Whether you are running a 50-bed community hospital or a 500-bed teaching hospital, you have probably had to roll out HL7 interfaces to facilitate communication between clinical systems or to communicate with partner facilities and providers. In fact, an HL7 interface engine has become as important to health care organizations as veins and arteries are to the human body.

As nations and regions push to share clinical information, however, health care's IT infrastructure is changing dramatically, and the need to deal with other interoperability standards, including a host of XML-based protocols, is taking root. Will HL7 continue to be a preferred integration standard or will it even retain a place in the integration space? 

Messaging

Today the need for the basic messaging provided in HL7 v2 is being augmented with an increased need for entities to exchange larger blocks of information, including comprehensive patient records. This has led to the demand for new interoperability standards that go beyond simple messaging protocols. The first standard that threatens to replace HL7 is HL7 itself.

In 2005, the HL7 organization introduced HL7 v3, an XML-based protocol, to facilitate information sharing, and to address the lack of standardization that was characteristic of HL7 v2. If anyone expected HL7 v2 users to quickly adopt HL7 v3 as their messaging protocol, they were mistaken. HL7 v3 has been criticized as too amorphous, too complicated and even unusable. But quietly, HL7 v3 has found its place, especially in regions where HL7 v2 didn't have a strong foothold and in large-scale health care systems that pool data and messages in various formats from large numbers of contributors and participants.

For example, the UK, the Netherlands and Sweden have all adopted HL7 v3 as the messaging protocol in initiatives to develop a national health record. Even in the United States, HL7 v3 is finding its way to a number of regional health information exchanges (HIEs), including several in New York City, and public health organizations, including the Centers for Disease Control and Prevention. But, don't expect it to replace HL7 v2 communication in hospitals and labs that have basic messaging requirements. The benefits in this case aren't compelling just yet, and it's likely that for adoption of HL7 v3 to take place in individual hospitals, it will flow down as a requirement from regional and national health organizations that have already adopted HL7 v3 as their internal protocol.

In addition to HL7 v3, there are a number of important XML-based document exchange protocols. Both the Continuity of Care Document (CCD) and Continuity of Care Record (CCR) have been adopted in relatively equal numbers. While neither has emerged the clear winner, it seems as if CCD has gained the upper hand because it has been adopted by the Healthcare Information Technology Standards Panel, the Integrating the Health Enterprise (IHE) organization, and the Social Security Administration.