Colorectal Cancer Screening and Management (CRCSM) Clinical Decision Support (CDS) Implementation Guide
0.1.0 - ci-build

Colorectal Cancer Screening and Management (CRCSM) Clinical Decision Support (CDS) Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

High Level Recommendation

Resources related to the High Level logic pathway.

High Level Flow

Brings together recommendations from Primary Screening Decision and Follow-up Screening Result.

HighLevel

Main CQL library

Primary Screening Decision

Resources related to the Primary Screening Decision mid-level logic pathway.

Primary Screening Decision

Primary Screening Decision pathway.

PrimaryScreeningDecision

Main CQL library

Screening Eligible

Resources related to ScreeningEligible logic path

Screening Eligible

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.

ScreeningEligible

Main CQL library

ScreeningEligibleActions

CQL library for logic path output/actions.

ScreeningEligibleEvents

CQL library for logic path decision points.

Decision to Screen

Resources related to DecisionToScreen logic path

Decision to Screen

Evaluates criteria for when to stop screening for colorectal cancer, and determines whether the patient is eligible for average risk screening, increased risk screening, or surveillance, based on the risk factors outlined by USPSTF.

Provides recommendations for screening and surveillance based on the identified risk path and specific risk factors.

DecisionToScreen

Main CQL library

DecisionToScreenActions

CQL library for logic path output/actions.

DecisionToScreenEvents

CQL library for logic path decision points.

Risk Factors

Resources related to IncreasedRiskExclusions logic path

Increased Risk Exclusions

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.

IncreasedRiskExclusions

Main CQL library

IncreasedRiskExclusionsActions

CQL library for logic path output/actions.

IncreasedRiskExclusionsEvents

CQL library for logic path decision points.

USPSTF Average Risk

Resources related to USPSTFAvgRisk flow

Average Risk

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.

USPSTFAvgRisk

Main CQL library

USPSTFAvgRiskActions

CQL library for logic path output/actions.

USPSTFAvgRiskEvents

CQL library for logic path decision points.

Due for Screening

Resources related to ScreeningDue flow

Screening Due Measure

Identifies patients who may be due for screening based on prior assessment and documentation of next due date and flags patient who may be overdue for potential enhanced outreach efforts.

Intended for use with either 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.

ScreeningDue

Main CQL library

ScreeningDueActions
ScreeningDueEvents

CQL library for logic path decision points.

Screening Incomplete

Resources related to ScreeningIncomplete flow

Screening Incomplete Measure

Identifies patients who have been ordered for screening or for follow-up study for abnormal screening but for whom a study report has not been received or documented as received.

Intended for use with either 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.

ScreeningIncomplete

Main CQL library

ScreeningIncompleteEvents

CQL library for logic path decision points.

Follow-up

Resources related to FollowUp logic path

Follow Up

Determines next steps, if any, based on result of screening tests. This may be triggered by a diagnostic report being received by the system or a test result being documented in a structured manner.

FollowUp

Main CQL library

FollowUpActions

CQL library for logic path output/actions.

FollowUpEvents

CQL library for logic path decision points.

Knowledge Artifacts: Activity Definitions

These define activities that can be performed as part of content in this implementation guide.

Colorectal Cancer Screening Service Request

This ActivityDefinition generates a ServiceRequest for screening study or specialty referral.

Communicate Eligible

This ActivityDefinition generates a CommunicationRequest containing information about the patient's ineligibility for screening.

Communicate Not Eligible

This ActivityDefinition generates a CommunicationRequest containing information about the patient's ineligibility for screening.

Communicate Recommendation to Stop Screening

This ActivityDefinition generates a CommunicationRequest recommending to stop screening.

Communicate Shared Decision Making to Continue Screening

This ActivityDefinition generates a CommunicationRequest recommending shared decision making on the decision to continue screening.

Screening Eligible Questionnaire Task

This ActivityDefinition generates a Questionnaire Task containing a request to complete a questionnaire.

Knowledge Artifacts: Libraries

These define logic, asset collections and other libraries as part of content in this implementation guide.

CDSConnectCommonsforFHIRv401
CRCSMCommonFunctions
CSMCommonFunctions
DataElements
DetermineNextDueDate
DetermineNextDueDateActions
DetermineNextDueDateEvents
FHIRHelpers
Hospice
PertinentHistory
Terminology

Structures: Questionnaires

These define forms used by systems conforming to this implementation guide to capture or expose data to end users.

Screening Eligible

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

Plan Definition Action Codes

This value set includes action codes for Plan Definitions within this implementation guide.

Plan Definition Action Reason Codes

This value set includes action reason codes for Plan Definitions within this implementation guide.

Recommendation Flag Codes

This value set includes flag codes for recommendation actions within this implementation guide.

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

CT Colonography Reporting and Data System (C-RADS)

Codes for C-RADS v2005 colorectal finding categories.

CT Colonography Reporting and Data System (C-RADS)

Codes for C-RADS v2023 colorectal finding categories.

Colonoscopy Result Observation Code System

Code representing cancer screening related observations

Plan Definition Action Code System

Code representing plan definition action codes

Plan Definition Action Reason Code System

Code representing plan definition action reason codes

Recommendation Flag Code System

Code representing due/overdue flags

Screening Observation Code System

Code representing cancer screening related observations

Other

These are resources that are used within this implementation guide that do not fit into one of the other categories.

CheckIsIncludedAndNotExcluded_false
ColinCarlson
DecisionToScreen_EduardElder
DecisionToScreen_FannyFamiglietti
DecisionToScreen_HankCarlson
DecisionToScreen_StellaParker
DecisionToScreen_eve-Age86AndOlder_no_eve-AgeOver76_no_eve-LifeExp10_no_eve-riskFactors_no_act-AvgRiskEligible
DecisionToScreen_eve-Age86AndOlder_no_eve-AgeOver76_no_eve-LifeExp10_no_eve-riskFactors_yes_act-incRiskEligible
DecisionToScreen_eve-Age86AndOlder_no_eve-AgeOver76_no_eve-LifeExp10_yes_act-sdmcontinuelifexp__eve-riskFactors_no_act-AvgRiskEligible
DecisionToScreen_eve-Age86AndOlder_no_eve-AgeOver76_no_eve-LifeExp10_yes_act-sdmcontinuelifexp__eve-riskFactors_yes_act-incRiskEligible
DecisionToScreen_eve-Age86AndOlder_no_eve-AgeOver76_yes_act-SelectivelyOfferScreening__eve-LifeExp10_no_eve-riskFactors_no_act-AvgRiskEligible
DecisionToScreen_eve-Age86AndOlder_no_eve-AgeOver76_yes_act-SelectivelyOfferScreening__eve-LifeExp10_no_eve-riskFactors_yes_act-incRiskEligible
DecisionToScreen_eve-Age86AndOlder_no_eve-AgeOver76_yes_act-SelectivelyOfferScreening__eve-LifeExp10_yes_act-sdmcontinuelifexp__eve-riskFactors_no_act-AvgRiskEligible
DecisionToScreen_eve-Age86AndOlder_no_eve-AgeOver76_yes_act-SelectivelyOfferScreening__eve-LifeExp10_yes_act-sdmcontinuelifexp__eve-riskFactors_yes_act-incRiskEligible
DecisionToScreen_eve-Age86AndOlder_yes_act-HarmsLikelyOutweighBenefits
EduardElder
FannyFamiglietti
FollowUp_FranColette
FollowUp_OllieOncken
FollowUp_PollyStuart
FollowUp_eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_no_eve-lastTestCTC_no_end-1
FollowUp_eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_no_eve-lastTestCTC_yes_eve-inconclusiveCTColonography_no_eve-abnormalCTColonography_no_end-1
FollowUp_eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_no_eve-lastTestCTC_yes_eve-inconclusiveCTColonography_no_eve-abnormalCTColonography_yes_act-FollowUpColonoscopy
FollowUp_eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_no_eve-lastTestCTC_yes_eve-inconclusiveCTColonography_yes_act-repeatScreening
FollowUp_eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_yes_eve-abnormalFlexSig_no_end-1
FollowUp_eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_yes_eve-abnormalFlexSig_yes_act-FollowUpColonoscopy
FollowUp_eve-lastTestColonoscopy_no_eve-lastTestStool_yes_eve-inconclusiveStoolTest_no_eve-abnormalStoolTest_no_end-1
FollowUp_eve-lastTestColonoscopy_no_eve-lastTestStool_yes_eve-inconclusiveStoolTest_no_eve-abnormalStoolTest_yes_act-FollowUpColonoscopy
FollowUp_eve-lastTestColonoscopy_no_eve-lastTestStool_yes_eve-inconclusiveStoolTest_yes_act-repeatScreening
FollowUp_eve-lastTestColonoscopy_yes_end-1
FollowUp_eve-lastTestColonoscopy_yes_eve-colonoscopyFindingCRC_no_eve-recommendedInterval_no_eve-colonoscopyFindingPolyps_no_end-1
FollowUp_eve-lastTestColonoscopy_yes_eve-colonoscopyFindingCRC_no_eve-recommendedInterval_no_eve-colonoscopyFindingPolyps_yes_act-followUpColonoscopist
FollowUp_eve-lastTestColonoscopy_yes_eve-colonoscopyFindingCRC_no_eve-recommendedInterval_yes_end-1
FollowUp_eve-lastTestColonoscopy_yes_eve-colonoscopyFindingCRC_yes_act-oncologyReferral
FranColette
HankCarlson
HighLevel_ColinCarlson
HighLevel_EduardElder
HighLevel_FannyFamiglietti
HighLevel_FranColette
HighLevel_HankCarlson
HighLevel_HollyHereditary
HighLevel_IsaacBrown
HighLevel_OllieOncken
HighLevel_PaulinePolyanski
HighLevel_PollyStuart
HighLevel_SallySimpson
HighLevel_StellaParker
HollyHereditary
IncreasedRiskExclusions_FannyFamiglietti
IncreasedRiskExclusions_HankCarlson
IncreasedRiskExclusions_HollyHereditary
IncreasedRiskExclusions_IsaacBrown
IncreasedRiskExclusions_PaulinePolyanski
IncreasedRiskExclusions_eve-HereditarySyndrome_no_eve-IBD_no_eve-HxCRC_no_eve-FamilyHx_no_eve-HxPolyps_no_act-AvgRiskScreeningEligible
IncreasedRiskExclusions_eve-HereditarySyndrome_no_eve-IBD_no_eve-HxCRC_no_eve-FamilyHx_no_eve-HxPolyps_yes_act-HxPolyps
IncreasedRiskExclusions_eve-HereditarySyndrome_no_eve-IBD_no_eve-HxCRC_no_eve-FamilyHx_yes_act-FamilyHxCRC
IncreasedRiskExclusions_eve-HereditarySyndrome_no_eve-IBD_no_eve-HxCRC_yes_act-HxCRC
IncreasedRiskExclusions_eve-HereditarySyndrome_no_eve-IBD_yes_act-IBD
IncreasedRiskExclusions_eve-HereditarySyndrome_yes_act-CRCHereditarySyndrome
IsScreeningEligible_false_ActiveCRC
IsScreeningEligible_false_HxTotalColectomy
IsScreeningEligible_false_Symptomatic
IsScreeningEligible_true
IsaacBrown
OllieOncken
PaulinePolyanski
PollyStuart
PrimaryScreeningDecision_CheckIsIncludedAndNotExcluded_false
PrimaryScreeningDecision_ColinCarlson
PrimaryScreeningDecision_EduardElder
PrimaryScreeningDecision_FannyFamiglietti
PrimaryScreeningDecision_HankCarlson
PrimaryScreeningDecision_HollyHereditary
PrimaryScreeningDecision_IsScreeningEligible_false_ActiveCRC
PrimaryScreeningDecision_IsScreeningEligible_false_HxTotalColectomy
PrimaryScreeningDecision_IsScreeningEligible_false_Symptomatic
PrimaryScreeningDecision_IsScreeningEligible_true
PrimaryScreeningDecision_IsaacBrown
PrimaryScreeningDecision_PaulinePolyanski
PrimaryScreeningDecision_PollyStuart
PrimaryScreeningDecision_SallySimpson
PrimaryScreeningDecision_StellaParker
SallySimpson
ScreeningEligible_ColinCarlson
ScreeningEligible_SallySimpson
ScreeningEligible_eve-HxTotalColectomy_no_eve-ActiveCRC_no_eve-Symptomatic_no_act-ScreeningEligible
ScreeningEligible_eve-HxTotalColectomy_no_eve-ActiveCRC_no_eve-Symptomatic_yes_act-Diagnostic
ScreeningEligible_eve-HxTotalColectomy_no_eve-ActiveCRC_yes_end-1
ScreeningEligible_eve-HxTotalColectomy_yes_end-1
ScreeningEligible_inc-AgeAtLeast18_MostRecentAgeValue_yes
ScreeningEligible_inc-AgeAtLeast18_error
ScreeningEligible_inc-AgeAtLeast18_no
ScreeningEligible_inc-AgeAtLeast18_yes
StellaParker
USPSTFAvgRisk_AgeOver45_yes_eve-priorScreeningExists_no_act-updateDueDateNow
USPSTFAvgRisk_StellaParker
USPSTFAvgRisk_eve-AgeOver45_no_act-RecommendStartScreeningAt45
USPSTFAvgRisk_eve-AgeOver45_yes_eve-priorScreeningExists_yes_act-determineDueDate
eve-Age86AndOlder_no_eve-AgeOver76_no_eve-LifeExp10_no_eve-riskFactors_no_act-AvgRiskEligible
eve-Age86AndOlder_no_eve-AgeOver76_no_eve-LifeExp10_no_eve-riskFactors_yes_act-incRiskEligible
eve-Age86AndOlder_no_eve-AgeOver76_no_eve-LifeExp10_yes_act-sdmcontinuelifexp__eve-riskFactors_no_act-AvgRiskEligible
eve-Age86AndOlder_no_eve-AgeOver76_no_eve-LifeExp10_yes_act-sdmcontinuelifexp__eve-riskFactors_yes_act-incRiskEligible
eve-Age86AndOlder_no_eve-AgeOver76_yes_act-SelectivelyOfferScreening__eve-LifeExp10_no_eve-riskFactors_no_act-AvgRiskEligible
eve-Age86AndOlder_no_eve-AgeOver76_yes_act-SelectivelyOfferScreening__eve-LifeExp10_no_eve-riskFactors_yes_act-incRiskEligible
eve-Age86AndOlder_no_eve-AgeOver76_yes_act-SelectivelyOfferScreening__eve-LifeExp10_yes_act-sdmcontinuelifexp__eve-riskFactors_no_act-AvgRiskEligible
eve-Age86AndOlder_no_eve-AgeOver76_yes_act-SelectivelyOfferScreening__eve-LifeExp10_yes_act-sdmcontinuelifexp__eve-riskFactors_yes_act-incRiskEligible
eve-Age86AndOlder_yes_act-HarmsLikelyOutweighBenefits
eve-AgeOver45_no_act-RecommendStartScreeningAt45
eve-AgeOver45_yes_eve-priorScreeningExists_no_act-updateDueDateNow
eve-AgeOver45_yes_eve-priorScreeningExists_yes_act-determineDueDate
eve-HereditarySyndrome_no_eve-IBD_no_eve-HxCRC_no_eve-FamilyHx_no_eve-HxPolyps_no_act-AvgRiskScreeningEligible
eve-HereditarySyndrome_no_eve-IBD_no_eve-HxCRC_no_eve-FamilyHx_no_eve-HxPolyps_yes_act-HxPolyps
eve-HereditarySyndrome_no_eve-IBD_no_eve-HxCRC_no_eve-FamilyHx_yes_act-FamilyHxCRC
eve-HereditarySyndrome_no_eve-IBD_no_eve-HxCRC_yes_act-HxCRC
eve-HereditarySyndrome_no_eve-IBD_yes_act-IBD
eve-HereditarySyndrome_yes_act-CRCHereditarySyndrome
eve-HxTotalColectomy_no_eve-ActiveCRC_no_eve-Symptomatic_no_act-ScreeningEligible
eve-HxTotalColectomy_no_eve-ActiveCRC_no_eve-Symptomatic_yes_act-Diagnostic
eve-HxTotalColectomy_no_eve-ActiveCRC_yes_end-1
eve-HxTotalColectomy_yes_end-1
eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_no_eve-lastTestCTC_no_end-1
eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_no_eve-lastTestCTC_yes_eve-inconclusiveCTColonography_no_eve-abnormalCTColonography_no_end-1
eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_no_eve-lastTestCTC_yes_eve-inconclusiveCTColonography_no_eve-abnormalCTColonography_yes_act-FollowUpColonoscopy
eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_no_eve-lastTestCTC_yes_eve-inconclusiveCTColonography_yes_act-repeatScreening
eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_yes_eve-abnormalFlexSig_no_end-1
eve-lastTestColonoscopy_no_eve-lastTestStool_no_eve-lastTestFlexSig_yes_eve-abnormalFlexSig_yes_act-FollowUpColonoscopy
eve-lastTestColonoscopy_no_eve-lastTestStool_yes_eve-inconclusiveStoolTest_no_eve-abnormalStoolTest_no_end-1
eve-lastTestColonoscopy_no_eve-lastTestStool_yes_eve-inconclusiveStoolTest_no_eve-abnormalStoolTest_yes_act-FollowUpColonoscopy
eve-lastTestColonoscopy_no_eve-lastTestStool_yes_eve-inconclusiveStoolTest_yes_act-repeatScreening
eve-lastTestColonoscopy_yes_end-1
eve-lastTestColonoscopy_yes_eve-colonoscopyFindingCRC_no_eve-recommendedInterval_no_eve-colonoscopyFindingPolyps_no_end-1
eve-lastTestColonoscopy_yes_eve-colonoscopyFindingCRC_no_eve-recommendedInterval_no_eve-colonoscopyFindingPolyps_yes_act-followUpColonoscopist
eve-lastTestColonoscopy_yes_eve-colonoscopyFindingCRC_no_eve-recommendedInterval_yes_end-1
eve-lastTestColonoscopy_yes_eve-colonoscopyFindingCRC_yes_act-oncologyReferral
eve-nextdueexists_no_act-determinedue
eve-nextdueexists_yes_eve-DetermineIfDueForScreening_due_act-orderTest
eve-nextdueexists_yes_eve-DetermineIfDueForScreening_notdue_end-1
eve-nextdueexists_yes_eve-DetermineIfDueForScreening_overdue_act-patientOutreach_act-orderTest
eve-pendingCTC_act-testpending
eve-pendingColonoscopy_act-testpending
eve-pendingFlexSig_act-testpending
eve-pendinggFOBT_act-testpending
eve-pendingsDNAFIT_act-testpending
inc-AgeAtLeast18_MostRecentAgeValue_yes
inc-AgeAtLeast18_error
inc-AgeAtLeast18_no
inc-AgeAtLeast18_yes