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Research Center for Charged Particle Research Center for Charged Particle TherapyTherapy

National Institute of Radiological Sciences , JAPANNational Institute of Radiological Sciences , JAPAN

Located at Chiba , JAPANInpatient: 100 bedsOutpatients: 70-100 patients/daySpecialized for a radiation therapy with a Carbon heavy particleFilm-less Environment (2005 ～ )

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PurposePurposeTo understand the concept of coordination on Sign-On/Patient Selection and its merits and demerits

To experience the effectiveness of the single-sign-on and synchronized patient selection by using the IHE-ITI EUA and PSA function

To realize how to login and change the patient in the EUA/PSA environment

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IntroductionIntroductionOur hospital is specially designed for the heavy particle radiation therapy. Systems (EMR, PACS, clinical database and schedule management system) are running. Some systems were recently replaced. Then we made a modification to use the IHE ITI profiles.We planed to study the effectiveness and availability of IHE[1] IT-Infrastructure profiles in the Japanese environment. The final aim is to evaluate the availability of the integration profiles in Japanese environment.We expand the function of the EUA and PSA, because one clinical unit includes 2 personal computers in the outpatient clinic and the ward. We defined the context area for the context manager defined by the HL7 CCOW (Clinical Context Management Specification)[2][3]. We developed the middleware to realize the function of the EUA (Enterprise User Authentication) and PSA (Patient Synchronized Applications).

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Out-Patient ClinicOut-Patient Clinic

PACS/Report Display

EMR Display

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Context Area Context Area RequirementRequirement

At least two PCs are required to perform context area.

because…EMR Client PC with a suitable monitor for textual information

PACS Viewer Client PC with a High resolution gray scale monitor for viewing images.

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Doctor Uses multi-PCs Doctor Uses multi-PCs

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MethodsMethodsLibrary: We developed three types of EUA/PSA middle-wares (ActiveX application, Java applet and Servlet).We use this middle-ware to communicate the context area manager each other. We analyzed the flow of the applications. We implemented the function of the EUA and PSA into the existing applications.Guideline: Next we established guidelines for the implementation of the EUA/PSA. The venders of the existing systems modified their applications according these guidelines. We evaluate the functionality of the EUA and PSA by using the each application.

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CAM FunctionCAM FunctionPC1 PC2

CAM: Context Area ManagerAP: Application 1,2 …PC: Personal Computer 　 1,2 …

CAM CAM

EMR

AP1ReportViewer

AP３PACS

Viewer

AP2

Context AreaContext Area

User-ID, Patient-ID

User-id

logIn Auto-logIn

User-id User-id

User-id

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Target SystemsTarget SystemsOur 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.

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EUAEUA （（ Single Sign-OnSingle 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 ）

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Log In(Single Sign On)Log In(Single Sign On)EMR/CPOE

PACS

Report

LogIn

Auto-LogIn

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PSAPSA （（ Patient Patient Synchronized Synchronized ApplicationApplication ））Login to EMR/CPOE(PC1)

Select Patient-A from EMR/CPOELogin to PACS(PC2)Automatically selects Patient-ASelect Patient-B from PACSAutomatically changes to Patient-B at EMRLogin to other applicationAutomatically selects Patient-B in other application

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Patient SelectionPatient SelectionEMR/CPOE

PACS

Report

Select Patient

Auto-Selection

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DiscussionDiscussionWe 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.

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Merit of IHE-ITI Merit of IHE-ITI EUA/PSAEUA/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

System Complex Simple

Bi-directional Function ○ ×

Patient Selection ○ ×

Application No limitation Browser　 Only

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ConclusionConclusionWe 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.

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ReferenceReference[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, HL

7 　 2006.5

Open Source SoftwareOpen 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.

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Thank you!!Thank you!!