Introduction: In 1993, The European Committee for Standardization (CEN) studied several syntaxes for interchange formats in healthcare, but excluded SGML due to resource constraints. We sought to extend the CEN report and formally evaluate the use of SGML as a message interchange format.
Methods: We followed the methodology set forth by CEN, using their example scenarios and healthcare data model. General message descriptions based on this model set the functional requirements for the interchange format. These general requirements are then mapped into SGML to see how well they can be supported.
Results: Results follow the CEN format, enabling a direct comparison of SGML with ASN.1, ASTM E1238, EDIFACT, EUCLIDES, and ODA (those syntaxes studied by CEN).
Conclusion: SGML compares favorably with other syntaxes investigated by CEN. None of the interchange formats support all functional requirements. Optimal and standard mechanisms of combining different formats through a modular approach to achieve greater overall functionality requires further study.