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

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.

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.

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: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.

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?

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.

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