Report on Japanese Activities

1. Report on Japanese Activities Hidenori Shinoda JIRA 9/3/2004

2. Push Model of MWL • Needs for Push Model of MWL in Japan • A technologist has to take many exams a day at a CR or DR. • In the case of CR with cassettes, a single device is sometimes shared by several rooms. • A device sometimes has a specific purpose, like for exams of chest, abdomen, head, etc. • A technologist hardly determines an appropriate room prior to patient’s arrival. They confirm the content of request, first, and then select a room which is proper to the exam. • Technologists want to put the information on a list to a specific modality for his or her convenience through the RIS terminal.

3. Order entry system issues an order on head and abdominal CT exam RIS receives the order Technologist confirms the order and transmits the worklist to a specific CT Take the exam at CT Fig.１ Typical example of a flow of imaging examination The worklist is pulled out by a CT using the DICOM MWL.

4. Order entry system issues an order for a X-ray exam for the chest in standing position, the abdominal (supine), and cranial frontal view. The requests contained in this order must be separated and transmitted to three different radiography systems. RIS receives the order Technologist confirms the order at a RIS terminal by the room 1. All the devices may not in the same room. CR-2 Exam for Abdomen CR-3 Exam for Head CR-1 Exam for Chest Fig. 2 An order for chest radiography (standing), abdominal radiography (supine), and cranial frontal view is placed at HIS and transmitted to RIS. This request must be separated and transmitted to three different CRs. If all These requests are delivered to each CR, the work flow is complicated and may cause errors.

5. Order entry system issues an order for a X-ray exam for the chest in standing position, the abdominal (supine), and cranial frontal view. A few RIS terminals are located and each of them has their own purposes. RIS receives the order. Technologist confirms the order at a RIS terminal by the room 1. Technologist confirms the order at a RIS terminal by the room 2. CR-1 Exam for Chest CR-2 Exam for Abdomen CR-3 Exam for Head Fig.3 This shows an example that each CR has specific role. E.g. CR-3 is for head exam. A specific role is assigned to a RIS. In this example, the room 1 is for exams for chest and abdomen and the room 2 for head. A request is separated and transmitted to RIS terminals.

6. Order entry system issues an order for a X-ray exam on abdomen in two directions and head from the front for the patient 1. Order entry system issues an order for a X-ray exam on chest, breast, and head for the patient 2. RIS receives the orders. Technologist confirms an order at RIS terminal by the room 2. Technologist confirms an order at RIS terminal by the room 1. A modality is shared by two rooms CR-1 Exam of abdomen in standing position for patient 1 CR-2 Exam of abdomen in laying position for patient 1 CR-3 Exams for heads for both patients CR-4 Exam of chest for patient 2 CR-5 Exam of breast for patient 2 Fig.4 This is an example of a case that a single modality is shared by two rooms. This case make us expect that two RIS terminals transmit a worklist to one CR.

7. Summary • Issues in the DICOM pull model • A technologist must confirm a content of an order and sometimes has to separate the information into segments that are proper to a specific modality. If they have to use MWL pull model, they have to operate twice, one at RIS terminal and the other at modality. This makes a workflow complex. • They have about 200 general X-ray exams a day at large hospitals. This forces technologists to carefully select a proper worklist when they use MWL pull model. • Currently, RIS send a signal to modality that triggers the modality to pull a proper worklist. However, this method is different with vendors.

8. METI launched a new project • Ministry of Economy, Trade, and Industry recently launched a new project that aims healthcare information systems to be provide interoperability. • Healthcare information systems in Japan are usually built on proprietary messaging protocols. • This project aims to provide systems at hospitals to have portability for data in electronic medical records, to refer data in different systems developed by different vendors, to communicate with systems developed by different vendors, and to be constructed on the common security bases. • Base standards are HL7 and DICOM • IHE-J is continued in the project.

9. MWHL discusses security issues. • Ministry of Welfare, Health, and Labor formed a committee and discussed security issues like medical data storage outside of medical facilities, electronic signature on healthcare documents, use of PKI, etc. • Almost all documents will be permitted to be handled in electronic form. One of exceptions will be prescription. • Doctors society criticizes the medical data storage outside of medical facilities. Because Japanese privacy rule dose not have items that penalize a person severely who violate the rule first time, whereas a doctor is punished if they illegally disclose patients’ health information. • In the discussion on PKI, one of the issues is privilege management.