VA-WH PAP SMEAR SCREENING (121)    REMINDER DEFINITION (811.9)

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
  1. EDIT DATE:   2013-07-16 10:25:29
    EDIT BY:   USER,SEVENTEEN
    EDIT COMMENTS:   
    Exchange Install
    
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
  1. FINDING ITEM:   VA-AGE
    CONDITION:   I V>29&(V<66)
    INTERNAL CONDITION:   I V>29&(V<66)
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  2. FINDING ITEM:   VA-WH PAP SMEAR SCREEN DEFER
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    REMINDER FREQUENCY:   4M
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-4M
  3. FINDING ITEM:   VA-WH PAP SMEAR UNSATISFACTORY IN LAB/WH PKG
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  4. FINDING ITEM:   VA-WH PAP SMEAR SCREEN FREQ - 4M
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  5. FINDING ITEM:   VA-WH PAP SMEAR SCREEN FREQ - 6M
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  6. FINDING ITEM:   VA-WH PAP SMEAR SCREEN FREQ - 1Y
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  7. FINDING ITEM:   VA-WH PAP SMEAR SCREEN FREQ - 2Y
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  8. FINDING ITEM:   VA-WH PAP SMEAR SCREEN FREQ - 3Y
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  9. FINDING ITEM:   VA-WH HYSTERECTOMY
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  10. FINDING ITEM:   VA-WH HX CERVICAL CANCER/ABNORMAL PAP
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  11. FINDING ITEM:   VA-WH PAP SMEAR ORDER
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  12. FINDING ITEM:   VA-WH HYSTERECTOMY W/CERVIX REMOVED
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   AND NOT
  13. FINDING ITEM:   VA-WH HPV TESTING NEGATIVE
    WITHIN CATEGORY RANK:   0
    CONDITION CASE SENSITIVE:   NO
    OCCURRENCE COUNT:   4
    USE STATUS/COND IN SEARCH:   YES
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   1
    NOT FOUND TEXT:   
    No record of any prior negative cervical HPV testing.
    
    BEGINNING DATE/TIME:   T-5Y
  14. FINDING ITEM:   VA-WH HPV TESTING POSITIVE
    WITHIN CATEGORY RANK:   0
    CONDITION CASE SENSITIVE:   NO
    OCCURRENCE COUNT:   2
    USE STATUS/COND IN SEARCH:   YES
    NO. OF FOUND TEXT LINES:   3
    NO. NOT FOUND TEXT LINES:   0
    FOUND TEXT:   
    Prior HPV testing positive for intermediate or high risk HPV type.
    Frequency of screening for cervical cancer should be adjusted
    appropriately.
    
  15. FINDING ITEM:   VA-AGE
    CONDITION:   I V<30
    INTERNAL CONDITION:   I V<30
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  16. FINDING ITEM:   VA-WH PAP SMEAR SCREEN FREQ - 5Y
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  17. FINDING ITEM:   VA-WH PAP SMEAR SCREEN IN WH PKG
    OCCURRENCE COUNT:   3
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  18. FINDING ITEM:   VA-WH PAP SMEAR SCREEN IN LAB PKG
    OCCURRENCE COUNT:   3
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  19. FINDING ITEM:   VA-WH PAP SMEAR DONE
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  20. FINDING ITEM:   VA-WH PAP SMEAR OBTAINED
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-7D
  21. FINDING ITEM:   VA-WH PAP SMEAR ORDER HEALTH FACTOR
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-9M
  22. FINDING ITEM:   VA-WH PAP SMEAR SCREEN NOT INDICATED
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
FUNCTION FINDINGS
  1. FUNCTION FINDING NUMBER:   1
    FOUND TEXT:   
    PAP smear screening every 5 years specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    MINIMUM AGE:   30
    REMINDER FREQUENCY:   5Y
    FUNCTION STRING:   (MRD(9,12,13,14,15,16,23)=MRD(23))&(MRD(23)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  2. FUNCTION FINDING NUMBER:   10
    FOUND TEXT:   
    A PAP smear result is the most recent finding.
    
    LOGIC:   ($P(FN(1),".")'<($P(FN(2),".")))&(FN(1)>0)&((FN(4)&FN(5)>FN(6))!'FN(7)!FN(8))
    MINIMUM AGE:   18
    MAXIMUM AGE:   65
    REMINDER FREQUENCY:   3Y
    FUNCTION STRING:   ($P(MRD(4,5,6),".")'<($P(MRD(7,8,9,10,11),".")))&(MRD(4,5,6)>0)&((FI(21)&MRD(21)>MRD(20))!'FI(20)!FI(22))
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    4. FUNCTION NUMBER:   4
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    5. FUNCTION NUMBER:   5
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    6. FUNCTION NUMBER:   6
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    7. FUNCTION NUMBER:   7
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    8. FUNCTION NUMBER:   8
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  3. FUNCTION FINDING NUMBER:   11
    FOUND TEXT:   
    A PAP smear result is the most recent finding.
    The most recent HPV testing was negative and the patient is ages 30-65.
    
    LOGIC:   ($P(FN(1),".")'<($P(FN(2),".")))&(FN(1)>0)&(FN(4)&(FN(5)>FN(6))&FN(7))
    MINIMUM AGE:   30
    MAXIMUM AGE:   65
    REMINDER FREQUENCY:   5Y
    FUNCTION STRING:   ($P(MRD(4,5,6),".")'<($P(MRD(7,8,9,10,11),".")))&(MRD(4,5,6)>0)&(FI(20)&(MRD(20)>MRD(21))&FI(1))
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    4. FUNCTION NUMBER:   4
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    5. FUNCTION NUMBER:   5
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    6. FUNCTION NUMBER:   6
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    7. FUNCTION NUMBER:   7
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  4. FOUND TEXT:   
    Negative HPV result, patient < age 30.  5year screening interval is NOT 
    recommended for patients less than age 30.
    
    LOGIC:   FN(1)&FN(2)
    FUNCTION STRING:   FI(20)&FI(22)
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  5. FOUND TEXT:   
     
    No prior HPV testing found.  
    \\
    
    LOGIC:   FN(1)&'FN(2)&'FN(3)
    FUNCTION STRING:   FI(1)&'FI(20)&'FI(21)
    NO. FOUND TEXT LINES:   3
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  6. FOUND TEXT:   
    \\
    A frequency for repeat Pap smears was entered more recently than the 
    entry for hysterectomy.
    
    LOGIC:   FN(1)>FN(2)
    FUNCTION STRING:   MRD(2)>MRD(12,13,14,15,16,23)
    NO. FOUND TEXT LINES:   3
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  7. FUNCTION FINDING NUMBER:   2
    FOUND TEXT:   
    PAP smear screening every 4 months specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    REMINDER FREQUENCY:   4M
    FUNCTION STRING:   (MRD(9,12,13,14,15,16,23)=MRD(12))&(MRD(12)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  8. FUNCTION FINDING NUMBER:   3
    FOUND TEXT:   
    PAP smear screening every 6 months specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    REMINDER FREQUENCY:   6M
    FUNCTION STRING:   (MRD(9,12,13,14,15,16,23)=MRD(13))&(MRD(13)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  9. FUNCTION FINDING NUMBER:   4
    FOUND TEXT:   
    Annual PAP smear screening specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    MINIMUM AGE:   18
    REMINDER FREQUENCY:   1Y
    FUNCTION STRING:   (MRD(9,12,13,14,15,16,23)=MRD(14))&(MRD(14)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  10. FUNCTION FINDING NUMBER:   5
    FOUND TEXT:   
    PAP smear screening every 2 years specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    MINIMUM AGE:   18
    REMINDER FREQUENCY:   2Y
    FUNCTION STRING:   (MRD(9,12,13,14,15,16,23)=MRD(15))&(MRD(15)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  11. FUNCTION FINDING NUMBER:   6
    FOUND TEXT:   
    PAP smear screening every 3 years specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    MINIMUM AGE:   18
    REMINDER FREQUENCY:   3Y
    FUNCTION STRING:   (MRD(9,12,13,14,15,16,23)=MRD(16))&(MRD(16)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  12. FUNCTION FINDING NUMBER:   7
    FOUND TEXT:   
    PAP smear screening not clinically indicated for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    REMINDER FREQUENCY:   0Y
    FUNCTION STRING:   (MRD(9,12,13,14,15,16,23)=MRD(9))&(MRD(9)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  13. FUNCTION FINDING NUMBER:   8
    FOUND TEXT:   
    The most recent PAP smear result in the Lab or Women's Health package was
    unsatisfactory.  The PAP smear needs to be repeated.
    
    LOGIC:   ($P(FN(1),".")=($P(FN(2),".")))&(FN(2)>0)
    REMINDER FREQUENCY:   1D
    FUNCTION STRING:   ($P(MRD(4,5,6,7,8,9,10,11),".")=($P(MRD(11),".")))&(MRD(11)>0)
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  14. FOUND TEXT:   
    Prior negative HPV results and no record of any positive HPV results.
    
    LOGIC:   FN(1)&'FN(2)
    FUNCTION STRING:   FI(20)&'FI(21)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
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
  1. URL:   http://vaww.prevention.domain.ext/Screening_for_Cervical_Cancer.asp
    WEB SITE TITLE:   VHA Guidance for Cervical Cancer Screening
    WEB SITE DESCRIPTION:   
    VHA Cervical Cancer Screening Guidance Statement for VHA clinical staff
    
  2. URL:   http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm
    WEB SITE TITLE:   US Preventive Services - Cervical Cancer Screening
    WEB SITE DESCRIPTION:   
    US Preventive Services Task Force Screening for Cervical Cancer web site.
    
  3. URL:   http://www.asccp.org/ConsensusGuidelines/UpdatedConsensusGuidelines/tabid/14181/Default.aspx
    WEB SITE TITLE:   American Society for Colposcopy and Cervical pathology
    WEB SITE DESCRIPTION:   
    ASCCP 2012 Updated Consensus Guidelines for Managing Abnormal Cervical
    Cancer Screening Tests and Cancer 
    
# 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
  1. REMINDER FREQUENCY:   3Y
    MINIMUM AGE:   21
    MAXIMUM AGE:   65
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
# SUM. COHORT FOUND LINES 0
# SUM. COHORT NOT FOUND LINES 0
# SUM. RES. FOUND LINES 0
# SUM. RES. NOT FOUND LINES 0