopLevelScreeningLibrary.cql +++ b/cql/TopLevelScreeningLibrary.cql @@ -77,12 +77,12 @@ define Excluded: define IsIncludedAndNotExcluded: IsIncluded and not Excluded -// TODO: ServiceRequest code element -define "ServiceRequest Code": +// TODO: ServiceRequestCode element +define "ServiceRequestCode": null // TODO: ServiceRequest orderDetail element -define "ServiceRequest Order Detail": +define "ServiceRequestOrderDetail": null // TODO: Report errors diff --git a/cql/TopLevelScreeningLibrary.json b/cql/TopLevelScreeningLibrary.json index c4905b61..c3430654 100644 --- a/cql/TopLevelScreeningLibrary.json +++ b/cql/TopLevelScreeningLibrary.json @@ -542,14 +542,14 @@ } ] } }, { - "name" : "ServiceRequest Code", + "name" : "ServiceRequestCode", "context" : "Patient", "accessLevel" : "Public", "expression" : { "type" : "Null" } }, { - "name" : "ServiceRequest Order Detail", + "name" : "ServiceRequestOrderDetail", "context" : "Patient", "accessLevel" : "Public", "expression" : { diff --git a/cql/export/AutogeneratedRiskTables.mjs b/cql/export/AutogeneratedRiskTables.mjs new file mode 100644 index 00000000..2fbaefd9 --- /dev/null +++ b/cql/export/AutogeneratedRiskTables.mjs @@ -0,0 +1,9757 @@ +export const AutogeneratedRiskTables = { + "library" : { + "annotation" : [ { + "translatorOptions" : "", + "type" : "CqlToElmInfo" + } ], + "identifier" : { + "id" : "AutogeneratedRiskTables", + "version" : "1.0.0" + }, + "schemaIdentifier" : { + "id" : "urn:hl7-org:elm", + "version" : "r1" + }, + "usings" : { + "def" : [ { + "localIdentifier" : "System", + "uri" : "urn:hl7-org:elm-types:r1" + }, { + "localIdentifier" : "FHIR", + "uri" : "http://hl7.org/fhir", + "version" : "4.0.1" + } ] + }, + "includes" : { + "def" : [ { + "localIdentifier" : "FHIRHelpers", + "path" : "FHIRHelpers", + "version" : "4.0.1" + } ] + }, + "statements" : { + "def" : [ { + "name" : "GeneralScreening", + "context" : "Unfiltered", + "accessLevel" : "Public", + "expression" : { + "type" : "List", + "element" : [ { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-negative", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NILM", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "0.0", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "0.12", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "5-year follow-up", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-negative", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ASC-US", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "0.04", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "0.4", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "3-year follow-up", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-negative", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "LSIL", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "1.05", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "1.96", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "1-year follow-up", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-negative", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ASC-H", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "3.42", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "3.78", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-negative", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "AGC", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "1.07", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "1.46", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-negative", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HSIL+", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "25.21", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "27.37", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy/Treatment", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-negative", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ALL", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "0.01", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "0.14", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "5-year follow-up", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-positive", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NILM", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "2.13", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "4.8", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "1-year follow-up", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-positive", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ASC-US", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "4.45", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "7.27", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-positive", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "LSIL", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "4.27", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "6.94", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-positive", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ASC-H", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "25.73", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "33.34", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy/Treatment", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-positive", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "AGC", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "26.27", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "34.53", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy/Treatment", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV-positive", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HSIL+", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "48.86", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "53.16", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy/Treatment", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV16+", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NILM", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "5.3", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "8.82", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV16+", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ASC-US", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "8.99", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "13.31", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV16+", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "LSIL", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "11.27", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "15.36", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV16+", + "type" : "Literal" + } + }, { + "name" : "pap", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ASC-H", + "type" : "Literal" + } + }, { + "name" : "value", + "value" : { + "type" : "Tuple", + "element" : [ { + "name" : "immediate", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "27.76", + "type" : "Literal" + } + }, { + "name" : "five_year", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Decimal", + "value" : "33.24", + "type" : "Literal" + } + } ] + } + }, { + "name" : "management", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy/Treatment", + "type" : "Literal" + } + } ] + }, { + "type" : "Tuple", + "element" : [ { + "name" : "history", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "NO HISTORY", + "type" : "Literal" + } + }, { + "name" : "hpv", + "value" : { + "valueType" : 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"value" : { + "classType" : "{http://hl7.org/fhir}string", + "type" : "Instance", + "element" : [ { + "name" : "value", + "value" : { + "name" : "reference", + "type" : "OperandRef" + } + } ] + } + } ] + } + }, + "operand" : [ { + "name" : "reference", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "resolve", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "reference", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "resolve", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "reference", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Reference", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "reference", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "resource", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Resource", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "extension", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "element", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Element", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "url", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "extension", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "resource", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Resource", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "url", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "hasValue", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "element", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Element", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "getValue", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "element", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Element", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ofType", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "identifier", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "is", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "identifier", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "as", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "identifier", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "elementDefinition", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "element", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Element", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "slice", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "element", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Element", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "url", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "name", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "checkModifiers", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "resource", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Resource", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "checkModifiers", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "resource", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Resource", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "modifier", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "checkModifiers", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "element", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Element", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "checkModifiers", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "element", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Element", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "modifier", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "conformsTo", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "resource", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Resource", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "structure", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "memberOf", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "code", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}code", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "valueSet", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "memberOf", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "coding", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Coding", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "valueSet", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "memberOf", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "concept", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}CodeableConcept", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "valueSet", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "subsumes", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "coding", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Coding", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "subsumedCoding", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Coding", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "subsumes", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "concept", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}CodeableConcept", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "subsumedConcept", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}CodeableConcept", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "subsumedBy", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "coding", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Coding", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "subsumingCoding", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Coding", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "subsumedBy", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "concept", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}CodeableConcept", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "subsumingConcept", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}CodeableConcept", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "htmlChecks", + "context" : "Patient", + "accessLevel" : "Public", + "external" : true, + "type" : "FunctionDef", + "operand" : [ { + "name" : "element", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Element", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}AccountStatus", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" 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"Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}SpecimenContainedPreference", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}SpecimenStatus", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Status", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}StrandType", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}StructureDefinitionKind", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}StructureMapContextType", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}StructureMapGroupTypeMode", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}StructureMapInputMode", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}StructureMapModelMode", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}StructureMapSourceListMode", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}StructureMapTargetListMode", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}StructureMapTransform", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}SubscriptionChannelType", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}SubscriptionStatus", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}SupplyDeliveryStatus", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}SupplyRequestStatus", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}SystemRestfulInteraction", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TaskIntent", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TaskPriority", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TaskStatus", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TestReportActionResult", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TestReportParticipantType", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TestReportResult", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TestReportStatus", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TestScriptRequestMethodCode", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TriggerType", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TypeDerivationRule", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}TypeRestfulInteraction", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}UDIEntryType", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}UnitsOfTime", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}Use", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}VariableType", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}VisionBase", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}VisionEyes", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}VisionStatus", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}XPathUsageType", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}base64Binary", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToBoolean", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}boolean", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToDate", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}date", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToDateTime", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}dateTime", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToDecimal", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}decimal", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToDateTime", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}instant", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToInteger", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}integer", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}string", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToTime", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}time", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}uri", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "ToString", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "name" : "value", + "type" : "OperandRef" + } + }, + "operand" : [ { + "name" : "value", + "operandTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}xhtml", + "type" : "NamedTypeSpecifier" + } + } ] + } ] + } + } +} + diff --git a/cql/export/ManageCommonAbnormality.mjs b/cql/export/ManageCommonAbnormality.mjs new file mode 100644 index 00000000..1da6cde8 --- /dev/null +++ b/cql/export/ManageCommonAbnormality.mjs @@ -0,0 +1,1538 @@ +export const ManageCommonAbnormality = { + "library" : { + "annotation" : [ { + "translatorOptions" : "", + "type" : "CqlToElmInfo" + } ], + "identifier" : { + "id" : "ManageCommonAbnormality", + "version" : "1.1.0" + }, + "schemaIdentifier" : { + "id" : "urn:hl7-org:elm", + "version" : "r1" + }, + "usings" : { + "def" : [ { + "localIdentifier" : "System", + "uri" : "urn:hl7-org:elm-types:r1" + }, { + "localIdentifier" : "FHIR", + "uri" : "http://hl7.org/fhir", + "version" : "4.0.1" + } ] + }, + "includes" : { + "def" : [ { + "localIdentifier" : "FHIRHelpers", + "path" : "FHIRHelpers", + "version" : "4.0.1" + }, { + "localIdentifier" : "Dash", + "path" : "DashboardLibrary", + "version" : "1.0.0" + }, { + "localIdentifier" : "Collate", + "path" : "CollateManagementData", + "version" : "1.1.0" + }, { + "localIdentifier" : "RiskTableLookup", + "path" : "AutogeneratedTableLookup", + "version" : "1.0.0" + } ] + }, + "contexts" : { + "def" : [ { + "name" : "Patient" + } ] + }, + "statements" : { + "def" : [ { + "name" : "Patient", + "context" : "Patient", + "expression" : { + "type" : "SingletonFrom", + "operand" : { + "dataType" : "{http://hl7.org/fhir}Patient", + "templateId" : "http://hl7.org/fhir/StructureDefinition/Patient", + "type" : "Retrieve" + } + } + }, { + "name" : "LookUpTable1", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "GetGeneralScreeningManagement", + "libraryName" : "RiskTableLookup", + "type" : "FunctionRef", + "operand" : [ { + "name" : "SecondMostRecentHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "SecondMostRecentCytologyCotestResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentCytologyCotestResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "GeneralScreeningManagementRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "LookUpTable1", + "type" : "ExpressionRef" + } + } + } + }, + "then" : { + "name" : "LookUpTable1", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "LookUpTable2", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "GetSurveillanceManagement", + "libraryName" : "RiskTableLookup", + "type" : "FunctionRef", + "operand" : [ { + "name" : "ThirdMostRecentHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "ThirdMostRecentCytologyCotestResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "SecondMostRecentHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "SecondMostRecentCytologyCotestResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentCytologyCotestResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "SurveillanceManagementRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "LookUpTable2", + "type" : "ExpressionRef" + } + } + } + }, + "then" : { + "name" : "LookUpTable2", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "LookUpTable3", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "GetColposcopyResultsManagement", + "libraryName" : "RiskTableLookup", + "type" : "FunctionRef", + "operand" : [ { + "name" : "ReferringHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "ReferringCytologyResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentBiopsyResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "ColposcopyResultsManagementRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "LookUpTable3", + "type" : "ExpressionRef" + } + } + } + }, + "then" : { + "name" : "LookUpTable3", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "LookUpTable4", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "GetPostColposcopyManagement", + "libraryName" : "RiskTableLookup", + "type" : "FunctionRef", + "operand" : [ { + "name" : "ReferringHpvResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "ReferringCytologyResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentBiopsyResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "ThirdMostRecentHpvResultPostBiopsy", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "ThirdMostRecentCytologyResultPostBiopsy", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "SecondMostRecentHpvResultPostBiopsy", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "SecondMostRecentCytologyResultPostBiopsy", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentHpvResultPostBiopsy", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentCytologyResultPostBiopsy", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "PostColposcopyManagementRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "LookUpTable4", + "type" : "ExpressionRef" + } + } + } + }, + "then" : { + "name" : "LookUpTable4", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "LookUpTable5", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "GetPostTreatmentManagement", + "libraryName" : "RiskTableLookup", + "type" : "FunctionRef", + "operand" : [ { + "name" : "MostRecentBiopsyResult", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "ThirdMostRecentHpvResultAfterTreatment", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "ThirdMostRecentCytologyResultAfterTreatment", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "SecondMostRecentHpvResultAfterTreatment", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "SecondMostRecentCytologyResultAfterTreatment", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentHpvResultAfterTreatment", + "libraryName" : "Collate", + "type" : "ExpressionRef" + }, { + "name" : "MostRecentCytologyResultAfterTreatment", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "PostTreatmentManagementRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "LookUpTable5", + "type" : "ExpressionRef" + } + } + } + }, + "then" : { + "name" : "LookUpTable5", + "type" : "ExpressionRef" + }, + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}String", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "TableRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Coalesce", + "operand" : [ { + "name" : "PostTreatmentManagementRecommendation", + "type" : "ExpressionRef" + }, { + "name" : "PostColposcopyManagementRecommendation", + "type" : "ExpressionRef" + }, { + "name" : "ColposcopyResultsManagementRecommendation", + "type" : "ExpressionRef" + }, { + "name" : "SurveillanceManagementRecommendation", + "type" : "ExpressionRef" + }, { + "name" : "GeneralScreeningManagementRecommendation", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "WhichTableMadeTheRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Case", + "caseItem" : [ { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "PostTreatmentManagementRecommendation", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "5", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "PostColposcopyManagementRecommendation", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "4", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "ColposcopyResultsManagementRecommendation", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "SurveillanceManagementRecommendation", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "2", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "GeneralScreeningManagementRecommendation", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "1", + "type" : "Literal" + } + } ], + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}Integer", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + }, { + "name" : "J1RecommendationText", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "After abnormal cervical cancer screening test results for patients 25 years or older, colposcopic biopsy results, or treatment of histologic HSIL, surveillance with either HPV testing alone or cotesting is preferred (AI). Surveillance with cervical cytology alone is acceptable only if testing with HPV or cotesting is not feasible (CIII). Cytology is recommended at 6-month intervals when 1-year intervals are recommended for HPV or cotesting, and annually when 3-year intervals are recommended for HPV or cotesting (AII).", + "type" : "Literal" + } + }, { + "name" : "TreatmentWithPregnancyConcernsRecommendationText", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Endocervical curettage, endometrial biopsy, and treatment without biopsy are unacceptable during pregnancy (EIII). A diagnostic excisional procedure or repeat biopsy is recommended only if cancer is suspected based on cytology, colposcopy, or histology (BII).\n\nFor patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). If the histologic HSIL cannot be specified as CIN 2, treatment is preferred, but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.", + "type" : "Literal" + } + }, { + "name" : "OneYearSurveillanceRecommendationText", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "When patients have an estimated risk of CIN 3+ based on history and current results that is below the threshold for immediate colposcopy (4.0% immediate risk) and above the 3-year follow-up threshold (≥0.55% at 5 years), repeat testing in 1 year with HPV-based testing is recommended (AII).", + "type" : "Literal" + } + }, { + "name" : "ThreeYearSurveillanceRecommendationText", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "When patients have an estimated 5-year CIN 3+ risk of 0.15% or greater but less than 0.55% based on history and current test results, repeat testing in 3 years with HPV-based testing is recommended (AII).", + "type" : "Literal" + } + }, { + "name" : "FiveYearSurveillanceRecommendationText", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "When patients have an estimated 5-year CIN 3+ risk of less than 0.15% based on past history and current test results, return to routine screening at 5-year intervals using HPV-based testing is recommended (AII).", + "type" : "Literal" + } + }, { + "name" : "ColposcopyRecommendationText", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients 25 years or older, when patients have an estimated immediate risk of diagnosis of CIN 3+ of 4.0% or greater based on history and current results, referral to colposcopy is recommended (AII).\n\nEndocervical curettage, endometrial biopsy, and treatment without biopsy are unacceptable during pregnancy (EIII). A diagnostic excisional procedure or repeat biopsy is recommended only if cancer is suspected based on cytology, colposcopy, or histology (BII).", + "type" : "Literal" + } + }, { + "name" : "ColposcopyOrTreatmentRecommendationText", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For nonpregnant patients 25 years or older with an estimated immediate risk of CIN 3+ 25% or greater and less than 60% based on history and current results, treatment using an excisional procedure without previous biopsy confirmation or histologic evaluation with colposcopy and biopsy are both acceptable (AII).", + "type" : "Literal" + } + }, { + "name" : "TreatmentRecommendationText", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For nonpregnant patients 25 years or older with an estimated immediate risk of CIN 3+ of 60% or greater based on history and current results, treatment using an excisional procedure without previous biopsy confirmation is preferred but colposcopy with biopsy is acceptable (BII).", + "type" : "Literal" + } + }, { + "name" : "Over65RecommendationText", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "If patients over age 65 years undergo HPV testing, cotesting, or cytology, management according to guidelines for patients aged 25 to 65 years is recommended (CII). If surveillance testing is recommended for either a history of abnormal screening results or treatment for precancer, discontinuing surveillance is unacceptable if the patient is in reasonably good health and testing is feasible (DII). Discontinuation of surveillance is recommended for patients with a limited life expectancy (EIII). This population will be managed based on logic defined for rare abnormalities and common abnormalities.", + "type" : "Literal" + } + }, { + "name" : "PositivePrimaryHpv", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "And", + "operand" : [ { + "type" : "AnyTrue", + "source" : { + "type" : "Query", + "source" : [ { + "alias" : "aC", + "expression" : { + "path" : "allConclusions", + "type" : "Property", + "source" : { + "name" : "MostRecentHpvReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } + } ], + "relationship" : [ ], + "return" : { + "expression" : { + "type" : "InValueSet", + "code" : { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "aC", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "High Risk HPV Positive Results", + "libraryName" : "Dash", + "type" : "ValueSetRef" + } + } + } + } + }, { + "type" : "IsNull", + "operand" : { + "name" : "MostRecentCytologyCotest", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } ] + } + }, { + "name" : "Recommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Case", + "caseItem" : [ { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "PositivePrimaryHpv", + "type" : "ExpressionRef" + }, { + "type" : "Not", + "operand" : { + "type" : "After", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentHpvReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } ] + } + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "After", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentHpvReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } ] + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Per the ASCCP Risk Management Guidelines (Egemen et al.), reflex testing with cervical cytology is indicated as surveillance given the patient’s history of abnormal results in order to provide an evidence-based care recommendation.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "65", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "1-year follow-up", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "OneYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "Greater", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "65", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "1-year follow-up", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "OneYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "Over65RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "65", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "3-year follow-up", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "ThreeYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "Greater", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "65", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "3-year follow-up", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "ThreeYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "Over65RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "65", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "5-year follow-up", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "FiveYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "Greater", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "65", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "5-year follow-up", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "FiveYearSurveillanceRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "J1RecommendationText", + "type" : "ExpressionRef" + } ] + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "Over65RecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "name" : "ColposcopyRecommendationText", + "type" : "ExpressionRef" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy/Treatment", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "ColposcopyOrTreatmentRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "TreatmentWithPregnancyConcernsRecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "Greater", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy/Treatment", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "name" : "ColposcopyOrTreatmentRecommendationText", + "type" : "ExpressionRef" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Treatment", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "type" : "Concatenate", + "operand" : [ { + "type" : "Concatenate", + "operand" : [ { + "name" : "TreatmentRecommendationText", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "\n\n", + "type" : "Literal" + } ] + }, { + "name" : "TreatmentWithPregnancyConcernsRecommendationText", + "type" : "ExpressionRef" + } ] + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "Greater", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + }, { + "type" : "Equal", + "operand" : [ { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Treatment", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "name" : "TableRecommendation", + "type" : "ExpressionRef" + } + }, { + "name" : "text", + "value" : { + "name" : "TreatmentRecommendationText", + "type" : "ExpressionRef" + } + } ] + } + } ], + "else" : { + "type" : "As", + "operand" : { + "type" : "Null" + }, + "asTypeSpecifier" : { + "type" : "TupleTypeSpecifier", + "element" : [ { + "name" : "action", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "text", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + } + } + } + } ] + } + } +} + diff --git a/cql/export/ManageRareAbnormality.mjs b/cql/export/ManageRareAbnormality.mjs new file mode 100644 index 00000000..c5c0fc15 --- /dev/null +++ b/cql/export/ManageRareAbnormality.mjs @@ -0,0 +1,10166 @@ +export const ManageRareAbnormality = { + "library" : { + "annotation" : [ { + "translatorOptions" : "", + "type" : "CqlToElmInfo" + } ], + "identifier" : { + "id" : "ManageRareAbnormality", + "version" : "1.1.0" + }, + "schemaIdentifier" : { + "id" : "urn:hl7-org:elm", + "version" : "r1" + }, + "usings" : { + "def" : [ { + "localIdentifier" : "System", + "uri" : "urn:hl7-org:elm-types:r1" + }, { + "localIdentifier" : "FHIR", + "uri" : "http://hl7.org/fhir", + "version" : "4.0.1" + } ] + }, + "includes" : { + "def" : [ { + "localIdentifier" : "FHIRHelpers", + "path" : "FHIRHelpers", + "version" : "4.0.1" + }, { + "localIdentifier" : "C3F", + "path" : "CDSConnectCommonsforFHIRv401", + "version" : "1.0.0" + }, { + "localIdentifier" : "Dash", + "path" : "DashboardLibrary", + "version" : "1.0.0" + }, { + "localIdentifier" : "Collate", + "path" : "CollateManagementData", + "version" : "1.1.0" + }, { + "localIdentifier" : "Common", + "path" : "CCSMCommonFunctions", + "version" : "1.0.0" + }, { + "localIdentifier" : "Symptomatic", + "path" : "ScreeningSymptomaticLibrary", + "version" : "1.0.0" + } ] + }, + "codeSystems" : { + "def" : [ { + "name" : "SNOMED-CT", + "id" : "http://snomed.info/sct", + "accessLevel" : "Public" + }, { + "name" : "ICD-9", + "id" : "http://hl7.org/fhir/sid/icd-9-cm", + "accessLevel" : "Public" + }, { + "name" : "ICD-10", + "id" : "http://hl7.org/fhir/sid/icd-10-cm", + "accessLevel" : "Public" + }, { + "name" : "NULL FLAVOR", + "id" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor", + "accessLevel" : "Public" + }, { + "name" : "LOCAL", + "id" : "http://OUR-PLACEHOLDER-URL.com", + "accessLevel" : "Public" + } ] + }, + "valueSets" : { + "def" : [ { + "name" : "Premenopausal", + "id" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.254", + "accessLevel" : "Public" + }, { + "name" : "All Results of High Risk HPV Test", + "id" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.233", + "accessLevel" : "Public" + }, { + "name" : "HSIL", + "id" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.256", + "accessLevel" : "Public" + }, { + "name" : "Normal Histology Finding", + "id" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.262", + "accessLevel" : "Public" + } ] + }, + "codes" : { + "def" : [ { + "name" : "ASC-H", + "id" : "441088002", + "display" : "Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding)", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "SNOMED-CT" + } + }, { + "name" : "CIN1", + "id" : "285836003", + "display" : "Cervical intraepithelial neoplasia grade 1 (disorder)", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "SNOMED-CT" + } + }, { + "name" : "Atypical Endometrial Cells", + "id" : "103646000", + "display" : "Atypical endometrial cells of undetermined significance (morphologic abnormality)", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "SNOMED-CT" + } + }, { + "name" : "Atypical Endocervical Cells", + "id" : "441094005", + "display" : "Atypical endocervical cells on cervical Papanicolaou smear (finding)", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "SNOMED-CT" + } + }, { + "name" : 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If any test is abnormal, then colposcopy is recommended (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "type" : "Or", + "operand" : [ { + "type" : "Or", + "operand" : [ { + "name" : "CytologyInterpretedAsAgcFavorNeoplasia", + "type" : "ExpressionRef" + }, { + "name" : "CytologyInterpretedAsEndocervicalCellsFavorNeoplasia", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsEndocervicalAis", + "type" : "ExpressionRef" + } ] + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "Or", + "operand" : [ { + "name" : "CancerDiagnosisAfterMostRecentCytology", + "type" : "ExpressionRef" + }, { + "type" : "And", + "operand" : [ { + "name" : "HistologyInterpretedAsCancer", + "type" : "ExpressionRef" + }, { + "type" : "Greater", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "type" : "ExpressionRef" + } + } ] + } ] + } ] + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG1.5", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients with atypical glandular or endocervical cells 'favor neoplasia' or endocervical AIS cytology, if invasive disease is not identified during initial colposcopic workup, a diagnostic excisional procedure is recommended. The diagnostic excisional procedure used in this setting should provide an intact specimen with interpretable margins (BII). Endocervical sampling above the excisional bed is preferred (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "Less", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "35", + "type" : "Literal" + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsAgcOrAis", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "CytologyInterpretedAsAtypicalEndometrialCells", + "type" : "ExpressionRef" + } + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "Pregnant", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG1.1", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is also recommended for nonpregnant patients younger than 35 years at increased risk of endometrial neoplasia based on clinical indications (e.g., abnormal uterine bleeding, conditions suggesting chronic anovulation, or obesity) (AII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "35", + "type" : "Literal" + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsAgcOrAis", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "CytologyInterpretedAsAtypicalEndometrialCells", + "type" : "ExpressionRef" + } + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "Pregnant", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG1.2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is recommended in conjunction with colposcopy and endocervical sampling in nonpregnant patients 35 years or older with all categories of AGC and AIS (AII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "name" : "CytologyInterpretedAsAgcOrAis", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsAtypicalEndometrialCells", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "Pregnant", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG1.3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients with atypical endometrial cells specified, initial evaluation limited to endometrial and endocervical sampling is preferred, with colposcopy acceptable at the time of initial evaluation. If colposcopy was deferred and no endometrial pathology is identified, additional evaluation with colposcopy is then recommended.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "name" : "CytologyUnsatisfactory", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Or", + "operand" : [ { + "type" : "Not", + "operand" : { + "name" : "AnyHpvSinceMostRecentCytology", + "type" : "ExpressionRef" + } + }, { + "name" : "NegativeOrUnknownHpvCotest", + "type" : "ExpressionRef" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG2.1", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients with an unsatisfactory cytology result and no, unknown, or a negative HPV test result, repeat age-based screening (cytology, cotest, or primary HPV test) in 2 to 4 months is recommended (BIII). Triage using HPV testing is not recommended (DIII). Before repeat cytology, treatment to resolve atrophy or obscuring inflammation when a specific infection is present is acceptable (CIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "name" : "CytologyUnsatisfactory", + "type" : "ExpressionRef" + } ] + }, { + "name" : "PositiveUntypedHpvCotest", + "type" : "ExpressionRef" + } ] + }, { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG2.2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test without genotyping for HPV 16 or HPV 18, repeat cytology in 2 to 4 months or colposcopy is acceptable (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + }, { + "name" : "CytologyUnsatisfactory", + "type" : "ExpressionRef" + } ] + }, { + "name" : "PositiveHpv16or18Cotest", + "type" : "ExpressionRef" + } ] + }, { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test with partial genotyping is positive for HPV 16 or HPV 18, direct referral for colposcopy is recommended (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "lowClosed" : true, + "highClosed" : false, + "type" : "Interval", + "low" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "21", + "type" : "Literal" + }, + "high" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "30", + "type" : "Literal" + } + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyAbsentTransformationZone", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsNilm", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG3.1", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Routine screening is recommended (BIII). When cervical cytology alone is performed for screening, HPV testing as a triage test after negative cytology and absent endocervical cells/transformation zone component in this age group is unacceptable (DIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "30", + "type" : "Literal" + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyAbsentTransformationZone", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsNilm", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Or", + "operand" : [ { + "type" : "Not", + "operand" : { + "name" : "AnyHpvSinceMostRecentCytology", + "type" : "ExpressionRef" + } + }, { + "name" : "UnknownHpvCotest", + "type" : "ExpressionRef" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "RareCytologyG3.2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "HPV testing is preferred (BIII). Repeat cytology in 3 years is acceptable if HPV testing is not performed (BIII). If HPV testing is performed, manage using Clinical Action Thresholds according to 2019 consensus guidelines.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "HasPremenopausalObservation", + "type" : "ExpressionRef" + }, { + "type" : "Not", + "operand" : { + "name" : "IsSymptomatic", + "libraryName" : "Symptomatic", + "type" : "ExpressionRef" + } + } ] + }, { + "name" : "MostRecentCytologyReportWasWithinPastFiveYears", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Or", + "operand" : [ { + "type" : "Or", + "operand" : [ { + "name" : "CytologyInterpretedAsBenignEndometrialCells", + "type" : "ExpressionRef" + }, { + "name" : "CytologyInterpretedAsEndometrialStromalCells", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsHistiocytes", + "type" : "ExpressionRef" + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + 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via cytology, no further evaluation is recommended (BII).", + "type" : "Literal" + } + } ] + } + } ], + "else" : { + "type" : "As", + "operand" : { + "type" : "Null" + }, + "asTypeSpecifier" : { + "type" : "TupleTypeSpecifier", + "element" : [ { + "name" : "action", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "text", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + } + } + } + }, { + "name" : "CytologyInterpretedAsAscH", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "AnyTrue", + "source" : { + "type" : "Query", + "source" : [ { + "alias" : "aC", + "expression" : { + "path" : "allConclusions", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "type" : "ExpressionRef" + } + } + } ], + "relationship" : [ ], + "return" : { + "expression" : { + "type" : "Equivalent", + "operand" : [ { + "name" : 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For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "Pregnant", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + } ] + }, { + "name" : "MostRecentBiopsyReportWasWithinPastYear", + "type" : "ExpressionRef" + } ] + }, { + "name" : "HistologyInterpretedAsCin3", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementHistologyI2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Treatment is recommended, and observation is unacceptable (AII). 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Additional situations for which cryotherapy is not recommended include the following: (a) the squamocolumnar junction or the upper limit of any lesion is not fully visualized; (b) endocervical canal sample is diagnosed as CIN 2+ or CIN that cannot be graded; (c) after previous treatment for CIN 2+; (d) in the setting of inadequate biopsies of the cervix to confirm histologic diagnosis; and (e) if cancer is suspected (EIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "Pregnant", + "libraryName" : "Dash", + "type" : "ExpressionRef" + } + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "RecentlyRespondedYesToFuturePregnancyConcernsQuestion", + "type" : "ExpressionRef" + } + } ] + }, { + "name" : "MostRecentBiopsyReportWasWithinPastYear", + "type" : "ExpressionRef" + } ] + }, { + "name" : "HistologyInterpretedAsCin2", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementHistologyI2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Treatment is recommended unless the patient's concerns about the effect of treatment on future pregnancy outweigh concerns about cancer (BII). Observation is unacceptable when the squamocolumnar junction or the upper limit of the lesion is not fully visualized or when the results of an endocervical sampling, if performed, is CIN 2+ or ungraded (EIII). For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.\n\nWhen treatment of histologic HSIL is planned, excisional treatment is preferred, and treatment with ablation is acceptable (BI). Outside of the setting of a clinical research trial, nonsurgical therapies, including topical agents, therapeutic vaccines, and other biologics, are unacceptable for the treatment of histologic HSIL (CIN 2 or CIN 3) (DIII). Hysterectomy is unacceptable as primary therapy solely for the treatment of histologic HSIL (CIN 2, CIN 3, or unqualified) (EII). When considering ablative therapy, in particular cryotherapy, ablation is unacceptable in the following circumstances as defined by the WHO: (a) the lesion extends into the canal and (b) when the lesion covers more than 75% of the surface area of the ectocervix or extends beyond the cryotip being used. Additional situations for which cryotherapy is not recommended include the following: (a) the squamocolumnar junction or the upper limit of any lesion is not fully visualized; (b) endocervical canal sample is diagnosed as CIN 2+ or CIN that cannot be graded; (c) after previous treatment for CIN 2+; (d) in the setting of inadequate biopsies of the cervix to confirm histologic diagnosis; and (e) if cancer is suspected (EIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + 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recommended (CII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Not", + "operand" : { + 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"valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementHistologyI3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Surveillance with HPV-based testing is recommended every 3 years for 25 years after histologic HSIL (unspecified or CIN2) even if beyond the age of 65 (BII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "InitialCervicalHistologyInterpretedAsUnspecifiedHsilOrCin2InLast18Months", + "type" : "ExpressionRef" + } + } + } ] + }, { + "type" : "Query", + "source" : [ { + "alias" : "SecondMostRecentNegativeHsilSurveillanceResult", + "expression" : { + "name" : "MostRecentNegativeHsilSurveillanceResult", + "type" : "ExpressionRef" + } + } ], + "relationship" : [ ] + } ] + }, { + "name" : "RecentlyRespondedYesToFuturePregnancyConcernsQuestion", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementHistologyI3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Subsequent surveillance with HPV-based testing should occur every year since the patient has demonstrated less than CIN2 and less than ASC-H during surveillance following a histologic unspecified or CIN2 result.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + } ] + }, { + "name" : "MostRecentBiopsyReportWasWithinPastYear", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Query", + "source" : [ { + "alias" : "RecentlyRespondedYesToFuturePregnancyConcernsQuestion", + "expression" : { + "name" : "HistologyInterpretedAsUnspecifiedHsil", + "type" : "ExpressionRef" + } + } ], + "relationship" : [ ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementHistologyI3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "If the histologic HSIL cannot be specified as CIN 2, treatment is preferred, but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "type" : "LessOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "50", + "type" : "Literal" + } ] + } ] + }, { + "name" : "MostRecentBiopsyReportWasWithinPastYear", + "type" : "ExpressionRef" + } ] + }, { + "name" : "HistologyInterpretedAsCin2", + "type" : "ExpressionRef" + } ] + }, { + "name" : "RecentlyRespondedYesToFuturePregnancyConcernsQuestion", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementHistologyI3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "name" : "MostRecentBiopsyReportWasWithinPastYear", + "type" : "ExpressionRef" + } ] + }, { + "name" : "HistologyInterpretedAsCin1OrNormal", + "type" : "ExpressionRef" + } ] + }, { + "name" : "PrecedingCytologyIsHsil", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementHistologyI4", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "When CIN 2+ is not identified, HSIL cytology is managed more aggressively than ASC-H cytology. For cytology showing HSIL, but biopsy showing histologic LSIL (CIN 1) or less, either an immediate diagnostic excisional procedure or observation with HPV-based testing and colposcopy at 1 year is acceptable, provided in the latter case that the initial colposcopic examination fully visualized the squamocolumnar junction and the upper limit of any lesion, and that the endocervical sampling, if collected, was less than CIN 2 (BII). When CIN2+ is not identified histologically after an ASC-H or HSIL cytology result, it is acceptable to review the cytologic, histologic, and colposcopic findings. If the review yields a revised interpretation, management should follow guidelines for the revised diagnosis (CIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "name" : "MostRecentBiopsyReportWasWithinPastYear", + "type" : "ExpressionRef" + } ] + }, { + "name" : "HistologyInterpretedAsCin1OrNormal", + "type" : "ExpressionRef" + } ] + }, { + "name" : "PrecedingCytologyIsAscH", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : 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Excisional procedures should optimally remove an intact specimen to facilitate accurate interpretation of margin status. Although there is no preference for cold knife conization versus LEEP, intentional disruption of the specimen by performance of a LEEP followed by a 'top hat' endocervical excision to achieve the desired specimen length is unacceptable. An excisional specimen length of at least 10 mm is preferred, and this can be increased to 18 to 20 mm for patients who are not concerned about the effect of treatment on future pregnancy. These dimensions are preferred regardless of whether hysterectomy is planned. After the initial diagnostic procedure, hysterectomy is the preferred management for all patients who have a histologic diagnosis of AIS, although fertility-sparing management for appropriately selected patients is acceptable. For patients with confirmed AIS with negative margins on the excisional specimen, simple hysterectomy is preferred. 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"ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "1", + "type" : "Literal" + } ] + } + }, { + "lowClosed" : true, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } ] + } + }, { + "value" : 3, + "unit" : "years", + "type" : "Quantity" + } ] + }, + "high" : { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } ] + } + } + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "path" : "date", + "type" : "Property", + "source" : { + "type" : "Indexer", + "operand" : [ { + "name" : "NegativeSurveillanceTestsAfterTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } ] + } + } + } + } ] + } ] + } ] + }, + "else" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Boolean", + "value" : "false", + "type" : "Literal" + } + } + }, { + "name" : "RecommendationForSurveillanceAfterAbnormalities", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Case", + "caseItem" : [ { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "HistologyInterpretedAsHistologicHsil", + "type" : "ExpressionRef" + }, { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : false, + "highClosed" : true, + "type" : "Interval", + "low" : { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + }, + "high" : { + "type" : "Add", + "operand" : [ { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + }, { + "value" : 5, + "unit" : "years", + "type" : "Quantity" + } ] + } + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + } + } + } ] + } ] + }, { + "name" : "SecondMostRecentHistologyInterpretedAsHistologicHsil", + "type" : "ExpressionRef" + } ] + }, { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "SecondMostRecentBiopsyReport", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : true, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + }, { + "value" : 5, + "unit" : "years", + "type" : "Quantity" + } ] + }, + "high" : { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + } + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "MostRecentTreatmentDate", + "type" : "ExpressionRef" + } + } + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "If recurrent histologic HSIL (CIN 2+) develops after excisional treatment, and repeat excision is not feasible or not desired, hysterectomy is recommended.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "name" : "PositiveHrHpvTestAfterTreatment", + "type" : "ExpressionRef" + }, { + "name" : "HasHistologicHsilWithin12MonthsBeforeTreatment", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy and appropriate biopsies should be performed if an hrHPV 'positive' result after treatment for histologic HSIL (AIII).", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "name" : "HasTreatmentInLastYear", + "type" : "ExpressionRef" + }, { + "name" : "HasHistologicHsilWithin12MonthsBeforeTreatment", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ2", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "After treatment, hrHPV-based testing is preferred at 6 months regardless of the margin status of the excisional specimen (BII). hrHPV-based testing includes cotesting and primary hrHPV testing. Follow-up at 6 months with colposcopy and ECC is acceptable (BIII). When margins are positive for CIN 2+ or ECC performed at the time of the excisional procedure shows CIN 2+ in patients 25 years or older who are not concerned about the potential effect of treatment on future pregnancy outcomes, repeat excision or observation is acceptable. For observation, HPV-based testing in 6 months is preferred; it is also acceptable to perform a colposcopy and ECC at 6 months.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "HasTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "type" : "GreaterOrEqual", + "operand" : [ { + "name" : "TreatmentForHighGradeHistologyOrCytologyDate", + "type" : "ExpressionRef" + }, { + "type" : "Subtract", + "operand" : [ { + "type" : "Now" + }, { + "value" : 25, + "unit" : "years", + "type" : "Quantity" + } ] + } ] + } ] + }, { + "type" : "Not", + "operand" : { + "name" : "InitialIntensiveSurveillancePeriod", + "type" : "ExpressionRef" + } + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "In patients treated for histologic or cytologic HSIL, after the initial HPV-based test at 6 months, annual HPV or cotesting is preferred until 3 consecutive negative tests have been obtained (AII). Discontinuation of screening is recommended if a patient has a limited life expectancy. Management according to the highest-grade abnormality found on histology or cytology is recommended.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "name" : "HasTreatmentForHighGradeHistologyOrCytology", + "type" : "ExpressionRef" + }, { + "type" : "GreaterOrEqual", + "operand" : [ { + "name" : "TreatmentForHighGradeHistologyOrCytologyDate", + "type" : "ExpressionRef" + }, { + "type" : "Subtract", + "operand" : [ { + "type" : "Now" + }, { + "value" : 25, + "unit" : "years", + "type" : "Quantity" + } ] + } ] + } ] + }, { + "name" : "InitialIntensiveSurveillancePeriod", + "type" : "ExpressionRef" + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "ManagementSurveillanceJ3", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "In patients treated for histologic or cytologic HSIL, after the initial intensive surveillance period, continued surveillance at 3-year intervals is recommended for at least 25 years after treatment of high-grade histology (histologic HSIL, CIN 2, CIN 3, or AIS) or high-grade cytology (HSIL, AGC, or persistent ASC-H) even if this is beyond the age of 65 years (BII). When patients with a history of treated high-grade histology or cytology reach the age of 65 years, if they have completed the initial 25-year surveillance period, continued surveillance at 3-year intervals is acceptable and may continue as long as the patient is in reasonably good health (BIII). Discontinuation of screening is recommended if a patient has a limited life expectancy. Management according to the highest-grade abnormality found on histology or cytology is recommended.", + "type" : "Literal" + } + } ] + } + } ], + "else" : { + "type" : "As", + "operand" : { + "type" : "Null" + }, + "asTypeSpecifier" : { + "type" : "TupleTypeSpecifier", + "element" : [ { + "name" : "action", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + }, { + "name" : "text", + "type" : { + "name" : "{urn:hl7-org:elm-types:r1}String", + "type" : "NamedTypeSpecifier" + } + } ] + } + } + } + }, { + "name" : "Recommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Coalesce", + "operand" : [ { + "name" : "RecommendationForSurveillanceAfterAbnormalities", + "type" : "ExpressionRef" + }, { + "name" : "RecommendationForHistologyResults", + "type" : "ExpressionRef" + }, { + "name" : "RecommendationForExceptionsToColposcopyThreshold", + "type" : "ExpressionRef" + }, { + "name" : "RecommendationForRareCytology", + "type" : "ExpressionRef" + } ] + } + }, { + "name" : "WhichRarityMadeTheRecommendation", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Case", + "caseItem" : [ { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "RecommendationForSurveillanceAfterAbnormalities", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "4", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "RecommendationForHistologyResults", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "3", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "RecommendationForExceptionsToColposcopyThreshold", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "2", + "type" : "Literal" + } + }, { + "when" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "RecommendationForRareCytology", + "type" : "ExpressionRef" + } + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "1", + "type" : "Literal" + } + } ], + "else" : { + "asType" : "{urn:hl7-org:elm-types:r1}Integer", + "type" : "As", + "operand" : { + "type" : "Null" + } + } + } + } ] + } + } +} + diff --git a/cql/export/ManageSpecialPopulation.mjs b/cql/export/ManageSpecialPopulation.mjs new file mode 100644 index 00000000..1f2d3503 --- /dev/null +++ b/cql/export/ManageSpecialPopulation.mjs @@ -0,0 +1,4059 @@ +export const ManageSpecialPopulation = { + "library" : { + "annotation" : [ { + "translatorOptions" : "", + "type" : "CqlToElmInfo" + } ], + "identifier" : { + "id" : "ManageSpecialPopulation", + "version" : "1.1.0" + }, + "schemaIdentifier" : { + "id" : "urn:hl7-org:elm", + "version" : "r1" + }, + "usings" : { + "def" : [ { + "localIdentifier" : "System", + "uri" : "urn:hl7-org:elm-types:r1" + }, { + "localIdentifier" : "FHIR", + "uri" : "http://hl7.org/fhir", + "version" : "4.0.1" + } ] + }, + "includes" : { + "def" : [ { + "localIdentifier" : "FHIRHelpers", + "path" : "FHIRHelpers", + "version" : "4.0.1" + }, { + "localIdentifier" : "C3F", + "path" : "CDSConnectCommonsforFHIRv401", + "version" : "1.0.0" + }, { + "localIdentifier" : "Dash", + "path" : "DashboardLibrary", + "version" : "1.0.0" + }, { + "localIdentifier" : "Collate", + "path" : "CollateManagementData", + "version" : "1.1.0" + }, { + "localIdentifier" : "Rare", + "path" : "ManageRareAbnormality", + "version" : "1.1.0" + }, { + "localIdentifier" : "CCF", + "path" : "CCSMCommonFunctions", + "version" : "1.0.0" + } ] + }, + "codeSystems" : { + "def" : [ { + "name" : "SNOMED-CT", + "id" : "http://snomed.info/sct", + "accessLevel" : "Public" + }, { + "name" : "ICD-9", + "id" : "http://hl7.org/fhir/sid/icd-9-cm", + "accessLevel" : "Public" + }, { + "name" : "ICD-10", + "id" : "http://hl7.org/fhir/sid/icd-10-cm", + "accessLevel" : "Public" + }, { + "name" : "NULL FLAVOR", + "id" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor", + "accessLevel" : "Public" + }, { + "name" : "LOCAL", + "id" : "http://OUR-PLACEHOLDER-URL.com", + "accessLevel" : "Public" + } ] + }, + "valueSets" : { + "def" : [ { + "name" : "Premenopausal", + "id" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.254", + "accessLevel" : "Public" + }, { + "name" : "All Results of High Risk HPV Test", + "id" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.233", + "accessLevel" : "Public" + }, { + "name" : "HSIL", + "id" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.256", + "accessLevel" : "Public" + }, { + "name" : "Normal Histology Finding", + "id" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.262", + "accessLevel" : "Public" + } ] + }, + "codes" : { + "def" : [ { + "name" : "ASC-H", + "id" : "441088002", + "display" : "Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding)", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "SNOMED-CT" + } + }, { + "name" : "CIN1", + "id" : "285836003", + "display" : "Cervical intraepithelial neoplasia grade 1 (disorder)", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "SNOMED-CT" + } + }, { + "name" : "LSIL", + "id" : "62051000119105", + "display" : "Low grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding)", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "SNOMED-CT" + } + }, { + "name" : "ASC-US", + "id" : "441087007", + "display" : "Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding)", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "SNOMED-CT" + } + } ] + }, + "contexts" : { + "def" : [ { + "name" : "Patient" + } ] + }, + "statements" : { + "def" : [ { + "name" : "Patient", + "context" : "Patient", + "expression" : { + "type" : "SingletonFrom", + "operand" : { + "dataType" : "{http://hl7.org/fhir}Patient", + "templateId" : "http://hl7.org/fhir/StructureDefinition/Patient", + "type" : "Retrieve" + } + } + }, { + "name" : "Under25And2YearsAgoCytologyResults", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "C", + "expression" : { + "name" : "SortedCytologyReports", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "And", + "operand" : [ { + "type" : "SameOrBefore", + "operand" : [ { + "path" : "date", + "scope" : "C", + "type" : "Property" + }, { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + }, { + "value" : 2, + "unit" : "years", + "type" : "Quantity" + } ] + } ] + }, { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "path" : "date", + "scope" : "C", + "type" : "Property" + }, { + "lowClosed" : true, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + }, { + "value" : 3, + "unit" : "years", + "type" : "Quantity" + } ] + }, + "high" : { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + } + } ] + }, { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + } + } + } ] + } ] + } + } + }, { + "name" : "Under25And2YearsAgoCytologyReport", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Indexer", + "operand" : [ { + "name" : "Under25And2YearsAgoCytologyResults", + "type" : "ExpressionRef" + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "0", + "type" : "Literal" + } ] + } + }, { + "name" : "AssociatedHpvCotest", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "type" : "Coalesce", + "operand" : [ { + "type" : "Query", + "source" : [ { + "alias" : "H", + "expression" : { + "name" : "SortedHpvReports", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "And", + "operand" : [ { + "type" : "In", + "operand" : [ { + "path" : "date", + "scope" : "H", + "type" : "Property" + }, { + "lowClosed" : true, + "highClosed" 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A diagnostic excisional procedure is recommended in patients when the squamocolumnar junction or the upper limit of all lesions are not fully visualized.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "GreaterOrEqual", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "21", + "type" : "Literal" + } ] + }, { + "type" : "Less", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + } ] + }, { + "name" : "HistologyInterpretedAsCin1OrNormal", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Or", + "operand" : [ { + "name" : "CytologyInterpretedAsAscusOrAbove", + "type" : "ExpressionRef" + }, { + "name" : "CytologyInterpretedAsAis", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } ] + } ] + }, { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : false, + "highClosed" : false, + "type" : "Interval", + "low" : { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, + "high" : { + "type" : "Add", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "value" : 3, + "unit" : "years", + "type" : "Quantity" + } ] + } + } ] + } ] + }, { + "name" : "SecondMostRecentCytologyInterpretedAsAscHOrHsil", + "type" : "ExpressionRef" + } ] + }, { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "SecondMostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : false, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "value" : 6, + "unit" : "months", + "type" : "Quantity" + } ] + }, + "high" : { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Colposcopy is recommended for cytologic ASC-US or above on repeat testing following a CIN1 or < CIN1 result that is preceded by a cytologic ASC-H, AGC, AIS, or HSIL result. Clinicians should switch to using risk estimates when patients reach the age of 25 years.", + "type" : "Literal" + } + } ] + } + }, { + "when" : { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "And", + "operand" : [ { + "type" : "Less", + "operand" : [ { + "precision" : "Year", + "type" : "CalculateAge", + "operand" : { + "path" : "birthDate.value", + "type" : "Property", + "source" : { + "name" : "Patient", + "type" : "ExpressionRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}Integer", + "value" : "25", + "type" : "Literal" + } ] + }, { + "name" : "HistologyInterpretedAsCin1OrNormal", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } ] + }, { + "name" : "CytologyInterpretedAsHsil", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } ] + }, { + "type" : "In", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentCytologyReport", + "libraryName" : "Rare", + "type" : "ExpressionRef" + } + }, { + "lowClosed" : false, + "highClosed" : false, + "type" : "Interval", + "low" : { + "type" : "Subtract", + "operand" : [ { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + }, { + "value" : 12, + "unit" : "months", + "type" : "Quantity" + } ] + }, + "high" : { + "path" : "date", + "type" : "Property", + "source" : { + "name" : "MostRecentBiopsyReport", + "libraryName" : "Collate", + "type" : "ExpressionRef" + } + } + } ] + } ] + }, + "then" : { + "type" : "Tuple", + "element" : [ { + "name" : "action", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "LessThan25HSIL3.1b", + "type" : "Literal" + } + }, { + "name" : "text", + "value" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Observation is recommended with colposcopy and cytology at 1 and 2 years following a cervical histology result of CIN1 or =6.9.0" - 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"requires": { - "color-convert": "^2.0.1" - } - }, - "color-convert": { - "version": "2.0.1", - "resolved": "https://registry.npmjs.org/color-convert/-/color-convert-2.0.1.tgz", - "integrity": "sha512-RRECPsj7iu/xb5oKYcsFHSppFNnsj/52OVTRKb4zP5onXwVF3zVmmToNcOfGC+CRDpfK/U584fMg38ZHCaElKQ==", - "requires": { - "color-name": "~1.1.4" - } - }, - "color-name": { - "version": "1.1.4", - "resolved": "https://registry.npmjs.org/color-name/-/color-name-1.1.4.tgz", - "integrity": "sha512-dOy+3AuW3a2wNbZHIuMZpTcgjGuLU/uBL/ubcZF9OXbDo8ff4O8yVp5Bf0efS8uEoYo5q4Fx7dY9OgQGXgAsQA==" - } } }, "wrappy": { diff --git a/package.json b/package.json index 7cced34f..3d535f40 100644 --- a/package.json +++ b/package.json @@ -6,13 +6,13 @@ "type": "module", "scripts": { "sushi": "node node_modules/.bin/sushi fsh-tank", - "test-cql": "./node_modules/.bin/mocha --reporter spec --recursive --timeout 100000", + "test-cql": "mocha --reporter spec --recursive --timeout 100000", "screening-example": "node --experimental-json-modules --no-warnings apply/screening-example.js" }, "license": "Apache-2.0", "dependencies": { - "cql-testing": "^2.5.0", - "encender": "^0.1.0", + "cql-testing": "github:ccsm-cds-tools/CQL-Testing-Framework#quantity", + "encender": "^0.3.0", "fsh-sushi": "^2.0.1" } } diff --git a/test/ManagementExceptionsToColposcopyThreshold/cases/2ConsecutiveUnsatisfactoryCytology.yml b/test/ManagementExceptionsToColposcopyThreshold/cases/2ConsecutiveUnsatisfactoryCytology.yml new file mode 100644 index 00000000..2c6ddadf --- /dev/null +++ b/test/ManagementExceptionsToColposcopyThreshold/cases/2ConsecutiveUnsatisfactoryCytology.yml @@ -0,0 +1,32 @@ +--- +name: 2 Consecutive Unsatisfactory Screening Tests - Colposcopy + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2017-05-01 +- + $iterate: *UnsatisfactoryCytoWithinPast5Years + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'Colposcopy' + text: 'Colposcopy should be performed after 2 consecutive unsatisfactory screening tests (CIII).' + WhichRarityMadeTheRecommendation: 2 \ No newline at end of file diff --git a/test/ManagementExceptionsToColposcopyThreshold/cases/AscHCytology.yml b/test/ManagementExceptionsToColposcopyThreshold/cases/AscHCytology.yml new file mode 100644 index 00000000..7a4381dc --- /dev/null +++ b/test/ManagementExceptionsToColposcopyThreshold/cases/AscHCytology.yml @@ -0,0 +1,27 @@ +--- +name: Patients with ASC-H Cytology - Colposcopy + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *AscHWithinPast5Years +- + $iterate: *DifferentHPVResultsWithinPast5Years + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'Colposcopy' + text: 'For patients with ASC-H cytology, colposcopy is recommended regardless of hrHPV result (AII).' + WhichRarityMadeTheRecommendation: 2 \ No newline at end of file diff --git a/test/ManagementExceptionsToColposcopyThreshold/cases/PositiveHpv16or18CotestNilmCytology.yml b/test/ManagementExceptionsToColposcopyThreshold/cases/PositiveHpv16or18CotestNilmCytology.yml new file mode 100644 index 00000000..65179484 --- /dev/null +++ b/test/ManagementExceptionsToColposcopyThreshold/cases/PositiveHpv16or18CotestNilmCytology.yml @@ -0,0 +1,32 @@ +--- +name: Positive HPV 16 or 18 and NILM Cytology - Colposcopy + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *PositiveHPV16or18ThisYear +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'Colposcopy' + text: 'For patients with hrHPV 18-positive NILM or hrHPV 16-positive NILM, colposcopy is recommended (AII).' + WhichRarityMadeTheRecommendation: 2 \ No newline at end of file diff --git a/test/ManagementExceptionsToColposcopyThreshold/cases/resources.yml b/test/ManagementExceptionsToColposcopyThreshold/cases/resources.yml new file mode 100644 index 00000000..f334706f --- /dev/null +++ b/test/ManagementExceptionsToColposcopyThreshold/cases/resources.yml @@ -0,0 +1,83 @@ +reusable_resources: +- &PositiveHPV16or18ThisYear + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708298003 Deoxyribonucleic acid of Human papillomavirus 16 (substance) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708299006 Deoxyribonucleic acid of Human papillomavirus 18 (substance) + effectiveDateTime: 2021-05-01 +- &DifferentHPVResultsWithinPast5Years + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708298003 Deoxyribonucleic acid of Human papillomavirus 16 (substance) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708299006 Deoxyribonucleic acid of Human papillomavirus 18 (substance) + effectiveDateTime: 2020-05-01 + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708301004 Deoxyribonucleic acid of Human papillomavirus 31 (substance) + effectiveDateTime: 2019-05-01 + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2018-05-01 + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - NULL FLAVOR#UNK Unknown + effectiveDateTime: 2017-05-01 +- &UnsatisfactoryCytoWithinPast5Years + - resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2019-05-01 + - resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2018-05-01 +- &AscHWithinPast5Years + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2019-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2017-05-01 \ No newline at end of file diff --git a/test/ManagementExceptionsToColposcopyThreshold/cqlt.yaml b/test/ManagementExceptionsToColposcopyThreshold/cqlt.yaml new file mode 100644 index 00000000..6a276479 --- /dev/null +++ b/test/ManagementExceptionsToColposcopyThreshold/cqlt.yaml @@ -0,0 +1,13 @@ +--- +library: + name: ManagementLibrary + paths: ../../cql +tests: + path: cases/ +options: + date: "2021-06-02T00:00:00.000Z" + vsac: + cache: .vscache + dumpFiles: + enabled: true + path: test_results diff --git a/test/ManagementHistologyResults/cases/I1UnspecifiedHistologicHSIL.yml b/test/ManagementHistologyResults/cases/I1UnspecifiedHistologicHSIL.yml new file mode 100644 index 00000000..41871e7a --- /dev/null +++ b/test/ManagementHistologyResults/cases/I1UnspecifiedHistologicHSIL.yml @@ -0,0 +1,30 @@ +--- +name: I.1 Management of Histologic HSIL, not Further Specified or Qualified + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#22725004 High-grade squamous intraepithelial lesion (morphologic abnormality) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI1' + text: 'Treatment is preferred if histologic HSIL cannot be specified (e.g., reported as histologic HSIL or histologic HSIL [CIN 2,3]) (CIII), but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I21HistologicHSILCin3.yml b/test/ManagementHistologyResults/cases/I21HistologicHSILCin3.yml new file mode 100644 index 00000000..03177259 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I21HistologicHSILCin3.yml @@ -0,0 +1,30 @@ +--- +name: I2.1 Management of Histologic HSIL (CIN3) + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#20365006 Squamous intraepithelial neoplasia, grade III (morphologic abnormality) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI2' + text: 'Treatment is recommended, and observation is unacceptable (AII). When treatment of histologic HSIL is planned, excisional treatment is preferred, and treatment with ablation is acceptable (BI). Outside of the setting of a clinical research trial, nonsurgical therapies, including topical agents, therapeutic vaccines, and other biologics, are unacceptable for the treatment of histologic HSIL (CIN 2 or CIN 3) (DIII). Hysterectomy is unacceptable as primary therapy solely for the treatment of histologic HSIL (CIN 2, CIN 3, or unqualified) (EII). When considering ablative therapy, in particular cryotherapy, ablation is unacceptable in the following circumstances as defined by the WHO: (a) the lesion extends into the canal and (b) when the lesion covers more than 75% of the surface area of the ectocervix or extends beyond the cryotip being used. Additional situations for which cryotherapy is not recommended include the following: (a) the squamocolumnar junction or the upper limit of any lesion is not fully visualized; (b) endocervical canal sample is diagnosed as CIN 2+ or CIN that cannot be graded; (c) after previous treatment for CIN 2+; (d) in the setting of inadequate biopsies of the cervix to confirm histologic diagnosis; and (e) if cancer is suspected (EIII).' + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I22HistologicHSILCin2.yml b/test/ManagementHistologyResults/cases/I22HistologicHSILCin2.yml new file mode 100644 index 00000000..4182ff3e --- /dev/null +++ b/test/ManagementHistologyResults/cases/I22HistologicHSILCin2.yml @@ -0,0 +1,30 @@ +--- +name: I2.2 Management of Histologic HSIL (CIN2) + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285838002 Cervical intraepithelial neoplasia grade 2 (disorder) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI2' + text: "Treatment is recommended unless the patient's concerns about the effect of treatment on future pregnancy outweigh concerns about cancer (BII). Observation is unacceptable when the squamocolumnar junction or the upper limit of the lesion is not fully visualized or when the results of an endocervical sampling, if performed, is CIN 2+ or ungraded (EIII). For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.\n\nWhen treatment of histologic HSIL is planned, excisional treatment is preferred, and treatment with ablation is acceptable (BI). Outside of the setting of a clinical research trial, nonsurgical therapies, including topical agents, therapeutic vaccines, and other biologics, are unacceptable for the treatment of histologic HSIL (CIN 2 or CIN 3) (DIII). Hysterectomy is unacceptable as primary therapy solely for the treatment of histologic HSIL (CIN 2, CIN 3, or unqualified) (EII). When considering ablative therapy, in particular cryotherapy, ablation is unacceptable in the following circumstances as defined by the WHO: (a) the lesion extends into the canal and (b) when the lesion covers more than 75% of the surface area of the ectocervix or extends beyond the cryotip being used. Additional situations for which cryotherapy is not recommended include the following: (a) the squamocolumnar junction or the upper limit of any lesion is not fully visualized; (b) endocervical canal sample is diagnosed as CIN 2+ or CIN that cannot be graded; (c) after previous treatment for CIN 2+; (d) in the setting of inadequate biopsies of the cervix to confirm histologic diagnosis; and (e) if cancer is suspected (EIII)." + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I31HistologicHSILConcernedAboutFuturePregnancy.yml b/test/ManagementHistologyResults/cases/I31HistologicHSILConcernedAboutFuturePregnancy.yml new file mode 100644 index 00000000..bd4e23ac --- /dev/null +++ b/test/ManagementHistologyResults/cases/I31HistologicHSILConcernedAboutFuturePregnancy.yml @@ -0,0 +1,35 @@ +--- +name: I3.1 Management of CIN2 in Those Who Are Concerned About the Potential Effect of Treatment on Future Pregnancy Outcomes + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285838002 Cervical intraepithelial neoplasia grade 2 (disorder) + effectiveDateTime: 2021-05-01 +- + resourceType: Observation + code: http://OUR-PLACEHOLDER-URL.com#FPCQ Does the patient have future pregnancy concerns related to treatment options? + status: final + valueCodeableConcept: SNOMEDCT#373066001 Yes (qualifier value) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI3' + text: 'For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I32UnspecifiedHistologicHSILConcernedAboutFuturePregnancy.yml b/test/ManagementHistologyResults/cases/I32UnspecifiedHistologicHSILConcernedAboutFuturePregnancy.yml new file mode 100644 index 00000000..007a1c89 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I32UnspecifiedHistologicHSILConcernedAboutFuturePregnancy.yml @@ -0,0 +1,35 @@ +--- +name: I3.2 Management of Unspecified Histologic HSIL in Those Who Are Concerned About the Potential Effect of Treatment on Future Pregnancy Outcomes + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#22725004 High-grade squamous intraepithelial lesion (morphologic abnormality) + effectiveDateTime: 2021-05-01 +- + resourceType: Observation + code: http://OUR-PLACEHOLDER-URL.com#FPCQ Does the patient have future pregnancy concerns related to treatment options? + status: final + valueCodeableConcept: SNOMEDCT#373066001 Yes (qualifier value) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI3' + text: 'If the histologic HSIL cannot be specified as CIN 2, treatment is preferred, but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I33HistologicHSILNegSurv1YearConcernedAboutFuturePregnancy.yml b/test/ManagementHistologyResults/cases/I33HistologicHSILNegSurv1YearConcernedAboutFuturePregnancy.yml new file mode 100644 index 00000000..ed3c167e --- /dev/null +++ b/test/ManagementHistologyResults/cases/I33HistologicHSILNegSurv1YearConcernedAboutFuturePregnancy.yml @@ -0,0 +1,52 @@ +--- +name: I3.3 Management of Histologic HSIL and Negative Surveillance for 1 Year in Those Who Are Concerned About the Potential Effect of Treatment on Future Pregnancy Outcomes + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *UnspecifiedHSILorCIN2LastYear +- + $iterate: *NegativeSurveillanceHistologyLastYear +- + $iterate: *NegativeSurveillanceCytologyLastYear +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2020-06-01 +- + $iterate: *NegativeSurveillanceHistologyThisYear +- + $iterate: *NegativeSurveillanceCytologyThisYear +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2021-06-01 +- + resourceType: Observation + code: http://OUR-PLACEHOLDER-URL.com#FPCQ Does the patient have future pregnancy concerns related to treatment options? + status: final + valueCodeableConcept: SNOMEDCT#373066001 Yes (qualifier value) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI3' + text: 'Subsequent surveillance with HPV-based testing should occur every year since the patient has demonstrated less than CIN2 and less than ASC-H during surveillance following a histologic unspecified or CIN2 result.' \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I33HistologicHSILNegSurv1YearConcernedAboutFuturePregnancy2.yml b/test/ManagementHistologyResults/cases/I33HistologicHSILNegSurv1YearConcernedAboutFuturePregnancy2.yml new file mode 100644 index 00000000..1b220e46 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I33HistologicHSILNegSurv1YearConcernedAboutFuturePregnancy2.yml @@ -0,0 +1,63 @@ +--- +name: I3.3 Management of Histologic HSIL and Negative Surveillance for 1 Year in Those Who Are Concerned About the Potential Effect of Treatment on Future Pregnancy Outcomes (primary HrHPV testing) + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#22725004 High-grade squamous intraepithelial lesion (morphologic abnormality) + effectiveDateTime: 2020-06-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2020-12-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2020-12-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2021-06-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2021-06-01 +- + resourceType: Observation + code: http://OUR-PLACEHOLDER-URL.com#FPCQ Does the patient have future pregnancy concerns related to treatment options? + status: final + valueCodeableConcept: SNOMEDCT#373066001 Yes (qualifier value) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI3' + text: 'Subsequent surveillance with HPV-based testing should occur every year since the patient has demonstrated less than CIN2 and less than ASC-H during surveillance following a histologic unspecified or CIN2 result.' \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I34HistologicHSILNegSurv3YearConcernedAboutFuturePregnancy2.yml b/test/ManagementHistologyResults/cases/I34HistologicHSILNegSurv3YearConcernedAboutFuturePregnancy2.yml new file mode 100644 index 00000000..d0007901 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I34HistologicHSILNegSurv3YearConcernedAboutFuturePregnancy2.yml @@ -0,0 +1,119 @@ +--- +name: I3.4 Management of Histologic HSIL and Negative Surveillance for 3 Years in Those Who Are Concerned About the Potential Effect of Treatment on Future Pregnancy Outcomes (4 neg surveillance) + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: Observation + code: http://OUR-PLACEHOLDER-URL.com#FPCQ Does the patient have future pregnancy concerns related to treatment options? + status: final + valueCodeableConcept: SNOMEDCT#373066001 Yes (qualifier value) + effectiveDateTime: 2021-06-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#22725004 High-grade squamous intraepithelial lesion (morphologic abnormality) + effectiveDateTime: 2017-06-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2017-12-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2017-12-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2017-12-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2018-06-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2018-06-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2018-06-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2019-06-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2019-06-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2019-06-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2020-07-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2020-07-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2020-07-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI3' + text: 'Surveillance with HPV-based testing is recommended every 3 years for 25 years after histologic HSIL (unspecified or CIN2) even if beyond the age of 65 (BII).' \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I34HistologicHSILNegSurv3YearsConcernedAboutFuturePregnancy.yml b/test/ManagementHistologyResults/cases/I34HistologicHSILNegSurv3YearsConcernedAboutFuturePregnancy.yml new file mode 100644 index 00000000..8d129ef8 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I34HistologicHSILNegSurv3YearsConcernedAboutFuturePregnancy.yml @@ -0,0 +1,118 @@ +--- +name: I3.4 Management of Histologic HSIL and Negative Surveillance for 3 Years in Those Who Are Concerned About the Potential Effect of Treatment on Future Pregnancy Outcomes + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *UnspecifiedHSILorCIN2FiveYearsAgo +- + resourceType: Observation + code: http://OUR-PLACEHOLDER-URL.com#FPCQ Does the patient have future pregnancy concerns related to treatment options? + status: final + valueCodeableConcept: SNOMEDCT#373066001 Yes (qualifier value) + effectiveDateTime: 2021-06-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2017-12-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2017-12-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2017-12-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2018-06-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2018-06-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2018-06-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2019-06-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2019-06-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2019-06-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2020-06-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2020-06-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2020-06-01 +- + $iterate: *NegativeSurveillanceHistologyThisYear +- + $iterate: *NegativeSurveillanceCytologyThisYear + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI3' + text: 'Surveillance with HPV-based testing is recommended every 3 years for 25 years after histologic HSIL (unspecified or CIN2) even if beyond the age of 65 (BII).' \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I35HistologicHSILRemainsPresentConcernedAboutFuturePregnancy.yml b/test/ManagementHistologyResults/cases/I35HistologicHSILRemainsPresentConcernedAboutFuturePregnancy.yml new file mode 100644 index 00000000..2cbc90b3 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I35HistologicHSILRemainsPresentConcernedAboutFuturePregnancy.yml @@ -0,0 +1,32 @@ +--- +name: I3.5 Management of Histologic HSIL and CIN2 Remains Present for a 2-year Period in Those Who Are Concerned About the Potential Effect of Treatment on Future Pregnancy Outcomes + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *UnspecifiedHSILorCIN2TwoYearsAgo +- + $iterate: *UnspecifiedHSILorCIN2ThisYear +- + resourceType: Observation + code: http://OUR-PLACEHOLDER-URL.com#FPCQ Does the patient have future pregnancy concerns related to treatment options? + status: final + valueCodeableConcept: SNOMEDCT#373066001 Yes (qualifier value) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI3' + text: 'If CIN 2 remains present for a 2-year period, treatment is recommended (CII).' \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I41HistologicLSILPrecededByHSILCytology.yml b/test/ManagementHistologyResults/cases/I41HistologicLSILPrecededByHSILCytology.yml new file mode 100644 index 00000000..00c64e94 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I41HistologicLSILPrecededByHSILCytology.yml @@ -0,0 +1,32 @@ +--- +name: I4.1 Management of LSIL (CIN1) or Less Preceded by HSIL Cytology + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#62061000119107 High grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-01-01 +- + $iterate: *HistologyCin1OrNormalThisYear + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI4' + text: 'When CIN 2+ is not identified, HSIL cytology is managed more aggressively than ASC-H cytology. For cytology showing HSIL, but biopsy showing histologic LSIL (CIN 1) or less, either an immediate diagnostic excisional procedure or observation with HPV-based testing and colposcopy at 1 year is acceptable, provided in the latter case that the initial colposcopic examination fully visualized the squamocolumnar junction and the upper limit of any lesion, and that the endocervical sampling, if collected, was less than CIN 2 (BII). When CIN2+ is not identified histologically after an ASC-H or HSIL cytology result, it is acceptable to review the cytologic, histologic, and colposcopic findings. If the review yields a revised interpretation, management should follow guidelines for the revised diagnosis (CIII).' + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I42HistologicLSILPrecededByAscHCytology.yml b/test/ManagementHistologyResults/cases/I42HistologicLSILPrecededByAscHCytology.yml new file mode 100644 index 00000000..4dd698aa --- /dev/null +++ b/test/ManagementHistologyResults/cases/I42HistologicLSILPrecededByAscHCytology.yml @@ -0,0 +1,32 @@ +--- +name: I4.2 Management of LSIL (CIN1) or Less Preceded by ASC-H Cytology + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2021-01-01 +- + $iterate: *HistologyCin1OrNormalThisYear + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI4' + text: 'For ASC-H, if the colposcopic examination can fully visualize the squamocolumnar junction and the upper limit of any lesion and that the endocervical sampling, if collected, is negative, observation at 1 year with HPV-based testing with cotesting or primary hrHPV testing is recommended; a diagnostic excisional procedure is not recommended (BII).' + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByASCHNegative2YearFollowUp.yml b/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByASCHNegative2YearFollowUp.yml new file mode 100644 index 00000000..abaf8a2a --- /dev/null +++ b/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByASCHNegative2YearFollowUp.yml @@ -0,0 +1,46 @@ +--- +name: I4.3 Management of LSIL (CIN1) or Less Preceded by ASC-H Cytology 2 Year Negative Follow Up - Recommendation 2 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2019-05-01 +- + $iterate: *HistologyCin1OrNormalTwoYearsAgo +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2020-05-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI4' + text: 'Retest with HPV-based testing (i.e., cotesting or primary hrHPV testing) every 3 years after surveillance tests are negative during the 2-year observation period following histologic LSIL (CIN1) or less preceded by ASC-H or HSIL cytology. Proceed with long-term surveillance (i.e., HPV-based testing every 3 years for at least 25 years, even if this is beyond the age of 65 years (BII).' + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByASCHNegativeFollowUp.yml b/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByASCHNegativeFollowUp.yml new file mode 100644 index 00000000..e6db4955 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByASCHNegativeFollowUp.yml @@ -0,0 +1,39 @@ +--- +name: I4.3 Management of LSIL (CIN1) or Less Preceded by ASC-H Cytology 1 Year Negative Follow Up - Recommendation 1 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2020-01-01 +- + $iterate: *HistologyCin1OrNormalLastYear +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI4' + text: 'HPV-based testing (i.e., cotesting or primary hrHPV testing) is recommended 1 year after the initial negative follow up result(s) when observation is elected after a histologic LSIL (CIN1) preceded by ASC-H or HSIL cytology.' + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByHSILNegative2YearFollowUp.yml b/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByHSILNegative2YearFollowUp.yml new file mode 100644 index 00000000..eb9db049 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByHSILNegative2YearFollowUp.yml @@ -0,0 +1,53 @@ +--- +name: I4.3 Management of LSIL (CIN1) or Less Preceded by HSIL Cytology 2 Year Negative Follow Up - Recommendation 2 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#62061000119107 High grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding) + effectiveDateTime: 2019-05-01 +- + $iterate: *HistologyCin1OrNormalTwoYearsAgo +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2020-05-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#309162003 Normal histology findings (finding) + effectiveDateTime: 2020-05-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI4' + text: 'Retest with HPV-based testing (i.e., cotesting or primary hrHPV testing) every 3 years after surveillance tests are negative during the 2-year observation period following histologic LSIL (CIN1) or less preceded by ASC-H or HSIL cytology. Proceed with long-term surveillance (i.e., HPV-based testing every 3 years for at least 25 years, even if this is beyond the age of 65 years (BII).' + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByHSILNegativeFollowUp.yml b/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByHSILNegativeFollowUp.yml new file mode 100644 index 00000000..7a907a10 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I43HistologicLSILPrecededByHSILNegativeFollowUp.yml @@ -0,0 +1,47 @@ +--- +name: I4.3 Management of LSIL (CIN1) or Less Preceded by HSIL Cytology 1 Year Negative FollowUp - Recommendation 1 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#62061000119107 High grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding) + effectiveDateTime: 2020-01-01 +- + $iterate: *HistologyCin1OrNormalLastYear +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2021-05-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#309162003 Normal histology findings (finding) + effectiveDateTime: 2021-05-01 + + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI4' + text: 'HPV-based testing (i.e., cotesting or primary hrHPV testing) is recommended 1 year after the initial negative follow up result(s) when observation is elected after a histologic LSIL (CIN1) preceded by ASC-H or HSIL cytology.' + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I44AbnormalTestAfterHSILASCHCytology.yml b/test/ManagementHistologyResults/cases/I44AbnormalTestAfterHSILASCHCytology.yml new file mode 100644 index 00000000..df566560 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I44AbnormalTestAfterHSILASCHCytology.yml @@ -0,0 +1,28 @@ +--- +name: I4.4 Abnormal Test Result after HSIL or AscH Cytology + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *HSILOrASCHCytologyLastYear +- + $iterate: *HistologyCin1OrNormalLastYear +- + $iterate: *AbnormalObservationPeriod + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'Colposcopy' + text: 'If any test is abnormal during the observation period after a HSIL and ASC-H cytology, a repeat colposcopy is recommended, and management based on resulting biopsies is recommended.' \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I45HSILCytologyAt1-2YearVisitOrASCHAt2Years.yml b/test/ManagementHistologyResults/cases/I45HSILCytologyAt1-2YearVisitOrASCHAt2Years.yml new file mode 100644 index 00000000..b53dd996 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I45HSILCytologyAt1-2YearVisitOrASCHAt2Years.yml @@ -0,0 +1,28 @@ +--- +name: I4.5 HSIL Cytology Results at Either the 1- or 2-year Visit or ASC-H Results that Persist at the 2-year Visit + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *HSILOrASCHCytologyTwoYearsAgo +- + $iterate: *HistologyCin1OrNormalTwoYearsAgo +- + $iterate: *HSILAt1YearOr2YearsOrASCHAt2Years + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI4' + text: 'A diagnostic excisional procedure is recommended for patients with HSIL cytology results at either the 1- or 2-year visit, or ASC-H results that persist at the 2-year visit (CIII).' \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I5HistologicLSILDiagnosedRepeatedlyForAtLeast2Years.yml b/test/ManagementHistologyResults/cases/I5HistologicLSILDiagnosedRepeatedlyForAtLeast2Years.yml new file mode 100644 index 00000000..4eba5442 --- /dev/null +++ b/test/ManagementHistologyResults/cases/I5HistologicLSILDiagnosedRepeatedlyForAtLeast2Years.yml @@ -0,0 +1,44 @@ +--- +name: I5 Histologic LSIL Diagnosed Repeatedly For at Least 2 Years + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1981-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2017-01-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2020-05-01 +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI5' + text: 'For patients 25 years or older with histologic LSIL (CIN 1) who is diagnosed at consecutive visits for at least 2 years, observation is preferred (BII) but treatment is acceptable (CIII). If treatment is selected and the entire squamocolumnar junction and all lesions were fully visualized during colposcopic examination, either excision or ablation treatments are acceptable (CII).' + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/I6ManagementOfAIS.yml b/test/ManagementHistologyResults/cases/I6ManagementOfAIS.yml new file mode 100644 index 00000000..434db77e --- /dev/null +++ b/test/ManagementHistologyResults/cases/I6ManagementOfAIS.yml @@ -0,0 +1,30 @@ +--- +name: I6 Management of AIS Adoption of Society of Gynecologic Oncology Recommendations + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#447760009 Endocervical adenocarcinoma in situ (disorder) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'ManagementHistologyI6' + text: "A diagnostic excisional procedure is recommended for all patients with a diagnosis of AIS on cervical biopsy to rule out invasive adenocarcinoma, even when definitive hysterectomy is planned. Excisional procedures should optimally remove an intact specimen to facilitate accurate interpretation of margin status. Although there is no preference for cold knife conization versus LEEP, intentional disruption of the specimen by performance of a LEEP followed by a 'top hat' endocervical excision to achieve the desired specimen length is unacceptable. An excisional specimen length of at least 10 mm is preferred, and this can be increased to 18 to 20 mm for patients who are not concerned about the effect of treatment on future pregnancy. These dimensions are preferred regardless of whether hysterectomy is planned. After the initial diagnostic procedure, hysterectomy is the preferred management for all patients who have a histologic diagnosis of AIS, although fertility-sparing management for appropriately selected patients is acceptable. For patients with confirmed AIS with negative margins on the excisional specimen, simple hysterectomy is preferred. For patients with confirmed AIS with positive margins on the excisional specimen, re-excision to achieve negative margins is preferred, even if hysterectomy is planned. For patients with AIS and persistent positive margins for whom additional excisional procedures are not feasible, either a simple or modified radical hysterectomy is acceptable. After hysterectomy, surveillance per the ASCCP surveillance guidelines for treated CIN 2+ is recommended (Section J.3).\n\nFor patients of reproductive age who desire future pregnancy, fertility-sparing management with an excisional procedure is acceptable provided that negative margins have been achieved on the excisional specimen, and the patient is willing and able to adhere to surveillance recommendations. If negative margins cannot be achieved after maximal excisional attempts, fertility-sparing management is not recommended. For patients who undergo fertility-sparing management, surveillance with cotesting and endocervical sampling is recommended every 6 months for at least 3 years, then annually for at least 2 years, or until hysterectomy is performed. For patients who have consistently negative cotesting and endocervical sampling results for 5 years, extending the surveillance interval to every 3 years starting in the sixth year of surveillance is acceptable. Small retrospective studies have shown HPV test results to be the best predictor for recurrent disease. Therefore, for patients who have consistently negative cotesting and endocervical sampling results, continued surveillance is acceptable after completion of childbearing. For patients who have had positive HPV test results or abnormal cytology/histologic results during surveillance, hysterectomy at the completion of childbearing is preferred (see Figure 11)." + WhichRarityMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cases/resources.yml b/test/ManagementHistologyResults/cases/resources.yml new file mode 100644 index 00000000..7a0139d4 --- /dev/null +++ b/test/ManagementHistologyResults/cases/resources.yml @@ -0,0 +1,220 @@ +reusable_resources: +- &UnspecifiedHSILorCIN2FiveYearsAgo + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#22725004 High-grade squamous intraepithelial lesion (morphologic abnormality) + effectiveDateTime: 2016-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285838002 Cervical intraepithelial neoplasia grade 2 (disorder) + effectiveDateTime: 2016-05-01 +- &UnspecifiedHSILorCIN2TwoYearsAgo + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#22725004 High-grade squamous intraepithelial lesion (morphologic abnormality) + effectiveDateTime: 2019-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285838002 Cervical intraepithelial neoplasia grade 2 (disorder) + effectiveDateTime: 2019-05-01 +- &UnspecifiedHSILorCIN2LastYear + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#22725004 High-grade squamous intraepithelial lesion (morphologic abnormality) + effectiveDateTime: 2020-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285838002 Cervical intraepithelial neoplasia grade 2 (disorder) + effectiveDateTime: 2020-05-01 +- &UnspecifiedHSILorCIN2ThisYear + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#22725004 High-grade squamous intraepithelial lesion (morphologic abnormality) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285838002 Cervical intraepithelial neoplasia grade 2 (disorder) + effectiveDateTime: 2021-05-01 +- &NegativeSurveillanceHistologyLastYear + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2020-12-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#309162003 Normal histology findings (finding) + effectiveDateTime: 2020-12-01 +- &NegativeSurveillanceCytologyLastYear + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2020-12-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#62051000119105 Low grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding) + effectiveDateTime: 2020-12-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441087007 Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding) + effectiveDateTime: 2020-12-01 +- &NegativeSurveillanceHistologyThisYear + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2021-06-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#309162003 Normal histology findings (finding) + effectiveDateTime: 2021-06-01 +- &NegativeSurveillanceCytologyThisYear + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2021-06-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#62051000119105 Low grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-06-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441087007 Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-06-01 +- &HistologyCin1OrNormalThisYear + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#165324008 Biopsy result normal (finding) + effectiveDateTime: 2021-05-01 +- &HistologyCin1OrNormalLastYear + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2020-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#165324008 Biopsy result normal (finding) + effectiveDateTime: 2020-05-01 +- &HistologyCin1OrNormalTwoYearsAgo + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2019-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#165324008 Biopsy result normal (finding) + effectiveDateTime: 2019-05-01 +- &HSILOrASCHCytologyLastYear + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#62061000119107 High grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding) + effectiveDateTime: 2020-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2020-05-01 +- &HSILOrASCHCytologyTwoYearsAgo + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#62061000119107 High grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding) + effectiveDateTime: 2019-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2019-05-01 +- &AbnormalObservationPeriod + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708298003 Deoxyribonucleic acid of Human papillomavirus 16 (substance) + effectiveDateTime: 2021-05-01 +# - resourceType: DiagnosticReport +# code: LOINC#65753-6 Cervix Pathology biopsy report +# status: final +# conclusionCode: +# - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) +# effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2021-05-01 +- &HSILAt1YearOr2YearsOrASCHAt2Years + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#62061000119107 High grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding) + effectiveDateTime: 2020-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#62061000119107 High grade squamous intraepithelial lesion on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441088002 Atypical squamous cells on cervical Papanicolaou smear cannot exclude high grade squamous intraepithelial lesion (finding) + effectiveDateTime: 2021-05-01 \ No newline at end of file diff --git a/test/ManagementHistologyResults/cqlt.yaml b/test/ManagementHistologyResults/cqlt.yaml new file mode 100644 index 00000000..6a276479 --- /dev/null +++ b/test/ManagementHistologyResults/cqlt.yaml @@ -0,0 +1,13 @@ +--- +library: + name: ManagementLibrary + paths: ../../cql +tests: + path: cases/ +options: + date: "2021-06-02T00:00:00.000Z" + vsac: + cache: .vscache + dumpFiles: + enabled: true + path: test_results diff --git a/test/ManagementRareCytology/cases/G11AGCAISWithoutAtypicalEndometrialCellsPatient.yml b/test/ManagementRareCytology/cases/G11AGCAISWithoutAtypicalEndometrialCellsPatient.yml new file mode 100644 index 00000000..100761fe --- /dev/null +++ b/test/ManagementRareCytology/cases/G11AGCAISWithoutAtypicalEndometrialCellsPatient.yml @@ -0,0 +1,25 @@ +--- +name: G1.1 Cytology Interpreted as AGC or AIS Without Atypical Endometrial Cells in Patient Younger Than 35 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *AgcOrAisWithinPast5Years + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG1.1' + text: 'For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is also recommended for nonpregnant patients younger than 35 years at increased risk of endometrial neoplasia based on clinical indications (e.g., abnormal uterine bleeding, conditions suggesting chronic anovulation, or obesity) (AII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G12AGCAISWithoutAtypicalEndometrialCells.yml b/test/ManagementRareCytology/cases/G12AGCAISWithoutAtypicalEndometrialCells.yml new file mode 100644 index 00000000..d751c63c --- /dev/null +++ b/test/ManagementRareCytology/cases/G12AGCAISWithoutAtypicalEndometrialCells.yml @@ -0,0 +1,25 @@ +--- +name: G1.2 Cytology Interpreted as AGC or AIS Without Atypical Endometrial Cells in Patient Older Than 35 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1979-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *AgcOrAisWithinPast5Years + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG1.2' + text: 'For nonpregnant patients of all ages with all subcategories of AGC and AIS, except when atypical endometrial cells are specified, colposcopy is recommended regardless of HPV test result; endocervical sampling is recommended at initial colposcopy except in pregnancy (for management in pregnancy, see Section K.2) (AII). Accordingly, triage by reflex HPV testing is not recommended, and triage by repeat cytology is unacceptable (DII). Endometrial sampling is recommended in conjunction with colposcopy and endocervical sampling in nonpregnant patients 35 years or older with all categories of AGC and AIS (AII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G13AGCAISWithAtypicalEndometrialCells.yml b/test/ManagementRareCytology/cases/G13AGCAISWithAtypicalEndometrialCells.yml new file mode 100644 index 00000000..e73c97cf --- /dev/null +++ b/test/ManagementRareCytology/cases/G13AGCAISWithAtypicalEndometrialCells.yml @@ -0,0 +1,25 @@ +--- +name: G1.3 Cytology Interpreted as AGC or AIS with Atypical Endometrial Cells + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *AgcOrAisWithAtypicalEndometrialCellsWithinPast5Years + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG1.3' + text: 'For patients with atypical endometrial cells specified, initial evaluation limited to endometrial and endocervical sampling is preferred, with colposcopy acceptable at the time of initial evaluation. If colposcopy was deferred and no endometrial pathology is identified, additional evaluation with colposcopy is then recommended.' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G14AGCorAtypicalEndocervicalCells.yml b/test/ManagementRareCytology/cases/G14AGCorAtypicalEndocervicalCells.yml new file mode 100644 index 00000000..179de26b --- /dev/null +++ b/test/ManagementRareCytology/cases/G14AGCorAtypicalEndocervicalCells.yml @@ -0,0 +1,27 @@ +--- +name: G1.4 Cytology AGC or Atypical Endocervical Cells and Histologic HSIL (CIN 2+) or AIS/cancer Not Identified + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *AGCOrAtypicalEndocervicalCellsLastYear +- + $iterate: *HistologyCin1OrNegThisYear + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG1.4' + text: 'For patients with cytology showing AGC not otherwise specified or atypical endocervical cells not otherwise specified in whom histologic HSIL (CIN 2+) or AIS/cancer is not identified, cotesting at one and two years is recommended. If both cotests are negative, repeat cotesting at 3 years is recommended. If any test is abnormal, then colposcopy is recommended (BII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G15AGCFavorNeoplasia.yml b/test/ManagementRareCytology/cases/G15AGCFavorNeoplasia.yml new file mode 100644 index 00000000..f29e81bf --- /dev/null +++ b/test/ManagementRareCytology/cases/G15AGCFavorNeoplasia.yml @@ -0,0 +1,27 @@ +--- +name: G1.5 Cytology Atypical Glandular or Endocervical Cells Favor Neoplasia or Endocervical AIS cytology + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *HistologyCin1OrNegWithinPast5Years +- + $iterate: *AgcFavorNeoplasiaOrAtypicalEndocervicalCellsFavorNeoplasiaOrAisThisYear + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG1.5' + text: "For patients with atypical glandular or endocervical cells 'favor neoplasia' or endocervical AIS cytology, if invasive disease is not identified during initial colposcopic workup, a diagnostic excisional procedure is recommended. The diagnostic excisional procedure used in this setting should provide an intact specimen with interpretable margins (BII). Endocervical sampling above the excisional bed is preferred (BII)." + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G21UnsatisfactoryCytologyMissingHPV.yml b/test/ManagementRareCytology/cases/G21UnsatisfactoryCytologyMissingHPV.yml new file mode 100644 index 00000000..f64560a4 --- /dev/null +++ b/test/ManagementRareCytology/cases/G21UnsatisfactoryCytologyMissingHPV.yml @@ -0,0 +1,30 @@ +--- +name: G2.1 Unsatisfactory Cytology with No HPV + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG2.1' + text: 'For patients with an unsatisfactory cytology result and no, unknown, or a negative HPV test result, repeat age-based screening (cytology, cotest, or primary HPV test) in 2 to 4 months is recommended (BIII). Triage using HPV testing is not recommended (DIII). Before repeat cytology, treatment to resolve atrophy or obscuring inflammation when a specific infection is present is acceptable (CIII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G21UnsatisfactoryCytologyUnknownOrNegHPV.yml b/test/ManagementRareCytology/cases/G21UnsatisfactoryCytologyUnknownOrNegHPV.yml new file mode 100644 index 00000000..057397a6 --- /dev/null +++ b/test/ManagementRareCytology/cases/G21UnsatisfactoryCytologyUnknownOrNegHPV.yml @@ -0,0 +1,27 @@ +--- +name: G2.1 Unsatisfactory Cytology with Unknown Or Negative HPV + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *CytoUnsatisfactoryThisYear +- + $iterate: *NegOrUnknownHPVThisYear + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG2.1' + text: 'For patients with an unsatisfactory cytology result and no, unknown, or a negative HPV test result, repeat age-based screening (cytology, cotest, or primary HPV test) in 2 to 4 months is recommended (BIII). Triage using HPV testing is not recommended (DIII). Before repeat cytology, treatment to resolve atrophy or obscuring inflammation when a specific infection is present is acceptable (CIII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G22UnsatisfactoryCytologyPositiveUntypedHpvCotest.yml b/test/ManagementRareCytology/cases/G22UnsatisfactoryCytologyPositiveUntypedHpvCotest.yml new file mode 100644 index 00000000..bddd1fc8 --- /dev/null +++ b/test/ManagementRareCytology/cases/G22UnsatisfactoryCytologyPositiveUntypedHpvCotest.yml @@ -0,0 +1,32 @@ +--- +name: G2.2 Unsatisfactory Cytology with Positive HPV test without Genotyping for HPV 16 or HPV 18 Cotest + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *CytoUnsatisfactoryThisYear +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708301004 Deoxyribonucleic acid of Human papillomavirus 31 (substance) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG2.2' + text: 'For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test without genotyping for HPV 16 or HPV 18, repeat cytology in 2 to 4 months or colposcopy is acceptable (BII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G23UnsatisfactoryCytologyPositiveHpvCotest.yml b/test/ManagementRareCytology/cases/G23UnsatisfactoryCytologyPositiveHpvCotest.yml new file mode 100644 index 00000000..9c1a2433 --- /dev/null +++ b/test/ManagementRareCytology/cases/G23UnsatisfactoryCytologyPositiveHpvCotest.yml @@ -0,0 +1,27 @@ +--- +name: G2.3 Unsatisfactory Cytology with Positive Hpv 16 or 18 Cotest + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *CytoUnsatisfactoryThisYear +- + $iterate: *PositiveHPV16or18ThisYear + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'Colposcopy' + text: 'For patients 25 years and older who are cotested and have unsatisfactory cytology and a positive HPV test with partial genotyping is positive for HPV 16 or HPV 18, direct referral for colposcopy is recommended (BII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G31AbsentTransformationZone.yml b/test/ManagementRareCytology/cases/G31AbsentTransformationZone.yml new file mode 100644 index 00000000..e7564047 --- /dev/null +++ b/test/ManagementRareCytology/cases/G31AbsentTransformationZone.yml @@ -0,0 +1,31 @@ +--- +name: G3.1 Absent Transformation Zone on Screening Cytology in Patient Age 21-30 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1996-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#412716005 Cervical smear transformation zone cells absent (situation) + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG3.1' + text: 'Routine screening is recommended (BIII). When cervical cytology alone is performed for screening, HPV testing as a triage test after negative cytology and absent endocervical cells/transformation zone component in this age group is unacceptable (DIII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G32AbsentTransformationZoneNoHPV.yml b/test/ManagementRareCytology/cases/G32AbsentTransformationZoneNoHPV.yml new file mode 100644 index 00000000..990ec742 --- /dev/null +++ b/test/ManagementRareCytology/cases/G32AbsentTransformationZoneNoHPV.yml @@ -0,0 +1,31 @@ +--- +name: G3.2 Absent Transformation Zone on Screening Cytology with Missing HPV in Patient Older than 30 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1985-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#412716005 Cervical smear transformation zone cells absent (situation) + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG3.2' + text: 'HPV testing is preferred (BIII). Repeat cytology in 3 years is acceptable if HPV testing is not performed (BIII). If HPV testing is performed, manage using Clinical Action Thresholds according to 2019 consensus guidelines.' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G32AbsentTransformationZoneUnknownHPV.yml b/test/ManagementRareCytology/cases/G32AbsentTransformationZoneUnknownHPV.yml new file mode 100644 index 00000000..08381830 --- /dev/null +++ b/test/ManagementRareCytology/cases/G32AbsentTransformationZoneUnknownHPV.yml @@ -0,0 +1,38 @@ +--- +name: G3.2 Absent Transformation Zone on Screening Cytology with Unknown HPV in Patient Older than 30 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1985-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#412716005 Cervical smear transformation zone cells absent (situation) + - SNOMEDCT#373887005 Negative for intraepithelial lesion or malignancy (finding) + effectiveDateTime: 2021-05-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - NULL FLAVOR#UNK Unknown + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG3.2' + text: 'HPV testing is preferred (BIII). Repeat cytology in 3 years is acceptable if HPV testing is not performed (BIII). If HPV testing is performed, manage using Clinical Action Thresholds according to 2019 consensus guidelines.' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G41BenignEndometrialCellsAsymptomaticPremenopausal.yml b/test/ManagementRareCytology/cases/G41BenignEndometrialCellsAsymptomaticPremenopausal.yml new file mode 100644 index 00000000..bbd6325d --- /dev/null +++ b/test/ManagementRareCytology/cases/G41BenignEndometrialCellsAsymptomaticPremenopausal.yml @@ -0,0 +1,27 @@ +--- +name: G4.1 Benign Endometrial Cells in Asymptomatic Premenopausal Patients + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1980-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *Premenopausal +- + $iterate: *BenignEndometrialCellsOrEndometrialStromalCellsOrHistiocytesThisYear + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG4.1' + text: 'For asymptomatic premenopausal patients with benign endometrial cells, endometrial stromal cells, or histiocytes, no further evaluation is recommended (BII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G41Symptomatic.yml b/test/ManagementRareCytology/cases/G41Symptomatic.yml new file mode 100644 index 00000000..5b83d452 --- /dev/null +++ b/test/ManagementRareCytology/cases/G41Symptomatic.yml @@ -0,0 +1,36 @@ +--- +name: G4.1 Benign Endometrial Cells in Symptomatic Premenopausal Patients + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1980-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: Observation + code: SNOMEDCT#32590007 Premenopausal amenorrhea (finding) + status: final + effectiveDateTime: 2021-05-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#125155008 Endometrial cells, cytologically benign, in a postmenopausal woman (finding) + effectiveDateTime: 2021-05-01 +- + resourceType: Condition + code: SNOMEDCT#312984006 Abnormal uterine bleeding unrelated to menstrual cycle (disorder) + onsetDateTime: 2021-01-01 + recordedDate: 2021-06-01 + +results: + IsIncludedAndNotExcluded: false \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G42BenignEndometrialCellsPostmenopausal.yml b/test/ManagementRareCytology/cases/G42BenignEndometrialCellsPostmenopausal.yml new file mode 100644 index 00000000..64a0e8ca --- /dev/null +++ b/test/ManagementRareCytology/cases/G42BenignEndometrialCellsPostmenopausal.yml @@ -0,0 +1,35 @@ +--- +name: G4.2 Benign Endometrial Cells in Postmenopausal Patients + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1980-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: Observation + code: SNOMEDCT#76498008 Postmenopausal state (finding) + status: final + effectiveDateTime: 2021-05-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#125155008 Endometrial cells, cytologically benign, in a postmenopausal woman (finding) + effectiveDateTime: 2020-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG4.2' + text: 'For postmenopausal patient with benign endometrial cells found via cytology, endometrial assessment is recommended (BII).' + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/G43BenignGlandularCellsPostHysterectomy.yml b/test/ManagementRareCytology/cases/G43BenignGlandularCellsPostHysterectomy.yml new file mode 100644 index 00000000..30637853 --- /dev/null +++ b/test/ManagementRareCytology/cases/G43BenignGlandularCellsPostHysterectomy.yml @@ -0,0 +1,32 @@ +--- +name: G4.3 Benign Glandular Cells in Post Hysterectomy Patients + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1980-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *HxOfAbsenceOrRemovalOfCervix +- + resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - http://OUR-PLACEHOLDER-URL.com#BGC Benign Glandular Cells + effectiveDateTime: 2018-05-01 + +results: + IsIncludedAndNotExcluded: true + RareAbnormalityRecommendation: + action: 'RareCytologyG4.3' + text: "For patients 'post-hysterectomy' with benign glandular cells identified via cytology, no further evaluation is recommended (BII)." + WhichRarityMadeTheRecommendation: 1 \ No newline at end of file diff --git a/test/ManagementRareCytology/cases/resources.yml b/test/ManagementRareCytology/cases/resources.yml new file mode 100644 index 00000000..fd0cc3f7 --- /dev/null +++ b/test/ManagementRareCytology/cases/resources.yml @@ -0,0 +1,221 @@ +reusable_resources: +- &HistologyCin1OrNegThisYear + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#309162003 Normal histology findings (finding) + effectiveDateTime: 2021-05-01 +- &HistologyCin1OrNegWithinPast5Years + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#309162003 Normal histology findings (finding) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#309162003 Normal histology findings (finding) + effectiveDateTime: 2018-05-01 + - resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#285836003 Cervical intraepithelial neoplasia grade 1 (disorder) + effectiveDateTime: 2016-05-01 +- &CytoUnsatisfactoryThisYear + - resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2021-05-01 +- &CytoUnsatisfactoryWithinPast5Years + - resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2018-05-01 + - resourceType: DiagnosticReport + code: LOINC#19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#126481000119106 Vaginal Papanicolaou smear unsatisfactory for evaluation (finding) + effectiveDateTime: 2021-05-01 +- &AGCOrAtypicalEndocervicalCellsLastYear + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441219009 Atypical glandular cells on cervical Papanicolaou smear (finding) + effectiveDateTime: 2020-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441094005 Atypical endocervical cells on cervical Papanicolaou smear (finding) + effectiveDateTime: 2020-05-01 +- &AgcFavorNeoplasiaOrAtypicalEndocervicalCellsFavorNeoplasiaOrAisThisYear + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373883009 Atypical glandular cells, favor neoplastic (morphologic abnormality) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#373882004 Atypical endocervical cells, favor neoplastic (morphologic abnormality) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#447760009 Endocervical adenocarcinoma in situ (disorder) + effectiveDateTime: 2021-05-01 +- &AgcOrAisWithinPast5Years + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441219009 Atypical glandular cells on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#254890008 Adenocarcinoma in situ of cervix (disorder) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#254890008 Adenocarcinoma in situ of cervix (disorder) + effectiveDateTime: 2018-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441219009 Atypical glandular cells on cervical Papanicolaou smear (finding) + effectiveDateTime: 2017-05-01 +- &AgcOrAisWithAtypicalEndometrialCellsWithinPast5Years + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441219009 Atypical glandular cells on cervical Papanicolaou smear (finding) + - SNOMEDCT#103646000 Atypical endometrial cells of undetermined significance (morphologic abnormality) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#254890008 Adenocarcinoma in situ of cervix (disorder) + - SNOMEDCT#103646000 Atypical endometrial cells of undetermined significance (morphologic abnormality) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#254890008 Adenocarcinoma in situ of cervix (disorder) + - SNOMEDCT#103646000 Atypical endometrial cells of undetermined significance (morphologic abnormality) + effectiveDateTime: 2020-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441219009 Atypical glandular cells on cervical Papanicolaou smear (finding) + - SNOMEDCT#103646000 Atypical endometrial cells of undetermined significance (morphologic abnormality) + effectiveDateTime: 2017-05-01 +- &NegOrUnknownHPVThisYear + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - NULL FLAVOR#UNK Unknown + effectiveDateTime: 2021-05-01 +- &PositiveHPV16or18ThisYear + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708298003 Deoxyribonucleic acid of Human papillomavirus 16 (substance) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708299006 Deoxyribonucleic acid of Human papillomavirus 18 (substance) + effectiveDateTime: 2021-05-01 +- &BenignEndometrialCellsOrEndometrialStromalCellsOrHistiocytesThisYear + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#125155008 Endometrial cells, cytologically benign, in a postmenopausal woman (finding) + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - http://OUR-PLACEHOLDER-URL.com#ESC Endometrial stromal cells + effectiveDateTime: 2021-05-01 + - resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#14295007 Resident tissue macrophage (cell) + effectiveDateTime: 2021-05-01 +- &Premenopausal + - resourceType: Observation + code: SNOMEDCT#32590007 Premenopausal amenorrhea (finding) + status: final + effectiveDateTime: 2021-05-01 + - resourceType: Observation + code: ICD-9#627.0 Premenopausal menorrhagia + status: final + effectiveDateTime: 2021-05-01 + - resourceType: Observation + code: ICD-10-CM#N92.4 Excessive bleeding in the premenopausal period + status: final + effectiveDateTime: 2021-05-01 +- &HxOfAbsenceOrRemovalOfCervix + - resourceType: Procedure + code: SNOMEDCT#116140006 Total hysterectomy (procedure) + status: completed + performedDateTime: 2000-05-01 + - resourceType: Condition + code: SNOMEDCT#37687000 Congenital absence of cervix (disorder) + onsetDateTime: 1980-05-01 + recordedDate: 2010-05-01 + - resourceType: Observation + code: SNOMEDCT#248911005 Uterine cervix absent (finding) + effectiveDateTime: 2020-05-01 diff --git a/test/ManagementRareCytology/cqlt.yaml b/test/ManagementRareCytology/cqlt.yaml new file mode 100644 index 00000000..6a276479 --- /dev/null +++ b/test/ManagementRareCytology/cqlt.yaml @@ -0,0 +1,13 @@ +--- +library: + name: ManagementLibrary + paths: ../../cql +tests: + path: cases/ +options: + date: "2021-06-02T00:00:00.000Z" + vsac: + cache: .vscache + dumpFiles: + enabled: true + path: test_results diff --git a/test/ManagementSpecialPopulations/cases/HysterectomyK41.yml b/test/ManagementSpecialPopulations/cases/HysterectomyK41.yml new file mode 100644 index 00000000..caed4b63 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/HysterectomyK41.yml @@ -0,0 +1,25 @@ +--- +name: K4.1 Hysterectomy Patient + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1995-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *HighGradePrecancerOrCancerCervixRemoval + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'HysterectomyK4' + text: 'Three annual hrHPV-based tests with cotest or primary hrHPV test are recommended after a hysterectomy is performed for treatment of a high-grade precancer or cancer.' + WhichPopulationMadeTheRecommendation: 2 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/HysterectomyK42.yml b/test/ManagementSpecialPopulations/cases/HysterectomyK42.yml new file mode 100644 index 00000000..0fee9ba0 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/HysterectomyK42.yml @@ -0,0 +1,56 @@ +--- +name: K4.2 Hysterectomy Patient + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1995-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#20365006 Squamous intraepithelial neoplasia, grade III (morphologic abnormality) + effectiveDateTime: 2018-01-01 +- + resourceType: Procedure + code: SNOMEDCT#116140006 Total hysterectomy (procedure) + status: completed + performedDateTime: 2018-05-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2019-05-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2020-05-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'HysterectomyK4' + text: 'HPV-based testing with cotest or primary hrHPV test is recommended every 3 years after a histologic HSIL (CIN2 or CIN3) or AIS results for 25 years, regardless of whether the patient has had a hysterectomy either for treatment or at any point during the surveillance period (CIII).' + WhichPopulationMadeTheRecommendation: 2 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31.yml b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31.yml new file mode 100644 index 00000000..8c90e216 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31.yml @@ -0,0 +1,27 @@ +--- +name: K3.1 Immunosuppressed + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *Immunocompromised +- + $iterate: *ASCUSOrAboveOrHPV16Or18ThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'ImmunosuppressedK3' + text: 'Colposcopy referral is recommended for immunocompromised patients of any age with cytology results of HPV-positive ASC-US or higher and for any cytology results of LSIL or worse.' + WhichPopulationMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31ChronicGraft.yml b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31ChronicGraft.yml new file mode 100644 index 00000000..92a00072 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31ChronicGraft.yml @@ -0,0 +1,29 @@ +--- +name: K3.1 Immunosuppressed Chronic Graft Versus Host Disease Diagnoses After Stem Cell + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *ChronicGraft +- + $iterate: *HematopoieticStemCellTransplantProcedure +- + $iterate: *ASCUSOrAboveOrHPV16Or18ThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'ImmunosuppressedK3' + text: 'Colposcopy referral is recommended for immunocompromised patients of any age with cytology results of HPV-positive ASC-US or higher and for any cytology results of LSIL or worse.' + WhichPopulationMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31GenitalGvHD.yml b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31GenitalGvHD.yml new file mode 100644 index 00000000..1368edd6 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31GenitalGvHD.yml @@ -0,0 +1,33 @@ +--- +name: K3.1 Immunosuppressed Genital Graft Versus Host Disease Diagnoses After Stem Cell + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: Condition + clinicalStatus: http://terminology.hl7.org/CodeSystem/condition-clinical#active Active + verificationStatus: https://www.hl7.org/fhir/codesystem-condition-ver-status#confirmed Confirmed + code: http://OUR-PLACEHOLDER-URL.com#GenitalGvHD Diagnosis of Genital GvHD + onsetDateTime: 2017-05-01 +- + $iterate: *HematopoieticStemCellTransplantProcedure +- + $iterate: *ASCUSOrAboveOrHPV16Or18ThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'ImmunosuppressedK3' + text: 'Colposcopy referral is recommended for immunocompromised patients of any age with cytology results of HPV-positive ASC-US or higher and for any cytology results of LSIL or worse.' + WhichPopulationMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31HPVPosASCUS.yml b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31HPVPosASCUS.yml new file mode 100644 index 00000000..96f33464 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31HPVPosASCUS.yml @@ -0,0 +1,39 @@ +--- +name: K3.1 Immunosuppressed HPV Positive ASCUS + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *Immunocompromised +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#720005005 Human papillomavirus deoxyribonucleic acid test positive, high risk on cervical specimen (finding) + effectiveDateTime: 2021-05-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441087007 Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'ImmunosuppressedK3' + text: 'Colposcopy referral is recommended for immunocompromised patients of any age with cytology results of HPV-positive ASC-US or higher and for any cytology results of LSIL or worse.' + WhichPopulationMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31HPVPosASCUSChronicGraft.yml b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31HPVPosASCUSChronicGraft.yml new file mode 100644 index 00000000..640a3940 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31HPVPosASCUSChronicGraft.yml @@ -0,0 +1,41 @@ +--- +name: K3.1 Immunosuppressed HPV Positive ASCUS Chronic Graft Versus Host Disease Diagnoses After Stem Cell + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *ChronicGraft +- + $iterate: *HematopoieticStemCellTransplantProcedure +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#720005005 Human papillomavirus deoxyribonucleic acid test positive, high risk on cervical specimen (finding) + effectiveDateTime: 2021-05-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441087007 Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'ImmunosuppressedK3' + text: 'Colposcopy referral is recommended for immunocompromised patients of any age with cytology results of HPV-positive ASC-US or higher and for any cytology results of LSIL or worse.' + WhichPopulationMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31HPVPosASCUSGenitalGvHD.yml b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31HPVPosASCUSGenitalGvHD.yml new file mode 100644 index 00000000..f0579bd3 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31HPVPosASCUSGenitalGvHD.yml @@ -0,0 +1,45 @@ +--- +name: K3.1 Immunosuppressed HPV Positive ASCUS Genital Graft Versus Host Disease Diagnoses After Stem Cell + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: Condition + clinicalStatus: http://terminology.hl7.org/CodeSystem/condition-clinical#active Active + verificationStatus: https://www.hl7.org/fhir/codesystem-condition-ver-status#confirmed Confirmed + code: http://OUR-PLACEHOLDER-URL.com#GenitalGvHD Diagnosis of Genital GvHD + onsetDateTime: 2017-05-01 +- + $iterate: *HematopoieticStemCellTransplantProcedure +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#720005005 Human papillomavirus deoxyribonucleic acid test positive, high risk on cervical specimen (finding) + effectiveDateTime: 2021-05-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441087007 Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'ImmunosuppressedK3' + text: 'Colposcopy referral is recommended for immunocompromised patients of any age with cytology results of HPV-positive ASC-US or higher and for any cytology results of LSIL or worse.' + WhichPopulationMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31IBDOrRA.yml b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31IBDOrRA.yml new file mode 100644 index 00000000..f67b18e9 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK31IBDOrRA.yml @@ -0,0 +1,29 @@ +--- +name: K3.1 Immunosuppressed IBD or RA on Immunosuppressants + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *InflammatoryBowelDiseaseOrRheumatoidArthritis +- + $iterate: *Immunosuppressant +- + $iterate: *ASCUSOrAboveOrHPV16Or18ThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'ImmunosuppressedK3' + text: 'Colposcopy referral is recommended for immunocompromised patients of any age with cytology results of HPV-positive ASC-US or higher and for any cytology results of LSIL or worse.' + WhichPopulationMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/ImmunosuppressedK32.yml b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK32.yml new file mode 100644 index 00000000..a48a4139 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK32.yml @@ -0,0 +1,32 @@ +--- +name: K3.2 Immunosuppressed + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *Immunocompromised +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441087007 Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'ImmunosuppressedK3' + text: 'Repeat cytology in 6 to 12 months when the patient is immunocompromised and is found to have cytologic ASC-US.' + WhichPopulationMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/ImmunosuppressedK33.yml b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK33.yml new file mode 100644 index 00000000..607e7b65 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/ImmunosuppressedK33.yml @@ -0,0 +1,34 @@ +--- +name: K3.3 Immunosuppressed + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1991-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *Immunocompromised +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441087007 Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding) + effectiveDateTime: 2020-05-01 +- + $iterate: *ASCUSOrAboveOrAISThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'Colposcopy' + text: 'Colposcopy is recommended when the patient is immunocompromised and is found to have cytologic ASC-US or higher or HPV positive after a cytologic ASC-US result.' + WhichPopulationMadeTheRecommendation: 3 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/PregnantPatientK21.yml b/test/ManagementSpecialPopulations/cases/PregnantPatientK21.yml new file mode 100644 index 00000000..c8ae801f --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/PregnantPatientK21.yml @@ -0,0 +1,27 @@ +--- +name: K2.1 Pregnant Patient + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1995-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *Pregnant +- + $iterate: *Cin2OrCin3ThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'PregnantPatientK2' + text: 'Surveillance colposcopy and testing (with diagnostic cytology or HPV depending on age) is preferred every 12 to 24 weeks but deferring colposcopy to the postpartum period is acceptable (BII). In postpartum period, colposcopy is recommended no earlier than 4 weeks after delivery (BII). In patients diagnosed with histologic HSIL (CIN2 or CIN3) during pregnancy, if a lesion is detected at postpartum colposcopy, an excisional treatment procedure or full diagnostic evaluation (cervical cytology, HPV, and biopsy) is acceptable (BII). In the absence of a lesion on colposcopy, a full diagnostic evaluation is recommended/ expedited treatment is not recommended (BII). For patients with a diagnosis of histologic HSIL (CIN 2) whose concerns about the effects of treatment on a future pregnancy outweigh their concerns about cancer, either observation or treatment is acceptable provided the squamocolumnar junction is visible and CIN 2+ or ungraded CIN is not identified on endocervical sampling (CII). If the histologic HSIL cannot be specified as CIN 2, treatment is preferred, but observation is acceptable if there are concerns related to future pregnancies (CIII). For patients 25 years or older, observation includes colposcopy and HPV-based testing with cotest or primary hrHPV testing at 6-month intervals for up to 2 years.' + WhichPopulationMadeTheRecommendation: 4 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/PregnantPatientK22.yml b/test/ManagementSpecialPopulations/cases/PregnantPatientK22.yml new file mode 100644 index 00000000..8ecadc2a --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/PregnantPatientK22.yml @@ -0,0 +1,32 @@ +--- +name: K2.2 Pregnant Patient + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1995-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *Pregnant +- + resourceType: DiagnosticReport + code: LOINC#65753-6 Cervix Pathology biopsy report + status: final + conclusionCode: + - SNOMEDCT#254890008 Adenocarcinoma in situ of cervix (disorder) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'PregnantPatientK2' + text: 'Referral to a gynecologic oncologist is preferred if AIS is diagnosed during pregnancy, but management by a gynecologist skilled in the colposcopic diagnosis and treatment of AIS is acceptable (CIII).' + WhichPopulationMadeTheRecommendation: 4 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/Young11LowGradeCytology.yml b/test/ManagementSpecialPopulations/cases/Young11LowGradeCytology.yml new file mode 100644 index 00000000..76107591 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/Young11LowGradeCytology.yml @@ -0,0 +1,25 @@ +--- +name: Younger Than 25 Initial Low Grade Cytology 1.1 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 2000-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *ASCUSOrLSILThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'Cytology' + text: 'Repeat cytology alone at one and two years is recommended after an initial low-grade cytology screening result of LSIL, ASC-US HPV-positive, or ASC-US result without HPV testing (BII). Clinicians should switch to using risk estimates when patients reach the age of 25 years.' + WhichPopulationMadeTheRecommendation: 5 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/Young11LowGradeCytologyPosHPV.yml b/test/ManagementSpecialPopulations/cases/Young11LowGradeCytologyPosHPV.yml new file mode 100644 index 00000000..e300103e --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/Young11LowGradeCytologyPosHPV.yml @@ -0,0 +1,37 @@ +--- +name: Younger Than 25 ASC-US/HPV-positive 1.1 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 2000-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441087007 Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-05-01 +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#708301004 Deoxyribonucleic acid of Human papillomavirus 31 (substance) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'Cytology' + text: 'Repeat cytology alone at one and two years is recommended after an initial low-grade cytology screening result of LSIL, ASC-US HPV-positive, or ASC-US result without HPV testing (BII). Clinicians should switch to using risk estimates when patients reach the age of 25 years.' + WhichPopulationMadeTheRecommendation: 5 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/Young12HSIL.yml b/test/ManagementSpecialPopulations/cases/Young12HSIL.yml new file mode 100644 index 00000000..120c763c --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/Young12HSIL.yml @@ -0,0 +1,25 @@ +--- +name: Younger Than 25 High Grade Cytology 1.2 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 2000-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *HighGradeCytologyThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'Colposcopy' + text: 'Colposcopy is recommended for individuals under 25 years old with cytologic HSIL, ASC-H, AGC or AIS (BII). Immediate treatment without histologic confirmation is not recommended for cytology HSIL or ASC-H. Clinicians should switch to using risk estimates when patients reach the age of 25 years.' + WhichPopulationMadeTheRecommendation: 5 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/Young13LowGradeCytologyPersists.yml b/test/ManagementSpecialPopulations/cases/Young13LowGradeCytologyPersists.yml new file mode 100644 index 00000000..fcaedb6c --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/Young13LowGradeCytologyPersists.yml @@ -0,0 +1,29 @@ +--- +name: Younger Than 25 Low Grade Cytology Persists at 2 Year Follow-up 1.3 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 1998-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *ASCUSOrLSILTwoYearsAgo +- + $iterate: *ASCUSOrLSILLastYear +- + $iterate: *ASCUSOrLSILThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'Colposcopy' + text: 'Colposcopy is recommended if low-grade cytology persists at the 2-year follow up visit after low-grade cytology results (BII). Clinicians should switch to using risk estimates when patients reach the age of 25 years.' + WhichPopulationMadeTheRecommendation: 5 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/Young14ASCUSHPVneg.yml b/test/ManagementSpecialPopulations/cases/Young14ASCUSHPVneg.yml new file mode 100644 index 00000000..69403e1f --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/Young14ASCUSHPVneg.yml @@ -0,0 +1,37 @@ +--- +name: Younger Than 25 ASC-US/HPV-Negative Result 1.4 + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 2000-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + resourceType: DiagnosticReport + code: LOINC#21440-3 Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] in Cervix by Probe + status: final + conclusionCode: + - SNOMEDCT#787724008 Human papillomavirus deoxyribonucleic acid test negative (finding) + effectiveDateTime: 2021-05-01 +- + resourceType: DiagnosticReport + code: LOINC#10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain + status: final + conclusionCode: + - SNOMEDCT#441087007 Atypical squamous cells of undetermined significance on cervical Papanicolaou smear (finding) + effectiveDateTime: 2021-05-01 + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'Cytology' + text: 'Cervical Cytology test (alone) is indicated 3 years after an ASC-US/HPV-Negative result. Clinicians should switch to using risk estimates when patients reach the age of 25 years.' + WhichPopulationMadeTheRecommendation: 5 \ No newline at end of file diff --git a/test/ManagementSpecialPopulations/cases/Young15aLSILBefore1YearFollowUp.yml b/test/ManagementSpecialPopulations/cases/Young15aLSILBefore1YearFollowUp.yml new file mode 100644 index 00000000..af5edf15 --- /dev/null +++ b/test/ManagementSpecialPopulations/cases/Young15aLSILBefore1YearFollowUp.yml @@ -0,0 +1,31 @@ +--- +name: Younger Than 25 Histologic LSIL Before 1 Year Follow Up 1.5a + +externalData: +- resources + +data: +- + resourceType: Patient + name: Joanne Smith + gender: female + birthDate: 2000-01-01 + extension: + - + url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex + valueCode: F +- + $iterate: *ASCUSOrLSILThreeYearsAgo +- + $iterate: *ASCUSOrLSILTwoYearsAgo +- + $iterate: *ASCUSOrLSILLastYear +- + $iterate: *HistologyCin1OrNormalThisYear + +results: + IsIncludedAndNotExcluded: true + SpecialPopulationRecommendation: + action: 'LessThan25LSIL5a' + text: 'For patients under 25 years old perform cervical cytology one year following cervical histologic LSIL(CIN1) or