1. IHE-J Endoscopy in Clinical Practice
Hideto Yokoi, MD, PhD
IHE-J Endoscopy Planning Committee,
Kagawa University Hospital
DICOM WG13 in Kyoto

2. Two methods of standardization
Standardization of contents
Terminologies, Classifications…
SNOMED, ICD-10…
Data models, Ontology…
MST
(Minimal Standard Terminology)
Standardization of communication.
Protocols for communication between systems
HL7, DICOM, TCP/IP, SSL…
Integrating the Healthcare Enterprise (IHE) Making concrete guidelines for HL7 and DICOM usage
Endoscopy has
the international terminology.
OMED (World Organisation of Digestive Endoscopy) supporting
DICOM WG13 in Kyoto

3. Our Target Flexible Endoscope Main targets: Digestive tracts
Bronchial tubes…
Biopsy Forceps
DICOM WG13 in Kyoto

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

5. 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 WG13 in Kyoto

6. GUI image that endoscopists want
Window of EMR
Date
Event
2007/10/30
Endoscopy (EGD)
Pathology (biopsy from stomach)
Germ culture 2. 1.
Endoscopy Image 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.
1. Group 1: ulcer
Group 3: anomaly
of some cells…
Pathology results
DICOM WG13 in Kyoto

7. 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
Non-Rad PACS
Konica I-PACS
Capacity ：2.5TB
Oto-system (3Z)
DICOM Storage
DICOM Gateway
(Olympus)
Secondary capture
system(3Z)
EzCAP2×５
DICOM Storage
Images and report
retrieve （URL）
Oto-Endoscope×5
GI Endoscope×3
US (GE-YMS)
Logic3×1
EMR Client (Fujitsu)
GI Endoscopists can
create reports

8. Trial Implementation Workflow
Conventional Electronic Medical Record (Fujitsu)
PACS (Konica)
⑦Endoscopy report and order for pathology study
②Patient Information
③Endoscopy Study Information 【OMI】
EMR / Order-Entry-System Server
①Endoscopy Order
Endoscopy Department System
Report Server
④Endoscopy order Acknowledge
⑥Order for Pathology Study
Endoscopy Department System Client Software
Report
Client Software
Client Machine
⑤Creating Report
Pathology Department system
⑤Entry the Endoscopy Procedure Result for finance
Start from Department
Client software
Japan Railway West
Endoscopy PACS
Legacy messages
②Patient Information
③Endoscopy Study Information 【OMI】
HL7 messages

9. 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 E E
Order Placer
Endoscopy Order Filler
Report Manager
→ES-1 Endoscopy
Order （OMG）
→ES-2 Endoscopy
Order （OMI） P
↓ES-4 Order for Pathology Study（OML）
MST Master Table of
Endoscopic Findings
Pathology Order Filler

10. “MST” Reporting system (structured)
Terminology of organ & site
Terminology for endoscopy study
DICOM WG13 in Kyoto

11. “MST” Reporting system
DICOM WG13 in Kyoto

12. Active cases Four University Hospitals share
Okayama University
Hospital
Yamaguchi University
Hospital
Four University Hospitals share
the RFP (Request For Proposal)
Based on IHE endoscopy workflow
Kagawa University
Hospital
Ehime University
Hospital
Easy connectivity
High reliability
Low cost for integration
Diagnostic accuracy with pathology as a gold standard can be accounted quickly.
DICOM WG13 in Kyoto

13. Look!!!
“Fifth” University Hospital Coming soon!!! <Tohoku University Hospital>
Hearing from endoscopists.
Revealing clinical demands
DICOM WG13 in Kyoto

14. Thank you.
DICOM WG13 in Kyoto