“IHE Endoscopy” should be a formal domain of the IHE May 2007 Endoscopy IHE-WG JAHIS (Japanese Association of Healthcare Information System Industry) Masaru Ikeda ( OPLYMPUS MEDICAL SYSTEMS Corp.) DOMAINS There is no Endoscopy domain yet. Radiology Laboratory Cardiology IT Infrastructure Pathology Endoscopy Ophthalmology Radiation therapy What I want to say… A new domain of the IHE for the endoscopy should be assumed to be made, and the domain to be formal. Because The IHE work flow of radiology doesn't meet endoscopy. Workflow of endoscopy is different from radiology’s examination. Some people who not relate to endoscope think that endoscope is same as radiology’s modality . Doesn’t it need to make new domain for endoscope, do it? But Therefore The WG that can be discussed by member who relate to the endoscope gathering is necessary. “IHE Endoscopy WG” in U.S.A. It becomes our partner Out of scope in today’s discussion Progress report of our activity Of course, evaluating the progress of the specified vender also Have the difference between the radiology examination and the endoscopy understood. It is difficult to explain to the people who don’t relate to endoscopy like radiologist. Even if it is an explanation in Japanese by the same Japanese. I want you to understand there is the difference, not understood detailed differences. However, explains difference only a little next. Difference between Radiology and Endoscopy For instance, Who does use modality ? Who does examine? Difference of working range done by examination once. until the image is acquired? until writing a paper? Are there any order to pathology for the inspection of the specimen material? Use-case is not the same as radiology’s Radiology Scheduled Workflow Pt.Registration Order Filler Procedure Scheduled ADT Order Management Creator PPS PPS PPS Image Manager Storage Commitment Modality PPS Modality Worklist Order Placer Image Creator Storage Commitment PPS Manager Pt.Registration Image Stored Image Archive Q/R Images Image Display Image Stored Acquisition Modality Blue: HL7 Messages Green: DICOM Messages Scheduled Workflow for Endoscopy 2007/01/25 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS e-PPS Manager Pre/Post Procedure Terminal 4 Procedure Scheduled ADT 1 Pt.Registration 21 Pt.Update e-Order Filler Placer Order Management 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided 8 Specimen PPS （return by DICOM instance number） Filler Order Management OP confirms state of OF and order to Pathology’s OF Image Archive 10 Modality Image Stored （11 Modality Presentation State Stored） Specimen Specimen Manager Ｌａｂｅｌ Printer Report Creator Image Display 18 Report Submission 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Pathology Order Filler Acquisition Modality 5 Modality Worklist Provided 22 GPPPS report finished/Order to Path. （Endoscope report completion notification/pathology inspection request notification） (define at GPPPS Part16; it may be UPPPS?） Human’s action Image Manager 12 Storage Commitment 5 Modality Worklist Provided Blue: HL7 Messages Green: DICOM Messages Order Placer 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update 13 Image Availability Query 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed Defined in Pathology field 1 Pt.Registration 21 Pt.Update 2 Placer Order Management 3 Filler Order Management 23 Demand for Path. Order State of Filler show demand for pathology 7 Modality PPS in Progress 9 Modality PPS Completed 2007/01/26 Report Manager 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) 19 Report Issuing Report Repository 20 Query Report 21 Retrieve Report Report Reader About Real system Though you might say that you want to see a real system, to know about them. We are at the stage where WG should be made for defining Technical Framework to make a real machine. • As for saying as the discussion based on a real machine, the step is reverse. If you wants to understand the image of the information system for endoscopy, it is possible to see present system that isn’t on the IHE. As for a system now at the time of not being in IHE, the requirements of the endoscopy is included. Therefore, If you want to understand workflow and differences, It‘s better to study present system than halfway system. It is thought that the disadvantage where extra confusion is caused is larger even if it examines it based on a halfway evaluation system. The present conditions There is “Endoscopy IHE Working Group” only in Japan. It is acting in the industry association of the JAHIS. We can discuss about use-case of Japan. But we don’t do them about other country. Then, also we can’t decide baseline of TF “Endoscopy IHE” for International . If there would be partner of another country, our progress will advance earlier. Present : Local activity – in Japan Future : International activity there will be partners in many country What should we do? make WG in U.S.A invite Endoscopists, Venders and other specialists of the IHE Who have to do them? How should it advance? What Organization should be a base? DICOM International Committee IHE Inc. Other We need your help and advice. Conclusion The following is necessary to evaluate “Endoscopy IHE” as an official domain of the “IHE”. Stand and put up working group to argue about “endoscopy IHE” in U.S.A. (also in Europe) Endoscopists, experts of medical information and related vendors in U.S.A. should be member of the “endoscopy IHE working group” in U.S.A. (Even WG for preparations is good) Japan and U.S.A., each WG cooperates and works on a new endoscopy domain in the “IHE”, and widen activity worldwide. Advice and backup of the IHE Inc. are necessary. The current result Review and renewal of Volume1 Technical framework Volume2 examination begins. Examination of lower digestive tract The above part digestive organs and lower digestive organs are integrated as digestive organs, and it reflects it in the work flow. Adjustment with pathology IHE-WG Materialization of mechanism of specimen material inspection request to pathology section Examination of message for order by HL7 Enlightenment to digestive organs endoscope society Route securing for thesis submission Thesis submission for instance Show Defining HL7 message for request of examination of specimen next page. It is progressing now. Order information exchange that centers on HIS case of Japan Department system Order Filler Order is done by HIS. Order to the other department passes HIS. Department system Order Filler HIS ADT Endoscopy system Order Filler HIS controls the flow of information in the hospital. There is specimen Department system Order Filler Pathology system Order Order Placer Order to pathology Filler Department system Order Filler procedure of H L7 m essage for request of exam ination of specim en S ystem for Endoscopy suite C entralO rdering system in H P S ystem for P athology Integrated R eporting system in H P A cquisition of patient's basic attribute inform ation P atient R egistration [R ad-1] (A D T ⇒O F) P rocedure before this step A cquisition of order-list to pathology section P lacer O rder M anagem ent [R ad-2] (O P ⇒O F) patient's basic attribute inform ation (A D T ⇒O F) P atient R egistration [R ad-1] order-list to endoscopy suite (O P ⇒O F) P lacer O rder M anagem ent [R ad-2] patient's acceptance start endoscopy inspection w rite report （ if there is a reporting system ） state that there is exnam ination request to pathology (O F⇒O P ) order to pathology division accept order （ from endoscopy division） P lacer O rder M anagem ent [R ad-2] (O P ⇒O F) get specim en starat pathology exam ination （ confirm endoscopy report） （ if there is a reporting system ） data of order inform ation basic elem ents item attribute explanation necessity for endoscopy O F controllclass for order X (01) A :new order M :m odify order D :delete order H P nam e X (20) H P that request exam ination H P code X (10) code w as assined division code X (02) division code division nam e X (04) division nam e D r.nam e - finalaction X (10) nam e of doctor w ho get specim en order num ber for endoscopy X (13) to confirm the order num ber of the endoscope past order num ber for path. X (13) to confirm past patient ID X (10) alpha-num eric ;padding space at rest patient "kana" nam e X (20) Japaneese character "kana" patient nam e X (20) Japaneese character and alphabet ;both O K sex X (01) 1:m ale 2:fem ale 3:unknow n birthday D ate(08) YYYYM M D D in-outpatient X (01) G :outpatient N :inpatient C :treat inpatient as reatm ent X (??) past inform ation sm oking,drinking X (??) H ow long has patient been infection X (??) ex.） H C V ，H IV exam ination type X (01) operation,rapid order type X (02) C elldiagnosis,O rganization diagnosis datailof order X (02) gathering date D ate(08) YYYYM M D D gathering tim e Tim e(08) H H M M order date D ate(08) YYYYM M D D disease nam e X (??) N am e of a disease in insurance purpose X (06) purpose of inspection;content of request diagnosis by clinical X (100) ex.) There is a doubt of cancer. passage by clinical X (2000) ex.) A norexia Endoscopy is executed this year. localopinion X (2000) com m ent X (2000) im age,schem a, type of exam ination X (06) 1 organ,2 organs,over 3 organs （ on accounting） addition X (06) on accounting num ber of group X (03) N um ber of repetitions of internalorgans countainer X (03) N um ber of containers w ith specim en below ;num ber of m aterials of input each internalorgans is repeated group num ber X (16) N um ber corresponding to num ber of groups num ber of specim en 9(02) num ber of specim en m aterials in organization diagnosis 材料（ 検体） ID （ 組織診では検体ID ） specim en ID detailed classification X (06) code of internalorgans nam e inform ation supplem entations other than internal collection part organs nam e collection m ethod X (06) C ode of collection m ethod com m ent X (100) The place w ith passing and the file fam ous picture schem a pass X (200) im age that the schem a chart is stored is described. order num ber 2 pathology X (13) Indeterm ination w hen it from endoscope is requested pathology com m ent X (2000) ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ necessity for pathology tim m ing getting from A D T or O P ○ at each order ○ prior at each order ○ at each order ○ at each order ○ at each order ○ at each order at each order ○ at each order ○ at regist patient ○ at regist patient ○ at regist patient ○ at regist patient at regist patient ○ at regist patient ○ at regist patient ○ at regist patient ○ at each order ○ at each order at each order ○ at each order ○ at each order at each order ○ at each order ○ at each order ○ at each order ○ at regist patient at each order ○ at each order ○ at each order at each order ○ at each order ○ at each order at each order at each order ○ at each order ○ at each order ○ at each order use control data data data data data data data data data data data data data data data data data data data data data data data data data data data data data data data data data data data data data ○ ○ ○ ○ at each order at each order at each order data data data ○ ○ at each order data at each pathology order acknow ledge after orderd acknow ledge next We will make Endoscopy TF Volume2. HL7 message for Endoscopy IHE It will makes from the industry association of the JAHIS, and it provides. DICOM message for Endoscopy IHE Basic idea will make from the industry association of the JIRA, and it propose. Get Public comments Public Volume1 World wide Update Ver.2 Translate to English DDW, Other meeting Enlightenment for spread Related society support contribution of thesis etc. END Scheduled Workflow for Endoscopy 2007/01/25 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS 1 Pt.Registration 21 Pt.Update e-Order Filler ADT 病理IHEでの 定義範囲 1 Pt.Registration 21 Pt.Update Placer Order Management 2 Placer Order Management 3 Filler Order Management 23 Demand for Path. Order Fillerが病理検査オーダ有りの状態を示す Order Placer Image Pathology Order Filler Filler Order Management 内視鏡のFillerにおける病理検査オーダ 有りのステートをPlacerが確認して、病理 へ検査オーダを出す 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Pre/Post 4 Procedure Scheduled e-PPS Procedure ○ 病理オーダに関する要件 Manager Terminal 2007/01/26 Image ・病理部門へのオーダは各部門からのオーダ発行でもかまわない。 13 Image Availability Query Manager Archive 7 Modality PPS in Progress つまり、HIS上のOPからのオーダでなくとも、部門から直接OPでオーダさ 9 Modality PPS Completed 10 Modality Image Stored 12 Storage Commitment れても良い。 （11 Modality Presentation State Stored） 5 Modality Worklist Provided ・ただし、院内で統一的に管理されたオーダ番号である必要がある。Acquisition ・院内で統一管理されたオーダ番号を生成機能があれば良い。 Modality 7 Modality PPS in Progress 9 Modality PPS Completed ・各OPは、そのオーダ番号をもらってオーダを発行すればよい。 5 Modality Worklist Provided Specimen Specimen Manager Ｌａｂｅｌ Printer PPS （DICOMのインスタンスナンバーで返す） ○8 Specimen 検体番号に関する要件 ・検体番号は、病院内で重複しないユニークなもので有れば良い。 7 Modality PPS in Progress 5 Modality Worklist Provided 8 Specimen PPS ・これが保証されれば各部門で管理生成されて良い。 Report Image 9 Modality PPS Completed 14 Query Images ・オーダ時にオーダ番号に検体番号の紐付けをして発行すればよい。 Creator Display オーダ番号生成機能 (15 Query Presentation State) 22 GPPPS report finished/Order to Path. 例（内視鏡レポート完了通知／病理検査依頼通知） 18 Report Submission 16 Retrieve Images Order Placerの情報源の一つ (17 Retrieve Presentation State) GPPPS Part16 に登録して使う 検体番号＝内視鏡へのオーダ番号＋枝番 院内で統一管理されている UPPPSへ変わる可能性有り） Report （サーバ？） 検体番号＝内視鏡へのオーダ番号＋内視鏡室内シリアル附番 4 Procedure Scheduled Manager Blue: 検体番号＝何らかの院内統一番号（＋枝番orシリアル番号） HL7 Messages 25 PtUpdate 19 Report Issuing 26 Procedure Update Green: DICOM Messages ・ 人間の端末操作による入力 Report Report ・ Modality Presentation State Stored；今のところ該当するモダリティは無いので、省略可 20 Query Report Repository 同様にQuery Presentation State及びRetrieve Presentation Stateも省略可能 21 Retrieve Report Reader Scheduled Workflow for Endoscopy 2007/01/25 見直し修正案 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS e-PPS Manager Pre/Post Procedure Terminal ADT 1 Pt.Registration 21 Pt.Update e-Order Filler 1 Pt.Registration 21 Pt.Update Placer Order Management Order Placer 2 Placer Order Management 3 Filler Order Management 23 Demand for Path. Order Fillerが病理検査オーダ有りの状態を示す 13 Image Availability Query 7 Modality PPS in Progress 9 Modality PPS Completed Image Manager 12 Storage Commitment 5 Modality Worklist Provided 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided 8 Specimen PPS （DICOMのインスタンスナンバーで返す） 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 病理IHEでの 定義範囲 オーダ番号 Pathology Order Filler ENDO20061211 Filler Order Management 内視鏡のFillerにおける病理検査オーダ 検体番号 有りのステートをPlacerが確認して、病理 ENDO20061211-2 へ検査オーダを出す 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update 4 Procedure Scheduled 2007/01/26 Image Archive 10 Modality Image Stored （11 Modality Presentation State Stored） Acquisition Modality Specimen Specimen Manager Ｌａｂｅｌ Printer 5 Modality Worklist Provided Report Creator Image Display 14 Query Images ○ Specimen Managerに対する要件 (15 Query Presentation State) 18 Report Submission 16。 Retrieve Images ・ Specimen Managerは検体ラベルプリンタと一緒にして、一つのモダリティ扱いとする (17 Retrieve Presentation State) ・つまり、画像の代わりにバーコード及び関連テキストが印刷されたラベルが生成されると言う考え。 Report 4 Procedure Scheduled Manager ・画像発生モダリティと同じようにMWLを受けて動作する。 Blue: HL7 Messages 25 PtUpdate ・画像番号に対して検体番号が対応する。 19 Report Issuing 26 Procedure Update Green: DICOM Messages 人間の端末操作による入力 ・ただし、インスタンスUIDではなく、インスタンスナンバーを用いる。 Report Report Modality Presentation State Stored；今のところ該当するモダリティは無いので、省略可 ・生検が発生しなかった場合はラベル印刷が発生しないがDICOMとしての問題は無い。 20 Query Report Repository Reader 22 GPPPS report finished/Order to Path. （内視鏡レポート完了通知／病理検査依頼通知） GPPPS Part16 に登録して使う UPPPSへ変わる可能性有り） 同様にQuery Presentation State及びRetrieve Presentation Stateも省略可能 21 Retrieve Report Scheduled Workflow for Endoscopy 2007/01/25 見直し修正案 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS e-PPS Manager Pre/Post Procedure Terminal e-Order Filler 1 Pt.Registration 21 Pt.Update Placer Order Management 7 Modality PPS in Progress 9 Modality PPS Completed Image Manager 12 Storage Commitment 5 Modality Worklist Provided オーダ情報では、検 体番号と依頼内容の 情報が含まれる 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided 8 Specimen PPS （DICOMのインスタンスナンバーで返す） Image Archive 10 Modality Image Stored （11 Modality Presentation State Stored） Acquisition Modality Specimen Specimen Manager Ｌａｂｅｌ Printer 5 Modality Worklist Provided Report Creator Image Display 22 GPPPS report finished/Order to Path. （内視鏡レポート完了通知／病理検査依頼通知） GPPPS Part16 に登録して使う UPPPSへ変わる可能性有り） Blue: HL7 Messages Green: DICOM Messages オーダ時に具体的にどのような 18 Report Submission 情報が送受信されるのかというReport 4 Procedure Scheduled Manager サンプルを用意すること！ 25 PtUpdate 26 Procedure Update 人間の端末操作による入力 Modality Presentation State Stored；今のところ該当するモダリティは無いので、省略可 同様にQuery Presentation State及びRetrieve Presentation Stateも省略可能 Pathology Order Filler Filler Order Management 内視鏡のFillerにおける病理検査オーダ 有りのステートをPlacerが確認して、病理 へ検査オーダを出す 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update 4 Procedure Scheduled 宿題 Order Placer 2 Placer Order Management 3 Filler Order Management 23 Demand for Path. Order Fillerが病理検査オーダ有りの状態を示す 13 Image Availability Query 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 病理IHEでの 定義範囲 ADT 1 Pt.Registration 21 Pt.Update 2007/01/26 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) 19 Report Issuing Report Repository 20 Query Report 21 Retrieve Report Report Reader
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