Joseph;
One reason you haven't seen benchmark comparisions between the
different
relational databases (Oracle, Sybase, DBase (you pick the release),
Informix), the vendors contractually inhibits their users from
publishing
the results. Why would they do that? Because they know the
outcome. It
ain't good for them. The Koreans did publish the results of one
benchmark
they did in one of the Last MUG Quarterlies. The results were
astounding.
Same hardware, same load, same task took the relationals 6 hours or
more to
complete. MUMPS took something less than one hour to complete.
Oracle used to be a true relational database and their
performance really
sucked. They hired Irene Chen from SAIC and the CHCS project.
They learned
some of why MUMPS is faster. Soon after Oracle became a relational
database
that mapped to a heirachical database internally. This gave them a
big
boost in performance and some improvement in scalability. They
just didn't
learn the rest of the lesson, how to make it scalable or learn how
to build
effective memory cacheing.
The result is that MUMPS allows for some very important performance
enhancement that other databases haven't learned yet. One such
enhancement
is that most read requests are satisfied in memory cache and these
requests
don't have to go out to disk. So only about 15% of the reads on a
loaded
system actually result in a physical read. This is a phenomenal
increase
in performance. A MUMPS system will speed up with more people on
the system
(to a max determined by the available memory and the CPU
performance), but
these limits are much higher numbers of users than Oracle or Sybase
could
support on the same hardware.
The bottom line is that there have been attempts to replace MUMPS
systems
in the past and the CHCS project for the DoD has been no
exception. They
have been trying to bring up CHCS II to replace the CHCS I system
which was
patterned after DHCP, the direct predicessor to VistA. After 15
years and
many millions of dollars, CHCS II has finally been withdrawn for
the last
time and CHCS I still runs the hospitals. If Oracle or Sybase, or
Informix
could do the job, they would be doing it. Where are they??
Want an idea of the complexity of the VistA model? Look up the
Entity
Relationship Diagrams. Then show one of the nearly 100 pdf files
to your
favorite Relational Database Guru and watch him blanch at the
numbers of
data elements and relationships represented there. On CHCS there
were over
22,000 different data elements in the data dictionary. In Northern
California, nearly 500,000 patient records are stored in less than 120
gigabytes of disk space. It would be interesting to see how much
space the
same information would take up in the relational model, then pack a
lunch,
cause it will take a good long time to traverse that data as a
relational
database.
----- Original Message -----
From: <[EMAIL PROTECTED]>
To: <hardhats-members@lists.sourceforge.net>
Sent: Saturday, June 11, 2005 5:22 PM
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
Yes, it will be interesting to see what can be done with Cache.
We're
looking into the patient screening issue I mentioned previously, for
example.
It's interesting, I never heard of this M/VistA being faster than SQL
relational until I started reading these messages. I'm keen to
see if
that's true. I just got done writing an HL7 data access object to
talk to
the HDR which is Oracle. (Don't ask why I'm talking HL7 to an Oracle
database, I'm not sure I know myself.) I will certainly be
looking at the
speed.
Yes, Oracle is expensive, perhaps prohibitively so. Is that the
only game
in town, I wonder? Surely there's something between SQL Server and
Oracle?
And yes, speed is essential. It's what makes VistAWeb so popular
with
providers, along with its simple interface. I'm not gonna be
happy if the
HDR slows it down.
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of
Nancy
Anthracite
Sent: Saturday, June 11, 2005 3:00 PM
To: hardhats-members@lists.sourceforge.net
Subject: Re: [Hardhats-members] == VistaWeb Missing Apps ==
It seem to me that you do want is an M database that is
reengineered for
VistA
because of its speed, easier mantainance and reliability and
additionally,
the ability to do SQL queries on that database. Seems like Cache
delivers
that and with the right additional software, GT.M can do that as
well.
The Intersystems folks knew what they were doing when they bought
up all
of
those flavors of M. The Epic folks know what they are doing as well.
Relational databases are slower and that has long been recognized,
and
they
require a lot more work to maintain and design. Oracle is
probably the
gorilla in that field and is very expensive and slow. Yea, maybe
you get
some pretty reports from it, but not likely in real time.
Tell all of the busy healh care worker why they have to wait when
they
should
be taking care of patients so that you can get reports easily. The
patients
and those who care for them are not likely to be very understanding.
On Saturday 11 June 2005 01:39 pm, Gillon, Joseph wrote:
Listen, I'm not sure what this says, but I somehow feel the need
to make
it
clear I have nothing but respect for VistA and its developers.
It was
great, in fact, still is, but the old gray mare ain't what she
used to
be
and is aging by the day. All systems that are worth a damn someday
reach
obsolescence. Which ain't to say VistA's going away any time soon.
It's
not hard to imagine a few years from now when several non-VA systems
will
be using it and the VA won't be. But the stuff the VA produces to
replace
it will be public domain too...
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of
Richard
G. DAVIS
Sent: Saturday, June 11, 2005 12:18 AM
To: hardhats-members@lists.sourceforge.net
Subject: Re: [Hardhats-members] == VistaWeb Missing Apps ==
I understand the "dichotomy" Gregory mentions, and I agree with the
views
he has expressed.
However, I believe the fundamental issue is less a technical
matter and
more an natural 'tension' between concerns for operational
effectiveness--delivery of quality health care, and the interest in
administrative IT that arises from management. These two groups
in most
any enterprise you may choose to study are chronically in a state of
'conflict' due their different priorities and requirements for
IT, and
information management architecture.
Where these competing forces arrive at a state of least tension, you
usually find that the two groups have separated their IT, both
software
and
hardware into two largely independent systems.
For those who have been in university/college settings, you may
remember
that those institutions tend to have "academic" computer centers and
associated resources under the governance of some faculty body, and
separate "administrative" computer systems used to run the
university
controlled the the 'CEO' of the institution.
DHCP has also been chronically plagued with an interesting form
of this
problem, that waxes and wanes over time.
At present within the VA we see the administrative folks throwing
their
territorial imperatives around and not giving due consideration
to the
operational requirements of the enterprise. These 'conflicts'
are often
deflected into debates about hardware issues, and software system
issues,
all of which are usually not at all relevant to the bed-rock
forces at
work
here. The person who says "MUMPS is a dead language, get rid of
VistA"
simply doesnąt understand the problem. It is easier to indict a
technology
that can't defend itself, that to tackle the real core problem(s).
Thus, the matter is not really about decentralized or centralized IT
resources. It is all about meeting the needs of health care
delivery
staff
and at the same time satisfying the needs of management.
I am frequently convinced that the best outcomes are achieved with
organizational structures, and IT systems that permit two relatively
independent systems to coexist, one optimized for health care
delivery,
and
one optimized for organizational administration. (The obvious
need for
effective interaction between these two systems is a subordinate or
collateral matter to the core issue.)
At the outset, DHCP was essentially free of intrusion of
administrative
demands. We built what seemed best for patient care. Only as
Congress
has
insisted that the DVA generate some revenue to supplement
appropriated
funds has the 'administrative' fist come down in a heavy handed
way on
top
of the health care interests. (Yes, there are other forces in
play here
as
well.) This trend has promoted increased 'tension' between the
operational
and administrative sides of the house.
The process needs to be focused on the organizational behavior
issues
where
the natural conflicts between the two sides of the house can be
resolved
appropriately. These processes are not technology based or driven.
Instead, they are very much about organization and management.
(It is
in
the spirit of the best of breed bureaucrats who prefer diffusion of
responsibility and scape-goating of technology that we so often
see the
cry
to throw out the 'old' stuff.)
Clearly, the VAH health care delivery process is mission critical
and
focused on the patient. The IT system need there is for a highly
'decentralized' framework that is centered on the patient/caregiver
partnership.
On the other hand, the DVA administration process must be able to
effectively manage the resources of the DVA to maintain its two main
lines
of business--entitlements and sick veterans. That requires a highly
'centralized' IT framework that is centered on the problem of
enterprise
management.
Whether these two groups are served by a single monolithic hardware
system
buried in a Colorado mountain, or by two slightly smaller computer
systems
situated at opposite ends of the Continental US, or by a massive
number
of
desktop computers is really not too important once the balance
between
these two competing groups has been achieved. After that, all us
'techno-nerds' can go off and play with our cool software and
hardware.
:-)
Regards,
Richard.
From: Joseph Dal Molin <[EMAIL PROTECTED]>
Reply-To: hardhats-members@lists.sourceforge.net
Date: Fri, 10 Jun 2005 19:36:54 -0400
To: hardhats-members@lists.sourceforge.net
Subject: Re: [Hardhats-members] == VistaWeb Missing Apps ==
The significant opportunity we have outside of the VA is to avoid
repeating the "data problem". How can that best be done? I think
Greg's
option is on target....not sure if this would be called a
"federated
model"...
Joseph
There is, of course, another option, one that
has been explored in a limited way, but not yet fully realized,
that
is
to build loosely coupled systems that are, at once,
decentralized an
integrated (at the functional level).
Gregory Woodhouse wrote:
This is why I've never been very enamored of the original name of
VistA,
Decentralized Hospital Computer System (DHCP). It wasn't
decentralized
at all, but rather each DHCP system was one of a number of
independent,
facility level systems. An ant colony is an example of a
decentralized
system: there is no centralized control, yet the colony is able to
work
together to accomplish a common task.
Unfortunately, this false dichotomy has continued to plague
VistA and
the continued development of VistA. Far too often, centralized
solutions
(either data or control, or both) are thought to be the only
alternative
to completely independent application instances having no
ability to
work together effectively. There is, of course, another option,
one
that
has been explored in a limited way, but not yet fully realized,
that
is
to build loosely coupled systems that are, at once,
decentralized an
integrated (at the functional level).
===
Gregory Woodhouse
[EMAIL PROTECTED]
<mailto:[EMAIL PROTECTED]>
"The whole of science is nothing more than a refinement
of everyday thinking." -- Albert Einstein
On Jun 10, 2005, at 2:30 PM, Sowinski, Richard J. wrote:
oe, your note title example can be explained in this way. For
years
Vista was used in a standalone manner. Each site, was
essentially an
island, that could create it's own note titles, lab test
names, etc.
Then, software like RDV's and Vistaweb came along, and exposed
(everyday) the fact that people used different terms at different
sites, for essentially the same data.
This is not a software problem, it's a data problem. It's an
artifact
of making what was essentially a standalone system, into a
networked
system.
It's cure, is standardization work. Unfortunately that work
can be
tedious and not as glorious as other work, which is why it has
been
a
slow starter. But sooner or later that work will get done, and
Vista
will be around for awhile.
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