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1.3 NEED FOR A STANDARD

The organization and delivery of healthcare services is an information-intensive effort. It is generally accepted that the efficacy of healthcare operations is greatly affected by the extent of automation of information management functions. Many believe that healthcare delivery agencies that have not automated their information systems are not able to compete effectively in the healthcare market of the 1990’s.

In the past two decades, healthcare institutions, and hospitals in particular, have begun to automate aspects of their information management. Initially, such efforts have been geared towards reducing paper processing, improving cash flow, and improving management decision making. In later years a distinct focus on streamlining and improving clinical and ancillary services has evolved, including bedside (in hospitals and other inpatient environments) and "patient-side" systems (in ambulatory settings). Within the last few years, interest has developed in integrating all information related to the delivery of healthcare to a patient over his or her lifetime (i.e., an electronic medical record). It has also been envisioned that all or part of this electronic medical record should be able to be communicated electronically anywhere as needed.

It is not uncommon today for the average hospital to have installed computer systems for admission, discharge, and transfer; clinical laboratories; radiology; billing and accounts receivable, to cite a few. Often these applications have been developed by different vendors or in-house groups, with each product having highly specific information formats. As hospitals have gradually expanded information management operations, a concomitant need to share critical data among the systems has emerged. Comprehensive systems that aim at performing most, if not all, healthcare information management are in production by selected vendors. These systems may be designed in a centralized or a distributed architecture. Nevertheless, to the extent that such systems are truly complete, their use would mitigate the need for an external data interchange standard such as HL7.

There are, however, many pressures on an institution to develop or acquire individual departmental applications on a modular basis. One source of such pressure is the special departmental needs that may not be addressed well (or perhaps at all) by a comprehensive vendor (i.e., so called "best-of-breed"). Another is the need to evolve the overall systems environment of a hospital through a series of incremental, departmental decisions rather than in a single, revolutionary acquisition. These pressures could be met by an environment containing a comprehensive system supplemented by departmental systems, or one consisting entirely of separate and discrete systems.

Network technology has emerged as a viable and cost-effective approach to the integration of functionally and technically diverse computer applications in healthcare environments. However, these applications have developed due to market structure rather than through a logical systems approach; they are therefore often ad hoc and idiosyncratic. Extensive site-specific programming and program maintenance are often necessary for interfacing these applications in a network environment. This occurs at considerable expense to the user/purchaser while often keeping vendor staff from other initiatives such as new product development. The need for extensive site-specific interface work could be greatly reduced if a standard for network interfaces for healthcare environments were available and accepted by vendors and users alike.

In summary, it is important that both vendors and users not be faced with the problem of supporting incompatible transaction/communications structures. Instead, a framework must be developed for minimizing incompatibility and maximizing the exchange of information between systems. It is proposed that HL7 can act as a superstructure in this environment to facilitate a common specification and specifications methodology. It is indeed both practical and economical to develop, and commit to, standard interfaces for computer applications in healthcare institutions.

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