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

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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?)