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“IHE-J Endoscopy” The concept of Japanese activities. Hideto Yokoi (IHE-Japan Endoscopy Working Group). Outline. Background Summarize the activities by IHE-J in digestive endoscopy scene Characteristics of workflow of endoscopy Discussion. What is an “Endoscopy”. Endoscope.

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Ihe j endoscopy the concept of japanese activities

“IHE-J Endoscopy”The concept of Japanese activities

Hideto Yokoi

(IHE-Japan Endoscopy Working Group)

IHE Endoscopy with DICOM WG13


Outline
Outline

  • Background

  • Summarize the activities by IHE-J in digestive endoscopy scene

    • Characteristics of workflow of endoscopy

  • Discussion

IHE Endoscopy with DICOM WG13


What is an endoscopy
What is an “Endoscopy”

Endoscope

Main targets:

Digestive tracts

Bronchial tubes…

Variety of “Endoscope”

Laparoscope

Capsule endoscope…

Biopsy Forceps

IHE Endoscopy with DICOM WG13


Standardization in digestive endoscopy scene
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


Activities of ihe j endoscopy wg
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


The workflow of radiology

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


The workflow of endoscopy

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


The comparison survey between endoscopy and radiology
The Comparison Survey between Endoscopy and Radiology

Chiba University Hospital

2004. June

※excluding RI, radiation therapy

IHE Endoscopy with DICOM WG13



Discussion
Discussion

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

  • IHE-J established “Endoscopy SWF”.

IHE Endoscopy with DICOM WG13


Ihe scheduled workflow of radiology

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


Ihe j endoscopy scheduled workflow

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


What is a workflow fitting endoscopy scene
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


    An ideal data structure for endoscopists
    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


    Gui image that we want

    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


    Discussion for pathology order from endoscopy reporting system we met an obstacle
    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


    System scheme in Japan reporting system.

    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


    Thank you
    Thank you. reporting system.

    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


    Current state of japan ihe activity
    Current state of Japan’ IHE activity reporting system.

    • 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


    Our scope
    Our scope reporting system.

    • 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


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