“IHE-J Endoscopy” The concept of Japanese activities

1. “IHE-J Endoscopy”The concept of Japanese activities Hideto Yokoi (IHE-Japan Endoscopy Working Group) IHE Endoscopy with DICOM WG13

2. Outline • Background • Summarize the activities by IHE-J in digestive endoscopy scene • Characteristics of workflow of endoscopy • Discussion IHE Endoscopy with DICOM WG13

3. What is an “Endoscopy” Endoscope Main targets: Digestive tracts Bronchial tubes… Variety of “Endoscope” Laparoscope Capsule endoscope… Biopsy Forceps IHE Endoscopy with DICOM WG13

4. Standardization in digestive endoscopy scene • Standardization of contents • Data models • MST • Standardization of communication. • Protocols for communication between systems • HL7 (using commonly in US endoscopy scene) • DICOM (discuss in WG13, contents(tag), movie format… ) • IHE Endoscopy has a international terminology. OMED (World Organisation of Digestive Endoscopy) supporting IHE-J endoscopy WG IHE Endoscopy with DICOM WG13

5. Activities of IHE-J Endoscopy WG • Technical Framework I Japanese version completed, Public comments invited: April 2006 • The English version created: September 2006 • TF II is now being created (by JAHIS) • Preparation for implementation is being conducted in Kagawa University Hospital • By Olympus, Fujitsu, JR west, DGS computer, Seafic software • Mutual connection with DICOM WG13 (Visible Light) • Informal meeting in RSNA 2006: November 29 • Plan: Connectathon in 2007, Year 2 document (discussion of new scenarios such as colonoscopy and laparoscopy) IHE Endoscopy with DICOM WG13

6. Ｒｄ Ｐｔ Ｐｔ Ｐｔ The Workflow of Radiology Radiologist Ordering System ReportDB PACS RIS Order for Study Report Physician Radiological Technician Image Acquisition Outpatient Service after the study Order and Reservation IHE Endoscopy with DICOM WG13

7. Result Ｐｔ Ｐｔ Ｐｔ Ｐｔ The Workflow of Endoscopy Pathology Dpt. Pathology System Ordering System Endoscopy System Report DB PACS Order of Pathological Study Order for Study Nurse Physician Endoscopist Order and Reservation Outpatient Service after the study Endoscopy Study Pre-medication IHE Endoscopy with DICOM WG13

8. The Comparison Survey between Endoscopy and Radiology Chiba University Hospital 2004. June ※excluding RI, radiation therapy IHE Endoscopy with DICOM WG13

9. The Workflow Comparison between Endoscopy and Radiology IHE Endoscopy with DICOM WG13

10. Discussion • IHE-J decided that the radiology SWF could not satisfy endoscopists’ demand. • IHE-J established “Endoscopy SWF”. IHE Endoscopy with DICOM WG13

11. 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 IHE “Scheduled Workflow” of Radiology Blue: HL7 Messages Green: DICOM Messages IHE Endoscopy with DICOM WG13

12. Connecting with “Pathology System” Including “Reporting Workflow” IHE-J “Endoscopy Scheduled Workflow” IHE Pathology ADT 1 Patient Registration 1 Patient Registration 12 Patient Update 12 Patient Update Pathology Order Placer 2 Placer Order Management e-Order Filler Order Placer 3 Filler Order Management Pathology Order Filler 6 Modality PPS in Progress 7 Modality PPS Completed Pathology order “request” Pathology order ID PPS for Pre/Post-treatment procedure 4 Procedure Scheduled 12 Patient Update 13 Procedure Update Pt. Status [ENDO-1] Status of Pre / Post-treatment Extension of worklist 14 Query Images 15 Query Presentation State 16 Retrieve Images 17 Retrieve Presentation State Image Manager Image Archive 6 Modality PPS in Progress 7 Modality PPS Completed 11 Image Availability Query e-PPS Manager 8 Modality Image Stored 9 Modality Presentation State Stored 10 Storage Commitment 5 Modality Worklist Provided Acquisition Modality 6 Modality PPS in Progress 7 Modality PPS Completed Pathology Order ID Ready [ENDO-3] Pathology Order ID Request [ENDO-4] Order Manager Report Creator Image Display 6 Modality PPS in Progress 7 Modality PPS Completed Pathology Specimen ID Request / Acquisition[ENDO-5] Path Order ID Request / Acquisition[ENDO-4] 24 Report Submission Report Ready [ENDO-2]↑ Specimen Label Printer Specimen Manager Report Status Completed [ENDO-6] 6 Modality PPS in Progress 7 Modality PPS Completed Report Manager Report Status Completed [ENDO-6] 25 Report Issuing E-Order Filler，e-PPS Manager Having extended specification for Endoscopy e-Order Filler Managing Pathology order and Endoscopy process e-PPS Manager Managing Modality PPS and Endoscopy process Actor Transaction RAD HL7 Messages DICOM Messages ENDO for Pathology Order Others Report Repository “Endo” Original From “Rad” HIS Extra 26 Query Report 27 Retrieve Report Human’s Input triggering “Actor” Report Reader IHE Endoscopy with DICOM WG13

13. What is a workflow fitting endoscopy scene? • The workflow needs an interaction with pathology department system. • Decided to have transactions for the linkage information between Endoscopy order/report and Pathology order/report. • The interaction needs endoscopy report describing where & how specimens were gotten. • Included “Reporting workflow” in the “Endoscopy SWF”. IHE Endoscopy with DICOM WG13

14. An ideal data structure for endoscopists • How do we handle a primary exam and secondary exam? • Endoscopy record • finding • Pathology report • (Procedure record) • Analytic report from Lab (biochemical test, germ culture etc.) • (Procedure record) • (Procedure record) • “Procedure record” • Financial data for insurance • Used material or/and device for logistics IHE Endoscopy with DICOM WG13

15. Report of endoscopy There is “Ulcer” in the stomach. stage: A1 Bleeding: (+) … biopsy:1. from the side of ulcer :2. oral side of 1. Endoscopy Image 1. 2. 1. 2. Pathology results GUI image that we want Window of EMR 1. Group 1: ulcer • Group 3: anomaly • of some cells… IHE Endoscopy with DICOM WG13

16. Discussion for “Pathology Order” from endoscopy reporting system.[We met an obstacle.] • The issue is discussed in Message Exchange Standard Committee in JAHIS • Many Japanese HIS are integrated by CPOE (computer physician order entry) system. • The CPOE is working as a “hub” integrating some department systems in Japanese hospitals. • Basically, CPOE does not accept the orders from department systems (only from physician’s console acceptable). IHE Endoscopy with DICOM WG13

17. System scheme in Japan RIS Laboratory information system Order Filler Order Filler Reporting system CPOE ADT Pathology information system Endoscopy information system Order Placer Order Filler Order Filler Reporting system Reporting system … … Order Filler Order Filler IHE Endoscopy with DICOM WG13

18. Thank you. The Member of IHE-J Endoscopy WG Masaru Ikeda Olympus Medical Systems Corp. Hitoshi Yoshimura Konica-Minolta MG Corp. Tsutomu Kawano Nihon Koden Corp. Masaki Ito SumishoElectronicsCo., Ltd. Kiyoshi Inoue Fujinon Toshiba ES Systems Co., Ltd. Takatoshi Yamanaka Fujitsu Corp. Shigeru Bito Seafic Software Corporation Nobuo Okazaki University of Arizona Masayuki A. Fujino Yokohama Seamen's Insurance Hospital Secretariat: JAHIS (Japanese Association of Healthcare Information Systems Industry), JIRA (Japan Industries Association of Radiological Systems) IHE Endoscopy with DICOM WG13

19. Current state of Japan’ IHE activity • The “Japan IHE Association” established in April 2007 • The sponsor is shifting from Ministry of Economy, Trade and Industry (METI) to Ministry of Health, Labour and Welfare (MHLW) • The change is hoped to lead the rapid spread of IHE in Japanese medical scene IHE Endoscopy with DICOM WG13

20. Our scope • To establish another “Endoscopy” profiles • Bronchoscopy • Laparoscopy • Capsule endoscopy… • Think about basic of DICOM protocol • MWM, MPPS are comfortable for endoscopy? IHE Endoscopy with DICOM WG13