Although echocardiography has been performed in many institutions, differences between institutions in echocardiographic diagnosis need to be addressed. For example, there is a difference in the implementation rate depending on the measurement item in Hokkaido Prefecture. To achieve better examinations, the expertise of the examiner, securing a sufficient number of examiners and time allocated for echocardiography, and the presence of a cardiovascular specialist who can be consulted are necessary. Standardization of measurement items and measurement methods plays a big role. Determining measurement items is a difficult problem, but it is desirable to standardize echocardiography to aim for uniform treatment policies based on echocardiographic findings. In order to maintain the knowledge level and technical level of examiners, education and training in a way that does not create regional disparities are necessary. Organized efforts are also desired for examiners at institutions that do not have cardiovascular specialists who can be consulted.