| Foreword | 5 |
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| Preface | 7 |
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| Trademarks and Disclaimer | 9 |
| Copy-Editor | 9 |
| Contributors | 9 |
| Reviewers | 10 |
| HL7 Conformance Working Group | 10 |
| Robert Snelick Acknowledgments | 10 |
| Frank Oemig Acknowledgments | 11 |
| Dedication | 12 |
| Contents | 13 |
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| About the Authors | 24 |
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| Acronyms | 26 |
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| List of Figures | 32 |
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| List of Tables | 40 |
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| Healthcare Information Technology | 46 |
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| 1 Introduction | 47 |
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| 1.1 The Case for Common Understanding | 49 |
| 1.1.1 The Need for Consistency | 50 |
| 1.2 Information Cycle | 51 |
| 1.3 Motivation for Cooperation | 52 |
| 1.4 Definition of Key Terms and Concepts | 53 |
| 1.4.1 Conformance | 53 |
| 1.4.2 Interoperability | 54 |
| 1.5 Interoperability Levels | 56 |
| 1.6 Standards Development Life-Cycle | 57 |
| 1.7 ISO/OSI Stack | 59 |
| 1.8 Reference Model for Open Distributed Processing (RM-ODP) | 61 |
| 1.9 Concept Relationships | 63 |
| 1.10 Approaches to Standards Development | 64 |
| 1.11 Testing | 66 |
| 1.12 Scope and Purpose | 67 |
| 1.13 Commonly Used Terms and Definitions | 69 |
| 1.14 Intended Audience | 71 |
| 1.15 Keywords for Use | 72 |
| 1.16 Summary | 72 |
| References | 73 |
| 2 Architecture | 75 |
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| 2.1 Interface | 75 |
| 2.1.1 Types of Interfaces | 76 |
| 2.1.1.1 Functional (Local + Remote) | 76 |
| 2.1.1.2 Message-Based Data Exchange | 77 |
| 2.1.1.3 Document Exchange | 78 |
| 2.1.2 Communication Paradigms | 79 |
| 2.1.3 Protocol Layer | 80 |
| 2.1.4 Levels for Interoperability | 80 |
| 2.2 Interfacing | 81 |
| 2.2.1 Impact on Interfaces | 82 |
| 2.3 Serving Interfaces with Data | 83 |
| 2.3.1 General “Capability” of a System | 83 |
| 2.3.2 Relevance for Interfaces | 85 |
| 2.4 Dynamic Behavior | 86 |
| 2.4.1 Message Pairs | 86 |
| 2.4.2 Timing | 87 |
| 2.4.3 Message Identification | 87 |
| 2.4.4 Routing to Multiple Destinations | 89 |
| 2.4.5 Responsibility of a System | 90 |
| 2.4.6 Event Handling | 91 |
| 2.4.7 Delayed Message Handling (Sender) | 92 |
| 2.4.8 Handling of Outdated Data (Receiver) | 93 |
| 2.5 Intermediate Message Handling | 94 |
| 2.6 Message Population | 95 |
| 2.7 Information Transmission | 96 |
| 2.8 Delete Indication | 97 |
| 2.8.1 Legal Requirements for Data Persistence | 100 |
| 2.8.2 Receiver Responsibility | 100 |
| 2.8.3 Data Granularity | 101 |
| 2.8.4 Impact of Order of Messages | 101 |
| 2.8.5 Sender Responsibility: Impact to System Design | 102 |
| 2.9 Null Flavors | 103 |
| 2.10 Snapshot Mode Versus Update Mode | 105 |
| 2.11 Considerations in Application Development | 108 |
| 2.11.1 Introducing Functional Requirements | 108 |
| 2.11.2 Conformance Discussion | 113 |
| 2.12 Summary | 116 |
| References | 117 |
| 3 Healthcare Standards Landscape | 118 |
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| 3.1 Introduction | 118 |
| 3.2 Standards Developing Organizations | 119 |
| 3.2.1 UNECE | 119 |
| 3.2.2 ASC (US) | 120 |
| 3.2.3 ASTM (US) | 121 |
| 3.2.4 HL7 | 121 |
| 3.2.4.1 Affiliates | 122 |
| 3.2.5 DICOM | 122 |
| 3.2.6 KBV, ZI and QMS (Germany) | 123 |
| 3.2.7 KV-Telematik (Germany) | 123 |
| 3.2.8 NCPDP (USA) | 124 |
| 3.2.9 OASIS | 125 |
| 3.3 Profile Development Organizations | 126 |
| 3.3.1 IHE | 126 |
| 3.3.2 ELGA (Austria) | 129 |
| 3.3.3 eHealth Suisse (Switzerland) | 130 |
| 3.3.4 HITSP (US) | 131 |
| 3.3.5 S | 131 |