CDC CRC Screening CDS L2
Introduction
Introduction
This document includes a semi-structured representation of evidence-based narrative guidelines for Colorectal Cancer Screening. Semi-structured representation, also known as Level 2 representation of guideline content and recommendations essential for the development of computable clinical decision support (CDS) artifacts. It includes:
- High-level and mid-level flow diagrams that visually illustrate portions of the guidelines
- A brief description of each portion of the CDS logic
- Semi-structured logic statements that list required clinical concepts, inclusion criteria, exclusion criteria, events (decision points), and actions (output, e.g. recommendations).
How to Navigate the Specification
Start with Pathway. This page includes:
- High-level flow diagram, which visually illustrate the main logic paths translated, applicable guidelines, and order of precedence and dependencies among logic paths.
- A combined view of mid-level flow diagrams, which provide a more detailed view of each logic path and how they relate to each other.
Each logic path has a dedicated page under Logic Paths, which includes the mid-level flow diagram for the path, as well as semi-structured logic statements. These may refer to:
- Data elements: logic statements used multiple times across the specification; and
- Terminology: clinical concepts that will eventually be represented by lists of codes.
Pathway
The high-level flow diagram identifies several different patient populations based on a patient’s symptoms, past medical history and previous screening results. The flow diagram also points to the corresponding guidelines that outline how that patient should be cared for. The mid-level flow diagram (which is divided across several pages) provides a more detailed view of the logic. It describes how population criteria are defined and decision points that identify relevant guidelines and patient-specific recommendations.
High-Level Flow Diagram
Mid-Level Flow Diagrams
Screening Decision/Genetic Risk Referral Mid-level Flow
Care Delivery and Follow-up Mid-Level Flow
Logic Paths
Semi-structured logic statements are comprised of three “sections” or components, each with a distinct purpose:
- Inclusion - describes target population criteria
- Exclusion - removes individuals from the target population based on evidence-based recommendations
- CDS Events - describes a decision point or trigger in the logic that leads to a recommendation or action
- CDS Actions - describes one or more “products” (e.g., calculations, recommendations) that the logic provides for a patient that meets the inclusion criteria, is not removed by the exclusion criteria, and meets the event criteria
Screening Eligible
Description
Determines whether colorectal cancer screening is viable or appropriate for a patient, regardless of risk level.
This path can be used to ensure any clinical decision support tools do not provide recommendations when screening is not appropriate or clinically applicable.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
None.
Exclusions
None.
Events
| Name | Description |
|---|---|
History of total colectomy | |
'Total colectomy' is TRUE | |
Current Colorectal Cancer? | |
'Current colorectal cancer' is TRUE | |
Colorectal Signs or Symptoms? | |
'Colorectal signs or symptoms' is TRUE | |
Actions
Eligible for screening Description Patient is eligible for colorectal screening. Pseudocode |
Recommendation: Consider diagnostic work up or examination Description Consider referral for a diagnostic workup or examination if patient has clinically significant signs or symptoms of colorectal cancer. Recommend aggressive evaluation (usually colonoscopy) of adults of age <50 years with colorectal symptoms, specifically those with bleeding symptoms: hematochezia, iron deficiency anemia, and/or melena with a negative upper endoscopy. Source: USMSTF, 2017 Pseudocode |
References
- USMSTF (2017): Rex, D. K., et al. (2017). Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 153(1), 307-323. https://doi.org/10.1053/j.gastro.2017.05.013
Decision to Screen
Description
This logic path evaluates criteria for when to stop screening for colorectal cancer, and determines whether the patient is eligible for average risk screening, based on the risk factors outlined by USPSTF.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients eligible for screening | Patients for whom screening is clinically appropriate. |
See 'Screening Eligible' logic path | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Life expectancy <10 years? | Life expectancy, generally defined as having greater than a 50% probability of surviving 10 years, is < 10 years. A validated tool such as www.eprognosis.com can help guide decision making. |
Age >= 76 years old? | |
Age >= 76 years old | |
Age >= 86 years old? | |
Age >= 86 years old | |
Has risk factor(s) for colorectal cancer? | |
See 'Increased Risk Exclusions' logic path | |
Actions
Average risk screening Description Patients who do not meet criteria for increased risk of colorectal cancer (as defined by USPSTF) can be screened as average risk patinnts. Pseudocode See 'Average Risk Screening' logic path. |
Recommendation: Stop screening Description Recommendation: Evidence is lacking on benefits and harms of colorectal cancer screening for individuals aged 86 and older. Competing causes of mortality likely preclude survival benefit that would outweigh the harms of screening. Pseudocode |
Recommendation: Selectively offer screening Description The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Source: USPSTF, 2021 Pseudocode |
Recommendation: Discuss decision to continue screening Description ACS advises that individuals should continue colorectal cancer screening as long as their overall health is good and they have a life expectancy of 10 years or more. Decision to continue screening in cases of limited life expectancy should be based on shared decision-making. Source: ACS (2018) Pseudocode |
Increased risk screening/surveillance Description Patient is at increased risk for colorectal cancer based on one or more non-modifiable risk factors. Pseudocode See 'Increased Risk Exclusions' logic path for specific increased risk populations and recommendations for increased risk screening/surveillance. |
References
- ACS (2018): Wolf, A. M. D., et al. (2018). Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians, 68(4), 250–281. https://doi.org/10.3322/caac.21457
- USMSTF (2017): Rex, D. K., et al. (2017). Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 153(1), 307-323. https://doi.org/10.1053/j.gastro.2017.05.013
- USPSTF (2021): Davidson, K. W., et al. (2021). Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA - Journal of the American Medical Association, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238
Increased Risk Exclusions
Description
This logic path determines whether a patient should be considered for average risk colorectal cancer screening or increased risk screening or surveillance. Patients who meet criteria for higher than average risk for colorectal cancer, as defined in the U.S. Preventative Services Task Force (USPSTF), are excluded from average risk screening recommendations.
This path can be used to ensure that USPSTF average-risk recommendations are suppressed for patients meeting increased risk criteria. It can also be used to identify and surface risk factors for colorectal cancer, and to direct patients to appropriate screening/surveillance recommendations for increased risk populations.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients eligible for screening | Patients for whom screening is clinically appropriate. |
See 'Screening Eligible' logic path | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Personal history of or at risk for hereditary cancer syndrome? | Patient has a clinical or genetic diagnosis of a colorectal cancer-associated hereditary syndrome, or is considered at risk for such a syndrome (e.g. suggestive family history, family history of confirmed mutation on a hereditary syndrome-associated gene). |
'Personal history of hereditary syndrome associated with colorectal cancer' OR 'Genetic marker for hereditary syndrome associated with colorectal cancer' OR 'Family history of genetic marker for hereditary syndrome associated with colorectal cancer' OR 'Family history of hereditary syndrome associated with colorectal cancer' | |
Personal history of inflammatory bowel disease? | A personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease) |
Personal history of colorectal cancer? | |
'Personal history of colorectal cancer' is TRUE | |
Family history of colorectal cancer or advanced polyp(s)? | First or second degree relative has or has had colorectal cancer. |
'Family history of colorectal cancer' exists OR 'Family history of potentially precancerous polyp(s)' exists | |
Personal history of potentially precancerous polyp(s)? | Patient has potentially precancerous polyps. |
Actions
Average risk screening Description Patient is eligible for colorectal screening as an average risk patient. Pseudocode See 'Average Risk Screening' logic path. |
Hereditary syndromes increased risk screening/surveillance Description Patient is eligible for screening/surveillance due to having or being at risk for a hereditary cancer syndrome. Pseudocode See 'Hereditary Syndromes' logic path |
IBD surveillance Description Patient is eligible for surveillance based on personal history of inflammatory bowel disease. Pseudocode See 'Inflammatory Bowel Disease' logic path. |
Post-colorectal cancer resection surveillance Description Patient is eligible for surveillance after colorectal cancer resection. Pseudocode See 'Personal History of Colorectal Cancer' logic path. |
Family history increased risk screening/surveillance Description Patient is eligible for increased risk screening or surveillance, considering family history of colorectal cancer and/or polyps, as well as personal history of polyps . Pseudocode See 'Family History of Colorectal Cancer or Advanced Polyps' logic path. |
Post-polypectomy surveillance Description Patient is eligible for post-polypectomy surveillance recommendations. Pseudocode See 'Personal History of Potentially Precancerous Polyps' logic path. |
Increased Risk Screening/Surveillance
This section outlines logic paths for screening/surveillance of patients who are at increased risk of developing colorectal cancer. These include screening of assymptomatic patients at increased risk for colorectal cancer (e.g. those with a family history of colorectal cancer), surveillance based on personal history (e.g. patients with a personal history of precancerous polyps), or surveillance as part of disease management (e.g. patients with inflammatory bowel disease). The guidelines supporting recommendations for colorectal cancer screening for increased-risk populations are population-specific.
Hereditary Syndromes
Description
This logic path provides recommendations for colorectal cancer surveillance in individuals with hereditary syndromes which carry an increased risk of colorectal cancer.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients who have or are at risk for a hereditary syndrome associated with an increased risk of colorectal cancer | Patient has a clinical or genetic diagnosis of a colorectal cancer-associated hereditary syndrome, or is considered at risk for such a syndrome (e.g. suggestive family history, family history of confirmed mutation on a hereditary syndrome-associated gene). |
'Personal history of hereditary syndrome associated with colorectal cancer' is TRUE OR 'Genetic marker for hereditary syndrome associated with colorectal cancer' is TRUE OR 'Family history of genetic marker for hereditary syndrome associated with colorectal cancer' is TRUE OR 'Family history of hereditary syndrome associated with colorectal cancer' is TRUE | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Personal history of Lynch syndrome, FAP, AFAP, MAP, PJS, JPS, SPS or Cowden syndrome? | Patient has a diagnosis of a hereditary syndrome associated with increased risk for colorectal cancer. |
Genetic marker for Lynch syndrome, FAP, AFAP, MAP, PJS, JPS, SPS or Cowden Syndrome? | Patient has a confirmed pathologic or likely pathologic genetic variant fpr a colorectal cancer-associated hereditary syndrome. |
Family history of genetic marker for Lynch syndrome, FAP, AFAP, MAP, PJS, JPS, or Cowden Syndrome? | Patient has a family member with a confirmed pathologic or likely pathologic genetic variant for a colorectal cancer-associated hereditary syndrome. |
Family history of SPS or familial colon cancer type X? | Patient has a family history of a syndrome not strongly associated with mutations in specific genes. |
FAMILY HISTORY of `Serrated polyposis syndrome` in `First-degree relative` EXISTS OR FAMILY HISTORY of `Familial Colorectal Cancer Type X` EXISTS | |
Actions
Recommendation: Refer to GI specialist for colonoscopy surveillance recommendations Description RECOMMENDATION: Refer to GI specialist for colorectal cancer (and possibly additional cancers) surveillance recommendations. Patients with a hereditary cancer syndrome require specialized management and colonoscopy surveillance for colorectal cancer (as well as additional surveillance for other cancers). Recommendations on when to start surveillance and surveillance intervals vary according to the syndrome. Pseudocode |
Recommendation: Colonoscopy surveillance recommendations for patients with confirmed syndrome apply Description RECOMMENDATION: Refer to GI specialist for colorectal cancer (and possibly additional cancers) surveillance recommendations. Surveillance for patients at risk for colorectal cancer hereditary syndromes is generally the same as for patients diagnosed with the syndrome. Recommendations on when to start surveillance and surveillance intervals vary according to the syndrome. Pseudocode |
References
- USMSTF (2014): Giardiello, F. M., et al. (2014). Guidelines on genetic evaluation and management of Lynch syndrome: A consensus statement by the US multi-society task force on colorectal cancer. American Journal of Gastroenterology, 109(8), 1159–1179. https://doi.org/10.1038/ajg.2014.186
- ACG (2015): Syngal, S., et al. (2015). ACG Clinical Guideline: Genetic Testing and Management of Hereditary Gastrointestinal Cancer Syndromes. American Journal of Gastroenterology 110(2):p 223-262. https://doi.org/10.1038/ajg.2014.435
- USMSTF (2017): Rex, D. K., et al. (2017). Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 153(1), 307–323. https://doi.org/10.1053/j.gastro.2017.05.013
- USMSTF (2022): Boland, C. R., et al. (2022). Diagnosis and Management of Cancer Risk in the Gastrointestinal Hamartomatous Polyposis Syndromes: Recommendations From the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 162(7), 2063–2085. https://doi.org/10.1053/j.gastro.2022.02.021
- NCCN (2.2024): NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric V.2.2024. https://www.nccn.org/professionals/physician_gls/pdf/genetics_ceg.pdf
Inflammatory Bowel Disease
Description
This logic path provides colorectal cancer screening recommendations for individuals with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients with a personal history of inflammatory bowel disease | Patients with a personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease) |
Exclusions
None.
Events
| Name | Description |
|---|---|
Primary Sclerosing Cholangitis? | |
CONDITIONS include `Primary Sclerosing Cholangitis` | |
Indeterminate or microscopic colitis? | |
CONDITIONS include `Indeterminate Colitis` with status active OR CONDITIONS include `Microscopic Colitis` with status active | |
Actions
Recommendation: initial colonoscopy at PSC diagnosis and surveillance colonoscopy every year Description RECOMMENDATION: * Initial screening colonoscopy: at the time of PSC diagnosis. * Surveillance interval: colonoscopy every year. Source: AGA, 2021; ACG, 2015; ACG, 2018; ACG, 2019 Pseudocode |
Patients not at increased risk for colorectal cancer Description Patients with microscopic or indeterminate colitis are not at increased risk for colorectal cancer. Pseudocode |
Recommendation: Initial colonoscopy 8-10 years after disease onset and surveillance colonoscopy every 1-5 years Description RECOMMENDATION: * Initial screening colonoscopy: 8-10 years after disease onset. * Modality and interval: colonoscopy every 1-5 years based on a recommendation from GI specialist. Considerations: * These recommendations do not apply to patients with Crohn's disease without colonic involvement. Source: AGA, 2021; ASGE, 2015; ACG, 2019; ACG, 2018 Pseudocode |
References
- AGA (2021): Murthy, S. K., et al. (2021). AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology, 161(3), 1043-1051.e4. https://doi.org/10.1053/j.gastro.2021.05.063
- ACG (2015): Lindor, K. D., et al. (2015). ACG Clinical Guideline: Primary Sclerosing Cholangitis. American Journal of Gastroenterology, 110(5), 646-659. https://doi.org/10.1038/ajg.2015.112
- ACG (2018): Lichtenstein, G.R., et al. (2018). ACG Clinical Guideline: Management of Crohn’s Disease in Adults. American Journal of Gastroenterology, 113(4), 481-517. https://doi.org/10.1038/ajg.2018.27
- ACG (2019): Rubin, D. T., et al. (2019). ACG Clinical Guideline: Ulcerative Colitis in Adults. The American journal of gastroenterology, 114(3), 384–413. https://doi.org/10.14309/ajg.0000000000000152
- ASGE (2015): Shergill, A.K., et al. (2015). The role of endoscopy in inflammatory bowel disease, Gastrointestinal Endoscopy, 81(5), 1101-1121.e13. https://doi.org/10.1016/j.gie.2014.10.030
Personal History of CRC
Description
This logic path provides recommendations on colorectal surveillance intervals for individuals with a personal history of CRC, as recommended by the U.S. Multi-Society Task Force of Colorectal Cancer (USMSTF).
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients with a personal history of colorectal cancer in remission | |
'Personal history of colorectal cancer' is TRUE | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Personal history of colorectal cancer resection? | |
`Colorectal cancer resection` PROCEDURE exists | |
Actions
Recommendation: Colonoscopy surveillance starting 1 year after surgery or post-operative clearing colonoscopy Description Initiate surveillance colonoscopy: 1 year after cancer resection or post-operative clearing colonoscopy. For patients with certain localized rectal cancers, additional local surveillance every 2-3 months for the first 2-3 after surgery/post-operative clearing colonoscopy should be considered. Routine surveillance intervals: * After the 1-year colonoscopy, the interval to the next colonoscopy should be 3 years (4 years after surgery or postoperative clearing colonoscopy). * After the 3-year colonoscopy, the interval to the next colonoscopy should be 5 years (9 years after surgery or postoperative clearing colonoscopy). * Subsequent colonoscopies should occur at 5-year intervals, until the benefit of continued surveillance is outweighed by diminishing life expectancy. For patients with certain localized rectal cancers (e.g. partial, local or endoscopic excision or who did not receive neoadjuvant therapy), consider additional local surveillance with (flexible sigmoidoscopy or EUS) every 3-6 months for the first 2-3 years after surgery/perioperative colonoscopy. Intervals for polyp surveillance: If potentially precancerous polyps are detected in surveillance, the subsequent surveillance interval should be provided by the endoscopist, consistent with the shorter interval of: * Recommendations for post-polypectomy surveillance * Recommendations for surveillance after colorectal cancer resection (routine surveillance intervals above). Source: USMSTF, 2016; USMSTF, 2020 Pseudocode |
References
- USMSTF (2016): Kahi, C. J., et al. (2016). Colonoscopy Surveillance after Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 150(3), 758-768.e11. https://doi.org/10.1053/j.gastro.2016.01.001
- USMSTF (2020): Gupta, S., et al. (2020). Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 158(4), 1131–1153.e5. https://doi.org/10.1053/j.gastro.2019.10.026
Family History of CRC or Advanced Polyps
Description
This logic path provides colorectal cancer screening recommendations for individuals with a family history of CRC or advanced polyps, according to recommendations from the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF) and the American College of Gastroenterology (ACG).
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Family history of colorectal cancer or potentially precancerous polyp(s)? | |
'Family history of colorectal cancer' exists OR 'Family history of potentially precancerous polyp(s)' exists | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Personal history of potentially precancerous polyp(s)? | Patient has potentially precancerous polyps. |
Endoscopist recommended interval in most recent colonoscopy? | The interval recommended by the endoscopist for the next screening or surveillance colonoscopy. |
'Recommended follow-up interval' associated with latest 'Colonoscopy' exists | |
Colorectal cancer or confirmed advanced precancerous polyp(s) in first-degree relative(s)? | |
FAMILY HISTORY includes `Colorectal Cancer` AND relationship is `First-degree relative` OR STRUCTURED DOCUMENTATION of `Confirmed Advanced Precancerous Polyp(s) in First-Degree Relative` | |
Relationship to family members with colorectal cancer known? | Whether the relationship is specified when a patient has a family history of colorectal cancer |
FAMILY HISTORY includes `Colorectal Cancer` AND relationship EXISTS | |
Patient age >= 40? | |
Patient age >= 40 | |
>= 2 first-degree relatives affected? | Total number of first-degree relatives affected with either colorectal cancer or confirmed advanced precancerous polyp(s). |
Structured documentation of `Number of affected relatives`value >=2 | |
Relative's age at diagnosis >= 60? | |
Relatives' youngest age at diagnosis >= 50? | |
Patient is >= 10 years younger than relatives' youngest age at diagnosis? | Patient age is <= 10 years younger than relatives' youngest age at diagnosis. |
Patient age >= 'Youngest affected relative age at diagnosis' - 10 years | |
Actions
Recommendation: Follow endoscopist recommendation Description Recommendation: Follow endoscopist-recommended interval for the next colonoscopy. Considerations: * Surveillance intervals should favor the shortest indicated interval based on family history or polyp findings. Source: USMSTF (2020), USMSTF (2017). Pseudocode Next due date = DATE of latest 'Colonoscopy' date + 'Recommended follow-up interval' associated with latest 'Colonoscopy' |
Recommendation: Follow-up with endoscopist Description Recommendation: Follow-up with endoscopist to determine appropriate interval for next colonoscopy. Considerations: * Surveillance intervals should favor the shortest indicated interval based on family history or polyp findings. Source: USMSTF (2020), USMSTF (2017). Pseudocode Next due date = insufficient information to calculate next due date |
Recommendation: Follow average risk recommendations Description Consideration: Patients with a family history of colorectal cancer or advanced polyp(s) in second-degree relatives should be treated as average risk. Source: ACG (2021) Pseudocode Next due date = See "Decision to Screen (USPSTF)" logic path |
Recommendation: Need more comprehensive family history Description Recommendation: A more comprehensive family history is needed to make a recommendation, including: * Whether the relative(s) with a colorectal cancer or confirmed advanced polyp are/were first degree relative(s), i.e., mother, father, sibling or child (blood only). * The age at which relative(s) was/were diagnosed with colorectal cancer or confirmed advanced polyp(s) --- For patients with a single first-degree relative (mother, father, sibling, child) with colorectal cancer or an advanced polyp(s): * If relative diagnosed at >= 60 years: * Start screening at 40 years old. * Modality and interval: tests and intervals are as per the average risk screening recommendations. * If relative diagnosed at < 60 years old: * Start screening 10 years before relative's age at diagnosis or age 40, whichever is earlier. * Modality and interval: colonoscopy every 5 years. * Considerations: If no significant neoplasia appears by age 60 years, can offer expanding the interval between colonoscopies. For patients with 2 or more first-degree relatives with colorectal cancer or an advanced polyp: * Start screening 10 years before the reatives' youngest age at diagnosis or age 40, whichever is earlier. * Modality and interval: colonoscopy every 5 years. Pseudocode Next due date = insufficient information to calculate next due date |
Recommendation: Colonoscopy every 5 years Description Recommendation: * Start screening: Age 40 or 10 years before the youngest affected relative, whichever is earlier * Modality and interval: colonoscopy every 5 years. Considerations: For those with a single first-degree relative with colorectal cancer in whom no significant neoplasia appears by age 60 years, physicians can offer expanding the interval between colonoscopies. Source: USMSTF (2017); ACG (2021) Pseudocode Next due date = today if NOT EXISTS 'Colonoscopy' OR Next due date = DATE of latest 'Colonoscopy' + 5 years |
Recommendation: Modalities and intervals per average risk recommendations Description Recommendation: * Start screening: Age 40 * Modality and interval: same as those for average-risk persons: * Colonoscopy every 10 years * High-sensitivity gFOBT or FIT every year * sDNA-FIT every 1 to 3 years * CT colonography every 5 years * Flexible sigmoidoscopy every 5 years * Flexible sigmoidoscopy every 10 years + FIT every year Source: USMSTF (2017); ACG(2021) Pseudocode Next due date = today if NOT EXISTS 'Previous screening test result' OR Next due date = "See determine next due date" logic path if 'Previous screening test result' exists |
Recommendation: Modality and interval dependent on relative's age at diagnosis Description Recommendation: * If relative diagnosed at < 60, colonoscopy every 5 years. * If relative diagnosed at >= 60, modalities and intervals are the same as for average-risk persons: * Colonoscopy every 10 years * High-sensitivity gFOBT or FIT every year * sDNA-FIT every 1 to 3 years * CT colonography every 5 years * Flexible sigmoidoscopy every 5 years * Flexible sigmoidoscopy every 10 years + FIT every year Source: USMSTF (2017); USMSTF (2020); USPSTF (2021) - for modalities for average risk screening. Pseudocode Next due date = insufficient information to calculate next due date |
Recommendation: Start screening at age 40 Description Recommendation: Start screening: Age 40. Source: USMSTF, 2017; ACG, 2021 Pseudocode Next due date = Patient birthdate + 40 years |
Recommendation: Start screening 10 years prior to relatives' youngest age at diagnosis Description Recommendations: Start screening: 10 years younger than the age at which the youngest first-degree relative was diagnosed. Source: USMSTF(2017); ACG (2021). Pseudocode Next due date = 'Youngest affected relative age at diagnosis' - 10 years |
Recommendation: Start screening at 40 or earlier Description Recommendation: Start screening: age 40 or 10 years younger than the age at which the youngest first-degree relative was diagnosed, whichever is earlier. Source: USMSTF(2017); ACG (2021). Pseudocode Next due date = insufficient information to calculate next due date |
References
- USMSTF (2017): Rex, D. K., et al. (2017). Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 153(1), 307–323. https://doi.org/10.1053/j.gastro.2017.05.013
- USMSTF (2020): Gupta, S., et al. (2020). Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastrointestinal Endoscopy, Gastroenterology, The American Journal of Gastroenterology, 91(3), 463-485.e5. https://doi.org/10.1016/j.gie.2020.01.014
- ACG (2021): Shaukat, A., et al. (2021). ACG Clinical Guidelines: Colorectal Cancer Screening 2021. American Journal of Gastroenterology, 116(3), 458-479. https://doi.org/10.14309/ajg.0000000000001122
Personal History of Neoplastic Polyps
Description
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Personal history of potentially precancerous polyp(s) | History of conventional adenoma or serrated lesion (sessile serrated polyp or traditional serrated adenoma) |
CONDITIONS include `History of potentially precancerous polyps` OR 'Finding(s) of potentially precancerous polyp(s)' associated with any previous 'Colonoscopy' exists | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Most recent CRC screening test is colonoscopy? | |
Endoscopist recommended interval in most recent colonoscopy? | The interval recommended by the endoscopist for the next screening or surveillance colonoscopy. |
'Recommended follow-up interval' associated with latest 'Colonoscopy' exists | |
Actions
Recommendation: Patient should be under colonoscopy surveillance Description Recommendation: Patient is at increased risk due to a history of potentially precancerous polyp(s). Colonoscopy surveillance is recommended. Pseudocode |
Recommendation: Next due date per endoscopist-recommended interval Description Recommendation: Follow endoscopist-recommended interval. Considerations: * Interval may be shorter than 10 years even if most recent colonoscopy is normal (e.g. when a patient had advanced adenoma(s) in baseline colonoscopy). Pseudocode Next due date = DATE of latest 'Colonoscopy' date + 'Recommended follow-up interval' associated with latest 'Colonoscopy' |
Recommendation: Follow-up with endoscopist Description Recommendation: Follow-up with endoscopist to determine appropriate interval for next colonoscopy. Considerations: * Interval may be shorter than 10 years even if most recent colonoscopy is normal (e.g. when a patient had advanced adenoma(s) in baseline colonoscopy). Pseudocode |
References
- USMSTF (2020): Gupta, S., et al. (2020). Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastrointestinal Endoscopy, Gastroenterology, The American Journal of Gastroenterology, 91(3), 463-485.e5. https://doi.org/10.1016/j.gie.2020.01.014
Average Risk Screening
Description
This logic path provides recommendations on the age to start and to stop screening, modalities and screening intervals for average risk patients, based on U.S. Preventative Services Task Force (USPSTF). It also determines the next due date for screening for average risk patients, based on their age and screening history.
The path is intended for use with either individual patient alerts/flagging or for generating asynchronous reports on a cohort of patients in order to target outreach or escalation.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
None.
Exclusions
| Name | Description |
|---|---|
Patients not eligible for screening | |
See "Screening Eligible" logic path | |
Patients at increased risk for colorectal cancer | |
See "Increased Risk Exclusions" logic path | |
Events
| Name | Description |
|---|---|
Age >= 45 years old? | |
Age >= 45 years old | |
Has prior screening? | |
'FOBT test' EXISTS OR 'Stool DNA-FIT test' EXISTS OR 'Colonoscopy' EXISTS OR 'CT colonography' EXISTS OR 'Flexible sigmoidoscopy' EXISTS | |
Actions
Recommendation: Start screening at 45 years old Description Start screening at 45 years old. Pseudocode Next due date = date patient is 45 years old. Source: USPSTF, 2021 |
Recommendation: Start screening Description Start screening now. Patients at average risk for colorectal cancer screening should start screening at 45 years old. Average risk recommended screening strategies and intervals: * Colonoscopy every 10 years * High-sensitivity gFOBT or FIT every year * sDNA-FIT every 1 to 3 years * CT colonography every 5 years * Flexible sigmoidoscopy every 5 years * Flexible sigmoidoscopy every 10 years + FIT every year Source: USPSTF, 2021 Pseudocode Next due date = now |
Recommendation: Continue routine screening Description Continue routine screening. Average risk recommended screening strategies and intervals: * Colonoscopy every 10 years * High-sensitivity gFOBT or FIT every year * sDNA-FIT every 1 to 3 years * CT colonography every 5 years * Flexible sigmoidoscopy every 5 years * Flexible sigmoidoscopy every 10 years + FIT every year Source: USPSTF, 2021 Pseudocode See 'Determine Next Due Date' logic path. |
References
- USPSTF (2021): Davidson, K. W., et al. (2021). Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA - Journal of the American Medical Association, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238
Determine Next Due Date (Average Risk)
Description
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients eligible for screening | |
See 'Screening Eligible' logic path | |
Patients at average risk for colorectal cancer | |
See 'Increased Risk Exclusions' logic path | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Most recent CRC screening test is colonoscopy? | |
Flexible sigmoidoscopy done within past 10 years? | |
current date minus DATE of latest 'Flexible sigmoidoscopy' is < 10 years | |
Most recent CRC screening test is FOBT or FIT? | |
Most recent CRC screening test is sDNA-FIT? | |
Most recent CRC screening test is CT colonography? | |
Most recent CRC screening test is flexible sigmoidoscopy? | |
Actions
Update next due date 10 years Description Source: USPSTF, 2021 Pseudocode Next due date = DATE of latest 'Colonoscopy' + MIN('Recommended follow-up interval', 10 years) |
Update next due date 1 year Description Source: USPSTF, 2021 Pseudocode Next due date = DATE of latest 'FOBT test' + 1 year |
Update next due date 1 to 3 years Description Source: USPSTF, 2021 Pseudocode Next due date range = [DATE of latest 'Stool DNA-FIT test' + 1 year, DATE of latest 'Stool DNA-FIT test' + 3 years] |
Update next due date 5 years Description Source: USPSTF, 2021 Pseudocode Next due date = DATE of latest 'CT colonography' + 5 years |
Update next due date 5 years Description Flex sig interval can be extended to 10 years if annual FIT is performed Source: USPSTF, 2021 Pseudocode Next due date = DATE of latest 'Flexible sigmoidoscopy' + MIN('Recommended follow-up interval', 5 years) |
References
- USPSTF (2021): Davidson, K. W., et al. (2021). Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA - Journal of the American Medical Association, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238
Genetic/Familial Risk Referral
Description
This logic path provides recommendations for referral to genetic counseling for genetic/familial cancer risk assessment and consideration for genetic testing. These recommendations are provided independently of screening/surveillance recommendations, but are intending to act as an available stepping stone to in determining if the patient’s risk for colorectal cancer justifies intensified screening/surveillance initiation and intervals.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients eligible for screening | Patients for whom screening is clinically appropriate. |
See 'Screening Eligible' logic path | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Family history of inherited genetic susceptibility to colorectal cancer? | |
FAMILY HISTORY includes DIAGNOSIS `Genetic mutation associated with increased risk of colorectal cancer` | |
Variant status known? | Patient has been tested for the familial variant and a result is available. |
Personal history of syndrome-related cancer diagnosed before age 50? | Patient has a history of a hereditary syndrome-related cancer diagnosed before age 50. |
CONDITIONS include `Cancers Associated with Hereditary Cancer Syndromes Conferring Increased Risk of Colorectal Cancer` AND age at diagnosis <= 50 years | |
Family history of hereditary syndrome-associated cancer? | Patient has a family history of a cancer associated with a hereditary syndrome. |
FAMILY HISTORY includes DIAGNOSIS `Cancers Associated with Hereditary Cancer Syndromes Conferring Increased Risk of Colorectal Cancer` | |
1 or more first-degree relative diagnosed with hereditary syndrome-associated cancer diagnosed before age 50? | Patient has at least one first-degree relative (mother, father, sibling or child) diagnosed with a hereditary cancer syndrome-related cancer before age 50. |
FAMILY HISTORY includes DIAGNOSIS `Cancers Associated with Hereditary Cancer Syndromes Conferring Increased Risk of Colorectal Cancer` AND age at diagnosis <= 50 years | |
3 or more relatives with a hereditary syndrome-associated cancer? | Patient has 3 or more relatives (first-degree relatives - mother, father, sibling, or child - or second degree relatives - grandparents, half-siblings, first cousins, aunts and uncles, nieces and nephews) |
COUNT OF (FAMILY HISTORY includes DIAGNOSIS `Cancers Associated with Hereditary Cancer Syndromes Conferring Increased Risk of Colorectal Cancer` in (`First-degree relative` OR `Second-degree relative`)) >= 3 | |
Actions
Recommendation: Consider referral to genetic counseling for possible genetic testing Description RECOMMENDATION: Cancer risk assessment and genetic counseling are highly recommended when genetic testing is offered, including consideration of the most appropriate tests to order. Source: NCCN (2024) Pseudocode |
Recommendation: Consider referral to genetic counseling for comprehensive cancer risk assessment/genetic evaluation Description RECOMMENDATION: Consider conducting a more comprehensive family history and/or referral to genetic counseling for a cancer risk assessment. Source: ACG (2014), NCCN (2024) Pseudocode |
References
- USMSTF (2014): Giardiello, F. M., et al. (2014). Guidelines on genetic evaluation and management of Lynch syndrome: A consensus statement by the US multi-society task force on colorectal cancer. American Journal of Gastroenterology, 109(8), 1159–1179. https://doi.org/10.1038/ajg.2014.186
- NCCN (2.2024): NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric V.2.2024. https://www.nccn.org/professionals/physician_gls/pdf/genetics_ceg.pdf
Due for Screening
Description
This logic path determines if a patient is due or overdue for screening/surveillance based a documented next due date.
This path is intended to flag patients for individual patient alerts, within the context of a clinical encounter or outside an encounter, or for generating asynchronous reports on a cohort/panel of patients in order to target outreach or escalation.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients eligible for screening | |
See 'Screening Eligible' logic path | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Next due date is available? | Documented next due date, based on output of previous pathways. |
EXISTS next due date | |
Due for screening? | Refer to next due date, which is the output of previous pathways involving assessment of patient history and risk factors, to determine whether patient is currently due for screening study, overdue or not yet due. |
OVERDUE if next due date >= 6 months ago DUE if next due date within 3 months from now OR < 6 months ago Otherwise NOT DUE | |
Actions
Decision to screen Description Determine if screening/surveillance is appropriate and if so, when the next due date should be. Pseudocode See 'Decision to screen logic path' |
Patient outreach Description Overdue alert Pseudocode |
Recommendation: Order screening test Description ORDER for recommended screening test if 'Most recent pending order or referral for colorectal screening test' does not exist Pseudocode |
References
Screening Test Incomplete
Description
This logic path determines if a patient has a pending screening test result. This includes primary screening tests - colonoscopy or non-colonoscopy - as well as a follow-up colonoscopy after an abnormal non-colonoscopy test has been ordered.
The path is intended for use with either individual patient alerts/flagging or for generating asynchronous reports on a cohort of patients in order to target outreach or escalation.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients eligible for screening | |
See 'Screening Eligible' logic path | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Pending colonoscopy order without subsequent report? | |
'Pending colonoscopy' exists AND Date of latest 'Colonoscopy' does not exists OR is before date 'Pending colonoscopy' order or referral was placed | |
Pending CT colonography order without subsequent report? | |
'Pending CT colonography' exists AND Date of latest 'CT colonography' does not exists OR is before date 'Pending CT colonography' order or referral was placed | |
Pending flexible sigmoidoscopy order without subsequent report? | |
'Pending flexible sigmoidoscopy' exists AND Date of latest 'Flexible sigmoidoscopy' does not exists OR is before date 'Pending flexible sigmoidoscopy' order or referral was placed | |
Pending sDNA-FIT order without subsequent report? | |
'Pending stool DNA-FIT test' exists AND Date of latest 'Stool DNA-FIT test' does not exists OR is before date 'Pending stool DNA-FIT test' order or referral was placed | |
Pending gFOBT or FIT order without subsequent report? | |
'Pending FOBT test' exists AND Date of latest 'FOBT test' does not exists OR is before date 'Pending FOBT test' order or referral was placed | |
Patient population | |
Population to which the patient fits criteria | |
Actions
Pending screening test Description Patient has incomplete screening tests Pseudocode Patient has incomplete screening tests |
Follow-up Screening Result
Description
This logic path makes recommendations and provides considerations for next steps after a screening colonoscopy, stool test, flexible sigmoidoscopy, or CT colonography.
The path may be triggered when a screening test report/results are available for review, and is intended for use with either individual patient alerts/flagging, or for generating asynchronous reports on any post-colonoscopy follow-up (e.g. documenting next screening due date, any follow-up with endoscopist).
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients eligible for screening | |
See 'Screening Eligible' logic path | |
Patients at average risk for colorectal cancer | |
See 'Increased Risk Exclusions' logic path | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Most recent screening test is colonoscopy? | |
Colonoscopy finding of colorectal cancer? | Colonoscopy finding of colorectal cancer. |
Finding of colorectal cancer' associated with latest 'Colonoscopy' exists | |
Diagnosis of CRC after a malignant colonoscopy finding? | |
Date of 'Current colorectal cancer' or 'Personal history of colorectal cancer' is after date of 'Finding of colorectal cancer' | |
Colonoscopy finding(s) of potentially precancerous polyp(s)? | Finding of adenoma(s), sessile serrated polyps, traditional serrated adenomas, or hyperplastic polyps >= 10 mm in size. |
'Finding(s) of potentially precancerous polyp(s)' associated with latest 'Colonoscopy' exists | |
Endoscopist recommended interval in most recent colonoscopy? | The interval recommended by the endoscopist for the next screening or surveillance colonoscopy. |
'Recommended follow-up interval' associated with latest 'Colonoscopy' exists | |
Most recent screening test is stool-based test? | |
Inconclusive stool-based test? | |
'Most recent screening test is gFOBT or FIT test' AND latest 'FOBT test' result is (`Inconclusive` OR `Invalid`) OR 'Most recent screening test is stool DNA-FIT test' AND latest 'Stool DNA-FIT test' result is (`Inconclusive` OR `Invalid`) | |
Positive stool-based test? | |
'Most recent screening test is gFOBT or FIT test' AND latest 'FOBT test' result is `Positive` OR 'Most recent screening test is stool DNA-FIT test' AND latest 'Stool DNA-FIT test' result is `Positive` | |
Most recent screening test is flexible sigmoidoscopy? | |
Flexible sigmoidoscopy finding(s) of colorectal cancer or potentially precancerous polyp(s)? | |
'Finding of colorectal cancer' associated with latest 'Flexible sigmoidoscopy' EXISTS OR 'Finding(s) of potentially precancerous polyp(s)' associated with latest 'Flexible sigmoidoscopy' EXISTS | |
Most recent screening test is CT colonography? | |
CT colonography result inconclusive? | |
'Finding of inadequate CT Colonography' associated with latest 'CT colonography' EXISTS | |
CT colonography finding(s) of colorectal cancer or potentially precancerous polyp(s)? | |
'C-RADS category C4 finding' associated with latest 'CT colonography' exists OR 'C-RADS category C2, C2a, C2a OR C3 finding' associated with latest 'CT colonography' exists | |
Actions
Recommendation: Repeat screening Description Repeat screening due to inconclusive test results. Pseudocode |
Recommendation: Order follow-up colonoscopy Description Order follow-up colonoscopy. Positive stool-based tests or abnormal findings identified by flexible sigmoidoscopy ot CT colonoscopy require follow-up with colonoscopy for the screening benefits to be achieved. Pseudocode |
Recommendation: Refer for oncology evaluation Description REFERRAL for Oncology evaluation Pseudocode |
Recommendation: Follow-up with endoscopist Description Recommend to follow-up with endoscopist to determine appropriate interval for next screening/surveillance colonoscopy. Pseudocode |
References
- USMSTF (2017): Rex, D. K., et al. (2017). Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 153(1), 307-323. https://doi.org/10.1053/j.gastro.2017.05.013
- USMSTF (2020): Gupta, S., et al. (2020). Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastrointestinal Endoscopy, Gastroenterology, The American Journal of Gastroenterology, 91(3), 463-485.e5. https://doi.org/10.1016/j.gie.2020.01.014
- USPSTF (2021): Davidson, K. W., et al. (2021). Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA - Journal of the American Medical Association, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238
Data Elements and Terminology
Data elements are logic statements that are used throughout the semi-structured specification to enhance readibility and reduce redundancy of frequently used logic phrases.
Terminology defines sets of clinical concepts and convey the specific distinguishing characteristics of the included member concepts.
Data Elements
| Name | Description |
|---|---|
Colorectal cancer resection | Resection of colon or rectal cancer |
PROCEDURES INCLUDE `Colorectal Cancer Resection` with status completed | |
Colorectal signs or symptoms | Patient reported symptoms or has signs concerning for colorectal cancer after the last screening test. |
REVIEW OF SYMPTOMS includes `Blood in Stool` OR REVIEW OF SYMPTOMS includes `Iron-deficiency Anemia without Specified Cause` OR REVIEW OF SYMPTOMS inclues `Non-bleeding colorectal symptoms` OR CONDITIONS include `Blood in Stool` OR CONDITIONS include `Iron-deficiency Anemia without Specified Cause` OR CONDITIONS include `Non-bleeding colorectal symptoms` | |
Confirmed advanced precancerous polyp(s) in first-degree relative(s) | Confirmed advanced polyp (polyp >= 10 mm, adenoma with tubulovillous or villous hystology, or adenoma or serrated lesion (sessile serrated polyp, traditional serrated adenoma) with high-grade dysplasia. |
Structured documentation of `Confirmed Advanced Precancerous Polyp(s) in First-Degree Relative` | |
CT colonography | Evidence of results from CT colonography. Can be determined from presence of diagnostic report or result documented in a structured form. |
Colonoscopy | Evidence of results from colonoscopy. Can be determined from presence of diagnostic report or result documented in a structured form. |
DIAGNOSTIC REPORT of type `Colonoscopy` exists OR Documented result of `Colonoscopy Procedure` exists | |
Current colorectal cancer | Currently diagnosed with invasive or non-invasive colorectal cancer, without having achieved remission |
CONDITIONS include `Colorectal Cancer` with status active | |
Family history of colorectal cancer | Patient has one or more relatives with a history of colorectal cancer |
CONDITIONS include `Family History of Colorectal Cancer` OR FAMILY HISTORY includes DIAGNOSIS `Colorectal Cancer` OR FAMILY HISTORY includes DIAGNOSIS `History of Colorectal Cancer` | |
Family history of genetic marker for hereditary syndrome associated with colorectal cancer | |
FAMILY HISTORY includes DIAGNOSIS 'Genetic marker for Lynch syndrome' OR FAMILY HISTORY includes DIAGNOSIS 'Genetic marker for FAP/AFAP' OR FAMILY HISTORY includes DIAGNOSIS 'Genetic marker for MAP' OR FAMILY HISTORY includes DIAGNOSIS 'Genetic marker for Peutz-Jeghers syndrome' OR FAMILY HISTORY includes DIAGNOSIS 'Genetic marker for juvenile polyposis syndrome' OR FAMILY HISTORY includes DIAGNOSIS 'Genetic marker for Cowden syndrome' | |
Family history of hereditary syndrome associated with colorectal cancer | |
FAMILY HISTORY includes DIAGNOSIS `Lynch syndrome` OR FAMILY HISTORY includes DIAGNOSIS `Familial adenomatous polyposis` OR FAMILY HISTORY includes DIAGNOSIS `Attenuated familial adenomatous polyposis` OR FAMILY HISTORY includes DIAGNOSIS `MUTYH-associated polyposis` OR FAMILY HISTORY includes DIAGNOSIS `Peutz-Jegher syndrome` OR FAMILY HISTORY includes DIAGNOSIS `Juvenile polyposis syndrome` OR FAMILY HISTORY includes DIAGNOSIS `Serrated polyposis syndrome` OR FAMILY HISTORY includes DIAGNOSIS `Cowden syndrome` OR FAMILY HISTORY includes DIAGNOSIS `Familial Colorectal Cancer Type X` | |
Family history of potentially precancerous polyp(s) | Patient has one or more relatives with a history of advanced polyps |
CONDITIONS include `Family History of Potentially Precancerous Polyps` OR FAMILY HISTORY includes DIAGNOSIS `Potentially Precancerous Polyp(s) Condition` | |
Finding of adequate bowel preparation | |
DIAGNOSTIC REPORT result of `Adequate bowel preparation` OR STRUCTURED DOCUMENTATION of `Adequate bowel preparation` | |
Finding of colorectal cancer | Finding of colorectal cancer as a result of a direct visualization test. |
DIAGNOSTIC REPORT result of `Colorectal cancer finding` OR STRUCTURED DOCUMENTATION `Colorectal cancer finding` | |
C-RADS category C4 finding | Finding of colorectal cancer (C-RADS category C4) as a result associated a diagnostic report or structured documentation. |
DIAGNOSTIC REPORT result of `C-RADS category C4` OR STRUCTURED DOCUMENTATION of `C-RADS category C4` | |
Finding of inadequate CT Colonography | Finding of inadequate study (C-RADS category C0) as a result associated a diagnostic report or structured documentation. |
DIAGNOSTIC REPORT result of `C-RADS category C0` OR STRUCTURED DOCUMENTATION of `C-RADS category C0` | |
Finding(s) of potentially precancerous polyp(s) | Finding of potentially precancerous polyp(s) as a result of a diagnostic report or structured documentation |
DIAGNOSTIC REPORT result is `Potentially Precancerous Polyp Finding(s)` OR STRUCTURED DOCUMENTATION of `Potentially Precancerous Polyp Finding(s)`EXISTS | |
Flexible sigmoidoscopy | Evidence of results from flexible sigmoidoscopy. Can be determined from presence of diagnostic report or result documented in a structured form. |
DIAGNOSTIC REPORT of type `Flexible Sigmoidoscopy`exists OR Documented result of `Flexible Sigmoidoscopy Procedure`exists | |
C-RADS category C2, C2a, C2a OR C3 finding | Finding of potentially precancerous polyp(s) (C-RADS categories C2a and C3, or C2 prior to 2023) in a diagnostic report or in structured documentation. |
DIAGNOSTIC REPORT result of `C-RADS category C2a` OR DIAGNOSTIC REPORT result of `C-RADS category 3` OR DIAGNOSTIC REPORT result of `C-RADS category C2` OR STRUCTURED DOCUMENTATION of `C-RADS category C2a`` OR STRUCTURED DOCUMENTATION of `C-RADS category 3` OR STRUCTURED DOCUMENTATION of `C-RADS category C2` | |
Recommended follow-up interval | Diagnostic report result or structured documentation of the recommended interval for the next screening or surveillance test provided by the endoscopist. |
DIAGNOSTIC REPORT result with code `Recommended follow-up interval` AND result VALUE EXISTS OR STRUCTURED DOCUMENTATION of `Recommended follow-up interval` AND VALUE EXISTS | |
Complete colonoscopy | Finding of examination complete to cecum. |
DIAGNOSTIC REPORT result of `Complete Colonoscopy` OR STRUCTURED DOCUMENTATION of `Complete Colonoscopy` | |
Genetic marker for hereditary syndrome associated with colorectal cancer | Patient has tested positive for a pathogenic or likely pathogenic variant of a gene associated with hereditary syndrome that puts patients at increased risk of colorectal cancer. |
Hereditary syndrome-associated variant status known | Patient has been tested for a known familial pathogenic/likely pathogenic variant associated with a hereditary cancer syndrome. |
STRUCTURED DOCUMENTATION of `Lynch-syndrome associated variant status`exists OR STRUCTURED DOCUMENTATION of `APC variant status`exists OR STRUCTURED DOCUMENTATION of `MUYTH variant status`exists OR STRUCTURED DOCUMENTATION of `STK variant status`exists OR STRUCTURED DOCUMENTATION of `BMPR1A variant status` exists OR STRUCTURED DOCUMENTATION of `SMAD4 variant status`exists OR STRUCTURED DOCUMENTATION of `PTEN variant status`exists | |
Genetic marker for Lynch syndrome | Patient has tested positive for a pathogenic or likely pathogenic variant of a gene associated with Lynch syndrome (MLH1, MSH2, MSH6, PMS2, EPCAM) |
STRUCTURED DOCUMENTATION of `Lynch-syndrome associated variant status`exists AND (`Genetic variation clinical significance` is `Pathogenic` OR `Likely Pathogenic`) | |
Genetic marker for FAP/AFAP | Patient has tested positive for a pathogenic or likely pathogenic variant of a gene associated with FAP/AFAP (APC). |
STRUCTURED DOCUMENTATION of `APC variant status`exists AND (`Genetic variation clinical significance` is `Pathogenic` OR `Likely Pathogenic`) | |
Genetic marker for MAP | Patient has tested positive for a pathogenic or likely pathogenic variant of a gene associated with MAP (MUTYH). |
STRUCTURED DOCUMENTATION of `MUYTH variant status`exits AND (`Genetic variation clinical significance` is `Pathogenic` OR `Likely Pathogenic`) | |
Genetic marker for Peutz-Jeghers syndrome | Patient has tested positive for a pathogenic or likely pathogenic variant of a gene associated with Peutz-Jeghers syndrome (STK11). |
STRUCTURED DOCUMENTATION of `STK variant status`exists AND `Genetic variation clinical significance` is `Pathogenic` | |
Genetic marker for juvenile polyposis syndrome | Patient has tested positive for a pathogenic or likely pathogenic variant of a gene associated with juvenile polyposis syndrome (BMPR1A, SMAD4). |
STRUCTURED DOCUMENTATION of `BMPR1A variant status`EXISTS AND (`Genetic variation clinical significance` is `Pathogenic`) OR STRUCTURED DOCUMENTATION of `SMAD4 variant status`exists AND `Genetic variation clinical significance` is `Pathogenic`) | |
Genetic marker for Cowden syndrome | Patient has tested positive for a pathogenic or likely pathogenic variant of a gene associated with Cowden syndrome (PTEN) |
STRUCTURED DOCUMENTATION of `PTEN variant status`exists AND (`Genetic variation clinical significance` is `Pathogenic`OR `Likely pathogenic`) | |
FOBT test | Evidence of results for fecal occult blood test (gFOBT or FIT) |
LABORATORY TEST with code `Fecal Occult Blood Test` AND status (final OR ammended or corrected) | |
Pending colonoscopy | Active order or referral for colonoscopy. |
ORDER with code `Colonoscopy Procedure` AND active status OR REFERRAL with code `Colonoscopy Procedure` AND active status | |
Pending CT colonography | Active order or referral for colonoscopy. |
ORDER with code `CT Colonography Procedure` AND active status OR REFERRAL with code `CT Colonography Procedure` AND active status | |
Pending flexible sigmoidoscopy | Active order or referral for colonoscopy. |
ORDER with code `Flexible Sigmoidoscopy Procedure` AND active status OR REFERRAL with code `Flexible Sigmoidoscopy Procedure` AND active status | |
Pending FOBT test | Active order or referral for colonoscopy. |
ORDER with code `Fecal Occult Blood Test` AND active status OR REFERRAL with code `Fecal Occult Blood Test` AND active status | |
Pending stool DNA-FIT test | Active order or referral for colonoscopy. |
ORDER with code `Stool DNA-FIT test` AND active status OR REFERRAL with code `Stool DNA-FIT test` AND active status | |
Most recent screening test is colonoscopy | |
'Colonoscopy' EXISTS AND NOT EXISTS latest of (latest 'FOBT test', latest 'Stool DNA-FIT test', latest 'CT colonography', latest 'Flexible sigmoidoscopy') OR 'Colonoscopy' EXISTS AND Date of latest 'Colonoscopy' is after DATE of latest of (latest 'FOBT test', latest 'Stool DNA-FIT test', latest 'CT colonography', latest 'Flexible sigmoidoscopy') | |
Most recent screening test is CT colonography | |
'CT colonography' EXISTS AND NOT EXISTS latest of (latest 'FOBT test', latest 'Stool DNA-FIT test', latest 'Colonoscopy', latest 'Flexible sigmoidoscopy') OR 'CT colonography' EXISTS AND DATE of latest 'CT colonography'is after DATE of latest of (latest 'FOBT test', latest 'Stool DNA-FIT test', latest 'Colonoscopy', latest 'Flexible sigmoidoscopy') | |
Most recent screening test is flexible sigmoidoscopy | |
'Flexible sigmoidoscopy' EXISTS AND NOT EXISTS latest of (latest 'FOBT test', latest 'Stool DNA-FIT test', latest 'Colonoscopy', latest 'CT colonography') OR 'Flexible sigmoidoscopy' exists and DATE of latest 'Flexible sigmoidoscopy' is after DATE of latest of (latest 'FOBT test', latest 'Stool DNA-FIT test', latest 'Colonoscopy', latest 'CT colonography') | |
Most recent screening test is gFOBT or FIT test | |
'FOBT test' EXISTS AND NOT EXISTS latest of (latest 'stool DNA-FIT test', latest 'Colonoscopy', latest 'CT colonography', latest 'Flexible sigmoidoscopy') OR 'FOBT test' EXISTS AND DATE of latest 'FOBT test' is after DATE of latest of (latest 'Stool DNA-FIT test', latest 'Colonoscopy', latest 'CT colonography', latest 'Flexible sigmoidoscopy') | |
Most recent screening test is stool DNA-FIT test | |
'Stool DNA-FIT test' EXISTS AND NOT EXISTS DATE of latest of (latest 'FOBT test', latest 'Colonoscopy', latest 'CT colonography', latest 'Flexible sigmoidoscopy') OR 'Stool DNA-FIT test' EXISTS AND DATE of latest 'Stool DNA-FIT test' is after DATE of latest of (latest 'FOBT test', latest 'Colonoscopy', latest 'CT colonography', latest 'Flexible sigmoidoscopy') | |
Patient receiving Hospice Services | Hospice services used by patient during the measurement period. |
CONDITIONS or ENCOUNTER DIAGNOSES include codes from `Hospice Intervention` or `Hospice Encounter` | |
Patient receiving Palliative Care Services | Palliative care services used by patient during the measurement period. |
CONDITIONS or ENCOUNTER DIAGNOSES include codes from `Palliative Care Intervention` or `Palliative Care Encounter` OR CONDITIONS include `Palliative Care Diagnosis` | |
Patient age 66 or older in Institutional Special Needs Plans or residing in long-term care facility | Patients age 66 or older in Institutional Special Needs Plans (SNP) or residing in long term care with POS code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period. |
AGE >= 66 years AND ENCOUNTER DIAGNOSES with POS code 32, 33, 34, 54 or 56 for more than 90 consecutive days | |
Patient with Frailty AND Medication for Dementia | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period. |
AGE >= 66 years AND >= 1 ENCOUNTER DIAGNOSES include `Frailty Diagnosis` AND >= 1 MEDICATIONS include `Dementia Medications` with dispense | |
Patient with Frailty AND Advanced Illness | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ED or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period. |
AGE >= 66 years AND >= 1 ENCOUNTER DIAGNOSES include `Frailty Diagnosis` AND EITHER >= 1 ENCOUNTER of type acute inpatient where DIAGNOSES include `Advanced Illness` OR >= 2 ENCOUNTERS of type outpatient, observation, ED or nonacute inpatient where DIAGNOSES include `Advanced Illness` | |
Personal history of colorectal cancer | Past history of invasive or non-invasive colorectal cancer, with remission. |
CONDITIONS include `Colorectal Cancer` with status inactive OR status in remission OR CONDITIONS include `History of Colorectal Cancer` | |
Personal history of Crohns disease | |
CONDITIONS include `Crohn's Disease` with status active CONDITIONS include `Crohn's Disease` with status in remission | |
Personal history of hereditary syndrome associated with colorectal cancer | |
CONDITIONS include `Lynch syndrome` with status active OR CONDITIONS include `Familial adenomatous polyposis` with status active OR CONDITIONS include `Attenuated familial adenomatous polyposis` with status active OR CONDITIONS include `MUTYH-associated polyposis` with status active OR CONDITIONS include `Serrated polyposis syndrome` with status active OR CONDITIONS include `Juvenile polyposis syndrome` with status active OR CONDITIONS include `Peutz-Jegher syndrome` with status active OR CONDITIONS include `Cowden syndrome` with status active | |
Personal history of inflammatory bowel disease | Personal history of IBD (Ulcerative colitis or Crohn's disease) |
Personal history of potentially precancerous polyp(s) | |
CONDITIONS include `Potentially Precancerous Polyp(s) Condition` OR 'Finding(s) of potentially precancerous polyp(s)' associated with any previous 'Colonoscopy' exists | |
Personal history of ulcerative colitis | |
CONDITIONS include `Ulcerative Colitis` with status active OR CONDITIONS include `Ulcerative Colitis` with status in remission | |
Previous screening test result | Evidence of past results for any of the USPSTF recommended colorectal cancer screening tests. |
'Colonoscopy' OR 'Flexible sigmoidoscopy' OR 'FOBT test' OR 'Stool DNA-FIT test' OR 'CT colonography' | |
Stool DNA-FIT test | Multitargeted stool DNA test with fecal immunochemical testing (MT-sDNA or FIT-DNA or sDNA-FIT) |
LABORATORY TEST with code `Stool DNA-FIT test`and status final OR LABORATORY TEST with code `Stool DNA-FIT test`and status ammended OR LABORATORY TEST with code `Stool DNA-FIT test`and status corrected | |
Total colectomy | Patient has a history of total resection of the colon. |
PROCEDURES INCLUDE `Total Colectomy` with status completed | |
Youngest affected relative age at diagnosis | Age at diagnosis for relative diagnosed earliest in life with either colorectal cancer or confirmed advanced precancerous polyp(s). |
STRUCTURED DOCUMENTATION of `Age of earliest affected relative at diagnosis` VALUE | |
Terminology
Terminology defines sets of clinical concepts and convey the specific distinguishing characteristics of the included member concepts.
- Clinical Focus - A statement describing the general focus of the set, including a description of the intended constituent concepts. This can include information about clinical relevancy or a statement about the general focus of the set.
- Inclusions - A statement that describes what specific concept or code criteria are included and why.
- Exclusions - A statement that describes what specific concept or code criteria would normally be included, but are specifically excluded by the authors, including their rationale for exclusions.
Adequate bowel preparation Clinical Focus Bowel preparation adequate for visualization of polyps >5 mm in size Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "Adequate Bowel Preparation": "703141002" from "SNOMED-CT" display 'Effective bowel preparation for procedure (finding)' Code System(s) SNOMED CT FHIR Element Observation.code Status #TODO Notes |
Age of earliest affected relative at diagnosis Clinical Focus Age at which the first-degree relative who was affected earliest was diagnosed Inclusions Exclusions Type Direct Reference Code Code/Value Set URI TBD Code System(s) TBD FHIR Element Observation.code Questionnaire.item.code Status #TODO Notes May end up being calculated if we set up the questionnaire at more granular level (e.g. relative and age at diagnosis), |
APC variant status Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Attenuated familial adenomatous polyposis Clinical Focus Diagnosis codes for attenuated familial adenomatous polyposis Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "AFAP SNOMED": ' 715866009 ' from SCT display 'Attenuated familial adenomatous polyposis (disorder)' code "AFAP ICD-10": 'D13.91' from "ICD-10" display 'Familial adenomatous polyposis' concept "AFAP": {"AFAP SNOMED", "AFAP ICD10"} display 'Attenuated familial adenomatous polyposis' Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code FamilyMemberHistory.condition.code Status Ready Notes |
Blood in Stool Clinical Focus Concepts for hematochezia Inclusions Melena and hematoschezia Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.330 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Observation.code Questionnaire.item.code Status Ready Notes #TODO needs clinical validation |
BMPR1A variant status Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Cancers Associated with Hereditary Cancer Syndromes Conferring Increased Risk of Colorectal Cancer Clinical Focus Concepts representing conditions for cancers associated with hereditary cancers syndromes that put patients at increased risk for colorectal cancer. Inclusions * Cancer of the colon or rectum, uterus, ovary, stomach , small intestine urinary tract (kidney, ureter, bladder), bile ducts, pancreas, or brain) Exclusions Type Value Set Code/Value Set URI Code System(s) ICD-10-CM SNOMED CT FHIR Element FamilyMemberHistory.condition.code Status #TODO Notes |
C-RADS category 3 Clinical Focus CT colonography reporting of polyp, possibly advanced adenoma Inclusions Exclusions Type Direct Reference Code (local) Code/Value Set URI CRADS#C3 Code System(s) CRADS (local) FHIR Element Observation.valueCodeableConcept Status Ready Notes |
C-RADS category C0 Clinical Focus CT colonography reporting of inadequate study and/or awaiting prior comparisons Inclusions Exclusions Type Direct Reference Code (local) Code/Value Set URI CRADS#C0 Code System(s) CRADS (local) FHIR Element Observation.valueCodeableConcept Status Ready Notes |
C-RADS category C2 Clinical Focus CT colonography reporting of intermediate polyp or indeterminate finding (prior to 2023 update) Inclusions Exclusions Type Direct Reference Code (local) Code/Value Set URI CRADS#C2 Code System(s) CRADS (local) FHIR Element Observation.valueCodeableConcept Status Ready Notes |
C-RADS category C2a Clinical Focus CT colonography reporting of intermediate polyp or indeterminate finding Inclusions Exclusions Type Direct Reference Code (local) Code/Value Set URI CRADS#C2a Code System(s) CRADS (local) FHIR Element Observation.valueCodeableConcept Status Ready Notes |
C-RADS category C4 Clinical Focus CT colonography reporting of likely malignant colonic mass Inclusions Exclusions Type Direct Reference Code (local) Code/Value Set URI CRADS#C4 Code System(s) CRADS (local) FHIR Element Observation.valueCodeableConcept Status Ready Notes |
Colonoscopy Clinical Focus Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.356 Code System(s) LOINC FHIR Element DiagnosticReport.code Status Ready Notes |
Colonoscopy Procedure Clinical Focus Concepts for a colonoscopy procedure intended for routine screening purposes or follow-up after an abnormal stool test Inclusions * Screening Exclusions * Diagnostic * Partial * Limited Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020 Code System(s) SNOMED CT CPT FHIR Element Procedure.code Status Ready Notes |
Colorectal Cancer Clinical Focus Concepts for diagnosis of invasive and non-invasive colorectal cancer. Inclusions * Non-invasive * Invasive * Primary and secondary Exclusions None. Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.325 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status Published (Experimental) Notes * Cannot reuse NCQA value set bc it includes codes for history of colon cancer. |
Colorectal cancer finding Clinical Focus Concepts for a finding of colorectal cancer Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.326 Code System(s) SNOMED CT FHIR Element DiagnosticReport.conclusionCode Observation.valueCodeableConcept Status Published (Experimental) Notes Same as Colorectal Cancer, but SNOMED CT only. |
Colorectal cancer resection Clinical Focus Surgery for the resection of colorectal cancer. Inclusions * Open and laparoscopic approaches Exclusions * endoscopic-only procedures Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.705 Code System(s) ICD-10-PCS SNOMED CT FHIR Element Procedure.code Status Placeholder Notes #TODO replace with subset of procedures for resection or destruction, add rectal procedures |
Confirmed Advanced Precancerous Polyp(s) in First-Degree Relative Clinical Focus Confirmed advanced polyp (any polyp >= 10 mm, adenoma with tubulovillous or villous histology, or adenoma or serrated lesion (sessile serrated polyp, traditional serrated adenoma) with high-grade dysplasia. Inclusions Exclusions Type Direct Reference Code (local) Code/Value Set URI #PolypsInFirstDegreeRelative Code System(s) LOCAL FHIR Element Observation.code Questionnaire.item.code Status Placeholder Notes |
Cowden syndrome Clinical Focus Diagnosis codes for Cowden syndrome Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "Cowden Syndrome SNOMED CT": '58037000' from "SNOMED-CT" display 'Cowden syndrome (disorder)' code "Cowden Syndrome ICD-10-CM": 'Q85.81' from "ICD-10-CM" display 'PTEN hamartoma tumor syndrome' concept "Cowden Syndrome": {"Cowden Syndrome SNOMED CT", "Cowden Syndrome ICD-10-CM"} display 'Cowden Syndrome' Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code FamilyMemberHistory.condition.code Status Ready Notes #TODO there may be more than 1 ICD-10-CM code for Cowden |
Crohn's Disease Clinical Focus Concepts identifying conditions indicative of Crohn's disease. Inclusions * Active * In remission Exclusions * Crohn's disease without colonic involvement (e.g. Crohn's disease isolated to the small bowel) Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.348 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status Published (Experimental) Notes #TODO need to replace in cervical cancer (value sets originally used have been deprecated) |
CT colonography Clinical Focus Concepts for a computed tomography colonography intended for routine screening purposes Inclusions * Screening Exclusions * Diagnostic Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.11.1097 Code System(s) LOINC FHIR Element DiagnosticReport.code DocumentReference.type Status Published (Experimental) Notes |
CT Colonography Procedure Clinical Focus Concepts for a computed tomography colonography intended for routine screening purposes Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.11.1144 Code System(s) SNOMED CT CPT FHIR Element Procedure.code Status Placeholder Notes #TODO replace with grouping value set of SNOMED and CPT value sets. |
Familial adenomatous polyposis Clinical Focus Diagnosis codes for familial adenomatous polyposis Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "FAP SNOMED CT": '72900001' from SCT display 'Familial multiple polyposis syndrome (disorder)' code "FAP ICD-10-CM": 'D13.91' from "ICD-10" display 'Familial adenomatous polyposis' concept "FAP": {"FAP SNOMED CT", "FAP ICD-10-CM"} display 'Familial adenomatous polyposis' Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code FamilyMemberHistory.condition.code Status Ready Notes |
Familial Colorectal Cancer Type X Clinical Focus Concepts identifying conditions indicative of familial colorectal cancer type X Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "Familial Colorectal Cancer Type X": '1197359006' from SCT display 'Familial colorectal cancer type X (disorder)' Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code FamilyMemberHistory.condition.code Status Ready Notes No concept in ICD-10-CM |
Family History of Colorectal Cancer Clinical Focus Concepts identifying family history of colorectal cancer Inclusions Exclusions Family history of hereditary syndromes Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.349 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code FamilyMemberHistory.condition.code Status Published (Experimental) Notes |
Family History of Familial Colorectal Cancer Type X Clinical Focus Concepts identifying conitions indicative of a family history of familial colorectal cancer type X Inclusions Exclusions Type Direct Reference Code Code/Value Set URI Code System(s) LOCAL FHIR Element Condition.code Status #TODO Notes No concepts available in SNOMED CT or ICD-10-CM that are specific to colorectal cancer type X |
Family History of Potentially Precancerous Polyps Clinical Focus Concepts identifying family history of potentially precancerous polyps Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.360 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status Published (Experimental) Notes No concepts available in SNOMED CT |
Genetic mutation associated with increased risk of colorectal cancer Clinical Focus Concepts identifying a family history of a variant known to be pathogenic or likely pathogenic and associated with an increased risk of colorectal cancer Inclusions Concepts that include mutations in genes associated with: * Lynch Syndrome * Familial Adenomatous Polyposis and Attenuated Familial Adenomatous Polyposis * Peutz-Jeghers Syndrome * Juvenile Polyposis Syndrome * Cowden Syndrome Exclusions Type Value Set Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
First-degree relative Clinical Focus Parents, children, siblings Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.92 Code System(s) HL7 RoleCode FHIR Element FamilyMemberHistory.relationship Status Ready Notes |
Flexible Sigmoidoscopy Clinical Focus Concepts for a flexible sigmoidoscopy procedure intended for routine screening purposes Inclusions * Screening Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.359 Code System(s) LOINC FHIR Element DiagnosticReport Status Published (Experimental) Notes |
Flexible Sigmoidoscopy Procedure Clinical Focus Concepts for a flexible sigmoidoscopy study Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010 Code System(s) ICD-10-CM SNOMED CT CPT FHIR Element Procedure.code Status Published Notes |
Genetic mutation associated with increased risk of colorectal cancer Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Genetic variation clinical significance Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Observation.code Status #TODO Notes |
Fecal Occult Blood Test Clinical Focus Concepts for tests detecting the presence of blood in feces, such as guaiac fecal occult blood tests and fecal immunochemical test Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.11.1020 Code System(s) LOINC FHIR Element Observation.code Status Ready Notes FIT and gFOBT are included in the same value set because LOINC does allow for full distinction of these tests. |
Hereditary Syndrome Associated with Colorectal Cancer Clinical Focus Concepts Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.342 Code System(s) SNOMED CT FHIR Element Condition.code Status Published (Experimental) Notes No concepts granualr enough for most syndromes in ICD-10-CM. |
History of Colorectal Cancer Clinical Focus Concepts for history of colorectal cancer Inclusions * Non-invasive * Invasive * Primary and secondary * In remission Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.349 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status Published (Experimental) Notes |
Inconclusive Clinical Focus Concepts for an inconclusive finding. Inclusions Exclusions None. Type Direct Reference Code Code/Value Set URI code "Inconclusive": "419984006" from "SNOMED-CT" display 'Inconclusive (qualifier value)' Code System(s) SNOMED CT FHIR Element Observation.valueCodeableConcept Status #TODO Notes |
Indeterminate Colitis Clinical Focus Concepts identifying conditions indicative of Indeterminate Colitis Inclusions Exclusions Type TBD Code/Value Set URI Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status #TODO Notes |
Invalid Clinical Focus Concepts for an invalid finding. Inclusions Exclusions None. Type Direct Reference Code Code/Value Set URI code "Invalid": "455371000124106" from "SNOMED-CT" display 'Invalid result (qualifier value)' Code System(s) SNOMED CT FHIR Element Observation.valueCodeableConcept Status Ready Notes |
Iron-deficiency Anemia without Specified Cause Clinical Focus Concepts for iron-deficiency anemia without known cause. Inclusions Anemia due to iron deficiency Exclusions Anemias not associated with iron deficiency. Iron-deficiency anemia due to inadequate dietary intake, iron metabolism deficiency, hereditary condition, or pregnancy. Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.332 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status Published (Experimental) Notes #TODO needs validation |
Juvenile polyposis syndrome Clinical Focus Diagnosis codes for juvenile polyposis syndrome Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "Juvenile polyposis syndrome": '9273005' from SCT display 'Juvenile polyposis syndrome (disorder)' Code System(s) ICD-10-CM SNOMED CT FHIR Element Status Ready Notes No concept available in ICD-10-CM |
Likely Pathogenic Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Lynch syndrome Clinical Focus Diagnosis codes for Lynch syndrome Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "Lynch Syndrome": ' 716318002 ' from "SCT" display 'Lynch syndrome (disorder)' Code System(s) ICD-10-CM SNOMED CT FHIR Element Status Ready Notes No concept available in ICD-10-CM |
Lynch-syndrome associated variant status Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Microscopic Colitis Clinical Focus Concepts identifying conditions indicative of Microscopic Colitis Inclusions Exclusions Type TBD Code/Value Set URI Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status #TODO Notes |
MUTYH-associated polyposis Clinical Focus Diagnosis codes for MUTYH-associated polyposis Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code: "MAP SNOMED CT": '423471004' from SCT display 'MYH-associated polyposis (disorder)' Code System(s) ICD-10-CM SNOMED CT FHIR Element Status Ready Notes No concept in ICD-10-CM |
MUYTH variant status Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Non-bleeding colorectal symptoms Clinical Focus Concepts for non-bleeding signs and symptoms often associated with colorectal cancer. Inclusions Diarrhea, constipation, tenesmus, abdominal pain or cramping, fatigue or weakness, unintended or unexplained weight loss, change in bowel habits or stool shape. Exclusions None. Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.336 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Observation.codeableConcept Status Published (Experimental) Notes #TODO Include upper abdominal pain? Consider abdominal tenderness? #TODO needs validation |
Number of affected relatives Clinical Focus Number of first-degree relatives Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "Number of affected family members": "104899-0" from "LOINC" display 'Number of affected family members' Code System(s) LOINC FHIR Element Observation.code Questionnaire.item.code Status Ready Notes |
Pathogenic Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Peutz-Jegher syndrome Clinical Focus Diagnosis codes for Peutz-Jegher syndrome Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "Peutz-Jegher syndrome": '54411001' from SCT display 'Peutz-Jeghers syndrome (disorder)' Code System(s) ICD-10-CM SNOMED CT FHIR Element Status Ready Notes Concept in ICD-10-CM is not sufficiently specific |
Positive Clinical Focus Concepts for a positive finding. Inclusions Exclusions None. Type Direct Reference Code Code/Value Set URI code "Positive": "10828004" from "SNOMED-CT" display 'Positive (qualifier value)' Code System(s) SNOMED CT FHIR Element Status Ready Notes |
Potentially Precancerous Polyp(s) Condition Clinical Focus Concepts for conditions indicating current or past potentially precancerous polyps Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.355 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code FamilyMemberHistory.condition.code Status Published (Experimental) Notes |
Potentially Precancerous Polyp Finding(s) Clinical Focus Concepts for serrated polyps, adenomatous polyps, traditional serrated adenomas and hyperplastic polyps (if >=10 mm) Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.353 Code System(s) SNOMED CT FHIR Element Observation.valueCodeableConcept QuestionnaireResponse.item.answer.valueCoding.code Status Published (Experimental) Notes SNOMED CT value set for Potentially Precancerous Polyp Condition |
Primary Sclerosing Cholangitis Clinical Focus Concepts identifying conditions indicative of Primary Sclerosing Cholangitis Inclusions Exclusions Type TBD Code/Value Set URI Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status #TODO Notes |
PTEN variant status Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status Notes |
Recommended follow-up interval Clinical Focus Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "Follow-up Plan": '470191000124102' from "SNOMED-CT" display 'Colorectal cancer screening follow-up planning (procedure)' Code System(s) SNOMED CT FHIR Element Observation.code Status Ready Notes #TODO consider LOINC code request |
Second-degree relative Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Serrated polyposis syndrome Clinical Focus Diagnosis codes for serrated polyposis syndrome Inclusions Exclusions Type Direct Reference Code Code/Value Set URI code "Serrated polyposis syndrome": '763536006' from SCT display 'Hyperplastic polyposis syndrome (disorder)' Code System(s) ICD-10-CM SNOMED CT FHIR Element Status Ready Notes No concept in ICD-10-CM |
SMAD4 variant status Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Stool DNA-FIT test Clinical Focus Concepts for a stool DNA-FIT test intended for routine screening purposes Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.11.1145 Code System(s) LOINC FHIR Element Status Ready Notes |
STK variant status Clinical Focus Inclusions Exclusions Type Code/Value Set URI Code System(s) FHIR Element Status #TODO Notes |
Total Colectomy Clinical Focus Surgical procedure of removing the entire colon Inclusions Exclusions * partial Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019 Code System(s) CPT ICD-10-PCS SNOMED CT FHIR Element Procedure.code Status Ready Notes * Reused from NCQA eCQMs |
Complete Colonoscopy Clinical Focus Complete colonoscopy to cecum, with photo documentation of cecal landmarks, such as the appendiceal orifice, terminal ileum, or ileocecal valve Inclusions Exclusions Type TBD Code/Value Set URI Code System(s) SNOMED CT FHIR Element Observation.valueCodeableConcept Status #TODO Notes |
Ulcerative Colitis Clinical Focus Concepts identifying conditions indicative of ulcerative colitis. Inclusions * Chronic * Acute or exacerbation * Complications documented as due to UC * Mild, moderate or severe Exclusions * Ulcerative Colitis in remission Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1078.879 Code System(s) ICD-10-CM SNOMED CT FHIR Element http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1032.345 Status Published (Experimental) Notes |
Hospice Intervention Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003 Code System(s) FHIR Element Encounter.code Status Ready Notes |
Hospice Encounter Clinical Focus The purpose of this value set is to represent concepts for encounters for hospice care services. Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003 Code System(s) HCPCS SNOMED CT FHIR Element Encounter.code Status Ready Notes * Reused from NCQA eCQMs |
Palliative Care Diagnosis Clinical Focus The purpose of this value set is to represent concepts that indicate a patient is receiving palliative care or services. Inclusions Includes concepts that represent palliative care or services. Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status Ready Notes Reused from NCQA eCQMs |
Palliative Care Intervention Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135 Code System(s) FHIR Element Procedure.code Status Ready Notes |
Palliative Care Encounter Clinical Focus The purpose of this value set is to represent concepts for encounters for palliative care services. Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090 Code System(s) SNOMED CT HCPCS FHIR Element Encounter.code Status Ready Notes * Reused from NCQA eCQMs |
Frailty Encounter Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088 Code System(s) CPT HCPCS FHIR Element Encounter.code Status Ready Notes * Reused from NCQA eCQMs |
Frailty Symptoms Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075 Code System(s) FHIR Element Condition.code Status Ready Notes |
Frailty Device Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300 Code System(s) SNOMED CT FHIR Element Device.code Status Ready Notes |
Frailty Diagnosis Clinical Focus The purpose of this value set is to represent concepts for a diagnosis of potential indicators of frailty. Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status Ready Notes |
Dementia Medications Clinical Focus The purpose of this value set is to represent concepts for dementia medications. Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.11.1517 Code System(s) RxNorm FHIR Element Status Ready Notes * Reused from NCQA eCQMs. The eCQMs use this value set to identify active meds. |
Advanced Illness Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status Ready Notes |
Hospice Diagnosis Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions Type Value Set Code/Value Set URI http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165 Code System(s) ICD-10-CM SNOMED CT FHIR Element Condition.code Status Ready Notes |