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MUMPS, the Programming Language For Healthcare
citadrianne writes: An ICU patient is monitored and assessed according to 12 different variables. These include such measurements as body temperature, heart rate, blood oxygenation, blood pH, and others. Together, they're used to formulate a quantitative answer to the question, "How bad is it, doc?" Many of these physiological signs are measured in real-time via electrodes and like a billion different varieties of catheter. Add to it barrages of lab tests done multiple times per day per patient and the need for 20 or so clinicians (per patient) to have access to all of this data, and the result is very a deep data problem. Multiply that data problem by hundreds of thousands of patients.
This is the fundamental problem that the programming language MUMPS (sometimes called just "M"), or the Massachusetts General Hospital Utility Multi-Programming System, aims to solve. To its proponents, MUMPS allows for a one of a kind synthesis of programming and database management, while to to its detractors, it's a bizarre anachronism with little connection to the evolution and innovation taking place elsewhere in programming. Probably to most people that do things with computers, MUMPS/M is poorly understood, at best, and more likely to be completely unknown.
This is the fundamental problem that the programming language MUMPS (sometimes called just "M"), or the Massachusetts General Hospital Utility Multi-Programming System, aims to solve. To its proponents, MUMPS allows for a one of a kind synthesis of programming and database management, while to to its detractors, it's a bizarre anachronism with little connection to the evolution and innovation taking place elsewhere in programming. Probably to most people that do things with computers, MUMPS/M is poorly understood, at best, and more likely to be completely unknown.
I have a doctor friend who, before becoming a doctor, was a CS grad. He's in his 50's now. When I told him we hired someone from Epic Systems that knew MUMPS, he exclaimed, "They still use that?! MUMPS was going out of style back when I was an undergrad!"
I believe it is also still used in older banking/financial tools.
I was unlucky enough to have to advise how best to integrate a cobbled-together creaking MUMPS system into a more modern healthcare environment where the business wanted to "use SQL" to write reports against the data in the MUMPS system... of course the ancients who wrote the MUMPS system had done so with a complete disregard for maintenance and extensibility. NOTHING in the system was well thought out... in fact it looked a lot like a bunch of programming novices had just added a crap-ton of data in attribute/value pairs in no particular structure over a period spanning many years with each individual change being in complete isolation because the authors did not understand what had gone on before. It was also sadly really easy to copy/paste vast tracts of code along with the persistent storage bit so guess what the novices I mentioned earlier did? Yup, they copied and pasted a bunch. Now while this distasteful in any language, consider how much this hurts when it's in effect your actual data storage you're copying and pasting along with the code Furthermore... the authors had used every shorthand short-cut in the book because they hated typing (and the reader apparently). I can honestly say I'd rather debug befunge in my head than work with anything remotely related to MUMPS, M or Cache every again. From what I saw, the system was a write-once/read-never data soup that had no place in the GP practice management software that had been written in it. The system held fairly small amounts of data in bloody idiotic structures that were impossible to read without writing more MUMPS. All the business was trying to do with it was print a few letters and government forms... something ANY SQL database along with a report writer would have handled in a much simpler, cheaper and more maintainable manner. *shudder*
As noted above, MUMPS (in the guise of Intersystems' Caché) is the database underlying both the VA's Vista and Epic Systems' Epic, which are probably the two leading large-scale EMR vendors on the planet. My 5 state hospital system uses the latter, having upgraded from a system that just handled part of one state and ran on top of Oracle and would regularly slow to a crawl. I don't know how much of Intersystem's marketing-speak to believe, but for a gigantic disparate database of branching nodes of something on the order of a million patients and all their chart notes, telemetry data for those who have been hospitalized, lab results and links out to everything from fetal heart tracings to MRI's, the thing is fast and seems to be close to bullet-proof. MUMPS itself is scary (to me, anyway) with its global variables and odd syntax, and I have a few bones to pick about the interface, but the database layer is really remarkable.
Agreed. I worked for Epic for many years and while M was a lot to get used to, you DO get used to it. And it is amazing for certain tasks.
Epic crushed a lot of competition by marketing a "fully integrated suite". All of the applications (there could be dozens) for a customer run off a single M database. Why wasn't the competition stronger? Many reasons, but one was because most competitors were using SQL and couldn't compete on performance.
The big limitation of M is reporting. Epic solved that by running extracts to a SQL "reporting database" and hooking up off the shelf reporting tools.
MUMPS is only used in healthcare/financial systems because those institutions developed applications in the 1970s and are still maintaining them. There is zero interest in MUMPS for any new development. At the time (the 1970s), MUMPS offered a lot of features that other languages didn't. It is basically a hierarchical key/value datastore (like the windows registry, or a filesystem), coupled with a minimalist programming language (it still doesn't support 'while' loops, switch statements or variable scoping). There is no concept of relationships (except between layers of the hierarchy), no way to enforce datatypes, no way to sort an array, no way to search the hierarchy for anything, no way to create discrete objects or associate methods with data.
It does contain some advanced features (for the 1970s); multi-threading, distributed data, and the ability to abbreviate all language commands down to 1-2 letters so your program can fit into 4k of RAM.
EPIC, the medical records product used by many hospitals in the US, is built on top of Intersystems Caché. Caché adds relational features to the MUMPS database, object-ish features to the MUMPS language and supports SQL queries. Internally, it converts all queries to MUMPS, and you could totally bypass the API and write anything you like directly to the database (violating any constraints the API would have imposed on you).
If you are interested in schema-less/noSQL databases, I would suggest you have a look at MongoDB. It has all the features MUMPS does, but without the ancient programming language attached to it. It also has powerful searching capabilities, can store terabytes of data and supports transparent replication and distributed storage.
If you are interested in a schema-less database for a MEDICAL ENVIRONMENT, where accuracy matters and the difference between having a '12' in the dosage column vs. "123 any street, anytown, usa" (silently converted to 123 when treated as a number) could kill somebody, then please consider an alternate profession.
As usual, the real WTF has more to do with the people/management than the languages used.
Except that MUMPS did it 30-40 years before such features were available in relational databases.
And see Henry Baker on "Relational Databases", Comm. of the ACM 35,4 (April 1992), 16,18.: