Tuesday, October 28, 2008

Information and Communication Technologies Standards in the Health Sector

A new study has been released on behalf of the Enterprise & Industry Directorate General of the European Commission on the topic of ICT standards in the health sector: current situation and prospects.

The study contains a number of interesting remarks on HL7, for example welcoming the current initiative towards greater collaboration between HL7, ISO and CEN.

But there are also critical remarks, for example to the effect that:

Small or medium-sized ICT manufacturers may not be willing to adopt commonly used standards because these are very complex and thus difficult and expensive to implement. This applies for example to HL7 version 3. It may be less costly to develop proprietary standards on their own. (p. 21)

And also this:

HL7’s v2.x standards were important steps towards standardising clinical messaging. However, several issues caused difficulties, above all different options to implement the standard. To correct this issue, the RIM was developed for v3.0, eliminating most of the implementation options. The concept behind HL7 v3.0 has been generally well received. However, the RIM caused new problems. Firstly, it is unlikely that the defined RIM classes and attributes could be applied to every domain in healthcare – which is what they are intended to do. Secondly, the RIM documentation is described as being “disastrously unclear”, poorly integrated with HL7 v3.0 documentation, and inconsistent.

Under these circumstances, it may be difficult for HL7 v3.0 to establish a large user base. ... HL7’s involvement in the joint initiative with ISO and CEN may have the objective to move faster to international adoption of HL7 standards. The outcome of this convergence work as well as the organisation’s ability to create a satisfactory RIM may determine the future importance of HL7. (p. 37f.; emphasis added)


Ren� said...

One should however put the quoted comment about the RIM in context: the only reference given in the report is a well known RIM-critique written by the author of this Blog in 2006. None of the experts that took part in the survey which forms the basis for this report made any comments in a similar vein, nor does the assessment make any statements about related "expert statements received for this report". To me this seems a bit thin in terms of support for the harsh statements quoted above.

The report in general, when assessing the current standards, does critique almost all of them for one reason or another. For example, to quote the very same European report: "CEN standards [Europe's very own SDO] are mainly developed by people with theoretical backgrounds which makes them hard to read and understand and used as well as too detached from reality". "ISO works 'too much detached from reality' and would benefit from more involvement from users."

Taken out of their context such quotes take on quite a different meaning than intended in this reasonably balanced report.

The report urges cooperation between SDOs; and given the practical implementation requirements of the English NHS as well as others, there is ample motivation to harmonize CEN's 13606, OpenEHR archetypes with the HL7 v3 RIM.

Such harmonization may lead to changes in the RIM - which will at the end of the day just make it stronger as a reference model. The only standards that aren't subject to change and self-reflection are those that are not implemented. At the end of the day, it's the user community that will determine what standards will be implemented.

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