Cervical Cancer Screening and Management
Clinical Decision Support

Using Computable Guidelines to Improve Cervical Cancer Screening and Management

Overview

The Centers for Disease Control and Prevention (CDC’s) Division of Cancer Prevention and Control partnered with the CMS Alliance to Modernize Healthcare federally funded research and development center (Health FFRDC) on a multi-year effort to develop clinical decision support (CDS) tools. CDC and the Health FFRDC developed these tools to encourage awareness and adoption of the most up-to-date cervical cancer screening guidance and the new risk-based approach for managing abnormal screening results.

The project team intends for the CDS to help clinicians provide cervical cancer screening and management (CCSM) care based on updated guidelines from several organizations including the United States Preventive Services Task Force (USPSTF) and the American Society for Colposcopy and Cervical Pathology (ASCCP). The Health FFRDC is developing the CDS using a reproducible process, utilizing interoperable health information technology (IT) standards including Health Level 7 International (HL7®) Fast Healthcare Interoperability Resources (FHIR®) and the Clinical Quality Language (CQL).

Background

Timely screening and follow-up can identify and treat cervical precancer and reduce the number of cervical cancer cases and deaths diagnosed each year. Updates to cervical cancer screening and management guidelines have incorporated the use of primary HPV testing, individualized risk assessments and changes to the types and frequency of testing depending on age. The increased complexity of these guidelines makes it challenging and error prone for clinicians to adhere to the latest recommendations.

Flow diagram of CDS in clinican workflow
A conceptual workflow diagram showing the interaction between clinician, CDS and EHR system.

By transforming narrative guidelines for cervical cancer screening and management into computable formats, and building CDS tools, these guidelines can be integrated into electronic health record (EHR) platforms. The CDS can evaluate a patient's clinical data against the guidelines and display appropriate screening and management recommendations.

Goals

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Improve Health Outcomes

Drive improved public health outcomes by enabling consistent interpretation of evidence-based but complex guidelines for cervical cancer screening and follow-up care for managing abnormal results.

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Improve Clinician Adoption

Make consistent and timely application of new cervical screening and mangement guidelines possible for clinicians without additional burden.

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Improve Patient Outcomes

Provide timely and appropriate screening and management options tailored according to individual patient risk and history.

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Improve Health Equity

Develop open-source tools based on health data standards to allow implementation in low-resource settings, and enable care for underserved populations.

Software, Tools and Standards

These are some of the key technologies used to implement computable guidelines for cervical cancer screening and management. The goal was to develop and use industry standards and open-source software, and be able to integrate with any electronic health systems which support these technologies.

CCSM CDS Tools

This is the main repository for the software developed for this effort. The tools and software developed for cervical cancer screening and management are available under an open-source license (Apache 2.0) and may be accessed from the CCSM-CDS-Tools GitHub Repository. These tools are built on open health data standards and tools, making them accessible to developers familiar with these technologies.

The primary software available includes:

Clinical Quality Language

Clinical Quality Langauge (CQL) is a high-level, domain-specific language used for representing clinically-focused logic and queries related to electronic health data. CQL is an HL7 standard, and is intended to be human readable. In addition to its use in clinical decision support, it is also widely used in the development of electronic clinical quality measures (eCQMs).

Fast Healthcare Interoperability Resources (FHIR®)

Fast Healthcare Interoperability Resources (FHIR®) is an international IT standard for representing and exchanging healthcare information electronically. FHIR provides general data structures or “resources” for representing a variety of clinical and healthcare-related data. The CCSM CDS Tools use FHIR to represent the structure of resources used in cervical cancer screening and management.

CDS Hooks

CDS Hooks is a specification for invoking clinical decision support tools at appropriate points in clinical workflow, across a variety of applications and interfaces. The CCSM CDS Tools software supports CDS Hooks integration with EHRs.

SMART on FHIR

Another interface supported by CCSM CDS Tools is the SMART on FHIR application programming interface (API). This allows the use and integration of new applications with existing health IT systems, such as EHRs and patient portals. The CCSM CDS Tools software supports the SMART on FHIR interface.

Contact Us

If you have an interest in the Cervical Cancer Screening and Management Clinical Decision Support effort, or are interested in using the above tools in a clinical setting, please contact us at cervical-cancer-cds-list@mitre.org.