1. IHE Endoscopy with DICOM WG13 “IHE-J Endoscopy” The concept of Japanese activities Hideto Yokoi (IHE-Japan Endoscopy Working Group)

2. IHE Endoscopy with DICOM WG13 Outline Background Summarize the activities by IHE-J in digestive endoscopy scene  Characteristics of workflow of endoscopy Discussion

3. IHE Endoscopy with DICOM WG13 What is an “Endoscopy” Endoscope Biopsy Forceps Main targets: Digestive tracts Bronchial tubes… Variety of “Endoscope” Laparoscope Capsule endoscope…

4. IHE Endoscopy with DICOM WG13 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

5. IHE Endoscopy with DICOM WG13 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)

6. IHE Endoscopy with DICOM WG13 The Workflow of Radiology Ｐｔ PACS Report DB Order and Reservation Image AcquisitionOutpatient Service after the study Ordering System Order for Study Report RIS Ｒｄ Ｐｔ Physician Radiological Technician Radiologist

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

8. IHE Endoscopy with DICOM WG13 The Comparison Survey between Endoscopy and Radiology OrderEndoscopy Radiology （※） Modified 315 ( 48.2%) 135 ( 1.2%) Ordinary 339 ( 51.8%) 11542 ( 98.8%) Total654 (100.0%) 11677 (100.0%) ※ excluding RI, radiation therapy Chiba University Hospital 2004. June

9. IHE Endoscopy with DICOM WG13 The Workflow Comparison between Endoscopy and Radiology ItemRadiologyEndoscopy Operators Mainly Radiological Technicians Endoscopists (Doctors) Pre-treatment Mainly Contrast Medium Suppressant of GI, GI cleansing, Anesthesia, Sedation Frequency of Order Modifications RarelyFrequently Additional OrderNot so manyi.e. biopsy ReportingMainly FreetextUsing “MST”

10. IHE Endoscopy with DICOM WG13 Discussion IHE-J decided that the radiology SWF could not satisfy endoscopists’ demand. IHE-J established “Endoscopy SWF”.

11. IHE Endoscopy with DICOM WG13 IHE “Scheduled Workflow” of Radiology ADT Order Placer Order Filler Acquisition Modality PPS Manager Image Manager Image Archive Image Creator Image Display Blue: HL7 Messages Green: DICOM Messages Pt.Registration Order Management Modality Worklist Procedure Scheduled Modality PPS PPS Image Stored Storage Commitment Creator PPS Storage Commitment Image Stored Q/R Images

12. IHE Endoscopy with DICOM WG13 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 6 Modality PPS in Progress 7 Modality PPS Completed Pt. Status [ENDO-1] Status of Pre / Post- treatment Extension of worklist 6 Modality PPS in Progress 7 Modality PPS Completed 10 Storage Commitment ADT e-Order Filler Acquisition Modality Image Manager Image Archive 1 Patient Registration 3 Filler Order Management 5 Modality Worklist Provided 4 Procedure Scheduled 12 Patient Update 13 Procedure Update 14 Query Images 15 Query Presentation State 16 Retrieve Images 17 Retrieve Presentation State 2 Placer Order Management 12 Patient Update 11 Image Availability Query Report Manager Report Creator Report Reader Report Repository Order Manager Image Display Report Status Completed [ENDO-6] Specimen Manager e-PPS Manager 6 Modality PPS in Progress 7 Modality PPS Completed 24 Report Submission 25 Report Issuing 26 Query Report 27 Retrieve Report Pathology Specimen ID Request / Acquisition [ENDO-5] Pathology Order ID Ready [ENDO-3] Transaction RAD HL7 Messages DICOM Messages ENDO for Pathology Order Others Pathology Order Placer Pathology Order Filler IHE Pathology Order Placer 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 process e-PPS Manager Managing Modality PPS and Endoscopy process Pathology Order ID Request [ENDO-4] Human’s Input triggering “Actor” From “Rad” Actor HIS “Endo” Original Extra Specimen Label Printer 6 Modality PPS in Progress 7 Modality PPS Completed Report Ready [ENDO-2]↑ Including “Reporting Workflow” Connecting with “Pathology System”

13. IHE Endoscopy with DICOM WG13 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”.

14. IHE Endoscopy with DICOM WG13 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

15. IHE Endoscopy with DICOM WG13 GUI image that we want DateEvent 2007-05-22Endoscopy (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

16. IHE Endoscopy with DICOM WG13 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).

17. IHE Endoscopy with DICOM WG13 ADT Order Placer System scheme in Japan CPOE Order Filler RIS Order Filler Endoscopy information system Order Filler … Order Filler Laboratory information system Order Filler Order Filler … Pathology information system Reporting system Reporting system Reporting system

18. IHE Endoscopy with DICOM WG13 Thank you. The Member of IHE-J Endoscopy WG Masaru IkedaOlympus Medical Systems Corp. Hitoshi YoshimuraKonica-Minolta MG Corp. Tsutomu KawanoNihon Koden Corp. Masaki ItoSumisho Electronics Co., Ltd. Kiyoshi InoueFujinon Toshiba ES Systems Co., Ltd. Takatoshi YamanakaFujitsu Corp. Shigeru BitoSeafic Software Corporation Nobuo OkazakiUniversity of Arizona Masayuki A. FujinoYokohama Seamen's Insurance Hospital Secretariat: JAHIS (Japanese Association of Healthcare Information Systems Industry), JIRA (Japan Industries Association of Radiological Systems)

19. IHE Endoscopy with DICOM WG13 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

20. IHE Endoscopy with DICOM WG13 Our scope To establish another “Endoscopy” profiles  Bronchoscopy  Laparoscopy  Capsule endoscopy… Think about basic of DICOM protocol  MWM, MPPS are comfortable for endoscopy?