Ten years into its making, the HL7 Reference Information Model (RIM) and its Version 3 (V3) family of messaging standards artefacts are still slowly evolving.  There are very few V3 messaging standards being implemented worldwide.  In a recent paper (" HL7 RIM: An Incoherent Standard")  authored by Barry Smith and Werner Ceusters (both of University of Buffalo, USA), the RIM is "criticized for failing to draw a clear distinction between entities in reality (patients, diseases, treatment acts, ...) and the records of such entities, for example in paper documents.  This paper is available from the following website: http://ontology.buffalo.edu/HL7/doublestandards.pdf