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The Medical fraternity and the healthcare service sector have long acknowledged the need fo r
smart, IT-based healthcare systems, operating globally. Semantic Interoperability is key, which is
the regulated and meaningful exchange o f valued healthcare information with homogenous
understanding amongst participating healthcare service providers. Health Level Seven (HL7) is
the predominant interoperability-related global healthcare standard in operation today.
Introduced in 1987, the standard has evolved to its current version 3 and has been embraced by
the National Health Services o f the most developed economies in Europe, North and South
America, and Australasia.
However, the standard is not without issues. Version v3 has been found to be difficult to
implement and maintain. A principle component o f the HL7 v3 development paradigm is the
Reference Information Model (RIM) which defines the complete language and vocabulary
schema used in the three v3 paradigms o f Messages, Clinical Document Architecture, and
Services, and indeed in all v3 implementations. This study determined that the RIM itself has
many documented issues which ultimately affect implementation. Thus, true global semantic
interoperability which is the germinal goal o f the HL7 standard is still an illusion.
This study focuses on the belief that the achievement o f true global interoperability is rooted at
the labyrinths o f specifications development and its associated foundational paradigms. This
study focused on the Reference Information Model (RIM), the foundational semantic and lexical
reference structure which affords vocabulary derivation to be used in all v3 system
implementations. Infusing sequencing and temporal dimensions to the RIM structure and
operation would promote and afford enhanced analytic, design, semantic interoperability, and
two-way traceability, which in turn would suffuse to high-calibre specifications generation and
true global International Interoperability in operation. In addition, multi-faceted interoperability
interpolation in these core processes would promote and enhance numerous allied activities as
well, from domain requirements cross-checking, audit, and consensus, to kindred system
development verification and validation.
This research therefore analyzed many o f the prevalent RIM issues indepth, and effected smart,
delicate, and prudent recasting o f this encyclopedic vocabulary and language reference
structure, to derive optimal efficiencies in specifications development and implementation.
