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Overlapping Clinical Integration Standards

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Discussion about the HL7 clinical data standard

Competing healthcare integration standards cause much confusion for users. The HL7 clinical data standard has been growing and changing for a very long time and it continues to do so with new releases of HL7 of 2.X (“recently” 2.5 and “soon” HL7 2.5.1 and even 2.6) and “soon” the HL7 3.0 messaging standard and reference information model.

Blair Heath wrote a blog posting in response to a formal journal article by Ed Hammond. Although not precisely referenced by Blair, I think the article by Ed was published in 2005: The Making and Adoption of Health Data Standards in Health Affairs, vol 24, no. 5 (2005).

Why HL7 users should care: Ed has been a member of HL7 since its formation and has been a deep advocate for getting standards in place for moving clinical data between different applications.

I thought Blair’s comments regarding the standards development process were interesting. Quoting his reaction to Ed’s article:

Competition among SDOs has led to further issues in [adopting] health data standards. The competition forces implementers to choose between the competing SDOs. There is also overlapping in some areas. For example, the scripting standard created by the NCPDP (National Council for Prescription Drug Programs) and the medication messaging standards defined by HL7. This causes conflict.

Hammond states, new versions of standards are coming out even before older versions reach the final ballot stage. This process results in confusion and instability and creates a moving target for standardization.

Both points can be summed up by this famous quote: “The good thing about standards is there are so many to choose from!”

I think the key is that no standard is ever “done” nor is it comprehensive. The HL7 standard has been growing and changing for a very long time. While most applications implement some flavor of HL7 2.3 or 2.3.1, they all have the ability to customize the version to whatever meets customer needs. The features than come in later releases of HL7 (2.5 and 2.6, for example) are rarely used for a long time. This is related to Ed’s comment that as users of standards we are always dealing with a moving target.

With the addition of HL7 3.0 to the mix, things will be very interesting in the land of HL7 for quite awhile.

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Dave Shaver

Dave Shaver is the CTO for Corepoint Health. Dave has more than 20 years experience in training, consulting, and software development. He’s deeply involved in the HL7 standards community, including co-chair of HL7 Infrastructure and Messaging committee and co-chair of the HL7 FHIR Governance Board.