U.S. Government Crafted OSS

matthewg writes "According to the New York Times the federal government has developed an open-source medical records system. It was originally developed for the Department of Veterans Affairs, and doctors started obtaining it under FOIA requests. Some good information on the process of converting it from an internal project to a deployable system exists, and how its open nature has made the system better is available at the WorldVista site." From the article: "Medicare has not estimated what its software giveaway is worth. But Duncan Pringle, chief Vista technologist at Perot Systems, said that each doctor in a practice paid about $20,000 to $25,000 to get started with a commercial system, including costs of software, a license fee charged to each doctor, installation and servicing."

Comments

Vista

[OneBarG]

So we can agree that the word "Vista" is the only reason this story is here, right?

Re:Vista

[EasyTarget]

Microsoft are like, so gonna sue their asses.

I mean it's incredible, the new windoze name has only been known for half a day, and already evil linux commies are trying to cash in on their intellectual properties.

Re:Vista

[kg4gyt]

AltaVista, WorldVista etc. etc. etc. should sue Microsoft on the same grounds that Microsoft sued Lindows- have to hate it when those things come back to bite.

Re:Vista

[srmalloy]

Given that DHCP/Vista has been around since long before Microsoft began developing Windows XP, much less Longhorn, as well as the fact that trying to sue the Veteran's Administration would be a PR debacle, I don't think that Bill Gates would be stupid enough to try -- going into court and having the VA produce decade-old documents demonstrating the prior use of the name would get the case dismissed with prejudice, and Microsoft would probably lose all rights to the name and have to put off their OS release for another five years while they pick a new one.

Re:Vista

[Anonymous Coward]

There are lots of other products that use the name Vista and were out long before the name decision. At my college we use a class management system called WebCT Vista. http://webct.com/software/viewpage?name=software_v ista

Vista? fishy...

[Anonymous Coward]

WorldVista? Is it an OSS app for Longhorn (a/k/a Vista)? Boy, Perot Systems is on the ball with new Microsoft developments: "Duncan Pringle, chief Vista technologist at Perot Systems" I smell something fishy here...

But... but... but...

[Rotten168]

The US government is still evil somehow! ;)

Re:But... but... but...

[Anonymous Coward]

i really need the "+0 illogical" mod option.

Re:But... but... but...

[Frank T. Lofaro Jr.]

Another abuse of the Flamebait mod.

Another reason I have Flamebait set as a +6.

It's almost always used to censor, not for any good use.

Shocking!

[LiquidCoooled]

I also hear Microsoft Vista will be Open Source as well ;)

Oh shit, sorry, its not April 1st.

Re:Shocking!

[DigiShaman]

Windows has always been Open Source. Just be sure not to patch it. *rimshot*

Re:Shocking!

[Anonymous Coward]

I also hear Microsoft Vista will be Open Source as well ;)

You mean "Open Sores", as in all the holes in the product that keep oozing and getting infected with viruses.

Finally!

[Anonymous Coward]

Could this open some eyes and increase interest in alternative (Linux, Mac) offerings?

Re:Finally!

[Anonymous Coward]

lol...no.

Note to self:

[JUSTONEMORELATTE]

Doctors are paying US$20k per head for software installs.

Nice to know in case my current day job comes to an unfortunate end.

Re:Note to self:

[nightsweat]

Yeah, but try invoicing them and collecting. Doctors are the only clients slower to pay than lawyers.

Re:Note to self:

[cduffy]

I'm working in this field.

It's not exactly an install-and-forget situation -- not remotely. The hardware is expensive, the support is labor-intensive (and most often involves sending people on-site to fix things that don't belong to us), and the set of 3rd-party software we need to write integrations for is massive.

Oh -- and from what I hear, this particular system is much despised by most of the MDs who use it. Certainly, the ones we have on staff have little but contempt (granted, we're a competitor) and one of my coworkers who's spent some time as a VA patient has repeatedly heard similar sentiments.

Re:Note to self:

[Qzukk]

Oh -- and from what I hear, this particular system is much despised by most of the MDs who use it.

Which is the reverse of what I hear. I was at a medical conference recently trying to pitch our own wares, and it seemed to me that half the people at the conference were from the state penitentiary system and used the state's software, and the other half were from VA hospitals and used Vista. I was told fairly consistently by the VA docs that they loved the system and that they'd never use anything else. Of course, the hospital set it up for these doctors, so they never had to deal with any of the guts.

Looking at the system myself, it looks like 99% of the headache is in setting it up. Once it's configured correctly, that's when you get the doctors praising it like it was the best thing since sliced bread.

The most interesting thing about the article is that the software's been Free all along, some group issued a FOIA request for the source code and got it, and it's been an opensource project for at least a year now.

Re:Note to self:

[matria]

I worked for two years in the medical records department of a large university medical campus environment and I never met a single doctor who liked any of the many different computerized systems used in the various departments across the campus or in the attached clinics and hospitals. Basically they were all unhappy about having to learn how to use the system and fought it tooth and nail, thus never learning it well. The only ones that were at all happy about the computerized systems were the ones who had very good secretaries and nurses who did all their computer work for them. "Dammit, Jim, I'm a doctor, not a computer tech!"

Even where I live now, in a different country that has a national health care system, every time I have a doctor's appointment, they're OK with swiping my card across the reader at the beginning, but they all have sour faces and bang on the keyboard with two fingers as they fill out the necessary forms. I've been here 8 years and never yet saw a doctor who was comfortable with the system. And I've seen doctors of all ages from quite a number of different countries, India, Russia, Canada, South Africa, Australia, France, England, Cuba, and they all react in the same way.

Re:Note to self:

[Anonymous Coward]

As someone whose day job *is* programming electronic medical record software, trust me: that money isn't going to us cubicle monkeys. Well, some of it does, after sifting down through the ranks, but I'm certainly not paying my mortgage off any faster by doing this.

Re:Note to self:

[Anonymous Coward]

I'm an engineer and my wife is an MD. Therefore I'm the defacto IT person at my wife's practice. She uses Medisoft for billing and scheduling (which seem to be OK) but the problem is finding good (easy to use and inexpensive) medical records software. Anyone have experience with electronic medical records?

Re:Note to self:

[Mad_Rain]

I've used the system at the VA hospitals, after working in a hospital with no computerized record system.

Let me tell you, there is night and day differences between the accessability and the readability of patient information in these two places. First, patient history of several years length is instantly available with the computerized system. Which is important when you're looking at the treatment path of someone who has been chronically ill and you don't want to restart a prior treatment that aparently did not help the patient. In the other hospital (a county hospital) system, we'd have a written binder of the current visit (usually up to a month or two), and later records we'd have to request from another department further information when needed.

Second, the vast majority of the doctor-entered information is in a standardized layout. At my prior location, there were several different layouts for the same SOAP (Subjective compliant, Objective evaluation, Assessment/Treatment, Plan) notes. With Vista, the notes I saw were all organized in much the same way, regardless of the care provider. (And don't get me started on doctor's handwriting ;) ).

And on another note - At the VA system I work in, I can expect about a monthly email saying when the Outlook system is going down for an upgrade or patch, and how we can expect outages over a couple of days. It seems like we get fewer emails about how Vista will be out for maybe a few hours (usually like 2am to 6am) with far less frequency. Again, it seems like it is much more stable once it's set up.

Re:Note to self:

[Anonymous Coward]

I used to work in this field. I have not seen this software. One of the grandparents is right. This is a fickel lot.

On the one had they are driving around in 200k cars, but to buy a 10 dollar mouse is like trying to pull teeth with a toothpick.

I would be willing to bet if the software is free, as in no cost, they 'love' it. Because it is free. Not a 20k licence per head. Even though the 20k bit of software may do a zillion other things that is even more useful. But just because it doesnt cost anything its 'awsome'. I see this mentality quite a bit in open source. Just because its 'free' its the 'best'. Even though it may not be better for what you are doing.

Now as for doctors many times the doctor is also the owner. They run it like a busness. Free stuff or low cost beats out more expensive stuff. As they want to drive the 200k car and live in the 1.5million dollar house. Not give money to some software guy for something the secretary can do just fine with a bunch of paper and a few pens.

If you make a piece of software that gets rid of the secretary up front. The doctors will make you a millionare. Most of this software still needs that person up front. So there is little ROI for the small 1-3 doctor shops. Larger offices start to see a uses as they can agregate data up and ease of getting to data.

Re:Note to self:

[southpolesammy]

Looking at the system myself, it looks like 99% of the headache is in setting it up. Once it's configured correctly, that's when you get the doctors praising it like it was the best thing since sliced bread.

So in other words, it's pretty much like every other piece of software out there with a fairly complex task to do. Just take a guess whether the praise or the complaints will get the most airtime...

Re:Note to self:

[stolaf]

I've used this system in a practice setting along with a few other medical information systems -- the VA system is by far the most complete and useful. This sentiment is repeated by all of the doctors and medical professionals that I've worked with. It has features that allow for easy tracking of prescriptions, allergies, and known diagnoses which decreases the chance for medical errors.

The main impediment to wide adoption is that since its so complete, its can be complex to use, let alone administer. However, after about 1 week using the system in a real medical practice, a practictioner can become familiar enough to dread ever going back to another computer system (or god forbid, a paper chart).

Re:Note to self:

[kotj.mf]

No shit.

I mean, I know you were being funny, but I did some digging in to what it actually makes it so difficult to install that the docs are willing to pay ten large.

Here's what I came up with.

A basic installation doesn't look like anything tougher than an afternoon's work.

Maybe it's time to pick up a part time job...

Re:Note to self:

[sprekken]

Is she an ophthamologist or oculoplastic surgeon?

Re:Note to self:

[markw365]

Yes, but the Navy has a web front end to it, which doctors love. :)

Re:Note to self:

[daigu]

My girlfriend is a doctor. She isn't big on computers either, but she loves the fact that systems like these enables her to look at images, keep tabs on patients and review patient information from home. It probably doesn't hurt that I solve the tech support problems for her...

Re:Note to self:

[ssummer]

The backend of Vista might be rough but of all the MIS software my collegues and I have used, Vista ranks at the top. It's actually seen as one of the benefits in working in the VA healthsystem.

Our city health corporation (NYC) uses a commercial product called Misys which is universally despised by anyone that comes close to it (well maybe not the backend people).

Why do we like Vista? It allows us a lot more freedom in terms of entering notes and orders. Also reviewing the medical record is A LOT more intuitive than with most commercial offerings.

Re:Note to self:

[Qzukk]

Now as for doctors many times the doctor is also the owner. They run it like a busness.

Which is also against my observations, at least in the "business" perspective. We used to do consultation for doctors as well as software. Trying to get them to advertise is the real "pulling teeth with a toothpick". They assume that just because they put up a shingle somewhere that patients will just magically appear. We got out of that business, we just couldn't deliver and when we couldn't deliver with the doctors rejecting every avenue of advertising that we put forward. Worse, it was impossible to make the doctors understand that it wasn't our fault that the magic patient fairy failed to smack them with its rubber mallet.

Re:Note to self:

[FictionPimp]

medisoft....uhhh shiver.

After working with medisoft, PM2000, and WebMD's medical manager and intergy, I have to say WebMD's got a huge leg up on small/medium sized buisness software.

Easy to use is already there, but inexpensive is about impossible.

Re:Note to self:

[abradsn]

You must be joking. I worked in a support office and on development for a short while (2 years) on some of this software. The user interface of mm is horible.

They are a huge monopolistic force working to curtail any competition. To be fair, that is one reason why I took that job (job security). (I could elaborate on this, but I'm actually pretty indifferent to the monopoly.)

I could write better software from the ground up in a 6 month period of time and many small vendors do this. The problem is that mm/webmd have bought all (almost) of them up. Honestly, I don't care at all about the industry anymore, but for a more motivated person this is an easy way to make a lot of money.

Also, to be fair, most of the other medical software out there is crap too, so in a way, your point is still probably perfectly valid.

Re:Note to self:

[dr_canak]

I work at a VA, and use the electronic medical record system daily. I have also worked at three of the largest teaching hospitals in my area. I can tell you, hands down, that the system in place at the VA does a horizon shot on anything out there currently in the private sector.

It is an extremely complex piece of software, which is highly modular. With that said...

(1) It is comprehensive in that it includes everything about a patient's medication history, treatment history, all progress notes, labs, images, imaging reports, scanned documents, orders, appointments, etc... dating back to the installation of the system approximately 6-10 years ago (depending on facility). And to a limited degree, I can create custom reports containing information that I need for treatment. Finally, there is a tremendous amount of field data, allowing me to create custom, templated progress notes that will pull relevant information into the electronic note.

(2) I can search almost the entire patient electronic chart by keyword, progress note title, date of entry, author of note etc... making it extremely easy to locate specific information I need.

(3) And of course, there is improved patient care because now everyone has access to everything regarding the patient in question. I can see exactly what other providers are doing, what medication has been ordered, administered and when. I can also access patient education materials, micromedex, the PDR, and a whole host of other material, right from the web while i'm in the chart.

I guess I could go on and on about the quality of the software. I've maybe explained 10-20% of what it does and how it's helpful. The downside is that, because it's modular/extensible, a lot gets added without as much user interface testing as there should be. Also, some parts of the system are cumbersome because they were cleary afterthoughts. But all-in-all, this is an extremely complete electronic medical record system that is hugely beneficial to patient and provider.

And finally, interestingly enough, a cottage industry of consulting firms that can roll out and support this software exists. And of course, this post wouldn't be complete without a typical government story. One of our informatics people (the staff who support the package internally) was recently reassigned to another clinical area. Rather than move to another clinical position, he was hired by the consulting firm we use to support the very software the VA developed, and now he may very well return to our hospital as an external consultant, doing what he did before he left (at a much higher price of course :-) ).

hth,
jeff

Re:Note to self:

[dr_canak]

I guess I should clarify one thing,

I'm referring to the GUI front end (CPRS) to the VISTA package. Everything I've stated about the GUI front end is true in VISTA, but some of the nicer windows functions only come from the GUI front end (e.g. you can't view an x-ray from within a VISTA terminal session). But all the progress notes, orders, meds, appointments, reports, etc... can be accessed from a plain old terminal.

jeff

Re:Note to self:

[danheskett]

I've done it, it's not that easy, plus, no doc I've ever worked for is going to hire you to install and then expect nothing after that.

Supporting medical practices is a full-time job. I used to, and my wife still does, work at a small VAR that supports about 125 small private practices. It takes a staff of about 12 to keep them reasonably happy with their billing software which is about 1/10th as complicates as Vista.

If you do this, well, just be prepared. And also, get yourself some errors and omissions insurance. Like with a $2M or $5M coverage window. If you forget to setup good log rotation and the system doesn't come up one day because of a lack of disk space or whatever, well, you are probably going to get sued. Doctors have no problem getting legal on you if anything goes wrong.

Re:Note to self:

[philcolby]

Oh -- and from what I hear, this particular system is much despised by most of the MDs who use it.

As a physician who uses the CPRS Vista system quite frequently, I have to disagree. I work at the second largest hospital in the country which currently supports at least 5 different EMR systems, of which only one supports physician order entry (POE) (and that's in the ER only). A crappy POE system will be rolled out over the next few years to supposedly help reduce medication errors and reduce the truckloads of paper documentation that we currently use to remain compliant with mundane JCAHO regulations. However, a full EMR- with electronic notes/daily documentation is still not in place and is still a few years away. The current systems are a hodgepodge of different applications poorly tied together and are exceedingly slow and difficult to access - a poor testament for what is supposed to be one of the most advanced medical centers in the world.

When I work at the VA down the street, the medical center there might as well be a third world country with third world medicine, but some time traveller left behind some remnants of future technology when it comes POE and documentation. The system, while plain and simple, is very fast and relatively easy to use. Sure it could be tweaked, but I will take ready access over bells and whistles any day. Vanderbilt Medical Center, a leader in EMR design, has a similar home grown system that is also very easy to use and is superior IMO. But CPRS Vista is essentially free- arcane, but free.

So instead, our hospital system will pay yet another technology vendor millions of dollars for a product that does the same thing as Vista, and probably much slower and less reliably.

Re:Note to self:

[cduffy]

FYI, I appreciate your input; being where I am, what I hear tends to be substantially weighted. Getting a feel for the extent and direction of such weighting (via comparing it to outside input) is quite interesting.

Re:Note to self:

[sdjunky]

That's a somewhat unfair assessment.

1. Many are working on creating/have created a version that runs on open source GTM (M being the language that VistA uses). This includes running on other hardware/os platforms than your usual servers, etc. You can see more here

2. The software on the backend has been in development for years and there is quite a bit of work on creating GUI's for the fronted (e.g. the Computers Patient Record System or "CPRS") and I find many users are quite pleased with it. Ask them which they prefer the GUI (CPRS) or the Telnet Session and they'll praise the first and curse the latter so saying they "despise" it without referencing which is not a fair statement.

3. The ease of use for a programmer to create the frontend and backend is amazingly intuitive for anybody whose done GUI & Internet applications.

Now for the not so positive. It's huge and you're not going to download/buy the CD of this and get it installed in your Dr's Office over a weekend. It takes knowledge of the application and system (well documented) to do so. But what class of software so large and complex that incorporates almost everything you need for a Hospital including Imaging, Billing, Admitting and Discharge, Patient Movement, Electronic Patient Record, and much more doesn't require such intensive labor and knowledge skills (perhaps from a contractor)?

Re:Note to self:

[NateTech]

Sounds like the whole rest of the IT services/hardware world. Join the club.

Re:Note to self:

[TheoMurpse]

That scares me that she can access this information from home. What strong crypto is in place to prevent someone from packet-sniffing the password and gaining access to the medical history of each patient?

Re:Note to self:

[FictionPimp]

I know all about it too, up until about a year ago I worked for MM myself. I got out of it because I didn't want to program in progress. I'm much happier away from the stress thats for sure.

Re:Note to self:

[mink]

Look at what CMHC Systems has to offer.

Re:Note to self:

[daigu]

There are applications that use SSL/TLS protocols as well as a full-strength general purpose crypto - Citrix for example.

The bottom line is that applications like these give physicians greater oversight over patients and positively impacts patient care. It is a good thing.

Re:Note to self:

[abradsn]

Maybe we've met before. My name is Brad. Who are you?

missing hyphen?

[Bazman]

I'm guessing this is meant to read 'U.S. Government-Crafted OSS'. Then it makes sense.

Re:missing hyphen?

[btsdev]

I thought the same thing when I read the title... "That's ludicrous! Al gore.. again?"

Re:missing hyphen?

[Bazman]

In case anyone else doesn't get it, it is the difference between 'Man eating shark' and 'Man-eating shark'. People who don't understand the difference can be seen running scared out of Chinese restaurants.

Re:missing hyphen?

[Anonymous Coward]

are your reading comprehension skills so low that you had to even think about it for it to make sense?

most people's brain correctly analyzes the sentance and gets the info out of it regardless of minor errors.

Re:missing hyphen?

[Anonymous Coward]

It makes perfect sense as it is, although the hyphen does change the gramatical structure of the sentence. It could mean, "[The] U.S. Government crafted [some] OSS." With the hyphen, it's not a sentence, but rather a noun phrase. You assumed it meant, "the U.S. Gov't invented the concept of OSS." I don't see any reason to jump to such conclusions.

It has some really nice features

[Anonymous Coward]

Communication with a central server allows police to be quickly dispatched if over-prescription of pain medicine or symptoms of illegal drug use are present.

Now I understand...

[blcamp]

How the U.S. Government has been saying "asta la VISTA" to our taxpayer dollars.

Sorry. Had to say it...

Re:Now I understand...

[farmgeek]

Looks like you can say Asta-la-vista to their web server too...

Re:Now I understand...

[Anonymous Coward]

Hasta la vista.... fyi.
Cool - I'm a spelliing nazi in another language now!

Re:Now I understand...

[Anonymous Coward]

spelliing

Re:Now I understand...

[justforaday]

You have to admit that this makes it really easy to pick out which slashdotters are little w4r3z m0nk33z.

Re:Now I understand...

[CcntMnky]

Wow, I've seen that joke twice today, and it wasn't even on the same topic!

Re:Now I understand...

[mink]

[shock] [horror]
You mean asta la vista is not strictly used be security pros?

Great, that $25,000 can chip away at...

[soma_0806]

the ridiculous premiums doctors have to pay in malpractice insurance as the court system does virtually nothing to stem the tide of bogus malpractice claims.

Seriously, I think this is great, but the government needs to do a bit more to help our medical professionals as certain states (like WV) are having to close down trauma centers because doctors can't meet the $200,000 a year insurance premiums

Re:Great, that $25,000 can chip away at...

[Dunbal]

Amen...

Re:Great, that $25,000 can chip away at...

[badmammajamma]

Please show me the statistics that prove there's all these "bogus malpractice claims". Sure, it's gonna happen on occasion but from what I've read on the subject this argument is blown way out of proportion.

See the following link for more info:

http://www.makethemaccountable.com/myth/RisingCost OfMedicalMalpracticeInsurance.htm

Re:Great, that $25,000 can chip away at...

[Anonymous Coward]

Who needs facts when you have "Fox News"?

Re:Great, that $25,000 can chip away at...

[hesiod]

That's wierd, I am from WV (currently in OH) and one of the doctors at my hospital has a license plate similar to your /. nick on it... craziness.

Anyway, back on-topic. I sort-of agree, but you must be more specific when you say "the government." I believe much of the problem is with the state governments (WV's is particularly inept, perhaps corrupt), not the federal government. West Virginia has a high number of lawyers in office, and in its poulation. This means they do everything they can to make sure everyone is busy suing the pants off of everyone else.

They also take advantage of the fact that there are very poor regions in WV, where the people automatically think "doctor == rich, I bet I can get some money out of that guy."

WV has been constantly going downhill for quite a while, yet the state has voted for the same party in almost every single election (2004 presidency was an extreme exception) for the last two decades. They don't consider any kind of change, even when the status quo is lower every year.

Re:Great, that $25,000 can chip away at...

[shis-ka-bob]

Perhaps the software can help lower the cost of malpractice claims. The article states that the VA greatly reduced the number of drug errors by using barcodes and software. This alone should go a long way to reducing these legitimate malpractice claims. If you add malpractice insurance into the equation, the software might pay for itself in lower premiums.

Re:Great, that $25,000 can chip away at...

[jonadab]

> Please show me the statistics that prove there's all these "bogus
> malpractice claims". Sure, it's gonna happen on occasion but from what
> I've read on the subject this argument is blown way out of proportion.

In the small community where I live (about ten thousand people, perhaps a hundred doctors of various kinds including general practice, obstetricians, specialists, dentists, everything), at least three doctors that I know about have closed their practices in the last five years, citing rising malpractice insurance costs as the main reason. The only remaining obstetrician in town will be forced to close his practice if he is hit with another malpractice claim. None of the claims against him so far would reasonably be considered legitimate; they were the standard

It can be a real problem. The degree of the problem varies significantly from state to state, and from one subfield in medicine to another.

Statistics? How big is the problem? I don't know. But it can be a real problem in some places, I know that.

Re:Great, that $25,000 can chip away at...

[bwcbwc]

This ties in with what's happened in Florida. A couple of years ago the state legislature held hearings to investigate the malpractice insurance problem. Witness after witness from the insurance industry gave presentations stating that bogus and excessive claims were the problem. Until they were put under oath. Then the claims became "we think", "look at this one incident" and "we don't have the data with us".

Re:Great, that $25,000 can chip away at...

[Anonymous Coward]

I don't need statistics. My father's a physician. Two malpractice lawsuits both raised his premiums.

In one case, he admitted a patient through the emergency room, turned the patient over to the staff physician since the guy didn't have a doctor. Dad got sick, went into another hospital himself. The guy had surgery a few days later, went into a coma from complications (this was a risk of the procedure - he was messed up). It cost the insurance company 20 grand in legal fees just to get my father's name off of the case.

In the second case, he got sued by a patient who had a stroke from taking a drug that he and FIVE other doctors told her to quit taking because ... prolonged use could cause a stroke.

So, I don't know about the stats, but from my view, it's 100% bogus. Malpractice should require criminal charges anyway. If criminal negligence can't be proven, there shouldn't be an allowance for civil damages.

Re:Great, that $25,000 can chip away at...

[badmammajamma]

I don't doubt that some doctors are unable to afford the cost of the insurance, but if you follow the link I mentioned above you see that the increasing cost of the insurance has nothing whatsoever to do with the claims. In fact, the CBO and GAO say that malpractice claims are AT MOST 2% of all medical costs. In fact, the number of claims over recent years has gone down (only marginally mind you) but the cost of the insurance has gone up dramatically. Oh, and profits on this insurance have gone up dramatically as well.

Re:Great, that $25,000 can chip away at...

[badmammajamma]

Saying that is the same thing as saying there should never be awards for malpractice because physicians are exremely reluctant to say their peers "made an error". It's not easy to win a malpractice suit as is and if the requirement were "beyond a reasonable doubt" which is what you need for a criminal case then you will simply make doctors immune to malpractice suits.

Oh, and that 20k in legal fees is nothing to the insurance company. They always overstate their legal costs. (I used to work for an insurance company.)

Don't Forget

[AKAImBatman]

U.S. Government Crafted OSS

Let's not forget that the Government was doing OSS before OSS existed. The Berkeley Software Distribution (BSD) was funded by DARPA during the creation of the Internet. Due to the rules behind government funding, the BSD Operating System (it was originally just some tools) was released free to the public.

It makes sense if you think about it. Public funds are going into making the software. So who should own the design? The public, of course! Entities like NASA have the same requirements, save for when NASA pays third parties to do the development (in which case the developer owns the rights).

Re:Don't Forget

[WindBourne]

Back in the 50's and 60's, most computer companies were OSS. Back then, you did not get programs. You got source code that you would compile. It was not until software companies came to be that programs were sent as executables.

Re:Don't Forget

[dominator]

While I happen to agree with you, the Feds don't. In 1980, Congress passed the Bayh-Dole Act, which allowed government-funded institutions to own the IP rights of the things they created (using public money).

The Feds are also increasingly using contractors to assemble and produce various sensitive information and products - a legal loophole that makes sure that the FOIA doesn't apply.

Just FWIW.

Re:Don't Forget

[dsci]

Public funds are going into making the software. So who should own the design? The public, of course!

Well, public funds helped finance the development of CHEETAH, for example. But, you cannot get a copy of it unless you are ALREADY a government contactor. You are out of luck if you want to use it to do proof-of-concept to GET a contract.

Also, our tax dollars fund all that wonderful NSF and DOE research in academia. BUT, if I want to read the results of that research, I need a subscription to a privately published journal. I can read the abstract online, but the 'buy the article,' one lousy article is about a third of the cost of an annual subscription.

(And yes, I am a proponent of open publication of scientific results. And yes, I know I can got the university library, a 40 mile trip, and probably read the articles I want).

I'd be willing to bet you could name many other examples of publicly generated intellectual property that is not freely available.

Re:Don't Forget

[AKAImBatman]

Back in the 50's and 60's, most computer companies were OSS.

Actually, that persisted throughout the history of mainframes. The primary reason was that the code had to be linked directly against the database. (Abstraction was not a feature anyone wanted to pay for.) I was still using a mainframe that derived from third party source code in the late 1990's. :-)

However, these companies weren't really OSS as OSS is defined by the OSI. The OSI defines Open Source as both having the code and being able to fork/redistribute it. Most of the programs sold with source had explicit contracts that defined no rights for redistribution or forking (save for internal use). For an example of this, just look at the USL vs. BSD case for an example of this tight software control. Some contracts even had NDAs attached!

Re:Don't Forget

[WindBourne]

How funny. I was using mainframes in the 70s :)

But you are correct. It was not true OSS. But we did have access to the code and could make changes as well as see why we were having problems. And yes, all the code back then had something to say that we could not release the code to others.

Re:Don't Forget

[brokenbeaker]

You just made me realize something - most of journal publication is now going online. If you are at a university, that's no problem, because university computers have access to the online versions. But now people can't walk into the stacks and read the print versions, since they are not there anymore... Most of the computers in my university's library need you to be a member of the university to use them. I wonder how much access is being lost because of this...

Re:Don't Forget

[crashley]

The Government will do research on a subject, then send the results off to have the data evaluated by a private company. It is the company that is either the publisher, or will publish it in a private journal. Since the article you are requesting will include research and conclusions that might are not Govenrment owned the FOIA wont help to get access to it. But if you want to get the raw data that was sent in for evaluation originally, the FOIA will get it for you, as long as the information is not classified in nature, or fall into one of the 9 "FOIA Caveats".

Re:Don't Forget

[dsci]

CHEETAH, like many others, is a software package developed in government labs or by academic researchers under government contract. If I am a government contractor, I can get CHEETAH for free, no problem. Though both I as an individual AND my company pay federal taxes, I cannot get CHEETAH to do feasibility calculations to GET the contract I was after.

Consider another example. There is a protein docking package that was developed in academia. Academic researchers can get it FOR FREE, but as a private sector research, the license to me is $10,000. Ten Thousand Dollars, for something I indirectly helped finance.

I may be completely wrong about this, but I don't see (philosophically) how FOIA matters a hill of beans to this argument.

Re:Don't Forget

[hurfy]

Same here. Had all source code and you could change it as needed but that was all. In fact, the same accounting system we used was still available under same terms in a PC port as of a couple years ago, haven't looked since.

Should have went with it. Our current one is too proprietary and overpriced with a sucky UI.

Anyways, this sounds cool for doctors. Maybe i should mention it to a few (hundred) hehe. We are a medical supply house :)

Re:Don't Forget

[lubricated]

> I can read the abstract online, but the 'buy the article,' one lousy article is about a third of the cost of an annual subscription.

Or you can usually email the author, most proffs are happy to send you a pdf.

Re:Don't Forget

[Anonymous Coward]

> Let's not forget that the Government was doing
> OSS before OSS existed.

Yes... and by screwing things up only the way the United States Government can, the GPL came to be as a better way of executing "free" software. In general, I think people tend to overlook just how long the GPL has actually been around (probably longer that the average ./ reader/first-poster). It's been around longer than Microsoft, that's for damned sure and it will be around long after microsoft is gone. Don't believe me? Ask yourself this question: What is the oldest publically traded company listed on the stock market that still executes the core business that founded the company. When dynamic, on-demand, automated code generation starts happening, GPL and OSS is going inherit the market out of pure necessity.

Oh, and to all you trolls out there who love to point out that Open Software is only worthy of consideration if your time is "free", you're absolutly missing the point. Nobody's time is worthless (a point that should be driven home by the simple fact that we all evenutally die) and that is exactly why you will be paid to develope, install and run GPL software that is used in money making ventures.

US Gvt. develops a medical software system...

[gsfprez]

based upon open source software... so it should absolutely be available to the public.

now, if you can tell me anything that should be MORE open source than this, I don't know what it is. Its based on GPL software and developed with my tax dollars. Hells yeah, I should get a copy of this as a US citizen and taxpayer.

I know that there are some very good medical records software pacakages out there... either they innovate or they die. Meaning, either they go to work, work and make their software better, or they die.

That sounds pretty much like why i go to work every day.... i don't see why software developers should get a free pass.

Re:US Gvt. develops a medical software system...

[justforaday]

I should get a copy of this as a US citizen and taxpayer.

Ahhh, but the question is do you feel that a Canadian, Japanese, or (god forbid!) French citizen/doctor/whoever should be able to get a copy of this for free also?

Re:US Gvt. develops a medical software system...

[NineNine]

now, if you can tell me anything that should be MORE open source than this, I don't know what it is. Its based on GPL software and developed with my tax dollars. Hells yeah, I should get a copy of this as a US citizen and taxpayer.

That's incredibly faulty logic. The US gov't makes and builds and buys billions of dollars worth of stuff every day. That doesn't mean you're entitled to it.

Re:US Gvt. develops a medical software system...

[Anonymous Coward]

This is not GPL'd, and it is only available to American citizens. It is public domain - zero restrictions if you can legally obtain it. There was a repository named COSMIC up until a few years ago that had copies of all the available codes and a request process. It's been modified at this point IIRC, but the code is still there. Source is not available on all codes, and there are some restrictions if parts of the codes have been developed by a contractor rather than a govt employee (?), and there are export control restrictions on some. But there is a wealth of great code in there that too many people just don't know about.

Re:US Gvt. develops a medical software system...

[matria]

" Meanwhile in the early 1980s major hospitals in Finland were the first institutions outside of the United States to adopt and adapt the VistA system to their language and institutional processes, creating a suite of applications called MUSTI and Multilab. Since then, institutions in Germany, Egypt, Nigeria, and other nations abroad have adopted and adapted the system for their use. "

From the WorldVista site on Sourceforge.

Re:US Gvt. develops a medical software system...

[Bloke down the pub]

If by 'stuff' you mean physical things, then your alnalogy is flawed. If he permanently borrows an Aircraft carrier, Uncle Sam is down to the tune of one flat-top. If that were true with software, I fear that nice Mr Torvalds would be somewhat impoverished.

Re:US Gvt. develops a medical software system...

[Suppafly]

That's incredibly faulty logic. The US gov't makes and builds and buys billions of dollars worth of stuff every day. That doesn't mean you're entitled to it.

But that doesn't mean that you shouldn't be.

Re:US Gvt. develops a medical software system...

[NineNine]

But that doesn't mean that you shouldn't be.

You're right. I'd love my share fo time in an F-14 Tomcat that I helped pay for.

Re:US Gvt. develops a medical software system...

[Frank T. Lofaro Jr.]

Umm, if there is no redistribution prohibition, does it really matter if non-US people can get it using the FOIA?

When all it would take is *ONE* willing US citizen to get it and redistribute it.

Which has apparently happened, and was not considered a problem.

Also, the French wouldn't use it even if we gave it to them on a silver platter - the leadership there doesn't like anything American very much.

How long will this last?

[finse]

Overall, this sounds like a pretty good deal for just about everyone except the proprietary software vendors. Does anyone here really think the proprietary software vendors will let this stand? I am willing to bet said vendors either a) lobby congress to pass a bill banning Medicare from providing this software or b) sue the government under a 'no compete' clause.

Re:How long will this last?

[gsfprez]

I worked with Aerospace Corporation, which is a FFRDC. Basically, it means its a non-profit company that works for the govt. strictly, and pays the high prices for Phds that the govt. can't pay - but since its thru a contract, we could. That also meant that they were a neutral party that could help us evaluate what contractors were telling us, since they couldn't possibly ever get the work.

In any case, they made an analysis tool call SOAP - Satellite Orbital Analysts Toolkit. Over time, it became VERY powerful - almost STK powerful.

But since it was developed on the govt's dime, STK had a shit fit. They sent letters to congress bitching that this outfit's tool was taking away their profits, since the govt. types didn't need to buy STK licenses any more in many cases.

I was always pissed about this a) because STK is the kitchen sink, the outhouse, the back yard, and the garage of satellite tools, and SOAP was great because it was a philips-head screwdriver, and often, all i wanted to do was screw in a screw - i didn't NEED anything more. b) STK's basic ppackage was "free" - but it didnt actually do jack shit, and to start working with it seriously was a $30k software outlay. c) we PAID for the SOAP software by paying the salaries of the guys that wrote it - so why should we get bitch slapped around for using it?

In the long run, it just ended up a constant feud, with the STK guys sending out nastygrams every few months, and we'd put boxes of STK on the wall and throw darts at it...

because i worked very close with the SOAP developers, and was sickened to think that TWO GUYS could make a better tool than the whole building full of people at STK. Bastard whiners.

Re:How long will this last?

[akb]

You do not know what you are talking about and should be moderated accordingly.

lobby congress to pass a bill banning Medicare from providing this software

Government produced information is public domain. Period.

sue the government under a 'no compete' clause

"no compete" clauses generally refer to provisions in a contract between two parties. What might that contract be in this case?

Re:How long will this last?

[rev_sanchez]

There is a lot that goes into an inpatient system aside from medical records that this wouldn't cover. This also looks a lot more like what a clinic group would use for charting than a full suite of medical software.

The software itself, while quite expensive, is only part of the cost of having a medical software suite. There is also a lot of money in supporting and customizing the software and general support. The IT staff at a lot of hospitals and clinic groups don't tend to be that tech savvy. There are exceptions of course but former nurses with a bit of a computer background are the rule. I think the vendors will do fine with this new open source option.

One really good thing about this is it could be a big step in an national electronic medical record that could follow you between hospitals. Go on vacation, get sick, and by the time you are in a bed your medical records from your old doctor are available to the attending doctor. Making that happen is good for patients and making that work well between different products, in different implementations or versions of Vista, and different sites is good for vendors putting out suites.

Re:How long will this last?

[gsfprez]

^Satellite Orbital Analysts Toolkit^Satellite Orbital Analysts Program

STK = Satellite ToolKit, made by Analytical Graphics

Here is what an FFRDC is. I would actually love to work at Aerospace if it wasn't so fscking far away from me on the freeway... stupid SoCal.

Re:How long will this last?

[holt]

There was an article posted on /. a little while ago about how the private weather companies are lobbying congress to force the National Weather Service to stop giving any non-emergency data to private entities, because it isn't fair that the gov't is competing with the private sector. I think it's ridiculous, personally, as I paid for the weather data to begin with, so I should get a copy for my own purposes. If the privates want to stay in business, they'll have to offer me something above and beyond what I've already paid for. The point is, though, that congress could pass a law making it illegal for Medicare to disclose the source code.

Re:How long will this last?

[akb]

You got the story about weather data wrong on a couple counts. It was about stopping the government providing the data in a form that could be consumed directly by end users in real time. The private companies still wanted the data from the government for themselves. It had nothing to do with FOIA as no one ever disputed that the data was public domain and should be accessible to all, the rub was in how accessible.

FOIA is a 30 year old law that effects every part of federal bureacracy. It will not be repealed.

The goverment is so good at everything else

[protocoldroid]

Yeah, the goverment is doing such a great job with everything else -- spending our taxes, foreign policy, etc...

[sarcasm]...I'm POSITIVE they can sling some great code!![/sarcasm]

Re:The goverment is so good at everything else

[WindBourne]

Considering that this code has been developed since the 70's, yes, they can. I worked in a medical lab (Metpath) back in the 80's coding with Mumps (now known as M). At that time, we worked closely with Insurances companies as well as DVA. I had the pleasure to talk to some of the major ppl behind this work. They were solid in their approach as well as in the code. BTW, back then, several of the ppl were MDs, so they were not intellectual slouches.

Just because something comes from the feds does not make it bad. Assuming that would be like assuming that MS is pure bad, and Linux is pure good. While I do not know MS, I do know that not all is good in Linux. We have our own set of issues. But much of it is good.

Conflict with "Windows Vista".

[argent]

Quick, someone come up with a retronym for "LONGHORN".

Re:Conflict with "Windows Vista".

[Anonymous Coward]

Veal

Re:Conflict with "Windows Vista".

[Anonymous Coward]

UNSIGNED LONGHORN?

Re:Conflict with "Windows Vista".

[idonthack]

Veal

Nah, they'd lose the Vegan and Animal Rights markets.

Re:Conflict with "Windows Vista".

[Anonymous Coward]

eh, NROHFNOL? ugm...

Opportunity

[catherder_finleyd]

I will wager that part of the costs mentioned in the article were for installation, integration, and support. Which means the MDs still have to pay, and we IT-people have an opportunity!

Open Source?

[Compholio]

Maybe I didn't pay close enough attention but the article seemed to say "distributing for free, usually costs $10K". It didn't seem to say "Open Source" anywhere... Does anyone actually know anything about this program?

Re:Open Source?

[birdthenerd]

It's covered under the FOIA - so not technically an 'open source' license. Written in M (Mumps). This is typically for many hospital information systems. Has windows GUI frontend. I've tried to install it and failed miserably. Maybe I'll wait for OfficeVista.

Re:Open Source?

[gkuz]

Does anyone actually know anything about this program?

I suppose actually going to the site linked in the submission would be too hard? There you can read that it really is a F/OSS, GNU/Linux-based system.

Re:Open Source?

[flabbergast]

FOIA = Freedom of Information Act. You can take the Fed Govt. to court to access information, usually court documents. This is the first time I've seen it used for software and I think its an excellent idea. Since no company owns Vista (the software wasn't done by a contractor) you can petition the government to release the source. That's why its open source.

As for $10k, you don't really believe the VA is going to give away hardware to run this software and someone to install the software, do you?

Re:Open Source?

[Anonymous Coward]

The software costs nada (some things are removed copyrighted CPT codes, things related to internal VA policies and practices, copyrighted mental health tests). However I've gone through many sites since reading this posting and the install in it's current state (pre vistaoffice or whatever it's called thats due out soon) looks to be a major pain in the butt as it wasn't designed to be installed from scratch (the original install was years ago with mountains of patches and updates since then). Also from what I've gathered running in a windoze envrionemnt requires intersys.com Cache (free single user trial download available), so you will have costs associated with that licensing at deployment. Not to mention hardware etc etc. even with sites like hardhats.org what explanation of different functions and procedures in the install seemt obe as clear as mud. Plenty of step by step, or scripts to download for parts of the installs but the why's of doing this and that are mostly absent (which for me just makes things more confusing).

Outsourced

[Anonymous Coward]

I heard they outsourced this project to india or at least all the tech support.

Anonymous Source

[Doc Ruby]

So the US Government Crafted OSS? I am most excited to learn that George W Bush invented Linux! Won't Al Gore be jealous!

Stuck in a rut

[It doesn't come easy]

OK, here's some flamebait.

An open souce project that provides great value and fills a really important need that is hard to install and maintain.

Where have I heard that before?

Re:Stuck in a rut

[Infinityis]

Hmm...my first guess was "Microsoft", but then I realized you said open source, not shared source (whatever that's supposed to mean).

Re:Stuck in a rut

[bwcbwc]

Sounds like a market opportunity for a support contractor.

Vista is written in mumps

[GGardner]

Sadly, though, Vista is written in the MUMPS programming language, which is quite possibly the worst, commercially successful programming language evar. Some unique things about mumps:

MUMPS is line-oriented, like old-school BASIC

Evaluation is strictly left-to-right, so 3 + 4 * 5 Doesn't yield the result you think.

There are no local variables. Everything is global, except for "globals", which are persistent, and stored in a hierarchical file on disk.

Re:Vista is written in mumps

[It doesn't come easy]

Might explain part of why it's difficult to get up and running.

Anyone make a MUMPS automatic translator to a better language?

Re:Vista is written in mumps

[Nigel_Powers]

Does anyone else find humor in the fact that a medical records application is programmed using a language with the same name as a childhood illness?

Not being familiar with MUMPS, I looked it up and found the ever-popular hello world example:

hello
f w "Hello World!",!

Aside from MUMPS and ADA, does the gub'ment use any non-wacky programming languages?

Re:Vista is written in mumps

[Anonymous Coward]

Well, I sure they have used Fortran and C too. :)

Re:Vista is written in mumps

[mystik]

Mumps code:

f p=2,3:2 s q=1 x "f f=3:2 q:f*f>p!'q s q=p#f" w:q p,?$x\8+1*8

[part of Keith Lynch's .signature; it prints a table of primes,
including code to format it neatly into columns--DPBS]
(from ftp://rtfm.mit.edu/pub/usenet/comp.lang.mumps/M_Te chnology_and_MUMPS_Language_FAQ,_Part_1_2
)

line noise?

Perl's got nothing on mumps.

Re:Vista is written in mumps

[slapout]

I couldn't be any worse than COBOL could it?

Re:Vista is written in mumps

[doublem]

Wait, wait, you're saying Microsoft's Vista is written in a limited, line oriented language?

No WONDER it keeps getting delayed!

Re:Vista is written in mumps

[juggleme]

Obligatory Wikipedia link: MUMPS

You forgot the only thing that makes MUMPS worth programming in: the array structure. Arrays are string indexed and are stored as B trees, making it easy to create your own DB structures. It can be faster than SQL DBs in applications with enough data and dimensions, hence its creation and use at hospitals (the first M is for Massachusetts general hospital) and its use in the financial sector. See the article for more stuff if you're interested (including links to open source implementations).

Re:Vista is written in mumps

[WindBourne]

Well, MUMPS was developed by a MD (patholigist IIRC) at Mass. General Hosp. as a Utilities Multi-Programming System. Just like GNU, he gets to name it and had a bit of fun with it.

Re:Vista is written in mumps

[schon]

MUMPS was developed by a MD (patholigist IIRC)

Well, that makes sense - it certainly is pathological. :o)

Re:Vista is written in mumps

[Globby]

I've worked for three of the big M(UMPS) vendors way back in the before-time. Another cool thing about it is that every variable is a string, and you can execute code that's stored in a variable. Any variable name starting with "^" is persistantly stored in the above mentioned B-tree structured sparse database; so I've seen weird shite like code fragments in a database retrieved, altered, and run all in about 20 characters (yes, *characters*) of code. Also, the indexes for the arrays are strings too, and often actually contain the data.

I wrote a radix conversion routine that simply substituted "111" for octal "7" (This was for a PDP-11!), et. al. and it ran 40 times faster than doing it the mathematical way.

Funky stuff.

Re:Vista is written in mumps

[archen]

Ada is not really a 'wacky' programming language, just not as common. The language itself is quite sensable and manageable. It was designed to be a robust language as well as encourage robust code. When you have mission criticle situations where programming / code errors are not an option, then what else will you use? C? C++? Perl? They couldn't find an acceptable solution so they came up with their own (keep in mind this language was first drafted over 20 years ago).

I don't much like Ada myself, but it has as many pro's and cons as any other language. With features such as concurrent execution and very good exeption handling built into the language, I don't think they had much of a choice considering only recently have those two things really recieved much attention from modern languages.

Re:Vista is written in mumps

[srmalloy]

f p=2,3:2 s q=1 x "f f=3:2 q:f*f>p!'q s q=p#f" w:q p,?$x\8+1*8

Unfortunately, that line of code has an error in it as posted; it has to have two spaces between the 'q' and the 's' inside the execute string (as I discovered, slashdot eats any attempt to format it properly, so it's not the poster's fault; take the underscores below and change them to spaces (and ignore the fact that the underscore is a MUMPS function, too; it's not used in this example):

f p=2,3:2 s q=1 x "f f=3:2 q:f*f>p!'q__s q=p#f" w:q p,?$x\8+1*8

You get a 'Quit without value expected to terminate context' error on the inner loop otherwise. For more readability, you can also spell out the commands, and get (again, having to use underscores to show a doubled space:

for p=2,3:2 set q=1 xecute "for f=3:2 quit:f*f>p!'q__set q=p#f" write:q p,?$x\8+1*8

Re:Vista is written in mumps

[Wizardstorm]

I'm so sorry, but you are completely wrong. MUMPS is not the language you think it is. Yes there are some old school aspects, but it has variables, and it can process lines in any order you want. It lends itself to object oriented coding very easily. However the bottom line is, it is the number one fastest database language out there. In addition it's used predominantly in the Banking field, as well as the medical field. You should be more careful about your comments. When MUMPS was first created 30 years ago some of what you said was true, but the GT.M version of MUMPS is actually more like Python than anything else. It's a very powerful database language, and that is why it's still alive, inspite of a lot of misinformation like what you are spreading.

Re:Vista is written in mumps

[mystik]

Having never written/read Mumps, I'm just defending my favorite language :)

Written out, that line of code makes much more sense. (But is still a bit weird to see) -- You seem to know the language, how is a function like that usually written?

xecute looks quite handy, looks like it's like an eval from other language (perl/javascript/scheme).

Re:Vista is written in mumps

[Col Bat Guano]

very good exeption handling built into the language

The exception handling is ok, not great. You can pass information along with an exception - but only if it's a string!
It does mean that exceptions won't cause other exceptions due to running out of memory. Ada is designed for embedded systems, so this does matter.

Re:Vista is written in mumps

[srmalloy]

It's normally written with the function shorthand, a holdover from when MUMPS was implemented on machines that were seriously limited in memory/storage, and since the shorthand versions took up fewer bytes, they were more effecient.

The Xecute command there in the middle is a programming trick; normally, MUMPS will take everything from the FOR command to the end of the line as being part of a FOR statement, so forcing a subset to be executed separately lets you limit what is brought inside the loop. Broken up more readably, with the current block-structuring features, you'd get something like this (again, the underlines functioning as spaces, and commented a lot more heavily than older MUMPS code would be):

; iterate p through 2, 3, 5, 7, 9, etc. (every odd number) forever
FOR p=2,3:2 DO
. SET q=1
. ; for every odd number f from 3 to the square root of p
. FOR f=3:2 quit:f*f>p!'q__DO
. ; if f divides p evenly, not a prime, so loop can exit
. . SET q=p#f
. ; end FOR
. ; if no divisor found, write out the number in columns
. WRITE:q p,?$x\8+1*8
; end FOR

Xecute takes a string and evaluates it as if it were MUMPS code, which lets you, for example, store the formatting function for a database field in a global as part of that global, rather than having to define it in each function that references the global.

Re:Vista is written in mumps

[tusey]

This is not a bad language. Just someone's very bad code. Either a bad programmer, or this code was intentionally written unreadable. Some people are talking about languages they don't know and don't understand. Assume there is a slight difference between the BASIC from 1960-s and VB.Net. There is also a difference between the MUMPS from the 1970-s and today. The latest platform from InterSystems is likely the most advanced and elegant DBMS ever created. And it is still MUMPS. There are three "big problems" about MUMPS that make it difficult to transfer applications to other languages. 1. The development speed in MUMPS is several times faster. So where it was enough just one mumps developer, you would have to hire 4-5 developers on a common language. 2. The MUMPS application are extremely fast. I know many unsuccessful transitions from MUMPS to relational DBMS. After the transition the reporting speed is normally slower by 30 (!!!) times. Compare - 10 seconds and 5 minutes. But notice that MUMPS _is_ relational: it supports SQL since mid-1990s or so. And it is still fast. 3. Many people just do not understand the idea of MUMPS. They think it the a problem of the language, not their own. So it you really want to quit MUMPS, prepare to spend $$$$$ to upgrade your hardware and hire 5 times more developers. But your customers maybe will not be happy anyway.

Re:Vista is written in mumps

[tusey]

You may think MUMPS is worst, but VistA has been written and it still works nationwide. The team of VistA creators was amazingly small. And you maybe do not know how big and complicated the VistA system is... You should not judge the language if you don't know even the basics. Your statements are not correct: a) That is not true. Classic MUMPS is a data tree-oriented language. Trees may be "global" (persistent) or "local". Data elements may be string or numeric. There is no strict typization - data types are converted on-the-fly. (Notice, that is not true about Cache'). Cache' is an object-oriented platform. b) Operators priority is not a universal law. You should use parenthesis if you cannot memorize the rules, or to make the code more clear). c) That is not true. There _are_ local variables. Actually there are 4 types of "local" variables as of today: - "local" variables - visible only to one process automatically destroyed when the process quit. - "new" variables - visible only within one block of code (and all blocks it executes). "New" variables are automatically destroyed when exiting from the block of code. - Formal parameters are also "local" unless they passed by reference. - "PRIVATE" variables (new in Cache 4). Same as new but only visible within the block of code. Not visible from above or below stack levels. Maybe I missed something but this is enough. If you really knew MUMPS, you would never say it is "worst". Especially regarding Cache' which is probably the best and most elegant DBMS/ Application Platform ever made.

Re:Vista is written in mumps

[tusey]

Oops, I guess you are saying "line oriented" about the code flow, not the data types... Well, anyway that it no longer true since 2000 (Cache' version 4).

This will be illegal in a few years

[davidwr]

Sooner or later, the Big Dollar Software Industry will sneak a little-noticed provision into some bill that will require the government to either buy commercial software or give vendors a chance to "underbid" custom software before the gov't develops its own, at least for big projects.

Furthermore, The Industry will make sure that if the government does make any of its own software, it must either not release it or charge more than industry does for similar solutions.

At least that's how I see The Industry spending it's lobbying dollars.

Re:This will be illegal in a few years

[YrWrstNtmr]

Take off the hat, son. Tin foil does not look good on you.

Re:This will be illegal in a few years

[Anonymous Coward]

That was "insightful"??? Exactly what insight was provided?

Wheres the tarball?

[waferhead]

I want to see if it will build on Mandrake 10.2.

Seriously, is this REALLY open source?

If my tax dollars paid for it's development, I want source...

(Visualizing nice canned preconfigured Linux or Mac boxes for Doctors offices///healthcare facilities)

Re:Wheres the tarball?

[Anonymous Coward]

It's on Sourceforge, idiot. Did it occur to you to follow the link before proceeding to "If it doesnt run on Lunix its not teh Open Sores!"?

Mandrake 10.2, for heaven's fucking sake....

Re:Wheres the tarball?

[ValentineMSmith]

Well, it's public domain, freely available via the U.S. Freedom of Information Act.

And, you can indeed have all of the source you want. But, unless you're prepared to read and modify source code that looks like:

S %=DP, X=D, Y=$P(DQ(DQ),U,4)="0:1"

you probably won't be able to do much with the code.

It's written in (M)umps, an old, old, heirarchial database developed for (surprise) hospital use by the Massachusetts General Hospital. The V.A. began developing this system in the early to mid-80's and some of the originals (like George Timson) are still involved the last I heard. They've added a relational database layer (complete with reporting system) on top of the M layer, and have implemented pretty much everything a hospital would need (from prescriptions to e-mail to patient encounter information and so on) in this language.

Right about the time Delphi 1 came out, the V.A. decided they needed to get into the GUI game and created a component that could be used from Delphi to transmit data to and from a V.A. database via TCP stream. This is the basis of the graphical system that an earlier poster mentioned.

Since then, there's been a lot of incredibly cool work done by programmers in the V.A. with this system. I worked as a programmer for the Topeka V.A.M.C. when they did the GUI patient medication admistration system, which caused the incidence of patient medication errors to drop through the floor (I didn't do much of the work on it, but went Cowboy Action Shooting on the weekends with the guy that did).

For all of the abuse that a lot of government employees take on /., pretty much every programmer I ever met or worked with in the V.A. was bright, dedicated, professional, and knew their business.

Anyway, if you're truly serious about downloading this, you need to go to Intersystems and download a copy of Cache for either Windows or Linux, and then go to Hardhats and download the the database. Back when I was still working with it, they had an actual Cache database file that you could download that was already pretty much preconfigured. Since it's been almost 4 years since I've done any VistA work, I'm not sure what the current state of the system is.

And for those of you saying that the commercial software companies aren't going to stand for this competition: the V.A. would periodically evaluate SQL-based databases to see if they could meet the needs of the V.A. Every test I'd ever heard of said that there was no software out there that could meet the needs of the V.A. and, even if they could find software that met their needs, the conversion from one system to another would be nightmarish (to say the least).

Re:Wheres the tarball?

[Otter]

Well, it's public domain, freely available via the U.S. Freedom of Information Act.

More to the point, it's freely available via *Sourceforge*! (As if the guy you're responding to has the slightest need for a hundred megs of MUMPS code, let alone plans to audit the thing before opening his Mandrake-based hospital.)

god you suck

[Anonymous Coward]

read the subject, you train wreck of unfunny

The original "government-crafted OSS"

[BigWhiteGuy_27]

Enough said

It isn't exactly OSS it is Public Domain.

[ivaldes3]

Which means it can be any license you'd like, including GNU GPL. RMS weighed in on this topic on Linux Medical News some years back: http://www.linuxmednews.com/974769856/index_html

BTW, VistA has been developed over decades within the VA despite multiple efforts to kill it. It is just now gathering recognition, momentum and federal dollars as well as support of lawmakers to be deployed privately. It has always been available by FOIA (Freedom of Information Act). However, the previous stance by VA and the federal government with regard to privatizing it has been neutral to hostile (how does this help veterans?) to it is okay to think about privatizing it to actively encouraging it.

Fantastic that is now getting the recognition, and hopefully widespread deployment, it deserves.

-- IV

hl7

[jjshoe]

unless it does hl7 it's junk.

Re:hl7

[Anonymous Coward]

Of course VistA does HL-7. But since there are several different versions of HL-7, and every manufacturer has their own interpretation, it still doesn't help as much as you think...

Huh? Wuzzat about the GPL?

[cduffy]

This is public domain software -- it's not under any license, because nobody owns it, but anyone who has a copy can do whatever they want with it.

A complete open source VistA stack

[popocatapetl]

There is a complete open source stack of VistA on GT.M on Linux. You can download a ready to run Linux live CD from the WorldVistA site at Source Forge (http://sourceforge.net/projects/worldvista). Grab a 512MB / 1GB USB flash drive, download and burn a CD image, and you're good to go.

Vista isn't actually open source in the normal way

[wildephyre]

It's public domain for starters, and Vista has existed in some form or another since the late 1960's. And how the Veterans Department releases it isn't actually in a functioning form.
I did some investigation into it a few months back as one of my customers is a small rural hospital who is shelling out a large sum of money to both IBM and a small software vendor for their management software/hardware.
The biggest knock on Vista is that its written in MUMPS, a rather obscure programming language dating to the late 60's. It's a really interesting language, but altogether it's something of a pain to deal with, and the only two open source implementations of it are the Sanchez GT/M stuff that WorldVista uses (which I'm not even sure *IS* open source, the licensing isn't very clear on it, further, alot of it is written in assembler which means its effectively non-portable), and another MUMPS->C translator developed by a guy at the University of Northern Iowa. http://math-cs.cns.uni.edu/~okane/cgi-bin/newpres/ m.compiler/compiler/index.cgi It's an interesting (and really very solid) system, but unless the MUMPS language it's written in gets some serious support behind it, it's lack of portability and available toolkits will doom it to further oblivion.

It does

[Tony]

It's not junk. It's very complete.

Re:It does

[jjshoe]

does it support hl7? Judging by your response that's a big, fat, NO.

i suggest you read up on hl7 and do some research. you will find some top hospitals in the process of using it if they don't allready.

Re:It does

[Anonymous Coward]

Can't you read? He said it does.

And can't you Google? Typing Vista HL7 into Google brings up a page mentioning it's HL7 Infrastructure as the first page. Do your own research before you point fingers.

And you seem totally clueless of what HL7 is. HL7 is just a messaging layer. You can add on top any system and it's a trivial addition once you take into account the rest of the complexity of EMR. Judging against an open source project EMR based solely on HL7 complaince is throwing the baby out with the bath water.

Re:It does

[Anonymous Coward]

I can read. he didn't say it did. Learn to follow posting orders.

I'm not going to google. if they want to leave the most important feature out of the story then so be it.

I work with hl7 every day. i know what it is. If you don't have hl7 you might as well kill the baby and eat it for lunch.

Very specialized components

[mparaz]

I was hoping it was something the average open source hacker could work on... like PHP, or J2EE/JavaEE... but when I saw the list of components... uh OK.

Re:Very specialized components

[hoka]

You want to put PHP/Java into a life-or-death critical system? Not only do these languages likely explicitly disallow this behavior since it would likely open them up to litigation, but it would probably be really bad when the Java VM or some PHP lib bug causes the failure of the system. If you look closely at the agreements of just about large software you install (Windows if you swing that way), you'll probably see a list of things disallowed. I believe Windows 2000 or XP explicitly disallowed it being put to use as a base for systems software in places like planes, nuclear reactors, etc. Of course other software/license agreements can be had if you really need something more stable, but thats probably not something you can get from Sun for Java or the PHP project.

Re:Very specialized components

[mparaz]

Good call. I did not realize that.

Bad news for my company ... (maybe)

[Anonymous Coward]

This could potentially be bad news for the company I work at. We deliver an enterprise-class medical software suite, known for integrating all the labwork, billing, nursing, ordering, scheduling, etc., systems into a single architecture. The thing costs several millions of dollars, though.

Some clients seem to like it because it gives you seamless operation through your entire organization, and others don't like it because it's a huge monolithic piece of software, and represents TONS of vendor lock-in.

I wish the execs up top here would realize that in this day in age, open standards like XML and now open source applications like this pose a huge threat to their business model, whose only strong point is that you get a highly integrated system (we're like the Microsoft of healthcare IT, basically).

Oh well. I'm just one lowly developer. What can I do about it? I'd like to see my company succeed, but I worry that they're way too stuck in the 20th-century "lock them in", "monolithic application", "integration over interopability", "the only standard is a defacto one" -mindset.

Re:Bad news for my company ... (maybe)

[urbaneassault]

"we're like the Microsoft of healthcare IT, basically" Ahh, the true quote of someone who works for Cerner.

Re:Bad news for my company ... (maybe)

[Man from Trantor]

Looked at the HIPPA specs? Plenty of room at th e waterhole there. MfT

Re:Bad news for my company ... (maybe)

[Anonymous Coward]

Do you work in San Diego, by chance?

PS: I will probably never see the reply to this message. =]

Re:Bad news for my company ... (maybe)

[Anonymous Coward]

Sounds like Cerner... My guess is there are lots of software companies you could work for, though.

What's up Doc?

[s000t]

Doctors deserve a little reprieve (25k), and this open source system will definitely help with communications and organization on patients. However I'm sure HIPPA is all over the docs and the system. With all the malpractice suits and red tape doctors have to put up with, they could use all the help/support they can get. As much as doctors do for us, it's good to see we still have some respect for them. Let's see what else our government has in store for us...

Isn't this ANOTHER "Old News" story?!?

[Anonymous Coward]

I'm sure I've read about this Medical System
a year (or longer) ago. What's new? Has it
been converted to LInux or what?

Now, even if it is / were newsworthy...
tell me... would YOU like to maintain a
computer application system created by
gov't contracts, over the [how many] years? ;-/

SourceForge must be hating this article...

[tcopeland]

...since the download for OpenVista is 177 MB. Hideous packaging, too - here's the contents of that file:

$ ls -l
total 1132
drwxr-xr-x 2 tom tom 4096 Jul 22 12:44 g
drwxr-xr-x 2 tom tom 581632 Jun 28 11:32 o
drwxr-xr-x 2 tom tom 561152 Jun 21 18:23 r
-rwxr-xr-x 1 tom tom 3576 Jun 21 18:37 vista

The "o" and "r" directories have 23K files each in them. Bizarre.

Re:SourceForge must be hating this article...

[PalmKiller]

Sourceforge aint crying, but their mirrors might be...

> The "o" and "r" directories have 23K files
> each in them. Bizarre.

Not really odd at all, a quick look told me that the o directory contains the object files derived from compiling the source files in the r directory (.m aka mumps or M database files) ...

Mumps is what vista is based on which is a database system that is available for free or commercially see http://www.mcenter.com/ for links to the free (go to link for m development committee) and commercial versions of MUMPS aka M compiled database. GT M is the free linux mumps compiler that comes with openvista.

Re:SourceForge must be hating this article...

[tcopeland]

> the o directory contains the object files

Yup, it's a bunch of binaries:

$ strings o/A1B2ADM.o
GTM_CODE
G(VW
G(VW
SlVW
S<PADDI

I guess it just looks a little odd... I'd expect to see them broken out into a directory hierarchy that mirrors a package or module structure. But perhaps M doesn't have a concept of such a thing?

Vista

[ewe2]

Well there's another OSS project that has to change its name...

Your sign should be:

[ratta]

Remember, Cthulhu for President! Why vote for the GREATER of two evils?

Re:Vista isn't actually open source in the normal

[Anonymous Coward]

Actually there is another commercial M like environment. Cache from Intersystems.

http://platinum.intersystems.com/csp/docbook/DocBo ok.UI.Page.cls?KEY=GMSM_languagediffs

I looked at this some time ago but haven't had time to delve into it in detail. I even downloaded a full runtime of Vista that loads as a cache.dat database file.

Re:Vistaprint is going to get sued...

[Anonymous Coward]

It's like a bananapeel you spot on the horizon: http://www.vistaprint.com/vp/ns/default.aspx

Local variables

[Tony]

There are no local variables.

Of course there are local variables-- that's what the N directive is all about. It's local within the scope of the in which it was declared.

Doctors

[mparaz]

Maybe that's a reason more people overseas want to be doctors in the US.

ANYTHING?!?

[ivi]

With Public-Domain software I can do ANYTHING?!?

Doe that include slapping a GPL onto it...
(ie, even if I didn't write it?!?

Re:ANYTHING?!?

[swillden]

With Public-Domain software I can do ANYTHING?!? Doe that include slapping a GPL onto it... (ie, even if I didn't write it?!?

I don't think so. You can certainly distribute it and claim that you're doing so under the GPL, no problem. But if someone then decides to, say, take your version and sell it as closed source, you probably don't have any legal recourse, because the GPL derives its power from the privileges granted to the copyright holder, and you do not own that copyright. No one does, actually, so no one would have standing to sue for "infringement".

Now, you certainly could add some bits of your own (which you would obviously own the copyright to) and release the pile as GPL. Anyone who violated the GPL terms on the combined product would then infringe your copyrights. If your additions are large enough and valuable enough, then it's possible that you could make your version the de facto standard and thereby GPL the original software, in effect if not in actuality.

Re:ANYTHING?!?

[matria]

Yes.

Re:ANYTHING?!?

[cduffy]

With Public-Domain software I can do ANYTHING?!?

Doe that include slapping a GPL onto it...
(ie, even if I didn't write it?!?

Yup. (Of course, someone *else* can slap a BSD license onto it, and someone *else* can use it with no license at all).

Backwards ! It was Developed by the Gov't First

[HighOrbit]

Vista was developed by the Government starting back in the late 70s - early 80s when the GPL was just a twinkle in Stallman's eye, as can be seen here. It is written in a near obsolete language called MUMPS. It was (and still is to some extent) accessed via VT100 telnet. A GUI and extra components were added in the 90s. Because it was developed by the Government, it is public domain. The OSS version is based on the Government's work.

Re:Backwards ! It was Developed by the Gov't First

[Master of Transhuman]

If I'm not mistaken, MUMPS is not obsolete. I believe it's still massively used in the medical industry.

See this:

MUMPS - Massachusetts General Hospital Utility Multi-Programming System. A
database-oriented OS and the language that goes with it. Used originally for medical records. Only data type is the character string. Persistent associative arrays. Current versions for IBM RT and R6000, DSM (Digital Standard Mumps) for DEC, Datatree MUMPS for IBM PC, Unix MUMPS from PFCS . "MUMPS Language Standard", ANS X11.1-1977, ASN X11-1990.
MUMPS User's Group, Box 208, Bedford MA 01730.
list: MUMPS-L@UGA.BITNET.

Hidden features

[doublem]

What most people don't know is that there are several new features included in the software, as it came from a government project.

All data is regularly bundled up and sent to the Department of Homeland Security for safe keeping.

Profiling software is run against the data to find "Terrorist Red Flag" items, such as injuries consistent with "Terrorist Training Programs". Please note, the occasional false positive is likely but only against people who are in intensive "Assault combat" classes like Karate. Hardly, save, mainstream activities to begin with, at least not to Government thinking!

The license also requires these features be kept in place. Removing such valuable reporting and safety features is in and of itself a terrorist act. Aiding and abetting and all that.

Isn't in cool what they're doing to protect us? Who knew "Privacy" and "Due Process" were so dangerous? Think how much safer we'll be when the government can cut through all that civil liberties red tape.

linuxmednews.com

[rkhalloran]

go to LinuxMedNews, where Vista and its derivatives has been an ongoing discussion for some time. And given that it seems to be running Slashcode for the site, should be very familiar to the crowd here...

My submission was worse.

[otis wildflower]

Glad to see this story got posted, even with my crappy submission.

The NYT seems a little breathless IMHO, with how wonderful Medicare is to be giving software away. VistA was IIRC _always_ public domain, as it was written under contract to the VA, and also IIRC the VA (and the USG) has the copyright.

VistA renamed from DHCP

[AndyChrist]

" The name "VistA" (Veterans Health Information System and Technology Architecture) dates back only to 1994, when the Under Secretary for Health of the U.S. Department of Veterans Affairs (VA), Dr. Ken Kizer, renamed what had previously been known as the Decentralized Hospital Computer Program (DHCP)."

Heheh.

Re:VistA renamed from DHCP

[biobogonics]

previously known as "Decentralized Hospital Computer Program (DHCP)."

as opposed to Dynamic Host Configuration Protocol (DHCP)

This threw me the first time someone asked me to set up DHCP on a computer, since my first thought was of the VA's medical records system!

INFORMATIVE??????? WTF

[WindBourne]

I used Mumps/M back in the 80's. It was rock solid for doing apps. At metpath labs, we did some massive apps with these and it was fine. While it has been 25 years since I used it, there were different implementations of the language, of which some had local variables (in subroutines). As to the global/persistent, who cares. It was simply a way to access the data. Even today, most DBs are nothing more than a hierarchical access.

Re:INFORMATIVE??????? WTF

[Anonymous Coward]

You must be new here.

The modding of a post NEVER has any relationship to the content!

all your medical records are belong to us

[dwntwnboi]

this could lead to government control based on medical condition -- what if i go in for a checkup and am declined to enter the office because the doctor ran my record beforehand and found i had aids?

Re:all your medical records are belong to us

[rebelcool]

Then you should get a new doctor and report that one to the medical board.

Much, if not all, of your medical info is stored in databases already.

Wow

[Enry]

I did the initial FOIA releases on CD back in 1993-1994. Most of my time was spent converting Word for Mac documentation to Word for Windows, RTF, and PS (and plain text IIRC). The easy stuff was actually getting the routines on a CD and burning it at 1x on a CD burner about the size of your desk. I think I still have a few releases kicking around my house.

At the time, the idea was that companies would take the FOIA release (which had everything except encryption routines) and create their own release they would sell to hospitals.

I remember getting some bloodwork a few months ago and seeing a computer screen with the familiar login screen for a MUMPS system.

US Goverment

[MECC]

Is therfore now officially communist, according to MS.

Re:Vista isn't actually open source in the normal

[tcopeland]

> The biggest knock on Vista is that
> its written in MUMPS, a rather
> obscure programming language

Wow, so true. From gtm_V5.0-000/_RSEL.m:

f s d=$o(d("D",d)) q:d="" i $p=$p(d("D",d)," ") s d=d("D",d),ctrap=$p($p(d,"CTRA=",2)," "),exc=$p(d,"EXCE=",2) q
e s (ctrap,exc)="" ; should never happen
s k=$l(exc,"""")
s k=$l(exc) i $e(exc,1,1)="""",$e(exc,k,k)="""" s exc=$e(exc,2,k-1)
if ctrap'="" s exc="s ctrap="_ctrap x exc
k d
s (cnt,rd)=0,out=1,(last,r(0))=$c(255)
i '$l($zro) s d=1,d(1)="" q
s d=0

Laws-a-mercy!

Someone Code A Replacement

[The_H0und]

With this code available, wouldn't it be relatively easy to code up a replacement in a more sane language with a more sane packaging system?

Surely someone wants to lead a project with this much visibility...

Re:Someone Code A Replacement

[ValentineMSmith]

It would be... decidedly nontrivial, unfortunately. The database structure, when combined with the language (and all of the "features" that are used in the both of them) would make it very difficult to use VistA as much more than a starting point for a specification for use with more mainstream technologies.

As an example, (M)umps is an intrepreted language. It is not at all uncommon to find application code stuffed into a variable, and then find that the variable gets executed in a completely different routine.

And once you've put code in a variable and executed it, there's not much left for which to live. :)

Re:Someone Code A Replacement

[Wizardstorm]

Problem with coding a replacement is that no other language can handle the amount of data as fast as MUMPS and it's variants. It's simply put the most powerful database language on the planet, and those in the Medical and Banking industries no this.

Re:Someone Code A Replacement

[Anonymous Coward]

From MUMPS to what, maybe Smallpox^H^H^Htalk?

I can just imagine some team of VA programmers tasked with the "conversion": MUMPS --> MS QuickBasic --> MS VisualBasic --> MS C## --> Sun Java. The most likely outcome would be a bunch of IT guys being treated for PTSD (Post Traumetic Stress Disorder).

unfair competition?

[jasongetsdown]

So how long will it be until vendors of the proprietary MD software start accusing the gov't of unfair competition. Its one thing to use it in VA hospitals which are government run, will there be a legal issue if its used elsewhere? I suppose they will still have a healthy business supporting it though.

Re:unfair competition?

[Anonymous Coward]

So how long will it be until vendors of the proprietary MD software start accusing the gov't of unfair competition.

Why do that? I'm sure they can get Senator Hatch's
phone number.

Spelling error

[Bloke down the pub]

You seem to have spelled crufted wrong.

Is public domain viral?

[John Harrison]

I hadn't really thought about this before in terms of software. I have been thinking about it in terms of books recently. We've got all these children's books that are obviously based on public domain sources. One is simply a well known nursery rhyme on each page with an illustration. Of course the enitre book is copyrighted. But the rhymes themselves are obviously public domain. Could I just take the text of those rhymes from the copyrighted book and publish my own book? What are the rules here?

Re:Is public domain viral?

[cduffy]

Of course the enitre book is copyrighted. But the rhymes themselves are obviously public domain. Could I just take the text of those rhymes from the copyrighted book and publish my own book?

So long as the publishers of the book didn't change the rhymes at all (ie. modernizing the spelling), sure.

Re:Is public domain viral?

[bluGill]

Maybe. Some of the rhymes that everyone knows are not as old as you think - someone holds copyright on them. (The song Happy Birthday is an obvious example)

Many books will change one word here and there. They may be able to copyright that change, see a lawyer. (In theory only substantial changes can be copyrighted)

They can copyright their layout even if everything (even the art) is public domain. You could potentially get in trouble for publishing a book with exactly the same public domain poems in it. (Particularly if the order is the same)

If the text they used was public domain you can use that. However there is still a lot that you can't use.

If this is more than an academic exercise and you plan on doing this, see a lawyer. I'm sure there are details I've forgotten/don't know. I might even have something wrong.

Re:Is public domain viral?

[John Harrison]

But who can you know when they've copyrighted the whole thing, with no disclaimers or citations?

Re:Is public domain viral?

[John Harrison]

I have no plans to publish a book. In the future I might have plans to use public domain code though, and it seems like a good idea to have some understanding of how things work.

Re:Is public domain viral?

[cduffy]

You don't.

Re:Is public domain viral?

[John Harrison]

Not to put too fine a point on it, but... that sucks.

Open Source Voting Code?

[Mean_Nishka]

I wonder if maybe the government should consider crafting its own open-source code for electronic voting machines to use as an backend engine for commercially produced machine..

Re:Vista isn't actually open source in the normal

[ivaldes3]

GT.M (MUMPS compiler) isn't Sanchez anymore, they were acquired by Fidelity. The Linux version *is* GNU GPL since 2000 http://www.linuxmednews.com/973641949/index_html Other platforms are proprietary licenses. GT.M is used to support mission-critical applications like banking and healthcare. The company says you've probably used GT.M with your bank account and never knew it.

There is a completely Linux/open source VistA stack available now, including the GUI CPRS client: http://www.linuxmednews.com/1112336432/index_html with a screenshot: http://www.linuxmednews.com/LMNphotos/cprs_on_linu x.jpg/view?display=large

That said, the *clinician* GUI is good. The VistA package is huge, absolutely huge. All the software needed to run a National health infrastructure and the only one that has been actually proven to work. However, much of it is character based for better or worse. Sometimes it is better because it really performs fast without the overhead of a GUI but then it doesn't have the convenience and polish of a GUI. On the other hand you have the functionality there it just isn't in a GUI. You cannot say the same about many proprietary packages that do not have the functionality to begin with.

Another shortcoming is the lack of a billing part that is usable in the private sector. However, the http://www.freeb.org/ project should fix that. Likewise, the vendor support infrastructure is limited to Medsphere, HP and some others but that is being addressed as well this year with the recent near $1 million CMS award to WorldVistA to train vendors http://www.linuxmednews.com/1116853791/index_html

-- IV

Re:Vista isn't actually open source in the normal

[popocatapetl]

As the guy who manages GT.M, let me assert that the licensing of GT.M as released on Source Forge (http://sourceforge.net/projects/sanchez-gtm) is GPL.

There is very little of GT.M that is written in assembler, but since GT.M is a compiler, the code generator is the real obstacle to portability. The assembler bits are mostly there to do things like manipulate stack frames, which a run time system needs to do.

Feel free to contact me at ks dot bhaskar at fnf dot com if you have any questions on this.

Lotsa medical FOSS out there...

[tuxmd]

There is other medical FOSS out there - GnuMed http://www.gnumed.org/ and OSCAR McMaster http://www.oscarhome.org/ (or http://www.goemr.com/ if you're in the USA) are two that come to mind off the top of my head.

Debian-med has a fairly big list -- http://www.debian.org/devel/debian-med/

Euspirit http://www.euspirit.org/ had a huge list... but the site seems to have evaporated.

I wrote a lengthy article about that FOSS in medicine-- it can be found here: http://www.utmj.org/issues/82.3/Technology_Review_ _82-3-202.pdf

But why proprietary system

[Anonymous Coward]

Why not look at what Brazil has done on the J2EE platform instead. It sure doesn't cost $10K to $20K to install and works well.........

This should save you a few thousand bucks

[modulo]

The installation instructions

You probably should know a little M or Caché to do this I would think...

What OS are you going to run?

[houghi]

I will have W-Vista.

You know, the one that is made by those powerhungry people who want to rule the world and enforce their will on everybody.

An Old Language Becomes New Again...

[Anonymous Coward]

I know two consultant who worked in UNIX and MUMPS for years, then MUMPS business fell off to nothing. They're probably be rolling in the dough soon, with this revelation.

MOD PARENT THE HECK UP!!!!!

[Anonymous Coward]

N/T

don't listen to detractors: it's awesome

[Sylvius]

Having worked as a physician at multiple hospitals with varying levels of electronic medical record/ordering systems, I can say, without a doubt, that the VA system is the best out there. I can order any test/med/etc, read any progress note (entered at any VA in the country), check all results all from the same thin client terminal. Pretty much everything else in the VA system is a horrible mess, but the computer system is absolutely amazing and head and shoulders above any of the (ludicrously expensive) commercial alternatives. If I worked at one of the commercial alternatives, I would be very nervous...

Vista?

[booch]

Hmm. Looks like the Microsoft viral (astro-turf) campaign has already started. We learn that their upcoming version of Windows is to be called "Vista", and only a few hours later, we start getting Slashdot submissions talking about "Vista" this and "Vista" that.

VISTA aka DHCP Has Been Available For Years

[NetSurferHI]

I worked at the VA for a number of years supporting this system at one of the medical centers. A lot of very talented and very dedicated VA employees built this system side by side with their users. Every software package had input from their users every step of the way, version by version. The doctors, nurses, social workers, etc. continuously went back and forth with the developers fine tuning what features they needed etc. Their users loved it so much that they went to bat for it when the mainframe folks at VA tried to kill it years ago. (See my link below for more info on this.) Originally it was called DHCP, or Decentralized Hospital Computer Program, and later named VISTA. This system is written by federal employees using a language called M (or MUMPS.) MUMPS is like PERL in that it is not stored compiled, can be run from a command line, etc.

Later on SAIC wrote VA and got a copy of all this software for the cost of the media and sold it back to DoD as CHCS, or Composite Health Care System, to run the DoD hospitals, FOR TWO BILLION DOLLARS US$. ANYONE can write to the VA under the FOIA and get a complete set of the software for the cost of media and shipping.

This software is used by a number of other institutions, including Indian Health Service (IHS), and even a country in Europe (can't remember the name off the top of my head) runs their entire national health care system on it. Some VA folks even flew out on their own vacation time and set it up for them.

The VA has been ahead of the private sector hospital industry in medical data processing for years (DHCP is nothing new - has been around for a long time developing into its current state.) For example, VA had paperless medical charts long before any private sector hospital did.

If you want to know more about the real story behind this, go to www.hardhats.org and read about the community supporting this. This website has been up for quite a while now. Combine this with the worldvista site and you will have a pretty good picture of the project and how it came to be.

Perot Systems? Correct me if I'm wrong, but...

[intnsred]

Perot Systems? Correct me if I'm wrong, but is this Ross Perot's company?

Didn't Ross Perot get his start by a gov't-funded Texas Blue Cross/Blue Shield software development project, which Perot then copied and started selling back to the gov't, semi-successfully until then-Calif. Gov. Ronald Reagan gave him a huge contract that made him a millionaire and put him on the road of becoming a very rich man?

Obfuscated Perl's got nothing on this.

[black hole sun]

From one of the source files in the aptly-named directory "r" (.......):

;Update admissions/discharges S XFR="AODS"_$S(I=2:"A",1:"D"),IFN=+$O(^DGPM(XFR,J,0 )) I '$D(^DGPM(IFN,0)) Q
F X=0,"ODS" S X(X)=$S($D(^DGPM(IFN,X)):^(X),1:"") I $P(X("ODS"),"^",7) D 3 Q
S (X(1),X("ODS1"))=""
I $P(X(0),U,17)
S:$D(^DGPM($P(X(0),U,17),0)) X(1)=^(0)
S:$D(^("ODS")) X("ODS1")=^("ODS") S DGSPEC=$O(^DGPM("APHY",IFN,0)),DGSPEC=$S($D(^DGPM( +DGSPEC,0)):$P(^(0),"^",9),1:""),DGSPEC=$S($D(^DIC (45.7,+DGSPEC,0)):$P(^(0),"^",2),1:"") S
DR=".01///"_+X(0)_";.03////"_DGSPEC_";.05////"_$S( $D(^DG(405.1,+$P(X(1),"^",4),0)):$P(^(0),"^",3),1: "") S
DR=DR_";.06////"_$S(+X(1):+X(1),1:"")_";.1////"_ $S($D(^DIC(4,+$P(X(1),"^",5),0)):$P(^(0),"^",1),1: "")_";.11////"_$P(X("ODS1"),"^",2)_";1.01////3" K DGSPEC Q

I'm beginning to see why the named this language after a disease

Re:Obfuscated Perl's got nothing on this.

[Wizardstorm]

Now this is just insulting. If I was to throw C++, or Ruby, or Python up on the screen and you didn't know that language then of course it would look strange. To a Mumps programmer this is very easy to read. It's terse single letter commands makes writing and debuging the code very quick and easy. I would also add you picked a routine that was dedicated to a very difficult process of figuring out after a hospital stay what the patient owes for payment. So do you think it would be possible to make this easy to read in any language. Hell it isn't easy to understand when spoken in english

Re:Obfuscated Perl's got nothing on this.

[Anonymous Coward]

The code can easily me made readable. For example, here is a sample function that is no different from any other language:

BrowseBy(CompArray,ByTag) ;Purpose: Allow a user to interact with dynamic text tree
; that will open and close nodes. ;Input: CompArray -- array to browse. Should be in this format
; CompArray("opening tag",a,b,c,d)
; ByTag -- the name to use in for "opening tag")

new aOpen set aOpen=0
new bOpen set bOpen=0
new cOpen set cOpen=0

new done set done=0
new input

for do quit:(done=1)
. do ShowBy(.CompArray,ByTag,aOpen,bOpen,cOpen)
. read "Enter option:",input:$get(DTIME,3600),!
. if input="" set input=0
. if +input>0 do
. . if aOpen=0 do
. . . set aOpen=input,bOpen=0,cOpen=0
. . else if bOpen=0 do
. . . set bOpen=input,cOpen=0
. . else if cOpen=0 set cOpen=input
. else if input=0 do
. . if cOpen'=0 set cOpen=0 quit
. . if bOpen'=0 set bOpen=0 quit
. . set aOpen=0
. else if input="^" set done=1

quit

From a patient's perspective...

[Kamiza Ikioi]

From the perspective of a guy who pays high insurance fees...

BY GOD! The US Government did something wonderful for the citizens. With a few tax dollars (best I ever spent) and now a volunteer developer force to keep it going in the FOSS community, the government just did the equivilant of developing a free drug that doctor's can prescribe for nearly anything.

It's things like this that will bring down medical costs, not by capping lawsuit limits, or government medical savings programs (which I've seen somewhat in action via a private insurance provider... horrible waste of money if you are a healthy adult, and not very useful if you aren't).

I don't do it often, but I've got to give the government kudos on this. They get a patriotic Jesus thumbs up from me!

There are more savings...

[WebCowboy]

...in using Vista than in the lower initial capital investment.

It is still common for medical information to exist in paper form only, leaving it prone to mistakes. Such mistakes in recordkeeping are responsible for mistakes in healthcare delivery that spawn malpractice suits (and no, they aren't all "bogus" although the money involved is often inflated--and the sad part is that both the doctor and patient are shafted in the end and only lawyers benefit).

The article has a good example--a VA nursse suggested implementing a scanning system for meds delivery and when it was inplemented there was an instant 80% reduction in mistakes. If a practice can reduce its error rate this effectively it means invariably that lawsuits will happen less often and there will be less opportunity for insurance companies to increase rates.

Furthermore, by introducing a robust, open electronic management system you can create a much more solid audit trail. If there is a suspicious malpractice case brought against a practice they can use the system to provide evidence of the exact care received by the patient. The bogus claimant then has a much more challenging task ahead of him in proving his argument against a very solid defence.

While I don't disagree that the government needs to be supportive of the nation's doctors (both in the US and in Canada), I have serious reservations about having government play an activist role in any area of insurance--and I'm dead-set against federal government involvement. This is because governments are notoriously ineffective at providing individualised service to people, and the higher the level of government the worse they are. Just like the medical system itself, the insurance industry is one of those that must be tailored to the individual (Can you imagine if hospital boards were all fired and all the hospitals in the nation were administered by the federal government? It would be even worse than HMOs!).

There are a lot of parallels between malpractice and auto insurance--complaints about bogus claims, skyrocketing rates and calls for the government to do something, so I'll use that as an example. In Canada, most provinces have auto insurance pretty much like the US, but in some provinces (notably BC and Saskatchewan) the government has stepped in and taken over due to the aforementioned issues. The end result is that those two provinces have among the lowest "average premiums" than any other part of the country.

Sounds great right? Well in reality that is only part of the story. The problem is that EVERYONE pays almost the SAME premiums--close to their average. OTOH, in Alberta auto insurance is quite expensive "on average", especially compared to Saskatchewan. However, Saskatchewan has an older poulation and the biggest city in the whole province is 200,000. Alberta's population is much bigger within about the same abount of land--the biggest city is about 1,000,000 people. Quite simply there are more cars per length of road in Alberta. Furthermore, Alberta has a younger population and far more new residents--both contributing to higher accident rates and higher average premiums.

Furthermore, at least half the population in Alberta pays LESS for auto insurance than they would in Saskatchewan (where making claims or getting points on your license has much less effect on your premium). In the case of my parents (in their 60s and claim free) they would pay 200 to 300% MORE in Saskatchewan. Who benefits? Young drivers mostly (which is good), but also those who have made claims/reported accidents or have many tickets on their record. In Alberta they can pay more than $5000/year (or more!) for auto insurance, where in Saskatchewan there is a cap on rates that is a fraction of that. That really skews the "average" rate.

Oh, and it would not be good to get in an accident involving a government-insured driver because you WILL GET NOTHING GUARANTEED unless you spend countless hours chasing down endless paper-pushers and appeali

VistA biggest competitor.

[tr0tt3r]

Hi,

My name is Fred Trotter I am the project manager for ClearHealth which is currently Office VistAs top competitor. I am also the project manager for the open source medical billing system FreeB. FreeB is the top contender to provide medical billing services to Office VistA. (which puts me in a position of coopertition with VistA) Because the VAs VistA operates with the federal government as a payer, there is no need for medical billing functionality in the core VistA. Interestingly this has directly impacted where VistA adoption has been able to occur; namely Federally funded clinics on Indian Reservations in the United States, and the entire country of Finland (from a very early fork). So generally VistA is a very powerful EHR for environments where you do not need to interact with more than one payer

I wanted to provide some insights regarding VistA gleaned from a newbies perspective. I have already attacked some of the myths on the LinuxMedNews discussion. Of those points mentioned in that discussion, I wanted to point out why so many differing opinions of VistA exist. This thread has already had the "VistA is great" and "Vista sucks" discussion which is largely invalid because it is almost impossible for these systems to be referring to the same thing. Because VistA is public domain under a FOIA request anyone can do anything they want with it.

More to the point they have done things with it. No two installations are alike. Even different VA hospitals have very different installations. I understand that there is even a Veterinary hospital that runs VistA. So it is really not possible to talk about whether VistA is "good" or "bad", rather it is only possible to describe its considerable community. Because the US govt releases the code under FOIA, there is no Linus to keep everyone on the same page.

There is an organization that attempts to make sense out of the chaos and that is WorldVista. WorldVistA tries to keep different versions of VistA compatible and to this end sponsors the OpenVistaA that often serves as the avatar, for better or worse of the VistA community.

There are also private companies that push VistA, most notably the well-fundedMedSphere. It is not clear whether this is a truely open source company, although they claim to be. Because VistA is FOIA there is no "keep-it-free" clause included. As a result MedSphere and anyone else is free to include proprietary code with VistA and then sell the result. MedSphere has made considerable improvements to their version of VistA and the VistA community is anxious to see those improvements, so it remains to be seen whether MedSphere is really an open source company or not. I think it will probably come out on the good side however, since its management includes Larry Augustin of VA Linux fame. My company http://uversainc.com/>Uversa considers MedSphere to be our only real competitor in the Open Source Medical Application market.

I try to post what Uversa is doing to slashdot on a regular basis. For the most part, what we have accomplished is ignored. Software to run doctors offices is pretty dry compared to robotics and video games, and my experience is that only geeks in the industry care to much. So I really cannot blame the editors. Still FreeB has been mentioned on slashdot before Other cool things that Uversa has done have largely been ignored. S

Re:Vista isn't actually open source in the normal

[stuffduff]

s k=$l(exc) i $e(exc,1,1)="""",$e(exc,k,k)="""" s exc=$e(exc,2,k-1)

is a really bad way to do it. It would be better to do it like this:

i $l(exec,"""") k=$p(exc,"""",2)

it would be better to pick good examples, not crappy ones.

Don't bash a language that you don't understand.

Badly worded headline.

[Captain Scurvy]

Am I the only person who read that headline and thought it was about how the U.S. government started the OSS movement?

"New OSS Project crafted by U.S. Government" or something similar would have been less confusing.

FreeMED, REMITT, and other OSS medical software

[rufus t firefly]

Although they rarely get this kind of press, there are quite a few other large-scale open source medical records and practice management packages out there.

VistA was/is a great effort from the Veterans' Administration to produce something capable of dealing with the volume of records that they had to deal with in a pretty efficient sort of way; I can't really say whether the same methodology works in smaller settings, but there are a great deal of other packages "competing" in a friendly, open source way with VistA, not just a single package, as other posters might have you think. :(

FreeMED is one of those packages, which has been around for about six years (since 1999), back before VistA was looking at producing a version of their software that was geared towards anything other than VA hospitals. Paired with REMITT, an opensource medical billing package, it doesn't take playing around with something like MUMPS to be able to run a practice efficiently, and in an open source sort of way.

I'm still amazed that this is news, as VistA and the Hardhats group have been doing the same thing for quite a few years now, and haven't had any press like this that I can remember.

Disclaimer: I'm the primary author of both the pieces of software mentioned in this article besides VistA. Take that as you will. If you're looking for relatively unbiased reporting on opensource medical software, go to LinuxMedNews.

Re:Vista isn't actually open source in the normal

[tcopeland]

> it would be better to pick
> good examples, not crappy ones

Unfortunately, I don't know the language, so I can't discriminate between good and bad examples.

> Don't bash a language that
> you don't understand.

Hm... I guess my intent was just to support the original poster's note that the code is a bit hard to follow. 'i $l(exec,"""") k=$p(exc,"""",2)' still looks pretty hard to follow to me...

Typical

[proteonic]

This is the garbage typical of the health care industry. This thing is put together with tools most developers have never heard of (MUMPS? EasiObjects?), instead of using tested and stable tools used by most open source developers and researchers in the field (ie those that could contribute the most to such a project). The only thing this ensures is that the original developers are going to make a pile of cash doing consulting work.

Re:Typical

[quantum bit]

LOL, tested and stable?

MUMPS is much older than Apache, PHP, Python, MySQL, or Linux. In the last 30 years it has probably changed less than any of the above did in their last minor point release.

MOSS

[Nick Driver]

So... if it's written in MUMPS (otherwise known as "M" for brevity), and it's Open Source Software, then wouldn't that make it a piece of MOSS.

;-)

Irony, oh Irony

[rastin]

Outside of articles targeted at the geek community that may be one of the best written pieces about an OSS project. It clearly describes both the pros and cons of using OSS. However, I find it amazing that the word 'Open Source' appears nowhere in the article!

FOIA Requests, anyone?

[CrkHead]

Anyone out here that has seen something they like while working on a federal contract? I'm sure there are several applications that would be useful, if only as an example of what happens when you design by a committee. I trust a few requsts could go a long way.

To their credit, they tend to be focused people

[Sycraft-fu]

You have to know a lot to be a doctor, I can see not wanting to learn about other shit not in your field.

This was ceritnaly true when I worked for the Neurology department. I was, literally, working for brain surgeons who didn't know how to setup their e-mail. Their basica philsophy seemed to be that they didn't need to know, because they could pay me to.

It was actually nice, in that they were all smart people, but they'd do what you told them. They knew they didn't know best about computers so you told them how to do thigns, or what not to do and they'd just accept it. So long as they could do what they wanted, which was fairly basic, they were happy.

The VA Did Something Right

[DynaSoar]

I use the VA system from both sides of the desk.

The systems is good. Not great, but not the usual VA shitjob either. I particularly enjoy being about to pull up hi res radiology done at other sites.

Half doctors complain about it. Doctors complain about most things. They think it's their appointed place to judge everything poorly rather than admit they're not perfect in ever way.

The half that doesn't, don't know any better. They're 'in-sourced'. You know they fits you have when you have to call someone in a cubicle farm on another continent? How'd you like to have your chronic illness evaluated by one of these? Don't tell me they're just as good -- I know better.

What the VA system doesn't do, and what the pressure of the VA does prevent, is the doctor you've almost certainly never seen before from reviewing your chart to find out not only what they problem is and has been, but what else might impinge on the treatment. I've caught several medication mistakes. Luckily I know enough to. Another major problem is that lots of the vets are old, and many have mental problems. Yet the doctors tend to rely on self-report to find out what the problem needing treated is. It shouldn't take 10 minutes for a doctor to figure out the guy sitting there isn't here to be treated for a bullet wound -- that was 40 years ago. Seen it. And I saw right there on the screen, alzheimers. But they typical VA primary care provider has 500 to 1000 patients. They don't have time to read even when they have the inclination.

There is a downside

[Anonymous Coward]

Of course, once your personal medical records are brought on-line, they are available to Choicepoint,
http://www.epic.org/privacy/choicepoint/
Experian and other data brokers -- and we know how secure THEY are, right?

I prefer paper.

Someone Code An ADA Replacement

[Anonymous Coward]

"As an example, (M)umps is an intrepreted language. It is not at all uncommon to find application code stuffed into a variable, and then find that the variable gets executed in a completely different routine."

There are languages that do this, other than MUMPS.

It's generally not considered a good thing to do, but it can be done.

Personally I'd redo the entire package in ADA. Especially for liability reasons.

But... but... but...Out of site moderation.

[Anonymous Coward]

Of course. Much as GWB follows an "out of site, out of mind" when it comes to some of his detractors. Slashdot follows the same with it's moderation system.* In both cases one can find out what the protestor was complaining about. You just have to make a greator effort to get the other side.

---
The "are you a script" word for today is doubter.

*I'll leave the irony of that position on a forum that has a YRO section open.

I use it every day

[matt20]

I took a job as a physician a couple of years ago at the VA, after retiring from private practice. I do both cardiology and internal medicine.

We paid a lot in the private sector for our system and it was not as good. I use the VA system Vista or CPRS with Dragon Naturally Speaking and have developed macros that do a lot of work for me. With a voice commmand I can order a group of labs, schedule a consult, pull up a spreadsheet of older lab values...

It is integrated with other imaging software that allows me to pull up an xray, ekg, ct scan etc... I can also pull up a number of reference programs like Up-to-Date to review and see the latest information.

Do I dare say or suggest it... I think it could be the embryo for a future national health care system.

Correction

[stuffduff]

i $l(exc,"""") k=$p(exc,"""",2)

Seen it, know it, understand it

[femur]

I read several of the responses to this posting and, true to Slashdot form, even though some /.ers knew about the software, most did not, and yet everyone had an opinion.... Democracy at its finest!

Seriously, though, I'd like to add some light. I've seen Vista in use at VA in MD/DC area; this is a wicked piece of software. IMO, if all hospitals used this software to its potential, patient care in the US would benefit greatly. Basically Vista puts all the records for a patient at the fingertips of hospital staff. And I mean ALL -- hematology, cardiology, radiology, oncology, any bloody -ology you can think of.

Which is pretty impressive, especially given that this started in VA hospitals. Any MD who has worked both public and gov't will tell you that typical VA patients usually have a greater incidence of multiple illnesses or concomitant disorders than patients in public hospitals -- or more specifically, the incidence of pts with concomitant illnesses is greater at VA hospitals than in the commercial hospitals within the immediate area surrounding the VA hospital. Vets are often just "more sick," for a variety of socioeconomic, medico-financial, age-related, and incidence-of-exposure reasons. And VA patients are often long-term, multiple-report patients -- meaning the typical patient has had several visits to the VA hospital versus his/her non-VA counterpart.

So in such an environment, there is a great driver for good patient recordkeeping (knowing what this patient's drug and treatment profile looks like over a long period of time) and clinical access (getting that information quickly and knowing it is accurate). And Vista (or "VistA") fills the bill. It does an extraordinary job in capturing patient information and making it available to a physician in a logical, well-thought-out manner. Sure, it may require some expert help to implement -- but show me any solution with the same broad med system involvement and impact that doesn't require paying for implementation expertise. I mean, some vendors may *say* their solution is OTS and can be implemented by any hospital IT group, but when it comes down to their software doing everything that a full Vista implementation can do, I bet the salesperson's story changes to "well, you will need to use our services group to implement across all those divisions...."

Now, Vista may be based on an old language, but that's the nature of some long-term projects. Hate to sound like an old guy at 38, but you young programmers wouldn't *believe* how much financial information in the US is still processed via COBOL in MVS.... Anyway, I'm sure most /.ers would agree that it ain't the language so much as the *result* that's important, and Vista is one well-tested, well-done, usable piece of software. And the developers of Vista and its proponents at the VA and within HHS have really gone out of their way to keep the software compatible with open tech standards -- not just the overarching ones like those the W3C police, but also open standards that are more medically specific like those created through Health Level 7 (http://www.hl7.org/).

The intersection of computer nerd and med-tech geek is sparsely populated, so I hope that all /.ers can understand that Vista really is a rare thing -- a government-initiated software product that adheres to open standards, is moderately user-friendly, actually improves the environment in which it is implemented, and provides significant benefit to its target (and at-risk) population.

***After reading my posting, I felt I needed to add that I have absolutely no connection with Vista or WorldVista. I've worked within HL7 on some standards and was introduced to the Vista system by a VA doc who was also presenting at a conference with me. In other words, this ain't been paid programming!

VISTA and M(UMPS)

[kemkerj]

I worked for over 7 years at the VA Medical Center in Atlanta, as sysadmin and lead programmer for their DHCP/VISTA installation.

MUMPS has a lot of strengths, as well as weaknesses. Try programming in a language with less than 26 commands. That's why you can abbreviate them all down to a single letter, for the most part. Once you get used to a very regular syntax, it becomes second nature to be able to read it and understand what's going on in a program without having to remember what some dangling pointer or other nonsense from the "modern" languages introduce.

I've never had a MUMPS routine experience a memory leak. I've never had a MUMPS routine crash a system because some idjit used setuid because he couldn't figure out how to do it any other way.

It's not an OS language, it's an apps language. Specifically, it's a database language that lets you code fast database code in a fast, interactive manner.

Yeah, it's pretty old. It's not "modern" and doesn't have all the cachet of a "glamorous" language like one of the new object-oriented languages. But I could write usable code very quickly and have it ready for production in almost no time at all. And it allowed the VA to run large databases using cheap, low-end hardware.

MUMPS takes a very simple route to applications programming. It's not perfect, but it has the wonderful advantage of working, when used properly. It excels at string handling. It was using what perl calls "hashes" long before Larry Wall started writing perl. Unlike perl, it even gives you a way to walk through the binary trees that are a result of the "sparse arrays" that MUMPS uses. File I/O? What file I/O? Just SET a Global Variable and it's stored on disk. Need to recall it? Just reference the Global Variable. It never went away, unless you KILLed it. Need temporary storage because you need to work with more data than there is physical memory? Just use those Globals again. Just remember to KILL them when you're done.

It's kind of neat when you can create a database structure where the data *is* the index:

As an old MUG (MUMPS Users Group) T-shirt used to say:

"MUMPS means never having to say you're sorting."

Sourceforge!

[midgley]

Look up OpenVista, and build it on GT.M both are GPL.