“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)
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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
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at regist patient
○
at regist patient
○
at regist patient
at regist patient
○
at regist patient
○
at regist patient
○
at regist patient
○
at each order
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at each order
at each order
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at each order
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at each order
at each order
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at each order
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at each order
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at each order
○
at regist patient
at each order
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at each order
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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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