ihe endoscopy with dicom wg13 “ihe-j endoscopy” the concept of japanese activities hideto yokoi...

IHE Endoscopy with DICOM WG13

“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

Biopsy Forceps

Main targets: Digestive tractsBronchial tubes…

Variety of “Endoscope”LaparoscopeCapsule endoscope…


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


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 Kag

awa 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)


The Workflow of Radiology

Ｐｔ

PACS ReportDB

Order and Reservation Image Acquisition Outpatient Service after the study

Ordering System

Order for Study

Report

RIS

Ｒｄ

ＰｔＰｔ

Physician Radiological Technician

Radiologist


The Workflow of Endoscopy

Ｐｔ

PACS Report DB

Ordering System

Endoscopy System

ＰｔＰｔＰｔ

PathologySystem

Order of Pathological Study

Endoscopist

Pathology Dpt.

Result

Order andReservation

Endoscopy Study Outpatient Serviceafter the study

Physician

Pre-medication

Order for Study

Nurse


The Comparison Survey between Endoscopy and Radiology

Order EndoscopyRadiology

（※）

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

Chiba University Hospital2004. June


The Workflow Comparison between Endoscopy and Radiology

Item Radiology Endoscopy

OperatorsMainly

Radiological Technicians

Endoscopists(Doctors)

Pre-treatmentMainly

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”


Discussion

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

IHE-J established “Endoscopy SWF”.


IHE “Scheduled Workflow” of Radiology

ADT

OrderPlacer

OrderFiller

AcquisitionModality

PPSManager

ImageManager

ImageArchive

ImageCreator

ImageDisplay

Blue: HL7 MessagesGreen: DICOM Messages

Pt.Registration Pt.Registration

Order Management

Modality Worklist

ProcedureScheduled

Modality PPS

PPS

PPS

ImageStored

StorageCommitment

Creator PPS

StorageCommitment

ImageStored

Q/R Images


IHE-J “Endoscopy Scheduled Workflow”

Report Status Completed [ENDO-6]

8 Modality Image Stored 9 Modality Presentation State Stored

Pathology order “request” Pathology order ID PPS for Pre/Post-treatment procedure

6 Modality PPS in Progress 7 Modality PPS Completed


Pt. Status [ENDO-1]Status of Pre / Post-treatmentExtension of worklist


10 Storage Commitment

ADT

e-OrderFiller

AcquisitionModality

ImageManager

ImageArchive

1 Patient Registration 1 Patient Registration

3 Filler Order Management

5 Modality Worklist Provided

4 Procedure Scheduled

12 Patient Update13 Procedure Update

14 Query Images15 Query Presentation State16 Retrieve Images17 Retrieve Presentation State

2 Placer Order Management

12 Patient Update 12 Patient Update

11 Image Availability Query

ReportManager

ReportCreator

ReportReader

ReportRepository

OrderManager

ImageDisplay

Report Status Completed [ENDO-6]

SpecimenManager

e-PPSManager


24 Report Submission

25 Report Issuing

26 Query Report27 Retrieve Report

Pathology Specimen IDRequest / Acquisition [ENDO-5]

Pathology Order ID Ready [ENDO-3]

TransactionRAD　　 HL7 Messages　　 DICOM MessagesENDO　　 for Pathology Order　　 Others

Pathology Order Placer

Pathology Order Filler

IHE Pathology

OrderPlacer

Path Order ID Request / Acquisition [ENDO-4]

E-Order Filler ， e-PPS Manager　　 Having extended specification for Endoscopy e-Order Filler　　 Managing Pathology order and Endoscopy processe-PPS Manager　　 Managing Modality PPS and Endoscopy process

Pathology Order ID Request [ENDO-4]

Human’s Inputtriggering “Actor”

From “Rad”

Actor

HIS“Endo” Original

Extra

SpecimenLabel Printer6 Modality PPS in Progress

7 Modality PPS Completed

Report Ready[ENDO-2]↑

Including “Reporting Workflow”

Connecting with “Pathology System”


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”.


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


GUI image that we want

Date Event

2007-05-22 Endoscopy (EGD)

Pathology (biopsy from stomach)Germ culture

2.1.

Report of endoscopy

There is “Ulcer” in the stomach. stage: A1 Bleeding: (+) … biopsy:1. from the side of ulcer :2. oral side of 1.

2.

1.

Endoscopy Image

1. Group 1: ulcer

2. Group 3: anomaly of some cells…

Pathology results

Window of EMR


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).


ADTOrderPlacer

System scheme in Japan

CPOE

OrderFiller

RIS

OrderFiller

Endoscopy information system

OrderFiller

…

OrderFiller

Laboratory information system

OrderFiller

OrderFiller

…

Pathology information system

Reportingsystem

Reportingsystem

Reportingsystem


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 CorporationNobuo Okazaki University of ArizonaMasayuki A. Fujino Yokohama Seamen's Insurance Hospital

Secretariat: JAHIS (Japanese Association of Healthcare Information Systems Industry), JIRA (Japan Industries Association of Radiological Systems)


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


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 “ihe-j endoscopy” the concept of japanese activities hideto yokoi...

Documents

modality pps completedpt

dicom messagesihej endoscopy

modality image

us endoscopy scenedicom

workflow comparison

workflow of radiologyblue

status endo

japanese version