Hi,
Lately I've been receiving many inquiries from folks from other IS / IT domains (e.g. financial, insurance, retail, etc.) that want to jump into the healthcare IS/IT bonanza that is about to commence. One thing that amazes me is all the misconceptions many have of our domain.
In some ways this dissapoints me, since I have been loyal to this domain for over 20 years, and despite how "greener the grass" may have appeared to be on other sides of the fence, I along with others have remained firm.
On the other hand, we do need all the help we can get since there is a lot of work that has to be done. So we, the strange healthcare IT breed, will have to welcome this massive influx of newbies.
But first lets get a couple of things straight: First, healthcare IS / IT folks DO KNOW about modern technologies, we are not limited to MUMPS programming and AS/400s. SOA, ESB, Web Services, REST, SOAP, SSO, etc. are part of our repertoire.
We are also starting to use titles such as: solutions architect, enterprise architect, etc. And yes, we also understand what Business Intelligence and XML are all about.
Second, we don't have different standards because of our supposedly capricious nature. In the healthcare domain, due to an imperative necessity we began developing integration standards long before other industries attempted it.
Initially, back in 1983, we created DICOM (Digital Imaging and Communications in Medicine), a standard for the distribution and sharing of images between a myriad of medical devices and IT equipment in hospitals and other healthcare delivery organizations. DICOM for many years was way ahead of its time. Major multinational companies were developing products with this standard, among them: Agfa, GE, HP, Philips, SIEMENS, TOSHIBA, etc.
Then, further down the timeline, in 1987, we founded HL7. One of HL7's missions was to create a messaging standard. This messaging standard would allow a myriad of legacy applications to be able to communicate with each other using a common protocol. It took many years, 21 so far, for this standard to be almost totally adopted by the industry. Currently, HL7 has been adopted by approximately 95% of the hospitals in the United States alone. You can see that HL7 existed long before XML was ever even thought about. Nevertheless, HL7 began working with XML technology since the formation of the SGML/XML Special Interest Group since 1996. Therefore we have 12 years of experience with XML.
In our domain there is a big difference in that we have to deal with many legacy applications that are dissimilar to those of other domains. Similar to the financial industry having to deal with legacy COBOL applications, we have had to maintain, support, and integrate many legacy applications, in COBOL as well as in many other supposedly "dead" languages.
The information we have to manage and integrate is also very different. It is also tenfold * tenfold more complex. While other domains only have to deal with credits and debits and a little demographic data, we have to deal with those as well, and additionally with laboratory test results, medical images, voice transcriptions (both textual and audible), documents as images, pathology data, pharmacological information, etc. Some of my readers will find this list short, so please pardon my omissions. A digital health record comprehends all the aforementioned types.
So before asking us why don't we use XML, solve an integration problem with a web service, or use standard industry business intelligence tools please delve a little further into the "nature of the beast" that we are dealing with. We aren't that different, but the "beast" is.
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