John S. Gage wrote:
>Thank you for an extraordinarily comprehensive reply. A
>point that is being made quite effectively is that there is
>no extant standard for an electronic medical record in the
>way that there are standards for operating system design
>or server design. Nevertheless, there are some extremely
>successful electronic medical records, VistA stands out,
>because all patients take medications, have physicals, give
>histories, see doctors, are allergic to things, etc.
When Vista started out (as the Underground Railroad), it and the MUMPS
community it sprang from were about the closest thing existent at that time
to open source. There were many independent vendors of MUMPS at that time
and the MUMPS standard was very strong and independent of any of them. That
is ultimately the reason why it achieved any success at all and why many
people, including myself, became involved with it at all.
>Maybe, just maybe, the problem is simpler than it appears
>(it's late at night, forgive me). VistA is very, very
>text-based, almost a glorified word-processor (forgive me),
Although the original MUMPS systems installed in the VA had to be disguised
as multi-user word processing systems in order to get past the proscriptions
against any locally controlled computing capabilities imposed by the central
power structure of the time, the closest transition now would be to an
object oriented database system.
>but it seems to mirror medical reality. Remember, the
>principle problem in medical records today is illegible
>handwritten notes. Maybe the most accurate model is a bowl
>of spagghetti (a word I can not spell). I'd love to have
>VistA in my hospital, but I'd hate to support a
>programming language monopoly...back to open source.
MUMPS has had an open standard for over 20 years and software written to
that standard, such as the main body of VISTA, is public domain and can run
on any standard MUMPS. The problem is that all of the major commercial
implementations have been acquired by a single vendor which now has a
virtual monopoly. What we need now is an Open Source implementation of
MUMPS.
>John Gage
>
>Thomas Beale wrote:
>
>> - Most of the requirements of linux is not a subject of
>> development - it is a given (unix API, device driver
>> specs, X-windows library specs, etc etc). EHR software is
>> not the same: there are no POSIX standard EHR/EMR
>> requirements lying around for people to work from.
---------------------------------------
Jim Self
Manager and Chief Developer
VMTH Computer Services, UC Davis
(http://www.vmth.ucdavis.edu/us/jaself)
