This week I’m at the May 2007 HL7 Working Group Meeting in Cologne, Germany. Although I travel extensively, almost all my travel is typically within the United States. Thus, dropping into a country with a culture and environment so different than my own has me deeply thinking about the international community of “real” users of HL7 for healthcare integration. I ran an informal survey to see if my thoughts about HL7’s use would be in line with other HL7 experts.
Background: As you probably know, HL7 is a family of international standards that are endorsed by or used within many countries. The HL7 standards — be them older V2.X messaging, new 3.X messaging, CDA/CCR/CDA, etc — reflect input from many realms. This internationalization of HL7 has been on-going since the early 2000s.
The premise: Despite the huge push to internationalize the standard, the total HL7 uptake (as measured by live use of a standard) outside the United States is still small when compared with total deployments within the US.
The motivation: This is an interesting topic for many reasons and was driven by a committee meeting where we were talking about HL7’s market position and brand.
The non-scientific survey: Over the course of the last few days, I’ve talked with about ten “Grand HL7 Gurus” about the topic of where HL7 is really used.
Assume that an ‘HL7 user’ is a hospital, clinic, RHIO, provincial health board, etc. that makes use of any HL7 standard. Include all HL7 2.X and 3.X messaging, CDA, CDD, Arden Syntax, etc. Estimate the percentage of ‘HL7 users’ in the world that are within the US.
The reaction: Some Grand Gurus asked for clarification such as, “How do you count a user? Per site? Per interface? Per install? Per clinician?” In all cases of clarification, I simply said that the Guru should make some assumptions on their counting and then should give me number. I did not want to constrain the Guru’s thinking because, well, they are Gurus.
In short, the general feeling is that 90% or more of HL7’s users are still within the United States. Interestingly, the lowest estimate I got from anyone was 80%; the highest was 98%.
With Gurus from across the globe generally agreeing that “most” of the HL7 users are in the US, it is deeply interesting to think about adoption rates and what this same survey will show in another five years. I think the non-US user count is growing much more quickly than even the fast-paced growth in the US. Thus, I posit that the non-US users will be on par with US users “soon”.
The interesting question will be what standard they will be using — most of HL7’s work in the last five years has been on the RIM, HL7 3.X, and CDA. In the US, most “HL7 users” are really HL7 2.X messaging users.
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