As David More points out in his introduction to the discussion, the implementation success of V3 thus far (and this means after some 14 years of development work) "has been somewhat patchy, with at least some proponents scaling back their enthusiasm for full adoption of the V3 Standard as some see it is lacking the necessary robustness and internal consistency for ongoing use." Dr More goes on to point out that, "While I am not sufficiently across the details of some of this to be able to form a trustworthy opinion a number of very smart people I have chatted with have expressed similar concerns."
In a comment, Grahame Grieve writes on behalf of HL7:
There's no reason for anyone to be afraid to comment. HL7 is not a police state, and there's an endless list of people who criticise and carp. They can expect a vigorous in kind response, but nothing more.
v3/RIM is not perfect. But it's not intended to be an ontology of everything. If only Barry would understand. It's just a model that has some use for interoperability. It's got some go-down-with-the ship type supporters, of course.
As does v2 (and all the other standards - they all have the folks who are going to go down with the ship). It's not enough to say it's simpler. There's more to it than that. The discussion is being had elsewhere, and here is not the place for it. HL7 continues to produce v2 (v2.7 is coming) but the community that is HL7 is switching to v3 because of it's power.
v3 itself does have a patchy record. I'm on record as saying that there won't be another full v3 implementation. People will cherry pick the parts that work - like CDA - and use them as they want.
I've got more to say but it's starting to rain and I'm out in the bush camping. Have a good weekend."These remarks raise many interesting questions. Grahame asserts that commentators -- whom he divides into critics and carpers -- can expect nothing more than a "vigorous in kind response". Why, then, are so many people reluctant to use their names when commenting critically on HL7? I also fully understand that HL7 V3 is not intended to be an "ontology of everything". Indeed its scope is a tiny, tiny fraction even of the healthcare domain. The problem, as I see it, lies rather on the part of HL7's own advocates when they advance claims for example to the effect that HL7 is "the data standard for biomedical informatics". Such claims give rise in turn to multiple efforts to reinvent various well-functioning wheels in somewhat less-well-functioning proprietary versions inside the walls of HL7. Over time, in result, HL7 becomes ever more complicated, ever more difficult to teach, and ever more difficult to apply successfully. Raising the inevitable question: who benefits from such developments? The following remarks were sent to me by the Asian health IT specialist (henceforth 'S') who was the author of the Cries for Help which originally provoked Grahame's comments:
Grahame (henceforth: G): "v3/RIM is not perfect. But it's not intended to be a ontology of everything. If only Barry would understand. It's just a model that has some use for interoperability. It's got some go-down-with-the ship type supporters, of course."
It's just a model that has some use for interoperability -- That's pretty lame! When a patient's life is on the line "some use for interoperability" is not good enough. The system has to be 100% perfect. Imagine using "some interoperability" to loosely move data across hospitals with the possibility of data errors. The more complex and opaque a system, the more are the chances of errors.And this is simply because it could be almost impossible to detect the tiny but fatal coding flaw that could be hidden under tons of code, trying to helplessly interpret overly complex V3 rules.
S: What power?!! V2.6 can actually do every thing that V3 does - only more elegantly, simply and transparently.
S: So does that mean that V3 is dead, long live V2?
G: "People will cherry pick the parts that work - like CDA - and use them as they want"
S: Why is HL7 diluting it's focus? It's main aim was to create and encourage a messaging standard for interoperability. Than why create a CDA? Why hijack a perfectly good CCR? The way it is going, tomorrow they may think of creating an EMR, EHR and later a HIS all of course based on the RIM!S continues as follows:
I say, Focus dear friends, focus. Make HL7 simple enough to be easily implementable. And make the HL7 standards more open/accessible.
On accessibility, this is what I have to say. Have you seen the latest restrictions on use of the HL7 standards? They were restrictive in the past, it has now gotten worse. Today the standard is totally commercialized. You cannot use it to create a professional, usable, realworld (aka 'commercial') app till you pay the HL7 group with a pound of your flesh. You cannot teach HL7 to any one - ditto, share it with a colleague in your hospital? - ditto .
So how does one spread the message of interoperability far and wide, how does one advocate use of the HL7 standard world wide, how does one make hospitals share records, when at each step you are told to cough up money!
So let HL7 frankly admit that it is in it for the money or go truly open and offer the standards to all like say, LOINC or ICD.
So, in conclusion, here is the true (no hidden agendas) mantra to making HL7 (V2x) a truly international standard.
1. Drop V3, simplify V2x and make it easily implementable
2. Make the HL7 standard truly open by offering it free for use.
Amen...Readers of this blog are warmly recommended to read the further comments at Australian Health Information Technology, which are of interest especially as concerns the views expressed on the potential implications of HL7 standards for the Australian National E-Health Transition Authority.
Postscript: March 27, 2011
Graham Grieve posted a comment here parts of which are addressed to the above-mentioned A>sian healthcare specialist, specifically:
S: HL7 becomes ever more complicated, ever more difficult to teach, and ever more difficult to apply successfully.
G: Yes. These are all true, and concerning. But complexity is complex. As are committee designed standards. Name a standard that hasn't got more complex over time...
S: That's pretty lame! When a patient's life is on the line "some use for interoperability" is not good enough
G: oh? Patient's lives are on the line? I'd never thought!
S: Imagine using "some interoperability" to loosely move data across hospitals with the possibility of data errors.
G: To be serious, it's hard to know how to respond to this. There's no context, no ground rules. As for this... "V2.6 can actually do every thing that V3 does - only more elegantly, simply and transparently" I can only assume that the "expert" hasn't implemented both CDA and v2. Perhaps not even read them. Or they have a very peculiar definition of "everything".
S: Have you seen the latest restrictions on use of the HL7 standards?
G: Errr, I've not heard that anything changed. What, specifically, has changed? I'm personally against charging for the standards, but developing standards is a costly business that has to be funded somehow. (Do I need to repeat for slow readers that I do *not* speak for HL7?)
S: So in conclusion here is the true (no hidden agendas)...
G: No hidden agendas? from an anonymous contributer? I don't even know why I'm bothering to respond.
Grahame provides his responses here: