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

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

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

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

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

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

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

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

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

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

“MST” Reporting system DICOM WG13 in Kyoto

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

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

Thank you. DICOM WG13 in Kyoto