In-house vs. Third-party
Unlike other standards, such as JPEG or HTTP for example, the Healthcare information technology standards, DICOM and HL7, are overwhelmingly detailed and complex. While most international standards are reletively short and focused on a narrow, well defined problem, HL7 and DICOM try to cover as much as possible.
Data model, network protocol, file format, workflow procedures, image compression, internationalization, semantic analysis, are just few examples of the many problems that these standards address, sometime in more than one way. Moreover, both DICOM and HL7 are constantly updated and expanded, sometimes 2, 3 and even 4 times every year.
While large enterprise organizations can afford large, dedicated, teams to develop and maintain their integration modules, other companies find this task challenging.