Some national and international standardization bodies derive income from the sales of standards and related documentation, but we propose that ways should be explored to change existing financing structures to facilitate availability, market penetration and implementation of standards and related documentations.

The RIM documentation is not clear and poorly integrated with those other parts of the V3 documentation for which the RIM itself is designed to serve as backbone. We discuss some of the internal inconsistencies as they serve as good case studies for the kind of ambiguities (for example in its sloppy use of terms such as 'act', 'Act', 'Acts', 'action', 'ActClass' 'Act-instance', 'Act-object') which should surely be avoided in the context of work on messaging standards.

In spite of large investments in HL7-based information systems, some of them by national governments, and in spite of the now familiar difficulties encountered in creating working implementations on the basis of such investments, there is astonishingly little secondary literature on the HL7 standard itself. One consequence of the absence of evidence-based criticism from independent outsiders is the appearance of certain symptoms of intellectual inbreeding in HL7's own literature.

We focus on just one set of issues, which concerns the RIM's unclear treatment of the distinction between information about an action on the one hand and this action itself on the other. The former is what is recorded in a message or record. The latter is what occurs, for example within a hospital ward or laboratory. When challenged, advocates and developers of the RIM will insist that the RIM is concerned exclusively with the former – with information – and of course the very title of the RIM is in keeping with this conception.

Interspersed throughout its documentation, however, we find also many references to the latter, often conveyed by means of the very same expressions. This problem is of crucial importance, given the characteristic claim advanced on behalf of the RIM that it will provide a shared, rigorous semantics for HL7 V3 messages, of a type which V2 lacked. We believe the RIM could enjoy even greater success if it addressed this problem openly and directly. It is desirable, in general, to promote the widespread use of existing standards. Availability of clear documentation about standards is a prerequisite for any successful implementation of standards.