Experience with an XML/HTTP-based federative approach to develop a hospital-wide clinical information system.

The authors present a two-year experience with an approach aimed at federating applications into a component-based hospital-wide clinical information system. Recognizing the need for better integration, clearer separation of knowledge from applications, as well as the necessity to respect and integrate the diversity of roles in a healthcare network, a strategy was implemented that included the development of a shared vision, organizational changes to promote appropriation at all levels, and the elaboration and maintenance of a common architecture and terminology by an instrumental technical group. Choices for federative technologies were in part based on their level of acceptance and potential to evolve. XML was used as the syntactic framework and HTTP as the transfer protocol. Within twelve months, the shared vision was developed, the architecture was specified, the key central components implemented, incorporated into the applications, and applications teams started producing shareable services using XML and HTTP.