“ IHE Endoscopy ” should be a formal domain of the IHE

1. “IHE Endoscopy” should be a formal domain of the IHE May2007 Endoscopy IHE-WG JAHIS (Japanese Association of Healthcare Information System Industry) Masaru Ikeda ( OPLYMPUS MEDICAL SYSTEMS Corp.)

2. DOMAINS There is no Endoscopy domain yet. Radiology Cardiology IT Infrastructure Laboratory Pathology Radiation therapy Endoscopy Ophthalmology

3. What I want to say… A new domain of the IHE for the endoscopy should be assumed to be made, and the domain to be formal. Because • The IHE work flow of radiology doesn't meet endoscopy. Workflow of endoscopy is different from radiology’s examination. But • Some people who not relate to endoscope think that endoscope is same as radiology’s modality . • Doesn’t it need to make new domain for endoscope, do it? Therefore • The WG that can be discussed by member who relate to the endoscope gathering is necessary. “IHE Endoscopy WG” in U.S.A.It becomes our partner

4. Out of scope in today’s discussion • Progress report of our activity Of course, evaluating the progress of the specified vender also • Have the difference between the radiology examination and the endoscopy understood. It is difficult to explain to the people who don’t relate to endoscopy like radiologist. Even if it is an explanation in Japanese by the same Japanese. I want you to understand there is the difference, not understood detailed differences. However, explains difference only a little next.

5. Difference between Radiology and Endoscopy For instance, • Who does use modality ? Who does examine? • Difference of working range done by examination once. • until the image is acquired? • until writing a paper? • Are there any order to pathology for the inspection of the specimen material? Use-case is not the same as radiology’s

6. Pt.Registration ADT Pt.Registration Order Filler Order Placer Order Management Procedure Scheduled Creator PPS Image Creator Storage Commitment Image Stored PPS PPS Manager Image Manager Image Archive Q/R Images Image Display PPS Storage Commitment Image Stored Modality PPS Acquisition Modality Modality Worklist Radiology Scheduled Workflow Blue: HL7 Messages Green: DICOM Messages

7. 2007/01/26 Scheduled Workflow for Endoscopy2007/01/25 Defined in Pathology field ADT 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS 1 Pt.Registration 21 Pt.Update 1 Pt.Registration 21 Pt.Update Placer Order Management e-Order Filler Order Placer Pathology Order Filler 2 Placer Order Management 3 Filler Order Management 23 Demand for Path. Order State of Filler show demand for pathology Filler Order Management OP confirms state of OF and order to Pathology’s OF 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update 4 Procedure Scheduled e-PPS Manager Pre/Post Procedure Terminal Image Manager Image Archive 13 Image Availability Query 7 Modality PPS in Progress 9 Modality PPS Completed 10 Modality Image Stored （11 Modality Presentation State Stored） 12 Storage Commitment 5 Modality Worklist Provided Acquisition Modality 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided Specimen Manager Specimen Ｌａｂｅｌ Printer 8 Specimen PPS　（return by DICOM instance number） 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 5 Modality Worklist Provided Report Creator Image Display 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) 22 GPPPS report finished/Order to Path. 　　（Endoscope report completion notification/pathology inspection request notification） (define at GPPPS Part16; it may be UPPPS?） 18 Report Submission Report Manager 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Blue: HL7 Messages Green: DICOM Messages 19 Report Issuing Human’s action Report Repository Report Reader 20 Query Report 21 Retrieve Report

8. About Real system • Though you might say that you want to see a real system, to know about them. • We are at the stage where WG should be made for defining Technical Framework to make a real machine. • As for saying as the discussion based on a real machine, the step is reverse. • If you wants to understand the image of the information system for endoscopy, it is possible to see present system that isn’t on the IHE.

9. As for a system now at the time of not being in IHE, the requirements of the endoscopy is included. Therefore, If you want to understand workflow and differences, It‘s better to study present system than halfway system. It is thought that the disadvantage where extra confusion is caused is larger even if it examines it based on a halfway evaluation system.

10. The present conditions • There is “Endoscopy IHE Working Group” only in Japan. It is acting in the industry association of the JAHIS. • We can discuss about use-case of Japan. • But we don’t do them about other country. • Then, also we can’t decide baseline of TF “Endoscopy IHE” for International . If there would be partner of another country, our progress will advance earlier. Present : Local activity – in Japan Future : International activity there will be partners in many country

11. What should we do? • make WG in U.S.A • invite Endoscopists, Venders and other specialists of the IHE • Who have to do them? • How should it advance? • What Organization should be a base? • DICOM International Committee • IHE Inc. • Other We need your help and advice.

12. Conclusion The following is necessary to evaluate “Endoscopy IHE” as an official domain of the “IHE”. • Stand and put up working group to argue about “endoscopy IHE” in U.S.A. (also in Europe) • Endoscopists, experts of medical information and related vendors in U.S.A. should be member of the “endoscopy IHE working group”in U.S.A. (Even WG for preparations is good) • Japan and U.S.A., each WG cooperates and works on a new endoscopy domain in the “IHE”, and widen activity worldwide. • Advice and backup of the IHE Inc. are necessary.

13. The current result • Review and renewal of Volume1 • Examination of lower digestive tract • The above part digestive organs and lower digestive organs are integrated as digestive organs, and it reflects it in the work flow. • Adjustment with pathology IHE-WG • Materialization of mechanism of specimen material inspection request to pathology section • Technical framework Volume2 examination begins. • Examination of message for order by HL7 • Enlightenment to digestive organs endoscope society • Route securing for thesis submission • Thesis submission

14. for instance • Show Defining HL7 message for request of examination of specimen next page. It is progressing now.

15. Order information exchange that centers on HIS case of Japan Order is done by HIS. Order to the other department passes HIS. Department system Department system Order Filler Order Filler HIS There is specimen ADT Endoscopy system Pathology system Order to pathology Order Filler Order Filler Order Placer There is specimen There is specimen HIS controls the flow of information in the hospital. Department system Department system Order Filler Order Filler

18. next • We will make Endoscopy TF Volume2. • HL7 message for Endoscopy IHE It will makes from the industry association of the JAHIS, and it provides. • DICOM message for Endoscopy IHE Basic idea will make from the industry association of the JIRA, and it propose. • Get Public comments • Public • Volume1 • Update Ver.2 • Translate to English • World wide • DDW, Other meeting • Enlightenment for spread • Related society • support contribution of thesis etc.

19. END

20. 2007/01/26 Scheduled Workflow for Endoscopy2007/01/25 病理IHEでの 定義範囲 ADT 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS 1 Pt.Registration 21 Pt.Update 1 Pt.Registration 21 Pt.Update Placer Order Management e-Order Filler Order Placer Pathology Order Filler 2 Placer Order Management 3 Filler Order Management 23 Demand for Path. Order Fillerが病理検査オーダ有りの状態を示す Filler Order Management 内視鏡のFillerにおける病理検査オーダ 有りのステートをPlacerが確認して、病理 へ検査オーダを出す 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update 4 Procedure Scheduled e-PPS Manager Pre/Post Procedure Terminal ○　病理オーダに関する要件 ・病理部門へのオーダは各部門からのオーダ発行でもかまわない。 　つまり、HIS上のOPからのオーダでなくとも、部門から直接OPでオーダされても良い。 ・ただし、院内で統一的に管理されたオーダ番号である必要がある。 ・院内で統一管理されたオーダ番号を生成機能があれば良い。 ・各OPは、そのオーダ番号をもらってオーダを発行すればよい。 ○　検体番号に関する要件 ・検体番号は、病院内で重複しないユニークなもので有れば良い。 ・これが保証されれば各部門で管理生成されて良い。 ・オーダ時にオーダ番号に検体番号の紐付けをして発行すればよい。 例 　検体番号＝内視鏡へのオーダ番号＋枝番 　検体番号＝内視鏡へのオーダ番号＋内視鏡室内シリアル附番 　検体番号＝何らかの院内統一番号（＋枝番orシリアル番号） 　　　　　・ 　　　　　・ Image Manager Image Archive 13 Image Availability Query 7 Modality PPS in Progress 9 Modality PPS Completed 10 Modality Image Stored （11 Modality Presentation State Stored） 12 Storage Commitment 5 Modality Worklist Provided Acquisition Modality 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided Specimen Manager Specimen Ｌａｂｅｌ Printer 8 Specimen PPS　（DICOMのインスタンスナンバーで返す） 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 5 Modality Worklist Provided Report Creator Image Display 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) オーダ番号生成機能 Order Placerの情報源の一つ 　院内で統一管理されている 　（サーバ？） 22 GPPPS report finished/Order to Path. 　　（内視鏡レポート完了通知／病理検査依頼通知） GPPPS Part16 に登録して使う UPPPSへ変わる可能性有り） 18 Report Submission Report Manager 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Blue: HL7 Messages Green: DICOM Messages 19 Report Issuing 人間の端末操作による入力 Report Repository Report Reader Modality Presentation State Stored；今のところ該当するモダリティは無いので、省略可 同様にQuery Presentation State及びRetrieve Presentation Stateも省略可能 20 Query Report 21 Retrieve Report

21. オーダ番号 ENDO20061211 検体番号 ENDO20061211-2 2007/01/26 Scheduled Workflow for Endoscopy2007/01/25 見直し修正案　 病理IHEでの 定義範囲 ADT 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS 1 Pt.Registration 21 Pt.Update 1 Pt.Registration 21 Pt.Update Placer Order Management e-Order Filler Order Placer Pathology Order Filler 2 Placer Order Management 3 Filler Order Management 23 Demand for Path. Order Fillerが病理検査オーダ有りの状態を示す Filler Order Management 内視鏡のFillerにおける病理検査オーダ 有りのステートをPlacerが確認して、病理 へ検査オーダを出す 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update 4 Procedure Scheduled e-PPS Manager Pre/Post Procedure Terminal Image Manager Image Archive 13 Image Availability Query 7 Modality PPS in Progress 9 Modality PPS Completed 10 Modality Image Stored （11 Modality Presentation State Stored） 12 Storage Commitment 5 Modality Worklist Provided Acquisition Modality 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided Specimen Manager Specimen Ｌａｂｅｌ Printer 8 Specimen PPS　（DICOMのインスタンスナンバーで返す） 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 5 Modality Worklist Provided Report Creator Image Display 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) ○Specimen Managerに対する要件 ・ Specimen Managerは検体ラベルプリンタと一緒にして、一つのモダリティ扱いとする。 ・つまり、画像の代わりにバーコード及び関連テキストが印刷されたラベルが生成されると言う考え。 ・画像発生モダリティと同じようにMWLを受けて動作する。 ・画像番号に対して検体番号が対応する。 ・ただし、インスタンスUIDではなく、インスタンスナンバーを用いる。 ・生検が発生しなかった場合はラベル印刷が発生しないがDICOMとしての問題は無い。 22 GPPPS report finished/Order to Path. 　　（内視鏡レポート完了通知／病理検査依頼通知） GPPPS Part16 に登録して使う UPPPSへ変わる可能性有り） 18 Report Submission Report Manager 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Blue: HL7 Messages Green: DICOM Messages 19 Report Issuing 人間の端末操作による入力 Report Repository Report Reader Modality Presentation State Stored；今のところ該当するモダリティは無いので、省略可 同様にQuery Presentation State及びRetrieve Presentation Stateも省略可能 20 Query Report 21 Retrieve Report

22. 2007/01/26 Scheduled Workflow for Endoscopy2007/01/25 見直し修正案　 病理IHEでの 定義範囲 ADT 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS 1 Pt.Registration 21 Pt.Update 1 Pt.Registration 21 Pt.Update Placer Order Management e-Order Filler Order Placer Pathology Order Filler 2 Placer Order Management 3 Filler Order Management 23 Demand for Path. Order Fillerが病理検査オーダ有りの状態を示す Filler Order Management 内視鏡のFillerにおける病理検査オーダ 有りのステートをPlacerが確認して、病理 へ検査オーダを出す 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update 4 Procedure Scheduled e-PPS Manager Pre/Post Procedure Terminal Image Manager Image Archive 13 Image Availability Query 7 Modality PPS in Progress 9 Modality PPS Completed 10 Modality Image Stored （11 Modality Presentation State Stored） 12 Storage Commitment オーダ情報では、検体番号と依頼内容の情報が含まれる 5 Modality Worklist Provided Acquisition Modality 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided Specimen Manager Specimen Ｌａｂｅｌ Printer 8 Specimen PPS　（DICOMのインスタンスナンバーで返す） 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 5 Modality Worklist Provided 宿題 オーダ時に具体的にどのような情報が送受信されるのかというサンプルを用意すること！ Report Creator Image Display 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) 22 GPPPS report finished/Order to Path. 　　（内視鏡レポート完了通知／病理検査依頼通知） GPPPS Part16 に登録して使う UPPPSへ変わる可能性有り） 18 Report Submission Report Manager 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Blue: HL7 Messages Green: DICOM Messages 19 Report Issuing 人間の端末操作による入力 Report Repository Report Reader Modality Presentation State Stored；今のところ該当するモダリティは無いので、省略可 同様にQuery Presentation State及びRetrieve Presentation Stateも省略可能 20 Query Report 21 Retrieve Report