Sunday, August 05, 2007

Dutch HL7 Concerns

In his HL7 Connection blog the Dutch healthcare management consultant Matthew Clapp seeks to provide an open forum for collaboration between and dialog between advanced and beginner professionals in the HL7 field. In his posting "Should Governments Rely on HL7?" of August 3, 2007 he points to what he sees as the the HL7 organization's failure to foster a more open, collaborative structure:

I’ve even received emails telling me that this site is a waste of time - that no one will bother reading it because I’m not on some HL7 committee. A community that insulates itself from criticism cannot be successful.

The Course of Life blog by the Dutch scientist and entrepreneur Albert de Roos contains two recent postings in a similar vein. The first, Some practical experiences with HL7 version 3, concludes that HL7v3 seems 'too complex to work with in a multidisciplinary environment":

The complexity of HL7v3 is a general problem and also causes delays in implementation at the technical level. I hoped it has been solved now, but in 2006 not all XML schemes that were distributed could be read by the most common XML parsers available, indicating some of the problems with the complexity of HL7v3 messages. ... These apparently trivial issues may cause many delays and frustration for software developers, I can tell you.

The release frequency is also a problem, introducing problems with the different versions. This can be illustrated by the many different versions of the DMIM and RMIMs that are available on the web. I don’t think any of these have been implemented in the field, so while trying to get the thing to work, the international organization rolls out new normative editions. The Dutch implementation of HL7v3 does not follow the international release schemes, but has been frozen in an earlier version. Trying to keep up with the updates is a full-time job. Combine this with the two releases of the complete Dutch documentation each year, which may include changes in the HL7 messages, and the chaos is complete. Of course, we are only in the proof-of-concept phase, so we can expect changes but is there a any guarantee that HL7 enters a relatively stable phase? What will happen to HL7v3 messages when HL7 international moves on to the clinical document architecture, is there a migration path?

In HL7 as standardization organization de Roos points to certain problematic consequences of the fact that the Dutch government "seems to have completely outsourced the entire process of healthcare standardization to HL7:

The different members of the technical committees of HL7 version 3 modeling are employees of software suppliers, consultant or work in a hospital or other health institution. Given the complexity of the modeling in HL7v3 and the limited number of people or organizations involved, it is doubtful whether the models represent indeed a consensus standard way of working. For instance, the involvement of commercial software suppliers may cause the models to closely represent their own software giving them a competitive edge.

To me, it is clear that HL7 is a lobby organization for its own products and that they try to sell their product wherever possible. There is nothing wrong with a lobby organization and its members can spend their money how they want. The problem here is that HL7v3 is sold as a finished product and as a de facto standard, but in fact is not a complete and finished product and never successfully implemented outside of a laboratory setting. It changes continually, indicated by the fact that the organization now moves towards a new product, clinical document architecture, to largely replace the HL7v3 framework. This shift of HL7 has consequences for the national EHRs that are based on HLv3, showing that national governments are not in control of the apparently evolving requirements for the EHR and its implementation. It is strange that the government puts its ambitions in the hands of an organization that they can’t control and where its members clearly have commercial interests or other ambition that are not in line with public or governmental ambitions.

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