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SIOS Technology, Inc.: Developing a next-generation cloud electronic medical record service with HL7® FHIR® on Google Cloud

About SIOS Technology, Inc. | Seijin Medical Corporation

SIOS Technology, Inc.
SIOS Technology, Inc. has been focused on commercializing open-source software and software products developed in house. The company recently launched products and services that leverage emerging technologies in its commitment to pursuing innovative software solutions to create greater value, and contribute to building a better society.

Seijin Medical Corporation
Founded in 1994, Seijin Medical Corporation is a pioneer in the psychiatric medical welfare industry, providing comprehensive medical services from emergency hospitals, to support for home living.

Industries: Healthcare
Location: Japan

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SIOS Technology, Inc. and Seijin Medical Corporation have developed INDIGO NOTE, a cloud-based electronic medical record service that uses HL7® FHIR®, the next-generation medical information exchange standard.

Google Cloud results

  • Helps standardize and develop a next-generation HL7® FHIR®-based electronic medical record service
  • Enables 24/7 operations without disruptions with GKE
  • Achieves rapid feedback cycles during development with Cloud Healthcare API

Contributes to future medical DX with a cloud-native system, INDIGO NOTE

SIOS Technology, Inc. (SIOS Technology) has launched INDIGO NOTE, a cloud-based electronic medical record service for psychiatric hospitals under the commission, supervision, and design of Seijin Medical Corporation (Seijin). INDIGO NOTE is built on HL7® FHIR® (Fast Healthcare Interoperability Resource), the next-generation medical information exchange standard, and uses HL7® FHIR®-compliant Cloud Healthcare API as its foundation.

Driving the future of medical care in Japan with cloud technology

INDIGO NOTE has adopted HL7® FHIR® as a standard for data storage and exchange, garnering worldwide attention. In addition, the secondary use of data is ensured by complying with the Ministry of Health, Labor and Welfare (MHLW) standards in handling test results, prescriptions, disease names, and more.

Another prominent feature is that it is deployed as a complete cloud service that distributes and manages data at multiple locations in Japan. Hospitals that use the system can achieve high availability but at a lower cost in terms of introduction and operation.

SIOS Technology, Inc. adopted Google Cloud products, including Google Kubernetes Engine (GKE), as the development and operation platform for INDIGO NOTE. In addition, INDIGO NOTE uses the HL7® FHIR® compliant Cloud Healthcare API as the data storage platform.

"INDIGO NOTE is a medical service, so it needs to operate 24 hours a day, 365 days a year without interruption. It also needs to link with various external systems. Taking these points into account, we decided that GKE, which enables rapid provisioning, would be suitable for the underlying host environment."

Hirotoshi Fujita, Director of INDIGO NOTE Development, SIOS Technology.

Dr. Shigemasa Katayama, chairman of Seijin, explains the background behind developing the new Electronic Medical Record EMR service, "Conventional EMR systems face various issues such as usability and compatibility with other hospitals, so we wanted to build a new EMR system that would lead to the development of medical care in Japan using cloud-based technology. MHLW also launched a concept for the healthcare standards and terminologies for enabling wide interoperability of EMR systems, and there was a movement to recommend HL7® FHIR®. In collaboration with SIOS Technology and Professor Eizen Kimura of Ehime University School of Medicine, we decided to proceed with development in the form of joint research."

The decisive factor in adopting Google Cloud as the system platform for INDIGO NOTE was the availability of medical services such as FHIR and DICOM® (Digital Imaging and Communications in Medicine), an international standard for medical data communication, and infrastructure construction. Kakuya Kawata, Board Member & Executive Vice President of SIOS Technology, said that all container-based services, including GKE, were fully managed services, which also helped in SIOS' decision.

"Google Cloud provided the most comprehensive solution for medical services, compared to other cloud services companies. After much consideration, we decided to adopt Google Cloud. The following were the main research items that made us decide to adopt Google Cloud, and Google Cloud fulfilled all of them," shares Kawata.

Research table

Ensuring high availability and ease of maintenance through microservices

INDIGO NOTE achieves high availability and maintainability by provisioning individual functions such as EMR and tenant management as independent microservices. "INDIGO NOTE is a medical service, so it needs to operate 24 hours a day, 365 days a year, without interruption. It also needs to link with various external systems. Taking these points into account, we decided that GKE, which enables rapid provisioning, would be suitable for the underlying host environment," says Hirotoshi Fujita, Director of INDIGO NOTE Development, SIOS Technology, explaining the reason for adopting GKE as the system infrastructure.

The core of INDIGO NOTE has a multi-tenant configuration. Still, the parts that need to be managed individually for each hospital, such as accounting and FHIR, are hosted in an independent single-tenant environment. In addition, executing the form rendering with a high load on Cloud Run is configured to distribute the load so that GKE's machine resources do not spike.

SIOS architecture
Click to enlarge image

The EMR datastore utilizes the HL7® FHIR® compliant Cloud Healthcare API described above. Yuji Tagawa, MedTech-SL Chief Engineer of SIOS Technology, was in charge of implementing and mapping out the appropriate FHIR resources and outlines the use of the Cloud Healthcare API, "INDIGO NOTE performs approximately 1,500 automated tests per day. To ensure that each test is not affected by the results of previous and subsequent tests, the CI/CD pipeline uses 20 containers, and six datastores. Then, a new Pub/Sub message queue is built and deleted when the test is completed. The Cloud Healthcare API is provisioned in seconds, so engineers can immediately obtain test results for their code. It allows us to have a fast feedback cycle."

Building a system design in collaboration with medical system experts

Dr. Katayama, who previously built a medical system in-house at his hospital, shares the challenges of developing the EMR system. "The ordering function, which manages tests and prescriptions made by doctors and nurses, is more complicated. Knowledge of the Japanese medical system is required to create a computerized provider order entry (CPOE) system. Though FHIR is developed for the international standard, some parts do not necessarily match the Japanese healthcare system, which may cause issues for us."

Tagawa adds that advice from medical experts was essential to clear this challenge. "With Dr. Katayama's full cooperation on the know-how of CPOE and EMR, we jointly proceeded with defining the requirements. Regarding FHIR, we received advice from our joint researcher, Professor Eizen Kimura, at Ehime University School of Medicine. We mapped the FHIR resources with the Japanese EMR system and carefully designed it so there would be no inconsistencies."

"INDIGO NOTE performs approximately 1,500 automated tests per day. To ensure that each test is not affected by the results of previous and subsequent tests, the CI/CD pipeline uses 20 containers, and six datastores. Then, a new Pub/Sub message queue is built and deleted when the test is completed. The Cloud Healthcare API is provisioned in seconds, so engineers can immediately obtain test results for their code. It allows us to have a fast feedback cycle."

Yuji Tagawa, MedTech-SL Chief Engineer, SIOS Technology.

It was necessary to adjust FHIR's function as a datastore, and align it with the Japanese medical system. "For example, regarding data search, there were some areas where the standard functions of FHIR alone were not enough to satisfy the requirements of the Japanese system. Concerning this, the Google Cloud support team proposed a method to use Elasticsearch, and we were able to solve it without incident. We are grateful for the flexible and detailed support we received from Google Cloud," says Tagawa. Kawata and Dr. Katayama are pleased with the success of INDIGO NOTE, which adopted HL7® FHIR®, and looks set to be a next-generation standard.

SIOS interviewees
Pictured from left to right:
・Dr. Shigemasa Katayama, Chairman, Seijin Medical Corporation.
・Kakuya Kawata, Board Member & Executive Vice President, SIOS Technology, Inc.
・Hirotoshi Fujita, Director of INDIGO NOTE Development, SIOS Technology, Inc.
・Yuji Tagawa, MedTech-SL Chief Engineer, SIOS Technology, Inc.

"In the future, the demand for EMR with a common format will continue to increase, especially when sharing patient information between hospitals and telemedicine from home. Since April 2022, the system has been revised to allow telemedicine from the first visit. Still, access to medical information has restrictions that must be met when patient records are required. Based on the powerful infrastructure of Google Cloud and cloud-native INDIGO NOTE, which was developed as a service, we should be able to address this and improve healthcare digital transformation (DX) in the future. SIOS Technology is also working with Dr. Katayama on a separate project involving medical AI research and development in collaboration with Google Cloud. We aim to strengthen our services by doing so," says Kawata.

"Japan is one of the countries with a particularly complicated medical system, but Google Cloud, which has strong medical services solutions and support, can match the system design. As a result, we have built a practical cloud service. In the future, patients can access their medical histories, drug information, test data, and more. They will also be able to record their life events and use them as personal records. I am excited to keep developing EMR in such a way," concludes Dr. Katayama.

"Japan is one of the countries with a particularly complicated medical system, but Google Cloud, which has strong medical services solutions and support, can match the system design. As a result, we have built a practical cloud service."

Dr. Shigemasa Katayama, Chairman, Seijin Medical Corporation.

Tell us your challenge. We're here to help.

Contact us

About SIOS Technology, Inc. | Seijin Medical Corporation

SIOS Technology, Inc.
SIOS Technology, Inc. has been focused on commercializing open-source software and software products developed in house. The company recently launched products and services that leverage emerging technologies in its commitment to pursuing innovative software solutions to create greater value, and contribute to building a better society.

Seijin Medical Corporation
Founded in 1994, Seijin Medical Corporation is a pioneer in the psychiatric medical welfare industry, providing comprehensive medical services from emergency hospitals, to support for home living.

Industries: Healthcare
Location: Japan