1
IHE-J EndoscopyThe concept of Japanese
activities

• Hideto Yokoi
• (IHE-Japan Endoscopy Working Group)

2
Outline

• Background
• Summarize the activities by IHE-J in digestive
  endoscopy scene
• Characteristics of workflow of endoscopy
• Discussion

3
What is an Endoscopy
Endoscope
Main targets Digestive tracts Bronchial
tubes Variety of Endoscope Laparoscope Capsu
le endoscope
Biopsy Forceps
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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
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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)

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The Workflow of Radiology
Radiologist
ReportDB
Ordering System
PACS
RIS
Order for Study
Report
Physician
Radiological Technician
Image Acquisition
Outpatient Service after the study
Order and Reservation
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The Workflow of Endoscopy
Pathology Dpt.
Pathology System
Ordering System
Report DB
Endoscopy System
PACS
Order of Pathological Study
Order for Study
Nurse
Physician
Endoscopist
Order and Reservation
Outpatient Service after the study
Endoscopy Study
Pre-medication
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The Comparison Survey between Endoscopy and
Radiology
Chiba University Hospital 2004. June
Order Endoscopy Radiology(?)
Modified 315 ( 48.2) 135 ( 1.2)
Ordinary 339 ( 51.8) 11542 ( 98.8)
Total 654 (100.0) 11677 (100.0)
? excluding RI, radiation therapy
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The Workflow Comparison between Endoscopy and
Radiology
Item Radiology Endoscopy
Operators Mainly Radiological Technicians Endoscopists (Doctors)
Pre-treatment Mainly Contrast Medium Suppressant of GI, GI cleansing, Anesthesia, Sedation
Frequency of Order Modifications Rarely Frequently
Additional Order Not so many i.e. biopsy
Reporting Mainly Freetext Using MST
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Discussion

• IHE-J decided that the radiology SWF could not
  satisfy endoscopists demand.
• IHE-J established Endoscopy SWF.

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IHE Scheduled Workflow of Radiology
Blue HL7 Messages Green DICOM Messages
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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 Manager
Specimen Label Printer
Report Status Completed ENDO-6
6 Modality PPS in Progress 7 Modality PPS
Completed
Report Manager
Report Status Completed ENDO-6
25 Report Issuing
Transaction RAD HL7 Messages
DICOM Messages ENDO for Pathology
Order Others
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
Report Repository
From Rad
Endo Original
HIS
Extra
26 Query Report 27 Retrieve Report
Humans Input triggering Actor
Report Reader
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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.

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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

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GUI image that we want
Window of EMR
Date Event
2007-05-22 Endoscopy (EGD)
Pathology (biopsy from stomach)
Germ culture

1. Group 1 ulcer

• Group 3 anomaly
• of some cells

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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 physicians console
  acceptable).

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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
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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 Sumisho Electronics Co., 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)

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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

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Our scope

• To establish another Endoscopy profiles
• Bronchoscopy
• Laparoscopy
• Capsule endoscopy
• Think about basic of DICOM protocol
• MWM, MPPS are comfortable for endoscopy?