OpenSourceSoftwareInMedicine-DrShinji

8/9/2019 OpenSourceSoftwareInMedicine-DrShinji

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Open Source Software in Medicine and itsCultivation in Japan

Shinji KOBAYASHIEhime University, Japan



Agenda

e-Health care

Background, health care in Japan

Many standards, few implementations

Open Source Software in Medicine

Japan Medical Association IT Declaration

ORCA Project

Medical Open Source Software Council in Japan

Discussion



e-Health care in Japan andMy bibliography

Era E-Health in Japan My bibliography

1970

Happy Origin

Start for research Born in Saga Japan at

April 19, 1970

1980

Hopeful

development

'Receipt computer'

Claiming system for

insurance

Manga, Anime, Computer

Medical student/ Kyushu

University

1990

Painful

growth

Clinical Physicians

Order / Entry system

MD license, 1995

Resident, 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 the10th 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 ownindividual system of additional subsidies for medicalcare 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 ireturn

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

BELONG 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 OSSby OSS (Open source software)(Open source software)SleepingGiant

standalones

Converting Claims Processing Computersto a Network Terminal

High-cost,

standalone receipt

computer now used

by 80% of medicalfacilities

Supportbusiness

・Setup・Maintenance・Option

network center

・Master update

・Coding of data

ORCAORCAResearch project of JMA which aimed atupgrading receipt computers for futuremedical IT

Multifunctional terminals



Componentry of JMA-Receipt System

Application Main body of JMA - receiptTable & Screen &

documents definition

Utility CLAIM, shell, etc… Various scripts

Toolsmonpe, gcc, OpenCOBOL,glade, Ruby, GNUpgp

OLTP MONTSUQI PANDA, glclient

GUIGNOME

Xwindow

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 informationdeleted

Improvement ofmedical quality

Proposal of a fairmedical 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

ld l



For Elderly(Concerning of Long-term Care Insurance)

• IKENSHO Software (OSS)– Medical certification documents required for

long-term care insurance (LTCI) for elderly andhandicapped 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/CPOEand '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 bygovernment fund

Java/JBoss Doctors are arranging for their use

NOA

Dr Ohashi (68yo)developed by 20 years experience PHP/Java Script

P j t G



Project Governance(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

Supportfee Support service

Bug report/request

Development feeSourcecodes

A u t h o r i z e

A u t h o r i z a t i o n f e e

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

EHR j



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

Di i



Discussion

E-Healthcare and Open source software

Who? Why? Who

Benefit for medical providers and patient

ORCA Project Success with JMA promotion

10% share/10years

Open standards CLAIM/MML

OpenEHR project

C l i



Conclusion

OSS in medical field Avoid 'lock-in'

Cost reduction

Synergy effect with open standard All stake holders should work together

Government, medical association, supportvendor, medical provider

Prevent oligopoly

More EMR vendors involved in medical field

F f t



For future..

More and more developers Internationalization

Localization

More standard More implementation for standard

Reform of ORCA

Reconstruct of legacy part(all?)

OpenSourceSoftwareInMedicine-DrShinji

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