"This stuff isn't hard if you know your way around a computer"
This is true. What's hard is finding recent grads willing to suck it up and work with 40 year old technology. If you want to submit claims to Medicare directly, you have to do it via ZMODEM on a direct dial 56k line. ATZ...ATDT PHONENUMBER...I do it every day.
As for development. Do you know a lot of MUMPS programmers? Do you know a lot of programmers who know what MUMPS even is? This is what 90% of the currently used EMRs use as a backend/DB. VistA, EPIC, Centricity, Meditech...all of these vendor packages use M, and there have always been jobs for people with MUMPS skills. At least there has for the 15 years I've been doing it. With the influx of Government monay, the need will only increase. But try finding classroom instruction in MUMPS - it doesn't exist.
You sound really confident though, so you are probably right.
"having the expertise required in a single language to land a good job"
If, first and foremost, you are concerned about landing a programming job, it helps to know what industry you're looking to enter. Healthcare and Electronic Medical Records are hot topics right now with a lot of money, private and public, backing it. IT adoption in Healthcare is seen as a panacea for all that ails, and while I may not agree with that directly, there is certainly a lack of trained programmers willing to work in the field. Most EMRs are decades old and use MUMPS as the back end.
Well, Enemy Territory:QW runs lickity split on my machine while Oblivion crawls. And Oblivion is older. So my fingers are also crossed that this means Bethesda starts putting out game that are better optimized.
Questions 4 and 5 assume a specific type of relational database. I've met plenty of competent programmers who wouldn't have ready answers for those questions. That said, if a candidate can't BS through these successfully, they'll have a difficult time navigating standard office politics, not just programming your DB.
"They probably did, in the same slipshod fashion they consructed their steaming pile of MUMPS."
I can't wait for a real company to come along that writes an EMR in Java/Oracle. They will obviously provide better training because of the technology they use.
"At least Epic is using strongly typed data fields, like chars, strings, integers, floats, and doubles." And it's all getting stored as a string because Epic runs on Cache, which is MUMPS. In fact 99% of Epic is still coded to the 1995 standard. They maintain that the code base is not dependent on Cahce and is M-implementation independent. I admit that from a practical standpoint this is BS...Intersystems basically owns that arena. GT.M is an option but good luck getting Hyperspace to work with it.
"The language is truly unlike anything most modern programmers are accustomed to." So the solution is to throw out 30 years of hard work because nobody cares to learn it? Where is the "modern" replacement? It doesn't exist because of the monumental effort required to create an EMR. I fail to see how getting new programmers accustomed to the technology is a problem when ISC provides Cache Object Script. Write your code with COS and you never have to use dot syntax again. Curly braces all the way.
Coding "MUMPS over Cache" provides hooks to any kind of UI you'd care to create. VistA doesn't have a very attractive UI (anyone know what CPRS is written in?), but MUMPS implementations have moved past the old roll and scroll in the past decade. Epic uses a Windows client written in VB, but is moving to.NET and a browser based UI ala IDX. VistA could do the same.
"But really with all the crap, legacy systems held together presently by silly string...you really almost need to start OVER."
Many hospitals are starting over. They're scraping their old, cobbled together systems (seperate Lab, Physician Practice, HIS vendors) and going with a single vendor. Epic, Cerner and the like have seen a lot of interest in going with single vendor installs.
Hi-o! Over here! In the corner...in the big empty room...How come nobody ever wants to play with me?
Seriously, any decent programmer can pick up the basics of MUMPS in a weekend. There are plenty of compelling reasons to do so. Developing VistA is both patriotic (helping US vets!) and globally humanistic (Open source helps 3rd world countries deploy better medical technology!). Not to mention the massive amount of money currently floating around to help develop and deploy EMRs.
As for projects which cover the same ground as VistA...where are they? The 2 biggest commercial players in EMRs - EPIC for large hospitals and Meditech for smaller, community hospitals - are both M-type platforms. There are NO other competitors written in other languages because building a hospital automation system is really complicated and takes decades to mature. Yes there are 100x more Java programmers out there, but we'll never see a commercially successful EMR written in Java because there is 0 business need for one now.
My name obviously implies bias, but the reason that many of the Medical record systems out there now - VistA, EPIC, GE/IDX, Amtrim for labs ect. - are based on MUMPS is because of its string handling capabilities. Much of a medical record is transcribed notes, character strings which need to be manipulated and stored. MUMPS was designed to do this from the start, which is why it's the right tool for the job. Take that DailyWTF with a very large pinch of salt.
The source for VistA is already available though a FOIA request, and GT.M (the MUMPS platform it runs on) is open source. Run the whole shebang on Linux and presto-changeo, Open Source EMR. This is what Medsphere is doing, selling services and support as the core business.
http://en.wikipedia.org/wiki/MUMPS
I agree with everything you said except - Re: laptop popularity - I have no problem playing 2 or 3 year old games on my laptop. Mind you, these are games that I buy at a discount, but they are still A+ titles (just old). I probably just made your point for you but, I've been drinking...
"Linux for the PC" - Yep...2009...the year of Linux on the desktop. Indeedy.
The "DDR as exercise" argument is still lost on me. I mean, if "real exercise" is a tedious waste of time, then how does DDR make it better? Beacuse you're dancing/playing a game? Then why not actually dance? I mean with real people and/or with live music (thereby supporting local music and possibly hooking up)?
I have the same problem with the esspress-o machines. They have them @ my gym (Sound Mind & Body in Seattle) and the first thing I thought of when I saw them was "How can I hack this?". I thought that because these thing are serve me better as Intellectual Exercise than as real physical exercise. I go to the gym to pedal a stationary bike because it's raining out and I can't ride my "real" bike. I sit at home playing Quake Wars because I'm done exercising and want to take a break from reality.
Taking a break from reality (gaming) is mutually exclusive from exercise (reality). I could say the same thing about sport and drinking, except you nerds would just throw Rugby in my face. Damn you nerds!!!!
MUMPS is far from forgotten. It's still in use as the core of Intersystems Cache, which powers a lot of the major Healthcare Information Systems (GE Centricity, EPIC, Sunquest Lab).
Also, the VA implememntation is called "VistA" and has been for years, so this isn't the first time that Gates & Co have gone to the MUMPS well and co opted a name for themselves.
This is probably my biggest beef with Epic and other Mumps-based apps that use a bloated client. There's just no need for it. IDX http://www.gehealthcare.com/usen/hit/products/cent ricity_business/index.html has a very nice Web front-end that does everything in a browser (albeit with unnecessary IE dependencies). Epic has a thick VB6.0 client and CPRS (The VAs VistA GUI http://www.hardhats.org/) is massive.
I know it's a lot of code to re-write, but it's not like vendors need to throw out the database code. Just fix a mistake made 10 years ago, not the one from 1964. Cache allows for some nice things in a browser based app (XEN? SVG?). Having that kind of UI really helps to manage desktops in a distributed environment like a hospital.
As someone who was up until 1:30 this morning frantically loading RAs into Chronicles in preparation for my Sunday go-live, I really needed to read your comment today. Dealing with Epics goat cluster of poor design decisions can easily lead an IS shop into a downward spiral of negativity and depression, loosing sight of the real purpose - patient care.
Does the "pain" I feel really matter when there are actual sick people up in that building relying on providers who need up-to-date and accurate information to deliver care? Perspective is important. Either that or I am about to lose my mind.
Oh, Epic Systems? No wonder. Dude, you're f****ed.
*sigh* - too true. Epic requires a monumental effort just to get the off-the-shelf product to work properly. Kaiser is doing a massive amount of internal development in addition to trying to implement as Epics biggest customer.
Part of me wants to think that Justin is just fresh meat who hasn't put in the time to become as jaded as the rest of us in HIS. The other part of me thinks he might be right and that Kaiser has bitten off way more than it can chew. Failure to understand the effort involved is just as pervasive as the massive waste he's critiquing, and just as harmful.
So there is no way to innovate/automate care.
It's not patient care that is responsible for the bloat in Healthcare job creation, it's all of the backend BS that our current system requires to keep those care providers paid. Billing, Scheduling, Payment posting and follow-up...all the things that need to happen to keep a doctors door open, and which require increasing numbers of employees to manage. There are a lot of various, standard industry tools which can be used to automate these data entry type jobs.
Healthcare has an overabundance of "seat fillers". People who have been performing repetitive data entry tasks for 20+ years, and who could easily be replaced by a script. One analyst with interfacing and scripting skills can replace 20 blue-haired cubicle jockies.
Since I've taken a stand in my life to only work 40 hours a week, I'm limited to working 8 hours a day. 2 to 3 of those hours are spent responding to e-mail, which requires very little concentration. "It's possible, but will take 30 hours...I can fit you in next September...What is your business need?" So I get all of my coding done in the morning, take a late lunch, then respond to all my emails in a food coma induced zombie state. Then I eat a chunk of dark chocolate, roll down all my windows and drive home.
they want to throw their personal preferences into the living room of the other 80% of the population.
So...say a hmosexual man has a "personal preference" for hairy, well endowed biker dudes. Now say that I, a heterosexual man, have a personal preference for girls in bikinis. If by "into the living room" you are talking about TV (and not say books or radio or any of the other things that americans do in living rooms), then I would say that TV sexualizes girls in bikinis WAY MORE than hairy, well endowed biker dudes. At least, that's how it works on the beer comercials I watch.
Seriously, you make it sound like the gays are just banging down you door so they can have sex in front of your grandmother. "We're here, we're queer, we're high on poppers and X and looking for you to fist us!"
Please let me know if I'm way off base here and living in one of the fortunate 20% of households whom the gays have decided, like a limp-wristed G-d on passover, to spare this indignity.
I just want to see them cutting back and forth between Carmack sitting on his gold plated rocket ship and Romero coding cell phone games from a double-wide.
Seriously though, I think that the basis for a good story could be found here. Not so much with the gaming geek audience, either. "Some Kind of Monster" appealed to me, even though I don't like Metallica. Getting all of those egos together to talk about who invented a genre as big and transformative as FPS's would be endlessly amusing.
I worked at a US Family Health Plan facility (like an HMO for veterans - one step below a VA hospital), and our contract with the DOD specifically listed the approved methods of data destruction. There was a software solution which we were able to use to recycle the hardware to poor rural school districs, mostly though we took those machines home or trashed them.
I would check with the DOD before you spend too much time messing around with drills or less-than-rigorous software solutions. They most likely have something in mind for the kind of information your facility handles.
The problem with the new console for me is that it's closed. "No need to swap caridges!" say the marketoids, like that's a good thing. I've got tons of old catridges sitting next to my TV, and would gladly pay $60 for new Atari hardware to play them on. I've purchased old and refurbished consoles in the past, and always burn them out.
Like the parent post says, if I don't care about having the an authentic Atari 2600 experience, I'll just buy the CD. Catridge switching is part of that experience.
I mean, how hard would it be for them to include the cart option?
Slashdot Mirror
"This stuff isn't hard if you know your way around a computer" This is true. What's hard is finding recent grads willing to suck it up and work with 40 year old technology. If you want to submit claims to Medicare directly, you have to do it via ZMODEM on a direct dial 56k line. ATZ...ATDT PHONENUMBER...I do it every day. As for development. Do you know a lot of MUMPS programmers? Do you know a lot of programmers who know what MUMPS even is? This is what 90% of the currently used EMRs use as a backend/DB. VistA, EPIC, Centricity, Meditech...all of these vendor packages use M, and there have always been jobs for people with MUMPS skills. At least there has for the 15 years I've been doing it. With the influx of Government monay, the need will only increase. But try finding classroom instruction in MUMPS - it doesn't exist. You sound really confident though, so you are probably right.
"having the expertise required in a single language to land a good job"
If, first and foremost, you are concerned about landing a programming job, it helps to know what industry you're looking to enter. Healthcare and Electronic Medical Records are hot topics right now with a lot of money, private and public, backing it. IT adoption in Healthcare is seen as a panacea for all that ails, and while I may not agree with that directly, there is certainly a lack of trained programmers willing to work in the field. Most EMRs are decades old and use MUMPS as the back end.
http://en.wikipedia.org/wiki/MUMPS
It's quirky, "old" and not OO, but if it's a JOB you want, there's worse things out there than helping deliver better care through M programming.
Well, Enemy Territory:QW runs lickity split on my machine while Oblivion crawls. And Oblivion is older. So my fingers are also crossed that this means Bethesda starts putting out game that are better optimized.
Questions 4 and 5 assume a specific type of relational database. I've met plenty of competent programmers who wouldn't have ready answers for those questions. That said, if a candidate can't BS through these successfully, they'll have a difficult time navigating standard office politics, not just programming your DB.
"They probably did, in the same slipshod fashion they consructed their steaming pile of MUMPS."
I can't wait for a real company to come along that writes an EMR in Java/Oracle. They will obviously provide better training because of the technology they use.
"At least Epic is using strongly typed data fields, like chars, strings, integers, floats, and doubles." And it's all getting stored as a string because Epic runs on Cache, which is MUMPS. In fact 99% of Epic is still coded to the 1995 standard. They maintain that the code base is not dependent on Cahce and is M-implementation independent. I admit that from a practical standpoint this is BS...Intersystems basically owns that arena. GT.M is an option but good luck getting Hyperspace to work with it.
"The language is truly unlike anything most modern programmers are accustomed to." So the solution is to throw out 30 years of hard work because nobody cares to learn it? Where is the "modern" replacement? It doesn't exist because of the monumental effort required to create an EMR. I fail to see how getting new programmers accustomed to the technology is a problem when ISC provides Cache Object Script. Write your code with COS and you never have to use dot syntax again. Curly braces all the way.
Coding "MUMPS over Cache" provides hooks to any kind of UI you'd care to create. VistA doesn't have a very attractive UI (anyone know what CPRS is written in?), but MUMPS implementations have moved past the old roll and scroll in the past decade. Epic uses a Windows client written in VB, but is moving to .NET and a browser based UI ala IDX. VistA could do the same.
Interoperability is handled by HL7 http://en.wikipedia.org/wiki/HL7 interfaces.
"But really with all the crap, legacy systems held together presently by silly string...you really almost need to start OVER."
Many hospitals are starting over. They're scraping their old, cobbled together systems (seperate Lab, Physician Practice, HIS vendors) and going with a single vendor. Epic, Cerner and the like have seen a lot of interest in going with single vendor installs.
Hi-o! Over here! In the corner...in the big empty room...How come nobody ever wants to play with me?
Seriously, any decent programmer can pick up the basics of MUMPS in a weekend. There are plenty of compelling reasons to do so. Developing VistA is both patriotic (helping US vets!) and globally humanistic (Open source helps 3rd world countries deploy better medical technology!). Not to mention the massive amount of money currently floating around to help develop and deploy EMRs.
As for projects which cover the same ground as VistA...where are they? The 2 biggest commercial players in EMRs - EPIC for large hospitals and Meditech for smaller, community hospitals - are both M-type platforms. There are NO other competitors written in other languages because building a hospital automation system is really complicated and takes decades to mature. Yes there are 100x more Java programmers out there, but we'll never see a commercially successful EMR written in Java because there is 0 business need for one now.
My name obviously implies bias, but the reason that many of the Medical record systems out there now - VistA, EPIC, GE/IDX, Amtrim for labs ect. - are based on MUMPS is because of its string handling capabilities. Much of a medical record is transcribed notes, character strings which need to be manipulated and stored. MUMPS was designed to do this from the start, which is why it's the right tool for the job. Take that DailyWTF with a very large pinch of salt. The source for VistA is already available though a FOIA request, and GT.M (the MUMPS platform it runs on) is open source. Run the whole shebang on Linux and presto-changeo, Open Source EMR. This is what Medsphere is doing, selling services and support as the core business. http://en.wikipedia.org/wiki/MUMPS
I agree with everything you said except - Re: laptop popularity - I have no problem playing 2 or 3 year old games on my laptop. Mind you, these are games that I buy at a discount, but they are still A+ titles (just old). I probably just made your point for you but, I've been drinking... "Linux for the PC" - Yep...2009...the year of Linux on the desktop. Indeedy.
The "DDR as exercise" argument is still lost on me. I mean, if "real exercise" is a tedious waste of time, then how does DDR make it better? Beacuse you're dancing/playing a game? Then why not actually dance? I mean with real people and/or with live music (thereby supporting local music and possibly hooking up)? I have the same problem with the esspress-o machines. They have them @ my gym (Sound Mind & Body in Seattle) and the first thing I thought of when I saw them was "How can I hack this?". I thought that because these thing are serve me better as Intellectual Exercise than as real physical exercise. I go to the gym to pedal a stationary bike because it's raining out and I can't ride my "real" bike. I sit at home playing Quake Wars because I'm done exercising and want to take a break from reality. Taking a break from reality (gaming) is mutually exclusive from exercise (reality). I could say the same thing about sport and drinking, except you nerds would just throw Rugby in my face. Damn you nerds!!!!
MUMPS is far from forgotten. It's still in use as the core of Intersystems Cache, which powers a lot of the major Healthcare Information Systems (GE Centricity, EPIC, Sunquest Lab). Also, the VA implememntation is called "VistA" and has been for years, so this isn't the first time that Gates & Co have gone to the MUMPS well and co opted a name for themselves.
This is probably my biggest beef with Epic and other Mumps-based apps that use a bloated client. There's just no need for it. IDX http://www.gehealthcare.com/usen/hit/products/cent ricity_business/index.html has a very nice Web front-end that does everything in a browser (albeit with unnecessary IE dependencies). Epic has a thick VB6.0 client and CPRS (The VAs VistA GUI http://www.hardhats.org/) is massive.
I know it's a lot of code to re-write, but it's not like vendors need to throw out the database code. Just fix a mistake made 10 years ago, not the one from 1964. Cache allows for some nice things in a browser based app (XEN? SVG?). Having that kind of UI really helps to manage desktops in a distributed environment like a hospital.
What are you talking about? http://www.metro.co.uk/news/article.html?in_articl e_id=46710&in_page_id=34MTAS is an excellent web server.
As someone who was up until 1:30 this morning frantically loading RAs into Chronicles in preparation for my Sunday go-live, I really needed to read your comment today. Dealing with Epics goat cluster of poor design decisions can easily lead an IS shop into a downward spiral of negativity and depression, loosing sight of the real purpose - patient care.
Does the "pain" I feel really matter when there are actual sick people up in that building relying on providers who need up-to-date and accurate information to deliver care? Perspective is important. Either that or I am about to lose my mind.
Oh, Epic Systems? No wonder. Dude, you're f****ed.
*sigh* - too true. Epic requires a monumental effort just to get the off-the-shelf product to work properly. Kaiser is doing a massive amount of internal development in addition to trying to implement as Epics biggest customer.
Part of me wants to think that Justin is just fresh meat who hasn't put in the time to become as jaded as the rest of us in HIS. The other part of me thinks he might be right and that Kaiser has bitten off way more than it can chew. Failure to understand the effort involved is just as pervasive as the massive waste he's critiquing, and just as harmful.
So there is no way to innovate/automate care. It's not patient care that is responsible for the bloat in Healthcare job creation, it's all of the backend BS that our current system requires to keep those care providers paid. Billing, Scheduling, Payment posting and follow-up...all the things that need to happen to keep a doctors door open, and which require increasing numbers of employees to manage. There are a lot of various, standard industry tools which can be used to automate these data entry type jobs. Healthcare has an overabundance of "seat fillers". People who have been performing repetitive data entry tasks for 20+ years, and who could easily be replaced by a script. One analyst with interfacing and scripting skills can replace 20 blue-haired cubicle jockies.
Since I've taken a stand in my life to only work 40 hours a week, I'm limited to working 8 hours a day. 2 to 3 of those hours are spent responding to e-mail, which requires very little concentration. "It's possible, but will take 30 hours...I can fit you in next September...What is your business need?" So I get all of my coding done in the morning, take a late lunch, then respond to all my emails in a food coma induced zombie state. Then I eat a chunk of dark chocolate, roll down all my windows and drive home.
Considering that the initial release date was christmas '96, this is a pretty massive dust off. No doubt we'll see it before Duke Nukem Forever.
Here is an interesting history of the title.
they want to throw their personal preferences into the living room of the other 80% of the population.
So...say a hmosexual man has a "personal preference" for hairy, well endowed biker dudes. Now say that I, a heterosexual man, have a personal preference for girls in bikinis. If by "into the living room" you are talking about TV (and not say books or radio or any of the other things that americans do in living rooms), then I would say that TV sexualizes girls in bikinis WAY MORE than hairy, well endowed biker dudes. At least, that's how it works on the beer comercials I watch.
Seriously, you make it sound like the gays are just banging down you door so they can have sex in front of your grandmother. "We're here, we're queer, we're high on poppers and X and looking for you to fist us!"
Please let me know if I'm way off base here and living in one of the fortunate 20% of households whom the gays have decided, like a limp-wristed G-d on passover, to spare this indignity.
I just want to see them cutting back and forth between Carmack sitting on his gold plated rocket ship and Romero coding cell phone games from a double-wide.
Seriously though, I think that the basis for a good story could be found here. Not so much with the gaming geek audience, either. "Some Kind of Monster" appealed to me, even though I don't like Metallica. Getting all of those egos together to talk about who invented a genre as big and transformative as FPS's would be endlessly amusing.
I worked at a US Family Health Plan facility (like an HMO for veterans - one step below a VA hospital), and our contract with the DOD specifically listed the approved methods of data destruction. There was a software solution which we were able to use to recycle the hardware to poor rural school districs, mostly though we took those machines home or trashed them.
I would check with the DOD before you spend too much time messing around with drills or less-than-rigorous software solutions. They most likely have something in mind for the kind of information your facility handles.
The release will be specifically for high-end PCs
Great! I look forward to playing this in 5 years when the components become affordable. That is if Steam is still running...
The problem with the new console for me is that it's closed. "No need to swap caridges!" say the marketoids, like that's a good thing. I've got tons of old catridges sitting next to my TV, and would gladly pay $60 for new Atari hardware to play them on. I've purchased old and refurbished consoles in the past, and always burn them out.
Like the parent post says, if I don't care about having the an authentic Atari 2600 experience, I'll just buy the CD. Catridge switching is part of that experience.
I mean, how hard would it be for them to include the cart option?