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Source1

{
  "resourceType": "PlanDefinition",
  "id": "CXCAD18SRecallScheduling",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD18SRecallSchedulingLogic"
            },
            {
              "url": "name",
              "valueString": "Recall — treatment after positive biopsy timeout"
            },
            {
              "url": "statement",
              "valueString": "/*\n * @output: CXCA.D#DE41 \"Recall: treatment timeout after positive biopsy (4 weeks)\"\n */\ndefine \"Recall — treatment after positive biopsy timeout\":\n  \"TreatmentAfterPositiveBiopsyTimedOut\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD18SRecallSchedulingLogic"
            },
            {
              "url": "name",
              "valueString": "Recall — HPV sample result timeout"
            },
            {
              "url": "statement",
              "valueString": "// =============================================================================\n// Recall trigger rules — one per A/641 section 2.3 timeout\n// =============================================================================\n\n/*\n * @output: CXCA.D#DE38 \"Recall: HPV sample result timeout (3 weeks)\"\n */\ndefine \"Recall — HPV sample result timeout\":\n  \"HPVSampleResultTimedOut\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD18SRecallSchedulingLogic"
            },
            {
              "url": "name",
              "valueString": "Recall — positive result follow-up timeout"
            },
            {
              "url": "statement",
              "valueString": "/*\n * @output: CXCA.D#DE39 \"Recall: positive result follow-up timeout (4 weeks)\"\n * The single most important trigger — fires for the LTFU population from\n * the April 2026 Khan-Uul pilot.\n */\ndefine \"Recall — positive result follow-up timeout\":\n  \"PositiveResultFollowUpTimedOut\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD18SRecallSchedulingLogic"
            },
            {
              "url": "name",
              "valueString": "Recall — biopsy result timeout"
            },
            {
              "url": "statement",
              "valueString": "/*\n * @output: CXCA.D#DE40 \"Recall: biopsy result timeout (4 weeks)\"\n */\ndefine \"Recall — biopsy result timeout\":\n  \"BiopsyResultTimedOut\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD18SRecallSchedulingLogic"
            },
            {
              "url": "name",
              "valueString": "Recall — missed scheduled examination"
            },
            {
              "url": "statement",
              "valueString": "/*\n * @output: CXCA.D#DE44 \"Recall: missed scheduled examination\"\n * No timeout — fires immediately once a missed appointment is detected.\n */\ndefine \"Recall — missed scheduled examination\":\n  \"MissedScheduledExamination\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD18SRecallSchedulingLogic"
            },
            {
              "url": "name",
              "valueString": "Recall — cytology slide unread timeout"
            },
            {
              "url": "statement",
              "valueString": "/*\n * @output: CXCA.D#DE42 \"Recall: cytology slide unread timeout (2 weeks)\"\n */\ndefine \"Recall — cytology slide unread timeout\":\n  \"CytologySlideUnreadTimedOut\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD18SRecallSchedulingLogic"
            },
            {
              "url": "name",
              "valueString": "Recall — second reminder needed"
            },
            {
              "url": "statement",
              "valueString": "/*\n * @output: CXCA.D#DE43 \"Recall: second reminder (4 weeks after first)\"\n */\ndefine \"Recall — second reminder needed\":\n  \"FirstReminderUnresolvedAtSecondTimeout\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "FHIR model information",
          "resource": "http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1"
        }
      ],
      "parameter": [
        {
          "name": "TreatmentAfterPositiveBiopsyTimedOut",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "HPVSampleResultTimedOut",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "PositiveResultFollowUpTimedOut",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "BiopsyResultTimedOut",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "MissedScheduledExamination",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "CytologySlideUnreadTimedOut",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "FirstReminderUnresolvedAtSecondTimeout",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Recall — treatment after positive biopsy timeout",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Recall — HPV sample result timeout",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Recall — positive result follow-up timeout",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Recall — biopsy result timeout",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Recall — missed scheduled examination",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Recall — cytology slide unread timeout",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Recall — second reminder needed",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "http://smart.who.int/cxca/StructureDefinition/cxca-bindingness",
      "valueCoding": {
        "system": "http://smart.who.int/cxca/CodeSystem/CXCA.Bindingness",
        "code": "legal",
        "display": "Legal — binding regulatory instrument"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical": "#effective-data-requirements"
    }
  ],
  "url": "http://smart.who.int/cxca/PlanDefinition/CXCAD18SRecallScheduling",
  "version": "0.0.1",
  "name": "CXCAD18SRecallScheduling",
  "title": "CXCA.D18.S — Recall Scheduling",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/plan-definition-type",
        "code": "eca-rule"
      }
    ]
  },
  "status": "draft",
  "experimental": false,
  "date": "2026-05-14T00:50:23+00:00",
  "publisher": "Dan Heslinga (independent contributor)",
  "contact": [
    {
      "name": "Dan Heslinga (independent contributor)",
      "telecom": [
        {
          "system": "url",
          "value": "https://github.com/dhes"
        }
      ]
    }
  ],
  "description": "Decision support for recall and re-call per Mongolia MOH Order A/641 (2020) section 2.3. Evaluates seven timeout triggers (HPV sample timeout, positive-result follow-up timeout, biopsy timeout, treatment-after-biopsy timeout, cytology unread timeout, second-reminder, missed scheduled exam) and instantiates a CommunicationRequest reminder for each fired trigger. The 187 LTFU women from the April 2026 Khan-Uul pilot represent the empirical case for why this layer matters — DE39 (positive-result follow-up timeout, 4 weeks) is the trigger that should fire for each of them.",
  "library": [
    "http://smart.who.int/cxca/Library/CXCAD18SRecallSchedulingLogic"
  ],
  "action": [
    {
      "title": "Recall — HPV sample result missing more than 3 weeks",
      "description": "An HPV sample was dispatched more than 3 weeks ago and no result has been entered. Issue a reminder to follow up with the lab.",
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "language": "text/cql-identifier",
            "expression": "Recall — HPV sample result timeout"
          }
        }
      ],
      "definitionCanonical": "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"
    },
    {
      "title": "Recall — positive screening result without follow-up exam after 4 weeks",
      "description": "A positive screening result was entered more than 4 weeks ago and no follow-up examination has been recorded. Issue a reminder to the patient and the clinician. THIS IS THE LTFU-PREVENTION TRIGGER — the 187 women lost to follow-up in the April 2026 Khan-Uul pilot would each have had this trigger fire.",
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "language": "text/cql-identifier",
            "expression": "Recall — positive result follow-up timeout"
          }
        }
      ],
      "definitionCanonical": "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"
    },
    {
      "title": "Recall — biopsy result missing more than 4 weeks",
      "description": "A biopsy sample was received at the lab more than 4 weeks ago and no histopathology result has been entered. Follow up with the lab.",
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "language": "text/cql-identifier",
            "expression": "Recall — biopsy result timeout"
          }
        }
      ],
      "definitionCanonical": "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"
    },
    {
      "title": "Recall — no treatment record more than 4 weeks after positive biopsy",
      "description": "A positive biopsy result has been entered for more than 4 weeks and no treatment record exists. Issue a reminder to schedule treatment.",
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "language": "text/cql-identifier",
            "expression": "Recall — treatment after positive biopsy timeout"
          }
        }
      ],
      "definitionCanonical": "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"
    },
    {
      "title": "Recall — cytology slide unread more than 2 weeks at lab",
      "description": "A cytology slide was received more than 2 weeks ago and no cytologist conclusion has been entered. Follow up with the lab.",
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "language": "text/cql-identifier",
            "expression": "Recall — cytology slide unread timeout"
          }
        }
      ],
      "definitionCanonical": "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"
    },
    {
      "title": "Recall — second reminder needed (first sent more than 4 weeks ago)",
      "description": "A first reminder was sent more than 4 weeks ago and the underlying gap remains unresolved. Issue a second reminder.",
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "language": "text/cql-identifier",
            "expression": "Recall — second reminder needed"
          }
        }
      ],
      "definitionCanonical": "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"
    },
    {
      "title": "Recall — missed scheduled examination",
      "description": "Patient missed a scheduled examination. Immediate reminder — no timeout wait.",
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "language": "text/cql-identifier",
            "expression": "Recall — missed scheduled examination"
          }
        }
      ],
      "definitionCanonical": "http://smart.who.int/cxca/ActivityDefinition/CXCAD18ReminderCommunicationRequest"
    }
  ]
}