Localisation of archetype to validatefeasibility of ISO 13606/openEHR in                 Japan           Shinji KOBAYASHI ...
Agenda• Localisation / Internationalisation  – Localisation/Isolation  – Translation, adaptation• ISO 13606/openEHR adopti...
Localisation / Internationalisation• Localisation  – Language translation  – Currency, Date, time, time zone  – Culture, r...
Localisation/Isolation  Regional                     Regional  community                     community                    ...
Common problems in software         localisation to Japan• Translation   – Word sequence       • Ex. From A to B(En) AからBへ...
Japan has specific features, but not               unique• Language and character is unique?  – Arabic languages are writt...
Translation• Is it really match?  – Pounding pain(en) がんがんする痛み(日本    語)• Hard to translate  – Word has various meanings in...
Form localisationSometimes, word sequence arrangements are needed for non European language.This arrangement needs not onl...
Favorable features to    localisation/internationalisation• Source code availability  – Open Source Software is ideal• Int...
Why openEHR?• Interoperability for   –   Clinical research   –   Healthcare governance   –   Evaluate clinical care   –   ...
The works of the openEHR.jp• The first regional activity of the openEHR project• Translation   – Architectural over view, ...
Localisation (Translation / Adoption) of               archetypes• Two translation facilities for existing archetype  – Cl...
Common problem of Japanese    translation in health care domain• Demographics   – Name, Address• Health care insurance   –...
Archetype in intractable disease         surveillance in Japan• Localisation  – Archetype translation to Japanese  – Desig...
Healthcare insurance in Japan• Universal care  – For all patient  – For all medical provider• Two systems  – Medical insur...
‘Nambyo’• So called ‘intractable disease’• Definition  – diseases that have resulted from an unidentifiable    cause and, ...
‘Tokutei shikkan’• Specified rare and intractable disease  – Public subsidized• Definition  – Chronic development and seri...
List of ‘tokutei shikkan’01 Behcet disease                           Parkinson disease                      Sheinker syndr...
The Specified Disease(tokuteishikkan) Treatment Research Program• Prefecture government  – Certificate and yearly renewal ...
Improvement ‘Tokutei-shikkan’    surveillance project organization• Leader   – Prof. Tsutom Chiba, Gastroenterology, Kyoto...
Problems• Certificate criteria   – Vary from prefecture to prefecture• National data registry   – Permitted researchers co...
2010/Feb.Traiinng@Melbourne     review                   MindMap Archetype prototyping
Hard discussion in Cape town
Clinical research form
Mindmap designed for clinical  research form, first trial
Concepts confusion (eg. SLE form)• Skin and mucous symptom  –   Skin itching           -symptom  –   Butterfly rash       ...
MindMap version 2
Mindmap version 3
MindMap current version
Archetype localisation/adaptation•   Address•   ESR/FBC•   Insurance•   Family history•   Severity?•   Modality?•   Termin...
Address in Nambyo form• Prefecture government  – Nation / prefecture budget  – management by prefecture  – Prefecture deal...
FBC archetype
ESR/FBC• ESR(Erythrocyte sedimentation ratio)  – Marker for SLE activity(not CRP)  – Included in FBC archetype• FBC(Full b...
Blood cell classification               (microscopic)•   Myeloblast          •   Erythroblast•   Promyelocyte        •   R...
Insurance• Universality?  – Public, private, conditions, country  – Domestic matter?• Admin entry?  – Needs for billing pr...
Health insurance(MML module)
Family History (cont.)Family History for Budd-Chiari syndrome(1) Interfamily onset 1.Yes (Relation:                      )...
Family History Archetye
Severity• Many criteria  – TNM, CTCAE, MGFA, Yahr, UC, Chron  – Grading?, Staging?• Compatibility?  – MG severity(MGFA) vs...
Problem and diagnostic archetype
Modality• Diagnostic imaging archetype  – X-Ray, CT, MRI..     • Detailed condition?        – Vendor name, Serial No., kVp...
Terminology• SNOMED-CT  – For western countries?  – Applicable in Asia, Africa?• Possibility of Free/Open/Libre terminolog...
Summary• Localisation/Internationalisation  – Not to isolate  – Demographics, Insurance• For intractable disease  – Genera...
Localisation of openEHR in Japan
Upcoming SlideShare
Loading in …5
×

Localisation of openEHR in Japan

1,230 views

Published on

Japanese activity in localisation of the openEHR project.

Published in: Health & Medicine, Technology
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,230
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
14
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Localisation of openEHR in Japan

  1. 1. Localisation of archetype to validatefeasibility of ISO 13606/openEHR in Japan Shinji KOBAYASHI Ehime university
  2. 2. Agenda• Localisation / Internationalisation – Localisation/Isolation – Translation, adaptation• ISO 13606/openEHR adoption in Japan – openEHR.jp works – Intractable disease surveillance program – Archetype localisation/adaptation• Summary
  3. 3. Localisation / Internationalisation• Localisation – Language translation – Currency, Date, time, time zone – Culture, rules, law – NOT isolation• Internationalisation – Capacity for multiple localisation – Resource for many countries and regions
  4. 4. Localisation/Isolation Regional Regional community community International communityInternational community International community Regional Regional Regional community community community Internationationalisation Localisation Isolation
  5. 5. Common problems in software localisation to Japan• Translation – Word sequence • Ex. From A to B(En) AからBへ(Ja) – Not one to one • By context, situation – No adequate concept in Japanese• Character encoding – UTF-8, UTF-16, S-JIS, JIS, EUC-JPN….• Address sequence – Reverse from Western style • Prefecture, City, Town, number• Tends to fork or isolate – Fitting for Japan unique situation?, Going to Galapagos?
  6. 6. Japan has specific features, but not unique• Language and character is unique? – Arabic languages are written from right to left – China and Korea also use 漢字• Culture is unique? – Each country has its own culture – Japan enthusiasts are all over the world.• Therefore our contribution can help other countries
  7. 7. Translation• Is it really match? – Pounding pain(en) がんがんする痛み(日本 語)• Hard to translate – Word has various meanings in situation • Shin-satsu(診察) – Clinical examination and consultation – Each doctor has each ‘Shinsatsu’ style – Concept is not common in/out Japan • Kyo-iku mama(教育ママ) • Health care(broader than 医療)
  8. 8. Form localisationSometimes, word sequence arrangements are needed for non European language.This arrangement needs not only dictionary rules, but more codes for it.
  9. 9. Favorable features to localisation/internationalisation• Source code availability – Open Source Software is ideal• International community – Premise to multi-lingual environment – Rich in other translation efforts – Capacity for localised patch• Regional community – Discuss on localisation – Promotion in Japan
  10. 10. Why openEHR?• Interoperability for – Clinical research – Healthcare governance – Evaluate clinical care – multi language environment• ISO 13606 Standard – Experience • >20years – Establishment • Open source software implementation by international community http://openehr.jp/
  11. 11. The works of the openEHR.jp• The first regional activity of the openEHR project• Translation – Architectural over view, openEHR licensing – openEHR primer,Eiffel FAQ – openEHR Models, Archetypes and Biomedical Ontologies• Delegation to international community – International congress, Medinfo2007, Medinfo 2010• Implementation – Ruby implementation for openEHR specifications• Seminars – MOSS, Seagaia meeting, This seminar!
  12. 12. Localisation (Translation / Adoption) of archetypes• Two translation facilities for existing archetype – Clinical Knowledge manager – Archetype Editor• Creation new archetype for domestic use – Archetype editor – Needs international discussion • The most of those we think it is only in Japan are often universal problem Social network system will help you.
  13. 13. Common problem of Japanese translation in health care domain• Demographics – Name, Address• Health care insurance – Universal care• Role instability – Doctor, Nurse, Radiologist, Pharmacist… • Laws define each role for health care professional • Change their role in hospital to hospital, area to area…• Term translation – Subjective representation(obscure definition)
  14. 14. Archetype in intractable disease surveillance in Japan• Localisation – Archetype translation to Japanese – Design for Japan domestic clinical issue• Adaptation – General practice <-> Specialised medical service • Auto-immune disease, neuron degenerative disorders – Archetype adaptation to Japanese clinical environment – Easy: Physiology, anatomical location – Difficult: Demographics, Administrative concept – Other problems: Chemistry
  15. 15. Healthcare insurance in Japan• Universal care – For all patient – For all medical provider• Two systems – Medical insurance(for all generation) – Long term care insurance(for aged people)• Other support program by national/local government – Handicapped, Children, Single mother…
  16. 16. ‘Nambyo’• So called ‘intractable disease’• Definition – diseases that have resulted from an unidentifiable cause and, without a clearly established treatment, have a considerably high risk of disability – diseases that chronically develop and require a significant amount of labor for the patient’s care, causing a heavy burden on other family members of the patient, both financially and mentally
  17. 17. ‘Tokutei shikkan’• Specified rare and intractable disease – Public subsidized• Definition – Chronic development and serious consequences – Treatment of these disease is expensive for patients and families. – Lack of information for diseases• Classification – 56 diseases, 615,568 patients registered
  18. 18. List of ‘tokutei shikkan’01 Behcet disease Parkinson disease Sheinker syndrome -fatal 56 Diencephalo-hypophysial02 multiple sclerosis 21 amyloidosis familial insomnia dysfunction -Syndrome of03 myasthenia gravis 0 22 ossification of posterior 39 primary pulmonary hypertension abnormal secretion of longitudinal ligament (OPLL) 40 neurofibromatosis type 1, prolactin -Syndrome of4 systemic lupus erythematosus abnormal secretion of (SLE) 23 Huntington disease neurofibromatosis type 2 gonadotropin -Syndrome of05 subacute myelo-optico- 24 moyamoya disease 41 subacute sclerosing abnormal secretion of neuropathy (SMON) 25 Wegener granulomatosis panencephalitis (SSPE) antidiuretic hormone -06 aplastic anemia 26 dilated cardiomyopathy, 42 Budd-Chiari syndrome Syndrome of abnormal07 sarcoidosis congestive cardiomyopathy 43 idiopathic chronic pulmonary secretion of Thyroid thromboembolism with stimulating hormone -08 amyotrophic lateral sclerosis 27 multiple system atrophy - pulmonary hypertension Cushing disease - (ALS) striatonigral degeneration Acromegaly -09 scleroderma , dermatomyositis, (SND) 44 lysosomal storage diseases - Hypopituitarism or polymyositis -olivopontocerebellar Fabry disease -other atrophy (OPCA) -Shy-Drager lysosomal storage diseases10 idiopathic thrombocytopenic syndrome 45 adrenoleukodystrophy (ALD) 615,568 patients registered purpura11 (1) polyarteritis nodosa (2) 28 epidermolysis bullosa 46 Familial Hypercholesterolemia microscopic polyangiitis 29 pustular psoriasis ( Homozygous type)12 ulcerative colitis 30 disseminated spinal canal 47 spinal muscular atrophy (SMA)13 Takayasu arteritis stenosis 48 spinal and bulbar muscular 31 primary biliary cirrhosis atrophy (SBMA)14 thromboangitis obliterans, 49 Chronic Inflammatory Buerger disease 32 severe acute pancreatitis 33 idiopathic necrosis of the Demyelinating15 pemphigus Polyneuropathy16 spinocerebellar degeneration femoral head 34 mixed connective-tissue disease 50 Hypertrophic cardiomyopathy17 Crohn disease 51 Restrictive cardiomyopathy18 fulminant hepatitis 35 primary immunodeficiency syndrome 52 Mitochondrial disease19 malignant rheumatoid arthritis 36 idiopathic interstitial pneumonia 53 lymphangioleiomyomatosis (rheumatoid vasculitis) 54 Severe erythema multiforme20 Parkinson disease and related 37 retinitis pigmentosa 38 prion diseases -Creutzfeldt- (Acute Phase) diseases -progressive 55 Ossification of the ligamentum supranuclear palsy - Jakob disease (CJD) - corticobasal degeneration - Gerstmann-Straussler- flavum
  19. 19. The Specified Disease(tokuteishikkan) Treatment Research Program• Prefecture government – Certificate and yearly renewal – Application document includes: • Application and consent form • Clinical research form certified by doctor • Certificate of residence, earnings, and other• Subsidy – Partial-total by earnings
  20. 20. Improvement ‘Tokutei-shikkan’ surveillance project organization• Leader – Prof. Tsutom Chiba, Gastroenterology, Kyoto Univ• Clinical group – Prof. Tsuneyo Mitsumori, Clinical immunology, Kyoto Univ – Prof. Ryosuke Takahashi, Clinical neurology, Kyoto Univ• Informatics Group – Prof Hiroyuki Yoshihara, Kyoto Univ – Eizen Kimura, Shinji KOBAYASHI, Prof Ken Ishihara, Ehime Univ
  21. 21. Problems• Certificate criteria – Vary from prefecture to prefecture• National data registry – Permitted researchers construct databases for their study at that time – Nation wide follow up system – Quality management – Epidemiological new findings – Security issues
  22. 22. 2010/Feb.Traiinng@Melbourne review MindMap Archetype prototyping
  23. 23. Hard discussion in Cape town
  24. 24. Clinical research form
  25. 25. Mindmap designed for clinical research form, first trial
  26. 26. Concepts confusion (eg. SLE form)• Skin and mucous symptom – Skin itching -symptom – Butterfly rash -inspection – discoid erythema -diagnosis – Photosensitive -diagnosis – Raynauds phenomenon -diagnosis – Oral or nasal ulcer -inspection – Alopecia -diagnosis(L65.9) – subcutaneous nodule -inspection – ulcer or infarction -inspection or diagnosis – Finger gangrain -diagnosis – Livedo reticularis -diagnosis
  27. 27. MindMap version 2
  28. 28. Mindmap version 3
  29. 29. MindMap current version
  30. 30. Archetype localisation/adaptation• Address• ESR/FBC• Insurance• Family history• Severity?• Modality?• Terminology
  31. 31. Address in Nambyo form• Prefecture government – Nation / prefecture budget – management by prefecture – Prefecture deal subsidy to patients• Address archetype localisation – Lack of granularity for Japanese local government – Reversed style
  32. 32. FBC archetype
  33. 33. ESR/FBC• ESR(Erythrocyte sedimentation ratio) – Marker for SLE activity(not CRP) – Included in FBC archetype• FBC(Full blood Count) – WBC, RBC, Ht, Hb, Plt,(ESR) – WBC classification lacks immature myeloid series• ESR is isolated from FBC• WBC classification -> cluster?
  34. 34. Blood cell classification (microscopic)• Myeloblast • Erythroblast• Promyelocyte • Reticulum• Myelocyte • Monoblast• Metamyelocyte • Promonocyte• Proerythroblast • Phagocyte• Basochromatic- • Lymphoblast• Orthochromatic • Plasmacyte• Normochromatic • Megakaryocyte• Megaloblast • Promegakaryocyte
  35. 35. Insurance• Universality? – Public, private, conditions, country – Domestic matter?• Admin entry? – Needs for billing procedure
  36. 36. Health insurance(MML module)
  37. 37. Family History (cont.)Family History for Budd-Chiari syndrome(1) Interfamily onset 1.Yes (Relation: ) 2.No(2) Collagen Disease 1.Yes (Disease Name: /Relation: ) 2.No(3) Blood disease 1.Yes (Disease Name: /Relation: ) 2.No(4) Venous thrombosis 1.Yes (Disease Name: /Relation: ) 2.No Collagen Blood Disease Disease Budd-Chiari (Interfamily onset) •Other items Principal •Marriage between Budd-Chiari relatives •Born in closed community• What model will be suitable for describing following family history?
  38. 38. Family History Archetye
  39. 39. Severity• Many criteria – TNM, CTCAE, MGFA, Yahr, UC, Chron – Grading?, Staging?• Compatibility? – MG severity(MGFA) vs Parkinson sevierty(Yahr) • Non sense – CTCAE/NIH-CTC • Partially meaningful
  40. 40. Problem and diagnostic archetype
  41. 41. Modality• Diagnostic imaging archetype – X-Ray, CT, MRI.. • Detailed condition? – Vendor name, Serial No., kVp…. – Procedure • Operation • Endoscopy – (Koray Atalag present)
  42. 42. Terminology• SNOMED-CT – For western countries? – Applicable in Asia, Africa?• Possibility of Free/Open/Libre terminology? – Wikipedia/SNS type terminology 2.0? – Responsibility? Don’t we need SNOMED-CT? Or Do we create terminology?
  43. 43. Summary• Localisation/Internationalisation – Not to isolate – Demographics, Insurance• For intractable disease – General practice <-> Specialised medical service• Terminology – What should we, Japanese do?

×