“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.)

There is no Endoscopy domain yet. DOMAINS There is no Endoscopy domain yet. Radiology Cardiology IT Infrastructure Laboratory Pathology Radiation therapy Endoscopy Ophthalmology

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. But 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? 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 ADT Order Placer Filler Acquisition Modality PPS Manager Image Archive Creator Display Pt.Registration Pt.Registration Modality Worklist Order Management PPS Procedure Scheduled Creator PPS Storage Commitment Image Stored Q/R Images PPS Modality PPS Storage Commitment Image Stored Blue: HL7 Messages Green: DICOM Messages

Scheduled Workflow for Endoscopy 2007/01/25 2007/01/26 Scheduled Workflow for Endoscopy　2007/01/25 　 Defined in Pathology field 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS ADT 1 Pt.Registration 21 Pt.Update 1 Pt.Registration 21 Pt.Update Placer Order Management e-Order Filler 2 Placer Order Management Order Placer Pathology Order Filler 3 Filler Order Management 23 Demand for Path. Order 　　State of Filler show demand for pathology Filler Order Management OP confirms state of OF and order to Pathology’s OF 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update e-PPS Manager Pre/Post Procedure Terminal 4 Procedure Scheduled Image Manager Image Archive 13 Image Availability Query 7 Modality PPS in Progress 9 Modality PPS Completed 12 Storage Commitment 10 Modality Image Stored （11 Modality Presentation State Stored） 5 Modality Worklist Provided Acquisition Modality 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided Specimen Manager Specimen Ｌａｂｅｌ Printer 8 Specimen PPS　（return by DICOM instance number） 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 5 Modality Worklist Provided Report Creator Image Display 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) 22 GPPPS report finished/Order to Path. 　　（Endoscope report completion notification/pathology inspection request notification） 　　(define at GPPPS Part16; it may be UPPPS?） 18 Report Submission Report Manager 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Blue: HL7 Messages Green: DICOM Messages 19 Report Issuing Human’s action Report Repository Report Reader 20 Query Report 21 Retrieve Report

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 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 Technical framework Volume2 examination begins. 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.

HIS controls the flow of information in the hospital. Order information exchange that centers on HIS case of Japan Department system Order is done by HIS. Order to the other department passes HIS. Department system Order Filler Order Filler HIS There is specimen ADT Endoscopy system Pathology system Order Filler Order to pathology There is specimen Order Placer Order Filler There is specimen HIS controls the flow of information in the hospital. Department system Department system Order Filler Order Filler

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 Update Ver.2 Translate to English World wide DDW, Other meeting Enlightenment for spread Related society support contribution of thesis etc.

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Scheduled Workflow for Endoscopy 2007/01/25 2007/01/26 病理IHEでの 定義範囲 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS ADT 1 Pt.Registration 21 Pt.Update 1 Pt.Registration 21 Pt.Update Placer Order Management e-Order Filler 2 Placer Order Management Order Placer Pathology Order Filler 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 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 e-PPS Manager Pre/Post Procedure Terminal 4 Procedure Scheduled ○　病理オーダに関する要件 ・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。 　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でオーダされても良い。 ・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。 ・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。 ・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。 ○　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。 ・これが保証されれば各部門で管理生成されて良い。 ・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。 例 　検体番号＝内視鏡へのオーダ番号＋枝番 　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 　検体番号＝何らかの院内統一番号（＋枝番orシリアル番号） 　　　　　・ Image Manager Image Archive 13 Image Availability Query 7 Modality PPS in Progress 9 Modality PPS Completed 12 Storage Commitment 10 Modality Image Stored （11 Modality Presentation State Stored） 5 Modality Worklist Provided Acquisition Modality 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided Specimen Manager Specimen Ｌａｂｅｌ Printer 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 5 Modality Worklist Provided Report Creator Image Display オーダ番号生成機能 　Order Placerの情報源の一つ 　院内で統一管理されている 　（サーバ？） 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) 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） 18 Report Submission Report Manager 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Blue: HL7 Messages Green: DICOM Messages 19 Report Issuing 人間の端末操作による入力 Report Repository Report Reader 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 20 Query Report 21 Retrieve Report

Scheduled Workflow for Endoscopy 2007/01/25 見直し修正案 2007/01/26 オーダ番号 　ENDO20061211 検体番号 　ENDO20061211-2 病理IHEでの 定義範囲 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS ADT 1 Pt.Registration 21 Pt.Update 1 Pt.Registration 21 Pt.Update Placer Order Management e-Order Filler 2 Placer Order Management Order Placer Pathology Order Filler 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 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 e-PPS Manager Pre/Post Procedure Terminal 4 Procedure Scheduled Image Manager Image Archive 13 Image Availability Query 7 Modality PPS in Progress 9 Modality PPS Completed 12 Storage Commitment 10 Modality Image Stored （11 Modality Presentation State Stored） 5 Modality Worklist Provided Acquisition Modality 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided Specimen Manager Specimen Ｌａｂｅｌ Printer 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 5 Modality Worklist Provided Report Creator Image Display ○　Specimen Managerに対する要件 ・ 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 。 ・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。 ・画像発生モダリティと同じようにMWLを受けて動作する。 ・画像番号に対して検体番号が対応する。 ・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。 ・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。 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) 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） 18 Report Submission Report Manager 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Blue: HL7 Messages Green: DICOM Messages 19 Report Issuing 人間の端末操作による入力 Report Repository Report Reader 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 20 Query Report 21 Retrieve Report

Scheduled Workflow for Endoscopy 2007/01/25 見直し修正案 2007/01/26 病理IHEでの 定義範囲 6 Pre-procedure PPS 7 Modality PPS in Progress 8 Specimen PPS 9 Modality PPS Completed 18 GPPPS report finished 24 Post-procedure PPS ADT 1 Pt.Registration 21 Pt.Update 1 Pt.Registration 21 Pt.Update Placer Order Management e-Order Filler 2 Placer Order Management Order Placer Pathology Order Filler 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 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 e-PPS Manager Pre/Post Procedure Terminal 4 Procedure Scheduled Image Manager Image Archive 13 Image Availability Query 7 Modality PPS in Progress 9 Modality PPS Completed 12 Storage Commitment 10 Modality Image Stored （11 Modality Presentation State Stored） 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 Acquisition Modality 7 Modality PPS in Progress 9 Modality PPS Completed 5 Modality Worklist Provided Specimen Manager Specimen Ｌａｂｅｌ Printer 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 宿題 オーダ時に具体的にどのような情報が送受信されるのかというサンプルを用意すること！ 5 Modality Worklist Provided Report Creator Image Display 14 Query Images (15 Query Presentation State) 16 Retrieve Images (17 Retrieve Presentation State) 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） 18 Report Submission Report Manager 4 Procedure Scheduled 25 PtUpdate 26 Procedure Update Blue: HL7 Messages Green: DICOM Messages 19 Report Issuing 人間の端末操作による入力 Report Repository Report Reader 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 20 Query Report 21 Retrieve Report