Reflections on the history of interoperability in hospitals.

OBJECTIVE

To discuss the origins of HL7 and its subsequent impact on interoperability in hospitals.

PROCESS

Reconstruction of historical events from review of personal notes, interviews with key participants and review of relevant publications.

CONCLUSIONS

The first versions of HL7 were based on the StatLAN protocol developed at the University of California, San Francisco and later commercialized by Simborg Systems Corporation. With the emergence of specialty clinical and departmental systems in the 1990s, a debate ensued between proponents of "open architecture" vs. "single vendor" systems. Although HL7 became the most widely used data-interchange protocol worldwide in healthcare, open architecture did not prevail in healthcare as it did in other industries. This is due to the unique market characteristics of the healthcare provider industry. The result today is the dominance of the healthcare IT marketplace by a small number of large vendors with relatively few options for in-depth specialty clinical systems.