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Internationalization of HL7

Publication date: Sep 24, 2009

At the HL7 working group meeting this week a number of issues were discussed related to the 'internationalization' of the HL7 organization. On the one hand the work of the HL7 organization is becoming ever more global in nature, whilst on the other hand HL7 will have to ensure that its standards solve local interoperability issues.

This week a HL7 working group meeting is being held in Atlanta (US). During this meeting a number of issues came up related to the internationalization of the HL7 organization. We have an ever increasing participation from a range of countries; the HL7 organization (focused on the US for historical reasons) is catching up. Two new affiliates were approved during this meeting: HL7 Russia and HL7 Hong Kong.

HL7 WGM attendee numbers (non-first time attendees only) for the 2004-2009 period using a sliding averager (n=3)
The graph above shows the number of attendees (actually, the number of non-first time attendees) for the 2004-2009 timeframe. In order to remove any seasonal fluctuations in attendee numbers (the meeting in September tend to better attended than the one in May) a sliding averager was applied; each data point represents the average number of attendees during the three ‘last’ working group meetings at that particular point in time. The number of non-US attendees (in blue) is increasing in a linear fashion. The number of US attendees (in red) is slowly decreasing. US based HL7 members I spoke with mostly attribute this to the increasing amount of standardization work (e.g. CDA implementation guides) undertaken in HITSP and/or IHE.

There was also some discussion about the location of the working group meetings. The board has made a decision a couple of years ago that one of the annual working group meetings (there are three such meetings a year) will be held outside of the US. Over the past few years meetings have been held in Canada, the Netherlands, Germany and Japan. In May 2010 the meeting will be held in Rio de Janeiro (Brazil). During the meeting there was discussion about the January or May 2011 meeting to be held in Sydney (Australia). From a global perspective it is a somewhat remote location; we do however already have significant commitments from the HL7 community to attend. For 2012 Paris (France) is a candidate location.

Some of these locations have meeting venues have a different business model than that used by US hotels. Let me illustrate the different business models using some fictitious figures. Let’s assume that the meeting space required during the week would cost USD 40000 if one were to solely contract the meeting space.

  • In the US hotels provide the meeting rooms for free provided one fills a minimum number of hotel rooms in the same hotel – the price of the room is higher than normal, the attendees that are staying in the conference hotel effectively end up paying for the meeting rooms. If we assume that conference delegates spend a total of 800 nights at the hotel, they’re effectively paying an additional USD 50 per night which goes towards the cost of the meeting rooms.
  • Outside of the US one has to pay for the meeting rooms – attendees are free to book at any hotel they wish. The USD 40000 has to be financed in a different way - maybe by increasing the fee for the meeting – which is unattractive from a marketing perspective even though attendees effectively end up paying the exact same overall costs (attendee fees + hotel costs).
A decision to increase the meeting fee for attendees at venues that use the second business model hasn’t been made yet (I’m not sure that it has been discussed at all). As long as a decision to increase the meeting fee hasn’t been taken there will be an artificial “loss/additional costs” to the international HL7 organization of (using our fictitious example) USD 40000. Increasing the meeting fee seems to be the best way to deal with this – after all the total cost of attending will be the same regardless of the business model used by the meeting venue. This’ll need to be sorted out to ensure that all countries could host a working group meeting regardless of the underlying business model.

Klaus Veil, an active HL7 member from Australia, and former board member of HL7 International, comments on some of the internationalization issues in the video below:

The board meeting held during the WGM discussed some of the internationalization aspects as well. Amongst other things, the board has decided to refer to the global organization as “HL7 international” (instead of HL7 Inc.), and to rename the “Affiliates Council” to “International Council”. A mechanism will be established whereby a US representative will be elected to participate in this meeting. I expect the role of the International Council is likely to change. Whereas the board of HL7 International has a global focus the country organizations of the International Council will have to ensure that the actions of the board are sufficiently aligned with the requirements at the local level. The International Council has a role to play in balancing the requirement for global standards with the requirement to support local implementations.

The internationalization of HL7 impacts all sorts of things (e.g. organizational and financial) which will need much more work – the above issues show that progress is being made. The HL7 community does seem to realize that internationalization is a necessity – but not at the cost of not being able to deal with local issues. This duality is a balancing act which will take time.


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