IHEJ Endoscopy in Clinical Practice Hideto Yokoi MD

IHE-J Endoscopy in Clinical Practice Hideto Yokoi, MD, Ph. D IHE-J Endoscopy Planning Committee, Kagawa University Hospital DICOM WG 13 in Kyoto

Two methods of standardization • Standardization of contents – Terminologies, Classifications… • SNOMED, ICD-10… – Data models, Ontology… • MST (Minimal Standard Terminology) • Endoscopy has the international terminology. OMED (World Organisation of Digestive Endoscopy) supporting Standardization of communication. – Protocols for communication between systems • • HL 7, DICOM, TCP/IP, SSL… Integrating the Healthcare Enterprise (IHE) Making concrete guidelines for HL 7 and DICOM usage DICOM WG 13 in Kyoto

Our Target Flexible Endoscope Biopsy Forceps Main targets: Digestive tracts Bronchial tubes… DICOM WG 13 in Kyoto

The Workflow of Endoscopy Ordering Endoscopy System Ｐｔ Order and Reservation Pathology System Order of Pathological Study Order for Study Physician Report DB PACS Pathology Dpt. Result Nurse Ｐｔ Pre-medication Endoscopist Ｐｔ Endoscopy Study DICOM WG 13 in Kyoto Ｐｔ Outpatient Service after the study

What is a workflow fitting endoscopy procedure? • 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 data of endoscopy procedure report describing where specimens were gotten. • Included reporting procedure in the “Endoscopy SWF”. DICOM WG 13 in Kyoto

GUI image that endoscopists want Window of EMR Date Report of endoscopy 2007/10/30 Event Endoscopy Image There is “Ulcer” in the stomach. stage: A 1 Bleeding: (+) … biopsy: 1. from the side of ulcer : 2. oral side of 1. Endoscopy (EGD) Pathology (biopsy from stomach) Germ culture 1. 2. 1. Group 1: ulcer 2. Group 3: anomaly of some cells… Pathology results DICOM WG 13 in Kyoto

Trial Implementation in Kagawa University Hospital EMR system (Fujitsu) EMR Client (Fujitsu) Pathology Department System (JR west) Endoscopy Order Resistration Pathology order DICOM MWM Endoscopy report Pathology order （HL-7） Images and report retrieve （URL） Endoscopy Order （HL-7） Endoscopy Order retrieve DICOM Storage Oto-system (3 Z) DICOM Gateway (Olympus) Secondary capture system(3 Z) Ez. CAP 2×５ Non-Rad PACS Konica I-PACS Capacity ： 2. 5 TB DICOM Storage Images and report retrieve （URL） Oto-Endoscope× 5 GI Endoscope× 3 US (GE-YMS) Logic 3× 1 EMR Client (Fujitsu) GI Endoscopists can create reports

Trial Implementation Workflow Conventional Electronic Medical Record (Fujitsu) PACS (Konica) ⑦Endoscopy report and order for pathology study EMR / Order. Entry-System Server ①Endoscopy Order Endoscopy Department System ②Patient Information ③Endoscopy Study Information 【OMI】 Report Server ④Endoscopy order Acknowledge ⑥Order for Pathology Study Endoscopy Department System Client Software Report Client Software Client Machine Pathology Department system ⑤Creating Report ⑤Entry the Endoscopy Procedure Result for finance Start from Department Client software Japan Railway West Legacy messages HL 7 messages Endoscopy PACS ②Patient Information ③Endoscopy Study Information 【OMI】

Actors, Transactions and Master Tables Conventional Master Table for Pathology Order ←ES-3 Endoscopy report and order for pathology study（MDM） P Conventional Master Table for Endoscopy Order P M E Order Placer P E →ES-1 Endoscopy Order （OMG） E Endoscopy Order Filler ↓ES-4 Order for Pathology Study（OML） Pathology Order Filler →ES-2 Endoscopy Order （OMI） Report Manager MST Master Table of Endoscopic Findings

“MST” Reporting system (structured) Terminology of organ & site Terminology for endoscopy study DICOM WG 13 in Kyoto

“MST” Reporting system DICOM WG 13 in Kyoto

Active cases Okayama University Hospital Yamaguchi University Hospital Four University Hospitals share the RFP (Request For Proposal) Based on IHE endoscopy Kagawa workflow University Hospital Ehime University Easy connectivity Hospital High reliability Low cost for integration Diagnostic accuracy with pathology as a gold standard can be accounted quickly. DICOM WG 13 in Kyoto

Look!!! “Fifth” University Hospital Coming soon!!! <Tohoku University Hospital> Hearing from endoscopists. Revealing clinical demands DICOM WG 13 in Kyoto

Thank you. DICOM WG 13 in Kyoto