Enterprise Imaging (Proof of Concept)
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Enterprise Imaging (Proof of Concept) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Endoscopy

Endoscopy is usually supported by a specialist Endoscopy Reporting System (ERS), linked to the EPR and to the imaging archive. It is rarely a feature of the EPR itself. Endoscopy matters to pathology because it is a major specimen collection point: many cancer biopsies are taken at endoscopy.

References

Systems

Part Role Examples
Endoscopy Reporting System (ERS) Lists and booking, structured procedure report (OGD, colonoscopy, ERCP, EUS, …), quality measures (sedation, comfort, completion), still image capture into the report, NED upload, often pathology requests for biopsies Specialist products such as Medilogik EMS, Olympus EndoBase, Unisoft GI Reporting Tool, Solus, Provation
Video processor and capture Scope image source; stills and video recording Scope manufacturers' processors and recorders; theatre video integration systems
Image archive Long-term storage of stills and video, increasingly DICOM into PACS or a VNA Trust PACS / VNA
Decontamination traceability Which scope was used on which patient, and its decontamination Part of the ERS, or a separate system

Product names are examples of the market, not a statement of what any trust uses.

Workflow

sequenceDiagram
    participant OP as Order Placer<br/>EPR / Order Comms
    participant ERS as Endoscopy Reporting System
    participant SCOPE as Video processor
    participant VNA as PACS / VNA
    participant LIMS as Pathology LIMS
    participant NED as National Endoscopy<br/>Database

    OP ->> ERS: Endoscopy request (HL7 v2 or FHIR)
    ERS -->> ERS: Book, list, check in
    SCOPE ->> ERS: Still images captured during procedure
    ERS ->> VNA: Images / video (DICOM, where supported)
    ERS ->> LIMS: Histopathology request for biopsies<br/>(IHE LAB-1 Placer Order Management)
    ERS ->> OP: Endoscopy report (HL7 v2 ORU / PDF, or FHIR DiagnosticReport)
    ERS ->> NED: Procedure data (XML web service)
    LIMS ->> OP: Pathology report (IHE LAB-3)

National Endoscopy Database

The National Endoscopy Database (NED) collects procedure data from endoscopy units across the UK. The ERS uploads each procedure to NED through a web service supplied by the ERS vendor. JAG reports that more than 15 million procedures have been uploaded since 2015, from over 530 sites. NED upload and JAG accreditation are related but separate processes.

Endoscopy and Pathology

The IHE Endoscopy Report and Pathology Order (ERPO) profile covers creating the endoscopy report and placing pathology orders from it. In the Cancer Pathology Report IG the endoscopist is the specimen collector, and the pathology request is a Placer Order Management [LAB-1] interaction. Whether the request is placed from the ERS or from the EPR is a local decision - To confirm for each trust.

FHIR

  • The endoscopy report is a DiagnosticReport. HL7 v2 table 0074 (diagnostic service section) has no endoscopy code, so the category is Open - see Terminology.
  • Endoscopy images in DICOM use the ES (Endoscopy) modality and appear in ImagingStudy like radiology images.
  • The HL7 Europe Imaging Report IG is written for imaging generally; whether it fits the endoscopy report is Open.