HL7 critical to tap global healthcare IT markets : Saji Salam, MD, MBA, Chairman, Health Level Seven India

Health Level Seven

[This article was published in the July 2008 issue of the eHEALTH Magazine (]

In a large and diverse country like India standardisation is not an idea too easily followed.


In a large and diverse country like India standardisation is not an idea too easily followed. However, some International standards developing organisations have been showing the Indian IT professionals the way to a unified language to share critical care data safely and securely.

Aggregated US provider and payer healthcare information technology spending was close to US$ 26 billion in 2004 and will grow to over US$ 34 billion by 2008, with a CAGR of 7%. By 2008 payer spending will amount to US$ 7.5 billion and provider spending will be at US$ 26.7 billion. (Forecast from Research & Reports)

To gear up for this emerging trend, CSC made a US$ 375 million acquisition of First Consulting Group along with increasing the offshore capabilities in India. CSC, IBM, Accenture, EDS and Perot systems with billion dollar deals, spread over several years, currently corner the healthcare provider market.


Indian IT firms have not been strong in the US provider market primarily due to the lack of availability of HL7 certified professionals in India. According to analysts, Syntel and TCS can capitalise on the growing healthcare provider market in US, primarily because of their extensive experience in HL7.

What is HL7?

Health Level Seven (HL7) is one of several American National Standards Institute (ANSI) – accredited Standards Developing Organisations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven’s domain is clinical and administrative data.

Headquartered in Ann Arbor, Michigan, Health Level Seven is like most of the other SDOs in that it is a not-for-profit volunteer organisation. Its members – providers, vendors, payers, consultants, government groups and others who have an interest in the development and advancement of clinical and administrative standards for healthcare�develop the standards. Like all ANSI-accredited SDOs, Health Level Seven adheres to a strict and well-defined set of operating procedures that ensures consensus, openness and balance of interest. A frequent misconception about Health Level Seven (and presumably about the other SDOs) is that it develops software. In reality, Health Level Seven develops specifications; the most widely used being a messaging standard that enables disparate healthcare applications to exchange key sets of clinical and administrative data.

Members of Health Level Seven are known collectively as the Working Group, which is organised into technical committees and special interest groups. The technical committees are directly responsible for the content of the Standards. Special interest groups serve as a test bed for exploring new areas that may need coverage in HL7’s published standards. HL7 India is one of the thirty international affiliate countries that make up the HL7 International organisation.

HL7’s mission

HL7 provides standards for interoperability that improve care delivery, optimise workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients. In all of our processes we exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, and our willingness to put the needs of our stakeholders first.

Evolution of HL7 India

Eight years ago when I was with the healthcare practice of a leading IT firm in India I happened to ask the IT Project Manager why HL7 was named HL7 and not HL8 or HL9. Pat came the answer “HL7 was founded by a group of seven IT professionals and hence the name HL7”. On doing further research I realised that the “Level Seven” refers to the highest level of the International Organisation for Standardisation (ISO) communications model for Open Systems Interconnection (OSI) – the application level. Shocked by the low level of awareness on HL7 in India I took upon myself the initiative to build HL7 in India.

I should say that the HL7 India organisation has been built “click by click” over the last 8 years. HL7 India organisation went on a massive education spree targeting health management schools and healthcare technology focused IT firms to drive home the message of adopting IT standards and building IT products based on HL7. Our focus then turned to creating HL7 certified professionals in India by getting the HL7 certification exams proctored in India. As founder of Health Level Seven India it gives me immense pride to note that, today India generates the most number of HL7 certified professionals in the world.

HL7 International

HL7 International is spread across 30 countries, across the world and most countries are involved in translating the HL7 standards or localising the standards for the healthcare systems in the respective countries. The International Committee provides a forum for the HL7 International Affiliates and other interested HL7 members to communicate and exchange views as well as discuss issues regarding the international development, adoption, application and implementation of the HL7 standard.

The International Committee collates, uates and puts into action – for processing by other entities within HL7 – any needs, issues and other inputs expressed and agreed to by the HL7 International Affiliates. The International Committee advises the Technical Steering Committee and Board of Directors on matters relating to areas of standardisation that are relevant to the International Affiliates.

The HL7 Board of Directors appoints the co-chair(s) of the International Committee. The International Affiliates select the International Board Representative from among the International Affiliate members.

HL7 certification exam in India

Certification exam for HL7 standards such as HL7 v2.5 and CDA is conducted in India. For IT/healthcare organisations with at least ten candidates who would like to take the test, examination proctors from HL7 India conduct exams at the healthcare/IT organisation’s premises. The answer sheets are then shipped to US and certificates are issued for the successful candidates by HL7 Inc USA. The fee for HL7 exam currently is INR 6000 per candidate and does not include travel expenses for the proctor. Individuals who wish to take the exam can contact HL7 India through the website

Standards based Healthcare Informatics Policy for India

The switch over from proprietary information systems to standards based systems can be a costly affair. The cost of implementation of HIPAA (Health Insurance Portability and Accountability Act) standards in the US is estimated to be between US$ 20- 40 billion. At the same time the US government decided to go ahead with the standardisation process as this could result in huge savings in the coming years. As we are in the early stages of automation of healthcare facilities, India is in an advantageous position to adopt/adapt these standards and not be investing too much on proprietary systems. However this calls for meticulous planning coupled with the right leadership to put in place the right healthcare informatics policy for the country, with an emphasis on open standards.

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