The EHCR – if not now , when ?

The promotion and uptake of Electronic Healthcare Record (EHCR) systems has been much slower than originally envisaged due to a number of factors. These include, the widespread under-investment in clinical computing, fragmented markets with attendant low profitability exacerbated by a lack of proven standards together with the need to protect investment in existing (legacy) IT systems. Furthermore the inability of the standards bodies to take a more global perspective with a clear strategy in place offers insufficient hope for the future. The divergence between a top-level generic architectural approach and a more bottom-up data driven approach continues to divide the IT community in healthcare. In the meantime technological developments, such as XML and the Internet, have continued and point to some approaches that might provide a way forward and protect current investment in existing (legacy) systems. Perhaps the first action should be to reduce the high expectations of having a record architecture standard adopted on a widespread basis followed by putting more emphasis on those areas where progress can be made. This paper proposes a pragmatic and evolutionary approach based on XML to handle the semantic interoperability with technical interoperability provided by a range of technologies from TCP/IP and middleware solutions based on CORBA, DCOM, and more recently, Web portals.