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.

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:

[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:

[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.

Now I understand...

[blcamp]

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

Sorry. Had to say it...

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

[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.

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.

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.

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?

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

[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?

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.

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

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.

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.

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.

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...

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).

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.

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: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.