In our view, open standards are essential — they encourage open debate about solutions; they enable the interoperability of systems and the exchange of information; they extend the useful life of both information and the systems that generate and consume that information.
Open standards provide the solid foundations for the digital age and the flow of data, information and knowledge which digital technology both enables and requires.
Effective clinical information systems use open standards at two levels — standards specific to healthcare and more general standards that allow healthcare systems to participate as fully signed up citizens of the connected digital world.
The reference platforms recommended here use open technology such as XML, Java and the Web technology, underpinned by general standards from the W3C, IETF and OASIS.
Standards in health informatics are dominated by the family of Health Level 7 (HL7) standards, including the original HL7 v2, the Reference Information Model of HL7 v3, the Clinical Document Architecture and the most recent FHIR standards. While HL7 is focused on information exchange and interoperability, the ISO 13606 standard is concerned with the structure of Electronic Health Records and the use of architectural forms for model-driven systems development. In combination, HL7 and ISO 13606 provide the standards-based framework for the representation of any clinical information.
Useful standards ‘profiles’ for healthcare (i.e. recommendations on how open standards can be applied and combined in specific scenarios) are promoted in initiatives such as Integrating the Healthcare Enterprise (IHE) and the Continua Health Alliance.
When it comes to classifying and coding clinical knowledge, we have the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT), the International Classification of Disease (ICD-11), Logical Observation Identifiers Names and Codes (LOINC) and the Unified Medical Language System (UMLS), all of which can be implemented over more general standards such as the Web Ontology Language (OWL) to move towards the better implementation of intelligent systems for clinical care.