Open source, not $19 billion, may be best health care stimulus
The federal economic stimulus package provides $19 billion to upgrade the U.S. health care system to digital records. It's a nice gesture, but the U.S. federal government has already developed a robust medical ERP system that could significantly improve U.S. health care. It's called VistA. It's open source.
It's already paid for.
VistA was developed by the U.S. Veterans Administration and the medical professionals involved in its extensive hospital network. Read: doctors developing software for other doctors.
This bottom-up development effort appears to be working: the VA hospital system consistently delivers superior care at less cost, as noted by ZDNet. As a volunteer at my local VA hospital, I get to see it firsthand.
Better quality health care at a much lower price. What's the punchline?
At first glance, there is none. VistA works, and works well, particularly when packaged and delivered by companies like Medsphere, perhaps the most prominent advocate for the open-source health care ERP system.
Scratch the surface, however, and you quickly run into a major problem with VistA: MUMPS (Massachusetts General Hospital Utility Multi-Programming System). MUMPS is the archaic programming language in which VistA was written, and which perpetuates its inflexible architecture.
Though some suggest the specialized knowledge needed to program in MUMPS is a selling point, let's put it this way: in the programming universe filled with PHP, Java, .Net, and other constellations of programmers, MUMPS is like a single Red Dwarf. It's not going anywhere except into oblivion.
There are other open-source answers to the U.S. health care problem, including the federal Connect project and Axial Exchange, which was set up by former Red Hat executives to commercialize these federal efforts. But none is more proven than VistA, which has successfully served U.S. veterans for many years.
One company, Software Revolution, claims that the MUMPS-based VistA code could be converted to Java at a cost of $125 million. If even remotely true, that could well prove to be a much smarter investment than $20 billion in stimulus money. Heck, given how easily billions are being spent in Washington today, $125 million is pocket change.
Open source might prove to be the wrong answer to the health care mess. But given the VA's success with VistA, President Obama should be spending pennies on the stimulus dollar with VistA before he looks elsewhere for solutions. It's already written. By all accounts, it works well.
It just needs to shake the MUMPS out.
Follow me on Twitter @mjasay.
Matt Asay brings a decade of in-the-trenches open-source business and legal experience to The Open Road, with an emphasis on emerging open-source business strategies and opportunities. Matt is vice president of business development at Alfresco, a company that develops open-source software for content management. He is a member of the CNET Blog Network and is not an employee of CNET. Disclosure. You can follow Matt on Twitter @mjasay. 
Please keep your sound reasoning and prudent fiscal policy ideas to yourself. We have a recession to fight and billions of tax dollars to take from the evil rich. Oh, the nerve...
It's about control, and yet another expansion of the Anointed Ones' power and budgets. This system wouldn't nationalize anything, so it's not part of any "solution".
As a side note, I'm pretty sure I remember the "MUMPS" language from a dailywtf article. Ah yes, there were at least two (hope I can link here):
http://thedailywtf.com/Articles/A_Case_of_the_MUMPS.aspx
http://thedailywtf.com/Articles/MUMPS-Madness.aspx
Time to pull your head out of Beck's backside and get some fresh air. With all the sponsors fleeing from that pro-violence inciting nutbag it won't be long before he is gone from the airwaves and will be forced to scream his putrid vile from a street corner.
Here's a tip: when the arguments against healthcare reform revolve around claims that deny my dad had an operation this year (he's 71 on Sunday), that my mum had any treatment for her cancer (it was terminal but she still received treatment at 63), that my 67yo aunt had an appendectomy or that my 69yo uncle doesn't continue to receive follow-up treatment after two heart attacks and a stroke then it's quite clear that there is no argument.
Here's another tip: Stephen Hawing _is_ English and gets _all_ his treatment on the NHS.
I'm just glad to live in a counry where, for all its faults, the healthcare system doesn't yet just leave you to die if you're poor.
Hopefully they won't move towards PHP, what a nightmare that is! Worse then the tower of babel that is the .net platform and its bastard languages.
Or let's see, let's convert it to Java automatically at a not inconsiderable cost, so, hmmmm it will now work identically but in another language ....and then what? Java will somehow allow it to be onwardly developed in a better way?....but I thought you said it worked very well as it is.
What happened to "if it ain't broke don't fix it"?
What about applying converse reasoning: if languages and databases other than Mumps were somehow so much better, why is VistA, by your own admission, working so well apparently against all the odds? Perhaps, just maybe, because actually Mumps is particularly well suited for the kinds of things that VistA addresses? Now wouldn't such an intriguing possibility be worth seriously investigating?
Healthcare changes all the time, record keeping rules changes and new treatments are developed. This requires the software to be updated and if it's written in some obscure language then it's difficult to find the people to do it which, in itself, defeats the point as only a few select people can work with it with any proficiency.
Might as well have all the records on paper but write them in some obscure Chinese dialect; sure, anyone can use a pen and paper and the language could probably be learned but if you want it handled properly you're getting in someone for whom it's his first language who's preferably also fluent in English and he won't come cheap.
Like I said, where's the evidence that there's actually a critical problem that needs fixing here?
Anyway, why do you care what it's written in? If it's so clearly been the basis of such a successful solution, don't you think you should be finding out about Mumps rather than complaining because you don't understand it?
This changes nothing about the fact that it's a specialist programming language and most definitely a sellers market where it comes to who the customer depends on. COBOL suffers from no maintainability issues at all so long as you've got a fat wallet to pay the programmer.
It is obviously maintainable since it has been maintained and extended over many years.
I'd also be careful criticising other programmers given the reasons you once stated for avoidinq relational databases. Most programmers in any area are sorely lacking, don't think your, or any other field, is exempt.
I also find it hard to believe that a language that looks like the deformed offspring of COBOL and Prolog is in any way general purpose. Not that this is in any way wrong in its place but if it's an expert system language based on the rules of predicate calculus then people need to stop pretending otherwise.
As a veteran, I have few complaints about the VA system. They are on par with the military system and I have never got any civilian, private care that is any better. The fact that I can go anywhere in the country and if I need to go to the VA hospital they can bring up my records, unlike civilian systems, is a huge plus.
Basically, MUMPS is a back-end workhorse combination programming language and database engine that is highly scalable, robust and parsimonious of computer resources. No, it doesn't run in your browser like Javascript, but that's front end technology. It's the software equivalent of falling off a log to connect your favorite front end to a MUMPS back end. Enterprise scale systems (as opposed to small applications) usually use multiple layers of technology.
There's no shortage of MUMPS programmers - besides, any competent PHP, Perl, Python, BASIC, or C programmer could easily be programming MUMPS within hours. What's more challenging when programming any enterprise scale ERP system (such as VistA) is understanding the software abstractions, the coding conventions, the data relationships, etc. that are part of the culture and expertise of that ERP system. Yes, you can spend $125 million tax payer handout dollars converting 100MB of MUMPS code to 1GB of Java code, but that doesn't make the system any more maintainable because it doesn't simplify the underlying complexity of what it takes to automate a large health care enterprise.
MUMPS is not a one size fits all solution. It does well what it does well, and integrates well with other technologies that do well what they do well.
Rather than throwing out the baby, why not build on top of the foundation that's served our veterans so well for so many years? I'm not suggesting Universities should create new degrees to begin to train the next generation of MUMPS developers, nor that everyone needs to learn MUMPS.
Medsphere's technologists have looked at this issue for years, in fact since the founding, and established the goal of being able to modernize the core system piece by piece, rather than rip and replace. That's why we've developed a software platform like OVID. This let's us build new applications in Java that tightly integrate with the VistA core. Don't want to write in Java? Fine, build out the necessary APIs as Web Services and hook-up your favorite scripting language.
Over time, applications can be replaced in part or whole as needed, but do not require us to perform a heart transplant everytime a new application (or technology) is desired.
http://tinyurl.com/mz9gse
databases simultaneously, e.g. banks, stock exchanges, travel
agencies, hospitals
it was and is used for data base oriented applications. yes it is archaic in some respects but it works where other languages fail.
So, if I am correct, the initial argument of this article (and the whole argument of the anti-reform posters at the top of this list) is basically pointless.
- by gteichrow September 10, 2009 12:05 PM PDT
- What?!?! No mention of Mirth, the open source integration engine?? Do yourself a favor and check it out: www.mirthcorp.com.
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