IHE-J 　 Workshop 　 in 　 Yamagata 　 20081

National Institute of Radiological Sciences ・　 MUKAI Masami

National Radiological National Radiological InstituteInstitute

100 Beds100 Beds

70 to 100 daily outpatients70 to 100 daily outpatients

4000 cases specialized in therapy-4000 cases specialized in therapy-resistingresisting

malignanciesmalignancies

Filmless from August 2005Filmless from August 2005

HER from Oct. 2005HER from Oct. 2005

2

Target SystemsTarget Systems► Our hospital has too many systems;Our hospital has too many systems;

EMR EMR HOPE/EGMAIN-EX C/S Edition®, HOPE/DrABLE-HOPE/EGMAIN-EX C/S Edition®, HOPE/DrABLE-

EX®, HOPE/LAINS-PC®EX®, HOPE/LAINS-PC® (Fujitsu)(Fujitsu) PACS-1 PACS-1 SDS-DicomViewer® (TechMatrix) SDS-DicomViewer® (TechMatrix)

PACS-2 PACS-2 SYNAPSE® (Fujifilm)SYNAPSE® (Fujifilm)

Reporting System Reporting System F-REPORT® (INFOCOM)F-REPORT® (INFOCOM)

Radiation schedule management system Radiation schedule management system RSS (Nippon Telegraph and Telephone East) RSS (Nippon Telegraph and Telephone East)

Electronic radiation record/RO-RIS Electronic radiation record/RO-RIS RIGIA RIGIA (Global-for) (Global-for)

► Physicians must login and select Physicians must login and select patients at each system.patients at each system.

4

CAM FunctionCAM FunctionPC1 PC2

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

CAM CAM

EMR

AP1ReportViewer

AP ３PACSViewer

AP2

Context AreaContext Area

User-ID, Patient-ID

User-id

logInAuto-logIn

User-id User-id

User-id

5

EUAEUA （（ Single Sign-OnSingle Sign-On ））

►User-A login to EMR/CPOE(PC1)User-A login to EMR/CPOE(PC1)►User-A participates to PACSUser-A participates to PACS （（ Auto Auto

loginlogin ） ） (PC2)(PC2)►………………►User-A logout from EMR/CPOEUser-A logout from EMR/CPOE►Auto logout from PACSAuto logout from PACS►User-B login to EMR/CPOEUser-B login to EMR/CPOE►User-B participates to PACSUser-B participates to PACS （（ Auto Auto

loginlogin ））

6

Log In(Single Sign On)Log In(Single Sign On)

EMR/CPOE

PACS

Report

LogIn

Auto-LogIn

7

PSAPSA （（ Patient Patient Synchronized ApplicatioSynchronized Applicatio

nn ））►Login to EMR/CPOE(PC1)Login to EMR/CPOE(PC1)►Select Patient-A from EMR/CPOESelect Patient-A from EMR/CPOE►Login to PACS(PC2)Login to PACS(PC2)►Automatically selects Patient-AAutomatically selects Patient-A►Select Patient-B from PACSSelect Patient-B from PACS►Automatically changes to Patient-B at Automatically changes to Patient-B at

EMREMR►Login to other applicationLogin to other application►Automatically selects Patient-B in other Automatically selects Patient-B in other

applicationapplication

8

Patient SelectionPatient SelectionEMR/CPOE

PACS

Report

Select Patient

Auto-Selection

9

DiscussionDiscussion► We wanted to reduce implementation problems and to We wanted to reduce implementation problems and to

unify the application interfaces: middle-ware could resolve unify the application interfaces: middle-ware could resolve these problems. We prepared guidelines for modification of these problems. We prepared guidelines for modification of the workflow. These guidelines include icons that indicate the workflow. These guidelines include icons that indicate the status of an application.the status of an application.

► The validity of the enhanced context area was confirmed. The validity of the enhanced context area was confirmed. In the future, the necessity of the visual integration will In the future, the necessity of the visual integration will increase, and the unified procedure for visual integration is increase, and the unified procedure for visual integration is very important.very important.

► The EUA/PSA defined by IHE ITI uses CCOW version 1.4, The EUA/PSA defined by IHE ITI uses CCOW version 1.4, which defines the patient subject as the patient ID. CCOW which defines the patient subject as the patient ID. CCOW version 1.5 defines detailed information about a patient version 1.5 defines detailed information about a patient such as DICOM objects. such as DICOM objects.

10

Merit of IHE-ITI EUA/PSAMerit of IHE-ITI EUA/PSA►EUA/PSA enhanced the effectiveness for EUA/PSA enhanced the effectiveness for

users.users. Decrease of Login and Patient selectionDecrease of Login and Patient selection Common interface of Login and Patient Common interface of Login and Patient

selectionselectionCCOW 　・

IHE EUA/PSAURL Link

System Complex Simple

Bi-directional Function ○ ×

Patient Selection ○ ×

Application No limitation Browser 　 Only

11

ConclusionConclusion► We developed three types of EUA/PSA We developed three types of EUA/PSA

middle-ware. Each application used suitable middle-ware. Each application used suitable middle-ware for running environments and middle-ware for running environments and also enabled the simple implementation of a also enabled the simple implementation of a single sign on and patient selection. single sign on and patient selection.

► We modified six existing information We modified six existing information systems to use the EUA/PSA middle-ware. systems to use the EUA/PSA middle-ware. These modifications require the These modifications require the considerable effort, but otherwise we considerable effort, but otherwise we achieved good seamless operation by the achieved good seamless operation by the EUA/PSA functions. We believe that the EUA/PSA functions. We believe that the EUA/PSA function will be indispensable for EUA/PSA function will be indispensable for multi-vender information systems and multi-vender information systems and useful for clinical safety.useful for clinical safety.

12

ReferenceReference[1] ITI Integration Profile, website http://www.ihe.net/[1] ITI Integration Profile, website http://www.ihe.net/

Tecnical_Framework/index.cfm#IT.Tecnical_Framework/index.cfm#IT.[2][2] Clinical Context Management Specification Clinical Context Management Specification

Version 1.4, The Health Level Seven, ANSI/CMS, Version 1.4, The Health Level Seven, ANSI/CMS, V1.4-2002.V1.4-2002.

[3] Best Practices and Common Mistakes, Version 1.0, [3] Best Practices and Common Mistakes, Version 1.0, HL7HL7 2006.52006.5

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.

IHE-J 　 Workshop 　 in 　 Yamagata 　 200817

National Institute of Radiological Sciences ・　 MUKAI Masami

PC1 PC2

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

CAM CAM

EMR

AP1ReportViewer

AP ３PACSViewer

AP2

Context　AreaContext　Area

User-ID, Patient-ID

User-id

logIn Auto-logIn

User-id User-id

User-id

System OverviewSystem Overview

Sharing User-ID/PT ID