John S. Gage wrote:
>I agree, largely because the snares,
>pitfalls, traps, and surprises that Brian Bray describes in
>his rationale for Open Source apply with a vengeance to VistA.
Vista started out as Open Source (before there was such as term) except for
its foundation in MUMPS which was based on a strong independent MUMPS
standard and a vibrant community of standards oriented commercial vendors.
The pitfalls that apply to Vista should serve as a warning to Open Source
and health care software development in general.
>I have a fear, however, that I would like to share with the
>group. Call me psychotically paranoid, but here goes.
>
>The V.A. is pouring money into VistA. Pouring money.
I am sure that a very very small percentage of that could produce an Open
Source MUMPS that could very quickly save them millions of dollars.
>I believe that it is installed in every V.A. hospital in the
>U.S. (100,000's of patients). Installed on PC's running
>against Compaq (DEC) servers. Installed with a GUI (CPRS)
>written in Delphi, I believe.
>
>Now look at HIPPA. HIPPA is a bill whose purpose was to make
>it so workers did not lose their health coverage when they
>changed jobs. But (BUT!) it contains a provision about
>computerized medical records. What it says is if Congress
>cannot pass legislation governing computerized medical
>records, then the Administrative branch will make the rules.
>Congress didn't and the Administration is.
>
>One could easily imagine similar legislation, or even NO
>legislation but just a liberal interpretation of HIPPA by the
>Administrative branch, that went something like this. "We
>have too many medical errors costing too many lives in
>medicine. Medical errors kill more people than automobiles (>
>40,000 per year). We don't even know what's going on in
>medicine [so where do the numbers come from?], because there
>are no records. Soooooooo, we will require electronic records
>as of July 1, 2001. Lacking a credible alternative, the
>electronic records will be VistA."
>
>I don't think this is entirely a fantasy. Certainly, the
>people at Intersystems and Compaq probably don't regard it as
>a fantasy. Not to mention Micro$oft (the clients run NT).
>Cerner and SMS, etc. would go nuts, but they might not carry
>the day.
>
>This is why a browser-based system is so strategic.
We have been working in this direction for 4-5 years now.
>Browser-
>based systems can be installed overnight without hardware
>costs (in institutions with PC clients, i.e. all
>institutions). What is going to come out of the other end of
>all this is going to be browser-based. How far will anyone
>get saying you have to install mainframes or even dedicated
>servers in every hospital, if there's a remote server
>alternative? If you want fancier GUI's than the browser can
>handle, then make it something a lot like an applet, but even
>that will be too much overhead at the institution side. Just
>browsers.
I believe that browser capabilities are very close to taking a major
qualitative leap forward. Have you taken a look at Mozilla
(http://www.mozilla.org) lately?
>John Gage
>
>"Daniel L. Johnson, MD" wrote:
>>2 cents: Without disparaging
>> VistA or any other previously developed system, my judgment
>> is that it is time to start fresh, with the newest
>> programming tools and higher-level languages, building on the
>> lessons learned from previous efforts. (This is related to
>> the theorem that well-developed systems become crufty and
>> it's most efficient to translate the lessons, algorithms,
>> standards, and paradigms acquired in development into a
>> clean-slate effort.)
I believe it is most efficient to build bridges to large existing systems
rather than to throw them out entirely. In the case of Vista, there is much
effective development that can be done within MUMPS and incredible
opportunites that could be realized with an open source version of MUMPS to
bridge to future object oriented systems.
MUMPS itself is really quite a small and (deceptively) simple thing that is
well suited to the role of web server and which has a long record of
supporting the ongoing evolution of complex information systems such as
required by health care.
>> DJmd
>
>
---------------------------------------
Jim Self
Manager and Chief Developer
VMTH Computer Services, UC Davis
(http://www.vmth.ucdavis.edu/us/jaself)
