1. IHE-J Workshop in Yamagata 2008 1 National Institute of Radiological Sciences ・ MUKAI Masami National Radiological Institute 100 Beds 70 to 100 daily outpatients 4000 cases specialized in therapy-resisting malignancies Filmless from August 2005 HER from Oct. 2005

2. 2 Target Systems ► Our hospital has too many systems;  EMR HOPE/EGMAIN-EX C/S Edition®, HOPE/DrABLE-EX®, HOPE/LAINS-PC® (Fujitsu)  PACS-1 SDS-DicomViewer® (TechMatrix)  PACS-2 SYNAPSE® (Fujifilm)  Reporting System F-REPORT® (INFOCOM)  Radiation schedule management system RSS (Nippon Telegraph and Telephone East)  Electronic radiation record/RO-RIS RIGIA (Global-for) ► Physicians must login and select patients at each system.

3. 3 CAM Function PC1PC2 CAM: Context Area Manager AP: Application 1,2 … PC: Personal Computer 1,2 … CAM EMR AP1 Report Viewer AP ３ PACS Viewer AP2 Context Area User-ID, Patient-ID

4. 4 CAM Function PC1PC2 CAM: Context Area Manager AP: Application 1,2 … PC: Personal Computer 1,2 … CAM EMR AP1 Report Viewer AP ３ PACS Viewer AP2 Context Area User-ID, Patient-ID User-id logIn Auto-logIn User-id

5. 5 EUA （ Single Sign-On ） ► User-A login to EMR/CPOE(PC1) ► User-A participates to PACS （ Auto login ） (PC2) ► ……… ► User-A logout from EMR/CPOE ► Auto logout from PACS ► User-B login to EMR/CPOE ► User-B participates to PACS （ Auto login ）

6. 6 Log In(Single Sign On) EMR/CPOE PACS Report LogIn Auto-LogIn

7. 7 PSA （ Patient Synchronized Application ） ► Login to EMR/CPOE(PC1) ► Select Patient-A from EMR/CPOE ► Login to PACS(PC2) ► Automatically selects Patient-A ► Select Patient-B from PACS ► Automatically changes to Patient-B at EMR ► Login to other application ► Automatically selects Patient-B in other application

8. 8 Patient Selection EMR/CPOE PACS Report Select Patient Auto-Selection

9. 9Discussion ► We wanted to reduce implementation problems and to unify the application interfaces: middle-ware could resolve these problems. We prepared guidelines for modification of the workflow. These guidelines include icons that indicate the status of an application. ► The validity of the enhanced context area was confirmed. In the future, the necessity of the visual integration will increase, and the unified procedure for visual integration is very important. ► The EUA/PSA defined by IHE ITI uses CCOW version 1.4, which defines the patient subject as the patient ID. CCOW version 1.5 defines detailed information about a patient such as DICOM objects.

10. 10 Merit of IHE-ITI EUA/PSA ► EUA/PSA enhanced the effectiveness for users.  Decrease of Login and Patient selection  Common interface of Login and Patient selection CCOW ・ IHE EUA/PSA URL Link SystemComplexSimple Bi-directional Function ○× Patient Selection○× ApplicationNo limitation Browser Only

11. 11 Conclusion ► We developed three types of EUA/PSA middle-ware. Each application used suitable middle-ware for running environments and also enabled the simple implementation of a single sign on and patient selection. ► We modified six existing information systems to use the EUA/PSA middle-ware. These modifications require the considerable effort, but otherwise we achieved good seamless operation by the EUA/PSA functions. We believe that the EUA/PSA function will be indispensable for multi-vender information systems and useful for clinical safety.

12. 12 Reference [1] ITI Integration Profile, website http://www.ihe.net/ Tecnical_Framework/index.cfm#IT. [2]Clinical Context Management Specification Version 1.4, The Health Level Seven, ANSI/CMS, V1.4-2002. [3] Best Practices and Common Mistakes, Version 1.0, HL7 2006.5 Open Source Software We propose the EUA/PSA function by using our EUA/PSA library to Japanese hospitals. We are now developing these middle-ware as open source software.

13. 13 IHE ITI Infrastructure Integration ProfileImplementation

14. 14 CCOW Mechanism Context Manager (1) Definition of Context (2) Definition of synchronization of Context Managing Process (3) Transaction Specifications on Context Manager and multi- systems systems “Single Sign On” & “Patient Synchronization”

15. 15 CPOE/EMR ► Vein Pattern Authentication

16. 16 ReportReport Medical Informatics System ～ target HISHIS ModalityModality Clinical DB DBClinical RIS-RORIS-RO LISLIS RISRIS Implementation Schedule DB DBSchedule PACS-1PACS-1 PACS-2PACS-2

17. IHE-J Workshop in Yamagata 2008 17 National Institute of Radiological Sciences ・ MUKAI Masami PC1PC2 CAM: Context Area Manager AP: Application 1,2 … PC: Personal Computer 1,2 … CAM EMR AP1 Report Viewer AP ３ PACS Viewer AP2 Context Area User-ID, Patient-ID User-id logIn Auto-logIn User-id System Overview Sharing User-ID/PT ID

18. IHE-J Workshop in Yamagata 2008 18 National Institute of Radiological Sciences ・ MUKAI Masami IHE-ITI EUA Workflow