| Name | Value |
|---|---|
| NAME | VA-WH PAP SMEAR SCREENING |
| PRINT NAME | PAP Smear Screening |
| DO IN ADVANCE TIME FRAME | 6M |
| SEX SPECIFIC | FEMALE |
| CLASS | NATIONAL |
| SPONSOR | VHA NATIONAL CENTER FOR HEALTH PROMOTION AND DISEASE PREVENTION (NCP) AND VHA OFFICE OF WOMEN'S HEALTH |
| USAGE | CR |
| EDIT HISTORY |
|
| DESCRIPTION | The main changes with the 2013 update of this reminder include:
of less than 5 years or severe comorbidities.
Addition of branching logic to the dialog
Addition of links in the dialog to new VHA screening algorithms
that include links to ASCCP guidelines for management of patients with
abnormal results.
VHA recommends screening for cervical cancer with cytology (Pap smear)
every 3 years for women ages 21-65 that have a cervix OR, for women ages
30-65 who want to lengthen the screening interval, screening with a
a change in the age range from 18-65 to 21-65 to match updated
combination of cytology and human papilloma virus (HPV) testing every 5
years.
VHA recommends AGAINST screening for cervical cancer in women who are
younger than 21 years.
VHA recommends AGAINST using HPV testing alone or in combination with
cytology for cervical cancer screening in women younger than 30 years.
VHA recommends AGAINST screening for cervical cancer in women older than
clinical guidance
65 years of age if they have had adequate prior screening and are not
otherwise at high risk for cervical cancer.
VHA recommends AGAINST screening for cervical cancer in women who have
had a total hysterectomy (cervix removal) for benign disease.
This reminder does not apply to women who have had a hysterectomy where
the cervix was removed.
Evidence of a PAP smear completed will satisfy the reminder for
addition of a every 5 year frequency option for women ages 30 and
up to 5 years, depending on the screening frequency specified by the
clinician and the presence of HPV screening. The clinician can alter the
screening frequency for individual patients based on prior results,
patient and family history, and discussions with the patient.
PAP Smears completed will resolve this reminder and may be recorded as one
of the following:
Laboratory result matching Cytology or Surgical Pathology SNOMED
Women's Health procedure result
Health Factor (Historical outside PAP smear result)
older who are screened with both a Pap test and an HPV test (with
PCE CPT procedure code
Completed consult order for outside procedure
In patients ages 30-65 who have evidence of a recent negative HPV result
and no prior abnormal PAP smear, the PAP smear will resolve the reminder
for 5 years.
Screening will be resolved by any of the following:
PAP smear obtained at this encounter (7 DAYS)
Health Factor for an order for PAP Smear screening (9 months)
associated addition of new terms for HPV testing)
Patient declined PAP smear (4 months)
Clinician deferred PAP smear (4 months)
Clinicians may manage follow-up screening to occur every 4 or 6 months
when PAP smear results are abnormal or unsatisfactory, or if they feel
screening should take place more often than 3 or 5 years based on
the patient's history, risk or strong patient preferences.
Management of an abnormal PAP is included in this screening reminder only
if the clinician indicates what frequency is required for an individual
addition of health factors that can be used by providers to
patient. A code for prior cervical cancer or CIN changes the
frequency to 1 year for 5 years. This 1 year frequency if subsequently
overridden if any other frequency is chosen by the clinician.
VA-WH HX CERVICAL CANCER/ABNORMAL PAP
This reminder term changes the frequency to every 1 year for 5 years as a
safety features so that patients with these diagnoses are not lost to
follow-up. This 1 year frequency is subsequently overridden if any other
frequency is chosen by the clinician.
indicate that screening is not clinically indicated because the patient
This reminder term is mapped to the taxonomy VA-CERVICAL CA/ABNORMAL PAP
findings. This term represents ICD9, ICD0, and CPT codes that indicate the
patient has a history of cervical cancer or a diagnosis CIN. Sites may
choose to only use documented diagnosis and procedure codes removing
mapping to Women's Health.
This reminder term is also mapped to the computed finding VA-WH PAP SMEAR
SCREEN IN WH PKG with a condition check for "Abnormal" used for the
search. If PAP smear results are documented in the Women's Health package,
is unlikely to benefit from screening due to an estimated life expectancy
the computed finding VA-WH PAP SMEAR SCREEN IN WH PKG will find the most
recent PAP Smear entry that has an "Abnormal" result. Sites can remove
this mapped item if they are not using the Women's Health package to store
PAP results.
The reminder term may also be mapped to the computed finding VA-WH PAP
SMEAR SCREEN IN LAB PKG with a condition check for "Abnormal" Result
Type. The Result Type is based on Procedure definitions in the Women's
Health Package.
|
| FINDINGS |
|
| FUNCTION FINDINGS |
|
| TECHNICAL DESCRIPTION | Technical Description:
exists that alters the baseline frequency to 4M, 6M, 1Y, 2Y,
3Y, or 5Y the baseline frequency will be overridden.
VA-WH PAP SMEAR SCREEN IN WH PKG
No mapping necessary. This term represents PAP Smear results
documented in the Women's Health (WH) Package. Use the new
VA-WH PAP SMEAR IN WH PKG computed finding distributed with
this reminder term. This computed finding looks for PAP smear
results in the Women's Health Package where results have been
recorded and the status is not Unsatisfactory.
This reminder is recommended for use by clinicians at Primary Care
VA-WH PAP SMEAR SCREEN IN LAB PKG
No mapping necessary. This term represents PAP Smear results
documented in the Laboratory package. Use the new VA-WH PAP
SMEAR IN LAB PKG computed finding distributed with this
reminder term.
This computed finding looks for PAP smear results in the
Laboratory package where the Result Status that is not
"Unsatisfactory"
Clinics (PACT/Primary Care,Medicine, Geriatric, Women's) and any
This computed finding will only work if the Women's Health WV
PROCEDURE TYPE file entry for PAP SMEAR has SNOMED codes
defined that are used by your local Lab Service to document
PAP Smear results in the Lab Package. The SNOMED codes need
to be defined regardless of whether the Women's Health
Package is being used.
VA-WH PAP SMEAR DONE
No mapping necessary. Use the new VA-WH PAP SMEAR SCREEN
CODES taxonomy distributed with this reminder term. This
other specialty clinics where primary care is given to female
taxonomy is similar to the VA-CERVICAL CANCER SCREEN taxonomy
distributed to the field with the first reminder package
distribution. The new taxonomy should be used, instead of the
VA-CERVICAL CANCER SCREEN taxonomy, because it does not
include codes such as Q0091 which represent PAP smears
obtained by the clinician.
Use the new WH PAP SMEAR OUTSIDE health factor to document PAP
Smear results completed outside the VA when the PAP Smear
results are not documented in Lab, Women's Health or Consult
patients.
packages.
VA-WH PAP SMEAR OBTAINED
Use the taxonomy VA-WH PAP SMEAR OBTAINED which contains
coded values that represent the clinician's actions taken to
obtain the PAP smear.
VA-WH PAP SMEAR ORDER HEALTH FACTOR
The following health factors are distributed with this term.
WH ORDER PAP SMEAR SCREEN HF (for use when an order menu
with a PAP Smear Screen order is used from the reminder
dialog) WH ORDER REFER WH CLINIC GYN CARE HF (for use when a
quick order is used for WH CLINIC GYN CARE referral in
reminder dialogs) WH ORDER REFER GYNECOLOGIST HF (for use
when a quick order is used for GYNECOLOGY referral in
reminder dialogs) WH ORDER REPEAT PAP HF (for use when an
order menu with a Repeat PAP Smear has been ordered)
This reminder term represents the action taken from the
dialog to indicate the clinician selected an element that
If the PAP smear is done in the private sector or at another VAMC
could generate an order for PAP Smear. The health factor
date will be used to calculate a short resolution frequency,
instead of using the Order's Start date.
Although these health factors remain in the reminder
definition, as requested by Women's Health, these are no
longer included in the reminder dialog since women should
no longer need to be referred from PC to specialty for Pap
smears.
facility, results can be recorded three ways to satisfy this
VA-WH PAP SMEAR SCREEN NOT INDICATED
Use the findings distributed with this reminder term or map
any local findings that indicate a PAP smear screen is not
indicated for this patient.
This term is distributed with mapping to the following
health factors:
INACTIVATE CERVIX CANCER SCREEN (distributed with the
first version of the Clinical Reminder package in 1996
to inactivate the CERVICAL CANCER reminder).
reminder:
WH PAP SMEAR SCREEN NOT INDICATED
VA LIMITED LIFE EXPECTANCY
and the following taxonomy:
VA-TERMINAL CANCER PATIENTS
Use in National VA-WH PAP SMEAR SCREENING reminder:
This term is used in WH reminders to inactivate PAP Smear
screening until a clinician overrides the inactivation by
selecting a health factor that is used by function findings
with frequencies of 1Y, 2Y, 3Y or 5Y. Begin date of T-6M has
been added to HF.VA LIMITED LIFE EXPECTANCY and
TX.VA-TERMINAL CANCER PATIENTS so screening will come due
again if the patient lives longer than expected or if the
patient has been misdiagnosed.
Updated March 2013 to include 2 new health factor which
both inactivate the reminder for 5 years:
WH CERV CA SCRN N/A 5 YRS-COMORBIDITIES
WH CERV CA SCRN N/A 5 YRS-LE<5YRS
This reminder is based on VHA Performance measures and US
* Results, with interpretation, can be entered and verified
Sites may prefer to use local LIMITED LIFE EXPECTANCY health
factors and add their health factors to other reminder
terms which cause the PAP Smear Screening reminder to be
due without requiring a clinician to select a finding to
reactivate the reminder. (e.g., Add the local life expectancy
health factor for "LOCAL LIFE EXPECTANCY 6M" to the VA-WH PAP
SMEAR SCREEN NOT INDICATED term).
VA-WH PAP SMEAR SCREEN DEFER
Use the WH PAP SMEAR DECLINED and/or WH PAP SMEAR DEFERRED
in the Lab package.
health factors distributed with this term, or add any local
health factors representing that PAP smear screening should be
deferred.
VA-WH PAP SMEAR UNSATISFACTORY IN LAB/WH PKG
No mapping necessary. This term represents unsatisfactory
PAP Smear results documented in the Laboratory and WH
packages. Use the new VA-WH PAP SMEAR IN LAB PKG computed
finding distributed with this reminder term. This computed
finding looks for PAP smear results in the Laboratory
* Results, with interpretation, can be manually entered into the
package where the Result Status is "Unsatisfactory"
Use the VA-WH PAP SMEAR IN WH PKG computed finding and the
value "UNSATISFACTORY" to find unsatisfactory PAP smear
results documented in the WH package.
This computed finding will only work if the Women's Health WV
PROCEDURE TYPE file entry for PAP SMEAR has SNOMED codes
defined that are used by your local Lab Service to document
PAP Smear results in the Lab Package. The SNOMED codes need
WH package.
to be defined regardless of whether the Women's Health Package
is being used.
INFORMATION FINDINGS:
---------------------
Function Findings (FF) will be used to determine the frequency of
this reminder. The following are information reminder terms that are
used in Function Findings to alter the baseline Age/Frequency. If the
most recent resolution finding is a documented result, the frequency
for the next PAP Smear will be based on these reminder terms.
* Summarized results can be entered as a historical entry (health
If multiple findings exist for the same date/time, the finding that
makes the reminder due most often will prevail. See the FUNCTION
FINDINGS section below for frequency logic.
VA-WH PAP SMEAR SCREEN FREQ - 4M
Use the WH PAP SMEAR SCREEN FREQ - 4M health factor
distributed with this reminder term, or add any local findings
that indicate PAP smear screening should occur every 4 months.
VA-WH PAP SMEAR SCREEN FREQ - 6M
factor or CPT code) in the patient record. Historical entries
Use the WH PAP SMEAR SCREEN FREQ - 6M health factor
distributed with this reminder term or add any local findings
that indicate PAP smear screening should occur every 6 months.
VA-WH PAP SMEAR SCREEN FREQ - 1Y
Use the WH PAP SMEAR SCREEN FREQ - 1Y health factor
distributed with this reminder term, or add any local findings
that indicate PAP smear screening should occur every year.
The taxonomy for abnormal PAP is included in this term.
should be based on reviewed results, not on patient comments.
VA-WH PAP SMEAR SCREEN FREQ - 2Y
Use the WH PAP SMEAR SCREEN FREQ - 2Y health factor
distributed with this reminder term, or add any local
findings that indicate the PAP smear screening should occur
every 2 years.
VA-WH PAP SMEAR SCREEN FREQ - 3Y
Use the WH PAP SMEAR SCREEN FREQ - 3Y health factor
distributed with this reminder term, or add any local
findings that indicate PAP smear screening should occur every
3 years.
The following reminder terms are "information only" terms that are
not used to alter the frequency, but provide information that may
be helpful to the clinician.
VA-WH HYSTERECTOMY
This reminder term represents hysterectomy related procedures.
It is pre-mapped to use the VA-HYSTERECTOMY taxonomy which was
distributed to the field in 1996. It is not used to alter the
Setup of Women's Health package before using this reminder:
patient cohort because it contains hysterectomy codes that
indicate the patients cervix may or may not have been
removed.
VA-WH HX CERVICAL CANCER/ABNORMAL PAP
This reminder term is mapped to the taxonomy VA-CERVICAL
CA/ABNORMAL PAP findings. This term represents ICD9, ICD0,
and CPT codes that indicate the patient has a history of
cervical cancer or a diagnosis for abnormal PAP. Sites may
choose to only use documented diagnosis and procedure codes
===========================================================
removing mapping to Women's Health.
This reminder term is also mapped to the computed finding
VA-WH PAP SMEAR SCREEN IN WH PKG with a condition check for
"Abnormal" used for the search. If PAP smear results are
documented in the Women's Health package, the computed finding
VA-WH PAP SMEAR SCREEN IN WH PKG will find the most recent PAP
Smear entry that has an "Abnormal" result. Sites can remove
this mapped item if they are not using the Women's Health
package to store PAP results.
Preventative Services Task Force recommendations for cervical cancer
Although this reminder has been developed to interface with the
The reminder term may also be mapped to the computed finding
VA-WH PAP SMEAR SCREEN IN LAB PKG with a condition check for
"Abnormal" Result Type. The Result Type is based on Procedure
definitions in the Women's Health Package.
VA-WH PAP SMEAR ORDER
Map local orderable items that represent PAP smear related
orders (e.g., Consult order to Women's Health Clinic).
Use the conditions that indicate the order is not completed,
Women's Health (WH) package, clinical use of the Women's health
discontinued, or cancelled. This reminder term represents
orders pending completion.
VA-WH HPV TESTING NEGATIVE
Any lab test that represents a negative HPV result for high
risk or intermediate risk HPV genotypes should be included in
this term. A sample condition is included in the term
definition. Do not include lab tests that represent low risk
HPV genotypes.
package is not required in order to use this reminder. However, use
A health factor for outside results or for use for results that
are not in Chemistry/Hematology is included in the term.
VA-WH HPV TESTING POSITIVE
Any lab tests that represent positive HPV results for high
or intermediate risk HPV on cervical specimens should be
included in this term. A sample condition is included in the
term definition. If your lab reports separate lab tests for
high/intermediate risk and low risk genotypes, DO NOT include
of the Women's Health package is required in order to use the
the low risk genotype test in this term.
A health factor for outside results or for use for results that
are not in Chemistry/Hematology is included in the term.
FUNCTION FINDINGS:
------------------
Frequency for this reminder will be determined using Function
Findings (FF) logic, which differentiates between completed results,
associated Pap Review results reminder. This screening reminder and
short-term (7D, 4M, 6M) and long term (1Y, 2Y, 3Y, 5Y) resolution
findings.
FF1
Was part of the original national reminder and is replaced
by FF(10) and FF(11)
FF2
Determines whether the most recent finding is VA-WH PAP SMEAR
SCREEN FREQ - 4M and changes the screening frequency to every
four months (4M).
the associated review results reminder dialogs will update the WH The
FF3
Determines whether the most recent finding is VA-WH PAP SMEAR
SCREEN FREQ - 6M and changes the screening frequency to every
six months (6M).
FF4
Determines whether a finding exists for VA-WH PAP SMEAR SCREEN
FREQ 1Y and changes the screening frequency to every year
(1Y).
FF6
Determines whether a finding exists for VA-WH PAP SMEAR SCREEN
associated reminder dialog will update the WH package at the same time
FREQ 3Y and changes the screening frequency to every three
years (3Y).
FF7
Determines whether a finding exists for VA-WH PAP SMEAR SCREEN
NOT INDICATED and changes the frequency to 0D, which will
stop the reminder from being due until some new activity
occurs.
FF8
Determines whether the most recent finding is a VA-WH PAP SMEAR
UNSATISTACTORY IN LAB PKG, which will make the reminder due
clinical care is recorded in CPRS GUI, thus eliminating the need for
again in one day (1D).
FF9
New in this update; allows text to display for prior negative
HPV results and no record of any positive HPV results
FF10
New in this update and along with FF11, replaces the old FF1
Most recent finding is a PAP smear result AND
1) patient <30, or
dual data entry.
2) HPV done and most recent result positive, or
3) no recent negative result of HPV testing
Frequency set to 3Y
FF11
New in this update and along with FF10, replaces the old FF1
Most recent finding is a PAP smear result AND
pt is 30-65, and most recent HPV was done in the past
5Y and was negative
Frequency set to 5Y
FF14
If a clinician entered frequency is entered more recently
than the entry for a hysterectomy, then the hysterectomy
finding (FI(2)) does not remove the patient from the cohort.
This was done for the unusual cases where continued screening
is recommended after removal of the cervix.
screening. In its first release in 2005, this reminder replaced the
In order for this reminder to interface with the Women's Health (WH)
Branching logic is used in the reminder dialog so that the clinician is
prompted to reassess frequency periodically if a prior clinician selected
frequency rather than the baseline frequency is controlling the
reminder. The branching logic also prompts clinician to reassess the
need for continued screening for patients who are older than 74 years.
Continued screening may be indicated in some cases based on prior
abnormal results. The reminder VA-BL WH PAP REVIEW FREQ and a new HS
object:|PAP SMEAR FREQUENCY| are also distributed with this patch for
this purpose.
package as it was originally designed, the WH package must be
2. Use the Reminder Dialog edit option to define the national
reminder dialog finding items which should be updated during CPRS
GUI reminder processing.
Review dialog elements in the national reminder dialog and change
any national health factors to local health factors, if
necessary. It is not unusual for local findings to be used in
your national dialogs. Any local findings used in the national
dialogs should be
installed and maintained. Please refer to the CPRS Integration: Women
Add order dialogs where appropriate for items the primary care
clinician should be able to order for PAP Smear Screening.
3. Alternately, use the Reminder Dialog options to copy the national
dialog, dialog elements, and dialog groups to make local
changes.
Add local dialog elements with local Order Dialogs for additional
Veterans Health (WVH) Install & Setup Guide for detailed instructions.
ordering options for the clinicians. Some sites have clinicians
order a consult to a service that provides PAP smears. If your
site does this, copy the reminder dialog to a local reminder
dialog, then add the local dialog element for the consult order
to the reminder dialog so this practice can continue.
4. If your site chooses not to send letters via the WH package
(sending letters is part of the Review results reminder, not this
reminder), copy the appropriate national dialog components to
local components and remove the findings related to WH
notifications.
The following is a subset of some of the specific features of WH that
must be in place in order for this reminder to work as it was
designed:
* Female veterans should be entered into the WH package.
* SNOMED codes are setup for the PAP SMEAR procedure in the WV
following national reminders relating to PAP smears and cervical
PROCEDURE TYPE file.
* WH parameters should be set up to automatically import PAP
smear
lab reports into the WH package when they are verified in the
VistA Lab package.
* The WV NOTIFICATION PURPOSE letters should be customized to
reflect site information and the correct letter content for
each type of letter.
* The Notification Purpose treatment need and treatment need
date offset should be defined if appropriate. These new fields
cancer screening:
will be used to update Women's Health data when purpose of
notifications are selected by clinicians from reminder
dialogs.
* The reminder dialog definitions should reference the
appropriate WV NOTIFICATION PURPOSE.
Setup of reminder terms and reminder dialogs before using this
reminder:
==============================================================
1. Use the Reminder Term options to map local representations of
findings:
PATIENT COHORT FINDINGS:
------------------------
The following reminder terms determine whether the reminder applies
to the patient.
VA-WH HYSTERECTOMY W/CERVIX REMOVED
No mapping necessary. Use the VA-WH HYSTERECTOMY W/CERVIX
REMOVED reminder taxonomy distributed with this term. Note
VA-*CERVICAL CANCER SCREEN
the VA-CERVICAL CA/ABNORMAL PAP reminder taxonomy is now
used for information only and should not be mapped to this
reminder term since it contains codes where the cervix may
not have been removed.
This reminder term is also mapped to the new health factor
WH HYSTERECTOMY W/CERVIX REMOVED.
RESOLUTION FINDINGS:
VA-PAP SMEAR
--------------------
The following reminder terms resolve the reminder. These resolution
terms are defined with a "Use in Resolution Logic", but no Frequency.
Frequency for this reminder will be determined by Function Findings
(FF) logic, which examines the most recent findings:
* If Function Findings determine that the most recent finding
is a result, the baseline age and frequency will be used.
* If Function Findings determine that an information finding
|
| CUSTOMIZED COHORT LOGIC | (SEX)&(AGE)&'(FI(2)&FF(14)) |
| INTERNAL PATIENT COHORT LOGIC | (SEX)&(AGE)&'(FI(2)&FF(14)) |
| PATIENT COHORT FINDINGS COUNT | 4 |
| PATIENT COHORT FINDINGS LIST | SEX;AGE;2;FF14 |
| INTERNAL RESOLUTION LOGIC | (0)!FI(4)!FI(5)!FI(6)!FI(7)!FI(8)!FI(9)!FI(10)!FI(11) |
| RESOLUTION FINDINGS COUNT | 8 |
| RESOLUTION FINDINGS LIST | 4;5;6;7;8;9;10;11 |
| AGE FINDINGS COUNT | 11 |
| AGE FINDINGS LIST | 10;FF1;FF2;FF3;FF4;FF5;FF6;FF7;FF8;FF10;FF11 |
| INFORMATION FINDINGS COUNT | 16 |
| INFORMATION FINDINGS LIST | 1;12;13;14;15;16;17;18;19;20;21;22;23;FF12;FF13;FF9 |
| WEB SITES |
|
| # OF GEN. COHORT FOUND LINES | 0 |
| # GEN. COHORT NOT FOUND LINES | 0 |
| # GEN. RES. FOUND LINES | 0 |
| # GEN. RES. NOT FOUND LINES | 0 |
| BASELINE AGE FINDINGS |
|
| # SUM. COHORT FOUND LINES | 0 |
| # SUM. COHORT NOT FOUND LINES | 0 |
| # SUM. RES. FOUND LINES | 0 |
| # SUM. RES. NOT FOUND LINES | 0 |