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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."
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.
Hasta la vista.... fyi.
Cool - I'm a spelliing nazi in another language now!
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.
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
http://www.LinuxMedNews.com Revolutionizing Medical Education and Practice.
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.
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./ 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.
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
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.
guns kill people like spoons make Rosie O'Donnell fat.
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.
If I have been able to see further than others, it is because I bought a pair of binoculars.
The Army reading list
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.
Actually there is another commercial M like environment. Cache from Intersystems.
o ok.UI.Page.cls?KEY=GMSM_languagediffs
http://platinum.intersystems.com/csp/docbook/DocB
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.
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.
Microsoft is to software what Budweiser is to beer.
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.
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...
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:
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).
Karma: Chameleon - mostly influenced by bad '80s New Wave music
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.
Note to ACs: I usually delete AC replies without reading them. If you want to talk to me, log in.
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.
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.
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.
"What do you think?" "I think 'What, do you think?!'"
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.
_ _82-3-202.pdf
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
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