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Open Source Software in Medicine and its Cultivation in Japan Shinji KOBAYASHI Ehime University, Japan MSC Malaysia Open Source Conference 2010. http://conf.oss.my/
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Open Source Software in Medicine and its Cultivation in Japan
Shinji KOBAYASHIEhime University, Japan
Agenda
e-Health care Background, health care in Japan Many standards, few implementations
Open Source Software in Medicine World wide trends Japan Medical Association IT Declaration ORCA Project Medical Open Source Software Council in Japan
Discussion
e-Health care in Japan and My bibliography
Era E-Health in Japan My bibliography
1970Happy Origin
Start for research Born in Saga Japan at April 19, 1970
1980Hopefuldevelopment
'Receipt computer'Claiming system for insurance
Manga, Anime, ComputerMedical student/ Kyushu University
1990Painful growth
Clinical Physicians Order / Entry system
MD license, 1995Resident, Clinical hematology/oncology
2000 Electronic medical record/Electronic health record, full digital
PhD. research and development on OSS in medical field
Japanese Medical Insurance System
From a patient and a medical perspective All citizens are able to join one insurance system Free access to providers and specialists Fee-for-service payment Providers must submit claims for processing by the
10th of the month following the visit. Co-payments collected by providers each visit Each prefecture and county-level government, as
well as cities, towns and villages, has its own individual system of additional subsidies for medical care payments.
Average life span and infant mortality rates are among the best in the world!
Health expenditure/GDP
'Receipt' claim form
Demographics Insurance number Diagnosis Laboratory test/exam Procedure Prescription Many local rules
'Receipt computer'
Claiming/billing application Calculate medical claim under complex rule Print out 'Receipt'
Database Patients' demographics
Name, birthday, insurance Disease, drug, procedures
Proprietary Data can be utilized for only 'Receipt' work
Problems of e-Health (in Japan)
High cost, Low investment Oligopoly market Suppression to raising cost for health care
Many standards, few implementation 'Paper' standard, restriction to use 'Proprietary' standards
'Lock in' Vendor lock in → Oligopoly Data lock in → absence of reusability
How many patients? Disease outcome?
AYDBTU?
VENDOR: ALL YOUR DATA ARE BELONGS TO US!?
OSS
Open license, free distribution Share intellectual resources
Avoid 'lock in' Health data has long life time as Human. Assurance for future availability
Drives open standard Reference implementation accelerate standard
Cost reduction Not aim, but result.
ORCA Project
JMA Standard Receipt Computer OSS, under GPL 2.0(translated into Japanese) Avoid 'lock-in'
Standard Implementation based 'de facto' MML/CLAIM protocol ↔ EMR
Collect data Health care policy based data against meaningless
government policy
Offer of receipt softwareOffer of receipt software by OSS by OSS (Open source software)(Open source software)Sleeping
Giant standalones
Converting Claims Processing Computers to a Network Terminal
High-cost, standalone receipt computer now used by 80% of medical facilities
Supportbusiness
・Setup・Maintenance・Option
network center ・Master update ・Coding of data
ORCAORCAResearch project of JMA which aimed at upgrading receipt computers for future medical IT
Multifunctional terminals
Componentry of JMA-Receipt System
Application Main body of JMA - receiptTable & Screen & documents definition
Utility CLAIM, shell, etc… Various scripts
Tools monpe, gcc, OpenCOBOL, glade, Ruby, GNUpgp
OLTP MONTSUQI PANDA, glclient
GUIGNOMEXwindow
GDM,libglade,Gtk widget (GtkPanda,etc…)
DB PostgreSQL pg_dump, tdump
Device driver XFree86 4.x , Printer driver GS driver, OCR fonts
OS Debian GNU/Linux woody, sarge
Hardware P4 2GHz, 512MB, 100GB.. GPU, Others device17/32
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
日レセ稼動状況(2002年5月~2010年4月)
稼動レベル1 レベル2 レベル3
医療機関
2002年 2003年 2004年 2005年 2006年 2007年 2008年 2009年 2010年 14
Adoption of ORCA(May 2002 ~April 2010)
14
Working・・・8800
Preparing・・・1145
Planning・・・ 498
【specification】
・OSS+Billing software, morethan 1M steps ・Process 1T JPY( 10B USD) claims/year ・Only 2 week for adjust new rules/2years
Personal information deleted Improvement of
medical qualityProposal of a fair medical policy
Outcome
Patients / Members
Feedback
Permit
Medicalfacilities
JMA
Fixed Point Survey Study (2006.12~)
• Voluntary participation by medical facilities• No information collected that can specify an individual patient• Secure security using electronic certification• Privacy of individual medical facilities strictly maintained
For Elderly (Concerning of Long-term Care Insurance)
• IKENSHO Software (OSS)– Medical certification documents required for
long-term care insurance (LTCI) for elderly and handicapped persons
– Medical certification documents for home-visit nursing– Number of users
• 13,259(as of April, 2007)
• KYUKANCHO Software (OSS)– Claims for service eligible for LTCI– Number of users
・1,067(as of April, 2007)
27/32
CLAIM standard
Communication standard between EMR/CPOE and 'Receipt computer' XML based standard Clinical information and Insurance data
Arranged for Japan insurance system
EMR development cost Remove the cost for 'Receipt computer' part > 20 EMRs implemented CLAIM to connect ORCA
OSS Electronic medical record
OpenDolphin Regional health care system supported by
government fund Java/JBoss Doctors are arranging for their use
NOA Dr Ohashi (68yo)developed by 20 years experience PHP/Java Script
Project Maintenance(Authorization System)
• Quality Assurance– The total resources of JMARI provide formal
support and certification for qualified persons ( business establishments)
JMARI
ORCA Support Center
JMARI-Authorized ORCA Support Business
(135 companies: 2007-04)14/32
20
Impacts of ORCA project
Declined price of 'Receipt Computer' Before ORCA: 30,000USD - 50,000USD After ORCA: 10,000USD – 20,000USD Declined also EMR
Market share 'Receipt computer' usually replaces 5-8 years
period 10%, 8800 installed.
Derived works OpenCOBOL , CLAIM standard
ORCA Ecosystem
JMA/JMARI Hospital/Clinic
Developer Support vendor
Membership fee
Information
Support fee Support service
Bug report/request
Development fee Source codes
Authorize
Authorizatio
n fee
Community
MOSS
Medical Open Source Software Council Glue work with ORCA and other projects Introduction OSS seeds to medical developers Introduction Medical OSS to general developers 1st seminar, April 2004 8th seminar, Oct 2009
Many Asian developers / students gathered Communication with developers, doctors, supports
MOSS1
openEHR.jp
The openEHR Project Implementation based standardization ISO/EN 13606
Local activity of the openEHR project Translation Adjust clinical concept for Japanese situation Ruby implementation
Conclusion
OSS in medical field Avoid 'lock-in' Cost reduction Synergy effect with open standard All stake holders should work together
Government, medical association, support vendor, medical provider
Prevent oligopoly More EMR vendors involved in medical field
For future..
More and more developers Internationalization Localization
More standard More implementation for standard
Reform of ORCA Reconstruct of legacy part(all?)