SGML: Use of SGML in Medicine

Announcement of New Initiative for Use of SGML in Medicine

A new initiative for use of SGML in medicine was announced last week at SGML '96. The initiative focuses on standard means of applying SGML to the markup of the electronic medical record (EMR).

Earlier, non-SGML, attempts to put patient records online have failed to achieve the flexibility and extensibility required of this record which must describe completely and without distortion the central transaction in medicine, the encounter between doctor or caregiver and patient. Lack of an electronic medical record has retarded the progress of medical informatics. Making this information available to applications is a key requirement for stabilization of the health care system and will invigorate our understanding of trends in disease and disease management.

The initiative is called The HL7/SGML Initiative and is formally under the auspices of Health Level 7 (HL7), an ANSI Standard Developers Organization.

"HL7 is a messaging standard in which certain triggering events cause the transmission of a specified message relating to the trigger event...

"New activities within HL7 include support of a new paradigm for healthcare data interchange--the object broker model; new work in the areas of security, privacy and confidentiality including authentication and authorization, encryption, digital signatures, and integrity; new work with Standard Generalized Markup Language (SGML); conformance and implementation; decision support; and new work in addressing the vocabulary problem....

"HL7 has approximately 1,600 members and over 450 organizations (corporate) members, including 90 percent of the largest information systems vendors serving the healthcare industry. HL7 has also become an international organization with 5 international affiliates (Canada, Finland, Germany, The Netherlands and New Zealand.)" Ed Hammond, Ph.D., Chair, HL7 Executive Committee, in the brochure for the next HL7 meeting (details below)

The HL7/SGML initiative is in the early stages of project planning and definition and welcomes participation from all those who share these goals. The two current projects are definition of Design Principles and creation of pilot demonstration projects.

Those presenting at SGML '96 made it clear that while planning for the design of the initiative is in the early stages, their vision for this initiative already differs substantially from earlier industry initiatives. The HL7/SGML initiative must design an information architecture that will make the EMR work within the heterogeneous computing environment of a healthcare enterprise and must make the information available to a wide range of applications from billing to epidemiology and decision support. They feel that it is a significant advantage to begin this initiative after the publication of the HyTime, DSSSL, and preliminary XML standards.

It is possible that working with the data models created by HL7 a "phase one" standard can be quickly drafted that will break down many of the barriers to implementation of the EMR and pave the way for individual enterprises to develop SGML-based implementations.

The next meeting of the initiative will be during the week of HL7 meetings January 21-25, Tampa, Florida. The exact schedule for the week is:

Tuesday, 21st   all day	      HL7 Introductory Tutorial
		1:15 -- 4:30  SGML tutorial
Weds, 22nd      AM            HL7 V3, Message Development Framework tutorial 
			                for object-brokered version 3 of HL7
                PM            open
Thurs, 23rd     AM            HL7/SGML SIG meets with IEEE Medix groups
	        PM            HL7/SGML SIG meeting
Fri, 24th       AM            HL7/SGML SIG breakout groups

Meetings are open to all, but it is requested that new attendees read the materials available on the web sites and attend once as an observer before participating in the discussion.

There is a registration fee for the conference (day or week) payable to HL7. The full week for HL7 members is $250, before 12/30. The fees go up after 12/30. You can get a brochure on the meeting by contacting the HL7 offices by phone or email (at last glance, it was not on their website.)

The future HL7 meetings scheduled for 1997 are:

April 14-19, Chicago
August 18-22, San Francisco

Committee Chair: John Mattison, Kaiser Permanente
Contact: Chris Zingo, Kaiser Permanente,, 818/564-3842

HL7/SGML site:
HL7 site:
HL7 Administrative Offices:
Mark McDougal
HL7 Headquarters
Tel: 313/677-7777
Email: HQ@HL7.ORG

The four committee members presenting at SGML '96 were:

Liora Alschuler - Email:
Tom Lincoln - Email:
Dan Essin - Email:
John Spinosa - Email:

The above information from:
Liora Alschuler
The Word Electric
POB 177, Route 5
East Thetford, VT 05043
Tel: 802/785-2623
From Wed Dec 4 15:41:07 1996
Date: Wed, 4 Dec 1996 16:41:19 -0500 (EST)
From: Liora Alschuler
Subject: new initiative